Klinik und Poliklinik fur Phoniatrie und Padaudiologie

Hannover, Germany

Klinik und Poliklinik fur Phoniatrie und Padaudiologie

Hannover, Germany
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Jungheim M.,Klinik und Poliklinik fur Phoniatrie und Padaudiologie | Ptok M.,Klinik und Poliklinik fur Phoniatrie und Padaudiologie
HNO | Year: 2017

Background: To transport a bolus from the mouth into the stomach, regular contraction of the pharyngeal muscles and a coordinated function of the upper esophageal sphincter (UES) are necessary. The muscle contraction generates intraluminal pressure, which pushes the bolus continuously forward. In contrast to imaging studies, manometric methods enable assessment of intraluminal pressure buildup and the function of the muscles involved. These methods were initially established for the esophagus and have been used increasingly in the pharynx for 7–8 years. Pharyngeal high-resolution manometry (pHRM) allows pressure measurements in high spatial and temporal resolution, and assessment of pharyngeal swallowing dynamics. Objective: An overview is given of the implementation, evaluation, and interpretation of the pHRM data, as well as of the current state of research. Materials and methods: PubMed and Scopus were searched for the keywords “high-resolution manometry” and “pharynx” or “upper esophageal sphincter”. Original articles, reviews, and book chapters on the subject pHRM were included. Results: Swallowing pressure conditions in the pharynx and the UES can be assessed by pHRM. The spatiotemporal pressure plot gives an overview of changes in pharyngeal motor function. Determination of swallowing parameters enables a sophisticated evaluation of swallowing; a comparison with normal values permits delimitation of pathologies. Conclusion: Although several swallowing parameters still need to be further evaluated for clinical routine, a pHRM study should nowadays always be carried out for a comprehensive evaluation of the swallowing process. © 2017 Springer Medizin Verlag GmbH


Schwemmle C.,Klinik und Poliklinik fur Phoniatrie und Padaudiologie
Sprache Stimme Gehor | Year: 2012

Like all sensory systems, the auditory system is highly organised. In order to process sensations from the environment, our brain responds to certain patterns of activity. This activity pattern shape is usually developed in early childhood. It is established that the tuning of neurons in the mammalian auditory cortex can be altered in the brain beyond the so-called sensitive periods" also known as the concept of plasticity. Along with computers and more sophisticated signal averaging techniques, improved methods for modelling and quantifying cortical activity have been developed. In combination with measurements of auditory perception it became possible to examine physiological correlates and changes in normal and disordered perception and to propose new brain-behavioural relationships. Especially auditory therapy can also take advantage of this plasticity for improving the patient's everyday communication. Here we present an overview of plasticity, measurement methods for objectifying brain activity and the cortical effects of auditory therapy. © Georg Thieme Verlag KG Stuttgart · New York.


Background: As unanimously found in several consensus papers, other conditions such as learning disorders need to be ruled out prior to labelling a child as having an auditory processing disorder (APD). Methods: In a retrospective study data from 386 children (245 boys, 141 girls) aged 6;0-9;11 years were investigated. All children were referred for behavioural problems suspected to be due to APD. The German auditory verbal learning test (Verbaler Lern- und Merkfähigkeitstest, VLMT) was administered. Results in a range of more than one/two standard deviations from the mean were regarded as deviant/pathological, while a test result under 15.8 was considered below normal. Results: The VLMT short term component was impaired in 202 children, the long term component (loss after interference) in 83 children and the recognition component in 298 children. Discussion: Compared with previously published results, our results suggest that approximately half of all children referred for APD diagnosis suffer from short-term memory deficit. We suggest the VLMT, and thus testing of short- and long-term memory skills, be administered routinely for thorough APD assessments. © Springer-Verlag 2010.


