Differences in medication adherence are associated with beliefs about medicines in asthma and COPD

Adherence to medication is crucial for achieving treatment control in chronic obstructive lung diseases. This study refers to the "necessity-concerns framework" and examines the associations between beliefs a...

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Vocal assessment of addicts on methadone therapy via the RBH scale and objective acoustic parameters

Publication date: Available online 10 November 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Veljko Mirkov, Slobodan M. Mitrović
IntroductionA large number of people around the world struggle daily to become free of their addiction to illegal psychoactive substances. In order to create an atmosphere of improved supervision, established communication and improved quality of life for drug addicts, centers have been set up to provide methadone as a substitute.ObjectiveThe aim of the research was to assess the vocal features of drug addicts on methadone therapy via subjective and objective parameters, to ascertain if vocal damage has occurred and to determine whether subjective and objective acoustic vocal parameters are related, and how.MethodsThe research included 34 adults of both genders who were undergoing methadone treatment. A subjective vocal evaluation assessed voice pitch and clarity, while the subjective acoustic analysis utilized the Roughness-Breathiness-Hoarseness scale of roughness-breathiness-hoarseness. Objective acoustic analysis was conducted after recording and analyzing an uninterrupted vocal /a/ of at least three seconds duration, using the "GllotisController" software.ResultsThe subjective acoustic analysis using the Roughness-Breathiness-Hoarseness scale showed pathological values in 52.9% male and 47% female participants. The average values of the roughness-breathiness-hoarseness for the entire sample were 0.91, 0.38 and 0.50, respectively. Lower roughness was associated with a higher fundamental frequency (f0) and lower jitter and shimmer values (p<0.05). There was a statistically significant correlation between breathiness, jitter (p<0.01) and shimmer (p<0.05), and between hoarseness and jitter (p<0.01).ConclusionA statistically significant correlation was found between the two subjective vocal assessments, voice clarity and pitch, and Roughness-Breathiness-Hoarseness scale, and the parameters of the objective acoustic vocal assessment.



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The protective effects of whortleberry extract against cisplatin-induced ototoxicity in rats

Publication date: Available online 10 November 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Doğukan Özdemir, Abdulkadir Özgür, Yıldıray Kalkan, Suat Terzi, Levent Tümkaya, Adnan Yılmaz, Metin Çeliker, Engin Dursun
IntroductionCisplatin is one of the main chemotherapeutic agents used for the treatment of many types of cancer. However, ototoxicity, one of the most serious side effects of cisplatin, restricts its usage.ObjectiveWe aimed to investigate the protective effects of whortleberry extract against cisplatin-induced ototoxicity by evaluating hearing and histopathological cochlear damage and by measuring the biochemical parameters affected byoxidative stress.MethodsForty-eight male rats were included in the study after performing Distortion Product Otoacoustic Emission test to confirm that their hearing levels were normal. The rats were randomly divided into six groups: the control group, the sham group, and, which received only whortleberry extract, only cisplatin, cisplatin+100mg whortleberry extract, cisplatin+200mg whortleberry extract, respectively. Audiologic investigation was performed by performing the Distortion Product Otoacoustic Emission test at the beginning and at the eighth day of the study. Cardiac blood samples were collected for biochemical analysis, and the rats were sacrificed to obtain cochlear histopathological specimens on the eighth day.ResultsThe results revealed that whortleberry protects hearing against cisplatin-induced ototoxicity independent of the dose. However, high doses of whortleberry extract are needed to prevent histopathological degeneration and oxidative stress.ConclusionThe results obtained in this study show that whortleberry extract has a protective effect against cisplatin-induced ototoxicity.



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An unconventional approach to dental health that works

One of the greatest fears for most people is a trip to the dentist, especially if they know there is work to be done. The grinding, pulling, smells, and needles are not exactly a situation that drums up warm and cozy feelings.

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Treating periodontitis to prevent heart disease – evidence unclear

Only 1 trial at high risk of bias was included in this recent update of a 2014 Cochrane review of periodontal therapy for preventing cardiovascular disease (CVD) providing insufficient evidence to support or refute whether periodontal therapy can prevent the recurrence of CVD in the long term in patients with chronic periodontitis.

The post Treating periodontitis to prevent heart disease – evidence unclear appeared first on National Elf Service.

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Effect of Home Bleaching on the Translucency of CAD/CAM Systems

Abstract

Purpose

To evaluate the effect of a home bleaching agent (Opalescence PF) on the translucency of CAD/CAM ceramic systems.

Materials and Methods

The 28 sintered ceramic specimens (IPS Empress CAD and IPS e.max CAD; 15 mm long, 10 mm wide, 1 mm thick) were divided into two subgroups as control and bleaching groups (n = 7). Carbamide peroxide (CP), 16%, home bleaching agent was applied onto the surface of each specimen for 6 hours per day for 7 days. A spectrophotometer (VITA Easyshade Advance) was used to measure the CIE L^*a^* b^* coordinates and the reflectance value (Y) of the specimens on white and black backgrounds. The translucency parameter (TP), contrast ratio (CR), and opalescence parameter (OP) of the specimens were calculated. The data were statistically analyzed using Kolmogorov–Smirnov, one-way ANOVA, Tukey's test, and Pearson's correlation.

