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.
Mechanisms of the upper esophageal sphincter (UES) when exposed to acid are still incompletely understood. The presented work investigated the reaction of the UES to acid exposure during swallowing. Ten healthy individuals swallowed ten 2 ml neutral water boli of pH 7, followed by 10 swallows each of different levels of acidity (pH 1.8, pH 3 and pH 5). Effects were analyzed by high-resolution manometry (HRM) for the primary parameter Restitution Time, as well as Resting Pressures, maximal, minimal pressures and time intervals. Restitution Times measured mean values of 12.67 s (SD ± 7.03 s) for pH 1.8, pH 7 = 8.69 s (SD ± 2.72 s), pH 3 = 7.56 s (SD ± 2.23 s) and pH 5 = 7.29 s (SD ± 2.55 s), showing prolonged Restitution Times in the UES when exposed to strong bolus acidity. This difference was significant towards the neutral bolus, but also to less acidic boli (pH 5: p = 0.006, pH 3: p = 0.009, pH 7: p = 0.038). Considerable differences of mean values were found for Post-Swallow Maximum and Period of Sphincter Activity. Also, Pre-Swallow Maximum values were found to be highest with the strongest acid. Relaxation Times showed a slight trend of prolongation for the highest bolus acidity. Prolonged Restitution Times may represent a reflexive protective mechanism triggered by receptors in the pharyngeal mucosa or the UES preventing regurgitation of acid into the pharynx and larynx, besides representing ongoing attempts of acid clearance. Exposure to high levels of acidity by a swallowed bolus does influence UES functions during swallowing.
Purpose: This study aims to attain metric data of the velopharyngeal dimensions of healthy subjects as well as patients with velopharyngeal insufficiency using the example of cleft and lip palate (CLP) in order to determine possible differences in the volumes of both groups.Methods: Volumes and distances of velopharyngeal areas were analyzed retrospectively using cone beam computed tomography data sets (n = 60). Group 1 included healthy patients receiving dental implants (n = 31). Group 2 was represented by patients with surgically closed cleft lip and palate (n = 29).Results: Biggest differences among mean values of both groups were found for: minimum axial area (p = 0.000), airway area caudal (p = 0.000), distance between posterior nasal spine and posterior pharyngeal wall (PPW) (p = 0.014), mean distance between velum and PPW (p = 0.000), length of PPW (p = 0.000) and length of anterior pharyngeal wall (p = 0.000).Conclusion: Differences in the shape and geometry of the velopharyngeal area in subjects with a regular velopharyngeal structure and function and patients with cleft palate do exist. The significant differences found here can be categorized into two groups: one reflects distances between the anterior and posterior pharynx, presenting longer distances for patients with CLP. The second significant difference regards values of length in cranio-caudal direction, which is longer in healthy subjects. With regards to these values, one could conclude, that even though total volumes of both groups did not differ in size, group 1 shows three-dimensional velopharyngeal shapes that are longer and narrower, whereas shapes of patients of group 2 tend to be wider and shorter in general.
Anfang dieses Jahres sind neue Gebührenordnungspositionen zur Hörgeräteversorgung bei Jugendlichen und Erwachsenen in den „Einheitlichen Bewertungsmaßstab“ (EBM) aufgenommen worden. Zur Qualitätssicherungsvereinbarung der Hörgeräteversorgung wird die Anwendung eines Fragebogens als obligater Leistungsinhalt gefordert. Hier soll ein Überblick über solche Fragebögenassessments und ihre Testgütekriterien gegeben werden. Übersichtsarbeit nach selektiver Literaturrecherche in PubMed. Es existiert eine Vielzahl an Fragebögen, die den eventuellen Nutzen einer Hörgeräteversorgung für die betroffenen Schwerhörigen objektivieren sollen. Viele Evaluationsstudien stammen aus den 80er bzw. frühen 90er Jahren des letzten Jahrhunderts und basieren auf den damals gängigen analogen Hörgeräten. Somit sind die Auswertungen nicht automatisch auf gängige digitale Geräte übertragbar. Nur eine geringe Anzahl der Tests wurde neben der meist englischen Originalversion auch in der deutschen Übersetzung ausreichend evaluiert. Jeder HNO-Arzt, der in der Hörgeräteversorgung Fragebögenassessments anwendet, sollte über die jeweiligen, wesentlichen Testgütekriterien informiert sein, um den Wert des mit dem Fragebogen erhaltenen Ergebnisses adäquat einschätzen zu können. At the beginning of 2012 new fee schedule positions have been introduced to the ambulatory physician fee schedule (“Einheitlicher Bewertungsmaßstab”, 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. For this systematic review a selective literature research in PubMed has been carried out. 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. 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.