Voice quality after thyroplasty type I using a silicone block.

AIM: The aim of the work was to evaluate the voice quality of 10 adult patients after thyroplasty type I using a silicone block. Preoperatively patients suffered from unilateral vocal fold paralysis. MATERIAL AND METHODS: We evaluated selected preoperative and postoperative patient findings (RBH according to Wendler classification, videolaryngostroboscopy and maximum phonation time MPT). The evaluation was performed by a phoniatrician and clinical speech therapist, using patient medical records and the Lingwaves and Glottis Analysis Tools (GAT) programs. RESULTS: Preoperatively we identified R1B1H1 - R3B3H3, postoperatively R0B0H0 - R3B3H2. In six cases the paralysed vocal cord was preoperatively in a paramedian position, twice in intermediate position and twice in a lateral position. In the case of 6 patients presbyphonic changes were present. Motility of the healthy vocal cord was within the norm. Postoperatively, the paretic vocal cord was medialised. We assessed the MPT value: preoperatively 3‒10 seconds, postoperatively 9‒17 seconds. Postoperatively we measured jitter (%), shimmer (%) and closing quotient values. In comparison with healthy subjects (Inwald et al. 2011), jitter and shimmer values were higher and closing quotient values after thyroplasty type I close to normal values (Tab.1). CONCLUSIONS: The postoperative voice quality was significantly better in comparison with the preoperative state; though, it never achieved the parameters of a normal voice. We confirmed the significant contribution of TPL I for the patients´ quality of life through partial rehabilitation of their voices.

[Hoarseness: biomechanisms and quantitative laryngoscopy]. / Heiserkeit: Biomechanik und quantitative Laryngoskopie.

Every phonosurgical procedure alters endolaryngeal anatomy; be it by removing tissue, or injection or implantation of autologous or foreign material. However, the effect that an altered airflow cross section and changed soft tissue elasticity will have on the voice cannot be predicted. With the aim of promoting rational indications for phonosurgery, the current article explains the biomechanisms of the normal and the disordered voice, including the complex interdependence of tissue viscoelasticity, glottal airstream and sound production. According to European Laryngological Society (ELS) recommendations, five - not entirely mutually independent - evaluation criteria form the basis of indication assessments: self-rating (by the patient), proxy rating (by the physician), technical signal analysis (computerized), aerodynamics (spirometry) and vibration analysis (stroboscopy). The ELS evaluation standards agreed upon in 2001 enable indications and - by virtue of pre- and postoperative comparisons - therapeutic successes to be assessed. The 10-year-old ELS protocol has been updated by a real-time method for visualizing vocal fold vibrations: the phonovibrogram (PVG) has replaced stroboscopy. Independently of the morphological anatomic details of the larynx, PVG visualizes the symmetry and regularity of vocal fold motion, thus allowing preoperative estimation of tissue elasticity.

[Validation of an automatic speech analysis in children with isolated cleft palate]. / Validierung einer automatischen Analyse der Sprechproben von Kindern mit isolierter Gaumenspalte.

BACKGROUND: Following surgical repair of cleft lip and palate, hearing and speech and language development are important issues for the continued care of affected childhood and adolescent patients. Therefore, PEAKS (Program for Evaluation and Analysis of all Kinds of Speech Disorders) was developed in order to rate speech intelligibility automatically and reduce the time required for diagnostics. PEAKS is based on a speech recognition system and was extended to incorporate a speaker model. This investigation validated PEAKS for isolated cleft palate. METHODS: From each of the 39 children with isolated cleft palate (3.1-14.5 years), 99 word productions were recorded digitally and analyzed-once "subjectively" by five experts and five nonexperts; once "objectively" using PEAKS. RESULTS: The automatic speech recognition system and the experts arrive at similar results with regard to speech intelligibility. The expert and nonexpert ratings differ significantly from each other. Within the group of nonexperts, a weak interrater reliability demonstrates the uncertainty associated with their ratings. CONCLUSION: PEAKS delivers reliable and representative results with regard to speech intelligibility among children and adolescents with isolated cleft palate. The automatic measurement of speech quality in children and adolescents with isolated cleft palate is possible.

[Evaluation of 2 German Parental Questionnaires: a comparative analysis of the FRAKIS questionnaire for early speech development and the early lexical development inventory ELAN for 2-year-olds]. / Validität der Elternfragebögen FRAKIS und ELAN bei der Vorsorgeuntersuchung U7.

