1
|
Miller S, Kallusky J, Zimmerer R, Tavassol F, Gellrich NC, Ptok M, Jungheim M. Differences in velopharyngeal pressures during speech sound production in patients with unilateral cleft lip and palate (UCLP) and healthy individuals. Ger Med Sci 2024; 22:Doc02. [PMID: 38651020 PMCID: PMC11034380 DOI: 10.3205/000328] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 02/16/2023] [Indexed: 04/25/2024]
Abstract
Background During articulation the velopharynx needs to be opened and closed rapidly and a tight closure is needed. Based on the hypothesis that patients with cleft lip and palate (CLP) produce lower pressures in the velopharynx than healthy individuals, this study compared pressure profiles of the velopharyngeal closure during articulation of different sounds between healthy participants and patients with surgically closed unilateral CLP (UCLP) using high resolution manometry (HRM). Materials and methods Ten healthy adult volunteers (group 1: 20-25.5 years) and ten patients with a non-syndromic surgically reconstructed UCLP (group 2: 19.1-26.9 years) were included in this study. Pressure profiles during the articulation of four sounds (/i:/, /s/, /ʃ/ and /n/) were measured by HRM. Maximum, minimum and average pressures, time intervals as well as detection of a previously described 3-phase-model were compared. Results Both groups presented with similar pressure curves for each phoneme with regards to the phases described and pressure peaks, but differed in total pressures. An exception was noted for the sound /i:/, where a 3-phase-model could not be seen for most patients with UCLP. Differences in velopharynx pressures of 50% and more were found between the two groups. Maximum and average pressures in the production of the alveolar fricative reached statistical significance. Conclusions It can be concluded that velopharyngeal pressures of patients with UCLP are not sufficient to eliminate nasal resonance or turbulence during articulation, especially for more complex sounds. These results support a general understanding of hypernasality during speech implying a (relative) velopharyngeal insufficiency.
Collapse
Affiliation(s)
- Simone Miller
- Department of Phoniatrics and Pediatric Audiology of the Department of Otolaryngology, Hannover Medical School, Hanover, Germany
- Institute of General Practice and Palliative Care, Hannover Medical School, Hanover, Germany
| | - Johanna Kallusky
- Department of Phoniatrics and Pediatric Audiology of the Department of Otolaryngology, Hannover Medical School, Hanover, Germany
| | - Rüdiger Zimmerer
- Department of Oral and Maxillifacial Surgery, University Hospital Tübingen, Germany
| | - Frank Tavassol
- Department of Oral and Maxillofacial Surgery, University Medicine Halle, Germany
| | | | - Martin Ptok
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Hanover, Germany
| | - Michael Jungheim
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Hanover, Germany
- HNO Phoniatrie Praxis, Bremen, Germany
| |
Collapse
|
2
|
Miller S, Peters K, Ptok M, Jungheim M. Modification of velopharyngeal closure pressures during phonation by neuromuscular electrical stimulation in healthy individuals. Ger Med Sci 2024; 22:Doc03. [PMID: 38651019 PMCID: PMC11034089 DOI: 10.3205/000329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 08/17/2023] [Indexed: 04/25/2024]
Abstract
Introduction Rhinophonia aperta may result from velopharyngeal insufficiency. Neuromuscular electrical stimulation (NMES) has been discussed in the context of muscle strengthening. The aim of this study was to evaluate in healthy subjects whether NMES can change the velopharyngeal closure pattern during phonation and increase muscle strength. Method Eleven healthy adult volunteers (21-57 years) were included. Pressure profiles were measured by high resolution manometry (HRM): isolated sustained articulation of /a/ over 5 s (protocol 1), isolated NMES applied to soft palate above motor threshold (protocol 2) and combined articulation with NMES (protocol 3). Mean activation pressures (MeanAct), maximum pressures (Max), Area under curve (AUC) and type of velum reactions were compared. A statistical comparison of mean values of protocol 1 versus protocol 3 was carried out using the Wilcoxon signed rank test. Ordinally scaled parameters were analyzed by cross table. Results MeanAct values measured: 17.15±20.69 mmHg (protocol 1), 34.59±25.75 mmHg (protocol 3) on average, Max: 37.86±49.17 mmHg (protocol 1), 87.24±59.53 mmHg (protocol 3) and AUC: 17.06±20.70 mmHg.s (protocol 1), 33.76±23.81 mmHg.s (protocol 3). Protocol 2 produced velum reactions on 32 occasions. These presented with MeanAct values of 13.58±12.40 mmHg, Max values of 56.14±53.14 mmHg and AUC values of 13.84±12.78 mmHg.s on average. Statistical analysis comparing protocol 1 and 3 showed more positive ranks for MeanAct, Max and AUC. This difference reached statistical significance (p=0.026) for maximum pressure values. Conclusions NMES in combination with articulation results in a change of the velopharyngeal closure pattern with a pressure increase of around 200% in healthy individuals. This might be of therapeutic benefit for patients with velopharyngeal insufficiency.
Collapse
Affiliation(s)
- Simone Miller
- Department of Phoniatrics and Pediatric Audiology of the Department of Otolaryngology, Hannover Medical School, Hanover, Germany
- Institute of General Practice and Palliative Care, Hannover Medical School, Hanover, Germany
| | - Katharina Peters
- Department of Phoniatrics and Pediatric Audiology of the Department of Otolaryngology, Hannover Medical School, Hanover, Germany
| | - Martin Ptok
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Hanover, Germany
| | - Michael Jungheim
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Hanover, Germany
- HNO Phoniatrie Praxis, Bremen, Germany
| |
Collapse
|
3
|
Walther W, Ptok M, Hager K, Miller S. Study protocol of the OrkA project: orofacial and communicative activation in old age- a cluster randomized prevention study in long-term care facilities in Lower Saxony, Germany. BMC Geriatr 2024; 24:179. [PMID: 38388406 PMCID: PMC10882768 DOI: 10.1186/s12877-024-04809-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/14/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND The process of aging involves numerous changes in the body, influencing physical, mental, and emotional well-being. Age-related changes and degradation can impact various functions of the swallowing process and lead to delayed word retrieval. Individuals with limited linguistic stimulation may experience a more rapid decline in cognitive performance. Thus, this project explores a preventive training program targeting swallowing and linguistic-communicative skills, aimed at preserving the social participation of older individuals residing in nursing homes. METHODS A preventive intervention program, combining orofaciopharyngeal and linguistic-communicative components, will be offered twice weekly over 12 weeks in long-term care facilities in the greater Hanover area. The program will aim at: (a) activating sensitive and motor skills in the orofaciopharyngeal area to counter age-related swallowing disorders, and (b) enhancing communicative abilities through semantic-lexical activation. A cluster randomized controlled trial will be conducted to investigate whether the intervention program improves swallowing skills in older adults. Additionally, a secondary analysis will explore the impact on language skills and social participation, as well as program acceptance. DISCUSSION The results will provide valuable insight into the effectiveness of preventive measures addressing swallowing and speech issues in older individuals. TRIAL REGISTRATION The trial was registered with DRKS (German register for clinical trials) in June 2023 (study ID: DRKS00031594) and the WHO International Clinical Trail Registry Platform (secondary register).
Collapse
Affiliation(s)
- Wenke Walther
- Institute of General Practice and Palliative Care, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| | - Martin Ptok
- Emeritus of the Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover, Germany
| | - Klaus Hager
- Institute of General Practice and Palliative Care, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Simone Miller
- Institute of General Practice and Palliative Care, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
- Department of Phoniatrics and Pediatric Audiology of the Department of Otolaryngology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| |
Collapse
|
4
|
Heise KM, Miller S, Ptok M, Jungheim M. [Prevalence of mucosal injuries during flexible endoscopic evaluation of swallowing in the presence of a nasogastric tube]. HNO 2024; 72:25-31. [PMID: 37796338 PMCID: PMC10781840 DOI: 10.1007/s00106-023-01361-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND The flexible endoscopic evaluation of swallowing (FEES) is an established low-risk examination method to assess the risk of penetration or aspiration in patients with dysphagia. FEES might be more difficult or of higher-risk when a nasogastric tube is in place. OBJECTIVE This study aims to identify whether the prevalence of mucosal lesions is higher when the endoscopy is carried out with a nasogastric tube in place. Pre-existing mucosal lesions were also documented. METHODS In a retrospective, monocentric study, a total of 918 FEES procedures routinely performed in hospitalized patients of a university hospital from January 2014 to March 2019 were evaluated. Mucosal lesions were identified and characterized for descriptive statistics. RESULTS In the video material analysed here, no endoscopy-related injuries were identified. However, pre-existing mucosal lesions, which often occurred as multiple lesions, were detected in 48.6% of the endoscopies. Further analysis showed that these pre-existing lesions were not worsened by the endoscopy performed. CONCLUSION The results demonstrate that transnasal flexible endoscopy is a safe, low-risk examination method, even in patients with a nasogastric tube. A very high number of pre-existing mucosal lesions were found, which is probably related to the previous insertion of the nasogastric tube. Due to the high number of pre-existing lesions, strategies should be developed to minimize injuries when placing nasogastric tubes.
Collapse
Affiliation(s)
- Kira-Milena Heise
- Klinik und Poliklinik für Phoniatrie und Pädaudiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Simone Miller
- Klinik und Poliklinik für Phoniatrie und Pädaudiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | - Martin Ptok
- Klinik und Poliklinik für Phoniatrie und Pädaudiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Michael Jungheim
- Klinik und Poliklinik für Phoniatrie und Pädaudiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| |
Collapse
|
5
|
Samara M, Thai-Van H, Ptok M, Glarou E, Veuillet E, Miller S, Reynard P, Grech H, Utoomprurkporn N, Sereti A, Bamiou DE, Iliadou VM. A systematic review and metanalysis of questionnaires used for auditory processing screening and evaluation. Front Neurol 2023; 14:1243170. [PMID: 37621857 PMCID: PMC10446894 DOI: 10.3389/fneur.2023.1243170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 07/19/2023] [Indexed: 08/26/2023] Open
Abstract
The recognition of Auditory Processing Disorder (APD) as a distinct clinical condition that impacts hearing capacity and mental health has gained attention. Although pure tone audiometry is the gold standard for assessing hearing, it inadequately reflects everyday hearing abilities, especially in challenging acoustic environments. Deficits in speech perception in noise, a key aspect of APD, have been linked to an increased risk of dementia. The World Health Organization emphasizes the need for evaluating central auditory function in cases of mild hearing loss and normal audiometry results. Specific questionnaires play a crucial role in documenting and quantifying the difficulties faced by individuals with APD. Validated questionnaires such as the Children's Auditory Processing Performance Scale, the Fisher's Auditory Problems Checklist, and the Auditory Processing Domains Questionnaire are available for children, while questionnaires for adults include items related to auditory functions associated with APD. This systematic review and meta-analysis identified six questionnaires used for screening and evaluating APD with a total of 783 participants across 12 studies. The questionnaires exhibited differences in domains evaluated, scoring methods, and evaluation of listening in quiet and noise. Meta-analysis results demonstrated that individuals with APD consistently exhibited worse scores compared to healthy controls across all questionnaires. Additionally, comparisons with clinical control groups showed varying results. The study highlights (i) the importance of standardized questionnaires in identifying and assessing APD, aiding in its diagnosis and management, and (ii) the need to use sub-scores as well as overall scores of questionnaires to elaborate on specific hearing and listening situations. There is a need to develop more APD specific questionnaires for the adult population as well as for more focused research on APD diagnosed individuals to further establish the validity and reliability of these questionnaires.
