ABSTRACT
In accordance with international consensus papers, auditory processing disorders (APD) are defined as disorders of central processes of hearing. Following the establishment of a commission of experts from the German Society for Phoniatrics and Pediatric Audiology, the existing S1 guideline was revised and updated. In this chapter, a position is taken on the clinical diagnostics of APD as well as on the delimitation of similar disorders.
Subject(s)
Audiology , Auditory Perceptual Disorders , Hearing/physiology , Practice Guidelines as Topic , Auditory Perception , Auditory Perceptual Disorders/diagnosis , Child , Hearing Tests , HumansABSTRACT
BACKGROUND: Stapedius muscle reflexes (SMR) are among the objective procedures which are used in the diagnostics of auditory processing disorders (APD). The significance of SRM for APD-diagnosis is open up to now. METHOD: Twenty-six children (8 - 10 years) with diagnosed APD and a control group of 17 children the same age were examined in order to determine whether differences with regard to the mean SMR (sine tones or band pass noise) exist between groups. In addition, differences between groups were investigated regarding the mean difference between the reflex thresholds for sine tones and the thresholds for band pass noises. RESULTS: Significant differences between groups existed in the mean value ipsilateral with 500 Hz, 1 kHz, 4 kHz and low bandpass noise as well as contralateral with 500 Hz. The contralateral measurements using sine tones (500 Hz, 1 kHz, 2 kHz and 4 kHz) showed reflex thresholds of about 100 dB only in the APD group. The results of the remaining types of stimulation showed a more or less distinctive area of overlap between the APD-group and the control group without the possibility of definite classification to a particular group. Group differences in the mean value with regard to the reflex thresholds for sine tones and the thresholds for band pass noises appeared only in low frequency stimuli. However, the area of overlap between the APD group and the control group in other frequencies was very large. CONCLUSION: Elevated thresholds measured in contralateral SMRs seem to support the assumption of APD. In contrast, the results of SMRs using ipsilateral measurements as well as low or high pass filtered noises contribute little toward diagnosing an APD. This applies identically to the difference between the reflex thresholds on sine tones and the thresholds on band-pass noises.
ABSTRACT
BACKGROUND: The diagnosis of APD (Auditory Perception Disorder) is a time consuming procedure. In Germany at the present, no screening test for APD exists which makes it possible to differentiate between children who are not likely to suffer from an APD and those who need to be diagnosed in detail. METHOD: The Munich Auditory Screening of Perception Disorders (MAUS) contains the following subtests: Series of Syllables, Words in Noise and Identification and Differentiation of Phonemes (test duration: 15 minutes). PATIENTS: The MAUS was standardized using 359 primary school children between 6 and 11 years of age. Furthermore, the MAUS was used in addition to the complete, extensive APD-diagnostics in testing 52 children (36 with APD and 16 without APD) within the age group mentioned. RESULTS: T-scores for each subtest were established by the standardization of the MAUS. The internal consistency of the test was sufficient. The intercorrelation between subtests was very slight. Therefore, each subtest seems to play an independent part in defining the construct of APD. Because of the results of the pilot study which formed the basis for the development of the screening instrument used, and because of the sensitivity scores reached in testing a group of 36 children with diagnosed APD, it can be expected that the MAUS will show a high sensitivity with regard to APD. CONCLUSION: Using the MAUS, it can be determined if and to what extent the test results of an individual deviate from those of the normal primary school population. The MAUS can identify children at risk of having an APD and can differentiate these children from those who are unlikely to suffer from an APD.
