[Development of a grading scale for the Sino-Nasal Outcome Test-20 German Adapted Version (SNOT-20 GAV)]. / Entwicklung einer Bewertungsskala für den Sino-Nasal Outcome Test-20 German Adapted Version (SNOT-20 GAV).

INTRODUCTION: Quality of life measurements with the Sino-Nasal Outcome Test-20 German Adapted Version (SNOT-20 GAV) in chronic rhinosinusitis (CRS) patients require normative values measured in a comparison group taken from the normal population. These will make it possible to reach conclusions on correlations between scores and severity of symptoms and also on how close such patients' scores can get to those scores recorded in healthy subjects after surgical treatment. PATIENTS AND METHODS: We collected SNOT-20 GAV data and data on the presence of CRS from 778 subjects via a web-based survey of employees of the University Hospital in Heidelberg. For comparison we used data collected before surgery and at 3 months and 1 year after surgery from 163 CRS patients who had undergone endonasal sinus surgery (ESS). RESULTS: Gender and age had no clinically significant impact on the SNOT-20 GAV scores. We defined an assessment scale with four classes of symptom intensity. Surgically treated patients with CRS showed a persisting small disadvantage in the scales of the SNOT-20 GAV compared with the reference subgroup without CRS. When surgically treated CRS patients were compared with the entire reference group these disadvantages were only obvious in the Primary Nasal Symptoms (PNS) scale and not in the other scales measuring quality of life. CONCLUSION: Patients with CRS benefit from ESS and subsequently reach scores similar to those recorded in the reference group. The newly developed four-level assessment scale is easy to use and gives the attending physician additional information about the severity of the patients' illness and its effects on their subjective wellbeing.

[The influence of the Tübingen soft palate plate and early cleft closure on swallowing and Eustachian tube function in children with Pierre Robin sequence]. / Früher Gaumenspaltverschluss und Tübinger Atmungsgaumenplatte : Mögliche Einflüsse auf die Tubenfunktion bei der Pierre-Robin-Sequenz.

CURRENT KNOWLEDGE: Children with Pierre Robin sequence (PRS) typically have difficulty with bolus transport and swallowing. Due to velopharyngeal insufficiency caused by the cleft palate, a high percentage of the children affected also have impaired Eustachian tube function. AIMS OF THE STUDY: In the literature, substantial information may be obtained on conductive hearing loss in PRS patients; however, no study has yet been performed to investigate whether wearing a soft palate plate and relatively early surgical cleft palate closure positively influence Eustachian tube function. In the present study this question was investigated. METHODS AND RESULTS: A total of 41 PRS children, 27 girls and 14 boys, were included in the study and were examined for hearing ability prior to and after surgical cleft palate closure. All of the children had been wearing a Tübingen soft palate plate until surgical cleft palate closure, which occurred at an age of 3-13 months (mean age 7.3 months). Based on data obtained prior to surgery by BERA, otoacoustic emissions and tympanometry, a hearing loss of more than 30 dB was diagnosed in 68.4% of the children. After 3-6 months, normal hearing ability was found in 70%. CONCLUSIONS: Wearing the Tübingen soft palate plate, and the improved swallowing function resulting from this, as well as early surgical cleft palate closure had a very positive impact on the hearing ability of the children included in the study.

[Quality control of audiologic results in a university phoniatric/pediatric institution. An example of expert assessment of occupational noise induced hearing loss]. / Qualitätskontrolle audiologischer Befunde einer universitären phoniatrisch/pädaudiologischen Einrichtung. Am Beispiel der Begutachtung der beruflichen Lärmschwerhörigkeit.

AIM: An investigation was made to reveal whether suspicion of occupational hearing loss can be satisfactorily determined by an otolaryngologist or workplace audiological measurement. These were compared with a formal audiometrical assessment at a university clinic. METHODS AND RESULTS: A retrospective study was made of 95 cases of noise induced hearing loss. A total of 78 individuals were investigated by an otolaryngologist and 70 by workplace audiometry. Using workplace audiometry, 27% of the tests showed a reduction in working capacity of at least 20%. In only five of these was a specialist opinion sought within a year. In 50%, this took longer than 5 years. A comparison of audiometric data from expert opinion revealed that there was conformity in only 47% with workplace audiometry and 48% with otolaryngologist testing. In some cases (27% workplace and 33% ENT practice), the measured hearing loss and calculation of disability exceeded that determined by the experts. CONCLUSIONS: The results of workplace audiometry demonstrated that hearing loss was frequently reported only after the workers had received a disability of at least 20%. Possible reasons for discrepancies in audiological testing might be the exaggeration of hearing loss by the worker, insufficient recovery time after noise exposure, or inexperienced audiologists. Our data show that audiometric testing in workplace audiometry, as well as in ENT practice, often reveal a higher disability rating compared to formal audiological (university) assessment, even if these discrepancies do not reach statistical significance.

