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The objective of this study was to improve the evaluation of unilateral vocal fold paralyses (uVFP) by means of an area measurement of the glottic plane, which describes the position of the paralysed vocal fold. The area measurements were related to electromyographic findings and clinical outcome (recovery, voice quality). In 56 patients (33 women and 23 men), uVFP were confirmed by endolaryngeal electromyography (EMG) of the paralysed vocal fold and cricothyroid muscles (CT). The EMG response was classified on a 4-point scale (from 0 to 3). Vocal fold position was divided into 'paramedian' and 'intermediate' and additionally quantified by measurement of the glottic area. An 'area quotient' (AQ) was calculated and related to the EMG findings and clinical outcome. Voice qualities were objectified regarding their additive noise (breathiness) and irregularity (roughness) using the 'Göttingen Hoarseness Diagram'. The majority of uVFP was due to iatrogenic lesions. The AQ of classically graduated 'paramedian' and 'intermediate' vocal fold positions was significantly different but did not correlate with objective voice quality values. There were no significant correlations regarding EMG findings, duration or recovery from paralyses. Laryngeal EMG remains the gold standard for verifying uVFP. But EMG did not correlate significantly with AQ or functional outcome of uVFP. The measurement of an AQ is suitable for obtaining continuous data describing the position of paralysed vocal folds beyond the terms 'paramedian' or 'intermediate' and provides the basis for clinical evaluations of diagnostic tools and therapeutic interventions.

Endoskopische submukose Tunneltechniken im Gastrointestinaltrakt ermoglichen heute einen Zugang zur muskularen Wandschicht oder nach Eroffnung derselben einen Zugang zur umliegenden Korperhohle, wie sie ansonsten nur von ausen thorakoskopisch, mediastinoskopisch, laparoskopisch oder offen chirurgisch zu erreichen ware. Im Rahmen von „Natural Orifice Transluminal Endoscopic Surgery“ (NOTES) wird diese Tunneltechnik als Z-formiger, ventilartiger Zugangsweg genutzt, wahrend die „Perorale Endoskopische Myotomie im Osophagus“ (POEM) oder Magen die submukosale Durchtrennung der Muskulatur zum Ziel hat. Das „Submukosale Tunneln und endoskopische Resezieren“ (STER) nutzt den Tunnel, um Tumoren der Muscularis-propria-Schicht mucosageschutzt zu excidieren und entlang des Tunnels abzutransportieren. Tunneltechniken im Rahmen der flachigen „Endoskopischen Submucosa-Dissektion“ schaffen einen submucosalen Tunnel, um unter Belassenen einer cranialen Aufhangung, ein zentrales, z.B. rohrenformiges Mucosa-Resektat zu schaffen, das eine komplette histo-pathologische Aufarbeitung und klare onkologische Aussage schafft. Die verschiedenen Techniken werden beschrieben.

Auditory processing disorder (APD) is defined as a processing deficit in the auditory modality and spans multiple processes. To date, APD diagnosis is mostly based on the utilization of speech material. Adequate nonspeech tests that allow differentiation between an actual central hearing disorder and related disorders such as specific language impairments are still not adequately available. In the present study, 84 children between 6 and 17 years of age (clinical group), referred to three audiological centers for APD diagnosis, were evaluated with standard audiological tests and additional auditory discrimination tests. Latter tests assessed the processing of basic acoustic features at two different stages of the ascending central auditory system: (1) auditory brainstem processing was evaluated by quantifying interaural frequency, level, and signal duration discrimination (interaural tests). (2) Diencephalic/telencephalic processing was assessed by varying the same acoustic parameters (plus signals with sinusoidal amplitude modulation), but presenting the test signals in conjunction with noise pulses to the contralateral ear (dichotic(signal/noise) tests). Data of children in the clinical group were referenced to normative data obtained from more than 300 normally developing healthy school children. The results in the audiological and the discrimination tests diverged widely. Of the 39 children that were diagnosed with APD in the audiological clinic, 30 had deficits in auditory performance. Even more alarming was the fact that of the 45 children with a negative APD diagnosis, 32 showed clear signs of a central hearing deficit. Based on these results, we suggest revising current diagnostic procedure to evaluate APD in order to more clearly differentiate between central auditory processing deficits and higher-order (cognitive and/or language) processing deficits.

Die endoskopische Submukosadissektion (ESD) hat sich fur die En-bloc-Resektion von Fruhkarzinomen oder Schleimhaut-Risikolasionen uber 2 cm Grose auch in der west-lichen Welt in den letzten Jahren klar etablieren konnen. Aus onkologischer Sicht bietet die ESD deutliche Vorteile gegenuber der sog. Piecemeal-Resektion oder Ablation. Wir stellen hier neue technische Entwicklungen vor, wie die flussigkeitsgestutzte Resektion, neue Resektions- und Dissektionsinstrumente, Unterspritzungssubstanzen sowie Hilfsinstrumente.