Collapse
Affiliation(s)
- Myrto Samara
- Department of Psychiatry, Faculty of Medicine, University of Thessaly, Larisa, Greece
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Hung Thai-Van
- Institut de l'audition, Institut Pasteur, Inserm, Paris, France
- Université Claude Bernard Lyon 1, Villeurbanne, France
- Service d’Audiologie et d’Explorations Otoneurologiques, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Martin Ptok
- Department of Phoniatrics and Pedaudiology, Hannover Medical School, Hannover, Germany
| | - Eleni Glarou
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Evelyne Veuillet
- Institut de l'audition, Institut Pasteur, Inserm, Paris, France
- Université Claude Bernard Lyon 1, Villeurbanne, France
- Service d’Audiologie et d’Explorations Otoneurologiques, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Simone Miller
- Department of Phoniatrics and Pedaudiology, Hannover Medical School, Hannover, Germany
| | - Pierre Reynard
- Institut de l'audition, Institut Pasteur, Inserm, Paris, France
- Université Claude Bernard Lyon 1, Villeurbanne, France
- Service d’Audiologie et d’Explorations Otoneurologiques, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Helen Grech
- Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Nattawan Utoomprurkporn
- Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Ear Institute, University College London, London, United Kingdom
- Chula Neuroscience Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Afroditi Sereti
- Clinical Psychoacoustics Laboratory, 3rd Psychiatric Department, Neurosciences Sector, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Doris-Eva Bamiou
- Ear Institute, University College London, London, United Kingdom
- National Institute for Health and Care Research, University College London Hospitals, UK Biomedical Research Centre, Deafness and Hearing Problems Theme, London, United Kingdom
- Department of Neuro-otology, University College London Hospitals, London, United Kingdom
| | - Vasiliki Maria Iliadou
- Clinical Psychoacoustics Laboratory, 3rd Psychiatric Department, Neurosciences Sector, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
6
|
Fast JF, Oltmann A, Spindeldreier S, Ptok M. Computational Analysis of the Droplet-Stimulated Laryngeal Adductor Reflex in High-Speed Sequences. Laryngoscope 2022; 132:2412-2419. [PMID: 35133015 DOI: 10.1002/lary.30041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/28/2021] [Accepted: 01/23/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVES/HYPOTHESIS The laryngeal adductor reflex (LAR) is an important protective mechanism of the airways. Its physiology is still not completely understood. The available methods for LAR evaluation offer limited reproducibility and/or rely on subjective interpretation. A new approach, termed Microdroplet Impulse Testing of the LAR (MIT-LAR), was recently introduced. Here, the LAR is elicited by a droplet and a laryngoscopic high-speed recording is acquired simultaneously. In the present work, image-processing algorithms for autonomous MIT-LAR sequence analysis were developed. This allowed the automated approximation of kinematic LAR parameters in humans. STUDY DESIGN Development and testing of computational methods. METHODS Computational image processing enabled the autonomous estimation of the glottal area, the glottal angle, and the vocal fold edge distance in MIT-LAR sequences. A suitable analytical representation of these glottal parameters allowed the extraction of seven relevant LAR parameters. The obtained values were compared to the literature. RESULTS A generalized logistic function showed the highest average goodness of fit among four different analytical approaches for each of the glottal parameters. Autonomous sequence analysis yielded bilateral LAR response latencies of (229 ± 116) ms and (182 ± 60) ms for cases of complete and incomplete glottal closure, respectively. The initial/average/maximum angular vocal fold adduction velocity was estimated at (157 ± 115) °s-1 /(891 ± 516) °s-1 /(929 ± 583) °s-1 and (88 ± 53) °s-1 /(421 ± 221) °s-1 /(520 ± 238) °s-1 for complete and incomplete glottal closure, respectively. CONCLUSION The automated extraction of LAR parameters from laryngoscopic high-speed sequences can potentially increase the objectiveness of optical LAR characterization and reduce the associated workload. The proposed methods may thus be helpful for future research on this vital reflex. LEVEL OF EVIDENCE NA Laryngoscope, 132:2412-2419, 2022.
Collapse
Affiliation(s)
- Jacob Friedemann Fast
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Hanover, Germany.,Institute of Mechatronic Systems, Leibniz Universität Hannover, Hanover, Germany
| | - Andra Oltmann
- Institute of Mechatronic Systems, Leibniz Universität Hannover, Hanover, Germany.,Department of Modeling and Simulation, Fraunhofer Research Institution for Individualized and Cell-Based Medical Engineering, Lübeck, Germany
| | - Svenja Spindeldreier
- Institute of Mechatronic Systems, Leibniz Universität Hannover, Hanover, Germany
| | - Martin Ptok
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Hanover, Germany
| |
Collapse
|
7
|
Peters K, Miller S, Ptok M, Jungheim M. Phonation-induced Upper Esophageal Sphincter Contraction Caused by Different Phonation Types. J Voice 2022:S0892-1997(22)00160-6. [PMID: 35906176 DOI: 10.1016/j.jvoice.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 10/16/2022]
Abstract
INTRODUCTION The upper esophageal sphincter (UES) has been reported to show activity during phonation. As it is still unknown whether the phonation-induced UES contraction represents a reflex or a simultaneous activation phenomenon, i.e. co-innervation, this study aims to investigate and characterize the phonation-induced contraction of the UES in healthy individuals by analyzing the influence of various phonation tasks on pressure parameters of the UES. METHODS Twenty-five healthy volunteers produced the German neutral vowel [ə] in five different phonation tasks (modal voice, whispering, voiceless speech, creaky voice, and whispery voice). Simultaneously, they underwent high resolution manometry and electroglottography for measurement of pressure parameters in the region of the UES and latencies between larynx and UES activation. RESULTS During all types of phonation, the maximum pressures of the UES increased significantly (maximum pressure increases of 72%-132%). With regard to mean pressures this was valid for modal voice and whispering (mean pressure increases of 20%-25%). Differences concerning total pressure changes reached statistical significance when comparing whispering and voiceless speech as well as whispery voice. However, differences concerning the total pressure change between modal voices on the one hand and voiceless speech and whispery voice on the other hand turned out to be small. The averaged time delay between larynx and UES activation ranged from approximately -15 ms (whispery voice) to +15 ms (whispering). CONCLUSION A phonation induced pressure increase of the UES was confirmed in this study and did exist for different types of phonation. The extent of total pressure changes in the UES increases in relation with laryngeal muscle activity necessary for the phonation type. Next to varying effects of different types of phonation on UES activation, very short latencies indicate that a phonation induced contraction of the UES exists most likely due to co-innervation of UES and laryngeal muscles by the vagus nerve.
Collapse
Affiliation(s)
- Katharina Peters
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Hannover, Germany.
| | - Simone Miller
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Hannover, Germany
| | - Martin Ptok
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Hannover, Germany
| | - Michael Jungheim
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Hannover, Germany
| |
Collapse
|
8
|
Miller S, Peters K, Ptok M. Review of the effectiveness of neuromuscular electrical stimulation in the treatment of dysphagia - an update. Ger Med Sci 2022; 20:Doc08. [PMID: 35875244 PMCID: PMC9284430 DOI: 10.3205/000310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/20/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Neuromuscular electrical stimulation (NMES) has been used as a treatment option in the therapy of dysphagia for several years. In a previous review of the literature, it was concluded that NMES might be a valuable adjunct in patients with dysphagia and in patients with vocal fold paresis. However, due to different stimulation protocols, electrode positioning and various underlying pathological conditions, it was difficult to compare the studies which were identified and it was concluded that more empirical data is needed to fully understand the benefits provided by NMES. The purpose of this systematic review is, therefore, to evaluate recent studies regarding a potential effectiveness of transcutaneous NMES applied to the anterior neck as a treatment for dysphagia considering these different aspects. METHOD For this systematic review, a selective literature research in PubMed has been carried out on 5th May 2021 using the terms electrical stimulation AND dysphagia and screened for inclusion criteria by two reviewers in Rayyan. The search resulted in 62 hits. RESULTS Studies were excluded due to their publication language; because they did not meet inclusion criteria; because the topical focus was a different one; or because they did not qualify as level 2 studies. Eighteen studies were identified with varying patient groups, stimulation protocols, electrode placement and therapy settings. However, 16 studies have reported of beneficial outcomes in relation with NMES. DISCUSSION The purpose of this systematic review was to evaluate the most recent studies regarding a potential effectiveness of NMES as a treatment for oropharyngeal dysphagia considering different aspects. It could generally be concluded that there is a considerable amount of level 2 studies which suggest that NMES is an effective treatment option, especially when combined with TDT for patients with dysphagia after stroke and patients with Parkinson's disease, or with different kinds of brain injuries. Further research is still necessary in order to clarify which stimulation protocols, parameters and therapy settings are most beneficial for certain patient groups and degrees of impairment.
Collapse
Affiliation(s)
- Simone Miller
- Klinik für Phoniatrie und Pädaudiologie, Hannover, Germany,*To whom correspondence should be addressed: Simone Miller, Klinik für Phoniatrie und Pädaudiologie, MHH OE 6510, 30623 Hannover, Germany, Phone: +49 511 532-5778, Fax: +49 511 532-4609, E-mail:
| | | | - Martin Ptok
- Klinik für Phoniatrie und Pädaudiologie, Hannover, Germany
| |
Collapse
|
9
|
Szejko N, Fremer C, Baacke F, Ptok M, Müller-Vahl KR. Cannabis Improves Stuttering: Case Report and Interview with the Patient. Cannabis Cannabinoid Res 2021; 6:372-380. [PMID: 34314602 DOI: 10.1089/can.2021.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Speech dysfluency, often referred to as stuttering, is a frequent speech disorder encountered in about 5% of children. Although in the majority of people affected, symptoms improve in adulthood, in some patients, stuttering persists and significantly impairs everyday functioning and quality of life. Treatment for stuttering includes speech therapy, cognitive behavioral therapy, and relaxation techniques. However, a substantial number of patients do not benefit sufficiently from these treatment strategies or are even treatment resistant. Methods: We present the case of a 20-year-old male with treatment-resistant stuttering, who markedly improved after treatment with medicinal cannabis. Results: Besides improved speech fluency as assessed by several phoniatric tests, we observed remission of (social) anxiety, improved mood, and reduced stress, resulting in an overall improvement of quality of life after cannabis therapy. The patient, in addition, reported improved attention, concentration, and sleep, increased self-confidence, and better social life. No side effects occurred. Over a time period of more than a year, treatment was equally effective. In an interview, the patient describes his personal view and the influence of cannabis-based treatment on his life. Conclusions: Medicinal cannabis could be effective in treatment of refractory stuttering, but these preliminary data have to be confirmed in controlled studies.
