["Ear rage": misophonia : Review and current state of knowledge]. / "Wut im Ohr": Misophonie : Übersicht und aktueller Wissensstand.

Misophonia is a devastating disorder. It is known as an affective sound-processing disorder characterized by the experience of strong negative emotions (e.g., anger, distress) in response to human sounds such as eating/swallowing/breathing. Other sounds produced by humans but not directly by human bodies can also be misophonic triggers (e.g. pen clicking) or environmental sounds (animal sounds/sounds of machines). The type of aversive triggers is individual. The reaction to trigger sounds can depend on many factors, such as assessment of the sound, personal experience, social context or psychological profile. However, there is currently no consensus in defining misophonia. Misophonia is also not yet classified by any official diagnostic system, although it seems to be a separate disorder. There are also associations with other disorders such as activity disorders, tinnitus, hyperacusis, and autism spectrum disorders. In 2013, the first definition criteria were published for the diagnosis of misophonia. Specifically, fMRI showed abnormal activation of the anterior insular cortex (AIC) and other brain areas responsible for the processing and regulation of emotions. To date, no randomized controlled trials evaluating treatments have been published. The use of cognitive and behavioral interventions have been reported as well as external sound systems and sound masking systems as known in the tinnitus retraining therapy. Sufferers try to minimize the trigger sounds by wearing ear plugs or music headphones. Otolaryngologists may also encounter patients with symptoms of misophonia, e.g., when hearing screening is requested or advice should be given on different therapeutic options. This report provides an overview of the current state of knowledge in misophonia and its diagnosis and treatment.

[Surgical reconstruction in laryngeal carcinoma]. / Chirurgische Rekonstruktionen beim Larynxkarzinom.

Tumors of the larynx can substantially impair vocal function, breathing and also swallowing. The primary goal of reconstructive surgical treatment of laryngeal tumors is to sufficiently resect the tumor while minimizing the effects of the treatment on the voice, breathing and swallowing. In general, primary reconstructions in primary laryngeal surgery have many advantages. The tissue at this point in time is soft because the scarring process has not yet been initiated. A better prerequisite for a sufficient glottic closure can also be expected through the immediate adjustment of the volume of the vocal folds; however, reconstructive treatment can also be carried out secondarily. Different methods of reconstructive surgery for laryngeal carcinoma are presented and discussed.

[Feeding, eating, and swallowing disorders in infants and children : An overview]. / Fütter­, Ess- und Schluckstörungen bei Säuglingen und Kindern : Ein Überblick.

Swallowing is a dynamic process that requires more than 30 muscles in the recruitment/coordination of the lips, tongue, palate, pharynx, larynx and esophagus. The eating and swallowing procedure is learned in sensitive or critical periods: when a certain degree of maturation has been achieved, the appropriate stimulus permits a certain milestone of development to occur. The swallowing procedure occurs in three main stages oral, pharyngeal, and esophageal. Therefore, swallowing disorders may present in any, some, or all of these stages in addition to feeding problems. Adult dysphagia, or difficulty swallowing, has long been reported in the literature. Infants and children also experience feeding disorders and swallowing problems, either because of developmental disorders, syndromes, behavioral or neurological conditions, respiratory problems, and/or gastroesophageal reflux, eosinophilic esophagitis or anatomical deficits. Feeding problems or dysphagia are seen in up to 25% of all children; approximately 40% of prematurely born infants have swallowing disorders, up to 64-78% with developmental disorders and up to 99% with cerebral palsy. Diagnostic options include health status, broad social environment, parent-child interactions, and parental concerns. Evaluation of dysphagia and feeding disorders involves a multifactorial approach. Imaging studies may include videofluoroscopy and/or fiberoptic evaluation of swallowing (FEES). Successful oral feeding must be measured in quality of meal time experiences with best possible oral sensorimotor skills and safe swallowing while not jeopardizing a child's functional health status or the parent-child relationship. An interdisciplinary team approach enables coordinated global assessment and therapy planning.

[Medication-induced dysphagia : A review]. / Medikamenteninduzierte Dysphagien : Ein Überblick.