Within the last years endoscopic submucosal dissection (ESD) has established its role for the "en bloc" resection of even large mucosal precancerous or early cancerous lesions. However, there is little literature concerning devices and settings used for successful ESD. In the following article we give an overview on technical requirements and report on our own experiences over the last years

In den letzten 10 Jahren hat die Diagnostik v. a. von hochauflosenden Chip- und Bild-Technologien profitiert, wie „big chips“, „high definition television“ (HDTV) oder „narrow band imaging“ (NBI). Der Dunndarm wurde mittels Videokapsel und Doppelballon-Enteroskopie-Technik in seiner ganzen Lange zuganglich. Die endoskopische Mukosaresektion (EMR) ist bei geeigneten flachen Schleimhautveranderungen onkologisch vergleichbar mit einer Operation (Op.) – bei geringerer Invasivitat, Letalitat und Komplikationsrate, wie Studien zu mukosalen Magen- oder Barrett-Fruhkarzinomen ergaben. Die endoskopische Submukosadissektion (ESD) ermoglicht die En-bloc-Exzision und komplette Histologie von Schleimhautbefunden, v. a. in Rektum und Magen. Die endosonographisch (EUS-)gesteuerte transgastrale endoskopische Ausraumung infizierter Pankreasnekrosen verdrangt zunehmend die Op. Bei „NOTES-Eingriffen“ („natural orifice transluminal endoscopic surgery“) werden naturliche Korperoffnungen als Zugangswege fur transluminale Op.-Verfahren in Bauch und Mediastinum eingesetzt. Von den Innnovationen in der Mikromechanik und -elektronik profitieren gastroenterologische interventionelle Endoskopiker und minimal-invasive Chirurgen gleichermasen.

Die endoskopische Submukosa-Dissektion (ESD) hat sich in den vergangenen Jahren in Europa an ersten Zentren als klinisch junges Verfahren etablieren konnen. Systematische Untersuchungen zu den notwendigen technischen Voraussetzungen, Ausstattungen oder Vorgehensweisen fehlen bisher jedoch im Wesentlichen. Im Folgenden soll auf einzelne verfugbare Daten aus der Literatur sowie eigene praktische Erfahrungen eingegangen werden.

Background: Verbal communication is a human feature and volitional vocalization is its basis. However, little is known regarding the cortical areas involved in human vocalization. Methods: Therefore, functional magnetic resonance imaging at 3 Tesla was performed in 16 healthy adults to evaluate brain activations related to voice production. The main experiments included tasks involving motor control of laryngeal muscles with and without intonation. In addition, reference mappings of the sensorimotor hand area and the auditory cortices were performed. Results: Related to vocalization, in addition to activation of the most lateral aspect of the primary sensorimotor cortex close to the Sylvian fissure (M1c), we found activations medially (M1a) and laterally (M1b) of the well-known sensorimotor hand area. Moreover, the supplementary motor area and the anterior cingulate cortex were activated. Conclusions: Although M1a could be ascribed to motor control of breathing, M1b has been associated with laryngeal motor control. Consequently, even though M1c represents a laryngeal sensorimotor area, its exclusiveness as suggested previously could not be confirmed. Activations in the supplementary motor area and anterior cingulate cortex were ascribed to “vocal-motor planning.” The present data provide the basis for further functional magnetic resonance imaging studies in patients with neurological laryngeal disorders.

Objectives: To describe the course of the superior laryngeal nerve (SLN) and its branches, in particular, with regard to supraglottic motor and sensory functions. Methods: In 30 normal human hemilarynges, the SLN with its internal (intSLN) and external branch (extSLN) were dissected under microsurgical conditions and marked with acrylic dye. All anatomic structures of the larynges (muscles, cartilages, and ligaments) were dissected in detail. Results: The intSLN subdivides into three branches. The superior branch (I) runs to the lingual (extralaryngeal) part of the epiglottis and sends small fibers through the epiglottic foramina to the laryngeal surface. The middle branch (II) runs through the aryepiglottic fold into the ventricular fold, and the inferior branch (III) to the piriform sinus and to the postcricoid region, forming various anastomoses (e.g., ansa galeni) with the recurrent laryngeal nerve (RLN). The extSLN runs to the cricothyroid muscle (CT) and sends a branch through the CT along the lower rim of the thyroid cartilage into the larynx and up to the ventricular fold. This ventricular branch is a potential candidate for the innervation of the ventricular muscle (VM). Conclusions: Our results may contribute to a better understanding of supraglottic actions that provide primary functions of the larynx (such as swallowing, coughing, and breathing). An enhanced knowledge of neurolaryngology also provides a basis for interpreting disorders or paralyzes following surgical treatments (e.g., thyroid surgery, partial laryngectomy) and helps to lower the risks.

