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


Ptok M.,Klinik fur Phoniatrie und Padaudiologie | Meyer S.,Klinik fur Phoniatrie und Padaudiologie | Ptok A.,Klinik fur Phoniatrie und Padaudiologie
HNO | Year: 2012

Background. The remarkable quality of modern hearing aids enables most hearing impaired individuals to take part in verbal communication without great effort. As a result, auditory training seems to have fallen into oblivion, even though its use is certainly still justified today. This article aims to review the development of these diverse therapy methods.Methods. For this systematic review, a selective literature research in PubMed using the keywords "auditory training" = 211 hits and "auditory rehabilitation" = 166 hits has been carried out. In addition, handbooks and monographs were taken into consideration.Results. For around 2,000 years, people have tried to restore hearing by acoustic stimulation. Initially it was believed that hearing could be "woken up" by means of acoustic stimulation. From the 19th Century onwards, auditory training was meant to support residual hearing and help understanding in verbal communication. Towards the end of the 20th Century, systematic approaches that were intended to enhance cognitive skills, such as concentration and attentiveness by acoustic stimulation, were developed.Discussion. The wish to integrate deaf individuals into the auditory verbal oriented society, the tremendous number of soldiers suffering from noise-induced hearing loss after World War II, modern hearing aids and cochlear implants, and finally availability of personal computers has fostered the development of auditory training methods. Further research has to investigate whether auditory training combined with drug therapy or other stimulation methods are beneficial. © Springer-Verlag 2012.


Meyer S.,Klinik fur Phoniatrie und Padaudiologie | Ptok M.,Klinik fur Phoniatrie und Padaudiologie
Laryngo- Rhino- Otologie | Year: 2012

Laryngeal Neuropathy and Irritable Larynx Syndrome: Synonyms or Distinct Entities Background: The term laryngeal neuropathy (LN) has first been used in veterinary medicine to describe an idiopathic and typically exercise induced inspiratory noise in horses. Nowadays, the term is often used in relation with intermittent vocal cord pareses in humans. Some authors use the term irritable larynx syndrome (ILS) in a similar context. This article reviews the state of knowledge regarding LN and ILS and discusses the somewhat confusing terminology. Method: For this systematic review a selective literature research in PubMed has been carried out. Results: 35 articles were found, which report on LN in animals and 17 articles reported on humans. 4 of these articles used the term irritable larynx syndrome. Discussion: Laryngeal neuropathy in horses usually affects the left recurrent laryngeal nerve and results in decreased vocal cord abduction and an inspiratory roaring or whistling noise, particularly during exercise. In dogs LN has been reported to also occur bilaterally. In association with humans LN has not been defined clearly in the literature. The term ILS on the other hand has only been used in relation to humans. The term describes a hypersensitivity of the laryngeal structures towards external stimuli, which causes symptoms such as dyspnea or cough among others. Sufficient knowledge does not exist for either of the 2 diseases, ILS or LN. As of yet, the term LN should not be used in human medicine to describe according symptoms of unknown aetiology. The term laryngeal movement disorder seems a lot more appropriate. The symptom oriented term irritable larynx syndrome also seems suitable to describe laryngeal hypersensitivity appropriately. © 2012 Georg Thieme Verlag KG Stuttgart New York.


Meyer S.,Klinik fur Phoniatrie und Padaudiologie | Ptok M.,Klinik fur Phoniatrie und Padaudiologie
HNO | Year: 2011

Background: The term Mondegreens describes misperceptions as defined by "slips of the ear", denoting that an utterance is perceived differently to what has actually been said. The analysis of these misperceptions permits a deeper insight into speech processing in the human brain. Method: A selective literature research in PubMed has been carried out for this systematic review. Results: Altogether, 24 publications were found addressing the issue of auditory misperceptions. Discussion: The analysis of Mondegreens enables a characterization of the different levels of speech processing as well as the processing steps involved. The hard of hearing in particular suffer from misperceptions. Therefore, it should be considered whether listening programs could be helpful in combination with hearing aids. © 2011 Springer-Verlag.


Meyer S.,Klinik fur Phoniatrie und Padaudiologie | Jungheim M.,Klinik fur Phoniatrie und Padaudiologie | Ptok M.,Klinik fur Phoniatrie und Padaudiologie
HNO | Year: 2011

Background: Infant- or child-directed speech (CDS) defines the code used to communicate with infants or children, which differs from standard adult speech in prosody, expressions, diction and word repetition etc. Method: A selective literature search in PubMed was carried out for the purposes of this systematic review. Results: Due to its specific advantages, child-directed speech facilitates the extraction and representation of relevant, meaningful sections from the continuous speech signal. Different speech communities use different variants of CDS. CDS is not only seen to be used by adults, but also by children communicating with younger children. However, there are speech communities that do not use CDS. Discussion: Taking into consideration findings previously described in the literature, CDS appears to positively support language acquisition in children, but does not represent a necessary prerequisite. However, there are no findings in the literature to indicate that the linguistically reduced CDS hinders early language acquisition. © 2011 Springer-Verlag.


Meyer S.,Klinik fur Phoniatrie und Padaudiologie | Ptok M.,Klinik fur Phoniatrie und Padaudiologie
HNO | Year: 2011

Background: Swallowing as a neurophysiological process has recently attracted much interest. Knowledge of cortical involvement in particular has raised hope that a novel form of dysphagia therapy might be possible by means of cortical stimulation. Method: For this systematic review a selective literature research in PubMed has been carried out. Results: The cortex is not only involved in the initiation of swallowing, but also during pharyngeal and esophageal phases. In addition, there appears to be a hemispheric dominance both for swallowing and its individual phases. Discussion: In light of recent study results, the theory of the pattern generators' autonomy must be abandoned, since pattern generators seem to be influenced rather by the cortex. During the recovery of unilateral impairments, the intact hemisphere seems to play a significant role due to cortical reorganisation processes. Several studies indicate that repetitive transcranial stimulation, and thereby modulation of cortical areas as a means of dysphagia therapy, could be beneficial. © 2010 Springer-Verlag.


