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The upper esophageal sphincter (UES) has been reported to show activity during phonation. As it is still unknown whether the phonation-induced UES contraction represents a reflex or a simultaneous activation phenomenon, i.e. co-innervation, this study aims to investigate and characterize the phonation-induced contraction of the UES in healthy individuals by analyzing the influence of various phonation tasks on pressure parameters of the UES.Twenty-five healthy volunteers produced the German neutral vowel [ə] in five different phonation tasks (modal voice, whispering, voiceless speech, creaky voice, and whispery voice). Simultaneously, they underwent high resolution manometry and electroglottography for measurement of pressure parameters in the region of the UES and latencies between larynx and UES activation.During all types of phonation, the maximum pressures of the UES increased significantly (maximum pressure increases of 72%-132%). With regard to mean pressures this was valid for modal voice and whispering (mean pressure increases of 20%-25%). Differences concerning total pressure changes reached statistical significance when comparing whispering and voiceless speech as well as whispery voice. However, differences concerning the total pressure change between modal voices on the one hand and voiceless speech and whispery voice on the other hand turned out to be small. The averaged time delay between larynx and UES activation ranged from approximately -15 ms (whispery voice) to +15 ms (whispering).A phonation induced pressure increase of the UES was confirmed in this study and did exist for different types of phonation. The extent of total pressure changes in the UES increases in relation with laryngeal muscle activity necessary for the phonation type. Next to varying effects of different types of phonation on UES activation, very short latencies indicate that a phonation induced contraction of the UES exists most likely due to co-innervation of UES and laryngeal muscles by the vagus nerve.

The laryngeal adductor reflex (LAR) is an important protective mechanism of the airways. Its physiology is still not completely understood. The available methods for LAR evaluation offer limited reproducibility and/or rely on subjective interpretation. A new approach, termed Microdroplet Impulse Testing of the LAR (MIT-LAR), was recently introduced. Here, the LAR is elicited by a droplet and a laryngoscopic high-speed recording is acquired simultaneously. In the present work, image-processing algorithms for autonomous MIT-LAR sequence analysis were developed. This allowed the automated approximation of kinematic LAR parameters in humans.Development and testing of computational methods.Computational image processing enabled the autonomous estimation of the glottal area, the glottal angle, and the vocal fold edge distance in MIT-LAR sequences. A suitable analytical representation of these glottal parameters allowed the extraction of seven relevant LAR parameters. The obtained values were compared to the literature.A generalized logistic function showed the highest average goodness of fit among four different analytical approaches for each of the glottal parameters. Autonomous sequence analysis yielded bilateral LAR response latencies of (229 ± 116) ms and (182 ± 60) ms for cases of complete and incomplete glottal closure, respectively. The initial/average/maximum angular vocal fold adduction velocity was estimated at (157 ± 115) °sThe automated extraction of LAR parameters from laryngoscopic high-speed sequences can potentially increase the objectiveness of optical LAR characterization and reduce the associated workload. The proposed methods may thus be helpful for future research on this vital reflex.NA Laryngoscope, 132:2412-2419, 2022.

Introduction: Speech dysfluency, often referred to as stuttering, is a frequent speech disorder encountered in about 5% of children. Although in the majority of people affected, symptoms improve in adulthood, in some patients, stuttering persists and significantly impairs everyday functioning and quality of life. Treatment for stuttering includes speech therapy, cognitive behavioral therapy, and relaxation techniques. However, a substantial number of patients do not benefit sufficiently from these treatment strategies or are even treatment resistant. Methods: We present the case of a 20-year-old male with treatment-resistant stuttering, who markedly improved after treatment with medicinal cannabis. Results: Besides improved speech fluency as assessed by several phoniatric tests, we observed remission of (social) anxiety, improved mood, and reduced stress, resulting in an overall improvement of quality of life after cannabis therapy. The patient, in addition, reported improved attention, concentration, and sleep, increased self-confidence, and better social life. No side effects occurred. Over a time period of more than a year, treatment was equally effective. In an interview, the patient describes his personal view and the influence of cannabis-based treatment on his life. Conclusions: Medicinal cannabis could be effective in treatment of refractory stuttering, but these preliminary data have to be confirmed in controlled studies.

OBJECTIVE The laryngeal adductor reflex (LAR) is an important mechanism to secure the airways from potential foreign body aspiration. An involvement of the upper esophageal sphincter (UES) in terms of a laryngo-UES contractile reflex has been identified after laryngeal mucosa stimulation. However, the LAR-UES relationship has not yet been fully explained. This study aimed to determine the magnitude, latency, and occurrence rate of the UES pressure response when the LAR is triggered in order to elucidate the functional relationship between the larynx and the UES. METHODS This prospective study included seven healthy volunteers (5 female, 2 male, age 22-34 years). Laryngeal penetration was simulated by eliciting the LAR 20 times in each individual by applying water-based microdroplets onto the laryngeal mucosa. UES pressures were measured simultaneously using high-resolution manometry. RESULTS Two distinct pressure phases (P1, P2) associated with the LAR were identified. P1 corresponded with a short-term UES pressure decrease in two subjects and a pressure increase in five subjects occurring 200 to 500 ms after the stimulus. In P2, all subjects experienced an increase in UES pressure with a latency time of approximately 800 to 1700 ms and an average of 40 to 90 mmHg above the UES resting tone. CONCLUSION Foreign bodies penetrating the laryngeal inlet lead to a reflex contraction of the UES. Phase P1 could be a result of vocal fold activity caused by the LAR, leading to pressure changes in the UES. The constriction during P2 could strengthen the barrier function of the UES in preparation to a subsequent cough that may be triggered to clear the airways. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E1778-E1784, 2021.