Objectives: We sought to treat autophonia due to a patulous eustachian tube using botulinum toxin. Methods: Because we assumed that the patulous eustachian tube was caused by abnormal activity of paratubal muscles (tensor and levator veli palatini muscles and salpingopharyngeus muscle), paralysis was performed via injection of botulinum toxin type A in a 45-year-old female professional musician who had had chronic unilateral autophonia for 20 years. In addition to a patient interview, an endoscopic examination of the nasopharynx (posterior rhinoscopy), ear microscopy, and impedance audiometry were performed to verify the diagnosis and the outcome after treatment. Results: The autophonia disappeared 1 week after treatment. Normalized tympanic ventilation was verified by impedance audiometry after 8 weeks. The period of symptom relief was 9 months. Conclusions: The administration of botulinum toxin type A provides a new option in the treatment of patulous eustachian tube. The reliability of this method and the effect of repeated injections remains to be proved in future studies.

Summary The authors investigated whether acoustic speaking voice analyses can be used to predict the beginning of mutation in 21 male members of a professional boys' choir. Over a period of 3 years before mutation, children were examined every 3 months by ear, nose, and throat (ENT) and phoniatric specialists. At the same time, the voice was evaluated acoustically using analysis features of the Goettingen Hoarseness Diagram (GHD). Irregularity component and noise component, jitter, shimmer, mean waveform correlation coefficient, and fundamental frequency were determined from recordings of the speaking voice. Significant changes of acoustic features appeared 7 and 5 months before mutation onset, which indicates that vocal function is already restricted 6 months before mutation onset. This acoustic voice analysis is therefore suitable to support the care of the professional singing voice.

BACKGROUND Quality of life is a relevant criterion for therapeutical outcome in laryngeal carcinoma patients. The aim of this study was to assess the self-related complaints in quality of life and functional outcome of voice among persons who had undergone laryngeal cancer surgery. METHODS The examination took place 67 months (SD 34.8) after the last surgery, on average and finishing of 60 therapy sessions (median). First a measurement with the Goettinger Hoarseness Diagram (GHD) was carried out. Next the subjects answered self-reported standardized questionnaires for life quality in oncological patients on the same day: EORTC-QLQ-C30 and 3 scales of the German Fragebogen zur Lebenszufriedenheit (health-related fulfillment, fulfillment with work/occupation, fulfillment with social environment). For disease-related symptoms of different head and neck domains the EORTC-HandN35 was administered. SUBJECTS Forty-four patients (37 males, 7 females) who were treated primarily with minimal invasive laser surgery followed by functional voice rehabilitation (Goettinger Konzept). Mean age: 60.1 (SD 9.7) years. RESULTS The acoustic voice quality according to the GHD showed a significant correlation with self-reported "Somatic Functioning" (- 0.32, p = 0.04) and "Social Functioning" (- 0.38, p = 0.01) in the EORTC-QLQ-C30 as well as with the symptom scales "Speech" (0.45, p < 0.0024) resp. "Social Contact" (0.45, p = 0.0021) in the EORTC-HandN35. Also hoarseness and health-related fulfillment (- 0.36, p = 0.02) as well as fulfillment with work/occupation (- 0.33, p = 0.03) correlated significantly. On the other hand, there was no significant association between the GHD and the assessment of global quality of life. CONCLUSION Postoperative phonatory reductions in patients with laser surgically treated laryngeal carcinoma have only a slight influence on overall quality of life. The same is true for the GHD. Assessment of self-reported quality of life in recommendation of oncologic treatment may not be able to replace the objective findings, but may be useful to detect other problems, e.g. psychosocial.

Background Recurrent laryngeal nerve monitoring (RLNM) has been suspected to reduce postoperative RLN paralysis (RLNP). However, functional outcome of RLNM in comparison with no nerve identification and visual nerve identification only has not been analyzed. Methods Analysis of 16,448 consecutive multi-institutional operations resulted in 29,998 nerves at risk. Three groups of different RLN treatment were compared: group 1, no RLN identification; group 2, visual RLN identification; and group 3, visual RLN identification and electromyographic monitoring. RLNM was performed with a bipolar needle electrode that was placed through the cricothyroid ligament into the vocal muscle. Results Risk factors for permanent RLNP were recurrent benign and malignant goiter (odds ratios, [ORs]), 4.7, and 6.7, respectively), primary surgery in thyroid malignancy (OR, 2.0), lobectomy (OR, 1.8), no nerve identification (OR, 1.4), low or medium volume hospital (OR, 1.3), and low volume surgeons (OR, 1.2). Conclusions Based on these data, visual nerve identification was identified to be the gold standard of RLN treatment in thyroid surgery. RLNM is a promising tool for nerve identification and protection in extended thyroid resection procedures. However, because of the overall low frequency of RLNP, no statistical difference compared with visual nerve identification only was reached in the setting of this study.

