Receptive speech in early implanted children later diagnosed with autism

Introduction: Incidence of children with autism spectrum disorder (ASD) is rising through the years with estimated 1 in 68 in the US in 2014. This incidence is also rising in the population of congenitally deaf children. Favorable outcome after early cochlear implantation is expected due to plasticity and reorganization capacity of brain in infants and toddlers, but outcomes could be significantly modified in children with diagnosed ASD. Current methods of screening for autism have difficulties in establishing diagnosis in children who have both autism and other developmental delays, especially at such an early age. The aim of the study was to assess the development of auditory perception and speech intelligibility in implanted children with profound congenital hearing loss who were diagnosed with ASD comparing to those who were typically developing. Material and methods: Fourteen children underwent cochlear implantation; four were later diagnosed with ASD and ten were typically developing. All children underwent intensive postoperative speech and hearing therapy. The development of auditory perception and speech intelligibility was assessed using the Categories of Auditory Performance (CAP) and the Speech Intelligibility Rating (SIR) during the 5-years follow-up. Results: In children later diagnosed with ASD, auditory processing developed slowly. Depending on the individual capabilities, by the age of six they could identify environmental sounds or discriminate speech sounds. Speech Intelligibility in children with ASD was at best rated as category 2, with very little or no progress up to the age of six, despite extensive speech and language therapy. Communication skills were strongly affected by a degree of autistic features expression. Conclusion: Preoperative psychological assessment in congenitally deaf infants should be expanded by the use of validated instruments for early detection of autism. The possibility of developing ASD should be kept in mind by all professionals involved in programs for cochlear implantation

Short-term auditory memory in environmental noise in cochlear implanted and normal hearing children

Auditivno (slušno) pamćenje je sposobnost da se informacije prezentovane usmeno, analiziraju mentalno, sačuvaju i upotrebe kada je potrebno. Osobe sa jakim kapacitetom ove vrste memorije nazivaju se “auditory learners”. Osnova za razvoj auditivnog pamćenja je očuvana funkcija sluha. Primena kohlearnog implanta dovela je do značajnog poboljšanja u percepciji zvukova, kvalitativno boljeg slušanja i razvoja auditivnog pamćenja kod gluve dece. Auditivno pamćenje je jedan od osnovnih uslova za razvoj jezičkih sposobnosti. Praktična ili potpuna gluvoća, kongenitalna ili stečena, može potpuno da zaustavi ili ozbiljno omete formiranje i razvoj auditivnog pamćenja. Teškoće auditivnog pamćenja javljaju se i kod dece urednog sluha. U tom slučaju trebalo bi da budu obuhvaćene preventivnim i korektivnim merama, u cilju sprečavanja njihovog produbljivanja i značajnijeg odražavanja na razvoj drugih sposobnosti i veština. Cilj istraživanja bio je da se ispita uticaj okolne buke na sposobnost neposrednog auditivnog pamćenja kod kohlearno implantirane i dece urednog sluha. Uzorak u istraživanju činilo je 18 kohlearno implantirane dece i 18 dece urednog sluha, uzrasta od četiri do deset godina, prosečnih intelektualnih sposobnosti i bez udruženih smetnji u razvoju. Deca u ispitivanom uzorku imala su najmanje 12 meseci slušnog uzrasta sa kohlearnim implantom (CI). Instrument istraživanja bio je Test za ispitivanje sposobnosti verbalnog pamćenja I‒IV, namenjen deci sa smetnjama u auditivnoj percepciji i verbalnoj memoriji, koja se sem u populaciji dece oštećenog sluha, najčešće javlja kod dece sa disfazijom. Ovim testom može se ispitivati opseg auditivne memorije, neposredno i odloženo verbalno pamćenje, redosled reprodukcije, gramatička razvijenost i semantičko shvatanje poruke. Za potrebe ovog istraživanja testom smo ispitivali neposredno verbalno pamćenje sa i bez prisustva okolne buke. Za utvrđivanje značajnosti odnosa između posmatranih varijabli korišćeni su korelaciona analiza, analiza varijanse i χ2 test. Rezultati ukazuju da se negativan uticaj okolne buke na neposredno auditivno pamćenje kod kohlearno implantirane i dece urednog sluha povećava sa porastom težine zadataka.Auditory memory is the ability to process, analyze, store and recall orally presented information. Persons with good capacity of auditory memory are called “auditory learners“. Auditory memory is among basic prerogatives for speech and language development. Cochlear implantation has improved the perception of sounds, quality of listening and auditory memory of deaf children considerably. Normal hearing is essential for the development of auditory memory. Practical or total deafness, whether congenital or acquired, could prevent or seriously disturb the development of auditory memory. Even normal hearing children can have auditory memory disorders. If so, they need intervention in order to prevent developmental consequences. The aim of this study was to investigate the impact of the environmental noise on auditory memory capacity in cochlear implanted and normal hearing children. The sample consisted of 18 cochlear implanted and 18 normal hearing children aged 4 to 10. All of the children in this study had normal intelligence and no additional handicaps. They had at least 12 months of cochlear implant (CI) experience. The instrument was the Test of immediate verbal memory (I-IV) by S. Vladisavljević (1983) designed for children with auditory perception and verbal memory disorders, both hearing impaired and dysphasic as well. The test is used for memory span assessment, immediate and delayed memory, rehearsal order, grammar and semantic comprehension of the message. In this study we applied the test both in quiet and noisy environment. Statistical significance between variables was tested using correlation coefficient, variance analysis and chi square test. The results indicate that the negative influence of environmental noise on immediate auditory memory in cochlear implanted and normal hearing children increases with task complexity