Zusammenfassung Hintergrund Die chronische Rhinosinusitis (CRS) zählt in Deutschland zu den häufigsten chronischen Erkrankungen und geht nicht selten mit einem jahrelangen Verlauf einher. Nach der aktuellen deutschen Leitlinie Rhinosinusitis sind für eine symptomatische Therapie der CRS die nasale Anwendung von Salzlösungen, topische Kortikosteroide, in Einzelfällen auch systemische Kortikosteroide sinnvoll. Die Evidenzlage für andere therapeutische Verfahren wie Akupunktur, Homöopathie und Phytotherapeutika wird als nicht ausreichend gesehen. In der vorliegenden Studie sollte untersucht werden, ob antiinflammatorische Effekte einer Elektrostimulationstherapie auch bei einer CRS nachgewiesen werden können. Methodik randomisierte, prospektive Single center Studie, primäres Setting; 16 Patientinnen und Patienten mit mittelgradig ausgeprägter chronischer Rhinosinusitis mit Polypen (cRScNP), entsprechend einem Lund / Mackay score von 6–12; heimbasierte Elektrostimulationstherapie (EST) mit amplitudenmoduliertem Strom (Basisfrequenz von 4000 Hz, Frequenzband von 100–250 Hz) über 2 Wochen adjuvant zu einer leitliniengerechten Sinusitistherapie mit topischen Kortikosteroiden; Messung der nasalen Stickstoffmonoxid Konzentration und Selbstbewertung der Beschwerden mit dem Fragebogeninstrument SNOT-20 GAV; Erhebungszeitpunkte t0 vor EST, t1 nach EST, t2 6 Wochen nach t1. Ergebnisse Die heimbasierte EST wurde von 16 Patientinnen und Patienten durchgeführt. Die vorliegenden Ergebnisse deuten darauf hin, dass die bereits seit langem bekannten positiven Effekte einer Elektrostimulationstherapie bei inflammatorischen Prozessen auch bei einer CRS bestehen. Diskussion Die adjuvante transsinuidale Elektrostimulation könnte somit die konservative Therapie der CRS bereichern. Weitere Studien mit größeren Kollektiven sind wünschenswert.

Zusammenfassung Hintergrund Bei etwa einem Drittel der Blasmusiker kommt es zu belastungsbedingten Insuffizienzen des velopharyngealen Abschlusses (VPA), d. h. der intraorale Druck übersteigt die durch den VPA gebildete Barriere. In dieser Studie sollte der Verschlussdruck im VPA beim Spielen einer Trompete gemessen und über prüft werden, welchen Einfluss eine 30-minütige Belastungssequenz auf die muskulären Aktivitäten im VPA hat. Material und Methoden Stichprobe: 6 gesunde Probanden. Aufgabe: Spielen des Tons h1 über 5 Sekunden mit 85 dB(A) und mit 100 dB(A). Methodik: Hochauflösungsmanometrie (HRM); Messzeitpunkte: t0: Messung ohne Einspielphase, t1 nach 30 min Trompetenspiel mit vorgegebenen Musikstücken. Variablen: mittlere Drücke (pmit), Minimal-(pmin)- sowie Maximaldrücke (pmax) zu t0 und t1 im VPA. Statistik: Prüfung auf Normalverteilung, t-test. Ergebnisse Alle gemessenen Drücke im VPA sanken von t0 zu t1 für produzierte 85 dB(A) Töne. Für 100 dB(A) Töne sanken nur die pmin. Die Drücke im VPA waren bei 100 dB(A) Tönen insgesamt höher als bei 85 dB(A) Tönen, signifikant war dieser Unterschied nur für pmin und pmax zu t0. Schlussfolgerung Lauter gespielte Töne erfordern eine stärkere muskuläre Kontraktion im VPA. Der niedrigere Verschlussdruck im VPA zum Zeitpunkt t1 kann Folge einer physiologischen muskulären Adaptation an das für den VPA notwendige Druckniveau oder bereits Zeichen einer muskulären Ermüdung sein. Dies ist möglicherweise für den Einsatz der HRM zur Beurteilung der Berufsfähigkeit von Blasinstrumentalisten von Bedeutung. Wie schon für die Phonation beschrieben, ließ sich auch hier mit einem dreiphasigen Modell, bestehend aus Initiation, stabiler Phase und Terminierung, der VPA Druckverlauf beschreiben.

This work presents a droplet applicator module to generate stable droplets with different muzzle energies for the reproducible endoscopic stimulation of the laryngeal adductor reflex (LAR). The LAR is a protective reflex of the human larynx; an abnormal LAR performance may cause aspiration pneumonia. A pathological LAR can be detected by evaluating its onset latency. The reflex can be triggered by shooting a droplet onto the laryngeal mucosa, which is referred to as Microdroplet Impulse Testing of the LAR (MIT-LAR). Stimulation intensity variation is desired as the reflex threshold may vary inter-individually. The kinetic energy of a droplet after detachment from the nozzle, i.e., its muzzle energy, is considered an appropriate metric for the LAR stimulation intensity. In this work, a suitable nozzle channel geometry is identified based on the experimental evaluation of droplet formation using three different nozzle channel geometries. Two nontoxic additives are evaluated regarding their effect on fluid properties and droplet formation. The range of achievable droplet muzzle energies is determined by high-speed cinematography in association with a physically motivated model of the macroscopic droplet motion. The experimental results show that sodium chloride is a suitable additive to enhance droplet stability in the studied parameter range with the proposed system. Droplet muzzle energy variation from 0.02 [Formula: see text] J to 1.37 [Formula: see text] J was achieved while preserving the formation of a single stimulation droplet. These results are an important prerequisite for a safe and reproducible LAR stimulation by MIT-LAR, which could also help to further elucidate the physiological mechanisms underlying this laryngeal reflex.

This study aims to determine Euclidean distances between landmark structures in the larynx and pharynx to optimize endoscope shaft designs with regard to gentle and patient-oriented handling. Four Euclidean distances between landmarks in the larynx and pharynx were analyzed based on CT data of 66 patients. Distance (1): labium inferius oris—posterior pharyngeal wall at the cervical vertebra C1 (atlas), anterior edge of the tuberculum anterius atlantis. Distance (2): posterior pharyngeal wall adjacent to C1—entrance of pyriform sinus. Distance (3): inferior edge of the uvula—superior edge of the epiglottis. Distance (4): base of the vallecula—posterior pharyngeal wall. The minimum angular field of view α required to observe the glottis with a rigid transoral laryngoscope was derived trigonometrically from distances (2) and (4). Average Euclidean distances measured: Distance (1): 90.7 mm ± 6.9 mm in men and 86.9 mm ± 5.9 mm in women. (2): 73.7 mm ± 13.4 mm and 56.2 mm ± 7.6 mm. (3): 25.2 mm ± 8.6 mm and 18.5 mm ± 6.8 mm. (4): 20.8 mm ± 4.6 mm and 16.5 mm ± 3.4 mm. α: 16.0° ± 3.9° and 16.6 ± 4.3°. As expected, statistically significant sex-related differences could be observed for distances (1)–(4). The results indicate that the length of transoral laryngoscopes should not be below 110 mm and that a minimum angular field of view of α = 17° is required to fully observe the laryngeal inlet.