Unfortunately, the authors of this article kept referring to “recurrent laryngeal nerve palsy” in an undifferentiated manner. This “diagnosis” can conceal a minimum of nine different forms of laryngeal palsy, whose treatment and prognosis vary—and this excludes the differential diagnosis of non-surgical and non-neurogenic fixation (1, 3). Whereas neurogenic lesions that include the recurrent nerve (2) are associated with paresis of the affected vocal fold, a similar paresis affects the external branch of the superior laryngeal nerve, in which the vocal folds retain normal mobility. It is presumably for this reason that this variant is often misdiagnosed, although the postoperative voice pathology is highly abnormal (3). Knowledge of this variant without involvement of the recurrent nerve is very important for surgical treatment, because it can—and should—be prevented only by separating the nerve branch before ligating the superior thyroid vasculature; in our own experience neither conservative approaches nor phonosurgery yield substantially better results.

Bislang wurde die Horgerate-Trageakzeptanz persistierend schallempfindungsgestorter Kinder (operationalisiert durch die Tragedauer) noch nicht systematisch in einem Langsschnitt erhoben, so dass die vorliegende Studie dieses erstmalig an einer kontinuierlichen Inanspruchnahmepopulation in Deutschland unternimmt. Datenbasis sind standardisierte Schatzurteile, die zu 4 Zeitpunkten uber einen Zeitraum von fast 30 Monaten zu 35 Kindern mit einer mono- bzw. binauralen horgeratversorgten Storung von deren Eltern abgegeben wurden. Alle Kinder hatten einen mittleren Horverlust von mindestens 26 dB (Horverlust bei 500, 1000, 2000, 4000 Hz). Unilateral gestorte Kinder tragen ihre Horhilfe weniger als bilateral gestorte. Dieser anfanglich nicht signifikante Unterschied (p=0.85) verandert sich uber den gesamten Beurteilungszeitraum, so dass am Ende unilateral horgestorte Kinder eine signifikant schlechtere Trageakzeptanz aufweisen (p=0.004). Gering- bzw. mittelgradig unilateral horgestorte Kinder akzeptieren ihre Horgerate, hingegen lehnen die mit schweren Horverlusten sie eher ab. Bilateral horgestorte Kinder haben a priori eine bessere Trageakzeptanz und steigern sie noch mit der Zeit. Jungen und Madchen unterscheiden sich in in ihrer mittleren Trageakzeptanz nicht bedeutsam. Ebenfalls zu keinem Zeitpunkt lies sich ein signifikanter Unterschied zwischen Lebensalter und Horgerate-Trageakzeptanz nachweisen. Die Anpassung elektroakustischer Horhilfen ist eine effektive Behandlungsmasnahme mit Akzeptanz und Compliance, besonders bei bilateral horgestorten Kindern. Fur unilateral horgestorte Kinder gilt es, die Qualitat der Horgeratversorgung weiter zu prufen.

The hoarseness diagram (Michaelis, Fröhlich, & Strube, 1998a) has been proposed as a new approach to describe different acoustic properties of voices. To test its performance in the analysis of pathologically disturbed and normal voices five requirements are suggested that should be met by any acoustic voice-analysis protocol to be used in voice research and clinical practice. The hoarseness diagram is then tested with regard to these requirements. Individual voices are found to show a satisfactory localization in the diagram. Aspects of stationarity are discussed in the context of four case studies. The different cases illustrate that changes in the acoustic analysis results are observed if the voice-generation conditions change, whereas results are stationary if phonation conditions do not change. Different pathological voice groups defined on grounds of the specific phonation mechanism are found to map to specific regions of the hoarseness diagram, with differences between group locations being significant. All results can be interpreted without exceptions if the two hoarseness diagram coordinates are taken to reflect the vibrational irregularity of the voice-generation mechanisms on the one side and the degree of closure of the vibrating structures on the other side. The hoarseness diagram and its underlying algorithms are thus shown to constitute a useful approach to acoustic voice analysis in research and clinical practice. The tests themselves demonstrate several application possibilities, including the quantitative monitoring of individual voices.

