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ABSTRACT: Background/Aims: In speech audiometry, sentence tests have the advantage of assessing more words within a given period of time than single-word tests do. Consequently, greater accuracy (steeper discrimination function) is achieved. The recently developed German Oldenburg Sentence Test for Children (OlKiSa) has been evaluated thus far for school-aged children in noise, and normative data for younger children in a quiet environment have been established. In this study, the focus is on its applicability in hearing-impaired children fitted with hearing aids or cochlear implants. Methods: The use of the OlKiSa in a quiet environment in hearing-impaired children aged 4 years or older was evaluated. One hundred and nineteen hearing-impaired children aged between 4 and 10 years performed the OlKiSa in a quiet environment. Individual speech reception thresholds (SRT) were measured aided and unaided and the slopes of the discrimination functions were calculated. Results: Independent of age, the mean slope of the discrimination function for SRT was about 7%/dB in both conditions, which is a high value of steepness for a speech audiometric test in a quiet environment. Conclusion: The OlKiSa in quiet is a reliable test procedure for hearing-impaired children aged 4 years and older.
Folia Phoniatrica et Logopaedica 09/2012; 64(5):227-233. · 1.12 Impact Factor
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ABSTRACT: To assess speech perception in children, speech audiometric sentence tests are generally better suited than single word tests because of their steeper discrimination function and thus higher sensitivity. A disadvantage of older German single word speech audiometric tests for children is their inapplicability in quiet and in noise. Moreover, their discrimination functions are shallower than those of optimized sentence tests, particularly in noise. The Oldenburg sentence test for children (Oldenburger Kinder-Satztest; OlKiSa) has already been shown to test reliably the speech perception in noise in normal-hearing children. Testing hearing-impaired children in noise, however, may be difficult. Therefore, quality criteria and norms for testing in quiet are also needed.
The OlKiSa in quiet was validated with 224 normal-hearing children between ages 4 to 10 years.
The discrimination functions are steeper (6.4 to 10.7 %/dB) than those of the commonly used German single word tests. Age-specific standards for 50% speech perception in quiet (speech reception threshold, SRT) are provided.
The OlKiSa is a valid audiometric test to quantify speech perception in quiet in children from age 4.
International journal of audiology 01/2012; 51(3):157-63. · 1.34 Impact Factor
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ABSTRACT: To develop a clear and meaningful set of definitions of types of hearing impairment.
A critical analysis was made of previous definitions together with a consideration of current knowledge of functions and dysfunctions of the auditory system.
A coherent set of definitions compatible with the contemporary understanding of auditory disorders and their perceptual effects is proposed.
Folia Phoniatrica et Logopaedica 01/2011; 63(1):43-8. · 1.12 Impact Factor
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Birgit May-Mederake,
Heike Kuehn,
Arno Vogel,
Annerose Keilmann,
Andrea Bohnert,
Sabine Mueller,
Gabriele Witt, Katrin Neumann,
Christiane Hey,
Anne Stroele,
Christian Streitberger,
Sabrina Carnio,
Patrick Zorowka,
Doris Nekahm-Heis,
Barbara Esser-Leyding,
Joanna Brachmaier,
Frans Coninx
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ABSTRACT: Newborn hearing screening and early intervention for congenital hearing loss have created a need for tools assessing the hearing development of very young children. A multidisciplinary evaluation of children's development is now becoming standard in clinical practice, though not many reliable diagnostic instruments exist. For this reason, the LittlEARS Auditory Questionnaire (LEAQ) was created to assess the auditory skills of a growing population of infants and toddlers who receive hearing instruments. The LEAQ relies on parent report, which has been shown to be a reliable way of assessing child development. Results with this tool in a group of children who received very early cochlear implantation are presented.
The LEAQ is the first module of the LittlEARS comprehensive test battery for children under the age of two who have normal hearing (NH), cochlear implants (CIs) or hearing aids (HAs). The LEAQ is a parent questionnaire comprised of 35 "yes/no" questions which can be completed by parents in less than 10 min. Sixty-three children who received unilateral CIs at a young age were assessed longitudinally and their performance was compared to that of a NH group.