[Factors influencing rehabilitation of sensorineural hearing loss with hearing aids]. / Einflussfaktoren auf die Rehabilitation der Innenohrschwerhörigkeit mit Hörgeräten.

BACKGROUND: A large proportion of older as well as younger patients do not use their hearing aids. Of the younger hearing impaired population, this occurs in the majority of those who do not benefit sufficiently from their hearing aids and, consequently, they face difficulties in their working and social life. SCIENTIFIC QUESTION: Our aim was to evaluate whether a classical hearing aid adjustment is of sufficient predictive value to determine whether adequate rehabilitation in everyday and professional life will occur. METHODS AND RESULTS: A questionnaire was returned by 197 adult hearing impaired patients. Only 108 were using their hearing aids all the time; 57 rarely and 32 never. The main reason for this low rehabilitation rate proved to be inadequate amplification. At the workplace, insufficient speech discrimination came into play. Another important factor was dysacusis induced by specific noise signals. There was an intolerable acoustic feedback in 40% which could not be sufficiently alleviated. Taking these results into account, only about a third of patients were sufficiently rehabilitated. CONCLUSIONS: Proof of effectiveness in a typical audiological testing situation is an important but not a fully reliable predictor for effectiveness in everyday life. Even when hearing aids are shown to be effective with such testing, their application in particular everyday or work situations may be insufficient of even impossible.

[Assessment of the Dichotic Listening Test by Feldmann in children with developmental reading and spelling disorders]. / Der dichotische Diskriminationstest von Feldmann in der Diagnostik von Kindern mit Lese- und Rechtschreibstörungen.

In Germany the dD by Feldmann is a frequently used test in child assessment. Unknown, however, is the validity of the dD in the assessment of children with specific developmental language disorders. The dD by Feldmann are pairs of three-syllable content words which are presented dichotically. In this controlled cross-sectional study 65 children took the dichotic listening test by Feldmann (dD). The experimental group comprised 34 children with developmental reading and spelling disorders. The control group comprised 31 children with normal reading and spelling development. Age and nonverbal IQ were matched in both groups. The mean age was 9.8 years (range 7 - 11 years). The dichotic listening performance of right and left ear was registered separately. Twenty word pairs were presented dichotically at a constant amplitude of 65 dB. Memorisation of word pairs was tested under free recall conditions. A score of 100 % can be attained, if all word pairs are repeated correctly. Results demonstrated that no child attained a score of 100 %. As expected, the children with the developmental reading and spelling disorders attained significantly lower scores than the children in the control group (42.4 % versus 64 %). The reason for the lower results in the experimental group was left ear dichotic listening performance. There were no significant differences in right dichotic listening performance. Raw score overlaps occurred to some extent in both groups, but scores of 30 % or less were only observed in the experimental group. Scores correlated significantly with age, but not with nonverbal IQ. However, dD performance significantly correlated with several measures of phonological and syntactic language development as well as with auditory working memory. Based on these results it is our opinion that performance scores of the dD by Feldmann should be interpreted cautiously until validation studies have been carried out.

[Significance of parental variables on early detection of pediatric hearing loss. Results of a retrospective survey of parents with hearing-impaired children]. / Der Einfluss von Elternmerkmalen auf die Früherkennung von kindlichen Hörstörungen. Ergebnisse einer retrospektiven Befragung von Eltern hörgeschädigter Kinder.

Despite significant improvements in early detection of hearing losses in children, a relatively long interval still exists from initial concern by families to definite audiological identification. The aim of our retrospective cross-sectional study was to identify parental factors contributing to the delay of early detection. The parents of 70 hearing-impaired children were interviewed. All children were fitted with hearing aids in our clinical and had no additional physical or cognitive disabilities. At an average age of 19.5 months, parents or family doctors noticed first signs of a possible hearing impairment. On average it then took an additional 7.2 months until hearing impairment was diagnosed by an expert and the necessary first steps taken for rehabilitation (fitting of hearing aids). Significantly, total hearing loss or profound hearing impairments were detected earlier than mild or moderate hearing impairments. In addition to hearing loss, parental education correlated significantly with an earlier start of rehabilitation. Statistical analysis revealed that children with hearing-impaired close relatives as well as first-born children tended to be diagnosed later. To further improve secondary prevention of hearing loss, the competence of specific parental groups should be taken into consideration.

[Recording otoacoustic emissions in expert evaluation of chronic noise-induced hearing loss]. / Die Ableitung otoakustischer Emissionen bei der Begutachtung der chronischen Lärmschwerhörigkeit.