Die Tatsache, dass ein Kind horgerateversorgt ist, bedeutet nicht automatisch, dass die Horgerate getragen werden. Ziel der Studie war, die Horgerate-Trageakzeptanz (operationalisiert durch die tagliche Tragedauer) versorgungspflichtiger, persistierend horgestorter Kinder zu untersuchen. 116 Elternteile einer knapp 4-jahrigen kontinuierlichen Inanspruchnahmepopulation von Kindern (mittleres Lebensalter 51,1±30,1 Monate) mit Horstorungen unterschiedlichen Schweregrads beurteilten nach der individuellen, storungsspezifischen Horgerateanpassung (im arithmetischen Mittel nach 5 Monaten) die Trageakzeptanz auf einer 5-Punkte-Likert-Skala. 58,6% der Kinder akzeptierten hiernach ihre elektroakustische Verstarkung “sehr gut” bzw. “gut”, 18,1% nahmen ihre Horgerate “mittelmasig” an, 23,3% “schlecht” bis “sehr schlecht” bzw. “gar nicht”. Madchen und Jungen unterschieden sich nicht signifikant in ihrer mittleren Trageakzeptanz. Die Trageakzeptanz bei unilateral horgestorten Kindern, insbesondere bei solchen mit chronischen Schallleitungsstorungen aufgrund von Ohrfehlbildungen, war deutlich eingeschrankt. Sehr junge Kinder (pralinguale Horstorungen), v. a. solche mit Mehrfachbehinderung und/oder primar nichtdeutschsprachigem Elternhaus zeigten eine “schlechte” bis fehlende Trageakzeptanz. Die Horgerate-Akzeptanz korrelierte aber nicht mit dem Schweregrad der Horstorung. Vor jeder Horgerate-Uberprufung sollte die Trageakzeptanz als ein Aspekt der Compliance mittels einer Ratingskala erhoben werden. Nicht zuletzt ist sie auch ein effizienter und sensibler Indikator fur Anpassung und Einstellung der Gerate sowie ggf. Veranderung der Diagnose.

The association between laryngeal contact granuloma and demographic/psychological variables was examined by using a psychosomatic approach to health research. A stepwise procedure of logistic regression analyses was utilized to get a final multivariate model of variables associated with the clinical finding of a laryngeal contact granuloma. The subjects consisted of 47 patients with contact granulomas and 110 patients with voice disorders due to other causes. Our analysis of 22 variables uncovered the following statistically significant factors for developing a contact granuloma: male gender (P = 0.0001), low achievement orientation (P = 0.0007), fear of physical lesions (P = 0.0038), impulsiveness (P = 0.0016), age > 60 years (P = 0.0012), low extraversion (P = 0.004), high achievement orientation (P = 0.0079), fear of appearing in public (P = 0.0216) and strain (P = 0.03). These results show that a variety of variables are important for predicting the development of a laryngeal contact granuloma. The usefulness of this set of risk variables for predicting a contact granuloma remains to be proved in a prospective study. It is possible that not only the nature but the number of risk factors are the prime determinants of outcome.

The paper summarizes the language profile of a group of 25 monolingual German speaking children originally diagnosed as expressive developmental language disordered during the preschool period at a University Speech-Language-Hearing Clinic (mean chronological age: 4:11 years). These subjects are followed up some 2-6 years after initial diagnosis and were compared with a match group of control children. Nonverbal intelligence, psycholinguistic abilities and language development were assessed with standardized tests at follow-up in elementary school age (mean chronological age: 8:7 years). The nonverbal intelligence in both samples was average. At follow-up evaluation 52 per cent of the clinical sample still presented mild phonological disorders and 42 per cent language impairments. The main characteristics were deficiencies in automatic and sequential processes of language usage (sequential auditory memory of digits, syntactic imitation, auditory closure), in the forming of morphological structures, in the...

Zur Prüfung der Hypothese, dass ehemals spezifisch sprech-/sprachentwicklungsgestörte Kinder schlechtere taktil-kinästhetische Leistungen als normale Kinder zeigen, wurde ein kontrollierter Gruppenvergleich von 25 monolingual deutschsprachigen Grundschülern (mittleres Alter 8;7 Jahre ± 7,1 Monate), bei denen vorschulisch (im Mittel mit 4;11 Jahren ±10,6 Monate) eine umschriebene Entwicklungsstörung von Sprechen und Sprache diagnostiziert wurde, mit 25 sprachgesunden Grundschülern durchgeführt (weder aktuell noch anamnestisch sprech-/sprachentwicklungsgestört, mittleres Alter 9;2 Jahre ± 8,3 Monate). Die Kinder waren hinsichtlich Geschlecht und Alter parallelisiert. Die Untersuchung ihrer nonverbalen Intelligenz (Coloured Progressive Matrices) ergab eine nahezu identische mittlere Leistungsfähigkeit. Es wurde der Subtest «Höhere taktile und kinästhetische Funktionen» der «Berliner-Luria-Neuropsychologischen Verfahren für Kinder» eingesetzt. Der aktuelle Sprachentwicklungsstand wurde mit dem «Heidelberger Sprachentwicklungstest» bestimmt. Die mittlere taktil-kinästhetische Leistung beider Gruppen (3,1 vs. 4,0) unterscheidet sich signifikant (p < 0,05); 32% der ehemals klinischen Stichprobe weisen eine unterdurchschnittliche Leistung auf. Die Analyse der Leistung hinsichtlich der ausführenden Hand zeigt keine bedeutsamen Differenzen zwischen rechts und links, weder bei den Rechts- noch bei den Linkshändern innerhalb einer jeden Gruppe, wohl aber bei Rechtshändern beider Gruppen den Trend, dass die nicht-dominante Hand somatosensibler arbeitet. Mittlere Sprach- und taktil-kinästhetische Leistung korrelieren in der ehemals klinischen Gruppe überzufällig (r = 0,45, p < 0,05), hingegen nicht in der Kontrollgruppe (r = 0,08). Insbesondere bei komplexen Fähigkeiten (Berührungslokalisation, Diskrimination «spitz/stumpf») hat die ursprünglich klinische Stichprobe Leistungsschwächen.

