Short latency and long latency auditory evoked responses in children with attention deficit disorder.

INTRODUCTION: Children diagnosed with attention deficit disorder (ADD) can present with different abnormalities in electrophysiological studies. OBJECTIVE: The purpose of this paper is to compare brainstem auditory (short latency) evoked responses (BSAER) and long latency auditory evoked responses (LLAER) in school children with and without ADD. MATERIALS AND METHODS: A normative study was carried out, 20 normal subjects were studied. All these patients underwent a study protocol including BSAER and LLAER. Eighteen school children diagnosed as ADD were included in the active group. Eighteen school children were selected as controls. All children from both groups underwent BSAER and LLAER. BSAER and LLAER results from both groups of patients were compared. RESULTS: Brainstem transmission was significantly longer in children with ADD. The latency of P300 was significantly longer in children with ADD. Also, mean amplitude of P300 was significantly decreased in children with ADD. CONCLUSION: The results of this study indicates that school children with ADD show significant abnormalities in BSAER and LLAER. These electrophysiological procedures involving the auditory system can be useful for the diagnosis of children with ADD.

Mothers of children with cleft palate undergoing speech intervention change communicative interaction.

INTRODUCTION: Natural learning must include language learning relationships that provide natural support for communication and language learning. OBJECTIVE: To find out if including the mother as an active participant during speech therapy sessions would improve the communicative style and mode of the interaction of the mothers with their cleft palate children. MATERIALS AND METHODS: Fifty-nine children with cleft palate and their mothers were included in the study group. The patients were divided into two groups randomly. Patients received the same treatment. Twenty-eight of the children were included in the control group. They participated in small working groups comprising the speech pathologist and two children. Thirty-one of the children were included in the experimental group. In this case, the mothers of the children were also included as active participants. The mothers of the patients from the two groups were assessed at the beginning and end of the speech therapy period to find out their style and mode of interaction. Pre- and post-data of the mothers from both groups were compared. RESULTS: Eighty-nine per cent of the mothers of the experimental group modified their patterns of interaction. In contrast, only 19% of the mothers of the control group modified their style and mode of interaction. A Fisher exact test demonstrated that the frequency of mothers from the experimental group that modified their style and mode of interaction was significantly greater as compared to the number of mothers from the control group that were able to modify their style and mode of interaction. CONCLUSIONS: Mothers of children with cleft palate and accompanying language delay modify their communicative style and mode of interaction through active participation in speech therapy.

Surgical treatment of submucous cleft palate: a comparative trial of two modalities for palatal closure.

Submucous cleft palate is a congenital malformation with specific clinical and anatomical features. It can be present with or without velopharyngeal insufficiency. Surgical treatment of this malformation is indicated only when velopharyngeal insufficiency has been demonstrated. This article compares two modalities of surgical treatment for submucous cleft palate. The first includes a minimal incision palatopharyngoplasty, as described in a previous report. The second combines the first technique with additional individualized velopharyngeal surgery (individualized pharyngeal flap or sphincter pharyngoplasty) performed simultaneously. The individualized part of the procedure was selected and performed according to the findings of videonasopharyngoscopy and multiview videofluoroscopy, as reported previously. Two hundred and three patients with submucous cleft palate were studied from 1990 to 1999. Videonasopharyngoscopy and multiview videofluoroscopy demonstrated velopharyngeal insufficiency in 72 patients, who were randomly divided into two groups. Those in group 1 (n = 37) underwent a minimal incision palatopharyngoplasty. Patients in group 2 (n = 35) also underwent that procedure but simultaneously received individualized pharyngeal flap or sphincter pharyngoplasty, according to the findings of videonasopharyngoscopy and multiview videofluoroscopy. The median age of the patients from both groups was not significantly different (p > 0.5). The frequency of residual velopharyngeal insufficiency after palatal closure was not significantly different in both groups of patients (14 percent versus 11 percent; p > 0.5). The mean size of the gap at the velopharyngeal sphincter during speech was not significantly different in both groups of patients before surgery (23 percent versus 22 percent; p > 0.5). After the surgical procedures, there was a nonsignificant difference between both groups of patients in mean residual size of the gap in cases of velopharyngeal insufficiency (7 percent versus 8 percent; p > 0.5). It seems that minimal incision palatopharyngoplasty is a safe and reliable procedure for palatal closure in patients with submucous cleft palate. The use of additional individualized velopharyngeal surgery performed simultaneously did not seem to decrease the frequency of residual velopharyngeal insufficiency. Moreover, the residual size of the gap at the velopharyngeal sphincter was not significantly reduced when an additional surgical procedure was performed simultaneously with palatal closure.