Collapse
Affiliation(s)
- Natalia Szejko
- Department of Neurology and Medical University of Warsaw, Warsaw, Poland.,Department of Bioethics, Medical University of Warsaw, Warsaw, Poland
| | - Carolin Fremer
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Franziska Baacke
- Clinic of Phoniatrics and Pediatric Audiology, Hannover Medical School, Hannover, Germany
| | - Martin Ptok
- Clinic of Phoniatrics and Pediatric Audiology, Hannover Medical School, Hannover, Germany
| | - Kirsten R Müller-Vahl
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| |
Collapse
|
10
|
Miller S, Diers D, Jungheim M, Schnittger C, Stürenburg HJ, Ptok M. Studying effects of neuromuscular electrostimulation therapy in patients with dysphagia: which pitfalls may occur? A translational phase I study. Ger Med Sci 2021; 19:Doc07. [PMID: 34194290 PMCID: PMC8204381 DOI: 10.3205/000294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 02/12/2021] [Indexed: 11/30/2022]
Abstract
Background: Previous results of clinical studies suggest that neuromuscular electrostimulation (NMES) therapy, especially in combination with traditional dysphagia therapy, may be helpful in patients with neurogenic swallowing disorders. In these studies, repetitive application of a rectangular current impulse was used to increase muscle strength of the anterior neck. However, according to sports physiological findings, an increase of muscle strength can be better achieved by using different NMES stimulation protocols, e.g. KOTS. The aim of the translational investigator-initiated, non-commercial pilot study presented here was to provide data and insights for the planning of subsequent phase II and III studies on the effectiveness of such stimulation protocols in dysphagia therapy. Methods: 30 post-stroke patients with oropharyngeal dysphagia were included in this prospective pilot study and randomly allocated to either neuromuscular electrostimulation (NMES) or sham stimulation in combination with traditional dysphagia therapy (TDT), a pre- and post-therapeutic fiberoptic-endoscopic evaluation of swallowing (FEES) with the Dysphagia Outcome and Severity Scale (DOSS) (primary outcome measure), Secretion Scale by Murray, Penetration and Aspiration Scale (PAS) and throat clearance (TC) abilities. Recruitment rate, interrater comparison and number of relevant adverse events were recorded as metadata. Results: Despite a recruiting time of over 24 months, only twelve patients could be included. Moreover, clinical data indicated a significant variance of clinical pictures. Significant differences in verum versus sham therapy were not observed. DOSS values in both study groups showed general improvements at the end of the trial. Interrater reliability was low. No adverse events were reported. Discussion: When planning further dysphagia therapy studies, it must be taken into account that it can be problematic to recruit sufficiently large study collectives within an appropriate study period. This is especially important since a possible additional benefit of NMES to TDT is probably rather small or may only occur in certain deficit constellations. The low interrater reliability observed here must be improved by appropriate training measures. Fortunately, no relevant undesirable side effects occurred. This could have a positive effect on the acceptance of volunteers to participate in the study.
Collapse
Affiliation(s)
- Simone Miller
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Hannover, Germany
| | - Daniela Diers
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Hannover, Germany
| | - Michael Jungheim
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Hannover, Germany
| | | | - Hans Jörg Stürenburg
- Department of Neurology, Klinik Niedersachsen, Erwin Röver GmbH und Co. KG, Bad Nenndorf, Germany
| | - Martin Ptok
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Hannover, Germany
| |
Collapse
|
11
|
Miller S, Ptok M, Jungheim M. Correction to: Influence of Acid Swallows on the Dynamics of the Upper Esophageal Sphincter. Dysphagia 2020; 36:456. [PMID: 33188489 PMCID: PMC8163678 DOI: 10.1007/s00455-020-10210-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Simone Miller
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Carl-Neuberg-Straße 1, Hannover, Germany.
| | - Martin Ptok
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Carl-Neuberg-Straße 1, Hannover, Germany
| | - Michael Jungheim
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Carl-Neuberg-Straße 1, Hannover, Germany
| |
Collapse
|
12
|
Meisoll FJ, Jungheim M, Fast JF, Miller S, Ptok M. Upper Esophageal Sphincter Response to Laryngeal Adductor Reflex Elicitation in Humans. Laryngoscope 2020; 131:E1778-E1784. [PMID: 33111975 DOI: 10.1002/lary.29166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 09/16/2020] [Accepted: 09/18/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The laryngeal adductor reflex (LAR) is an important mechanism to secure the airways from potential foreign body aspiration. An involvement of the upper esophageal sphincter (UES) in terms of a laryngo-UES contractile reflex has been identified after laryngeal mucosa stimulation. However, the LAR-UES relationship has not yet been fully explained. This study aimed to determine the magnitude, latency, and occurrence rate of the UES pressure response when the LAR is triggered in order to elucidate the functional relationship between the larynx and the UES. METHODS This prospective study included seven healthy volunteers (5 female, 2 male, age 22-34 years). Laryngeal penetration was simulated by eliciting the LAR 20 times in each individual by applying water-based microdroplets onto the laryngeal mucosa. UES pressures were measured simultaneously using high-resolution manometry. RESULTS Two distinct pressure phases (P1, P2) associated with the LAR were identified. P1 corresponded with a short-term UES pressure decrease in two subjects and a pressure increase in five subjects occurring 200 to 500 ms after the stimulus. In P2, all subjects experienced an increase in UES pressure with a latency time of approximately 800 to 1700 ms and an average of 40 to 90 mmHg above the UES resting tone. CONCLUSION Foreign bodies penetrating the laryngeal inlet lead to a reflex contraction of the UES. Phase P1 could be a result of vocal fold activity caused by the LAR, leading to pressure changes in the UES. The constriction during P2 could strengthen the barrier function of the UES in preparation to a subsequent cough that may be triggered to clear the airways. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E1778-E1784, 2021.
Collapse
Affiliation(s)
- Frederik J Meisoll
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Hannover, Germany
| | - Michael Jungheim
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Hannover, Germany
| | - Jacob F Fast
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Hannover, Germany.,Institute of Mechatronic Systems, Leibniz Universität Hannover, Hannover, Germany
| | - Simone Miller
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Hannover, Germany
| | - Martin Ptok
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Hannover, Germany
| |
Collapse
|
13
|
Fast JF, Westermann KA, Laves MH, Jungheim M, Ptok M, Ortmaier T, Kahrs LA. Droplet applicator module for reproducible and controlled endoscopic laryngeal adductor reflex stimulation. Biomicrofluidics 2020; 14:044112. [PMID: 32831985 PMCID: PMC7414942 DOI: 10.1063/5.0004351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 07/28/2020] [Indexed: 06/11/2023]
Abstract
This work presents a droplet applicator module to generate stable droplets with different muzzle energies for the reproducible endoscopic stimulation of the laryngeal adductor reflex (LAR). The LAR is a protective reflex of the human larynx; an abnormal LAR performance may cause aspiration pneumonia. A pathological LAR can be detected by evaluating its onset latency. The reflex can be triggered by shooting a droplet onto the laryngeal mucosa, which is referred to as Microdroplet Impulse Testing of the LAR (MIT-LAR). Stimulation intensity variation is desired as the reflex threshold may vary inter-individually. The kinetic energy of a droplet after detachment from the nozzle, i.e., its muzzle energy, is considered an appropriate metric for the LAR stimulation intensity. In this work, a suitable nozzle channel geometry is identified based on the experimental evaluation of droplet formation using three different nozzle channel geometries. Two nontoxic additives are evaluated regarding their effect on fluid properties and droplet formation. The range of achievable droplet muzzle energies is determined by high-speed cinematography in association with a physically motivated model of the macroscopic droplet motion. The experimental results show that sodium chloride is a suitable additive to enhance droplet stability in the studied parameter range with the proposed system. Droplet muzzle energy variation from 0.02 μ J to 1.37 μ J was achieved while preserving the formation of a single stimulation droplet. These results are an important prerequisite for a safe and reproducible LAR stimulation by MIT-LAR, which could also help to further elucidate the physiological mechanisms underlying this laryngeal reflex.
Collapse
Affiliation(s)
- J. F. Fast
- Author to whom correspondence should be addressed:
| | - K. A. Westermann
- Institute of Mechatronic Systems, Leibniz Universität Hannover, 30823 Garbsen, Germany
| | - M.-H. Laves
- Institute of Mechatronic Systems, Leibniz Universität Hannover, 30823 Garbsen, Germany
| | - M. Jungheim
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, 30625 Hannover, Germany
| | - M. Ptok
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, 30625 Hannover, Germany
| | - T. Ortmaier
- Institute of Mechatronic Systems, Leibniz Universität Hannover, 30823 Garbsen, Germany
| | | |
Collapse
|
14
|
Diers D, Fast JF, Götz F, Kahrs LA, Miller S, Jungheim M, Ptok M. Euclidean distances of laryngopharyngeal structures obtained from CT data for preclinical development of laryngoscopic devices. Surg Radiol Anat 2019; 42:695-700. [PMID: 31858189 DOI: 10.1007/s00276-019-02397-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 12/04/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE This study aims to determine Euclidean distances between landmark structures in the larynx and pharynx to optimize endoscope shaft designs with regard to gentle and patient-oriented handling. METHODS Four Euclidean distances between landmarks in the larynx and pharynx were analyzed based on CT data of 66 patients. Distance (1): labium inferius oris-posterior pharyngeal wall at the cervical vertebra C1 (atlas), anterior edge of the tuberculum anterius atlantis. Distance (2): posterior pharyngeal wall adjacent to C1-entrance of pyriform sinus. Distance (3): inferior edge of the uvula-superior edge of the epiglottis. Distance (4): base of the vallecula-posterior pharyngeal wall. The minimum angular field of view α required to observe the glottis with a rigid transoral laryngoscope was derived trigonometrically from distances (2) and (4). RESULTS Average Euclidean distances measured: Distance (1): 90.7 mm ± 6.9 mm in men and 86.9 mm ± 5.9 mm in women. (2): 73.7 mm ± 13.4 mm and 56.2 mm ± 7.6 mm. (3): 25.2 mm ± 8.6 mm and 18.5 mm ± 6.8 mm. (4): 20.8 mm ± 4.6 mm and 16.5 mm ± 3.4 mm. α: 16.0° ± 3.9° and 16.6 ± 4.3°. CONCLUSIONS As expected, statistically significant sex-related differences could be observed for distances (1)-(4). The results indicate that the length of transoral laryngoscopes should not be below 110 mm and that a minimum angular field of view of α = 17° is required to fully observe the laryngeal inlet.
Collapse
Affiliation(s)
- Daniela Diers
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Hannover, Germany
| | - Jacob Friedemann Fast
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Hannover, Germany.,Institute of Mechatronic Systems (imes), Leibniz Universität Hannover, Hannover, Germany
| | - Friedrich Götz
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Lüder Alexander Kahrs
- The Hospital for Sick Children, Centre for Image Guided Innovation and Therapeutic Intervention (CIGITI), Toronto, Canada.,Department of Mathematical and Computational Sciences, University of Toronto Mississauga, Mississauga, Canada
| | - Simone Miller
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Hannover, Germany.
| | - Michael Jungheim
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Hannover, Germany
| | - Martin Ptok
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Hannover, Germany
| |
Collapse
|
15
|
Kallusky J, Zimmerer R, Tavassol F, Gellrich NC, Ptok M, Jungheim M. Deglutition in Patients With Hypernasality Associated With Unilateral Cleft Lip and Palate Evaluated With High-Resolution Manometry. Cleft Palate Craniofac J 2019; 57:238-244. [DOI: 10.1177/1055665619877053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To evaluate pharyngeal pressure profiles during swallowing in patients with unilateral cleft lip and palate (UCLP) and identify compensation mechanisms. Design: Prospective experimental study. Setting: University Hospital and Medical School. Participants: Ten volunteers and 10 patients with nonsyndromic repaired UCLP with hypernasality (age: 19-27 years, 5 females and 5 males per group) were included. Interventions: All participants swallowed 2 and 10 mL of water and underwent high-resolution manometry (HRM). Main Outcome Measures: Pharyngeal and upper esophageal sphincter (UES) parameters were measured using HRM. Student t test was used for statistical intergroup comparisons. Additionally, the Sydney Swallowing Questionnaire (SSQ) was used as a subjective measure. Results: Patients exhibited reduced velopharyngeal closing pressure and velopharyngeal and tongue base (TB) region contraction times, compared to volunteers ( P < .05). The UES opening and closing functions did not change. The SSQ revealed nasal regurgitation in some patients. Conclusions: In patients with UCLP, velopharyngeal region alterations are caused by impaired muscle force and function. The reduced TB contraction time may be a compensation mechanism allowing bolus transportation without nasal regurgitation. However, deglutition is not completely altered since UES function remains normal. Future studies will need to reveal at which point a decrease in velopharyngeal closing pressure will result in velopharyngeal insufficiency.