According to Negus and Pressman the sphincter systems of the vocal folds and the ventricular folds form a respiratory "laryngeal double valve function". Correspondingly, we found a physiological phonation system of the glottis and a pathological-compensatory one of the supraglottis. They appear to be regulated through an automatic phonatory control system with the glottal phonatory function evidently acting as sensor level. In order to confirm this hypothesis, objective voice analyses with glottal-relevant parameters of 26 voice-rehabilitated patients after minimally invasive laser surgery of glottal carcinomas are presented and integrated into a "hoarseness diagram" with the coordinates roughness and breathiness. Using statistically deliminated acoustic dusters, our data show a qualitative hierarchy of different postoperative phonation mechanisms. They demonstrate the influence of the vibratory capacity of glottal and supraglottal structures on the quality of the vibratory closure. Both functional parameters evidently determine the resulting voice quality in the sense of our hypothesis.

We describe clinical experiences in the management of three patients with laryngopharyngeal dystonia causing severe breathing problems. In contrast to spasmodic dysphonia, which presents with action-induced involuntary spasms of laryngeal muscles during speaking, all three patients showed laryngopharyngeal spasms primarily during respiration. In analogy to spasmodic dysphonia we propose the term spasmodic laryngeal dyspnea for this rare condition. Localized unilateral botulinum toxin injected into the thyroarytenoid muscle and /or ventricular folds reduced the quantity and quality of spasms and led to a pronounced improvement of breathing problems.

Der naturliche Spracherwerbsprozess ist bei horgestorten Kindern beeintrachtigt, wobei pralingual horgeschadigte Kinder das Lexikon der gesprochenen Sprache nicht nur zeitlich verzogert, sondern auch defizitar erwerben sollen. Es wurden daher zwei Inanspruchnahmepopulationen 2- bis 5jahriger Kinder (N = 110 sprachentwicklungsgestorte mit Normakusis, N = 34 beidseitig schallempfindungsgestorte mit binauraler Horgerateversorgung) mit einer unausgelesenen Stichprobe von 66 hor- und sprachunauffalligen Kindergartenkindern hinsichtlich ihres aktiven Wortschatzumfangs verglichen. Bei alien Gruppen wurde testpsychologisch vorab eine mindestens durchschnittliche nonverbale Intelligenz nachgewiesen; die Zweijahrigen konnten wegen fehlender Normen nicht getestet werden. Die beiden klinischen Stichproben unterschieden sich in ihrem aktiven Wortschatzumfang voneinander kaum, wohl aber von dem der normalen Kinder. Die Ergebnisse werden auf dem Hintergrund von Grad und Entstehungszeitpunkt der Horstorung sowie Kindergartenbesuch diskutiert. Die spezifische Sprachentwicklungsstorung stellt eine tiefergreifende kognitive Entwicklungsstorung dar als die Sprachentwicklungsstorung infolge binauraler Schallempfindungs-Schwerhorigkeit bei Kindern. Hieraus resultiert die Forderung nach einer moglichst fruhen fachspezifischen Erstdiagnostik.

In a multidimensional design using the hypothesis of a psychosomatic genesis, 28 patients (1 female, 27 male) showed, in their personality profile, increased scores in 'impulsiveness', 'emotionality (neuroticism)', 'strain' and 'inhibition'. In addition to the voice disorders other somatic symptoms were observed, especially general symptoms as dysthymia, depression and excessive vegetative stimulation. Their social competence was reduced by the fear of making contacts and the inability 'to say no'. Also psychosocial stress factors were registered due to loss of a loved one with feelings of an existential danger. Thus, contact granuloma can be considered as a secondary reaction to a specific combination of personal disposition and social life situation. Lastly a causal model is presented, which can be used as a diagnostic criterion.

