Tapia syndrome caused by a vertebral artery dissection.

A 63-year-old man presented to our otorhinolaryngology department with hoarseness and neck pain of 3 weeks' duration. After a thorough workup, we established a diagnosis of Tapia syndrome secondary to a vertebral artery dissection. We review the literature and discuss the clinical presentation of this rare syndrome.

The integration experience of hearing impaired elementary school students in separated and integrated school settings.

Integration experiences of hearing impaired German elementary school students in separate educational settings (n = 31) were compared with those of counterparts at the same level in integrated settings (n = 26), and evaluated in regard to psychosocial behavior, semantic-lexical abilities, and communicative skills. Analysis of questionnaire responses and intelligence subtests showed that the only difference between the samples concerned perceived well-being in school, and favored the integrated students. Other percentages of variance are explainable by school type (10%), parents' hearing status (12%), and use of bimodal communication (11%). The integrated students demonstrated a higher level of integration experience, associated with fewer psychosocial abnormalities and better communicative skills. The results indicate that educational setting is not the only factor influencing students' perceived well-being. Other contextual factors, e.g., hearing status of parents and communicative skills, have a similar positive impact on integration experiences

Psychic stress and quality of life in parents during decisive phases in the therapy of their hearing-impaired children.

OBJECTIVE: This study was performed to analyze psychic stress and quality of life in the parents of children with hearing impairment in the course of various phases of treatment. DESIGN: At three measuring points over a course of 12 months, the degree of parental stress and the quality of life was surveyed prospectively. In addition, the children's hearing and speech status was surveyed. Parents whose children were treated with hearing aids or cochlear implants were the target of this survey. At the outset of the study, data of 123 parents were available. The average age of the children was 38 months. RESULTS: It was not possible to demonstrate generally heightened psychic stress in any phase of treatment. Differentiation into subgroups must be performed, as parental stress depends on possible changes of treatment and the child's speech status. Initially, quality of life was clearly reduced but gradually became statistically insignificant. CONCLUSIONS: The results point out the necessity of supporting the parents with counseling and psychosocial support, especially in the initial fitting phase and in the various decision and orientation phases.

Parental distress: the initial phase of hearing aid and cochlear implant fitting.

The results of previous cross-section studies suggest that childhood hearing impairment may lead to parental psychosocial stress. The present study investigated whether modifications in parental psychic state can be ascertained in connection with the child's treatment events and the child's hearing and speech status, in a prospective study design. Data were available on 116 fathers and mothers regarding the pre-cochlear implant examination or hearing aid fitting of their child. In the course of the child's treatment, parental quality of life improved from a low to a normal level. Among children who were at the stage of pre-examination for a cochlear implant, better hearing and speech capacity was linked to more severe impairment of the parental state. It is emphasized that the parents whose children showed comparatively good language development at the time of pre-examination for a cochlear implant were especially subjected to stress.

A comparison between parents of children with cochlear implants and parents of children with hearing aids regarding parental distress and treatment expectations.

OBJECTIVE: The aim of the present study was to compare the parents of children with a hearing aid (HA) and children with a cochlear implant (CI) regarding their psychological distress, their expectations from treatment, their family climate, and the way they first obtained information on HA/CI. METHODS: 154 parents (return quota 41%; 81 mothers and 73 fathers) of 90 children with a HA and 103 parents (return quota 59%; 57 mothers and 46 fathers) of 57 children with a CI were interviewed by means of a questionnaire. RESULTS: Both groups of parents felt distressed, particularly at the time of diagnosis. Their psychological well-being was gradually stabilized in the further course of rehabilitation. Due to the operation associated with it, fitting with a CI brought on a phase of heightened parental psychological distress compared with less invasive treatment with a HA. Regarding family climate, more distress was found in parents of CI children than in parents of HA children. Expectations from therapy appeared realistic in both parental groups; however, after CI fitting, the parents of the CI children showed heightened expectations by comparison with the parents of the HA children. CONCLUSIONS: The results of our study suggest that the parents of hearing impaired children fitted with a HA or a CI may be divided into two subgroups with divergent psychosocial parameters. For the counseling of the parents of hearing impaired children in clinical practice, it would seem important to take these specific differences into consideration.

Receptive and expressive language skills of 106 children with a minimum of 2 years' experience in hearing with a cochlear implant.

OBJECTIVE: The aim of the study was to assess the speech development of children with at least 2 years' hearing experience with a cochlear implant (CI). METHODS: One hundred and six children were tested, all of whom had used the CI for at least 2 years. Receptive and expressive language development were tested using the scales of early communication skills for hearing-impaired children after Geers and Moog and the Reynell developmental language scales III. In addition, free-field audiometry was performed. Pre-postoperative measurements were compared statistically, and a linear regression analysis was carried out. RESULTS: Clear improvements in the gain in functional hearing 2 years after receiving the CI as well as clear improvements in both speech perception and speech production were ascertained. All deviations were statistically highly significant (P<0.000). The receptive and expressive speech test results correlate positively to a great extent. The results of logistic regressive analysis indicate that the speech production measured depends decisively on age at implantation, age at time of test, speech production before implantation, and additional handicaps. CONCLUSION: Based on the conception of the WHO, a statistically significant improvement of both impairment and disability can be confirmed. In the present study, the regression analysis established the age at implantation as the most important prognostic factor. While the percentage of children with good speech development is larger with early implanted children than with late implanted children, some of the children among the early implanted group show unsatisfactory speech development of unknown origin. Improvements in speech development are likely to be achieved when more children are diagnosed and implanted early. This finding urgently requires the introduction of a general newborn screening program. Thorough anamnesis and assessment during parent counseling of the manifold factors described are a prerequisite for the precise estimation of the difficulties to be met and the expected effectiveness of the implant in each individual case.

Harmful substances on the opera stage: possible negative effects on singers' respiratory tracts.

Objective, quantitative information is lacking in the medical community about actual working conditions for professional singers onstage, and moreover, about which conditions are safe. Physicians, speech-language pathologists, and speech scientists focusing on laryngology should have relevant information about the opera as workplace and the medical sequelae of unhealthy environments. We describe five toxic substances to which singers presenting to our clinics were exposed while working professionally on the opera stage: (1) aromatic diisocyanates, (2) penicillium frequentans in cork granulate, (3) formaldehyde in cork granulate, (4) cobalt and aluminum (pigment components), and (5) quartz sand capable of entering the alveolae. Biological considerations and clinical data for some subjects suggest a direct causal link between the exposures and the patients' complaints and findings. Our observations suggest that whenever singers complain about deleterious conditions such as dry and hot onstage climate or suspicion of the presence of harmful substances, the specific conditions existing in the theater in question should be investigated. Harmful substances are not only poorly tolerated by singers, but also they should be preventable.