OBJECTIVE: The German parental questionnaires FRAKIS and ELAN are 2 screening instruments, usable in the German preventive paediatric examinations for 2-year-olds. This study investigates the difference between the questionnaires with regard to validity, reliability, time and cost-efficiency and usability in daily clinical practice. METHOD: The parents of 25 children filled in the questionnaires FRAKIS and ELAN. As a reference test, the German speech development test 2 (SETK-2, Grimm 2000) was applied. Vocabulary results were compared with SETK-2 subtest production I (word production). RESULTS: Both parental questionnaires correlated significantly with the SETK-2 subtest production I. ELAN and FRAKIS showed equal results in classifying patients as "critical-below average" or "uncritical-indifferent". CONCLUSION: The ELAN as well as FRAKIS are both appropriate screening tools for identifying language developmental delay in 2-year-olds.

[Perceptual and automatic voice and speech analysis of chronic laryngitis and T1 vocal cord cancer]. / Perzeptive und maschinelle Stimm- und Sprechanalyse bei chronischer Laryngitis und T1-Stimmlippenkarzinom.

BACKGROUND: Patients with chronic laryngitis and T1 vocal cord cancer were compared using perceptual and text-based objective voice and speech analyses in order to determine which group is more affected in its ability to communicate and whether a distinction between the two pathologies is possible. PATIENTS AND METHODS: In all, 13 patients with histologically proven chronic laryngitis and 13 patients with T1 vocal cord cancer were compared perceptually by five speech therapists on the basis of seven criteria and objectively by a speech recognition system and prosodic analysis. RESULTS: Both, the data of the five speech therapists and the results of the automatic analysis revealed no significant differences between the two patient groups. CONCLUSION: A distinction between chronic laryngitis and T1 vocal cord carcinoma by mere voice and speech analysis is not possible, because the patient groups do not show significant differences in their voice quality.

[Phoneme analysis and phoneme discrimination of juvenile speech therapy school students]. / Lautanalyse und Lautdiskrimination jugendlicher Sprachheilschüler.

BACKGROUND: Phoneme analysis and phoneme discrimination, important factors in acquiring spoken and written language, have been evaluated in juvenile speech therapy school students. The results have been correlated with the results of a school achievement test. The following questions were of interest: Do students in the lower verbal skill segment show pathological phoneme analysis and phoneme discrimination skills? Do the results of the school achievement test differ from the results by students visiting German "Hauptschule"? How does phoneme analysis and phoneme discrimination performance correlate to other tested parameters? PATIENTS AND METHODS: 74 students of a speech therapy school ranging from 7 (th) to 9 (th) grade were examined (ages 12;10-17;04) with the Heidelberg Phoneme Discrimination Test H-LAD and the school achievement test "Prüfsystem für Schul- und Bildungsberatung PSB-R 6-13". RESULTS: Compared to 4 (th) graders the juvenile speech therapy school students showed worse results in the H-LAD test with good differentiation in the lower measuring range. In the PSB-R 6-13 test the examined students did worse compared to students visiting German "Hauptschule" for all grades except 9 (th) grade. Comparing H-LAD and PSB-R 6-13 shows a significant correlation for the sub-tests covering language competence and intelligence but not for the concentration tests. CONCLUSIONS: Pathological phoneme analysis and phoneme discrimination skills suggest elevated need for counseling, but this needs to corroborated through additional linguistic parameters and measuring non-verbal intelligence. Further trails are needed in order to clarify whether the results can lead to sophisticated therapy algorithms for educational purposes.

[Speech intelligibility degree and coping after multimodal therapy of oral squamous carcinoma]. / Sprachverständlichkeit und Krankheitsverarbeitung nach der Therapie von Mundhöhlenkarzinomen.

BACKGROUND: Multimodal treatment of oral cancer can cause speech disorders and diminish speech intelligibility. Speech intelligibility is an essential part of social interaction and therefore important for coping with the disease. The aim of this study was to investigate the influence of speech intelligibility on coping strategies and a standardized questionnaire. PATIENTS AND METHODS: Speech recordings from 76 patients 60.7 ± 11.4 years old (19 women, 57 men) were performed at least 6 months after multimodal treatment of T1-T4 squamous cell carcinoma of the oral cavity and evaluated by automatic speech recognition. Speech intelligibility was quantized as correctly recognized words of a standard text (word recognition rate WR). Coping was evaluated by the Trier Scales of Coping Strategies via questionnaires. RESULTS: Speech intelligibility scores WR rated between 22.2% and 84.3% (mean value 54.2 ± 15.7). Coping strategies vary considerably between the patients and between the scales. WR and the Trier Scales significantly correlate in 3 of the 5 categories (Rumination, Search for Information and Exchange of Experiences). CONCLUSION: Reduced speech intelligibility after multimodal treatment of oral cancer is associated with a change of coping strategy. This includes not only communication-based strategies (Search for Information and Exchange of Experiences) but also intra-psychic processes like rumination.

