Evaluation of quality of life in patients after cochlear implantation surgery in 2014-2017.

INTRODUCTION: Profound hearing loss significantly affects the quality of life of deaf people as well as their families. Observation of the benefit from the use of cochlear implants in deaf patients allows to assess the success of treatment with this method and its impact on the quality of life of these patients. The aim of this study was to determine the quality of life in patient after the cochlear implantation in the material of Department of Phoniatrics and Audiology of the Medical University in Poznan. MATERIAL AND METHODS: The study involved implanted patients who voluntarily joined to the project entitled "Observational study of the implanted patient (Cochlear-IROS)". It has a prospective character, it is an international and long-term study, covering the observation of patients up to three years after implantation. Standardized HUI and SSQ questionnaires were used. 70 patients were included in the analysis, the mean age at the time of the cochlear implantation was 47.6 years. In the research group there were 33 men and 37 women. In the whole group, the patients' age at implantation was at least 18 years, max. 80 years. RESULTS: The results of the SSQ questionnaire, which deals with the self-assessment of hearing ability in everyday situations, indicate that in the subjective assessment of patients one year after surgery the speech hearing improved by 77%, spatial hearing by 84%, and the quality of hearing by 49%. The general quality of life before the first connection of the sound processor according to the HUI questionnaire, the patients rated at 0.49 (0-1 scale, where 0 - corresponds to the death condition and 1 - full health). After one year from the implantation, this rating increased to 0.56. CONCLUSIONS: The implantation of the cochlear implant significantly increases the patient's quality of life, its physical and emotional functioning. Statistically significant better self-assessment of patients mainly concerned hearing speech and spatial hearing - especially after 1 year of connecting the speech processor.

Voice improvement in patients with recurrent respiratory papillomatosis after combined treatment with cidofovir and CO2 laser surgery.

Mechanical debulking of laryngeal papillomas is associated with voice disorders due to impairment of the vocal fold's mucosa. Intraepithelial injection of cidofovir reduces damage to the laryngeal structures and thus improves vocal parameters. The aim of our study was to compare vocal quality before and after cidofovir and CO2 laser treatment by means of objective phoniatric parameters and to obtain evidence concerning voice outcomes. The vocal parameters of 42 patients with RRP were assessed before and after intralesional cidofovir and CO2 laser debulking treatment (Lumenis AcuPulse 40 CO2 laser, wavelength 10.6 µm; Lumenis Ltd., Yokneam, Israel). The laser was used in SuperPulse™ mode with power tailored on the target structures (average 7 W). The depth of tissue penetration was 1 mm with a single burst of energy lasting 0.3 ms. Most of the patients had previously undergone traditional surgery (1-105 procedures); in 7/42, the video stroboscopic examination revealed extensive scar tissue covering the mucosa of the vocal folds, limiting the mucosal wave. The significance level for all calculations was p < 0.05. Statistical analysis was performed using Statistica 10 by StatSoft Polska. The methodology included subjective voice evaluation (GRBAS), videostroboscopy, analysis of the acoustic laryngeal tone (MDVP), spectrographic analysis, and voice handicap index (VHI). The GRBAS scale during spontaneous conversation revealed better phonation results after cidofovir treatment in all 42 patients. Scars were not observed in the presented group. In the MDVP laryngeal tone analysis before surgery parameters defining the amplitude and frequency of laryngeal tone were significantly elevated compared to the state after surgery. After treatment, both jitter and shimmer were reduced in all subjects. Even more pronounced changes were observed in the spectrographic analysis. In all analyzed patients, there was a significant reduction in VHI scores showing improvement in voice self-assessment. A satisfactory improvement in voice quality was observed in all RRP patients treated with cidofovir and CO2 laser.

Incidence of Otologic Symptoms and Evaluation of the Organ of Hearing in Patients with Temporomandibular Disorders (TDM).