Background: Girls tend to acquire language skills faster than boys do. Furthermore, specific language impairment and dyslexia are diagnosed more often in males than in females. We investigated whether auditory verbal learning skills in boys are inferior to those of girls as a possible cause for gender dependency in language acquisition. Methods: In a retrospective study, data from 386 children (245 male, 141 female) age 6 years to 9 years 11 months were investigated. The Auditory Verbal Learning Test (Verbaler Lern- und Merkfähigkeitstest) was administered. Results: After gender, age, and IQ matching, girls showed a small advantage in long-term memory and recognition. Discussion: Our results are in contrast to findings that suggest superior verbal memory and learning in adult females compared with males. © Springer Medizin Verlag 2009.


Schwemmle C.,Klinik und Poliklinik fur Phoniatrie und Padaudiologie | Ptok M.,Klinik und Poliklinik fur Phoniatrie und Padaudiologie
Monatsschrift fur Kinderheilkunde | Year: 2013

Background: The triple X syndrome or trisomy X syndrome, also known as 47,XXX syndrome is a sex chromosomal abnormality, occurring in approximately 1 in 1,000 female births. It is one of the most common female chromosomal numeric abnormality. As many individuals are mildly affected or asymptomatic, it is estimated that only 10% of individuals with trisomy X are actually diagnosed. Patients with this syndrome do not usually present with major malformations, but rather subtle and highly variable clinical features such as poor motor coordination, language delay, cognitive deficits and learning disabilities (often mild). In some cases patients may present with behavioural problems as hyperactivity, poor social interaction and mild depression or epilepsy. In these individuals non-specific facial dysmorphism and various hand and feet abnormalities (e.g. clinodactyly) are reported. Heart abnormalities are rare, while some cases with urogenital malformations and premature ovarial failure or strabismus have been described. The prognosis is variable, depending on severity of the manifestations and on quality and timing of treatment. Case report: We report a 9;1 year old girl with mild dysmorphic facial features, delay of language acquisition and learning difficulties. The overall constellation of symptoms led to genetic diagnostics. Conclusion: In girls and female teenagers with development and language delay, learning disabilities and mild dysmorphic features a chromosomal analysis may be initiated at least at the request of the parents to clarify the etiology of developmental abnormalities. © 2012 Springer-Verlag Berlin Heidelberg.


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

Background: Chronic hoarseness, globus sensation or mucous obstruction are among a wide range of symptoms possibly related to laryngopharyngeal reflux (LPR). Method and results: A selective literature research was carried out using PubMed, in which original articles and reviews in German and English were included. Altogether, 2541 articles were found. Despite the large number of publications, there are still open questions regarding aspects of LPR. Discussion: It can be assumed that refluxate reaching the larynx can damage it. Due to the fact that the symptoms possibly related to LPR can, however, be linked to other causes, a careful consideration of the patient's medical history is of the utmost importance, followed by mandatory laryngoscopy. Diagnostic procedures, such as the trial administration of proton pump inhibitors (PPI) or long-term pH measurement should be used selectively. Depending on the individual symptoms, breathing or voice therapy and/or PPI therapy might be useful. Lifestyle changes including dietary measures should also be contemplated. © 2012 Springer-Verlag.


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

Background: Extraesophageal reflux disease often requires diagnosis and treatment by a phoniatry or ear, nose and throat specialist. The disease needs to be differentiated from gastroesophageal reflux disease. Objective: A new oropharyngeal pH measuring system with a single channel probe has recently been introduced. The aim of this study was to compare oropharyngeal pH-metry with the existing diagnostic methods for extraesophageal reflux disease and to present initial results in our own patients. Methods: A literature search for oropharyngeal pH-metry was performed in the databases NHS EED, HTA, DARE, Clinical trials, Cochrane reviews and Medline/PubMed. A selective literature search was also carried out on the problem of extraesophageal reflux disease. Results: Evaluation scales, trial proton pump inhibitor therapy or pH-metry, for example, can be used to diagnose extraesophageal reflux disease. pH-metry can be performed using a classical two-channel pH-metry system; a new oropharyngeal pH measuring system has recently been introduced. This new method has been evaluated in initial studies for normative data and has been compared to two-channel pH-metry. Prospective randomised studies to diagnose extraesophageal reflux disease with the new oropharyngeal pH-metry method are still lacking. Discussion: Oropharyngeal pH-metry has some potential advantages compared to classical two-channel pH-metry; however, a lot of questions remain unanswered. These will be discussed and illustrated with the help of a number of own patient case reports. © 2011 Springer-Verlag.