All CI children reached the maximum possible score on the LEAQ on average by 22 months of hearing age, i.e. 38 months of chronological age. In comparison, the NH group reached the maximum score by 24 months of age demonstrating that auditory skills of CI children often develop quicker than those of NH children. In the two comparison groups of children aged (a) younger and older than 12 months, and (b) between 6-9 and 21-24 months at first fitting, the early implanted children reached the highest scores faster than the later implanted children. Furthermore, three children with additional needs were tested. They showed slower growth over time but also received benefits from early implantation.
The LEAQ is a quick and effective tool for assessing auditory skills of very young children with or without hearing loss. In our study, the auditory skills of children with CI progressed very quickly after implantation and were comparable with those of NH peers.
International journal of pediatric otorhinolaryngology 10/2010; 74(10):1149-55. · 0.85 Impact Factor
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ABSTRACT: A properly performed fiberoptic endoscopic evaluation of swallowing (FEES(®)) is comprehensive and time-consuming. Editing times of FEES protocols and attempts for efficiency maximization are unknown. Here, the protocol editing times of completed FEES examinations were determined. The present study reports the time savings and quality gains of a newly developed documentation system tailored to the FEES standard of Langmore. Four independent examiners analyzed twelve videos of FEES procedures, six without and six with the documentation system. Effectiveness of the documentation system was evaluated according to the times for total evaluation, interpretation, documentation, report writing, and for report completeness. The documentation system reduced editing times and increased report completeness with large effect sizes. Averaged total evaluation time decreased from 42 to 27 min, report completeness increased from 55 to 80%. The use of the documentation system facilitates and improves the assessment of the swallowing process.
Folia Phoniatrica et Logopaedica 10/2010; 63(4):201-8. · 1.12 Impact Factor
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ABSTRACT: Stuttering is a neurodevelopmental disorder associated with left inferior frontal structural anomalies. While children often recover, stuttering may also spontaneously disappear much later after years of dysfluency. These rare cases of unassisted recovery in adulthood provide a model of optimal brain repair outside the classical windows of developmental plasticity. Here we explore what distinguishes this type of recovery from less optimal repair modes, i.e. therapy-induced assisted recovery and attempted compensation in subjects who are still affected. We show that persistent stuttering is associated with mobilization of brain regions contralateral to the structural anomalies for compensation attempt. In contrast, the only neural landmark of optimal repair is activation of the left BA 47/12 in the orbitofrontal cortex, adjacent to a region where a white matter anomaly is observed in persistent stutterers, but normalized in recovered subjects. These findings show that late repair of neurodevelopmental stuttering follows the principles of contralateral and perianomalous reorganization.
Brain 09/2009; 132(Pt 10):2747-60. · 9.46 Impact Factor
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ABSTRACT: Transitory evoked otoacoustic emissions (TEOAE) have been recorded in 60 ears of 31 adult volunteers with nearly normal hearing at stimulus levels ranging from 83 dB SPL peak equivalent down to the individual response threshold using linear and nonlinear recording mode. The stimulus level dependence of response incidence and amplitude has been analysed for the integral response and in time windows selecting response components of limited latency ranges. At stimulus levels above 70 dB SPL peak equivalent the TEOAE records received in linear mode are contaminated with stimulus artifacts. At moderate stimulus levels the TEOAE amplitude differs only to a small extent between the two recording modes. At low levels the linear mode turns out to be better suited for signal detection due to its inherent lower noise level. The response threshold, defined as the highest stimulus level yielding a reproducibility of at least 60%, is significantly correlated to hearing threshold. The consideration of time windowed responses yields best results with respect to incidence and threshold of responses in the latency range between 5 and 10 ms, but it does not enhance frequency specificity.
07/2009; 46(8):407-418.
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ABSTRACT: Because documentation and report writing in fiberoptic endoscopic evaluation of swallowing (FEES) is time consuming and susceptible to omissions, a software solution to ameliorate these problems by maintaining document quality is desirable.