[Speech developmental delay in preschool children: evaluation of screening with anamnesis questions]. / Sprachentwicklungsstörungen bei Vorschulkindern: Bewertung des Screenings mit Anamnesefragen.

BACKGROUND: In western societies, delay of speech development is frequent and important as it may affect the entire development of a child. Therefore, early diagnosis and treatment is of outstanding relevance. For screening purposes in clinical practice, questionnaires focussing on speech development are assumed to be both valid and economic assessment tools. In this study, results of a questionnaire based on "milestones in early childhood development" as previously reported by Michaelis for German children were compared with results of systematic German speech development tests. PATIENTS AND METHODS: In a retrospective study, data were collected from 25 German preschool children. Their parents had completed a questionnaire on their child's development prior to the examination with 4 questions focussing on speech development. In this report, the answers on these 4 questions are evaluated against the background of systematic German speech development tests, i.e. the H-SET and PLAKSS, and an unsystematic examination by an experienced speech and language phonologist. RESULTS: The questionnaire had a sensitivity of 50% and a specificity of 7%. The positive and negative predictive values were 55.9% and 5%, respectively. CONCLUSION: A questionnaire based on "milestones in early childhood development" as previously reported by Michaelis for German children, is clinically invalid for screening speech development in preschool children.

[Intelligibility of children with bilateral and unilateral cleft lip and palate]. / Sprachverständlichkeit von Kindern mit bilateralen und unilateralen Lippen-Kiefer-Gaumen-Spalten.

OBJECTIVE: Data about the effect of unilateral or bilateral cleft lip and palate (CLP) on speech quality are inconsistent. In this study we firstly quantify the intelligibility of children with unilateral and bilateral CLP objectively by means of automatic speech recognition system (ASR). METHODS: Speech data of 72 German speaking children (8.7+/-3.0 years) with CLP thereof 17 children with bilateral CLP, 23 with CLP on the right side, and 32 on the left, were compared. A group of 159 children aged 9.1+/-2.9 years served as control group. To quantify intelligibility we calculated the word recognition rate (WR) as the percentage of correctly recognized words of a standardized speech test (PLAKSS). RESULTS: Between the 3 cleft groups, there was no significant difference in WR. Compared to the control group (WR mean 63.5%+/-12.1%), the patient group (WR mean 48.1%+/-16.3%) shows significant lower WR (p< 0.001). The WR rises with increasing age in the control group and in the patient groups with unilateral cleft significantly. This couldn't be observed in the children with bilateral CLP. In this group the males showed a significantly higher WR than the females. In the control group as in the patient groups with unilateral cleft there is no significant difference between girls and boys. CONCLUSIONS: Despite the greater extent of the malformation of children with a bilateral CLP, there is no significant difference to the children with only a unilateral cleft lip and palate.

[Satisfaction of dysphonic patients with psychosomatic assessment and intervention]. / Zufriedenheit dysphoner Patienten mit einer psychosomatischen Diagnostik und Intervention.

BACKGROUND: Comorbid physical and psychological complaints are more common in patients with dysphonia than in the general population. In a prospective randomized study the effects of structured psychosomatic diagnostics and verbal intervention on the satisfaction of patients with dysphonia were investigated. MATERIALS AND METHODS: A total of 54 dysphonic patients (33 women, 21 men, age 51.1+/-16.4 years) with dysphonia (organic n=36, functional n=18) were examined and their subjective experiences were collected by the following psychometric questionnaires: voice-related quality of life (VRQOL), hospital anxiety and depression scale (HADS-D) and the "Giessener Beschwerdebogen" (Giessen questionnaire on physical complaints GBB). Patients were randomized into 2 groups: group 1 (n=27) filled in the questionnaires and the answers were reviewed within the medical consultation. This was followed by an interview on patient satisfaction. In the control group 2 (n=27) a medical examination and consultation were carried out and then questioned on patient satisfaction. The psychometric questionnaires were completed by the patients shortly before leaving the department. RESULTS: The study group 1 was significantly more satisfied than group 2 on different statistic levels according to the items compared. CONCLUSIONS: Patients suffering from dysphonia are positively influenced with respect to patient satisfaction by a structured psychosomatic diagnostic and intervention.