BACKGROUND Numerous studies have discussed cases of concomitant temporomandibular disorders (TMD) and otologic symptoms (OS). However, attempts to determine the true origin of these symptoms combined with assessments of the condition of the organ of hearing are relatively rare. This study aimed to evaluate the frequency and type of OS in patients with TMD, and attempted to determine the origin of the OS in the studied group of patients. MATERIAL AND METHODS 246 patients, aged 40.08±11.12 years (F=147, M=99) with TMD, from the Department of Oral Rehabilitation of Poznan University of Medical Sciences. METHODS: dental history interviews and clinical examinations. There were 2 groups-G1 and G2-selected on the basis of the presence or absence of OS in the medical history stage. After audiological evaluation, 2 subgroups were identified: G1.1 and G1.2. RESULTS OS were observed in 36.18% (G1). In 48 patients (53.93%), the audiological evaluation found there was no impairment of the organ of hearing (G1.2). Audiological abnormalities were found in 46.07% (n=41) of the patients (G1.1). The OS which differentiated the 2 groups were a plugging sensation as well as otalgia (more frequent in group G1.2) and hearing impairment (more frequent in group G1.1). CONCLUSIONS 1. The OS which most frequently accompany with TMD were fullness and otalgia. 2. It is recommended that a subjective assessment of hearing loss in patients with TMD and concomitant OS should be included in the medical history stage. 3. Clicking and popping are significantly more frequent in patients without concomitant hearing impairment.

[Evaluation of the results of the prevention program "Protect your voice" implemented by The Greater Poland Center of Occupational Medicine of Poznan]. / Ocena wyników programu profilaktycznego "Chron swój glos" przeprowadzonego przez Wielkopolskie Centrum Medycyny Pracy w Poznaniu.

BACKGROUND: The aim of the study was to evaluate the rationale for training in voice emission and voice prophylaxis among teachers and to assess the effects of voice disorders rehabilitation in the selected group of teachers participating in the program "Protect your voice." MATERIAL AND METHODS: An anonymous survey was conducted among 463 teachers participating in the training part of the program. The effectivness of rehabilitation of teachers with occupational voice disorders was evaluated among 51 subjects (average age: 43 years) taking part in diagnostic and rehabilitation part of the program. Phonation voice exercises with speech therapist and physiotherapy (iontophoresis, inhalations and elektrostimulation) were administered. Evaluation of rehabilitation was based on phoniatric examination, including videostroboscopy and statistical calculations. RESULTS: The survey showed that among teachers there is high demand (98%) for training in proper voice emission, hygiene and prevention of voice. The effectiveness of rehabilitation has been confirmed by the observed improvements in phonatory activities of larynx, proper breathing during phonation (p = 0.0000), the voice quality (p = 0.0022), prolonged phonation time (an average of 1.39 s), increased number of people who correctly activated resonators (p = 0.0000) and increased number of people with phonation without excesive muscle tension of the neck. CONCLUSIONS: The results indicate that among all the professionally active teachers, there is a need for regular training of proper voice emission and vocal hygiene and then conduct individually phonation and breathing exercises, supported by the physiotherapy. This should be an effective method of voice disorders prevention in teachers. Med Pr 2017;68(5):593-603.

Vocal training in an anthropometrical aspect.

OBJECTIVES: As shown in our previous paper, the dimensions of the cerebral parts of the cranium and face of the vocal students were higher than those of the non-singing students. The aim of the present study was to analyse the type of voice and its development depending on selected dimensions. METHODS: A total of 56 vocal students - 36 women and 20 men - who underwent anthropometric measurements were divided into groups according to their voice type. Two professors of singing made a subjective, independent evaluation of individual students' vocal development progress during the four years of training. The findings were analysed statistically with the current licensed versions of Statistica software. RESULTS: We found statistically significant positive correlation between: the head length, head and face width, depth of upper and middle face, nose length and student's voice development. CONCLUSIONS: The dimensions of the head and the face have no impact on type of voice; however, some anatomical characteristics may have impact on voice development.

Hypothyroidism Affects Olfactory Evoked Potentials.

Background. Objective electrophysiological methods for investigations of the organ of smell consist in recordings of olfactory cortex responses to specific, time restricted odor stimuli. In hypothyroidism have impaired sense of smell. Material and Methods. Two groups: control of 31 healthy subjects and study group of 21 with hypothyroidism. The inclusion criterion for the study group was the TSH range from 3.54 to 110 µIU/mL. Aim. Assessment of the latency time of evoked responses from the olfactory nerve N1 and the trigeminal nerve N5 using two smells of mint and anise in hypothyroidism. Results. The smell perception in subjective olfactory tests was normal in 85% of the hypothyroid group. Differences were noticed in the objective tests. The detailed intergroup analysis of latency times of recorded cortical responses PN5 and PN1 performed by means between the groups of patients with overt clinical hypothyroidism versus subclinical hypothyroidism demonstrated a significant difference (p < 0.05) whereas no such differences were found between the control group versus subclinical hypothyroidism group (p > 0.05). Conclusion. We can conclude that registration of cortex potentials at irritation of olfactory and trigeminal nerves offers possibilities for using this method as an objective indicator of hypothyroidism severity and prognostic process factor.