Efficacy of Epley maneuver in treatment of benign paroxysmal positional vertigo of the posterior semicircular canal

Background/Aim. Benign paroxysmal positional vertigo is one of the most frequent peripheral vestibular system disorders. The aim of this study was to examine the efficacy of the Epley maneuver in treating benign paroxysmal positional vertigo of the posterior semicircular canal (p- BPPV) and to discover possible causes of failure. Methods. This prospective study included 75 patients. In all the cases medical history showed and the positioning Dix-Hallpike test confirmed the diagnosis of p-BPPV. We also performed clinical ENT examination, searching for spontaneous nystagmus, vestibulospinal tests, caloric test, and audiometry. All the patients were treated by the modified Epley canalith repositioning maneuver. The patients were followed up at the intervals of seven and, fourteen days, and one, tree, and six months and one year. The maneuver was repeated if vertigo and nystagmus on control positioning test persisted. The transition from positive into negative Dix Hallpike test after one or two Epley maneuver was considered as success in treatment. Results. After the initial Epley maneuver the recovery rate was 90.7%, and after the second 96%. In three (4%) patients with secondary p-BPPV, symptoms did not cease even after the second repositioning maneuver. The etiology of p-BPPV had a significant effect on the maneuver’s success rate (p < 0.01), whereas duration of symptoms, age and gender had no effect (p > 0.05). After a successful treatment 11 (14.66%) patients had recurrent attack of BPPV during the first year. Conclusion. The Epley maneuver is very successful repositioning procedure in treating p- BPPV. The patients with idiopathic form p-BPPV showed higher success rate with Epley maneuver than those with secondary p-BPPV

Assessment of senses of hearing and balance in chronic suppurative otitis media

Chronic suppurative otitis media is among the most frequent illnesses treated in ENT wards. To establish the diagnosis, otomicroscopy alone usually suffice. Assessing the sense of hearing, often the sense of balance, too, is mandatory. Assessment of hearing will show the extent of conductive and sensorineural hearing loss. Apart from this, sometimes, when the finding is not obvious, it is necessary to conduct audiological investigation in more detail in order to establish whether the diagnosis of chronic suppurative otitis media is correct. Existence and extent of conductive hearing loss or confIrmation of tympanic membrane perforation by tympanometry can help a great deal. Also, some new results about the site of perforation and the middle ear volume influence on conductive hearing loss may help have a better insight into chronic suppurative otitis media. Assessing the sense of balance may show dysfunctions with not yet necessarily permanent damage: perilymphatic fistula and benign paroxysmal positional vertigo (BPPV). Unilateral or bilateral damage may be diagnosed with appropriate tests of vestibuloocular reflex (VOR): spontaneous nystagmus, head impulse test, head shaking test. These bedside tests do not require bulky, expensive equipment for stimulus delivery or special equipment for recording nystagmus. In addition, their significance is their ability to provide enough information without performing caloric testing which is contraindicated in chronic suppurative otitis media

Large hibernoma of the neck: A case report

Introduction. A hibernoma is a rare benign tumor derived from vestigial remnants of brown adipose tissue. In neonates this tissue makes up about 5% of the body mass and its amount greatly decreases after birth, persisting only in scattered subcutaneous areas. In rare cases, brown fat continues to grow leading to a hibernoma that may be located in the head and neck. We present an illustrative case of a large hibernoma of the neck with infraclavicular extension and discuss about diagnostic and treatment difficulties. Case report. A 29-year-old male presented with large, slowly progressive, painless neck mass that was noticed 6 months earlier. Computed tomography (CT) and magnetic resonance (MR) showed a well-vascularized, soft tissue tumor of the lateral region of the neck and supraclavicular fossa with extension below clavicle. Treatment included arterial embolization followed by challenging surgical removal of the tumor. Dissection was performed at III, IV and V levels of the neck, making complete resection possible without the tumor fragmentation or major blood vessels and cranial nerves injuries. The final diagnosis of the hibernoma was made by histopathological analysis. The patient had no signs of recurrence during three-year follow-up. Conclusion. Although the CT scan and MR may raise the suspicion, hibernoma is definitely diagnosed by a pathologist. It is very important to exclude the malignant processes, foremost liposarcoma. The tumor fragmentation during surgery should be avoided because the high vascularity of the tumor tissue carries a substantial risk for hemorrhage. Our experience with preoperative embolization and complete tumor resection in this case showed positive impact on the final outcome