Subject(s)
Auditory Perceptual Disorders/diagnosis , Mass Screening , Auditory Perceptual Disorders/epidemiology , Auditory Perceptual Disorders/etiology , Child , Cross-Sectional Studies , Diagnosis, Differential , Female , Humans , Incidence , Male , Mass Screening/standards , Perceptual Masking , Phonetics , Reference Values , Semantics , Sensitivity and Specificity , Speech PerceptionABSTRACT
BACKGROUND: Due to the increased frequency of screening tests in new-born infants, the number of subsequent examinations of very young children has increased in the Departments of Phoniatrics and Pediatric Audiology. To exclude hearing loss in young children, click stimulated brainstem evoked response audiometry (BERA) and otoacoustic emission tests are, in general, considered to be reliable methods. However, pathologic BERA thresholds and pathologic hearing reactions have been observed occasionally in young infants who show improved and even normal hearing reactions in subjective and objective hearing tests after some months. PATIENTS AND RESULTS: Our group of 14 children (ten female, four male) was initially examined by BERA at the ages of 1-7 months. Twelve children had an elevated risk of hearing loss due to complications in the pre-, peri- and postnatal period. In the BERA, no deafness was diagnosed, but in all children at least monaural pathologic BERA thresholds were observed. Subjective hearing tests confirmed hearing loss. Objective and even subjective hearing reactions improved and normalised within a few months at least monaurally. CONCLUSION: In very young infants, the possibility of a delayed maturation of the auditory pathways must be considered when a hearing loss is diagnosed. Our examples prove that young children with sensorineural hearing loss need more than one objective hearing examination during the first year of life.
Subject(s)
Auditory Pathways/growth & development , Evoked Potentials, Auditory, Brain Stem/physiology , Hearing Loss, Sensorineural/congenital , Infant, Premature, Diseases/diagnosis , Neonatal Screening , Pregnancy Complications/diagnosis , Auditory Pathways/physiopathology , Auditory Threshold/physiology , Brain Stem/growth & development , Brain Stem/physiopathology , Female , Follow-Up Studies , Hearing Loss, Sensorineural/physiopathology , Humans , Infant , Infant, Newborn , Infant, Premature, Diseases/physiopathology , Male , Otoacoustic Emissions, Spontaneous/physiology , Pregnancy , Pregnancy Complications/physiopathology , Remission, SpontaneousABSTRACT
BACKGROUND: Neurinomas of the vestibulocochlear nerve unrelated to neurofibromatosis in children are extremely rare. Only 20 cases in children under the age of 16 are reported in the literature. Progressive unilateral hearing loss, tinnitus, vertigo and neurological deficits due to cranial nerve or brainstem compression are clinical signs. PATIENT AND RESULTS: We report on the case of a 12-years-old girl with an unilateral hearing loss, progressing to total deafness. Otoacoustic emissions were normal. In the MRI a large cerebellopontine angle tumor was found, identified as schwannoma of the vestibulocochlear nerve. CONCLUSIONS: The importance of MR Imaging in children with progressive unilateral hearing loss is demonstrated in this case.
Subject(s)
Deafness/etiology , Hearing Loss, Sensorineural/etiology , Neuroma, Acoustic/diagnosis , Brain Stem/pathology , Cerebellum/pathology , Child , Diagnosis, Differential , Disease Progression , Female , Hearing Tests , Humans , Image Enhancement , Magnetic Resonance ImagingABSTRACT
We report on two patients affected by Cogan's syndrome since infancy.Cogan's syndrome is described as the association of abrupt or intermittent worsening of vestibulo-auditory function and non-syphilic interstitial keratitis or, in patients with "atypical" Cogan's syndrome, various severe, inflammatory eye diseases. The first patient was affected with different inflammatory eye diseases from her fifth year and became blind in one eye when she was 7 years old. At that time, a deterioration of her hearing ability was also diagnosed. The hearing loss progressed to a severe hearing disorder. The second patient suffered from different inflammatory eye diseases from his second year. When he was 3 years old,he was diagnosed with a severe hearing disorder that progressed.Cogan's syndrome was diagnosed when he was 13 years old. The recognition of Cogan's syndrome is particularly complex in young patients. The difficulty of the diagnosis requires a search for ophthalmic diseases in young children with acute and progressive vestibulo-auditory symptoms.
