Normalisation of voice parameters in patients with unilateral vocal fold palsy: is it realistic?

BACKGROUND: Disorders of voice can limit an individual's participation and impair social interaction, thus affecting overall quality of life. Perceptual and objective evaluations can provide the clinician with detailed information regarding voice disorders. METHODS: This study comprised 40 subjects aged 34-46 years, 20 of whom (10 male, 10 female) had unilateral vocal fold palsy. Data were obtained for all participants from: the Voice Handicap Index, the grade, roughness, breathiness, asthenia and strain ('GRBAS') scale, acoustic voice analysis, electroglottography, and voice range profiles. RESULTS: The voice evaluations revealed statistically significant (p < 0.05) differences between the controls and study group, both in males and females, pre- and post-therapy. CONCLUSION: Despite the normalisation of vocal parameters, acoustic, perceptual and self-rated assessments revealed statistically significant differences after therapy. Hence, acoustic measures, namely electroglottographic perturbation, and voice frequency and intensity range, are recommended prior to termination of therapy.

Parental Expectation and Perception of CI Benefits in Their Implanted Wards.

Parents of implanted children develop a set of expectations prior to implantation about future performance and outcomes of their child. This set of expectations has an important impact on post-implant satisfaction levels. The position of the parent in the household makes them uniquely placed to assess the impact of implantation in the context within which the child grows up. There is strong need to find out expectations of parents from CI outcomes in implanted children. The functional benefits of CI may be measured by administering the parental perception of CI benefits in their implanted wards. The primary aim of the study was to find out different expectations of CI outcomes in parents of CI users and the perception of CI outcomes in the parents of CI users. Secondary aim was to find out the most important concerns of parents towards their implanted children. Twenty families with a child implanted for duration of more than 2 years were selected for the study. Two questionnaires (1) Parent Expectations Questionnaire for Cochlear Implants (Nemours children clinic) and (2) Parents and their cochlear implanted child Questionnaire (O'Neill Int J Pediatr Otorhinolaryngol 68: 149-160 2004) were administered on these parents. Results were analyzed qualitatively. Parents expected their implanted children to use the telephone, to be able to detect soft sounds, to listen in crowds, to be able to easily understand others, and to show improvement in communication skills. The quality of speech, process of implantation, to take time off for the appointments at the implant centre and making decision to proceed with implantation were main concerns of the parents. Parents have a high expectation from their implanted children in all domains of life i.e. communication abilities, social and academic skills. Parents have high positive views about the outcomes of the CI. However there are areas which need attention for a positive outcome from the point of view of parents of implanted children.

Oropharyngeal exercises in the treatment of obstructive sleep apnoea: our experience.

INTRODUCTION: Oropharyngeal exercises are new, non-invasive, cost effective treatment modality for the treatment of mild to moderate obstructive sleep apnoea. It acts by increasing the tone of pharyngeal muscles, is more physiological, and effects are long lasting. AIM OF THE STUDY: The aim of our present study was to evaluate the effect of oropharyngeal exercises in the treatment of mild to moderate obstructive sleep apnoea. METHOD: Twenty patients of mild to moderate obstructive sleep apnoea syndrome (OSAS) were given oropharyngeal exercise therapy for 3 months divided into three phases in graded level of difficulty. Each exercise had to be repeated 10 times, 5 sets per day at their home. Oropharyngeal exercises were derived from speech-language pathology and included soft palate, tongue, and facial muscle exercises. Anthropometric measurements, snoring frequency, intensity, Epworth daytime sleepiness and Berlin sleep questionnaire, and full polysomnography were performed at baseline and at study conclusion. RESULTS: Body mass index (25.6 ± 3.1) did not change significantly at the end of the study period. There was significant reduction in the neck circumference (38.4 ± 1.3 to 37.8 ± 1.6) at the end of the study. Significant improvement was seen in symptoms of daytime sleepiness, witnessed apnoea, and snoring intensity. Significant improvement was also seen in sleep indices like minimum oxygen saturation, time duration of Sao2 < 90 %, sleep efficiency, arousal index, and total sleep time N3 stage of sleep at the end of study. CONCLUSION: Graded oropharyngeal exercise therapy increases the compliance and also reduces the severity of mild to moderate OSAS.

Deeper insertion of electrode array result in better rehabilitation outcomes - Do we have evidence?

OBJECTIVE: To study the outcome analysis in cochlear implantees in relation to depth of insertion. METHODS: 30 patients of non-syndromic congenital profound hearing loss in the age range of 2-12 years received cochlear implantation by a posterior tympanotomy round window approach. Depth of insertion was calculated using post-operative X-rays (modified Stenver's view) and categorized into four groups, viz. fair insertion (Group A <180°), good insertion (Group B 180-<270°), very good insertion(Group C 270-360°), excellent insertion (Group D >360°). The outcome analysis of each implantee was carried out in a follow up interval of every 3 months using Meaningful Auditory Integration Scale (MAIS), Infant Toddler Meaningful Auditory Integration Scale (IT-MAIS), Category of Auditory Performance (CAP), and Speech Intelligibility Rating (SIR). RESULTS: Overall 30, 29, 25, and 22 patients have completed 3, 6, 9, and 12 months follow up respectively. The MAIS scores in Group C were significantly better than Group B at 6, 9, and 12 months (P<0.05). The mean CAP score of Group C was more than rest of the groups with significant difference between Group C and Group D at 12 months (P<0.05). The mean SIR scores were maximum in Group C with significant difference between Group C and Group B at 9 and 12 months (P<0.05). CONCLUSION: The study demonstrates that insertion from 270° to 360° gives optimum hearing outcomes as compared to deeper insertion, although larger sample and long term follow-up is warranted for definite conclusions.

Communication outcomes following cochlear implantation in a child with cystic cochleovestibular anomaly.

Cochlear implantation is one of the best amongst the various management options available for children and adults with severe to profound sensorineural hearing loss. Inner ear and internal auditory canal (IAC) malformations accounts to approximately 25% of congenital sensorineural hearing loss in children. The primary goal of this report was to evaluate the communication outcomes after cochlear implantation in a child with cystic cochleovestibular anomaly (CCVA). The child was evaluated through various standardized outcome measures at regular intervals to track the progress in terms of auditory and spoken language skills. The scores on Categories of Auditory Perception (CAP), Meaningful Auditory Integration Scale (MAIS), Speech Intelligibility Rating (SIR), Meaningful Use of Speech Scale (MUSS), and listening and spoken language skills showed a significant leap in 12 months duration post implantation. The report thus highlights and correlates the significant progress in auditory and spoken language skills of the child with congenital malformations to appropriate auditory rehabilitation and intensive parental training.