In order to assess occupational hearing loss, damage to outer hair cell function must be demonstrated. Measurements of transiently evoked otoacoustic emissions (TEOAE) and distortion products (DPOAE) allow clinicians to investigate objectively the cochlear amplification process. In this prospective study, 50 persons with suspected occupational hearing losses were tested with pure-tone and speech audiometry. Additionally, TEOAE and DPAOE were determined. Significant linear correlations were observed when comparing hearing thresholds and speech discriminations with evoked emissions. Three groups were formed based on the OAE results: group A, TEOAE- and DPOAE-positive; group B, TEOAE-negative, DPOAE positive; group C, TEOAE- and DPOAE-negative. The groups were compared with regard to the weighted and simple discrimination scores and percentage of hearing loss computed according to the Boenninghaus-Röser tables. Analysis of variance showed significant differences in hearing losses among the three groups, allowing an objective statement to be made about the degree of work compromise: group A, < 10%; group B, 10-15% group C, > or = 20%.

[Improvement of communication behavior of laryngectomized and voice-rehabilitated patients by a psychological training program]. / Verbesserung des Kommunikationsverhaltens stimmrehabilitierter Laryngektomierter durch ein psychologisches Trainingsprogramm.

An important goal of laryngectomee rehabilitation is achieving the best possible result in voice restoration. In addition to good voice quality, efficient intelligibility in daily conversation requires specific communication skills, which are very often neglected in speech therapy. In this study 51 male laryngectomees were randomized to an intervention group or an attention control group. After hospital discharge the intervention group participated in a psychological training program aimed at improving the communication behavior of the laryngectomees. This training was part of a comprehensive rehabilitation program (lasting over six months) and consisted of four modules: Improvement of communication over the disability; Discrimination of factors affecting intelligibility; Development of behavioral strategies for improving intelligibility in daily conversation; Transferring the strategies to daily live. The effectiveness of training was evaluated by a questionnaire which covered three important aspects of communication behavior. As a result of the intervention the patients influenced more effectively their own communication behavior and also influenced more adequately the behavior of typical communication partners. Present finding with the psychological training program demonstrated that the communication behavior of laryngectomees can be significantly improved.

[Subjective attitudes of laryngectomized patients of the cause of the tumor disease. Correlation with psychosocial adjustment and pre- and postoperative alcohol and tobacco consumption]. / Subjektive Vorstellungen von Laryngektomierten über die Ursachen ihrer Tumorerkrankung. Zusammenhang mit der psychosozialen Anpassung sowie dem prä- und postoperativen Alkohol- und Tabakkonsum.

One or two days before operation 62 male patients with laryngeal or pharyngeal malignancies were questioned about their subjective beliefs concerning the causes of their cancer. Additionally they were asked about their current and past tobacco and alcohol consumption. Six months after the operation 51 of the 62 patients were interviewed about their psychosocial adjustment and their postoperative tobacco and alcohol consumption. Before the operation most of the patients (81%) reported that they already had been thinking about the possible causes of their malignant disease. Four out of five patients were smokers and consumed alcohol daily, at least until disease onset. According to psychiatric criteria more than 50% of the daily alcohol consumers were diagnosed as alcoholics. As was expected, "smoking" was rated as the most important causal factor in tumor etiology. Furthermore, "air pollution", "unhealthy working conditions" and "fate" were rated as important pathogenic factors of the individual cancer. Surprisingly "alcohol" was only rated as an important causal factor by a few patients. The causal factor "smoking" was correlated neither with actual pre- and postoperative smoking behavior, nor with postoperative psychosocial adjustment. "Alcohol" was positively associated with a postoperative reduction of alcohol consumption, on the one hand, and with increased postoperative psychological distress, on the other. Significant positive relationships were also found between "fate" and postoperative psychological distress and rejection of altered voice (e.g. laryngectomy). In conclusion, medical information about the possible causes of cancer should try to focus the attention of the patients on current and future stress factors and not on past risk behavior (e.g. alcohol and tobacco consumption), which cannot be altered retrospectively.(ABSTRACT TRUNCATED AT 250 WORDS)

[Voice rehabilitation after laryngectomy with voice prostheses. Results of a prospective follow-up study]. / Stimmrehabilitation nach Laryngektomie mit Stimmprothesen. Ergebnisse einer prospektiven Verlaufsuntersuchung.