The assessment of the impact of anorexia nervosa on the vocal apparatus in adolescent girls - A preliminary report.

BACKGROUND: Chronic undernourishment in the course of anorexia nervosa leads to various metabolic and hormonal changes, which translates to the impaired functioning of the majority of systems and internal organs. The impact of eating disorders on the condition of the vocal apparatus has been described in the literature; nevertheless, it concerns mainly bulimia nervosa. OBJECTIVES: assessment of the vocal apparatus in adolescent girls diagnosed with anorexia nervosa from the point of view of possible influence on the function and structure of the larynx, low body mass accompanying anorexia, as well as energy deficiency, hormonal and emotional disturbances. MATERIALS AND METHODS: The research included 41 girls aged 12-19 years, diagnosed with anorexia, who were assessed for the condition of the vocal apparatus, using the perceptual assessment of voice according to GRBAS scale, videolarynostroboscopy, acoustic assessment, and voice self-assessment in Jacobson's VHI scale (voice handicap index). RESULTS: The perceptual assessment of voice using the GRBAS scale revealed that changes in voice were mainly weak, asthenic in nature (70.73%) and there was also the feature of puffing perceived in voice (41.46%). In voice self-assessment with the use of VHI, most subjects seemed to point to changes of voice self-perception in emotional subscale (68%). Videolaryngostroboscopy revealed some features of functional disturbances of voice in more than half of subjects, mainly in the form of hyperfunctional dysphonia (31.78%). The maximal phonation time was significantly shorter, in proportion to duration of the primary disease. In the acoustic analysis, the decrease in the basic frequency F0 and narrowing of the voice scale were observed. 55% of older, post-adolescent patients presented with the structure of the larynx that was inappropriate for their age. CONCLUSIONS: These results might indicate that anorexia nervosa could have led to the structural and functional changes in the vocal apparatus. Such disturbances may be explained by the hormonal dysfunctions as well as starvation. Hormonal substitution at the appropriate time might be beneficial for the structure and phonation function of the larynx in girls with AN.

Quality of life and hearing after cochlear implant placement in patients over 60 years of age.

OBJECTIVE: Multicenter evaluation of the quality of life and quality of hearing after Nucleus® cochlear implant placement in patients over 60 years of age. REFERENCE AND METHOD: Evaluation was performed in patients receiving cochlear implants after the age of 60 years as a part of the Cochlear-Implanted Recipient Observational Study (Cochlear-IROS). This study is a prospective, international and long-term assessment which enables observation of recipients for up to three years after implantation. Data regarding subjective evaluation of the quality of life and quality of hearing were gathered before the first switch-on of the sound processor and one year afterwards. Standardized questionnaires were used in this evaluation, including Health Utility Index (HUI mk. III) and Speech, Spatial and Qualities of Hearing (SSQ) Scale. Data were also gathered regarding the aetiology of hearing loss, hearing aid usage, tinnitus and vertigo, as well as on the telephone usage and the professional status of recipients. RESULTS: Included in the evaluation, were 20 subjects who were over 60 years old at the moment of the cochlear implant surgery. The study group consisted of 12 men and 8 female patients. The average age of CI recipients at the moment of implantation was 67.8 years (min. 60, max. 80 years). The SSQ questionnaire outcomes regarding self-assessment in the field of ability to hear in everyday situations one year after the surgery indicate that speech understanding increased by 180%, spatial hearing increased by 135 % and quality of hearing increased by 98%. Overall quality of life before the first sound processor switch-on as assessed using the HUI questionnaire was at the level of 0.38 (on 0-1 scale, where 0 equals death, and 1 equals full health). One year after the implantation, this assessment increased by 33% (up to 0.5 on the scale). CONCLUSION: The effectiveness of the cochlear implantation in patients with severe hearing loss after 60 years of age with respect to the quality of life and hearing was confirmed. Statistically significant improvement was demonstrated in the self-assessment of patients in relation to the speech understanding, spatial hearing and quality of hearing, as well as quality of life.