Based on the FEES procedure of Langmore, a documentation software (DS) which presents a digitized FEES recording and masks with precast text fields was designed to facilitate and unify data input. The oropharyngeal secretion scale of Murray and the penetration-aspiration scale of Rosenbek were integrated to increase comparability of dysphagia information. Four independent examiners analyzed 12 digitized FEES-recordings, 6 without and 6 with the DS, to determine its effect on the times needed for total evaluation, interpretation, documentation, report writing, and report completeness.
The documentation software (DS) reduced the total evaluation time from 42 min to 18 min and increased the evaluation completeness from 55% to 95%, both with very large effect sizes. The time saving was mainly due to an automated report generation at the end of the analysis.
The DS can be offered as a valuable and effective tool in daily clinical routine and for research purposes.
Medical science monitor: international medical journal of experimental and clinical research 03/2009; 15(3):MT41-6. · 1.70 Impact Factor
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ABSTRACT: Prior to cochlear implant (CI) surgery in children, the integrity of the auditory pathway is sometimes assessed by electrical ear canal stimulation (ECS). However, the evaluation of reactions as auditory is subjective. To test the prognostic value of ECS, functional magnetic resonance imaging (fMRI) was performed during ECS vicariously in 18 adult CI candidates. Activation of the primary auditory cortex was detected in 9 of 16 cases when auditory sensations during ECS occurred, and tended to be more bilaterally distributed in CI candidates than in normal-hearing controls. ECS sensations only tended to correlate with fMRI activations. However, solely frequency discrimination during electrical stimulation predicted CI outcome, but neither other auditory sensations nor fMRI activations did so satisfactorily, which limits the diagnostic value of these measures. Instead, preoperative residual hearing (nonamplified and amplified) was a robust predictor for CI benefit.
Audiology and Neurotology 05/2008; 13(5):281-92. · 2.46 Impact Factor
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ABSTRACT: The International Association of Logopedics and Phoniatrics (IALP) assessed the therapy status of fluency disorders, service opportunities, and education of logopedists (speech-language pathologists) with a mail survey in Eastern Europe. Information was collected on the following aspects: incidence, prevalence, availability of information, non-therapeutic support for persons who stutter (PWS), providers of diagnostics and therapy, cooperating professionals, therapy approaches, forms, goals, financing, early detection and prevention, training of professionals, specialization in stuttering therapy, needs for improving the situation of PWS, and problems which hinder better care. Stuttering therapy for children is available in many countries and is frequently provided by the educational system. Therapy for adults is provided best by the health services but is not satisfactorily available everywhere. Modern therapeutic approaches coexist with obsolete ones. Lack of resources, awareness, entitlement, and assessment of therapy effectiveness are pervasive problems. EDUCATIONAL OBJECTIVES: Readers will be able to describe and evaluate: (1) the therapy status of fluency disorders and service opportunities in various East-European countries; (2) the training of logopedists (speech-language pathologists); (3) specialization in stuttering therapy; and (4) the organizational services for PWS within the health and human service systems.
Journal of Fluency Disorders 04/2008; 33(1):66-71. · 4.05 Impact Factor
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ABSTRACT: In order to investigate whether the Lidcombe Program effects a short-term reduction of stuttered speech beyond natural recovery, 46 German preschool children were randomly assigned to a wait-contrast group or to an experimental group which received the Lidcombe Program for 16 weeks. The children were between 3;0 and 5;11 years old, their and both of their parents' native language was German, stuttering onset had been at least 6 months before, and their stuttering frequency was higher than 3% stuttered syllables. Spontaneous speech samples were recorded at home and in the clinic prior to treatment and after 4 months. Compared to the wait-contrast group, the treatment group showed a significantly higher decrease in stuttered syllables in home-measurements (6.9%SS vs. 1.6%SS) and clinic-measurements (6.8%SS vs. 3.6%SS), and the same increase in articulation rate. The program is considered an enrichment of currently applied early stuttering interventions in Germany. EDUCATIONAL OBJECTIVES: Readers will discuss and evaluate: (1) the short-term effects of the Lidcombe Program in comparison to natural recovery on stuttering; (2) the impact of the Lidcombe Program on early stuttering in German-speaking preschool children.