Impairments of sound discrimination, speech comprehension in background noise, memory, etc. can be assessed within the diagnosis of an auditory processing and perception disorder (AVWS) in a structured manner using the questionnaire (DGPP-AVWS-FB) provided by the German Society for Phoniatrics and Pedaudiology. The aim is to report on experiences with the use of this questionnaire in a pedaudiology practice. In particular, it was to be determined whether information on the auditory behaviour provided by parents is similar or different to information provided by kindergarten teachers (KGK) or teachers at school (LK).During a nine-month period, all parents who presented their children to be examined for a possible AVWS were handed the DGPP-AVWS-FB to be completed by them and by KGK/LK. In order to compare the agreement of the judgements, two questionnaires on attention and concentration or on executive functions (DISYPS II, BRIEF or BRIEF-P) were also given. Data from children with peripheral hearing impairment or cognitive developmental disorder were not used. The correlation coefficient was then calculated for the respective items, scales and indices.Completed questionnaires were available at the end of the study period for a total of 20 primary school children and 7 kindergarten children. In kindergarten children, only KGK but not parents, in school children however, 1x only parents, 16x only LK and in the remaining 3 others both parents and LK suspected an impaired auditory processing. The evaluation of the DGPP-AVWS-FB ultimately reflected this different assessment of the symptoms: with the exception of children in whom both parents and LK suspected an AVWS, the information provided by the parents showed only little agreement with the information provided by the KGK/LK. In comparison, the responses to the other two questionnaires were also different, but the data on attention and hyperactivity in kindergarten children tended to be more similar.The data presented could be explained by a different behavior of the children at home or in kindergarten/school. It could also be that the same behavior is evaluated differently. Low correlations are already known for questionnaires on attention deficit/hyperactivity disorder and executive functions.For the clinical routine it is recommended to document the reported symptoms standardized with the DGPP-AVWS-FB and in particular to determine whether an abnormal auditory behavior is noticeable in only one or two or more environments.Beeinträchtigungen der Lautdiskrimination, des Sprachverständnisses im Störlärm, der Merkfähigkeit u. s. w. können im Rahmen einer Diagnostik bezüglich einer auditiven Verarbeitungs- und Wahrnehmungsstörung (AVWS) strukturiert mit dem von der Deutschen Gesellschaft für Phoniatrie und Pädaudiologie erstellten Fragebogen (DGPP-AVWS-FB) erfasst werden. Hier soll über Erfahrungen bei Verwendung dieses Fragebogens in einer phoniatrisch-pädaudiologischen Praxis berichtet werden. Insbesondere sollte ermittelt werden, ob Angaben der Eltern zum auditiven Verhalten ihrer Kinder ähnlich oder different zu Angaben von Erzieherinnen und Erziehern im Kindergarten (KGK) respektive von Lehrkräften in der Schule (LK) sind.In einem neunmonatigen Zeitraum wurde allen Eltern, die ihre Kinder zur Abklärung einer eventuellen AVWS vorstellten, der DGPP-AVWS-FB zum Ausfüllen durch sie sowie durch KGK/LK ausgehändigt. Zum Vergleich der Übereinstimmung der Beurteilungen wurden auch jeweils zwei Fragebögen zur Aufmerksamkeit und Konzentration bzw. zu exekutiven Funktionen (DISYPS II, BRIEF oder BRIEF-P) mitgegeben. Daten von Kindern mit peripherer Hörstörung oder kognitiver Entwicklungsstörung wurden nicht verwendet. Dann wurde für die jeweiligen Items, Skalen und Indices der Korrelationskoeffizient berechnet.Ausgefüllte Fragebögen lagen zum Schluss des Untersuchungszeitraums von insgesamt 20 Grundschulkindern sowie 7 Kindergartenkindern vor. Bei letztgenannten erfolgte die Vorstellung ausschließlich auf Veranlassung der KGK, bei einem Schulkind wurde eine AVWS durch die Eltern, nicht aber durch LK, bei drei Schulkindern sowohl durch die Eltern wie durch LK und bei 16 Schulkindern nur durch LK vermutet. Die Auswertung der DGPP-AVWS-FB spiegelte letztlich diese unterschiedliche Einschätzung der Symptomatik wieder: die Angaben der Eltern zeigten, mit Ausnahme der Angaben bei Kindern, bei denen sowohl Eltern wie LK eine AVWS vermuteten, nur eine geringe Übereinstimmung zu den Angaben der KGK/LK. Im Vergleich dazu waren die Antworten zu den beiden anderen Fragebögen ebenfalls unterschiedlich, die Angaben zur Aufmerksamkeit und Hyperaktivität bei Kindergartenkindern tendenziell aber ähnlicher.Die hier aus der phoniatrisch-pädaudiologischen Praxis vorgestellten Daten könnten mit einem unterschiedlichen Verhalten der Kinder im häuslichen Umfeld respektive im Kindergarten/in der Schule zu erklären sein. Es könnte auch sein, dass dasgleiche Verhalten unterschiedlich bewertet wird. Für Fragebögen-Instrumente zur Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung und zu exekutiven Funktionen sind niedrige Korrelationen bereits bekannt. Für die klinische Routine empfiehlt sich, die berichteten Symptome standardisiert mit dem DGPP-AVWS-FB zu dokumentieren und insbesondere auch festzustellen, ob ein auffälliges auditives Verhalten nur in einer oder in zwei bzw. mehreren Umgebungen auffällt.

Although neuromuscular electrical stimulation (NMES) is increasingly used in dysphagia therapy, patient responses to NMES are inconsistent and conflicting results have been reported. This, together with a lack of information about the effects of NEMS on the swallowing process, has led to an ongoing debate about its impact on swallowing function. In order to address this, we set out to (i) collect baseline information on the physiological effects of NMES on the complex pharyngeal phase of swallowing and (ii) to compare two different stimulation protocols. In doing so, we provide information useful for evaluating the therapeutic effectiveness of NMES on the swallowing process. In a prospective study, 29 healthy participants performed water swallows after receiving continuous NMES for 10 min. The stimulus was applied in the submandibular region using one of two different stimulation protocols: low-frequency stimulation (LFS) and mid-frequency stimulation (MFS). Swallowing parameters of the pharynx and UES were measured using high-resolution manometry. Maximum tongue base pressure increased by 8.4% following stimulation with the MFS protocol. Changes in UES function were not found. LFS stimulation did not result in any significant changes in the parameters examined. The MFS protocol enhances tongue base retraction during swallowing in healthy volunteers. The magnitude of the effect, however, was small, possibly due to the ability of healthy subjects to compensate for external influences, such as NMES, and may actually prove to be much greater in patients with diminished tongue base retraction. Thus, further studies are needed to determine whether a similar effect is also achievable in dysphagic patients with impaired bolus propulsion, possibly allowing MFS stimulation of the tongue base region to be used as an additional treatment tool.