As a highly differentiated physiological process, swallowing may be affected by a variety of confounding factors. Primarily described are swallowing disorders caused by mechanical anatomic changes (e. g., alteration of the cervical spine, goiter), surgery for head and neck tumors, thyroid abnormalities, and neuromuscular disorders. Age-related cerebral neurological and blood vessel-associated changes can also cause dysphagia (so-called presbyphagia) or worsen the condition.Medication-associated dysphagia is recognized far less frequently, not paid due attention, or accepted in silence; particularly in older patients. Furthermore, pharmacological interference of different medications is frequently inadequately considered, particularly in the case of polypharmacy.Initial treatment of medication-induced dysphagia includes a critical review of medication status, with the aim of reducing/discontinuing the causative medication by giving precise instructions regarding its administration; as well as antacid medication, diet, and professional oral stimulation or swallowing training.To date, medication-induced dysphagia has not occupied the focus of physicians and therapists. This is despite the fact that many active agents can have a negative effect on swallowing and medication-induced dysphagia caused by polypharmacy is not uncommon, particularly in old age. This article presents an overview of the different classes of drugs in terms of their direct or indirect negative effects on the swallowing function.

[Position paper of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery and the German Society of Phoniatrics and Pediatric Audiology - current state of clinical and endoscopic diagnostics, evaluation, and therapy of swallowing disorders in children and adults]. / Positionspapier der DGHNO und der DGPP - Stand der klinischen und endoskopischen Diagnostik, Evaluation und Therapie von Schluckstörungen bei Kindern und Erwachsenen.

Position Paper of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery and the German Society of Phoniatrics and Pediatric Audiology - Current State of Clinical and Endoscopic Diagnostics, Evaluation, and Therapy of Swallowing Disorders in Children and AdultsSwallowing disorders are frequent. The main concern is mortality due to aspiration induced pneumonia and malnutrition. On the other hand quality of life is severely affected. The demographic trend indicates an increase of dysphagia in the future. Neurodegenerative diseases, tumors of the digestive tract and sequelae of tumor treatment in the head and neck region are the main pathologic entities.Predominantly ENT physicians and phoniatrists, are asked for diagnostics and therapy who will coordinate the interdisciplinary treatment according to the endoscopic findings.A differentiated approach in history, diagnostics, and symptom oriented treatment is necessary for the mostly complex disorders. The integration of non-medical personnel such as logopeds (speech language pathologists), physiotherapists, and occupational therapists in planning and executing an effective therapy expands and completes the patient-oriented care. Conservative treatment by these therapists is an important pillar in the treatment. Parts of the specific diagnostics can be taken over by them in close cooperation.In particular an interdisciplinary cooperation with the staff from intensive care medicine is indispensable.The diagnostic procedures of specific endoscopy as described in this position paper are part of the primary and fundamental tasks of ENT specialists and phoniatrists.Endoscopy is a medical service that is basically not delegable. Consequently substitution of the physician is precluded.

[Inducible laryngeal obstruction vs. bronchial asthma]. / Belastungsinduzierte laryngeale Obstruktion in Abgrenzung zum Asthma bronchiale.

UNLABELLED: Inducible Laryngeal Obstruction vs. Bronchial -Asthma Background: Inducible laryngeal obstructions (ILO) represent paroxysmal and sometimes severe dyspnea caused by different factors. Symptomatically ILO resembles bronchial asthma and is therefore often misdiagnosed. In the following 3 cases regarding a special type of ILO, the exercise induced laryngeal obstruction (EILO) will be presented. It will also be demonstrated, how EILO can be diagnosed and differentiated from bronchial asthma. METHOD: Laryngeal symptoms were provoked by spiroergometry (treadmill or bicycle) and inspected by laryngoscopy. RESULTS: Symptoms could be provoked in all of the 3 patients by either treadmill or bicycle spiroergometry. When a stridor occurred, usually 1.5-2 min after the anaerobe threshold had been exceeded, spiroergometry showed a decline or plateau of carbon dioxide emission and oxygen intake. Laryngoscopy revealed adduction of the vocal cords during inspiration occa-sionally with a collapse of supraglottic structures towards the endolarynx. DISCUSSION: This article is the first to report that EILO can be distinctly depicted by spiroergometry. The decline or plateau in oxygen and carbon dioxide curves in coordination with the onset of stridor, approximately 1.5-2 min after the anaerobe threshold had been exceeded, was found to be reproducible in all cases. Furthermore, endoscopy immediately following peak exhaustion represents a practical tool for the identification of EILO.·

[Swallowing and dysphagia in the elderly]. / Schlucken und Schluckstörungen im Alter.