The aim of the study was to investigate the psychological state of patients with contact granuloma. Twenty-eight patients with laryngeal contact granuloma and 36 patients suffering from primary organic laryngeal disorders were tested by different personality and clinical inventories. Several differences between these samples characterized the contact granuloma patient as impulsive, inhibited, weak, anxious, and disturbed by somatic complaints as well as by depression. Nevertheless the group of patients with contact granuloma had no more stressful life events than the group with primary organic laryngeal disorders. Using a group approach and standardized methods of testing we could, for the first time, statistically confirm assumptions about the emotional and psychosomatic state of patients with contact granuloma.

Die endoskopische Mucosaresektionen (EMR) von grosen Polypen im Colo-Rectum in „Piece-Meal“-Techik ist mit einer Rezidivrate von etwa 15% (Lit. 3–32%) assoziiert. Zudem haben flachige Polypen grosenabhangig ein zunehmendes Risiko der malignen Entartung. ESD-Erfahrungen im Colorektum auserhalb von Japan existieren bisher nur begrenzt. Patienten und Methode: 28.03.2006 bis 09.11.2009: 24 Patienten (ASA 2–3) mit solitaren breitbasigen Polypen ≥2cm im Rectum → ESD (m 66J; 49–85J.; 10 F, 14M). 6/24 Pat. (25%) hatten vorangegangene lokale Therapie (2 Pat. 2x EMR; 2 Pat. 1x EMR; 2 Pat. chir. Resektion). Lok.: 14/24 (58%) distales, 7 (29%) mittleres, 3 (13%) proximales Rectum. Ergebnisse: 21/24 (87%) der Lasionen makroskopisch „en bloc“ entfernt. Resektatgrose in Formalin fixierten, gepinnt 2,2×1,8 bis 9,0×8,0cm. Histologisch „sicher im Gesunden“ 14/24 (58%), in 5/24 (21%) bei thermischen Artefakten keine sichere Aussage zum Rand moglich. 2x pT1-Adenokarzinom, 1x neuroendokrines Ca (3/24; 12,5%). Alle drei pT1-Ca werden operiert bei 1x L +, 1x V+/G3 und 1x v.a. R1-Situation. 19/21 Resektate:. tubulovillose Adenome (11/19 LGD, 9/19 HGIEN=37,5% aller Lasionen), 1x villoses, 1x tubulares Adenom mit LGD. Methoden-ass. Letalitat: 0%: Komplikationen: 1x Vollwanddefekt → Macro-Clip (OTSC) → o.k., 1x am Folgetag Defekt → Vakuumschwammtherapie, erfolgreich konservativ, 1x in Pat. mit AAR unter Vollheparin → transf.bed. Blutung am 11. Tag p.r., 1x in Pat. mit zirkularer Abtragung uber 8cm im dist. Rectum → Striktur → 3x Ballon. Kein Patient musste komplikationsbedingt operiert werden. Mediane Nachbeobachtung 168 Tage (11–1343), Rezidive makro+PE: 0%. Schlussfolgerung: ESD ist eine auch ‘in der westlichen Welt’ auserhalb Japans erfolgreich einsetzbare, endoskopische ‘en bloc’ Res.-Technik, die fur flachige Lasionen im Rektum eine komplette histo-path. Aufarbeitung nach onkolog. Kriterien ermoglicht. Die auch in unserem Kollektiv nachweisbare hohe Rate von pT1-Karzinomen, HG-IEN oder HGD in flachigen Rektumlasionen, die Letalitat von 0%, konserv. Therapie rel. Komplikationen (16,7%) in 100% und Rezidivrate von bisher 0% uber ≤2½ J. zeigt eine eindeutige Favorisierung der ESD gegenuber ‘Piece-Meal’ oder der chir. Lokaltherapie bei flachigen mukosalen Rektumlasionen.

Objectives: To evaluate and to compare the diagnostic value of videostroboscopy (VS) and high-speed glottography (HGG) in dysphonic patients. Study Design: Randomized, prospective study. Methods: A total of 162 patients underwent indirect laryngoscopy using both methods (VS and HGG). The resulting 324 films were evaluated by two professionals (laryngologists, MDs) using a standardized protocol containing established criteria to classify vocal fold vibratory movement qualities. Results: The rating “not assessable” was mentioned significantly more often in VS than in HGG (P < .001). In HGG, methodologic failures were less frequent, and the length of investigation was shorter. Even if the agreement between the two raters was higher in HGG (54%) compared with VS (42%), both percentage values show a low accordance in diagnostic findings. Conclusions: Regardless of the method used (VS or HGG), perceptive evaluations of vibratory movements of vocal folds revealed a higher variability than assumed. This result supports the need for objective methods to analyze vocal fold vibratory movements. Therefore, real-time imaging of vocal fold vibratory movements using HGG will be necessary.