[Automated postlaryngectomy telephone test]. / Automatisierung des Postlaryngektomie-Telefontests.

OBJECTIVE: In this study, an objective version of the postlaryngectomy telephone test (PLTT) for measuring speech intelligibility based on automatic speech recognition is presented. METHODS: Thirty-one patients with tracheoesophageal substitute voice (25 men and six women, 63.4+/-8.7 years) were evaluated by 11 naïve listeners. The automatic measurement of speech intelligibility was expressed by means of word accuracy and word recognition rates, or the percentage of correctly recognized words from a word sequence. These automatic measures were compared with the subjectively obtained PLTT values. RESULTS: The average PLTT intelligibility of the 11 naïve listeners was 47%; the automatically obtained word accuracy and word recognition rates were much lower (approximately 0% and 15%, respectively). The correlation between subjective and automatic evaluation, however, reached more than 0.9 in some of the examined cases. CONCLUSION: Automatic speech recognition provides an efficient, objective measure that is equivalent to the overall PLTT intelligibility value.

[Reproducibility and reliability of phonovibrograms. Quantification of healthy vocal fold vibrations]. / Reproduzierbarkeit und Reliabilität des Phonovibrogramms. Quantifizierung gesunder Stimmlippenschwingungen.

BACKGROUND: Phonovibrography is capable of visualizing vocal fold vibrations in a static two-dimensional image, the so-called phonovibrogram (PVG). It allows quantification of the entire vocal fold vibration patterns. In this study we investigated the accuracy and reproducibility of PVG measures by analyzing high-speed laryngoscopy videos of healthy vocal fold vibrations. METHODS: High-speed laryngoscopy videos of 12 female speech therapists and 12 vocalists from the Regensburg Cathedral choir were analyzed. For evaluation purposes, PVG analysis was performed for two different sections of each video. RESULTS: The mean difference between the high-speed sections was 1.6 degrees +/-0.5 degrees for the female and 2.3 degrees +/-0.6 degrees for the male subjects. Within the sections, the mean variance of the PVG parameters was 3.5 degrees +/-0.7 degrees (therapists) and 3.7 degrees +/-1.0 degrees (vocalists). Likewise, a high left/right accordance of the PVG parameters, 5.3 degrees +/-0.5 degrees for therapists and 5.9 degrees +/-1.9 degrees for vocalists, was obtained. CONCLUSION: Vibrational patterns of normal vocal fold vibrations were very precisely quantified by the introduced PVG parameters. The high accuracy and reproducibility of PVG analysis provides a basis for prospective clinical trials dealing with precise characterization of pathological vibration patterns.

[Complaints of patients with dysphonia]. / Klagsamkeit von Patienten mit Dysphonien.

BACKGROUND: In this study, the problems and difficulties experienced by German-speaking voice patients were assessed using a structured questionnaire. METHODS: A total of 54 patients, 30 women and 24 men, aged 48.5+/-15.8 years suffering from benign organic and functional voice disorders, underwent systematic phoniatric examination including a detailed interview about the voice problem. The same procedure was applied to 56 age and gender matched normal control persons. RESULTS: There were no significant gender or diagnosis-related differences concerning the number and type of symptoms and symptom-related complaints (p>0.05). Most patients (88.9%) felt disturbed by their voice problem in a total of 118 different daily situations. CONCLUSIONS: The way patients experience voice disorders does not depend on the origin of the disorder and not on the gender. The data allow the conclusion that the case history of dysphonic patients can be assessed by a structured voice interview.

[Questionnaire on auditory perception disorders: psychometric correlates in preschool children]. / Anamnesebogen für auditive Verarbeitungs- und Wahrnehmungsstörungen : Psychometrische Korrelate im Vorschulalter.

