Klinik und Poliklinik fur Phoniatrie und Padaudiologie

Hannover, Germany

Klinik und Poliklinik fur Phoniatrie und Padaudiologie

Hannover, Germany
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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.

Schmidt C.-M.,Klinik und Poliklinik fur Phoniatrie und Padaudiologie | am Zehnhoff-Dinnesen A.,Klinik und Poliklinik fur Phoniatrie und Padaudiologie | Deuster D.,Klinik und Poliklinik fur Phoniatrie und Padaudiologie
HNO | Year: 2013

Nonorganic (functional) hearing loss in children is characterized by hearing loss without a detectable corresponding pathology in the auditory system. It is not an uncommon disease in childhood. Typically, there is a discrepancy between elevated pure tone thresholds and normal speech discrimination in everyday life. We evaluated 85 original publications, 27 reviews and 4 textbook articles. Mean age at diagnosis was 11.3 years. Girls were affected twice as often as boys. Patient histories showed a high prevalence of emotional and school problems. Pre-existing organic hearing loss can be worsened by nonorganic causes. A brainstem audiometry should confirm the diagnosis. The differential diagnosis includes auditory processing disorder, elevated thresholds in mental retardation and auditory neuropathy. We recommend taking a personal history including biographical factors, a psychological assessment including intelligence testing and referral to a child psychiatrist. Prognosis seems to be dependent on the severity of the patient's school and/or personal problems. Categorization following the Austen-Lynch model can be a valuable prognostic factor. © Springer-Verlag 2012.

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 | Kuhn D.,Klinik und Poliklinik fur Phoniatrie und Padaudiologie | Miller S.,Klinik und Poliklinik fur Phoniatrie und Padaudiologie
HNO | Year: 2014

Background: During first language acquisition (L1), children need to gather knowledge about the speech sounds and grammar of their mother tongue. Furthermore, communication skills require an adequate vocabulary. Individual profiles of vocabulary acquisition can vary considerably. However, actively using around 50 words by the age of 24 months is considered a milestone in first language acquisition. This is usually followed by the so-called vocabulary spurt, a rapid increase in lexical knowledge. This article provides an overview of the theories of lexical development and discusses how the acquisition of vocabulary may be explained. Methods: A selective literature search was conducted in PubMed and Scopus. Current textbooks were also considered. Results: In order to acquire new words, a child has to identify what the new string of speech sounds refers to. The child has to construct a valid concept of the word and subsequently store both word and concept into long-term memory. Several theories have been put forward to explain lexicon organization, the acquisition of concepts and the mechanisms underlying the so-called fast mapping phenomenon in particular. All of these attempt to explain the phenomenon of lexicon acquisition in terms of a model scheme. In the context of the fast mapping mechanism, constraints and assumptions, cognitive, intentionalist and emergence-based theories are discussed. Discussion: Knowledge of the different theories of vocabulary acquisition is mandatory to understand the construction of the tests used to assess vocabulary skills in clinical practice and to apply these appropriately. © 2014 Springer-Verlag Berlin Heidelberg.

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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