Disturbances of the swallowing process can occur at any age and might lead to choking. However, the risk of dysphagia increases with advanced age. This is not only due to a higher incidence of diseases that cause dysphagia, but also to age-related changes in the mechanisms of swallowing. Aging affects all of the anatomic structures involved in the swallowing process. Important changes include limitations to mastication, delayed triggering of the swallowing reflex, expansion of pharyngeal structures, prolonged pharyngeal propulsion, loss of pharyngeal sensitivity, increased rigidity of the esophageal wall and reduced esophageal contractility. Changes in swallowing function caused by aging alone are termed presbyphagia. If these changes are so severe that their compensation is no longer possible, presbydysphagia occurs. For diagnostic and therapeutic purposes it is mandatory to evaluate presbyphagic and presbydysphagic changes in the swallowing process, and to distinguish these from other non-age-related causes of dysphagia.

[Physiology of the upper esophageal sphincter]. / Physiologie des oberen Ösophagussphinkters.

The upper esophageal sphincter (UES) forms a barrier between the pharynx and the esophagus. When opened, the UES allows the food bolus to pass into the esophagus, as well as permitting emesis and eructation. The basal sphincter tone constitutes a barrier function which serves to prevent reflux and passive aerophagia in the case of deep breathing. Basal sphincter tone is dependent on several influencing factors; during swallowing, sphincter opening and closure follow a complex multiphase pattern. This article presents an overview of the current understanding of UES physiology.

[Anatomy of the upper esophageal sphincter]. / Anatomie des oberen Ösophagussphinkters.

The upper esophageal sphincter (UES) forms a barrier between the pharynx and the esophagus. When closed, the barrier function serves to prevent reflux and aerophagia; when open, swallowing, belching and vomiting are possible. The closing muscles include caudal parts of the inferior pharyngeal sphincter and cranial parts of the upper esophagus musculature. Sphincter opening is achieved by muscles that insert from the outside to connect to the larynx and pharynx in the sphincter region. The closing muscles are innervated by branches of the glossopharyngeal and vagal nerves, and central control is probably mediated by several reflexes. This article presents an overview of the current understanding of the complex UES anatomy.

[Infantile swallowing]. / Frühkindliches Schlucken.

BACKGROUND: Increasing numbers of preterm infants 1 and ever-improving potentials in neonatal medicine will lead to a rising incidence in infantile feeding problems. Profound knowledge regarding the development and anatomy of pre- and postnatal swallowing functions is essential for the assessment and therapy of infantile feeding and swallowing problems. METHOD: For this systematic review a selective literature research in PubMed has been carried out. RESULTS: Oropharyngeal structures and oral-motor skills for sucking and swallowing develop during embryonic and foetal stages and enable postnatal oral feeding. Knowledge of pre- and postnatal developmental stages of oral-motor development and swallowing serves as a base for the assessment of preterm infants' abilities and tolerance for feeding. A direct comparison of the swallowing process between infants, children and adults is not possible due to different anatomical characteristics. Developmental processes and neurologically triggered coordination procedures of early feeding skills are complex and very susceptible to faults. Disruption can cause severe disorders of swallowing coordination. Feeding problems are a common problem in preterm infants. Differentiated assessments on the basis of these results and early intervention facilitating oral-motor skills can accelerate the transition from tube to oral feeding and prevent further feeding issues.

[Guideline-conform diagnostics in language impairments]. / Leitliniengerechte Diagnostik bei Spracherwerbsstörungen.

In order to distinguish more accurately and easily between language difficulties in need of therapy or special support versus language impairments a S2K guideline was developed by interdisciplinary teams of different (medical) societies and professional associations. This guideline was published in 2011 and has replaced all existing monodisciplinary guidelines. According to the new S2K guideline standardised measures of language testing are mandatory. Apart from reviewing the S2K guidelines, this article aims to suggest how these guidelines can be established in clinical practice. By closely following this new guideline, testing and diagnosing children with language difficulties is believed to be enhanced considerably, and also comply with quality management standards.