Evaluation of the vestibular autorotation test (VAT) for measuring vestibular oculomotor reflex in clinical research.

BACKGROUND: A method is needed to measure parameters of vertigo and disequilibrium. Our objective was to ascertain whether the vestibular autorotation test (VAT) gives numerical data on the vestibular oculomotor reflex (VOR) that are useful for clinical research. METHODS: A VAT was carried out on 17 healthy young volunteers twice, with an interval of 7 days (group A), and on a single occasion on another 17 volunteers of similar age and health (group B). The parameters studied were vertical and horizontal gains and phases and horizontal eye velocity symmetry. The resulting values were paired inter-session in the same individuals of group A, and between the first test of group A with the test in group B, chosen at random. Variances for the sets of numbers in each parameter as a whole and for each frequency of stimulation were calculated and statistical validity was determined. RESULTS: No significant differences were found between the inter-session and inter-individual results. Variances of gain (horizontal and vertical) were small, but variances of phase and symmetry were large. An analysis of frequencies of stimulation revealed that variances increased with the elevation of frequency. CONCLUSIONS: For clinical research and evaluation, the VAT affords sufficiently consistent figures for vertical and horizontal gain in the entire spectrum of frequencies tested (2-5.9 Hz) and for horizontal phases between 2-3.9 Hz. Vertical phases and horizontal asymmetry vary too greatly for our stated purpose.

Active participation of mothers during speech therapy improved language development of children with cleft palate.

Whole language intervention uses the principles of natural language learning, which consider language not as an independent system but as a system intimately related to other cognitive and social abilities. This paper compares the outcome of speech therapy given in different settings to two groups of children with cleft palate. Those in the first group were treated by the speech pathologist alone (control group), whereas those in the second group were treated by the speech pathologist but were also accompanied by their mothers (experimental group). The purpose of this study was to find out if including the mother as an active participant in speech therapy sessions would improve the language development of children with cleft palate who also had additional language delays. Both groups were evaluated before and after treatment to evaluate the advance of each group. The patients accompanied by their mothers had significantly better language skills compared with patients treated without their mothers. The results support the statement that language development is related to mother-child mode of daily life interaction in children with cleft palate.

Restoration of facial contour in Romberg's disease and hemifacial microsomia: experience with 118 cases.

The experience with free flaps and conventional reconstructive procedures for 118 patients with Rombergapos;s disease and hemifacial microsomia over a 10-year period is presented. The groin free flap was used most frequently for patients with Rombergapos;s disease, whereas the scapular free flap was used for patients with hemifacial microsomia. The rectus abdominis or the latissimus dorsi free flap was chosen only when additional volume was required. To achieve better contour, secondary procedures, such as defatting the flap, pedicled temporal fascial flaps, cartilage and bone grafts, orthognathic surgery, and bone distraction were performed in severe cases. For patients with Rombergapos;s disease, excellent results were achieved in 35% (n = 28) of mild cases, in 72% (n = 27) out of 38 moderately and in 41% (n = 5) out of 12 severely affected patients. In hemifacial microsomia group (n = 40) excellent results were obtained in 66% of cases.

Free flaps for head and neck reconstruction in non-oncological patients: experience of 200 cases.