The purpose of this study was to present the current topographic and anatomical knowledge in neurolaryngology, with special regard to laryngeal paralyses as a major complication in thyroid surgery.Microscopic anatomical preparation of 22 human hemilarynges was accomplished.Due to their neuroanatomical courses, the following extralaryngeal nerves may be at risk in thyroid surgery: the external branch of the superior laryngeal nerve, the paralaryngeal part of the vagal nerve, the Ansa Galeni, the trunk of the recurrent laryngeal nerve (RLN) and the delicate branches of the RLN to the posterior cricoarytaenoid muscle. The anterior and posterior branches of the RLN (antRLN and postRLN) are less endangered by thyroid surgery because they are covered by the thyroid cartilage and posterior cricoarytaenoid muscle (PCA), respectively. In contrast, the antRLN is vulnerable if a ventilation tube is dislocated, with cuff-induced pressure to the glottic level.The increased knowledge in neurolaryngology provides the basis for a selective neuromonitoring to lower the risk of laryngeal paralyses after thyroid surgery.

Objectives: We performed a prospective study to assess respiratory function and voice quality before and after laser microsurgical bilateral posterior cordectomy performed for chronic airway obstruction in patients with bilateral vocal fold paralysis. Methods: In 17 patients a laser microsurgical posterior cordectomy was performed as an immediate bilateral approach. Roughness, breathiness, hoarseness, and dyspnea were evaluated both subjectively (on a scale from 0 to 3) and objectively (body plethysmography, computerized voice analysis: Göttingen Hoarseness Diagram). Results: After laser surgery, the patients' respiratory function was significantly increased and was sufficient for all activities of daily living. The body plethysmographic measure of airway resistance had superior descriptive power and correlated significantly with the clinical degree of dyspnea (scale 0 to 3). Pretreatment and posttreatment impairment of voice quality was objectively documented with the Göttingen Hoarseness Diagram; the phonatory results measured with it correlated significantly with the subjective clinical evaluation of hoarseness. Aphonia did not occur. Conclusions: A bilateral approach for laser microsurgical posterior cordectomy combines excellent airway improvement and satisfactory voice preservation. In bilateral vocal fold paralysis, pretreatment and posttreatment clinical data should be evaluated by objective measures.

Mutations in the connexin 26 gene (GJB2) are responsible for the major part of nonsyndromic autosomal recessive or apparently sporadic prelingual deafness in Caucasians (DFNB1). We screened 228 German hearing-impaired persons for mutations in the GJB2 gene by sequence analysis. Homozygous or compound heterozygous GJB2 mutations were detected in 38/228 (16.7%) of hearing impaired persons. The most frequently occurring mutation was the c.35delG mutation, which was found in 71.1% of the mutated alleles. The next frequent mutation detected in the group of hearing impaired persons was the c.101T>C mutation (9/76 alleles; 11.8%). One new mutation, c.567delA, was observed. We further studied the presence of a 10bp deletion in the 5' UTR of the GJB2 gene (c.-493del10) which was assumed to occur together with the c.101T>C mutation. Ten out of thirteen patients (76.9%) were found to be carriers of both the c.101T>C mutation and the 10bp variant and in 7/14 alleles a linkage disequilibrium between c.101T>C and the 10bp deletion was proven. In 4/14 alleles the linkage was ruled out and for the remaining 3 cases the phase determination was not possible. Seventy one controls were screened for the prevalence of Cx26 mutations and for the c.-493del10 variant. Heterozygosity frequency in the control group was for c.35delG 4.2%, for c.101T>C 1.4% and for c.-493del10 it was 5.6%. © 2002 Wiley-Liss, Inc.

Objectives To assess the merits of computer-aided voice analysis procedures for very irregular voices of patients after total and laser surgical partial laryngectomy, and to characterize qualitative differences in speech and voice function between these 2 groups of patients. Design Cross-sectional study. Setting University hospital in Gottingen, Germany. Patients Twenty-nine patients with advanced laryngeal carcinomas (T3-T4; according to the Union Internationale Contre le Cancer, TNM staging system, stages III-IVa) were examined: 18 patients with tracheoesophageal speech (voice prosthesis) after total laryngectomy and 11 patients who underwent partial transoral resection of the larynx (by means of laser microsurgery without surgical voice rehabilitation). Main Outcome Measures Speech intelligibility was measured by a standardized and validated telephone test, and voice quality was determined by 2 computerized voice analysis systems (multidimensional voice program and Gottingen hoarseness diagram). Results The telephone test demonstrated a significantly better speech performance of the patients who had undergone organ-preserving surgery. The voices of both patient groups were too irregular for a qualitative differentiation with the multidimensional voice program. The multidimensional voice program results also failed to show significant correlations to speech intelligibility. The Gottingen hoarseness diagram showed significantly more regular voices in patients with partial laryngectomy than total laryngectomy. These results were correlated with speech intelligibility. Conclusions The Gottingen hoarseness diagram is suitable for a qualitative assessment even of irregular voices. Voice prosthesis offers a voice quality that at best approaches that of patients with partial laryngectomy.