Phenotype-genotype discordance in congenital malformations with communication disorders resembling trisomy 18 (Edwards syndrome).

PATIENT: Female, 6 FINAL DIAGNOSIS: Phenotype-genotype discordance in congenital malformations with communication disorders resembling trisomy 18 (Edwards syndrome) Symptoms: - MEDICATION: - Clinical Procedure: - Specialty: Otolaryngology. OBJECTIVE: Congenital defects. BACKGROUND: Communication process disorders are very frequent in rare cases of chromosomal aberrations (deletions, insertions, and trisomies) such as Down syndrome (trisomy 21), Turner syndrome, Edwards syndrome (trisomy 18), or Patau syndrome (trisomy 13). Sometimes phenotype may delusively correspond to the characteristic features of a given syndrome, but genotype tests do not confirm its presence. CASE REPORT: We present the case of a 6-year-old girl admitted to the Clinic of Phoniatrics and Audiology for the assessment of communication in the course of congenital malformations with phenotype characteristic for trisomy 18 (Edwards syndrome). Immediately upon birth, dysmorphic changes suggesting trisomy 18 (Edwards syndrome) were observed, but trisomy 18 was excluded after karyotype test results were normal (46, XX). CONCLUSIONS: DISTURBED ARTICULATION WAS DIAGNOSED: deformed linguo-dental and palatal sounds, interdental realization with flat tongue of the /s/, /z/, /c/, /dz/, /s/, /z/, /c/, /dz/ sounds (sigmatismus interdentalis). Hearing loss was confirmed.

Assessing auditory processing disorders in children with developmental dyslexia using auditory cognitive event-related potentials.

OBJECTIVES: It has been suggested that dyslexia is linked to a core cognitive deficit in phonological awareness tasks and/or in the processing of auditory stimuli. Auditory evoked potentials are a valid, objective measure of the accuracy of central auditory processing in humans. The aim of this study was to assess auditory evoked potentials in children with dyslexia. PATIENTS AND METHODS: Sixty-six children participated in the study. A set of hearing tests and the recording of complex event-related potentials (ERPs) were performed. RESULTS: Mixmatch negativity (MMN) and P300 waves were significantly more frequent in the healthy children (control group) than in children with dyslexia. The P300 wave was present in all subjects from the control group, the MMN wave in 92% of them. In the dyslexic group, complex ERPs were recorded roughly 33% of the time. Latencies of complex ERPs in children with dyslexia were greater than latencies in children in the control group. MMN and P300 maturation (change with age) was observed only for the control group. A wide range of MMN and P300 responses was observed across children with dyslexia. CONCLUSION: Complex ERPs may be useful in determining the condition of audiologic functions; however, on their own they are not sufficient to recognize dyslexia because of the heterogeneity of nonspecific changes.

Affective temperament in women with functional aphonia.

OBJECTIVES: The aim of the present study was to assess the affective temperament in women with functional aphonia. STUDY DESIGN: Cross-sectional. METHODS: Forty-one women with functional aphonia underwent an examination of affective temperament by means of the Temperament Evaluation of Memphis, Pisa and San Diego Autoquestionnaire. RESULTS: Compared with the reference group, women with functional aphonia show significantly higher rates of depressive and anxious temperament. CONCLUSIONS: The results of the present study are concordant with the previous findings, indicating elevated levels of depressive and anxious symptoms in aphonic patients. Implications for the therapy of functional aphonia as well as considerations for further studies are discussed.

[The application of the manual physiotherapy treatment for patient with after trauma dysphonia]. / Zastosowanie manualnych technik fizjoterapeutycznych w rehabilitacji dysfonii pourazowej.