Although the results of surgical rehabilitation by means of voice prostheses are on the average better than rehabilitation via oesophageal speech, the tracheoesophageal puncture (TEP)-technique has so far not been widely used in Germany. The majority of hospitals still prefer the "traditional" method of voice rehabilitation using oesophageal speech. The present prospective study was undertaken to compare the results of postlaryngectomy vocal rehabilitation, if patients were offered the surgical voice rehabilitation via voice prosthesis as an alternative to oesophageal speech. Taking into account all the patients who underwent laryngectomy from 1989 until 1990 in Tübingen, primary surgical voice rehabilitation was performed in 44 out of 54 patients (81.5%). Interestingly enough, 34 patients who underwent laryngectomy were able to perform communication via the telephone on the day of their discharge. Moreover, one-third of the laryngectomised patients showed a significant increase in speech intelligibility within the first six months after laryngectomy. 36 patients with laryngectomy were able to attain proficiency 6 months after surgery. In 12 patients the prosthesis had to be removed, since either phonation was impossible or patients successfully learned and preferred oesophageal speech. In conclusion, independent of the method of voice rehabilitation (prosthesis, electrolarynx, oesophageal speech), our results support the hypothesis that a voice rehabilitation regimen will yield a higher rehabilitation rate of patients if rehabilitation via surgical voice is offered as an alternative to learning the oesophageal voice. Therefore, it seems to be advisable that patients are allowed to have the choice between surgical rehabilitation and oesophageal speech restoration.(ABSTRACT TRUNCATED AT 250 WORDS)

[Speech intelligibility and psychosocial adaptation in various voice rehabilitation methods following laryngectomy]. / Sprachverständlichkeit und psychosoziale Anpassung bei verschiedenen Stimmrehabilitationsmethoden nach Laryngektomie.

Intelligibility and psychosocial adjustment are measured by the PLTT (Post-Laryngectomy-Telephone-Test) and a newly developed questionnaire (FPAL). 110 male patients with total or partial laryngectomies are tested. Three different groups are compared with each other: laryngectomees with voice prostheses, laryngectomees with oesophageal voice or artificial larynx, and patients with partial laryngectomies. As was to be expected, intelligibility (single words and sentences) was best in patients with partial laryngectomies. The intelligibility of the laryngectomees with voice prostheses is significantly higher than the intelligibility of patients with oesophageal voice or artificial larynx. There was no difference between the groups with regard to the subjective assessment of intelligibility in relation to various communication partners. Partial laryngectomies have the lowest negative impact on the social and psychological situation of the patients. Laryngectomees, however, are more lonely, indicate more psychological stress in social interactions, and have a less positive evaluation of their life. Statistical analyses reveal no difference in psychosocial adjustment between laryngectomees with voice prostheses, oesophageal voice and artificial larynges.

[Anxiety and coping with anxiety in patients with head and neck cancers]. / Angst und Angstbewältigung bei Patienten mit einem Karzinom im Kopf-/Halsbereich.

In addition to their oncological symptoms, 82% of head and neck cancer patients showed anxiety. A high level of anxiety was found in 14% of the patients before surgery and 16% of the patients after surgery. In order to achieve a comprehensive treatment, it is very important to have some basic knowledge of conditions causing anxiety, reaction to anxiety, coping with anxiety, and anxiety-reinforcing conditions. In a longitudinal study of 50 men undergoing surgery for head and neck carcinoma, the subjective level of anxiety before and after surgery and the coping strategies were evaluated by a valid and reliable psychological method. The coping strategies "giving up" and "intake of medication, alcohol and nicotine" were positively correlated with higher levels of anxiety and anxiety reinforcement. The objective level of threat of surgery, such as the extent of impairment imposed by the operation or the individual prognosis, was not correlated with the subjective level of anxiety. It is possible for even minor diagnostic procedures to induce high anxiety. Talking to the patient about the outcome of investigations and the treatment is not enough to reduce anxiety. It is necessary to enhance the patient's feeling of personal control through continual contact with the doctor. A therapeutic approach for anxiety intervention which can be used by the physician is recommended. This intervention strengthens the level of the individual's self-control and reduces his anxiety-reinforcing behaviour, such as compulsive thinking, alcohol and nicotine use and social withdrawal.

[Subjective and objective voice assessment following partial resection of the larynx]. / Subjektive und objektive Stimmevaluation nach Kehlkopfteilresektion.

There is no generally accepted, standardized approach for evaluation of voice quality and of intelligibility after partial laryngectomy. A voice evaluation which considers some aspects of voice quality is possible by assessing physical and acoustic voice parameters. But this approach does not consider how the patient subjectively assesses his postoperatively altered voice and how the patient believes he is understood by various communication partners. In this study objective and subjective variables of the voice quality of 32 patients with partial laryngectomies were measured. First, selected physical and acoustic variables of voice quality were quantified. Second, subjective criteria of voice quality and of intelligibility were assessed by a questionnaire. A significant correlation between variables of objective and subjective voice quality was found. The maximum vocal intensity, the maximum pitch, and the intensity range correlated significantly with the subjective assessment of intelligibility. No relationship was found between the acoustic variables and the subjectively perceived degree of vocal disability.