Subject(s)
Acanthamoeba Keratitis/diagnosis , Autoimmune Diseases/diagnosis , Hearing Loss, Sensorineural/diagnosis , Acanthamoeba Keratitis/drug therapy , Adolescent , Adult , Autoimmune Diseases/drug therapy , Blindness/diagnosis , Blindness/drug therapy , Brain Diseases/complications , Brain Diseases/diagnosis , Child , Child, Preschool , Disease Progression , Eye Diseases/diagnosis , Eye Diseases/drug therapy , Female , Follow-Up Studies , Hearing Loss, Sensorineural/drug therapy , Humans , Immunosuppressive Agents/therapeutic use , Intellectual Disability/diagnosis , Intellectual Disability/drug therapy , Male , Meniere Disease/diagnosis , Meniere Disease/drug therapy , Occipital Lobe/pathology , Parietal Lobe/pathology , SyndromeABSTRACT
We report on two patients affected by Cogan's syndrome since infancy.Cogan's syndrome is described as the association of abrupt or intermittent worsening of vestibulo-auditory function and non-syphilic interstitial keratitis or, in patients with "atypical" Cogan's syndrome, various severe, inflammatory eye diseases.The first patient was affected with different inflammatory eye diseases from her fifth year and became blind in one eye when she was 7 years old.At that time, a deterioration of her hearing ability was also diagnosed. The hearing loss progressed to a severe hearing disorder.The second patient suffered from different inflammatory eye diseases from his second year.When he was 3 years old,he was diagnosed with a severe hearing disorder that progressed.Cogan's syndrome was diagnosed when he was 13 years old.The recognition of Cogan's syndrome is particularly complex in young patients.The difficulty of the diagnosis requires a search for ophthalmic diseases in young children with acute and progressive vestibulo-auditory symptoms.
ABSTRACT
The number of patients with chronic dysphagia is increasing as more patients with neurologic diseases and carcinomas of the head and neck can be successfully treated and survive. The expert assessment of a dysphagia should be based not only on anamnestic data, as proposed by the German guidelines "Anhaltspunkte für die ärztliche Gutachtertätigkeit im sozialen Entschädigungsrecht und nach dem Schwerbehindertengesetz," but also on clinical, endoscopic, and radiologic examinations. Modern procedures of treatment enable us to prevent aspiration or insufficient nutrition; nevertheless, dysphagia causes severe limitations for the patients.
Subject(s)
Deglutition Disorders/diagnosis , Disability Evaluation , Expert Testimony/legislation & jurisprudence , Chronic Disease , Deglutition Disorders/etiology , Deglutition Disorders/rehabilitation , Eligibility Determination/legislation & jurisprudence , Germany , Humans , Rehabilitation, Vocational , Social Security/legislation & jurisprudenceABSTRACT
BACKGROUND AND PURPOSE: Although dysarthria is a frequent symptom in cerebral ischemia, there is little information on its anatomic specificity, spectrum of associated clinical characteristics, and etiologic mechanisms. METHODS: An investigation of 68 consecutive patients with sudden onset of dysarthria due to a single infarction confirmed by MRI or CT was conducted. RESULTS: Dysarthria was associated with a classic lacunar stroke syndrome in 52.9% of patients. Isolated dysarthria and dysarthria-central facial and lingual paresis occurred in 2.9% (n = 2) and 10.3% (n = 7), respectively. Dysarthria-clumsy hand syndrome was observed in 11.7% (n = 8) of patients and associated with pure motor hemiparesis and/or ataxic hemiparesis in 27.9% (n = 19). The lesions were due to small-vessel disease in 52.9% (n = 36), to cardioembolism in 11.8% (n = 8), and to large-vessel disease in only 4.4% (n = 3) of cases. Infarctions were located in the lower part of the primary motor cortex (5.9%; n = 4), middle part of the centrum semiovale (23.5%; n = 16), genu and ventral part of the dorsal segment of the internal capsule (8.8%; n = 6), cerebral peduncle (1.5%; n = 1), base of the pons (30.9%; n = 21), and ventral pontomedullary junction (1.5%; n = 1). Isolated cerebellar infarctions affected the rostral paravermal region in the superior cerebellar artery territory. CONCLUSIONS: Extracerebellar infarcts causing dysarthria were located in all patients along the course of the pyramidal tract. This finding correlates with the frequent occurrence of associated pyramidal tract signs in 90.7% (n = 62) of patients. Isolated cerebellar infarcts leading to dysarthria were in all cases located in the territory of the superior cerebellar artery.