Collapse
Affiliation(s)
- Johanna Kallusky
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Hannover, Germany
| | - Rüdiger Zimmerer
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Frank Tavassol
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Nils-Claudius Gellrich
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Martin Ptok
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Hannover, Germany
| | - Michael Jungheim
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Hannover, Germany
| |
Collapse
|
16
|
Iliadou V, Kiese-Himmel C, Bamiou DE, Grech H, Ptok M, Chermak GD, Thai-Van H, Stokkereit Mattsson T, Musiek FE. Clinical Expertise Is Core to an Evidence-Based Approach to Auditory Processing Disorder: A Reply to Neijenhuis et al. 2019. Front Neurol 2019; 10:1096. [PMID: 31681157 PMCID: PMC6813210 DOI: 10.3389/fneur.2019.01096] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 09/30/2019] [Indexed: 11/19/2022] Open
Abstract
The opinion article "An Evidence-based Perspective on Misconceptions Regarding Pediatric Auditory Processing Disorder" by Neijenhuis et al. (1) presents a distorted view of the evidence-based approach used in medicine. The authors focus on the amorphous non-diagnostic entity "listening difficulties" not auditory processing disorder (APD) and create confusion that could jeopardize clinical services to individuals with APD. In our perspective article, we rebut Neijenhuis et al. (1), and more importantly, we present a rationale for evidence-based practice founded on the premise that research on APD is only clinically applicable when conducted on clinical populations diagnosed with APD.
Collapse
Affiliation(s)
- Vasiliki Iliadou
- Clinical Psychoacoustics Lab, Third Department of Psychiatry, Neuroscience Sector, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christiane Kiese-Himmel
- Phoniatric and Pediatric Audiological Psychology, University Medical Center Göttingen, Georg-August-University, Göttingen, Germany
| | - Doris-Eva Bamiou
- Faculty of Brain Sciences, University College London Ear Institute, University College London, London, United Kingdom
| | - Helen Grech
- Department of Communication Therapy, Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Martin Ptok
- Department of Phoniatrics and Pediatric Audiology, Medizinische Hochschule Hannover, Hanover, Germany
| | - Gail D. Chermak
- Department of Speech and Hearing Sciences, Elson S. Floyd College of Medicine, Washington State University Health Sciences Spokane, Spokane, WA, United States
| | - Hung Thai-Van
- Department of Audiology and Otoneurological Evaluation, Hospices Civils de Lyon, Paris Hearing Institute, Centre de l'Institut Pasteur, Inserm U1120, Paris, France
| | | | - Frank E. Musiek
- Neuroaudiology Lab, University of Arizona, Tucson, AZ, United States
| |
Collapse
|
17
|
Friedemann Fast J, He J, Ortmaier T, Jungheim M, Ptok M, Kahrs LA. An actuated larynx phantom for pre-clinical evaluation of droplet-based reflex-stimulating laryngoscopes. Current Directions in Biomedical Engineering 2019. [DOI: 10.1515/cdbme-2019-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
The laryngeal adductor reflex (LAR) is an important protective function of the larynx to prevent aspiration and potentially fatal aspiration pneumonia by rapidly closing the glottis. Recently, a novel method for targeted stimulation and evaluation of the LAR has been proposed to enable non-invasive and reproducible LAR performance grading and to extend the understanding of this reflexive mechanism. The method relies on the laryngoscopically controlled application of accelerated water droplets in association with a high-speed camera system for LAR stimulation site and reflex onset latency identification. Prototype laryngoscopes destined for this method require validation prior to extensive clinical trials. Furthermore, demonstrations using a realistic phantom could increase patient compliance in future clinical settings. For these purposes, a model of the human larynx including vocal fold actuation for LAR simulation was developed in this work. The combination of image processing based on a custom algorithm and individual motorization of each vocal fold enables spatio-temporal droplet impact detection and controlled vocal fold adduction. To simulate different LAR pathologies, the current implementation allows to individually adjust the reflex onset latency of the ipsi- and contralateral vocal fold with respect to the automatically detected impact location of the droplet as well as the maximum adduction angle of each vocal fold. An experimental study of the temporal offset between desired and observed LAR onset latency due to image processing was performed for three average droplet masses based on highspeed recordings of the phantom. Median offsets of 100, 120 and 128 ms were found (n=16). This offset most likely has a multifactorial cause (image processing delay, inertia of the mechanical components, droplet motion). The observed offset increased with increasing droplet mass, as fluid oscillations after impact may have been detected as motion. In future work, alternative methods for droplet impact detection could be explored and the observed offset could be used for compensation of this undesirable delay.
Collapse
Affiliation(s)
- Jacob Friedemann Fast
- Leibniz Universität Hannover, Institute of Mechatronic Systems, Appelstr. 11a, Hannover , Germany
| | - Jiazhen He
- Leibniz Universitat Hannover, Institute of Mechatronic Systems, Hannover , Germany
| | - Tobias Ortmaier
- Leibniz Universitat Hannover, Institute of Mechatronic Systems, Hannover , Germany
| | - Michael Jungheim
- Hannover Medical School, Department of Phoniatrics and Pediatric Audiology, Carl-Neuberg-Str. 1, Hannover , Germany
| | - Martin Ptok
- Hannover Medical School, Department of Phoniatrics and Pediatric Audiology, Carl-Neuberg-Str. 1, Hannover , Germany
| | - Lüder Alexander Kahrs
- Center for Image Guided Innovation and Therapeutic Intervention (CIGITI), The Hospital for Sick Children, 555 University Ave, Toronto , Canada
- Department of Mathematical and Computational Sciences, University of Toronto Mississauga, Mississauga Rd, Mississauga , ON, Canada
| |
Collapse
|
18
|
Abstract
Zusammenfassung
Hintergrund Beeinträchtigungen der Lautdiskrimination, des
Sprachverständnisses im Störlärm, der Merkfähigkeit u. s. w. können im Rahmen
einer Diagnostik bezüglich einer auditiven Verarbeitungs- und
Wahrnehmungsstörung (AVWS) strukturiert mit dem von der Deutschen Gesellschaft
für Phoniatrie und Pädaudiologie erstellten Fragebogen (DGPP-AVWS-FB) erfasst
werden. Hier soll über Erfahrungen bei Verwendung dieses Fragebogens in einer
phoniatrisch-pädaudiologischen Praxis berichtet werden. Insbesondere sollte
ermittelt werden, ob Angaben der Eltern zum auditiven Verhalten ihrer Kinder
ähnlich oder different zu Angaben von Erzieherinnen und Erziehern im
Kindergarten (KGK) respektive von Lehrkräften in der Schule (LK) sind.
Methodik In einem neunmonatigen Zeitraum wurde allen Eltern, die ihre
Kinder zur Abklärung einer eventuellen AVWS vorstellten, der DGPP-AVWS-FB zum
Ausfüllen durch sie sowie durch KGK/LK ausgehändigt. Zum Vergleich der
Übereinstimmung der Beurteilungen wurden auch jeweils zwei Fragebögen zur
Aufmerksamkeit und Konzentration bzw. zu exekutiven Funktionen (DISYPS II, BRIEF
oder BRIEF-P) mitgegeben. Daten von Kindern mit peripherer Hörstörung oder
kognitiver Entwicklungsstörung wurden nicht verwendet. Dann wurde für die
jeweiligen Items, Skalen und Indices der Korrelationskoeffizient berechnet.
Ergebnisse Ausgefüllte Fragebögen lagen zum Schluss des
Untersuchungszeitraums von insgesamt 20 Grundschulkindern sowie 7
Kindergartenkindern vor. Bei letztgenannten erfolgte die Vorstellung
ausschließlich auf Veranlassung der KGK, bei einem Schulkind wurde eine AVWS
durch die Eltern, nicht aber durch LK, bei drei Schulkindern sowohl durch die
Eltern wie durch LK und bei 16 Schulkindern nur durch LK vermutet. Die
Auswertung der DGPP-AVWS-FB spiegelte letztlich diese unterschiedliche
Einschätzung der Symptomatik wieder: die Angaben der Eltern zeigten, mit
Ausnahme der Angaben bei Kindern, bei denen sowohl Eltern wie LK eine AVWS
vermuteten, nur eine geringe Übereinstimmung zu den Angaben der KGK/LK. Im
Vergleich dazu waren die Antworten zu den beiden anderen Fragebögen ebenfalls
unterschiedlich, die Angaben zur Aufmerksamkeit und Hyperaktivität bei
Kindergartenkindern tendenziell aber ähnlicher.
Diskussion Die hier aus der phoniatrisch-pädaudiologischen Praxis
vorgestellten Daten könnten mit einem unterschiedlichen Verhalten der Kinder im
häuslichen Umfeld respektive im Kindergarten/in der Schule zu erklären sein. Es
könnte auch sein, dass dasgleiche Verhalten unterschiedlich bewertet wird. Für
Fragebögen-Instrumente zur Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung und zu
exekutiven Funktionen sind niedrige Korrelationen bereits bekannt. Für die
klinische Routine empfiehlt sich, die berichteten Symptome standardisiert mit
dem DGPP-AVWS-FB zu dokumentieren und insbesondere auch festzustellen, ob ein
auffälliges auditives Verhalten nur in einer oder in zwei bzw. mehreren
Umgebungen auffällt.
Collapse
Affiliation(s)
- Thomas Koch
- HNO-Phoniatrie/Pädaudiologie-Gemeinschaftspraxis Calenberger
Esplanade
| | - Corinna Bergmann
- HNO-Phoniatrie/Pädaudiologie-Gemeinschaftspraxis Calenberger
Esplanade
| | - Martin Ptok
- MHH Klinik und Poliklinik für Phoniatrie und
Pädaudiologie
| |
Collapse
|
19
|
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is one of the most common chronic diseases in Germany and is often accompanied by years of chronic rhinosinusitis. According to the current German guideline "Rhinosinusitis", the nasal application of salt solutions, topical corticosteroids and in individual cases also systemic corticosteroids appear useful for a symptomatic therapy of CRS. The evidence for other therapeutic procedures such as acupuncture, homeopathy and phytotherapeutics is seen as insufficient. The aim of the present study was to investigate whether anti-inflammatory effects of electrostimulation therapy can also be demonstrated in CRS. METHODOLOGY randomized, prospective single center study, primary setting; 16 patients with moderate chronic rhinosinusitis with polyps (cRScNP), corresponding to a Lund / Mackay score of 6-12; home based electrostimulation therapy (EST) with amplitude modulated current (base frequency of 4000 Hz, frequency band of 100-250 Hz) over 2 weeks adjuvant to a concurrent sinusitis therapy with topical corticosteroids; measurement of nasal nitric oxide concentration and self-assessment of complaints with the questionnaire instrument SNOT-20 GAV; survey points t0 before EST, t1 after EST, t2 6 weeks after t1. RESULTS Home based EST was performed by 16 patients. The results indicate that the positive effects of electrostimulation therapy in inflammatory processes also exist in CRS. DISCUSSION Adjuvant transsinuidal electrostimulation could thus enrich the conservative therapy of CRS. Further studies with larger collectives are desirable.