[Neuromuscular electric stimulation therapy in otorhinolaryngology]. / Neuromuskuläre Elektrostimulationsverfahren in der HNO-Heilkunde.

BACKGROUND: Animal experiments have shown that after specific nerve traumatization, neuromuscular electrostimulation (NMES) can promote nerve regeneration and reduce synkinesia without negatively interfering with normal regeneration processes. NMES is used routinely in physical rehabilitation medicine. METHODS: This systematic literature search in the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, the DAHTA database, the Health Technology Assessment Database and MEDLINE or PubMed considered studies on the use of NMES in otorhinolaryngology that have been published in German or English. RESULTS: The search identified 180 studies. These were evaluated and relevant studies were included in the further evaluation. DISCUSSION: In the fields of otorhinolaryngology and phoniatry/paediatric audiology, clinical studies investigating the effects of NMES on facial and laryngeal paresis, as well as dysphonia and dysphagia have been carried out. The evidence collected to date is encouraging; particularly for the treatment of certain forms of dysphagia and laryngeal paresis.

[Gonosomal trisomy syndrome. Five case reports and review of literature]. / Gonosomale Trisomien. Fünf Fallberichte mit Literaturübersicht.

Gonosomal trisomies (GT) or so called sex chromosome trisomies (SCTs) are the most common chromosomal abnormalities in humans. The addition of extra X and/or Y chromosomes leads to neurodevelopmental differences, with increased risk for developmental delays, cognitive impairments, executive dysfunction, and behavioural and psychological disorders. Attentional problems, hyperactivity, autistic spectrum disorders and impulsivity are commonly described. Rates of language and communication problems are high in all 3 trisomies. Especially in cases of language impairment ENT specialists may be the main contact to rule out hearing loss. Here, we present 5 patients with SCT. In 2 boys and a young man, SCT was already known (47,XXY; 47,XYY; 47,XYY), in 2 cases we initiated genetic investigation (47,XXX; 47,XXY). Main symptom of the 4 children was a language delay; the young man reported had a history of mild language and motor coordination delay, too. Main complaints of the adult patient were problems with speech-in-noise perception. Furthermore 2 of the patients had mild facial dysmorphic features. The prognosis of the development in patients with SCT is variable, depending on severity of the manifestations and on quality and timing of treatment. Furthermore, in children with motor development/language delay a chromosomal analysis may be initiated at least at the request of the parents to clarify the etiology of developmental abnormalities. If the suspicion of hearing impairment as the cause of problems is not confirmed in a patient, ENT specialists should also consider SCA as a possible cause in the differential diagnosis.

[Tetrasomy 18p syndrome and hearing loss. An unusual case]. / Tetrasomie 18p und Innenohrschwerhörigkeit. Ein ungewöhnlicher Fall.

Tetrasomy 18p is a rare chromosomal disease (1:140,000 live births), which affects females and males equally, and might be hereditary or caused by spontaneous changes (de novo formation) within the chromosome. The phenotype results from the presence of a small extra metacentric marker chromosome, an isochromosome 18p. The syndrome is characterized by mild-to-moderate mental retardation, poor language acquisition, seizures, microcephaly, short statue, minor facial dysmorphic features, congenital heart diseases, uro/renal malformations, abnormal muscle tone, spasticity of the lower limbs, and delayed ability to stand and walk. To our knowledge sensorineural hearing loss is described in the literature but has not been described as a typical phenotypic symptom of tetrasomy 18p.In the following report, a boy with tetrasomy 18p is described. In addition to psychomotor retardation with muscular hypotonia and orofacial dismorphysms, bilateral severe hearing loss was diagnosed. Thus, in all infants with known chromosomal aberration, early diagnostic procedures must be performed to unveil sensorineural hearing loss that might be overseen because of mental retardation. In particular, a brainstem-evoked response audiometry (BERA) should be considered for early diagnosis and treatment of possible hearing loss. Furthermore, in all children with developmental delay and dysmorphic features a chromosomal analysis should be initiated.

[Genetic causes in mild speech acquisition delay with/without mild developmental delay: significance for ENT physicians]. / Genetische Ursachen bei Störungen der Sprachentwicklung mit/ohne allgemeine Entwicklungsstörung : Bedeutung für HNO-Arzte.