Two hundred free flaps for reconstructing the head and neck regions in 192 patients with non-oncological pathology were studied. Pathological entities included Romberg's disease, hemifacial microsomia, acquired facial palsy, trauma, and burn sequelae. Indications for selecting a specific free flap for reconstructing each case, details of anastomoses, reexploration, flap success, operative time, length of hospitalization, and complications were studied. The long-term results of cosmetic and function were also obtained. Patient age ranged from 6 to 40 years. The most common diagnosis was Romberg's disease 39% (n = 75), followed by hemifacial microsomia 20% (n = 40). The free flap most frequently used was the scapular 32% (n = 64), followed by the groin free flap 21% (n = 42). A total of 190 flaps (95%) were successful, whereas only 10 (5%) were lost. The mean operative time was 5:30 h and the average hospital stay was only 6 days. There were no major complications and no deaths in the study group. The patients were followed for at least 1 year in all cases. It is concluded that free flaps are safe and reliable procedures for reconstructing complex head and neck non-oncological defects.

Linguistic development in cleft palate patients with and without compensatory articulation disorder.

INTRODUCTION: Cleft palate patients frequently show compensatory articulation disorder (CAD). CAD severely affects speech intelligibility and requires a prolonged period of speech intervention. CAD has been considered a phonologic disorder. Thus, it seems necessary to explore the relationship between CAD and language development. OBJECTIVE: To study the relationship between language development and the presence of CAD in cleft palate patients. MATERIALS AND METHODS: Cleft palate children with residual velopharyngeal insufficiency (VPI) after palatal closure, with and without CAD were studied. Only patients with an age ranging from 3 to 8 years were included in the study group. Twenty-nine cleft palate patients with residual VPI and CAD were included in the first group (active). The second group was assembled with 29 cleft palate patients with residual VPI without CAD, matched by age and sex (control). For evaluating language development, all patients were analyzed using the Situational-Discourse-Semantic (SDS) Model [13]. This Model is a valuable tool for conducting naturalistic observation and descriptive assessment of language development. The SDS Model provides a detailed description of three contexts (situational, discourse, and semantic) in ten levels of cognitive and linguistic organization. RESULTS: In all contexts considered by the model of cognitive and linguistic organization used for this study, i.e. SDS, a Fischer exact test demonstrated that patients with CAD showed a significantly higher frequency of language delay as compared with patients without CAD. None of the patients present with CAD showed an adequate level of language development. The degree of language delay was greater in the situational context as compared to the semantic and discourse contexts. CONCLUSIONS: Cleft palate patients present with CAD, demonstrated a significantly higher frequency of delay in language development as compared with cleft palate patients present with VPI without CAD. From the results of this paper, it seems that a detailed evaluation of all aspects of cognitive and linguistic organization should be performed in cleft palate patients, especially in patients present with CAD. Moreover, it seems that speech intervention in cleft palate patients with CAD should address not only the articulation process, but also specific aspects of language development.

A comparative trial of two modalities of speech intervention for compensatory articulation in cleft palate children, phonologic approach versus articulatory approach.

To compare two modalities of speech intervention (SI) in cleft palate children with compensatory articulation disorder (CAD). The first modality was a phonologic based intervention, the second modality was an articulatory or phonetic intervention. The main purpose is to study whether a phonologic intervention may reduce the total time of speech therapy necessary for correcting CAD in cleft palate children as compared to an articulatory intervention. A prospective, comparative, and randomized trial was carried out. Cleft palate children with velopharyngeal insufficiency and CAD were included in the study group. Only patients with an age ranging from 3 to 7 years were included. A total of 29 patients were selected and were divided randomly into two groups. Fifteen patients were included in the first group (control) and received articulatory SI. Fourteen patients were included in the second group (active) and received phonologic SI. The speech pathologist in charge of the SI was the same in all cases. A blind procedure was utilized whereby each patient was evaluated independently by two speech pathologist every three months until both examiners were convinced that CAD had been completely corrected. The mean total time of SI required for the normalization of speech in the two groups of patients was compared. Median age in the control group was 54 months, and 55.50 months in the active group (P > 0.05). The mean total time of SI in the control group was 30.07, and 14.50 in the active group. A Student's t-test demonstrated that the total time of SI was significantly reduced (P < 0.001) when a phonological intervention was utilized. Phonologic based SI significantly reduced the time necessary for correcting CAD in cleft palate children.