Collapse
Affiliation(s)
- Thomas Koch
- HNO-Gemeinschaftspraxis Calenberger Esplanade HNO
| | - Martin Ptok
- MHH Klinik und Poliklinik für Phoniatrie und Pädaudiologie
| |
Collapse
|
20
|
Ptok M, Nickisch A. Audiometrische Verfahren zur Erkennung kindlicher Hörstörungen. Monatsschr Kinderheilkd 2018. [DOI: 10.1007/s00112-018-0442-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
21
|
Iliadou VV, Ptok M, Grech H, Pedersen ER, Brechmann A, Deggouj N, Kiese-Himmel C, S Liwin Ska-Kowalska M, Nickisch A, Demanez L, Veuillet E, Thai-Van H, Sirimanna T, Callimachou M, Santarelli R, Kuske S, Barajas de Prat JJ, Hedever M, Konukseven O, Veraguth D, Mattsson TS, Martins JH, Bamiou DE. European 17 countries consensus endorses more approaches to APD than reported in Wilson 2018. Int J Audiol 2018; 57:395-396. [PMID: 29490518 DOI: 10.1080/14992027.2018.1442937] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Vasiliki Vivian Iliadou
- a Neuroscience, Medical School , Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Martin Ptok
- b Department of Phoniatrics and Pediatric Audiology , Hannover Med School , Hannover , Germany
| | - Helen Grech
- c Department of Communication Therapy, Faculty of Health Sciences , University of Malta , Msida , Malta
| | - Ellen Raben Pedersen
- d The Maersk Mc-Kinney Moller Institute , University of Southern Denmark , Odense , Denmark
| | | | - Naïma Deggouj
- f Audio-Phonological Center , St Luc's University Hospital, Université Catholique de Louvain (UcL) , Brussels , Belgium
| | - Christiane Kiese-Himmel
- g Phoniatric and Pediatric Audiological Psychology , University Medical Center Göttingen, Georg- August-University , Göttingen , Germany
| | | | - Andreas Nickisch
- i Department of Hearing-Language-Cochlear Implants , Kbo-Kinderzentrum München , Munich , Germany
| | | | - Evelyne Veuillet
- k Equipe Audiologie , UMR CNRS 5020, Hospices Edouard Herriot , Lyon , France
| | - Hung Thai-Van
- l Faculté de Médecine Lyon Est , Universite Claude Bernard Lyon 1 , Villeurbanne , France
| | - Tony Sirimanna
- m Department of Audiology and Audiological Medicine , Great Ormond Street Hospital , London , UK
| | - Marina Callimachou
- n ENT and Audiology Department , Nicosia General Hospital , Nicosia , Cyprus
| | | | - Sandra Kuske
- p Latvia Children Hearing Center , Riga , Latvia
| | | | - Mladen Hedever
- r Speech Therapy Department, Fac. of Educ. and Rehab. Sciences , University of Zagreb , Zagreb , Croatia
| | - Ozlem Konukseven
- s Faculty of Health Sciences, Audiology Department , Istanbul Aydın University , Istanbul , Turkey
| | - Dorothy Veraguth
- t Department of Otorhinolaryngology-Head and Neck Surgery , University of Zurich, University Hospital Zurich , Zurich , Switzerland
| | - Tone Stokkereit Mattsson
- u Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences , NTNU, Norwegian University of Science and Technology , Trondheim , Norway.,v ENT Department , Aalesund Hospital , Aalesund , Norway
| | - Jorge Humberto Martins
- w Cochlear Implant Unit, Department of Otorhinolaryngology and Head and Neck Surgery , Centro Hospitalar e Universitário de Coimbra , Coimbra , Portugal
| | - Doris-Eva Bamiou
- x Academic Unit of Audiological Medicine , Institute of Child Health , London , UK , and.,y Department of Neuro-otology , National Hospital for Neurology and Neurosurgery , London , UK
| |
Collapse
|
22
|
Kühn D, Ptok M, Jungheim M. [Evaluation of velopharyngeal closing pressure during trumpet play with high-resolution manometry]. Laryngorhinootologie 2018; 97:321-326. [PMID: 29462829 DOI: 10.1055/s-0043-124971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE In about one-third of brass instrumentalists, there are stress-related insufficiencies of velopharyngeal closure (VPC), i. e. the intraoral pressure exceeds the barrier formed by the VPC. Here, it was the aim to measure the VPC closing pressure while playing a trumpet and to evaluate the influence of a 30 minute stress sequence on the muscular activities in the VPC. MATERIAL AND METHODS Sample: 6 healthy volunteers; task: to play the sound h1 for 5 seconds with 85 dB(A) and with 100 dB(A). METHODOLOGY High-resolution manometry (HRM). SAMPLING t0: measurement without warm up phase t1 after 30 min trumpet play; practice phase with predefined pieces of music. VARIABLES mean (pmit), minimum (pmin) and maximum pressure (pmax) in the VPA at t0 and t1. STATISTICS testing for normal distribution, t-test. RESULTS All measured pressures in the VPC decreased from t0 to t1 for tones produced at 85 dB(A). For 100 dB(A) tones only the pmin decreased significantly. The pressures in the VPA were higher at 100 dB(A) tones overall compared to 85 dB(A) tones, significant differences were found for pmin and pmax at t0. CONCLUSION Tones played at louder volumes require a stronger muscular contraction in the VPC. The lower VPC pressure after the exercise phase (t1) can either result from a physiological muscular adaptation to the pressure level necessary for a sufficient VPC or already be a sign of muscular fatigue. These findings may be important to assess the work ability of wind instrumentalists by HRM. As shown for the phonation, the VPC pressure profile for the trumpet play can also be described with a three-phase model consisting of an initiation, a stable phase and a termination.
Collapse
|
23
|
Iliadou VV, Ptok M, Grech H, Pedersen ER, Brechmann A, Deggouj N, Kiese-Himmel C, Śliwińska-Kowalska M, Nickisch A, Demanez L, Veuillet E, Thai-Van H, Sirimanna T, Callimachou M, Santarelli R, Kuske S, Barajas J, Hedjever M, Konukseven O, Veraguth D, Stokkereit Mattsson T, Martins JH, Bamiou DE. A European Perspective on Auditory Processing Disorder-Current Knowledge and Future Research Focus. Front Neurol 2017; 8:622. [PMID: 29209272 PMCID: PMC5702335 DOI: 10.3389/fneur.2017.00622] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 11/07/2017] [Indexed: 11/25/2022] Open
Abstract
Current notions of “hearing impairment,” as reflected in clinical audiological practice, do not acknowledge the needs of individuals who have normal hearing pure tone sensitivity but who experience auditory processing difficulties in everyday life that are indexed by reduced performance in other more sophisticated audiometric tests such as speech audiometry in noise or complex non-speech sound perception. This disorder, defined as “Auditory Processing Disorder” (APD) or “Central Auditory Processing Disorder” is classified in the current tenth version of the International Classification of diseases as H93.25 and in the forthcoming beta eleventh version. APDs may have detrimental effects on the affected individual, with low esteem, anxiety, and depression, and symptoms may remain into adulthood. These disorders may interfere with learning per se and with communication, social, emotional, and academic-work aspects of life. The objective of the present paper is to define a baseline European APD consensus formulated by experienced clinicians and researchers in this specific field of human auditory science. A secondary aim is to identify issues that future research needs to address in order to further clarify the nature of APD and thus assist in optimum diagnosis and evidence-based management. This European consensus presents the main symptoms, conditions, and specific medical history elements that should lead to auditory processing evaluation. Consensus on definition of the disorder, optimum diagnostic pathway, and appropriate management are highlighted alongside a perspective on future research focus.
Collapse
Affiliation(s)
| | - Martin Ptok
- Department of Phoniatrics and Pediatric Audiology, Hannover, Germany
| | | | - Ellen Raben Pedersen
- The Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Odense, Denmark
| | | | - Naïma Deggouj
- Audio-Phonological Center, St Luc's University Hospital, Université Catholique de Louvain (UcL), Brussels, Belgium
| | - Christiane Kiese-Himmel
- Phoniatric and Pediatric Audiological Psychology, University Medical Center Göttingen, Georg-August-University, Göttingen, Germany
| | | | - Andreas Nickisch
- Department of Hearing-Language-Cochlear Implants, Kbo-Kinderzentrum München, Munich, Germany
| | | | | | | | - Tony Sirimanna
- Department of Audiology and Audiological Medicine, Great Ormond Street Hospital, London, United Kingdom
| | | | | | | | - Jose Barajas
- Clnica Barajas, Santa Cruz de Tenerife, Canary Islands, Spain
| | - Mladen Hedjever
- Faculty of Education and Rehabilitation Sciences, Speech Therapy Department, University of Zagreb, Zagreb, Croatia
| | - Ozlem Konukseven
- Faculty of Health Sciences, Audiology Department, Istanbul Aydın University, Istanbul, Turkey
| | - Dorothy Veraguth
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Switzerland
| | - Tone Stokkereit Mattsson
- Faculty of Medicine and Health Sciences, Department of Neuromedicine and Movement Science, NTNU, Trondheim, Norway
| | - Jorge Humberto Martins
- Cochlear Implant Unit, Department of Otorhinolaryngology and Head and Neck Surgery, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Doris-Eva Bamiou
- Faculty of Brain Sciences, UCL Ear Institute, University College London, London, United Kingdom
| |
Collapse
|
24
|
Jungheim M, Kallusky J, Ptok M. [Effect of Bolus Volume on Pharyngeal Swallowing Dynamics Evaluated with Small High-Resolution Manometry Catheters]. Laryngorhinootologie 2017; 96:112-117. [PMID: 28147382 DOI: 10.1055/s-0042-118231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The bolus volume has a modulating effect on the swallowing dynamics, but previously reported adaptations of the pharyngeal function have been inconsistent. Therefore, the aim of this study was to comprehensively evaluate changes of pressure and time parameters in the pharynx and upper esophageal sphincter (UES) in relation to the swallowed bolus volume with high-resolution manometry (HRM). To examine the normal swallowing physiology, particularly thin HRM probes were used, which were expected to influence the investigated structures only minimally.10 healthy volunteers accomplished 10 swallows with 2 and 10 ml water respectively in an upright position, while an HRM-examination was performed. Pressure and time parameters of the velopharynx, the tongue base region and the UES were determined and analyzed for statistical differences with respect to the bolus volume.Swallowing larger bolus volumes resulted in both, a longer closure of the velopharynx and in a longer opening of the UES. Volume dependent pressure changes in the pharyngeal swallowing sequence were not detectable.Under the chosen test conditions, bolus volume had an impact on the time parameters of the pharyngeal phase, thus, temporal adaptations of the automated swallowing dynamics were detected. Changes in pharyngeal pressure parameters as shown in other studies cannot be confirmed. They may be due to HRM probes with a larger diameter, which take an effect on the pharyngeal structures themselves. With regard to diagnostic aspects, HRM studies should always be conducted with different bolus volumes in order to investigate the swallowing process completely.
Collapse
Affiliation(s)
- Michael Jungheim
- Klinik und Poliklinik für Phoniatrie und Pädaudiologie, Medizinische Hochschule Hannover, Hannover
| | - Johanna Kallusky
- Klinik und Poliklinik für Phoniatrie und Pädaudiologie, Medizinische Hochschule Hannover, Hannover
| | - Martin Ptok
- Klinik und Poliklinik für Phoniatrie und Pädaudiologie, Medizinische Hochschule Hannover, Hannover
| |
Collapse
|
25
|
Abstract
Despite normal hearing thresholds in pure tone audiometry, 0.5-1 % of children have difficulty understanding what they hear. An auditory processing disorder (APD) can be assumed, which should be clarified and treated. Based on a selective literature search in the PubMed and Scopus databases using the term "auditory processing disorder", several consensus papers are discussed. Numerous studies on APD have revealed partially contradicting results, thus fueling critical discussion regarding validity and reliability-of specific audiometric APD methods and the APD construct in particular. In order to correctly advise parents and, where necessary, treat affected children, otorhinolaryngologists, phoniatrists, and pediatric audiologists must understand the psychometric properties of applied tests and have knowledge of current discussion. Diagnosis is generally a multistep interdisciplinary process.