Mental retardation (MR) has a prevalence of about 2%, and developmental speech disorders with unknown cause about 7%. Very often, developmental delay represents an early warning sign of later developmental problems, such as mental retardation and other developmental disorders (DD). Prognosis depends on many factors, most notably the limiting factor provided by the severity of the underlying brain dysfunction and its consequences for communication, cognition and other behaviour. Chromosomal aberrations are the major cause of MR and also play a role in mild forms of DD and speech acquisition delay. ENT specialists are confronted with children with DD or language acquisition disorders. If the suspicion of hearing impairment as the cause of problems in daily life is not confirmed in a patient, ENT specialists should also consider genetic causes in the differential diagnosis.

[Autism spectrum disorders. Current knowledge and importance for ENT specialists]. / Autistische Kommunikationsstörungen. Aktueller Wissensstand und Bedeutung für HNO-Arzte.

Autism is a behavioural syndrome, present from early life and defined by deficient social interaction, language and communication, and play. Variations in symptomatology and in prognosis among characteristic persons display a variety of other signs such as attention deficits, mental retardation and seizures that are not specific to autism and that denote dysfunction in other brain systems. Its aetiology is unknown in the vast majority of cases. There is a small minority of persons in whom autism has a known aetiology, such as fragile X chromosome abnormality, congenital rubella, tuberous sclerosis and a variety of structural abnormalities and metabolic diseases of the brain. A causal treatment is so far not possible, and there remains a regrettable lack of evaluated treatment standards. Prognosis depends on many factors, most notably the limiting factor provided by the severity of the underlying brain dysfunction and its consequences for communication, cognition and other behaviour. ENT specialists are confronted with children, adolescents and even adults in whom autistic disease has already been diagnosed in the course of investigations/treatment. If the suspicion of hearing impairment as the cause of problems in daily life is not confirmed in a patient not hitherto known to have autism ENT specialists should also consider autism in the differential diagnosis. In this report the diagnostic and therapeutic strategies currently applied for autism and its importance for ENT specialists are presented.

[Hearing aid fitting in children with difficulties processing auditory information-evaluation of parents' satisfaction]. / Hörgeräteversorgung bei Kindern mit Hörschwierigkeiten trotz eines normalen peripheren Hörvermögens--Erfassung der elterlichen Zufriedenheit.

BACKGROUND: Some children suffer from difficulties processing auditory information despite normal cochlear function. Here we raised the question if hearing aid (HA) fitting might be beneficial for such children. METHODS: 32 children with auditory information processing deficits were fitted with HA. Three months after fitting parents were asked about individual benefits for hearing behavior using a questionnaire. RESULTS: Parents' rating indicated a significant improvement of auditory information processing after HA fitting. A high internal consistence of subscales except for loudness perception was found. CONCLUSIONS: According to the data presented it seems reasonable to assume that hearing aids may ameliorate adverse affects of auditory processing deficits. Further studies supporting these findings and possibly including an audiometric proof are warranted.

[Attention deficit and hyperactivity disorder: what is currently known and its significance for ENT specialists]. / Störungen der Aufmerksamkeit und Aktivität (ADHS): Aktueller Wissensstand und Bedeutung für HNO-Arzte.

Attention deficit hyperactivity disorder (ADHD) is a behavioural disorder characterised by marked problems with inattention and increased impulsiveness, with or without hyperactivity; in most cases it becomes obvious in nursery-school-age children, and the latest point for its initial appearance is while the child affected is at primary school. Even in children of normal intelligence, the cognitive, emotional, and social development is decidedly limited, which can have corresponding ramifications for adult life. If left untreated it can progress to dissocial development and give the impression of an impulsive personality disorder in adulthood.ENT specialists are also confronted with children, adolescents and even adults in whom ADHD has already been diagnosed in the course of investigations/treatment. If the suspicion of hearing impairment as the cause of problems in daily life is not confirmed in a patient not hitherto known to have ADHD ENT specialists should also consider ADHD in the differential diagnosis. In this report the diagnostic and therapeutic strategies currently applied for ADHD and their importance for ENT specialists are presented.