ABSTRACT
BACKGROUND: The audiological treatment of children with aural atresia makes high demands on physicians and acousticians. Conventional hearing systems are often not tolerated by children and therefore do not meet the needs of the early and efficient therapy of hearing disorders. Aim of the present study was the evaluation of the audiological functional gain in children with uni- and bilateral aural atresia provided with the middle ear implant Vibrant Soundbridge(®) (VSB(®)) below the age of 6 years as well as the analysis of parents' satisfaction assessed with questionnaires. MATERIAL AND METHODS: The VSB(®) was implanted in 16 children, 13 with unilateral and 3 with bilateral aural atresia, with the mean age of 2;11±1;6 years. 3 months after the first fitting of the audio processor, pure-tone audiometry via free field testing with and without the hearing system was performed. Furthermore, parents completed a standardized questionnaire to evaluate their satisfaction with the VSB(®) treatment quality. The questionnaire included items on the acceptance by children, handling, listening effort, behavior, satisfaction, quality of life, aesthetics, and the length of daily use. RESULTS: The use of the VSB(®) resulted in a significantly improved hearing level: 20 dB on average (Z=- 3.06; p=0.002; n=12). The analysis of parents' questionnaire demonstrated high or very high satisfaction with VSB(®) in all subjects. Primarily, the length of daily use of the VSB(®) was significantly higher than that of the hearing system used before with 10.0±2.1 vs. 2.7±2.2 h per day (Z=- 3.06; p=0.002; n=14). CONCLUSION: The VSB(®) presented a good alternative for audiological treatment of uni- and bilateral aural atresia at toddler and pre-school age.
Subject(s)
Hearing Loss, Conductive , Ossicular Prosthesis , Quality of Life , Audiometry, Pure-Tone , Child, Preschool , Ear , Hearing Aids , Humans , Infant , Treatment OutcomeABSTRACT
BACKGROUND: The Penetration-Aspiration Scale was developed by Rosenbek et al. to enable standardized documentation of this cardinal symptom of a swallowing disorder. OBJECTIVES: The objective was to create and validate a German version of the Penetration-Aspiration Scale according to the guidelines governing the translation of foreign language measurement tools. MATERIALS AND METHODS: Both reliability and validity were examined based on the ratings of 80 randomized endoscopically evaluated swallows, 10 for each severity level. Ratings were carried out by four independent raters: two with more than 3 years' experience with dysphagia and a further two with less than 3 years' experience. The swallows were rerated after 4 weeks. RESULTS: Both intrarater (Kendall's Tau: τs > 0.643; median 0.773; ps < 0.001) and interrater reliability were highly significant (two-way mixed single ICC coefficient of 0.799 for the first rating session and 0.728 for the second session; ps < 0.001). Results from the raters with less than 3 years' experience were significantly different from the reference standard in three out of four cases, whereas this was not the case for the more experienced raters. However, for each film, the median of the individual ratings from all four raters correlated almost perfectly with the reference standard (first rating session: τ = 0.894; second rating session: τ = 0.843; ps < 0.001). CONCLUSION: The German version of the Penetration-Aspiration Scale according to Rosenbek presented here was demonstrated to be both reliable and valid. Despite its dependency on the raters' experience, it can therefore be used as a graduation instrument for swallowing disorders in German-speaking countries and make an important contribution to evidence-based medicine in dysphagiology for both clinical and scientific use.
Subject(s)
Algorithms , Deglutition Disorders/classification , Deglutition Disorders/pathology , Esophagoscopy/methods , Severity of Illness Index , Visual Analog Scale , Adult , Aged , Female , Germany , Humans , Male , Middle Aged , Observer Variation , Reproducibility of Results , Sensitivity and SpecificityABSTRACT
INTRODUCTION: Despite its potential complications, partial aponeurectomy still is the mainstay of treatment whenever it comes to significant contracture in Dupuytren's disease. With the goal in mind to identify new therapeutic strategies we isolated and characterised cells from healthy palmar aponeurosis (Kon) and compared them to cells isolated from palmar aponeurosis of patients with a primary manifestation of Dupuytren's disease (PrimDup) as well as from patients with recurrent Dupuytren's disease (RezDup). As cells from palmar aponeurosis from patients with Dupuytren's disease share characteristics with stem cells, such as the ability to differentiate into other cell types, we analysed the stemness, morphology and integrin receptor profiles of the cells. MATERIALS AND METHODS: A total of 15 Dupuytren samples were collected from regular partial aponeurectomy procedures. From these, 3 donors without extrinsic risk factors were selected per group (RezDup, PrimDup). Cells were isolated and expanded under standard cell culture conditions. Cells from healthy patients served as control (Kon). Growth curves were produced. Cells were subjected to osteogenic and adipogenic differentiation using standard protocols. Semiquantitative PCR analysis of the integrins α2, ß3, ß5 and fibronectin was performed. RESULTS: PrimDup cells proliferated significantly faster than control cells, which in turn proliferated faster than RezDup cells. Both PrimDup and control cells went into senescence after approximately 40 days whereas RezDup cells proliferated over the entire period of 100 days. Osteogenic and adipogenic differentiation was best in cells derived from Dupuytren patients while Kon cells differentiated poorly. PCR analysis revealed that fibronectin-binding integrins ß3 and ß5 are upregulated in Dupuytren's disease. CONCLUSIONS: PrimDup cells grow faster than the other cell types suggesting that their growth regulation may be altered. The fact that RezDup cells do not reach senescence over 100 days in culture indicates that senescence regulating factors may be altered. As cells from Dupuytren patients differentiate better along the osteogenic and adipogenic lineages, they probably possess a higher level of stemness. Their modified integrin profile may be a key to future therapies.