Velopharyngeal motion after sphincter pharyngoplasty: a videonasopharyngoscopic and electromyographic study.

Sphincter pharyngoplasty is a surgical procedure for managing velopharyngeal insufficiency after palatal closure. This procedure is intended to create an active diaphragm for velopharyngeal closure. The purpose of this study was to evaluate velopharyngeal motion after sphincter pharyngoplasty, by using selective electromyography and simultaneous videonasopharyngoscopy. Twenty-five patients who were subjected to sphincter pharyngoplasty from 1985 to 1996 were reviewed. All conditions were evaluated by using electromyography with simultaneous videonasopharyngoscopy. The following velopharyngeal muscles were examined: superior constrictor pharyngeus, palatopharyngeus, and levator veli palatini. The palatopharyngeus was included in the superiorly based surgical flaps inserted at the posterior pharyngeal wall. Twenty-three patients (92 percent) showed complete velopharyngeal closure. The two patients with residual velopharyngeal insufficiency showed a defect size of 20 and 25 percent. None of the patients showed electromyographic activity at the superiorly based flaps, indicating absence of activity of the palatopharyngeus muscles. However, all patients showed normal electromyographic activity at the superior constrictor pharyngeus and the levator veli palatini. Videonasopharyngoscopy demonstrated that lateral pharyngeal wall movements, which ranged from 25 to 40 percent, were related to strong electromyographic activity at the superior constrictor pharyngeus. It is concluded that the superiorly based pharyngeal flaps of the sphincter pharyngoplasty do not seem to create an active diaphragm for velopharyngeal closure. Moreover, the observed sphinctering seems to be passive, caused by the contraction of the superior constrictor pharyngeus.

Frontotemporal fasciocutaneous island flap for facial aesthetic subunit reconstruction.

The frontotemporal fasciocutaneous island flap is a useful source of tissue for correcting aesthetic units of the face. The quality of the tissue may be enhanced, and a successful color and texture match may be achieved. This flap is based on the temporal vessel system and its own fascia. Its provides excellent venous drainage and its pedicle length and arc of rotation may be increased. The donor scar is hidden under the hair-bearing area. The frontotemporal fasciocutaneous island flap was used in patients with inferior eyelid defects, for cheek reconstruction, for providing coverage of superior and inferior lip defects, for restoring the normal anatomy of columellar defects, and for reestablishing the contour of menton defects. The frontotemporal fasciocutaneous island flap was employed successfully in 9 patients at the Hospital Gea Gonzalez. The wide treatment possibilities for the reconstruction of aesthetic units in the face with the frontotemporal fasciocutaneous island flap are illustrated.

Effect of contralateral masking on the latency of otoacoustic emissions elicited by acoustic distortion products.

Otoacoustic emissions (OAE) are sound products generated by the outer hair cells (OHC) in the inner ear. The OHC are capable of moving spontaneously or in response to acoustic stimuli (spontaneous otoacoustic emissions and evoked otoacoustic emissions), these movements are known as electromotility. Electromotility is affected when contralateral acoustic stimulation is introduced to the ear. Different types of stimuli may produce this response. Clicks, pure tones, and white masking noise have been used as contralateral stimulation. This effect appears to be mediated by the medial efferent olivocochlear bundle. Contralateral masking produces suppression of OAE, especially on the amplitude. However, the effect of contralateral masking on the latency of distortion product otoacoustic emissions (DPOAE) has not been studied. The purpose of this paper is to investigate whether contralateral masking, with wide band masking noise, may produce a significant change on the latency of the DPOAE. Three different latency measurements of DPOAE measurements were made on low, middle and high frequencies of fl including 574 Hz, 2454 Hz and 4919 Hz. Each one of these frequencies was measured with and without contralateral masking. Twenty-eight ears of 15 subjects were studied. Non-significant differences (P > 0.05) between masked and unmasked conditions were found in all cases. It is concluded that contralateral masking does not appear to affect latency of DPOAE.