UNLABELLED: As a result of laryngeal injures an abnormal phonation is frequently observed. It is the consequence of structural and functional changes of the laryngeal tissues directly and indirectly responsible for the voice emission. Physiotherapy enables the normalization of the tension and function of the anatomical structures changed after trauma. THE AIM OF THE STUDY: Presentation of the results of the physiotherapy and voice rehabilitation treatment established for patient with voice disorders, occurred after cranio-cerebral trauma. MATERIAL AND METHODS: The 47 year old man two years after cranio-cerebral trauma was presented, which voice was hoarse, produced with a strong neck and shoulder girdle muscle tension. Phonation time was significantly shortened. During the manual examination the abnormal of mobility, range of movement and soft tissue tension in neck, head and upper trunk area has been observed. The systematic rehabilitation program was started 2 years after injury and it was continued for four months. The individual program contains physiotherapy, osteopathic and speech therapy treatment. The phoniatric examination was performed before and after rehabilitation RESULTS: After four months of treatment and after self-therapy exercises the significant changes were observed. Patient's voice became no more strain, but stronger and socially effective. CONCLUSIONS: The application of an individual therapy which contained osteopathic manual muscle-fascial techniques allows a subjective and objective improvement of voice in a examined patient. This procedure is an effective complement to logopedic and phoniatric therapy for patients after trauma of the larynx.

Voice estimation in patients after reconstructive subtotal laryngectomy.

BACKGROUND: Treatment of laryngeal cancers, may include surgery, radiotherapy, chemotherapy, or a combination. Total laryngectomy (TL) has been the standard surgical treatment. Partial laryngectomy procedures were performed, their advantage over TL is preservation of laryngeal functions. METHODS: The investigation was carried out on a group of 20 patients (3 female and 17 male), who underwent surgery according the techniques mentioned above. The methods of investigation were based on perceptual voice estimation (GRBAS), videolaryngostroboscopy, acoustic voice analysis, aerodynamic measure maximum phonation time, voice self-assessment (VHI). RESULTS AND CONCLUSIONS: The perceptual voice estimation revealed a good phonation result in only 3 cases after using surgery with the Calearo method as well as the best results of MPT. The VHI reflected severe voice handicap in 2 patients (26 to 40 points). No statistically significant differences were observed between the values of the acoustic parameters in MDVP analysis after following operation -CHEP, Calearo, Sedlacek.

[Binaural asymmetric sensorineural hearing loss in audiological practice]. / Ocena obustronnego asymetrycznego niedosluchu czuciowo-nerwowego w praktyce audiologicznej.

OBJECTIVES: To estimate binaural asymmetric sensorineural hearing loss in own material of patients treated in Dept. of Phoniatrics and Audiology. MATERIAL & METHODS: The retrospective analysis was performed on the group of 1816 patients hospitalized in 2008 due to hearing disorders. Asymmetry of hearing loss was classified on Margolis and Saly criteria in PTA, and in ABR results in children. CONCLUSIONS: Binaural asymmetric sensorineural hearing loss was found in 70 patients (3.9%). In a group of 46 differences of inter-aural threshold level in PTA were estimated on 21 to 30 dB. After audiological examination 14% of this patients were qualified for MRI investigation, in 2 (3%) of them acoustic neurinoma was found. The hearing aids fitting were performed in 44% of a group of 70 patients.

[The smokers voice self assessment based on Voice Handicap Index (VHI)]. / Samoocena glosu u palaczy w oparciu o Wskaznik Niesprawnosci Glosu (VHI).

Complex voice assessment due to European Laryngeal Society proposals (2000) contains voice self estimation based on the Polish version of the Voice Handicap Index (VHI). This study focuses on the relation between voice handicap and smoking in dysphonic patients, who are using voice professionally. Thirty outpatient (25 female and 5 male, aged 40 to 55 years) voice department attendees suffering from professional dysphonia took part in this study. All patients after phoniatric examination completed the Polish version of the Voice Handicap Index (VHI). The questions concern functional, emotional and physical complains due to dysphonia. Most of smokers did not complain of dysphonia related problems comparing to non smokers. Even the scores of functional and emotional scales of VHI in smokers shown better results (less handicap) than in nonsmokers. Smoking does not affect patients handicap due to dysphonia measured in the Voice Handicap Index.

[Further research on speech tests]. / Dalsze badania nad testami mowy utrudnionej.