Importance of early ventilation tubes insertion in chronic otitis media with effusion in children with congenital cleft palate

Background/Aim. Otitis media with effusion (OME) is almost universal in children with cleft palate with an incidence of more than 90%, but the approach to managing this problem varies significantly among authors. The Eustachian tube dysfunction is the main factor that leads to the presence of the middle ear effusion. This is especially prominent in children with congenital cleft palate and explains the prolonged course of this process. The objective of this study was to determine the effectiveness of early ventilation tubes insertion in children with cleft palate at the time of palatoplasty by monitoring the course and duration of the disease as well as development of complications. Methods. In the prospective study with predefined regular follow-up intervals and parameters, the two groups of children were observed. The group one (E) included 45 children with congenital cleft palate who underwent the early insertion of ventilation tubes during palatoplasty, and the group two (C) had the same number of children with cleft palate who were treated conservatively on an as-needed basis. Assessment parameters were findings of otomicroscopy, tympanometry, play and pure tone audiometry. Each child was followed-up for 5 full years at total of nine follow-up examinations. Results. Result analysis showed that there were no statistically important differences between the two study groups in terms of the course and duration of the presence of the middle ear effusion, or in terms of complications and speech development. Conclusion. Based on the results obtained, we can conclude that there is no significant benefit in early ventilation tubes insertion in children with cleft palate, therefore our recommendation is watchful waiting and a conservative treatment on an as-needed basis, with the ventilation tubes insertion when a surgeon, based on his or her experience and individual findings considers it necessary

Unexpected bony structure in tonsillar fossa during tonsillectomy

Introduction. The elongated styloid process is a very rare clinical entity. In most cases it is asymptomatic, but also could cause Eagle’s syndrome. We presented a rare case of the anatomic variation of styloid process and its clinical implication. Case report. In the left tonsillar fossa an unexpected bony structure was found during the routine tonsillectomy on a 16-year-old female patient. Computed tomography showed the elongated styloid process. No further treatment was necessary because it was asymptomatic in the follow-up period. Conclusion. The elongated styloid process is a very rare condition, but physicians should be aware of it and keep it in mind in order to make the diagnosis in patients with suggestive symptoms

Sposobnost odgovaranja na pitanja kod dece sa kohlearnim implantom

Specifičnost oštećenja sluha – novi korac

Why do Treatment Failure and Recurrences of Benign Paroxysmal Positional Vertigo Occur?

Objective: To investigate the potential risk factors associated to the treatment failure and recurrence of benign paroxysmal positional vertigo (BPPV). Study Design: Prospective cohort study. Setting: Tertiary referral center. Patients: Four hundred patients with benign paroxysmal positional vertigo, 119 men and 281 women, aged 27 to 88 years. Intervention: Patients were treated once a week, with only one, appropriate, depending on the affected canal, repositioning maneuver (modified Epley, Semont, barbecue/inverted Gufoni, Kim). The control Dix-Hallpike test and the roll test were performed on 7 days. Main Outcome Measures: The treatment outcome and recurrence were evaluated with regard to sex, age, duration of symptoms, etiologic factors, migraines, osteoporosis, vascular risk factors, endocrine diseases, localization of otoconia, and simultaneous involvement of multiple canals. Results: The results indicate that treatment was negatively affected by patients' age, osteoporosis, and head trauma, without them causing recurrent symptoms. The highest number of uncured patients was observed in the 73- to 88-year-old age group (14.8%). The application of more than one maneuver was necessary in 27.5% of cases with primary BPPV and 88.9% with secondary BPPV. The highest treatment success was achieved in the group with BPPV of the posterior semicircular canal (F = 3.668, p = 0.026). The recurrence rate was 15.5%. Conclusion: Potential risk factors associated to the treatment failure were as follows: the age older than 50, secondary BPPV, head trauma, the occurrence of osteoporosis, and localization of otoconia in the anterior semicircular canal. The analyzed factors did not have impact on the recurrence

Efekat kohkearne implantacije kod pacijenta sa neurofibromatozom tip dva – studija slučaja

Specifičnost oštečenja sluha – novi korac