Das Bolusvolumen hat einen modulierenden Einfluss auf die Schluckdynamik, allerdings sind bisher gewonnene Ergebnisse bezuglich der Adaptation der Pharynxfunktion uneinheitlich. Das Ziel war es deshalb, schluckvolumenbedingte Veranderungen von Druck- und Zeitparametern im Pharynx und oberen Osophagussphinkter (oOS) mit der Hochauflosungsmanometrie (HRM) umfassend zu untersuchen. Um die normale Schluckphysiologie zu evaluieren, wurden besonders dunne HRM-Sonden eingesetzt, von denen nur eine geringe Beeinflussung der untersuchten Strukturen zu erwarten war. 10 gesunde Probanden fuhrten wahrend einer HRM-Untersuchung jeweils 10 Schluckversuche mit 2 ml und 10 ml Wasser in aufrechter Position durch. Druck- und Zeitparameter fur die Velopharynx- und Zungengrundregion sowie den oOS wurden bestimmt und die Ergebnisse fur die beiden Bolusvolumina statistisch auf Unterschiede untersucht. Bei groseren Schluckvolumina waren ein langerer Verschluss des Velopharynx und eine langere Offnung des oOS feststellbar. Veranderungen der Druckparameter waren nicht nachweisbar. Das Bolusvolumen hatte einen Einfluss auf die Zeitparameter der pharyngealen Phase, sodass zeitliche Anpassungen der automatisierten Schluckdynamik nachgewiesen werden konnten. In anderen Studien gezeigte Anderungen pharyngealer Druckparameter konnten nicht bestatigt werden. Sie sind moglicherweise durch HRM-Sonden mit grosem Durchmesser bedingt, die selbst einen Einfluss auf die Kontraktionseigenschaften der Pharynxstrukturen nehmen konnen. Unter diagnostischen Gesichtspunkten sollten HRM-Untersuchungen immer mit unterschiedlichen Bolusvolumina durchgefuhrt werden, um den Schluckvorgang vollstandig zu untersuchen.

The article “Influence of Acid Swallows on the Dynamics of the Upper Esophageal Sphincter”, written by “Simone Miller, Martin Ptok, Michael Jungheim”, was originally published electronically on the publisher’s internet portal on 4 September 2020 without open access. With the author(s)’ decision to opt for Open Choice the copyright of the article changed on 30 October 2020 to © The Author(s) 2020 and the article is forthwith distributed under a Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/), which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.

The laryngeal adductor reflex (LAR) is an important protective function of the larynx to prevent aspiration and potentially fatal aspiration pneumonia by rapidly closing the glottis. Recently, a novel method for targeted stimulation and evaluation of the LAR has been proposed to enable non-invasive and reproducible LAR performance grading and to extend the understanding of this reflexive mechanism. The method relies on the laryngoscopically controlled application of accelerated water droplets in association with a high-speed camera system for LAR stimulation site and reflex onset latency identification. Prototype laryngoscopes destined for this method require validation prior to extensive clinical trials. Furthermore, demonstrations using a realistic phantom could increase patient compliance in future clinical settings. For these purposes, a model of the human larynx including vocal fold actuation for LAR simulation was developed in this work. The combination of image processing based on a custom algorithm and individual motorization of each vocal fold enables spatio-temporal droplet impact detection and controlled vocal fold adduction. To simulate different LAR pathologies, the current implementation allows to individually adjust the reflex onset latency of the ipsi- and contralateral vocal fold with respect to the automatically detected impact location of the droplet as well as the maximum adduction angle of each vocal fold. An experimental study of the temporal offset between desired and observed LAR onset latency due to image processing was performed for three average droplet masses based on highspeed recordings of the phantom. Median offsets of 100, 120 and 128 ms were found (n=16). This offset most likely has a multifactorial cause (image processing delay, inertia of the mechanical components, droplet motion). The observed offset increased with increasing droplet mass, as fluid oscillations after impact may have been detected as motion. In future work, alternative methods for droplet impact detection could be explored and the observed offset could be used for compensation of this undesirable delay.