INTRODUCTION: The purpose of speech audiometry is to extend the diagnostics of central auditory processes. First audiometric tests were monaural tests introduced in the fifties by Bocca and Calearo to diagnose Central Auditory Processing Disorders (CAPD). Monaural tests are characterized by low redundancy, which allows for deciphering a given word or phrase only if the amount of accessible information exceeds a required minimum. Until now, a new monaural filtered speech test has been drawn up at the Department of Phoniatrics and Audiology. The purpose of the research was to draw up and assess the effectiveness of monaural low redundancy tests, in which the acoustic signal has been compressed or noise has been added. MATERIALS AND METHOD: 35 people with normal hearing, aged 16-60, have been examined. The test material included: a compressed speech test, in which the speech signal has been accelerated by 25% with the use of Cool Edit Pro 2.0; the pauses between the words have not been shortened a speech-in-noise test, in which the noise has been added with the use of Cool Edit Pro 2.0. The signal/noise ratio has been set at the level of 10 dB. The examination has been conducted at three different volume levels: 25, 35 and 45 dB. CONCLUSIONS: Best results have been achieved at the volume level of 45 dB (above hearing threshold); There were differences in results at volume levels 25 dB and 35 dB in compressed speech test and at volume level 25 dB in speech in noise. Both tests have shown the influence of age on the test result which suggests undiagnosed CAPD among people (with normal hearing) aged over 55.

[Polish language dychotomic tests for speech audiometry Part 2: A study of people with normal hearing from various age groups]. / Testy utrudnione w audiometrii mowy dla jezyka polskiego (czesc II). Badania osób z prawidlowym sluchem w róznych grupach wiekowych.

INTRODUCTION: Evaluation of the objective results in the clinical examination of central auditory disorders requires the use of reliable language tests which provide the means for the estimation of patients' audio-verbal communicative skills. MATERIALS AND METHODS: The authors present a new set of more difficult language tests in Polish, including a filtered speech test, numeral and verbal dichotic tests and the normal Calearo test. The tests were evaluated on a group of people with good hearing from various age groups. CONCLUSIONS: The presented tests are the only existing ones created for the Polish language which expand the diagnostic possibilities in the case of central auditory processing disorders. It was found that there is a right ear predominance in dichotic tests, which grows together with the patient's age. This observation can be very beneficial in practice, allowing for hearing aids to be better fitted.

[Subjective assessment of voice functions among teachers taking part in the rehabilitation program]. / Subiektywna ocena czynnosci glosowej u nauczycieli uczestniczacych w programie rehabilitacyjnym.

INTRODUCTION: In daily phoniatric practice, apart from laryngoscopy, another simple and useful method of examining the voice organ is perceptual voice assessment based on the GRBAS scale. An extension to this examination can be the Voice Handicap Index test (VHI). MATERIALS AND METHODS: 79 female teachers taking part in a 7-week-long rehabilitation course on voice emission techniques. Before and after the course the participants were subject to phoniatric examination including laryngovideostroboscopy, GRBAS scale assessment and determining the voice handicap index (VHI). RESULTS: After the course, a substantial improvement has been observed in voice emission, perceptual assessment and the VHI test. It has been observed that there is a statistically significant correlation between GRBAS and VHI results and mean phonation time (MPT) measured before and after the course. CONCLUSIONS: The VHI test should be included in complex analysis of the effects of intensive rehabilitation.

[The local and sensual conditions of delay of voice breaking in adolescent boys]. / Uwarunkowania miejscowe i zmyslowe przedluzonej mutacji.

Disorders of voice breaking in adolescent boys (mutational dysphonia) could be a result of local, hormonal, neuropsychiatric or sensual factors. The aim of this paper was the voice assessment of three subjects with incomplete mutation with particular additional factors, disturbing hearing, voice and speech: like hearing loss, hyperfunctional childhood dysphonia and speech dysfluency. Diagnostics included complete phoniatric examination with perceptive estimation, videostroboscopy and acoustic voice analysis, done before and after treatment. Rehabilitation process results were well seen in perceptive and objective voice analysis except significant improvement of fundamental frequency average. Analysis of incomplete mutation etiological factors need special attention due to coexist with another voice, speech and hearing disorders, which undergo with high tension of voice organ muscles or with the lack of phonation auditory feedback.

[Voice disorders in recurrent laryngeal granuloma dependend on GERD]. / Zaburzenia glosu w nawrotowym ziarniniaku krtani w przebiegu GERD.

The voice disorders in a case of recurrent laryngeal granuloma with chronic gastroesophageal reflux was described. There was emphasized necessity of complex treatment pharmacological and phoniatric, as well as there were pointed out some indications of microsurgery.