Ptok M.,Klinik und Poliklinik fur Phoniatrie und Padaudiologie
Deutsches Arzteblatt | Year: 2011

Background: 1-2 out of 1000 newborns have markedly impaired hearing. Methods: Review of the pertinent literature, which was retrieved with a selective search of the following databases: NHS EED (Economic Evaluation Database), HTA (Health Technology Assessment), DARE (Database of Abstracts of Reviews on Effectiveness), Clinical Trials, CDSR (Cochrane Database of Systematic Reviews), and PubMed. Results: The current scientific evidence favors universal neonatal hearing screening (UNHS) for the early detection of hearing impairment. UNHS is best performed in two stages: first measurement of otoacoustic emissions and then automated assessment of the brainstem auditory evoked response. To be effective, UNHS programs must have a high coverage rate, high sensitivity and specificity, and proper tracking with a low rate of loss to follow-up. Children with positive screening tests for hearing impairment should undergo confirmatory testing as soon as possible and then receive the appropriate treatment. Early intervention is particularly critical for speech acquisition. Conclusion: The early detection and treatment of hearing impairment in newborns and infants has a beneficial effect on language acquisition.


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

Background: High-resolution manometry (HRM) represents a valuable tool for the evaluation of peristalsis in the oesophagus. Due to the wide spacing of the pressure transducers, however, examination of the upper oesophageal sphincter's relaxation period has not proved satisfactory as yet. Design: A feasibility study was carried out to clarify whether evaluation of the upper oesophageal sphincter's behaviour during swallows is possible using a catheter with very closely spaced pressure transducers. Setting: University hospital. Procedure: Healthy subjects were analysed using a specially developed catheter as well as a modified software to evaluate whether swallow-associated behaviour could be verified. Results: Interpreting pressure profiles in terms of resting pressure, residual pressure, relaxation time and maximum peristaltic pressure proved to be feasible. The present analysis supports the existence of distinct dynamic swallow-associated phases, which conform to the phases that had previously been postulated. An additional initial phase, however, should be added. Conclusion: This newly created catheter design in combination with the modified software enable a very detailed evaluation of the sphincter's swallow-associated behaviour and represent a valuable, minimally invasive tool with no exposure to radiation for dysphagia diagnosis as well as treatment planning. © Springer-Verlag 2012.


Ptok M.,Klinik und Poliklinik fur Phoniatrie und Padaudiologie | Dunkelmann A.,Klinik und Poliklinik fur Phoniatrie und Padaudiologie
HNO | Year: 2011

Background: We recently proposed test material for the purpose of testing phonological processing. While data regarding validity and reliability could already be established, normative data for preschool children are lacking. Material and Methods: A total of 203 preschool children aged 5.0-5.11 years participated in the study. Low level phonological processing was tested using minimal pairs for both words and non-words (logatoms). The items were chosen with respect to age-appropriate vocabulary, phoneme features, phoneme contrast and phoneme position. Results: Our results indicate that overall test results follow a normal distribution. In contrast, the test subscales exhibited a skew. However, no significant ceiling effect was observed. There were no significant gender differences but differences among mono- versus bilingually raised children. Discussion: As predicted from previous results and calculations our data now confirm a distribution following a Gaussian curve. Thus, one important prerequisite for using this test material for clinical purposes has been met. This material can now be applied for preschool children and individual raw scores may be transformed to percentile ranks. Ceiling effects of individual subscales can be explained by each specific level of difficulty. © 2010 Springer-Verlag.

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