Journal of Fluency Disorders 04/2008; 33(1):52-65. · 4.05 Impact Factor
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ABSTRACT: Previous studies suggest that anatomical anomalies [Foundas, A. L., Bollich, A. M., Corey, D. M., Hurley, M., & Heilman, K. M. (2001). Anomalous anatomy of speech-language areas in adults with persistent developmental stuttering. Neurology, 57, 207-215; Foundas, A. L., Corey, D. M., Angeles, V., Bollich, A. M., Crabtree-Hartman, E., & Heilman, K. M. (2003). Atypical cerebral laterality in adults with persistent developmental stuttering. Neurology, 61, 1378-1385; Foundas, A. L., Bollich, A. M., Feldman, J., Corey, D. M., Hurley, M., & Lemen, L. C. et al., (2004). Aberrant auditory processing and atypical planum temporale in developmental stuttering. Neurology, 63, 1640-1646; Jancke, L., Hanggi, J., & Steinmetz, H. (2004). Morphological brain differences between adult stutterers and non-stutterers. BMC Neurology, 4, 23], in particular a reduction of the white matter anisotropy underlying the left sensorimotor cortex [Sommer, M., Koch, M. A., Paulus, W., Weiller, C., & Buchel, C. (2002). Disconnection of speech-relevant brain areas in persistent developmental stuttering. Lancet, 360, 380-383] could be at the origin of persistent developmental stuttering (PDS). Because neural connections between the motor cortex and basal ganglia are implicated in speech motor functions, PDS could also be associated with a dysfunction in basal ganglia activity [Alm, P. (2004). Stuttering and the basal ganglia circuits: a critical review of possible relations. Journal of Communication Disorders, 37, 325-369]. This fMRI study reports a correlation between severity of stuttering and activity in the basal ganglia and shows that this activity is modified by fluency shaping therapy through long-term therapy effects that reflect speech production improvement. A model of dysfunction in stuttering and possible repair modes is proposed that accommodates the data presented here and observations previously made by us and by others.
Brain and Language 02/2008; 104(2):190-9. · 3.12 Impact Factor
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ABSTRACT: Transitory evoked otoacoustic emissions (TEOAE) have been recorded in 60 ears of 31 adult volunteers with nearly normal hearing at stimulus levels ranging from 83 dB SPL peak equivalent down to the individual response threshold using linear and nonlinear recording mode. The stimulus level dependence of response incidence and amplitude has been analysed for the integral response and in time windows selecting response components of limited latency ranges. At stimulus levels above 70 dB SPL peak equivalent the TEOAE records received in linear mode are contaminated with stimulus artifacts. At moderate stimulus levels the TEOAE amplitude differs only to a small extent between the two recording modes. At low levels the linear mode turns out to be better suited for signal detection due to its inherent lower noise level. The response threshold, defined as the highest stimulus level yielding a reproducibility of at least 60%, is significantly correlated to hearing threshold. The consideration of time windowed responses yields best results with respect to incidence and threshold of responses in the latency range between 5 and 10 ms, but it does not enhance frequency specificity.
International Journal of Audiology 09/2007; 46(8):407-18. · 1.40 Impact Factor
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ABSTRACT: Among persons with intellectual disability, the prevalence of hearing impairments is high. During the German Special Olympics Summer Games 2004, a hearing screening was conducted on 755 athletes with intellectual disabilities. Obligatory screening included ear inspection and recording of otoacoustic emissions, and optional screening included tympanometry and brief pure-tone audiometry. 38.0% of the athletes failed the screening. 53.0% needed ear wax removal. 56.1% of the fails indicated sensorineural hearing loss and 13.6% indicated mixed hearing loss. 12.5% of the fails were caused by unremovable ear wax, 1.4% by ear canal affections, and 16.4% by middle ear problems. Left ear fails were more frequent than right ear fails. A peripheral hearing disturbance can thus be expected in every third subject. The high failure rate, a considerable percentage of previously undetected profound hearing loss (1.1%), and the frequent need for ear wax removal, suggest that nearly half of persons with intellectual disabilities need regular otological or audiological consultations.