Chronic rhinosinusitis (CRS) is one of the most common chronic diseases in Germany and is often accompanied by years of chronic rhinosinusitis. According to the current German guideline "Rhinosinusitis", the nasal application of salt solutions, topical corticosteroids and in individual cases also systemic corticosteroids appear useful for a symptomatic therapy of CRS. The evidence for other therapeutic procedures such as acupuncture, homeopathy and phytotherapeutics is seen as insufficient. The aim of the present study was to investigate whether anti-inflammatory effects of electrostimulation therapy can also be demonstrated in CRS.randomized, prospective single center study, primary setting; 16 patients with moderate chronic rhinosinusitis with polyps (cRScNP), corresponding to a Lund / Mackay score of 6-12; home based electrostimulation therapy (EST) with amplitude modulated current (base frequency of 4000 Hz, frequency band of 100-250 Hz) over 2 weeks adjuvant to a concurrent sinusitis therapy with topical corticosteroids; measurement of nasal nitric oxide concentration and self-assessment of complaints with the questionnaire instrument SNOT-20 GAV; survey points t0 before EST, t1 after EST, t2 6 weeks after t1.Home based EST was performed by 16 patients. The results indicate that the positive effects of electrostimulation therapy in inflammatory processes also exist in CRS.Adjuvant transsinuidal electrostimulation could thus enrich the conservative therapy of CRS. Further studies with larger collectives are desirable.Die chronische Rhinosinusitis (CRS) zählt in Deutschland zu den häufigsten chronischen Erkrankungen und geht nicht selten mit einem jahrelangen Verlauf einher. Nach der aktuellen deutschen Leitlinie Rhinosinusitis sind für eine symptomatische Therapie der CRS die nasale Anwendung von Salzlösungen, topische Kortikosteroide, in Einzelfällen auch systemische Kortikosteroide sinnvoll. Die Evidenzlage für andere therapeutische Verfahren wie Akupunktur, Homöopathie und Phytotherapeutika wird als nicht ausreichend gesehen. In der vorliegenden Studie sollte untersucht werden, ob antiinflammatorische Effekte einer Elektrostimulationstherapie auch bei einer CRS nachgewiesen werden können. METHODIK: randomisierte, prospektive Single center Studie, primäres Setting; 16 Patientinnen und Patienten mit mittelgradig ausgeprägter chronischer Rhinosinusitis mit Polypen (cRScNP), entsprechend einem Lund / Mackay score von 6–12; heimbasierte Elektrostimulationstherapie (EST) mit amplitudenmoduliertem Strom (Basisfrequenz von 4000 Hz, Frequenzband von 100–250 Hz) über 2 Wochen adjuvant zu einer leitliniengerechten Sinusitistherapie mit topischen Kortikosteroiden; Messung der nasalen Stickstoffmonoxid Konzentration und Selbstbewertung der Beschwerden mit dem Fragebogeninstrument SNOT-20 GAV; Erhebungszeitpunkte t0 vor EST, t1 nach EST, t2 6 Wochen nach t1.Die heimbasierte EST wurde von 16 Patientinnen und Patienten durchgeführt. Die vorliegenden Ergebnisse deuten darauf hin, dass die bereits seit langem bekannten positiven Effekte einer Elektrostimulationstherapie bei inflammatorischen Prozessen auch bei einer CRS bestehen.Die adjuvante transsinuidale Elektrostimulation könnte somit die konservative Therapie der CRS bereichern. Weitere Studien mit größeren Kollektiven sind wünschenswert.

Current notions of "hearing impairment", as reflected in clinical audiological practice, do not acknowledge the needs of individuals who have normal hearing pur tone sensitivity but who experience auditory processing difficulties in everyday life that are indexed by reduced performance in other more sophisticated audiometric tests such as speech audiometry in noise or complex non-speech sound perception. This disorder, defined as "Auditory Processing Disorder" (APD) or "Central Auditory Processing Disorder" is classified in the current tenth version of the International Classification of diseases as H93.25 and in the forthcoming beta eleventh version. APDs may have detrimental effects on the affected individual, with low esteem, anxiety, and depression,and symptoms may remain into adulthood. These disorders may interfere with learning per se and with communication, social, emotional, and academic-work aspects of life. The objective of the present paper is to define a baseline European APD consensus formulated by experienced clinicians and researchers in this specific field of human auditory science. A secondary aim is to identify issues that future research needs to address in order to further clarify the nature of APD and thus assist in optimum diagnosis and evidence-based mamagement. This European consensus presents the main symptoms, conditions, and specific medical history elements that should lead to auditory processing evaluation. Consensus on definition of the disorder, optimum diagnostic pathway, and appropriate management ar highlighted alongside a perspective on future research focus.

Objectives/Hypothesis Examination of tissue structures by optical coherence tomography (OCT) has been shown to be useful on mucous membranes of the vocal folds, but so far its application to the human larynx has been limited because it is technically cumbersome and usually needs to be performed with sedation. Here a newly developed, noninvasive combined laryngoscopy and OCT procedure is described and its suitability for ambulatory OCT studies evaluated. Because inhalation therapies utilizing saline solutions are commonly used as a treatment option for disorders of the airways, and vocal fold epithelium is most likely to be affected due to its superficial positioning, epithelial thickness was chosen as a relevant test parameter and evaluated before and after saline inhalation. Methods Seven vocally healthy participants performed a 10-minute inhalation of saline solution and underwent a combined laryngoscopy and OCT before and after the inhalation therapy. Endoscopy was performed using a newly developed combined laryngoscopy and OCT device. The OCT images were used to estimate the epithelial thickness of the vocal folds. Results Epithelial thickness measured in all participants before treatment was comparable in size reported in previous studies. Statistical differences before and after inhalation were not detected. Conclusion The newly developed combined laryngoscopy and OCT procedure enables rapid investigation of the vocal fold epithelium. Inhalation of saline solution did not appear to affect the thickness of the epithelium of the vocal folds in vocally healthy subjects, as evaluated by OCT. Level of Evidence N/A. Laryngoscope, 2016

In about one-third of brass instrumentalists, there are stress-related insufficiencies of velopharyngeal closure (VPC), i. e. the intraoral pressure exceeds the barrier formed by the VPC. Here, it was the aim to measure the VPC closing pressure while playing a trumpet and to evaluate the influence of a 30 minute stress sequence on the muscular activities in the VPC.Sample: 6 healthy volunteers; task: to play the sound h1 for 5 seconds with 85 dB(A) and with 100 dB(A).High-resolution manometry (HRM).t0: measurement without warm up phase t1 after 30 min trumpet play; practice phase with predefined pieces of music.mean (ptesting for normal distribution, t-test.All measured pressures in the VPC decreased from t0 to t1 for tones produced at 85 dB(A). For 100 dB(A) tones only the pTones played at louder volumes require a stronger muscular contraction in the VPC. The lower VPC pressure after the exercise phase (t1) can either result from a physiological muscular adaptation to the pressure level necessary for a sufficient VPC or already be a sign of muscular fatigue. These findings may be important to assess the work ability of wind instrumentalists by HRM. As shown for the phonation, the VPC pressure profile for the trumpet play can also be described with a three-phase model consisting of an initiation, a stable phase and a termination.Bei etwa einem Drittel der Blasmusiker kommt es zu belastungsbedingten Insuffizienzen des velopharyngealen Abschlusses (VPA), d. h. der intraorale Druck übersteigt die durch den VPA gebildete Barriere. In dieser Studie sollte der Verschlussdruck im VPA beim Spielen einer Trompete gemessen und über prüft werden, welchen Einfluss eine 30-minütige Belastungssequenz auf die muskulären Aktivitäten im VPA hat.Stichprobe: 6 gesunde Probanden. Aufgabe: Spielen des Tons h1 über 5 Sekunden mit 85 dB(A) und mit 100 dB(A). Methodik: Hochauflösungsmanometrie (HRM); Messzeitpunkte: t0: Messung ohne Einspielphase, t1 nach 30 min Trompetenspiel mit vorgegebenen Musikstücken. Variablen: mittlere Drücke (pAlle gemessenen Drücke im VPA sanken von t0 zu t1 für produzierte 85 dB(A) Töne. Für 100 dB(A) Töne sanken nur die pLauter gespielte Töne erfordern eine stärkere muskuläre Kontraktion im VPA. Der niedrigere Verschlussdruck im VPA zum Zeitpunkt t1 kann Folge einer physiologischen muskulären Adaptation an das für den VPA notwendige Druckniveau oder bereits Zeichen einer muskulären Ermüdung sein. Dies ist möglicherweise für den Einsatz der HRM zur Beurteilung der Berufsfähigkeit von Blasinstrumentalisten von Bedeutung. Wie schon für die Phonation beschrieben, ließ sich auch hier mit einem dreiphasigen Modell, bestehend aus Initiation, stabiler Phase und Terminierung, der VPA Druckverlauf beschreiben.