Collapse
Affiliation(s)
- M Ptok
- Klinik für Phoniatrie und Pädaudiologie, MHH OE 6510, 30623, Hannover, Deutschland.
| | - S Miller
- Klinik für Phoniatrie und Pädaudiologie, MHH OE 6510, 30623, Hannover, Deutschland
| | - D Kühn
- Klinik für Phoniatrie und Pädaudiologie, MHH OE 6510, 30623, Hannover, Deutschland
| |
Collapse
|
26
|
Jungheim M, Busche A, Miller S, Schilling N, Schmidt-Thieme L, Ptok M. Calculation of upper esophageal sphincter restitution time from high resolution manometry data using machine learning. Physiol Behav 2016; 165:413-24. [DOI: 10.1016/j.physbeh.2016.08.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 07/08/2016] [Accepted: 08/04/2016] [Indexed: 10/21/2022]
|
27
|
Ptok M, Kühn D, Miller S, Jungheim M, Schroeter S. [Laryngeal and larynx-associated reflexes]. HNO 2016; 64:435-44. [PMID: 27240793 DOI: 10.1007/s00106-016-0169-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The laryngeal adductor reflex and the pharyngoglottal closure reflex protect the trachea and lower respiratory tract against the entrance of foreign material. The laryngeal expiration reflex and the cough reflex serve to propel foreign material, which has penetrated in the cranial direction. The inspiration reflex, the sniff reflex, and the swallowing reflex are further larynx-associated reflexes. In patients with dysphagia the laryngeal adductor reflex can be clinically tested with air pulses. The water swallow test serves to show the integrity of the cough reflex. The sniff reflex is useful to test the abduction function of the vocal folds. Future studies should address laryngeal reflexes more specifically, both for a better understanding of these life-supporting mechanisms and to improve diagnostic procedures in patients with impaired laryngeal function.
Collapse
Affiliation(s)
- M Ptok
- Klinik für Phoniatrie und Pädaudiologie, MHH OE 6510, 30623, Hannover, Deutschland.
| | - D Kühn
- Klinik für Phoniatrie und Pädaudiologie, MHH OE 6510, 30623, Hannover, Deutschland
| | - S Miller
- Klinik für Phoniatrie und Pädaudiologie, MHH OE 6510, 30623, Hannover, Deutschland
| | - M Jungheim
- Klinik für Phoniatrie und Pädaudiologie, MHH OE 6510, 30623, Hannover, Deutschland
| | - S Schroeter
- Klinik für Phoniatrie und Pädaudiologie, MHH OE 6510, 30623, Hannover, Deutschland
| |
Collapse
|
28
|
Abstract
BACKGROUND Patients with myotonic dystrophy (MD) are known to suffer from oropharyngeal dysphagia and esophageal motility disorders, which are often the cause of aspiration pneumonia. So far only little is known about the pharyngeal contractility and the function of the upper esophageal sphincter in these patients, in particular only few data are available for manometric investigations allowing assessment of the pharyngeal pressure build-up during swallowing. The aim of this study was to collect such data in patients with MD using high resolution manometry. METHOD In two patients with MD high resolution manometry studies were performed during swallowing and phonation to determine pressure-dependent parameters. The results were compared with normal values from healthy subjects. RESULTS In both patients a reduced pressure in the entire pharynx during swallowing was determined. The duration of the contraction in the velopharynx and tongue base region was shortened. The structural course of the swallowing process and the opening and closing functions of the upper esophageal sphincter were regular. During realization of closed vowels a reduced pressure build-up in the velopharyngeal region was observed. CONCLUSION The force of contraction and the associated pharyngeal pressure build-up during swallowing were reduced resulting in an incomplete clearing of the pharynx. Beside myopathic disorders, neuromuscular disorders also have to be considered. The functional course of the swallowing process and the swallowing pattern was retained. The reduced pressure build-up in the velopharyngeal region can be considered as the cause for rhinophonia. To evaluate the pharyngeal function in patients with MD, high resolution manometry is a useful tool for assessing the pharyngeal function besides the basic diagnostics.
Collapse
Affiliation(s)
- M Jungheim
- Klinik und Poliklinik für Phoniatrie und Pädaudiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland,
| | | | | |
Collapse
|
29
|
Jungheim M, Donner S, Bleeker S, Ripken T, Krueger A, Ptok M. Effect of saline inhalation on vocal fold epithelial morphology evaluated by optical coherence tomography. Laryngoscope 2016; 126:E332-6. [PMID: 26972688 DOI: 10.1002/lary.25891] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 12/09/2016] [Accepted: 12/31/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Examination of tissue structures by optical coherence tomography (OCT) has been shown to be useful on mucous membranes of the vocal folds, but so far its application to the human larynx has been limited because it is technically cumbersome and usually needs to be performed with sedation. Here a newly developed, noninvasive combined laryngoscopy and OCT procedure is described and its suitability for ambulatory OCT studies evaluated. Because inhalation therapies utilizing saline solutions are commonly used as a treatment option for disorders of the airways, and vocal fold epithelium is most likely to be affected due to its superficial positioning, epithelial thickness was chosen as a relevant test parameter and evaluated before and after saline inhalation. METHODS Seven vocally healthy participants performed a 10-minute inhalation of saline solution and underwent a combined laryngoscopy and OCT before and after the inhalation therapy. Endoscopy was performed using a newly developed combined laryngoscopy and OCT device. The OCT images were used to estimate the epithelial thickness of the vocal folds. RESULTS Epithelial thickness measured in all participants before treatment was comparable in size reported in previous studies. Statistical differences before and after inhalation were not detected. CONCLUSION The newly developed combined laryngoscopy and OCT procedure enables rapid investigation of the vocal fold epithelium. Inhalation of saline solution did not appear to affect the thickness of the epithelium of the vocal folds in vocally healthy subjects, as evaluated by OCT. LEVEL OF EVIDENCE N/A. Laryngoscope, 126:E332-E336, 2016.
Collapse
Affiliation(s)
- Michael Jungheim
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Hannover, Germany.
| | - Sabine Donner
- Biomedical Optics Department, Laser Zentrum Hannover e.V, Hannover, Germany
| | - Sebastian Bleeker
- Biomedical Optics Department, Laser Zentrum Hannover e.V, Hannover, Germany
| | - Tammo Ripken
- Biomedical Optics Department, Laser Zentrum Hannover e.V, Hannover, Germany
| | - Alexander Krueger
- Biomedical Optics Department, Laser Zentrum Hannover e.V, Hannover, Germany
| | - Martin Ptok
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Hannover, Germany
| |
Collapse
|
30
|
Ptok M, Schroeter S. Charakterisierung des laryngealen Adduktionsreflexes durch Stimulation mit Mikrotröpfchen-Impulsen (microdroplet impulse testing). Laryngorhinootologie 2016; 95:482-9. [DOI: 10.1055/s-0041-111516] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- M. Ptok
- MHH, Klinik und Poliklinik für Phoniatrie und Pädaudiologie, Hannover
| | - S. Schroeter
- MHH, Klinik und Poliklinik für Phoniatrie und Pädaudiologie, Hannover
| |
Collapse
|
31
|
|
32
|
Donner S, Bleeker S, Ripken T, Ptok M, Jungheim M, Krueger A. Automated working distance adjustment enables optical coherence tomography of the human larynx in awake patients. J Med Imaging (Bellingham) 2015; 2:026003. [PMID: 26158116 DOI: 10.1117/1.jmi.2.2.026003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 05/20/2015] [Indexed: 11/14/2022] Open
Abstract
Optical coherence tomography (OCT) provides structural information of laryngeal tissue which is comparable to histopathological analysis of biopsies taken under general anesthesia. In awake patients, movements impede clinically useful OCT acquisition. Therefore, an automatic compensation of movements was implemented into a swept source OCT-laryngoscope. Video and OCT beam path were combined in one tube of 10-mm diameter. Segmented OCT images served as distance sensor and a feedback control adjusted the working distance between 33 and 70 mm by synchronously translating the reference mirror and focusing lens. With this motion compensation, the tissue was properly visible in up to 88% of the acquisition time. During quiet respiration, OCT contrasted epithelium and lamina propria. Mean epithelial thickness was measured to be 109 and [Formula: see text] in female and male, respectively. Furthermore, OCT of mucosal wave movements during phonation enabled estimation of the oscillation frequency and amplitude. Regarding clinical issues, the OCT-laryngoscope with automated working distance adjustment may support the estimation of the depth extent of epithelial lesions and contribute to establish an indication for a biopsy. Moreover, OCT of the vibrating vocal folds provides functional information, possibly giving further insight into mucosal behavior during the vibratory cycle.
Collapse
Affiliation(s)
- Sabine Donner
- Laser Zentrum Hannover e.V. , Biomedical Optics Department, Hollerithallee 8, 30419 Hannover, Germany
| | - Sebastian Bleeker
- Laser Zentrum Hannover e.V. , Biomedical Optics Department, Hollerithallee 8, 30419 Hannover, Germany
| | - Tammo Ripken
- Laser Zentrum Hannover e.V. , Biomedical Optics Department, Hollerithallee 8, 30419 Hannover, Germany
| | - Martin Ptok
- Hannover Medical School , Clinic for Phoniatry and Paediatric Audiology, Carl-Neuberg-Street 1, 30625 Hannover, Germany
| | - Michael Jungheim
- Hannover Medical School , Clinic for Phoniatry and Paediatric Audiology, Carl-Neuberg-Street 1, 30625 Hannover, Germany
| | - Alexander Krueger
- Laser Zentrum Hannover e.V. , Biomedical Optics Department, Hollerithallee 8, 30419 Hannover, Germany
| |
Collapse
|
33
|
Abstract
BACKGROUND The requirement for otorhinolaryngologists and phoniatricians to diagnose dysphagia and evaluate its extent is on the rise, particularly in light of demographic changes. The gold standards in confirmatory diagnostics are fiberoptic endoscopic evaluation of swallowing (FEES) and the videofluoroscopic swallowing examination (VFS). Standardized assessments, such as questionnaires or assessments involving probatory swallows are often applied as screening or supportive measures. This article aims to give a critical overview of the assessment tools frequently used in clinical routine. Test quality is assessed, particularly compared to FEES and VFS. METHODS A selective literature search using PubMed has been conducted. RESULTS On the basis of this lierature search, 48 assessment tools were identified. These can be classified into screening tools, instrument-based tools (implementation standards and evaluation protocols) and questionnaire-based assessment inventories. DISCUSSION In order to diagnose and evaluate dysphagia on the basis of assessment critieria, clinicians should be aware of indications for, as well as the advantages, disadvantages and test quality of the assessment tools. Considering the different assessment tools for anamnesis and probatory swallowing, rather low sensitivities and specificities for possible penetration and aspiration are evident. In cases where these symptoms of dysphagia are not evident and reliably assessable, confirmatory assessment via FEES or VFS is essential.