International Journal of Audiology 03/2006; 45(2):83-90. · 1.40 Impact Factor
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ABSTRACT: The decision to mandate, finance, and implement a universal newborn hearing screening (UNHS) requires the evaluation of its therapy-directed benefit by comparing (1) a procedure employing a UNHS with (2) a targeted screening for at-risk babies for neonatal hearing disorders and (3) a procedure without systematic screening. In a cohort study the outcome of the UNHS program of Hessen in 2005 with 17,439 screened newborns was analyzed. Validity, effectiveness, and efficiency were evaluated and compared to a sample of 98 Hessian and 355 German children who were detected in 2005 as hearing-impaired but not by an UNHS. The UNHS group had a PASS rate of 97.0%. Forty-nine hearing-impaired children were diagnosed at a median age of 3.1 months and treated at a median age of 3.5 months. Corresponding values for the Hessian non-UNHS group were 17.8 and 21.0 months. For Germany the median age at diagnosis was 39.0 months. The age at therapy onset correlated negatively with parameters of speech/language and psychosocial development. A targeted screening would have resulted in a low sensitivity of 65.3%. Hence, a UNHS is the most effective way to an early therapy of neonatal hearing disorders with an optimal outcome.
Folia Phoniatrica et Logopaedica 02/2006; 58(6):440-55. · 1.12 Impact Factor
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ABSTRACT: Neuroimaging studies have indicated that persistent developmental stuttering (PDS) may be associated both with an abnormality in white matter of left-hemispheric speech areas and a right-hemispheric hyperactivity. The latter may compensate for the deficient structural connectivity in the left hemisphere. To investigate the effects of stuttering therapy on brain activity nine male adults with PDS underwent functional magnetic resonance imaging (fMRI) before and within 12 weeks after fluency shaping therapy. Brain response differences during overt sentence reading before and after therapy were assessed by utilizing random effects analyses. After therapy, a more widespread activation was observed in frontal speech and language regions and temporal areas of both hemispheres, particularly and more pronounced on the left side. Interestingly, distinct posttreatment left-sided activation increases were located directly adjacent to a recently detected area of white matter anomaly [M. Sommer, M.A. Koch, W. Paulus, C. Weiller, C. Buchel (2002). Disconnection of speech-relevant brain areas in persistent developmental stuttering. The Lancet, 360, 380-383] suggesting that fluency shaping techniques reorganize neuronal communication between left-sided speech motor planning, motor execution, and temporal areas. Hence, a therapeutic mechanism can be assumed to remodel brain circuitry close to the source of the dysfunction instead of reinforcing compensation via homologous contralateral brain networks. EDUCATIONAL OBJECTIVES: The reader will learn about and be able to: (1) describe brain activation changes detected shortly after fluency-shaping therapy; (2) identify left-hemispheric regions where a (re)functionalization after fluency-shaping therapy seems to occur adjacent to a recently described abnormal white matter region in PDS subjects; and (3) discuss how an effective cerebral compensation mechanism for stuttering could work.
Journal of Fluency Disorders 02/2005; 30(1):23-39. · 4.05 Impact Factor
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ABSTRACT: There is recent evidence of focal alteration in fibre tracts underlying the left sensorimotor cortex in persistent developmental stuttering (PDS) [Lancet 360 (2002) 380]. If, as proposed, this anatomical abnormality is the cause of PDS, then overactivation in the right hemisphere seen with functional neuroimaging in stutterers may reflect a compensatory mechanism. To investigate this hypothesis, we performed two functional magnetic resonance imaging (fMRI) experiments. The first showed systematic activation of a single focus in the right frontal operculum (RFO) in PDS subjects during reading, which was not observed in controls. Responses in this region were negatively correlated with the severity of stuttering, suggesting compensation rather than primary dysfunction. Negative correlation was also observed during the baseline task that consisted in passive viewing of meaningless signs, indicating that RFO compensation acts independently of specific demands on motor speech output. The second experiment, that involved a covert semantic decision task, confirmed that RFO activation does not require overt utterances or motor output. In combination these findings suggest that the RFO serves a nonspecific compensatory role rather than one restricted to the final stages of speech production.