Die Elektrostimulationstherapie wird im rehabilitativen Kontext schon sehr lange verwendet. In der HNO-Heilkunde hat sich bisher der Einsatz von neuromuskularer Elektrostimulationstherapie (NMES) bei Fazialisparesen, Dysphonien und Dysphagien durchgesetzt. Studienergebnisse weisen darauf hin, dass die Kombination von Elektrostimulation und traditioneller Therapie in der Behandlung dieser Krankheiten einen tendenziell besseren Effekt zeigt als die traditionell angewandte Therapie allein.

The bolus volume has a modulating effect on the swallowing dynamics, but previously reported adaptations of the pharyngeal function have been inconsistent. Therefore, the aim of this study was to comprehensively evaluate changes of pressure and time parameters in the pharynx and upper esophageal sphincter (UES) in relation to the swallowed bolus volume with high-resolution manometry (HRM). To examine the normal swallowing physiology, particularly thin HRM probes were used, which were expected to influence the investigated structures only minimally.10 healthy volunteers accomplished 10 swallows with 2 and 10 ml water respectively in an upright position, while an HRM-examination was performed. Pressure and time parameters of the velopharynx, the tongue base region and the UES were determined and analyzed for statistical differences with respect to the bolus volume.Swallowing larger bolus volumes resulted in both, a longer closure of the velopharynx and in a longer opening of the UES. Volume dependent pressure changes in the pharyngeal swallowing sequence were not detectable.Under the chosen test conditions, bolus volume had an impact on the time parameters of the pharyngeal phase, thus, temporal adaptations of the automated swallowing dynamics were detected. Changes in pharyngeal pressure parameters as shown in other studies cannot be confirmed. They may be due to HRM probes with a larger diameter, which take an effect on the pharyngeal structures themselves. With regard to diagnostic aspects, HRM studies should always be conducted with different bolus volumes in order to investigate the swallowing process completely.

Objective: Neuromuscular electrical stimulation (NMES) has been proposed in the treatment of laryngopharyngeal dysfunctions (dysphonia, dyspnoea, dysphagia) for more than 40 years. Several studies have investigated possible therapeutic effects. Some researchers described favourable results, whereas others did not find relevant benefits. This article aims to review available studies to give an overview regarding the current state of knowledge. Methods: We conducted a selective literature search using PubMed. Results: In total, 356 papers were identified: 6 case reports, 11 reviews, 43 prospective clinical trials and 3 retrospective trials were found. Conclusion: Due to different stimulation protocols, electrode positioning and various underlying pathological conditions, summarizing the present studies appears to be difficult. However, there is evidence that NMES is a valuable adjunct in patients with dysphagia and in patients with vocal fold paresis. Nevertheless, more empirical data is needed to fully understand the benefits provided by NMES. Further research suggestions are put forward.

Die Hochauflosungsmanometrie (HRM) wird zunehmend zur Untersuchung des oberen Osophagussphinkters (oOS) und der Pharynxkontraktion wahrend des Schluckens eingesetzt. Neben der Verwendung unterschiedlicher Manometriesysteme erfolgt auch die Auswertung der Messergebnisse bisher uneinheitlich. Ziel dieser Arbeit ist deshalb, einen Uberblick uber die bereits verwendeten Schluckparameter zu geben, zu erklaren, welche Schwierigkeiten bei der Auswertung noch vorliegen und darzustellen, wie diese uberwunden werden konnen. Mithilfe einer selektiven Literaturrecherche in PubMed wurden Arbeiten ausgewahlt, die eine genaue Beschreibung der Auswertung der Schluckparameter enthielten. Anhand eigener Messergebnisse werden diese grafisch dargestellt und Auswertungsstrategien diskutiert. Bei der Beurteilung der Schluckfunktion sind neben der Kontinuitat der muskularen Kontraktionswelle und der Offnungsfunktion des oOS insbesondere auch die velopharyngeale Verschlusszone und die Zungengrundregion von Interesse. Um die Funktion in diesen Bereichen zu quantifizieren, werden Druckminima und -maxima, Zeitintervalle, durchschnittliche Drucke, Druckgradienten, Druckintegrale, Passagegeschwindigkeiten und anatomische Parameter bestimmt. Um die Vergleichbarkeit von HRM-Untersuchungsergebnissen zu gewahrleisten, ist neben der geratetechnischen Beschreibung auch eine genaue Definition der ausgewerteten Schluckparameter notwendig. Eine Integration der Parameter in die Herstellersoftware ware zukunftig wunschenswert, um eine vergleichbare und zugige Auswertung der Untersuchungen zu ermoglichen. Zusatzlich ist eine Konsensbildung notwendig, um einen strukturierten Untersuchungsvorgang festzulegen und zu entscheiden, welche Parameter zur Untersuchung des Schluckvorgangs notwendig sind.

Eine intakte velopharyngeale Funktion ist fur viele Aufgaben des oberen Aerodigestivtrakts, u. a. fur die korrekte Produktion sprachlicher Laute, notwendig. Bei der velopharyngealen Insuffizienz (VPI) kommt es zu einem inkompletten oder unbestandigen Nasenrachenabschluss und konsekutiv zur Rhinophonie oder zu Schluckbeschwerden. Der VPI konnen anatomisch-strukturelle, neurophysiologische und funktionelle Defizite zugrunde liegen. Ziel dieses Artikels ist es, einen Uberblick uber die Ursachen der VPI zu geben.