Collapse
Affiliation(s)
- S Miller
- Klinik für Phoniatrie und Pädaudiologie, Medizinische Hochschule Hannover, MHH OE 6510, 30623, Hannover, Deutschland,
| | | | | | | |
Collapse
|
34
|
Jungheim M, Schubert C, Miller S, Ptok M. [Normative Data of Pharyngeal and Upper Esophageal Sphincter High Resolution Manometry]. Laryngorhinootologie 2015; 94:601-8. [PMID: 25739072 DOI: 10.1055/s-0034-1395532] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND High resolution manometry (HRM) can provide information about the muscular contraction of the pharynx and the upper esophageal sphincter (UES) and represents an important tool in the diagnostics of dysphagia. To compare the results of swallowing studies interindividually and to identify pathological swallows, normative data are necessary. Normative data for the use of an HRM-probe with a large diameter has already been published. As previously has been shown these probes can influence the normal contraction of the pharynx and the UES. In this study comprehensive normal values are presented for small HRM-probes in diameter (2 mm), that only minimally affect pharyngeal and UES contractions. METHOD 29 healthy volunteers underwent pharyngeal and upper esophageal HRM. All subjects performed 10 water swallows of 2 ml in an upright position. Pressure and time dependent parameters of the velopharyngeal region, the tongue base and the UES have been evaluated. Mean and median values and different percentile ranges were calculated. RESULTS The normative values for the key parameters were (mean±SD): maximum velopharyngeal pressure 269.9±113.1 mmHg, maximum tongue base pressure 278±93.6 mmHg, maximum UES pressure 205.8±64.0 mmHg, UES resting pressure 42.5±18.7 mmHg and relaxation time of the UES 681.6±86.8 ms. Further parameters have been measured. CONCLUSION Time dependent values are comparable to those already published. Especially in the UES lower pressures can be measured when a small HRM-probe is used. The normative data established in this study might help to distinguish pathological from physiological swallows using HRM.
Collapse
Affiliation(s)
- M Jungheim
- Klinik und Poliklinik für Phoniatrie und Pädaudiologie, Medizinische Hochschule Hannover, Hannover
| | - C Schubert
- Klinik und Poliklinik für Phoniatrie und Pädaudiologie, Medizinische Hochschule Hannover, Hannover
| | - S Miller
- Klinik und Poliklinik für Phoniatrie und Pädaudiologie, Medizinische Hochschule Hannover, Hannover
| | - M Ptok
- Klinik und Poliklinik für Phoniatrie und Pädaudiologie, Medizinische Hochschule Hannover, Hannover
| |
Collapse
|
35
|
Thoenes M, Zimmermann U, Ebermann I, Ptok M, Lewis MA, Thiele H, Morlot S, Hess MM, Gal A, Eisenberger T, Bergmann C, Nürnberg G, Nürnberg P, Steel KP, Knipper M, Bolz HJ. OSBPL2 encodes a protein of inner and outer hair cell stereocilia and is mutated in autosomal dominant hearing loss (DFNA67). Orphanet J Rare Dis 2015; 10:15. [PMID: 25759012 PMCID: PMC4334766 DOI: 10.1186/s13023-015-0238-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 02/03/2015] [Indexed: 01/08/2023] Open
Abstract
Background Early-onset hearing loss is mostly of genetic origin. The complexity of the hearing process is reflected by its extensive genetic heterogeneity, with probably many causative genes remaining to be identified. Here, we aimed at identifying the genetic basis for autosomal dominant non-syndromic hearing loss (ADNSHL) in a large German family. Methods A panel of 66 known deafness genes was analyzed for mutations by next-generation sequencing (NGS) in the index patient. We then conducted genome-wide linkage analysis, and whole-exome sequencing was carried out with samples of two patients. Expression of Osbpl2 in the mouse cochlea was determined by immunohistochemistry. Because Osbpl2 has been proposed as a target of miR-96, we investigated homozygous Mir96 mutant mice for its upregulation. Results Onset of hearing loss in the investigated ADNSHL family is in childhood, initially affecting the high frequencies and progressing to profound deafness in adulthood. However, there is considerable intrafamilial variability. We mapped a novel ADNSHL locus, DFNA67, to chromosome 20q13.2-q13.33, and subsequently identified a co-segregating heterozygous frameshift mutation, c.141_142delTG (p.Arg50Alafs*103), in OSBPL2, encoding a protein known to interact with the DFNA1 protein, DIAPH1. In mice, Osbpl2 was prominently expressed in stereocilia of cochlear outer and inner hair cells. We found no significant Osbpl2 upregulation at the mRNA level in homozygous Mir96 mutant mice. Conclusion The function of OSBPL2 in the hearing process remains to be determined. Our study and the recent description of another frameshift mutation in a Chinese ADNSHL family identify OSBPL2 as a novel gene for progressive deafness. Electronic supplementary material The online version of this article (doi:10.1186/s13023-015-0238-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Michaela Thoenes
- Institute of Human Genetics, University Hospital of Cologne, Cologne, Germany.
| | - Ulrike Zimmermann
- Molecular Physiology of Hearing, Hearing Research Centre Tübingen (THRC), Department of Otolaryngology, University of Tübingen, Tübingen, Germany.
| | - Inga Ebermann
- Institute of Human Genetics, University Hospital of Cologne, Cologne, Germany.
| | - Martin Ptok
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Hannover, Germany.
| | - Morag A Lewis
- Wolfson Centre for Age-Related Diseases, King's College London, London, UK.
| | - Holger Thiele
- Cologne Center for Genomics (CCG) and Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany.
| | - Susanne Morlot
- Institute for Human Genetics, Hannover Medical School, Hannover, Germany.
| | - Markus M Hess
- Department of Voice, Speech and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Andreas Gal
- Department of Human Genetics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | | | - Carsten Bergmann
- Center for Human Genetics, Bioscientia, Ingelheim, Germany. .,Renal Division, Department of Medicine, University Medical Center Freiburg, Freiburg, Germany.
| | - Gudrun Nürnberg
- Cologne Center for Genomics (CCG) and Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany.
| | - Peter Nürnberg
- Cologne Center for Genomics (CCG) and Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany. .,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.
| | - Karen P Steel
- Wolfson Centre for Age-Related Diseases, King's College London, London, UK.
| | - Marlies Knipper
- Molecular Physiology of Hearing, Hearing Research Centre Tübingen (THRC), Department of Otolaryngology, University of Tübingen, Tübingen, Germany.
| | - Hanno Jörn Bolz
- Institute of Human Genetics, University Hospital of Cologne, Cologne, Germany. .,Center for Human Genetics, Bioscientia, Ingelheim, Germany.
| |
Collapse
|
36
|
Abstract
BACKGROUND Before the era of objective audiometric procedures, the primary aim of subjective audiometric procedures was determination of the hearing threshold, e.g. to assess hearing aid indications. Nowadays, the results of objective audiometric procedures play a major role in hearing threshold determination in children. Contrastingly, subjective audiometric procedures are also employed in order to verify, or acquire an objective picture of, social hearing abnormalities evident from the children's anamneses. METHODS A selective literature search was conducted in the PubMed and Scopus databases and current textbooks were also considered. RESULTS Subjective audiometric procedures for children employ both nonlinguistic and linguistic stimuli. Procedures can differ in many ways and it can be differentiated between, for example, observational or behavioural audiometry and procedures in which the children are explicitly instructed on how to react to signals. DISCUSSION Several subjective audiometric procedures have been developed to examine the hearing and listening skills of children. Some of these tests differ significantly in terms of their intended application, test construction and test quality criteria. Only a detailed understanding of the particular subjective audiometric procedure being applied enables formulation of the"correct" questions; which, providing the child is willing to cooperate, can also be specifically answered using the test.
Collapse
Affiliation(s)
- M Ptok
- Klinik für Phoniatrie und Pädaudiologie, Medizinische Hochschule Hannover, MHH. OE 6510, 30623, Hannover, Deutschland,
| |
Collapse
|
37
|
Ptok M. [Care of geriatric otorhinolaryngology patients]. HNO 2014; 62:620. [PMID: 25139627 DOI: 10.1007/s00106-014-2916-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- M Ptok
- Klinik und Poliklinik für Phoniatrie und Pädaudiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland,
| |
Collapse
|
38
|
Abstract
BACKGROUND Laryngeal Adductor Reflex Background: A rapid closure of the vocal folds is necessary, whenever foreign materials or food particles penetrate into the larynx. Otherwise a passage of these particles into the trachea or the lower respiratory tract would be imminent. An aspiration could mechanically block the respiratory tract and cause severe dyspnoea or cause aspiration pneumonia. METHOD For this systematic review a selective literature research in PubMed and Scopus using the keywords "laryngeal adductor reflex" and "vocal fold closure" has been carried out. RESULTS Apart from the oesophago-glottal and pharyngo-glottal closure reflexes, the laryngeal adductor reflex (LAR) has been investigated in particular. The LAR qualifies as a reflectory laryngeal adductor mechanism and involves early, presumably di- or oligosynaptic ipsilateral LAR1 as well as late polysynaptic ipsi- and contralateral LAR2 components. In clinical routine diagnostic settings of dysphagia, LAR is only assessed qualitatively and usually triggered by air pulses or tactile stimulation. DISCUSSION Dysphagiologists often find that not only the laryngeal sensibility in general is impaired, but especially the protective laryngeal adduction mechanism, which results in a higher risk of aspiration. Thus, it appears mandatory to test the LAR not only qualitatively but also quantitatively. Unfortunately a valid and reliable method that can be employed in clinical practice has not yet been put forward.
Collapse
Affiliation(s)
- M Ptok
- Klinik und Poliklinik für Phoniatrie und Pädaudiologie, MHH, Hannover
| | - S Bonenberger
- Klinik und Poliklinik für Phoniatrie und Pädaudiologie, MHH, Hannover
| | - S Miller
- Klinik und Poliklinik für Phoniatrie und Pädaudiologie, MHH, Hannover
| | - D Kühn
- Klinik und Poliklinik für Phoniatrie und Pädaudiologie, MHH, Hannover
| | - M Jungheim
- Klinik und Poliklinik für Phoniatrie und Pädaudiologie, MHH, Hannover
| |
Collapse
|
39
|
Miller S, Jungheim M, Schwemmle C, Schoof S, Ptok M. [Inducible laryngeal obstruction vs. bronchial asthma]. Laryngorhinootologie 2014; 93:677-81. [PMID: 24995475 DOI: 10.1055/s-0034-1375659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
UNLABELLED Inducible Laryngeal Obstruction vs. Bronchial -Asthma Background: Inducible laryngeal obstructions (ILO) represent paroxysmal and sometimes severe dyspnea caused by different factors. Symptomatically ILO resembles bronchial asthma and is therefore often misdiagnosed. In the following 3 cases regarding a special type of ILO, the exercise induced laryngeal obstruction (EILO) will be presented. It will also be demonstrated, how EILO can be diagnosed and differentiated from bronchial asthma. METHOD Laryngeal symptoms were provoked by spiroergometry (treadmill or bicycle) and inspected by laryngoscopy. RESULTS Symptoms could be provoked in all of the 3 patients by either treadmill or bicycle spiroergometry. When a stridor occurred, usually 1.5-2 min after the anaerobe threshold had been exceeded, spiroergometry showed a decline or plateau of carbon dioxide emission and oxygen intake. Laryngoscopy revealed adduction of the vocal cords during inspiration occa-sionally with a collapse of supraglottic structures towards the endolarynx. DISCUSSION This article is the first to report that EILO can be distinctly depicted by spiroergometry. The decline or plateau in oxygen and carbon dioxide curves in coordination with the onset of stridor, approximately 1.5-2 min after the anaerobe threshold had been exceeded, was found to be reproducible in all cases. Furthermore, endoscopy immediately following peak exhaustion represents a practical tool for the identification of EILO.·
Collapse
Affiliation(s)
- S Miller
- Klinik und Poliklinik für Phoniatrie und Pädaudiologie, Medizinische Hochschule Hannover, Hannover
| | - M Jungheim
- Klinik und Poliklinik für Phoniatrie und Pädaudiologie, Medizinische Hochschule Hannover, Hannover
| | - C Schwemmle
- Klinik und Poliklinik für Phoniatrie und Pädaudiologie, Medizinische Hochschule Hannover, Hannover
| | - S Schoof
- Klinik für Pädiatrische Kardiologie und Intensivmedzin, Medizinische Hochschule Hannover, Hannover
| | - M Ptok
- Klinik und Poliklinik für Phoniatrie und Pädaudiologie, Medizinische Hochschule Hannover, Hannover
| |
Collapse
|
40
|
Schwemmle C, Rost I, Spranger S, Jungheim M, Ptok M. A boy with mild mental retardation, mild sensorineural hearing loss and mild facial dysmorphism caused by a 19p13.2 deletion: a case report and review of the literature. Int J Pediatr Otorhinolaryngol 2014; 78:1190-3. [PMID: 24814572 DOI: 10.1016/j.ijporl.2014.03.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 03/27/2014] [Accepted: 03/29/2014] [Indexed: 01/21/2023]
Abstract
The investigation of patients with congenital anomalies and/or intellectual disability with modern genetic methods allows the recognition of an increasing number of cases with these chromosomal rearrangements. Here, we present a mildly mentally retarded boy with mild facial dysmorphism, language development delay, mild sensorineural hearing loss due to a deletion of 1,14 Mb on chromosome 19p 13.2. The deletion was de novo and familial history negative for this disorder. To our knowledge this is the first description of a patient with symptoms mentioned above associated with a 19p13.2-p13.2 deletion.