Speech outcome and maxillary growth in patients with unilateral complete cleft lip/palate operated on at 6 versus 12 months of age.

A prospective study of speech outcome and maxillofacial growth was carried out in cleft palate patients. Seventy-six cleft palate patients were randomly selected for the study group; 41 patients were operated on at 12 months of age, and 35 patients were operated on at 6 months of age. All patients were followed until they were 4 years of age. All patients underwent a complete speech evaluation, videonasopharyngoscopy, videofluoroscopy, and maxillofacial assessment. The rate of velopharyngeal insufficiency did not differ between the two groups (17 to 19 percent; p > 0.05). However, phonologic development was significantly better (p < 0.05) in the patients operated on at 6 months of age. Furthermore, none of the patients operated on at 6 months of age showed compensatory articulation disorder. In contrast, 62 percent of the patients with postoperative velopharyngeal insufficiency operated on at 12 months of age showed compensatory articulation disorder (p < 0.05). Maxillofacial assessment showed that there were non-significant differences (p > 0.05) in maxillofacial growth in both groups of patients. All patients showed similar degrees of maxillary collapse (p > 0.05). The results of this study suggest that cleft palate repair performed at 6 months of age significantly enhances speech outcome and prevents compensatory articulation disorder.

Videonasopharyngoscopy as an instrument for visual biofeedback during speech in cleft palate patients.

Videonasopharyngoscopy was used as an instrument for visual biofeedback during speech in cleft palate patients. Seventeen cleft palate patients were randomly selected for the study. All patients showed velopharyngeal insufficiency (VPI), compensatory articulation (CA) and negative movement of lateral pharyngeal walls (NMLPW) during speech. Nine patients received speech therapy for correcting CA. Eight patients received speech therapy and underwent videonasopharyngoscopy as an instrument for visual biofeedback of the velopharyngeal sphincter. After 12 weeks, NMLPW was modified in the patients receiving speech therapy and visual biofeedback. In contrast, NMLPW was still present in eight out of nine patients receiving only speech therapy. These patients received visual biofeedback and NMLPW was corrected in all cases. After six months, all 17 patients had corrected CA during isolated speech. All patients received a tailor-made pharyngeal flap. VPI was completely corrected in 15 cases. In the two cases in which VPI was still present postoperatively, the size of the defect at the velopharyngeal sphincter had been significantly reduced. In these two patients, visual biofeedback was used postoperatively for increasing lateral pharyngeal walls (LPW) motion towards the borders of the flap. After 18 months since the onset of speech therapy all the patients had normal nasal resonance and normal articulation during connected speech.

Three different techniques for mandibular reconstruction after hemimandibulectomy.

Mandibular reconstruction is a condition in which both bone defect and function must be restored. A wide range of approaches--from grafts to distant bone flaps--have been used for correcting bony defects. However, adequate mastication has been restored in only a few cases. In this article the results of three different techniques for mandibular reconstruction after hemimandibulectomy were studied. Sixteen patients underwent a second mandibular reconstruction after hemimandibulectomy and were monitored at least 1 year. Three different techniques were used: (1) full-thickness galeoparietal bone flap (eight patients), (2) free iliac crest graft (three patients), and (3) free fibular grafts (five patients). Occlusion on the nonoperated side and the possibility and function of osseointegrated denture in the vascularized bone transfer were evaluated. The full-thickness galeoparietal flap and free iliac crest bone flap appeared to be good options. However, only acceptable or poor occlusion could be achieved on the normal side. The fibular free flap demonstrated good results and good occlusion. Nonetheless, dental implantation was difficult because a prosthesis for reaching the normal height of the mandible was necessary.