BACKGROUND: A standardized questionnaire on central auditory processing disorders ["Anamnesebogen zur Erfassung auditiver Verarbeitungs- und Wahrnehmungsstörungen (AVWS)"] was developed by the German Society of Phoniatrics and Pediatric Audiology and standardized for school-age children. This study was designed to elucidate the validity of this questionnaire in preschool children. METHODS: The responses, which were given by the parents of 84 preschool children with respect to auditory discrimination and auditory memory, were correlated with the results of the Heidelberg screening test for preschool children (HVS), and their accuracy of prediction was determined. RESULTS: Similar to the results of other studies in school-age children, weak but significant correlations were found between the questionnaire results regarding auditory discrimination and auditory memory and the respective results of the HVS subtests. With a few exceptions, the questionnaire's accuracy of prediction was low. CONCLUSION: For preschool children, the questionnaire provides a reasonable method to get specific information about a child's history in a standardized and economic way. However, it is not valid as a screening or diagnostic tool.

Automatic quantification of speech intelligibility of adults with oral squamous cell carcinoma.

OBJECTIVE: It has been the aim of the present study to introduce a novel automatic technique for the objective and quantitative assessment of speech intelligibility to the evaluation of postoperative outcome. PATIENTS AND METHODS: Forty-six patients with oral carcinomas, mean age 59.8 +/- 10.1 years, and an age-matched control group of 40 subjects without oral diseases. Recordings of a standard text read by the patients and the control group were analyzed by an automatic speech recognition system. RESULTS: For the patients, automatic speech recognition yielded word recognition rates between 8 and 82% (mean 49 +/- 19%), for the control group between 60 and 91% (76 +/- 7%). Automatic evaluation closely correlated with the experts' perceptual evaluation of intelligibility (r = -0.93; p < 0.01). The multi-rater kappa of the experts alone (0.55) differed only slightly from the multi-rater kappa of the experts and the speech recognition system (0.58). CONCLUSION: For adults with speech disorders, automatic speech recognition may serve as a valuable tool to assess global speech outcome after treatment of oral squamous cell carcinoma objectively and quantitatively for clinical and research purposes.

[Basic research on vocal fold dynamics: three-dimensional vibration analysis of human and canine larynges]. / Grundlagenuntersuchungen für Stimmlippendynamik : 3D-Schwingungsanalyse menschlicher und caniner Kehlköpfe.

BACKGROUND: The understanding of normal and pathological vocal fold dynamics is the basis for a pathophysiological motivated voice therapy. Crucial vocal fold dynamics concerning voice production occur at the medial part of the vocal fold which is seen as the most critical region of mucosal wave propagation. Due to the limited size of the larynx the possibilities of laryngeal imaging by endoscopic techniques are limited. MATERIAL AND METHODS: This work describes an experimental set-up that enables quantification of the entire medial and superior vocal fold surface using excised human and in vivo canine larynges. RESULTS: The data obtained enable analysis of vocal fold deflections, velocities, and mucosal wave propagation. The reciprocal dependencies can be examined and different areas of vocal fold dynamics located. The vertical components obscured in clinical endoscopy can be visualized. This is not negligible. CONCLUSIONS: In particular it is shown that the vertical deflection, which cannot be observed by clinical examination, plays an important part in the dynamics and therefore cannot be omitted for therapeutic procedures. The theoretically assumed entrainment and influence of the two main vibration modes enabling normal phonation is confirmed.

[Phonovibrogram: vocal fold dynamics integrated within a single image]. / Phonovibrogramm: Stimmlippendynamik in einem Bild.

BACKGROUND: Stroboscopy is widely used and is quite adequate for the examination of normal voices, but with increasing hoarseness its suitability declines, even when it is supplemented by video recordings and image evaluation. Real-time procedures such as videokymography or high-speed (HS) video imaging are more suitable methods of observing the movements of the vocal folds in such cases. A drawback of any video recording is the later time-consuming offline replay of the films in slow motion and our restricted pattern recognition for motion and other time-dependent processes. METHODS: The phonovibrogram (PVG) is an image-processing algorithm that extracts the vocal fold motions of a whole laryngoscopic HS video film and automatically compresses them into a single image. RESULTS: Simple patterns that vary from person to person are revealed by PVG; these can be categorized by means of simple geometric forms, which a human observer can more easily recognize and interpret than dynamic motion patterns. The PVG computation is described in detail and an extensive guide to interpretation is given, illustrated by reference to theoretical and real examples. CONCLUSION: In clinical conditions, HS laryngoscopic video recording is useful only in association with automatic image processing. The PVG procedure is a promising approach and tests should be performed with a view to further clinical validation.