Bei einer unversorgten Gaumenspalte resultiert nahezu immer ein fehlerhafter velopharyngealer Abschluss. Hier werden die Anatomie und Physiologie der Strukturen, die den velophayngealen Abschluss bewirken, erlautert. Anhand dieser Kenntnisse kann dann die bei einem Patienten vorliegende Fehlfunktion bewertet werden.

Die Kollagenosen aus der Gruppe der Autoimmunkrankheiten zeigen eine Vielfalt von Symptomen, da sie neben der Beteiligung kollagener Gewebe Entzundungen der grosen/kleinen Gefase verursachen. Kehlkopfveranderungen sind bei Kollagenosen seit langem bekannt. Larynxmukositiden, -odeme, Epiglottitiden, lokale muskulare Dystrophien und Stimmlippenveranderungen, verursacht durch Rheumaknotchen, Zysten, Granulome und Bamboo nodes, sind beschrieben worden. Cricoarytaenoidarthritiden, laryngeale Myositiden oder N.-recurrens-Affektionen konnen Stimmlippenminderbeweglichkeiten verursachen. Die Erstbehandlung besteht in Kortisongaben (oral), bei umschriebenen Stimmlippenveranderungen auch durch Kortikoidinjektionen in die Lasion sowie Stimmschonung. Stimmtherapien konnen im Verlauf sinnvoll sein. Bei frustranem Verlauf ist evtl. eine Abtragung der Lasion sinnvoll. Rezidive sind bei allen Behandlungsformen moglich. Im Hinblick auf die Haufigkeit von Autoimmunkrankheiten und ihre Assoziation mit Dysphonien sollten alle therapeutisch Tatigen auch an autoimmuninduzierte Kehlkopfpathologien denken. Da Dysphonien auch ein Erstsymptom von Autoimmunkrankheiten sein konnen, ist bei anamnestischem Verdacht eine fruhzeitige rheumatologische bzw. serologische Diagnostik wunschenswert.

Vocal fold lesions related to autoimmune diseases are rheumatoid nodules and, to a lesser extent, bamboo nodes. Mostly transverse, they are located in the middle third of the vocal cord and exhibit a yellowish appearance. The characteristic shape of these lesions led to their name. These vocal fold deposits may interfere with the normal vibratory cycle during phonation and thus may be an unusual cause of hoarseness. We present a 43-year-old woman with known mixed connective tissue disease and a dysphonia. Laryngostroboscopy showed bamboo nodes as described above. We applied several laryngeal injections of cortisone as described previously in the literature. Since this treatment did not lead to a sufficient voice improvement, we attempted to surgically remove the deposits. After the surgery, the voice improved considerably. In all patients with rheumatic diseases who suffer from a rough, breathy, or unstable voice, a laryngostroboscopic examination should be done. If, however, a bamboo node lesion of the vocal folds is found by the laryngologists, an associated autoimmune disorder must be assumed, and adequate diagnostic procedures have to be initiated. Local laryngeal injections (1-3 times) with steroids should be the first line of therapy. In unsuccessful cases, subsequent surgery can be a useful treatment of bamboo nodes to stabilize and improve voice quality.

Genitopatellar syndrome is characterized by absent/hypoplastic patellae, genital and renal abnormalities, dysmorphic facial features, and mental retardation. Cardiac anomalies, ectodermal dysplasia, and radio-ulnar synostosis have been suggested as additional features. We report on additional female patient with sensorineural hearing loss, cleft palate, and hypothyroidism in addition to known anomalies. Findings are discussed based on a literature review of the known patients with the genitopatellar syndrome.

The objective of this study was to evaluate a new intervention for chronic dysphonias, consisting of a 2-week outpatient treatment period using intensified voice therapy combined with elements of physical medicine, including physiotherapy (orthotherapy, detonisation and training of the trunk muscles, respiratory therapy and others), manual therapy (mobilization of the cervical spine), inhalations, vibration massages, thermotherapy, classical massages and active relaxation (e.g. autogenic training, progressive muscle relaxation). In addition, the autonomous regulation was influenced by hydrotherapy according to Kneipp. A handicap questionnaire was given to 37 patients with diverse aetiologies of dysphonia before and after intervention. The change score was compared between baseline handicap levels (none, mild, moderate, severe), and between patients with organic and functional dysphonias. The questionnaire was also given to 40 healthy volunteers for comparison with patients' baseline values. Overall handicap was significantly reduced in patients with moderate baseline handicap values, whereas no significant changes could be detected in patients with severe handicap; patients with mild handicap values did receive some benefit. A significant difference in the intervention outcome was found between patients with organic and functional dysphonias. In conclusion, the results suggest that ambulatory rehabilitative measures are most effective in patients with moderate functional dysphonias, and that severe dysphonias with organic backgrounds may require longer rehabilitation phases.

Highly and moderately skilled choral singers listened to a perfect fifth reference, with the instruction to complement the fifth such that a major triad resulted. The fifth was suddenly and unexpectedly shifted in pitch, and the singers' task was to shift the fundamental frequency of the sung tone accordingly. The F0 curves during the transitions often showed two phases, an initial quick and large change followed by a slower and smaller change, apparently intended to fine-tune voice F0 to complement the fifth. Anesthetizing the vocal folds of moderately skilled singers tended to delay the reaction. The means of the response times varied in the range 197- 259 ms depending on direction and size of the pitch shifts, as well as on skill and anesthetization.

For more than 40 years, electrical stimulation procedures for unilateral recurrent laryngeal nerve paresis (URLNP) therapy have been proposed. However, it is unclear whether electrical stimulation therapy is effective for URLNP patients. In this study we compare the outcome of traditional voice exercise treatment (VE) with electrical stimulation-supported voice exercise (ES). A total of 90 URLNP patients were recruited to participate in a prospective, randomized trial. The decrease in vocal fold irregularity (CFx) and increase in maximum phonation time (MPT) after a 3-month therapy period were the dependent variables. In the ES group, CFx improved to a significantly greater extent than in the VE group. MPT increased similarly in both groups. Our data indicate that ES is superior to VE for patients with URLNP. Because no further data exist, it can be assumed that improvement following VE only reflects spontaneous recovery. However ES appears to be an effective non-surgical therapeutic procedure.