Linguistic interaction: the active role of parents in speech therapy for cleft palate patients.

As speech and language intervention becomes more naturalistic, it seems obvious that language and other developmental competencies are, in a strong way, a function of the quality and quantity of relationships in which the child evolves. This paper compares two different speech therapy groups of cleft palate children. Children included in the first group received therapy alone with the speech pathologist, whereas children from the second group received speech therapy accompanied by their mothers. The purpose was to evaluate and provide the mothers with interaction modes for facilitating communication. Both groups were evaluated before and after the therapy period in order to measure the advance of each group. The patients accompanied by their mothers showed a significantly higher linguistic advance as compared to patients receiving therapy without their mothers. The results in this study support the statement that linguistic development in the cleft palate child is strongly related to adult-child mode of interaction.

Importancia de la edad en la cirugía de la parálisis facial congénita: resultados preliminares / Age factor in the surgical treatment of congenital facial palsy: preliminary results

Se utilizaron injertos cruzados de nerviofacial para el tratamiento quirúrgico de parálisis facial permanente asociada a microsomia hemifacial en 15 pacientes. Las edades al momento de la cirugía variaron de 2 meses a 10 años. Los pacientes fueron divididos en grupos de acuerdo a su edad al momento de la indicación de cirugía. Se concluye que los injertos cruzados de nervio facial en pacientes con parálisis facial asociada a microsomia hemifacial proporcionan buenos resultados en especial cuando la cirugía se realiza en las primeras semanas de vida extrauterina

Congenital facial palsy and crossed facial nerve grafts: age and outcome.

Crossed facial nerve grafts for treating unilateral permanent facial palsy in association with hemifacial microsomia were studied in 18 patients, ages ranging from 2 months to 10 years. Patients were divided into groups according to the age at the time of indication of surgery. It is concluded that crossed nerve grafting for facial palsy associated with hemifacial microsomia appears to be an adequate procedure especially when the surgery is indicated soon after birth.

Ambulatory vs. in-patient stapedectomy: a randomized twenty-patient pilot study.

A prospective study was undertaken to determine whether stapedectomy can safely be performed in an outpatient setting. Twenty patients with otosclerosis amenable to surgical treatment were divided into two groups; those in the hospitalized group were admitted the day before surgery and discharged 24 hours after the procedure. The patients in the ambulatory group were admitted on the day surgery was scheduled and released 1 or 2 hours after the procedure. We analyzed the intensity and duration of postoperative vertigo, and the hearing gain obtained, studying the speech frequencies(500 to 2000 Hz) separately from the high frequencies (4000 to 8000 Hz). No significant difference was found at 1, 3, and 6 months of follow-up in any of the parameters studied, concluding that small-fenestra stapedectomy can safely be performed as an outpatient procedure.

Recovery of congenital facial palsy in patients with hemifacial microsomia subjected to sural to facial nerve grafts is enhanced by electric field stimulation.

The effect of electric field stimulation for promoting axonal growth between sural to facial nerve grafts in cases of congenital permanent facial palsy associated with hemifacial microsomia was studied. For this purpose, a total of 17 patients with unilateral congenital permanent facial palsy associated with hemifacial microsomia were studied pre- and post-operatively. A sural to facial nerve graft was performed in all cases and long term postoperative electric field stimulation was randomly applied to half of the patients. Although improvement occurred in both groups, the results indicated that clinical and electrophysiological recovery was significantly better in patients receiving post-operative electric field stimulation. The results, therefore, suggest that electric stimulation of the grafted area induces improvements of facial palsy over and above those observed in the non-stimulated patients.