NeuroImage 10/2003; 20(2):1356-64. · 5.89 Impact Factor
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ABSTRACT: The purpose of this study was to establish functional magnetic resonance imaging (fMRI) for the investigation of brain function during overt speech production in stuttering. Up to now this technique has rarely been used for the investigation of speech production paradigms because artifacts related to overt speaking largely impair the sensitivity toward task-related activation. Recently, the temporal delay of the hemodynamic response has been exploited to achieve a suppression of speech-related artifacts. By the limitation to very short utterances (one word), a temporal segregation of the respective effects was accomplished by means of an event-related experimental design. However, the investigation of speech production in persons who stutter requires a more extensive speaking situation. Since longer and more complex utterances evoke more symptoms of stuttering than reading of single words, a useful task should at least include the reading of full sentences. In this study we performed simulations to investigate the correlation of speech-related artifacts with the respective hemodynamic response in dependency on speech duration and rate of data sampling. Furthermore, we show that prolonged stimulus durations and repetition times of 3 s still allow an effective suppression of speech-related artifacts in fluent as well as in nonfluent speakers. Not only were obvious false activations at high contrast cerebrospinal fluid tissue borders widely eliminated, subjects also displayed consistent activation in speech-related and motor areas. As these results widely resemble those obtained by earlier neuroimaging studies on language production, event-related fMRI seems to be capable of recording neurophysiological correlates of overt speech production.
NeuroImage 08/2003; 19(3):1076-84. · 5.89 Impact Factor
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ABSTRACT: Rapid subglottal pressure changes related to the glottal cycles influence the aerodynamics of phonation. Various methods to measure these have been developed, but are not practical for routine phoniatric use. For that reason, a noninvasive measurement tool is necessary. This article presents a technique that uses a microphone positioned at the skin of the jugular fossa to record the signal which arises in the subglottal spaces and is transmitted through the soft tissue to the surface of the skin. Using the program Glottal Segmentation of Voice and Speech, jugular microphone recordings from two healthy subjects were compared with simultaneously recorded direct intratracheal measurements during the same phonation. A systematic error arising from the transmission properties of the microphone and the soft tissue leads to phase and amplitude deviations. These must be taken into account and require correction. This correction procedure leads to high correlations and a good agreement between the two signals. Even without this correction the jugular microphone measurements proved to be useful as a diagnostic and a therapeutic tool in cases where chest resonance specific processes appear affected. In addition, they offer material for research purposes. Although based on a small number of subjects, the new method shows a good validity; testing on a larger number of subjects will probably strengthen the validity.
Journal of Voice 07/2003; 17(2):140-59. · 1.39 Impact Factor
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ABSTRACT: A new, fast screening algorithm based on auditory brainstem response (ABR) recorded at a high click repetition rate is proposed. Response detection is carried out in the frequency domain by a statistical test procedure which includes the fundamental frequency and the harmonics below 800 Hz. First, the method was tested in 25 young adults. ABRs were recorded in the repetition rate range 20/s to 400/s. With a mean response detection time of 31 s, a click repetition rate of 140/s was found to be the optimum rate among the adult group. The method was then tested using a group of 114 neonates in whom the repetition rate range 60/s to 200/s was examined. At the repetition rate 90/s, which was found to be the optimum rate in neonates, the mean detection time was 24.6 s. In addition to the fast ABR detection, the proposed screening algorithm also allows simultaneous hearing screening of both ears using a one-channel data recording.
International Journal of Audiology 04/2003; 42(2):59-70. · 1.40 Impact Factor