Collapse
Affiliation(s)
- Cornelia Schwemmle
- Department of Phoniatrics and Pedaudiology, Medical University Hannover, Germany.
| | - Imma Rost
- Institute of Genetics, Martinsried, Germany
| | | | - Michael Jungheim
- Department of Phoniatrics and Pedaudiology, Medical University Hannover, Germany
| | - Martin Ptok
- Department of Phoniatrics and Pedaudiology, Medical University Hannover, Germany
| |
Collapse
|
41
|
Jungheim M, Janhsen AM, Miller S, Ptok M. Impact of Neuromuscular Electrical Stimulation on Upper Esophageal Sphincter Dynamics. Ann Otol Rhinol Laryngol 2014; 124:5-12. [DOI: 10.1177/0003489414539132] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: Beside traditional dysphagia therapy, neuromuscular electrical stimulation (NMES) has been proposed to treat patients with dysphagia. Considering the complexity of the nerve-muscle interaction during swallowing, the underlying physiology of NMES remains unclear. Here, we addressed the question of whether NMES can modify upper esophageal sphincter (UES) dynamics. Methods: In a prospective study, 26 healthy volunteers performed water swallows with and without NMES. The stimulus was applied in a participant- and operator-initiated stimulation above, near, and below the motor threshold. Swallowing parameters were measured using high-resolution manometry. Results: The UES relaxation time was found to be extended by 10%, indicating a modification in UES dynamics. Conclusions: The chosen NMES paradigm influenced the involuntary swallowing phase by extending relaxation time, providing more time for bolus passage into the esophagus. Future studies will have to evaluate if this effect can be found in patients with dysphagia and whether it is beneficial for treatment.
Collapse
Affiliation(s)
- Michael Jungheim
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Hannover, Germany
| | | | - Simone Miller
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Hannover, Germany
| | - Martin Ptok
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Hannover, Germany
| |
Collapse
|
42
|
Miller S, Jungheim M, Ptok M. [First language acquisition research and theories of language acquisition]. HNO 2014; 62:242-8. [PMID: 24817502 DOI: 10.1007/s00106-014-2855-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND In principle, a child can seemingly easily acquire any given language. First language acquisition follows a certain pattern which to some extent is found to be language independent. Since time immemorial, it has been of interest why children are able to acquire language so easily. Different disciplinary and methodological orientations addressing this question can be identified. METHODS A selective literature search in PubMed and Scopus was carried out and relevant monographies were considered. RESULTS Different, partially overlapping phases can be distinguished in language acquisition research: whereas in ancient times, deprivation experiments were carried out to discover the "original human language", the era of diary studies began in the mid-19th century. From the mid-1920s onwards, behaviouristic paradigms dominated this field of research; interests were focussed on the determination of normal, average language acquisition. The subsequent linguistic period was strongly influenced by the nativist view of Chomsky and the constructivist concepts of Piaget. Speech comprehension, the role of speech input and the relevance of genetic disposition became the centre of attention. The interactionist concept led to a revival of the convergence theory according to Stern. DISCUSSION Each of these four major theories--behaviourism, cognitivism, interactionism and nativism--have given valuable and unique impulses, but no single theory is universally accepted to provide an explanation of all aspects of language acquisition. Moreover, it can be critically questioned whether clinicians consciously refer to one of these theories in daily routine work and whether therapies are then based on this concept. It remains to be seen whether or not new theories of grammar, such as the so-called construction grammar (CxG), will eventually change the general concept of language acquisition.
Collapse
Affiliation(s)
- S Miller
- Klinik für Phoniatrie und Pädaudiologie, Medizinische Hochschule Hannover, MHH. OE 6510, 30623, Hannover, Deutschland,
| | | | | |
Collapse
|
43
|
Ptok M. [Practical information on language acquisition]. HNO 2014; 62:241. [PMID: 24817501 DOI: 10.1007/s00106-014-2854-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M Ptok
- Klinik und Poliklinik für Phoniatrie und Pädaudiologie, Medizinische Hochschule Hannover, C.-Neuberg-Str. 1, 30625, Hannover, Deutschland,
| |
Collapse
|
44
|
Jungheim M, Miller S, Kühn D, Ptok M. Prosodie, Inputsprache und Spracherwerb. HNO 2014; 62:249-53. [DOI: 10.1007/s00106-013-2816-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
45
|
Ptok M, Kühn D, Miller S. Wortschatzerwerb. HNO 2014; 62:258-65. [DOI: 10.1007/s00106-014-2857-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
46
|
Rittich E, Jungheim M, Ptok M. [Phonation onset and simultaneous activation of non-larynx related muscles]. Laryngorhinootologie 2014; 93:514-20. [PMID: 24566875 DOI: 10.1055/s-0033-1364031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Various voice therapy techniques include not only phonation exercises but also measure to regulate tonus of non-larynx related muscles. This is based on the belief that the use of non-laryngeal muscles may affect laryngeal muscle action during phonation onset und phonation. Here we raised the question if indeed a well defined activation of muscles distant to the larynx may effect phonation onset time and the vibratory cycles following thereafter. METHOD Prospective partly randomized single center pilot study with 8 healthy volunteers. Analysed variables were time of phonation onset and closed quotient (Qx) derived via electroglottgraphy. According to a randomization protocol volunteers had to press a training device ( + condition) or to keep the hand quiet ( - condition). RESULTS Comparism of both conditions did not reveal any significant difference, however Qx tended to be higher in the + condition. DISCUSSION The data presented here does not confirm that activation of hand muscles influences phonation onset time. However the preceding vibratory cycles may be altered towards a higher tone of intralaryngeal muscles regulating vocal fold tension. Further studies including more volunteers or patients with functional voice disorders and protocols employing the activation of other muscle groups are warranted in order to shed more light into the interrelationship between larynx and other muscle activation during phonation.
Collapse
Affiliation(s)
- E Rittich
- Klinik und Poliklinik für Phoniatrie und Pädaudiologie, Medizinische Hochschule Hannover, Hannover
| | - M Jungheim
- Klinik und Poliklinik für Phoniatrie und Pädaudiologie, Medizinische Hochschule Hannover, Hannover
| | - M Ptok
- Klinik und Poliklinik für Phoniatrie und Pädaudiologie, Medizinische Hochschule Hannover, Hannover
| |
Collapse
|
47
|
Abstract
BACKGROUND Animal experiments have shown that after specific nerve traumatization, neuromuscular electrostimulation (NMES) can promote nerve regeneration and reduce synkinesia without negatively interfering with normal regeneration processes. NMES is used routinely in physical rehabilitation medicine. METHODS This systematic literature search in the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, the DAHTA database, the Health Technology Assessment Database and MEDLINE or PubMed considered studies on the use of NMES in otorhinolaryngology that have been published in German or English. RESULTS The search identified 180 studies. These were evaluated and relevant studies were included in the further evaluation. DISCUSSION In the fields of otorhinolaryngology and phoniatry/paediatric audiology, clinical studies investigating the effects of NMES on facial and laryngeal paresis, as well as dysphonia and dysphagia have been carried out. The evidence collected to date is encouraging; particularly for the treatment of certain forms of dysphagia and laryngeal paresis.
Collapse
Affiliation(s)
- S Miller
- Klinik für Phoniatrie und Pädaudiologie, MHH. OE 6510, 30623, Hannover, Deutschland
| | | | | | | | | |
Collapse
|
48
|
Abstract
OBJECTIVE Neuromuscular electrical stimulation (NMES) has been proposed in the treatment of laryngopharyngeal dysfunctions (dysphonia, dyspnoea, dysphagia) for more than 40 years. Several studies have investigated possible therapeutic effects. Some researchers described favourable results, whereas others did not find relevant benefits. This article aims to review available studies to give an overview regarding the current state of knowledge. METHODS We conducted a selective literature search using PubMed. RESULTS In total, 356 papers were identified: 6 case reports, 11 reviews, 43 prospective clinical trials and 3 retrospective trials were found. CONCLUSION Due to different stimulation protocols, electrode positioning and various underlying pathological conditions, summarizing the present studies appears to be difficult. However, there is evidence that NMES is a valuable adjunct in patients with dysphagia and in patients with vocal fold paresis. Nevertheless, more empirical data is needed to fully understand the benefits provided by NMES. Further research suggestions are put forward.
Collapse
Affiliation(s)
- Simone Miller
- Department of Phoniatrics and Pediatric Audiology, Hanover Medical School, Hanover, Germany
| | | | | | | |
Collapse
|
49
|
Abstract
BACKGROUND A clicking noise in the larynx can probably be provoked in many adults. However, these clicks are not usually associated with pain and physicians are not consulted. The combination of a clicking larynx and pain may severely reduce an individual's quality of life. Up until now, the so-called clicking larynx syndrome (CLS) has not been defined in German teaching literature. Therefore, this article reviews the international literature on CLS and also presents three case reports. METHODS A selective literature search using PubMed and Google was conducted. The Google search resulted in the identification of several patient forums. Three case reports are also presented (multiple-case report). RESULTS A total of 4 studies were identified in which different kinds of clicking sounds in the larynx were described. These sounds were typically provoked by movements of the head and/or neck, swallowing or circumlaryngeal manipulation. In forums patients reported many different types of laryngeal clicking sounds, which were often described as extremely irritating. Three patients have recently presented with such symptoms at our department. DISCUSSION The literature published on CLS suggests (although does not strictly prove) that laryngeal clicking sounds are caused by friction between the superior cornu or the top edge of the thyroid cartilage and the hyoid, or alternatively due to contact of these structure with the cervical spine. Seldom do patients report a former laryngeal trauma. The causes of the associated pain remain unclear. The treatment of choice seems to be resection of the structures associated with the clicking noise by thyroplastic surgery or reduction of the hyoid bone greater horn. It is therefore important to inform patients with mild CLS that these clicking sounds are harmless and to advise CLS patients suffering from pain of the appropriate treatment options.
Collapse
Affiliation(s)
- M Jungheim
- Klinik und Poliklinik für Phoniatrie und Pädaudiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland,
| | | | | |
Collapse
|
50
|
Schwemmle C, Morlot S, Ptok M. Homozygous R127H mutation in the GJB2 gene in a boy with initial unilateral severe hearing loss. Klin Padiatr 2013; 225:405-6. [PMID: 24158896 DOI: 10.1055/s-0033-1354375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|