Objective After swallowing, the upper esophageal sphincter (UES) needs a certain amount of time to return from maximum pressure to the resting condition. Disturbances of sphincter function not only during the swallowing process but also in this phase of pressure restitution may lead to globus sensation or dysphagia. Since UES pressures do not decrease in a linear or asymptotic manner, it is difficult to determine the exact time when the resting pressure is reached, even when using high resolution manometry (HRM). To overcome this problem a Machine Learning model was established to objectively determine the UES restitution time (RT) and moreover to collect physiological data on sphincter function after swallowing. Methods and material HRM-data of 15 healthy participants performing 10 swallows each were included. After manual annotation of the RT interval by two swallowing experts, data were transferred to the Machine Learning model, which applied a sequence labeling modeling approach based on logistic regression to learn and objectivize the characteristics of all swallows. Individually computed RT values were then compared with the annotated values. Results Estimates of the RT were generated by the Machine Learning model for all 150 swallows. When annotated by swallowing experts mean RT of 11.16 s ± 5.7 (SD) and 10.04 s ± 5.74 were determined respectively, compared to model-generated values from 8.91 s ± 3.71 to 10.87 s ± 4.68 depending on model selection. The correlation score for the annotated RT of both examiners was 0.76 and 0.63 to 0.68 for comparison of model predicted values. Conclusions Restitution time represents an important physiologic swallowing parameter not previously considered in HRM-studies of the UES, especially since disturbances of UES restitution may increase the risk of aspiration. The data presented here show that it takes approximately 9 to 11 s for the UES to come to rest after swallowing. Based on maximal RT values, we demonstrate that an interval of 25–30 s in between swallows is necessary until the next swallow is initiated. This should be considered in any further HRM-studies designed to evaluate the characteristics of individual swallows. The calculation model enables a quick and reproducible determination of the time it takes for the UES to come to rest after swallowing (RT). The results of the calculation are partially independent of the input of the investigator. Adding more swallows and integrating additional parameters will improve the Machine Leaning model in the future. By applying similar models to other swallowing parameters of the pharynx and UES, such as the relaxation time of the UES or the activity time during swallowing, a complete automatic evaluation of HRM-data of a swallow should be possible.

ZusammenfassungDie auditorische Neuropathie (AN) zeichnet sich durch nachweisbare evozierbare otoakustische Emissionen (EOAE) und nicht ableitbare bzw. nur mit erhöhten Schwellen ableitbare auditorisch evozierte Hirnstammpotenziale aus. Als Ursache mus eine Funktionsstörung der inneren Haarzellen und/oder eine Störung der neuronalen Reizweiterleitung bei intakten äußeren Haarzellen angenommen werden.Betroffene Patienten verhalten sich in schweren Fällen wie Schwerhörige mit einer hochgradigen kochleären Schwerhörigkeit, in milderen Fällen kann das Tonschwellenaudiogramm weitgehend normal sein, das Sprachverständnis ist meistens jedoch deutlich eingeschränkt.Die auditorische Neuropathie scheint häufiger zu sein als noch vor einiger Zeit angenommen. Bei anamnestisch zu vermutender Schwerhörigkeit, insbesondere bei Kindern mit einem Sprachentwicklungsrückstand – gerade, wenn ein Sprachaudiogramm noch nicht durchführbar erscheint – gutem Tonschwellenaudiogramm und nachweisbaren EOAE ist die auditorische Neuropathie immer diffenzialdiagnostisch zu berücksichtigen.

Examination of tissue structures by optical coherence tomography (OCT) has been shown to be useful on mucous membranes of the vocal folds, but so far its application to the human larynx has been limited because it is technically cumbersome and usually needs to be performed with sedation. Here a newly developed, noninvasive combined laryngoscopy and OCT procedure is described and its suitability for ambulatory OCT studies evaluated. Because inhalation therapies utilizing saline solutions are commonly used as a treatment option for disorders of the airways, and vocal fold epithelium is most likely to be affected due to its superficial positioning, epithelial thickness was chosen as a relevant test parameter and evaluated before and after saline inhalation.Seven vocally healthy participants performed a 10-minute inhalation of saline solution and underwent a combined laryngoscopy and OCT before and after the inhalation therapy. Endoscopy was performed using a newly developed combined laryngoscopy and OCT device. The OCT images were used to estimate the epithelial thickness of the vocal folds.Epithelial thickness measured in all participants before treatment was comparable in size reported in previous studies. Statistical differences before and after inhalation were not detected.The newly developed combined laryngoscopy and OCT procedure enables rapid investigation of the vocal fold epithelium. Inhalation of saline solution did not appear to affect the thickness of the epithelium of the vocal folds in vocally healthy subjects, as evaluated by OCT.N/A. Laryngoscope, 126:E332-E336, 2016.

BACKGROUND: For the treatment of unilateral vocal fold paresis, aspects of nerve regeneration, muscle protection and compensation of impaired function have to be considered. Several behavioural voice treatment procedures and electrical stimulation regimen have been suggested. Here practical considerations of electro stimulation procedures are discussed. In contrast to behavioural therapy, electro stimulation therapy is performed in a home based procedure.

One major advantage of acutely dissociated inferior colliculus (IC) neurons in electrophysiological investigations is their complete isolation from the surrounding cellular network. In this way, patch-clamp recordings can be performed under controlled conditions to study membrane properties of IC neurons in more detail. The aim of the present study was to adapt a dissociation method for immature IC neurons to the highly sensitive, fragile and vulnerable mature IC neurons of mammals (mice). The modification of a pronase-based dissociation protocol with respect to concentration, incubation time and handling (trituration) of the cells yielded intact, live IC neurons with a clean cell surface so that they were well suited for further electrophysiological investigations in our study. The largely modified dissociation protocol is described in detail and critically discussed.

Seit mehr als 50 Jahren untersucht man, ob die kognitiven Fahigkeiten bzw. der Spracherwerb von Kindern mit Lippen-, Kiefer- und Gaumenspalten (LKG-Spalten) im Vergleich zu Kindern ohne Spaltfehlbildung unterschiedlich sind. Wahrend zunachst keine gravierenden Unterschiede aufgedeckt werden konnten, zeichnen aktuelle Studien, die auch Kleinkinder und Erwachsene einbeziehen und die Pravalenz von Lernstorungen sowie die biologischen Grundlagen kognitiver Prozesse untersuchen, jedoch ein differenziertes Bild 1 . Im Folgenden soll, in enger Anlehnung an die Ubersicht von Hardin-Jones 1 , ein Uberblick uber die aktuelle Studienlage gegeben werden.