Background: The laryngeal adductor reflex (LAR), a reflexive vocal fold closing mechanism, includes an early, probably di- or oligosynaptic ipsilateral LAR1- and a late ipsilateral and contralateral LAR2 polysynaptic component. In a clinical evaluation of dysphagia the LAR can be triggered by air pulses or tactile stimuli and typically assessed only qualitatively. Methodology: The development and construction of a device that can selectively shoot very small water droplets (microdroplet impulse testing MIT). Results: The MIT device has a water reservoir with an infinitely adjustable pressure. The opening period of the piezo-electrically operated valve determines the droplet size. With a high-speed camera system, the change in the airspeed of the drop can be determined, depending on the set water reservoir pressure. With the knowledge of the droplet size, the shooting speed and the estimation of the distance between the valve and laryngeal mucosa or airspeed can be determined the muzzle energy. By mounting the MIT device to a high speed glottography system, the time between the impact of the droplet on the laryngeal mucosa and the start of the laryngeal adduction, the LAR latency can be determined using an image by image evaluation. Discussion: In dysphagia with penetration or aspiration it is presumed that the protective function of the larynx is no longer adequately ensured. The MIT–LAR device provides a valid and reliable method to assess LAR quantitatively. Furthermore, it holds the promise of being a simple to handle method that can be used clinically for routine diagnostics. © 2016, Springer-Verlag Berlin Heidelberg.


Miller S.,Klinik fur Phoniatrie und Padaudiologie | Kuhn D.,Klinik fur Phoniatrie und Padaudiologie | Ptok M.,Klinik fur Phoniatrie und Padaudiologie
Laryngo- Rhino- Otologie | Year: 2013

Assessment Inventories for Hearing Aid Outcome Background: At the beginning of 2012 new fee schedule positions have been introduced to the ambulatory physician fee schedule ("Einheitlicher Bewertungsmaßstabo", EBM) regarding the hearing aid fittings of youngsters and adults. With regards to quality assurance the use of a hearing aid outcome self-assessment inventory is made compulsive. This article aims to review available hearing aid (self-) assessment inventories as well as the evaluations regarding criteria for test quality implemented. Method: For this systematic review a selective literature research in PubMed has been carried out. Results: There are various self assessment inventories measuring hearing aid benefit. Many of the studies evaluating these inventories were implemented during the 1980ies and early 90ies when analogue hearing aids were commonly used. These results cannot automatically be transferred to the nowadays common digital devices. Only a small amount of studies investigated German translations of the mostly originally English inventories. Discussion: In order to be able to identify the actual meaning of resulting values from these inventories, it is important for ENT doctors and audiologists to be well informed of the tests' quality criteria.


Ptok M.,Klinik fur Phoniatrie und Padaudiologie
HNO | Year: 2014

Background: Before the era of objective audiometric procedures, the primary aim of subjective audiometric procedures was determination of the hearing threshold, e.g. to assess hearing aid indications. Nowadays, the results of objective audiometric procedures play a major role in hearing threshold determination in children. Contrastingly, subjective audiometric procedures are also employed in order to verify, or acquire an objective picture of, social hearing abnormalities evident from the children’s anamneses. Methods: A selective literature search was conducted in the PubMed and Scopus databases and current textbooks were also considered. Results: Subjective audiometric procedures for children employ both nonlinguistic and linguistic stimuli. Procedures can differ in many ways and it can be differentiated between, for example, observational or behavioural audiometry and procedures in which the children are explicitly instructed on how to react to signals. Discussion: Several subjective audiometric procedures have been developed to examine the hearing and listening skills of children. Some of these tests differ significantly in terms of their intended application, test construction and test quality criteria. Only a detailed understanding of the particular subjective audiometric procedure being applied enables formulation of the“correct” questions; which, providing the child is willing to cooperate, can also be specifically answered using the test. © 2014, Springer-Verlag Berlin Heidelberg.


Kuhn D.,Klinik fur Phoniatrie und Padaudiologie | Miller S.,Klinik fur Phoniatrie und Padaudiologie | Ptok M.,Klinik fur Phoniatrie und Padaudiologie
Laryngo- Rhino- Otologie | Year: 2013

Background: The term Cricopharyngeal Bar (CPB) describes a posterior indentation at the pharyngoesophageal junction which becomes apparent during a Video Fluoroscopic Swallowing Exam (VFSE, modified barium swallow). The effect CPBs might have on swallowing is still under debate. This paper intends to review appearance, effects and the associated therapy of CPBs. Method: For this systematic review a selective literature research in PubMed has been carried out. Results: CPBs are usually diagnosed during VFSE. As VFSEs are mostly carried out in dysphagic patients, CBPs were also associated with dysphagia. Even though, CPBs are often related to dysphagia, they do also appear in patients without dysphagia. Therefore, the appearance of a CBP does not automatically represent the cause of dysphagic symptoms. Its impact on swallowing might, however, depend on the dimension of the protrusion as well as the weakening and dysfunction of the inferior pharyngeal constrictor muscle. Discussion: CBPs often present as an incidental finding during a modified barium swallow. A relation to dysphagia can only be assumed for severe CPBs. Therapy options include cricopharyngeal myotomy or esophago-gastro endoscopy using either bougies or balloons. © Georg Thieme Verlag KG Stuttgart. New York.

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