[Numeric quantification of intelligibility in schoolchildren with isolated and combined cleft palate]. / Numerische Quantifizierung der Verständlichkeit von Schulkindern mit isolierter und kombinierter Gaumenspalte.

OBJECTIVE: Even after adequate surgical and nonsurgical treatment, combined or isolated clefts often cause functional disorders, such as speech disorders. Speech disorders vary widely in extent and can take the form, for example, of specific features of articulation, with altered nasal emission and shifted articulation, leading to reduced speech intelligibility. So far it has not been possible to describe the relationship between cleft type and intelligibility except subjective, categorical evaluation. METHODS: Intelligibility of the speech as influenced by cleft palate in 58 children aged 9+/-2 was quantified objectively and numerically by means of automatic speech recognition technology in speech recordings for the PLAKSS test [test for psycholinguistic analysis of childhood speech impairments]. It was found that 33 children had a unilateral cleft lip and palate (CLP), 9, bilateral CLP, 10, isolated cleft palate, and 6, submucosal cleft palate. As a control group, 84 children aged 9+/-1 years and with physiological articulation were recruited from a mainstream school. Speech intelligibility is expressed as word accuracy, which means the percentage of correctly recognized words in a word sequence. RESULTS: Word accuracy levels in the control group were between 39% and 84% (mean 62%+/-10%), while the children with clefts achieved values between 0% and 73% (mean 42%+/-17%). There was no difference in intelligibility between children with isolated cleft palate and those with combined cleft type. Differences were, however, found between each group and the control group (p<0.01). CONCLUSION: Speech intelligibility of children with isolated cleft palate does not significantly differ from that of children with combined cleft type including the palate, as has been objectively quantified for the first time by objective methods. In the presence of speech disorders, the need for diagnosis and therapy is just as great in children with isolated cleft palate as in children with combined cleft types.

[The influence of conductive hearing loss on DPOAE-threshold. The effect of an individually optimized stimulation]. / Der Einfluss einer Schallleitungsstörung auf die DPOAE-Schwelle. Möglichkeiten einer individuell optimierten Auslösung.

BACKGROUND: The DPOAE-threshold, estimated from extrapolated I/O functions, allows an objective assessment of the mechanical sensitivity of the inner ear. In children, the specificity of this diagnostic tool is impaired by conductive hearing loss. METHODS: In this study, we propose an individual optimization of the primary tone level ratio. This procedure allows the detection of a conductive hearing loss that can be accounted for when estimating the DPOAE-threshold. By means of a simulation using DPOAE-data from 22 normally hearing subjects, the effects of this procedure on the estimation of the DPOAE-threshold are examined. RESULTS: An individually optimized DPOAE stimulation distinctly improves the signal-to-noise ratio of the DPOAE which enables an estimation of the DPOAE-threshold for sound conductive losses up to 15 dB. The DPOAE-threshold only worsens in individual cases. CONCLUSIONS: An individually optimized stimulation paradigm may improve the specificity of inner ear diagnostics with the DPOAE-threshold. A clinical evaluation of the method in children, however, is necessary.

[Hearing impairment in children and adolescents with Down's syndrome]. / Hörvermögen bei Kindern und Jugendlichen mit Down-Syndrom.

BACKGROUND: There are controversial opinions about the incidence of hearing impairment of children and adolescents with Down's syndrome as an additional cause for obstruction in social and communicative live. Next to congenital diseases of the inner ear, functional limitations can often lead to conductive hearing disorders in patients with Down's syndrome. PATIENTS AND METHODS: The hearing ability, otoscopic and audiometric characteristics of 115 patients aged 3.2+/-2.9 years were analysed retrospectively over 42 months. RESULTS: A total of 86 children showed morphologic otoscopic peculiarities: transitory evoked otoacoustic emissions (TEOAE) were often non-reproducible, even in patients with normal hearing abilities(14.1% of cases), and were not evaluable in 32.8% of cases. Half of the patients showed hearing loss, 82% of whom suffered from a conductive hearing loss, 6.9% from a combined, and 8.6% from isolated sensorineural hearing loss. Hearing loss was first diagnosed when the children were 4.6+/-3.4 years old. CONCLUSION: The frequent occurrence of hearing loss justifies and requires an early and continuous pedaudiological examination. As a common screening examination, TEOAE is limited due to its cost, however, it fulfils its purpose as a means of distinguishing healthy children from those with possible hearing disorders. In most cases, objective and subjective audiometric methods must be combined in order to precisely define the hearing ability.