Results

Statistically significant differences in the TP values after 16% CP bleaching treatment were observed (p ˂ 0.05); however, no significant differences were found in the OP and CR values after the surface treatment (p ˃ 0.05).

Conclusions

According to our study, patients who have all-ceramic restorations in their mouths should be careful when using home bleaching agents, because whitening agents can affect the translucency of all-ceramic restorations such as e.max CAD and Empress CAD.

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Environmental microbiology: Geographic coordinates guide natural product discovery

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Nuclear IGF-1R predicts chemotherapy and targeted therapy resistance in metastatic colorectal cancer

Nuclear IGF-1R predicts chemotherapy and targeted therapy resistance in metastatic colorectal cancer

Nuclear IGF-1R predicts chemotherapy and targeted therapy resistance in metastatic colorectal cancer, Published online: 09 November 2017; doi:10.1038/bjc.2017.279

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Combining DNA damaging therapeutics with immunotherapy: more haste, less speed

Combining DNA damaging therapeutics with immunotherapy: more haste, less speed

Combining DNA damaging therapeutics with immunotherapy: more haste, less speed, Published online: 09 November 2017; doi:10.1038/bjc.2017.376

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Neutrophils: driving progression and poor prognosis in hepatocellular carcinoma?

Neutrophils: driving progression and poor prognosis in hepatocellular carcinoma?

Neutrophils: driving progression and poor prognosis in hepatocellular carcinoma?, Published online: 09 November 2017; doi:10.1038/bjc.2017.386

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BPIFB1 (LPLUNC1) inhibits migration and invasion of nasopharyngeal carcinoma by interacting with VTN and VIM

BPIFB1 (LPLUNC1) inhibits migration and invasion of nasopharyngeal carcinoma by interacting with VTN and VIM

BPIFB1 (LPLUNC1) inhibits migration and invasion of nasopharyngeal carcinoma by interacting with VTN and VIM, Published online: 09 November 2017; doi:10.1038/bjc.2017.385

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Favourable prognostic role of histological regression in stage III positive sentinel lymph node melanoma patients

Favourable prognostic role of histological regression in stage III positive sentinel lymph node melanoma patients

Favourable prognostic role of histological regression in stage III positive sentinel lymph node melanoma patients, Published online: 09 November 2017; doi:10.1038/bjc.2017.397

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IGF-1R: SUMO-ing its weight in chemoresistant colorectal cancer

IGF-1R: SUMO-ing its weight in chemoresistant colorectal cancer

IGF-1R: SUMO-ing its weight in chemoresistant colorectal cancer, Published online: 09 November 2017; doi:10.1038/bjc.2017.377

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A new panel of pancreatic cancer biomarkers discovered using a mass spectrometry-based pipeline

A new panel of pancreatic cancer biomarkers discovered using a mass spectrometry-based pipeline

A new panel of pancreatic cancer biomarkers discovered using a mass spectrometry-based pipeline, Published online: 09 November 2017; doi:10.1038/bjc.2017.365

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Tumour-infiltrating inflammatory and immune cells in patients with extrahepatic cholangiocarcinoma

Tumour-infiltrating inflammatory and immune cells in patients with extrahepatic cholangiocarcinoma

Tumour-infiltrating inflammatory and immune cells in patients with extrahepatic cholangiocarcinoma, Published online: 09 November 2017; doi:10.1038/bjc.2017.401

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The Contribution of Surface Electromyographic Assessment for Defining the Stage of Peripheral Facial Paralysis: Flaccid or Sequelae Stage

Int Arch Otorhinolaryngol
DOI: 10.1055/s-0037-1607335

Introduction Surface electromyographic activity may not be symmetric, even in subjects with no facial paralysis history. Objective To evaluate the contribution of the index of electromyographic (IEMG) activity in the identification of the two extremes of the facial paralysis course. Methods Thirty-four subjects with unilateral peripheral facial paralysis were selected. A control group was composed of volunteers without a history of facial paralysis. The electromyographic assessment of the facial muscle was performed by placing surface electrodes during movements of the forehead, eyes and lips using MIOTEC equipment, such as the MIOTOOL (Miotec, Porto Alegre, Brazil) software. The electromyographic activity was also recorded in other channels during the primary activity to identify the presence of synkinesis. The statistical analysis was performed using the Statistical Package for Social Sciences for Macintosh (SPSS Inc, Chicago, IL, USA). The IEMG activity was obtained from the division of the electromyographic activity root mean square (RMS) values on both sides. Results There was a statistically significant difference among the groups in all the analyzed indexes. The ocular-oral synkinesis in all patients must be correctly identified (with 100% sensitivity and specificity) using an IEMG activity of 1.62 as a cutoff point. The oral-ocular synkinesis must be correctly identified (93.3% sensitivity and 95.9% specificity) using the IEMG activity of 1.79 as a cutoff point. Conclusion The IEMG activity is below the normal scores in patients in the flaccid stage, whereas patients in the sequelae stage can either show normal values or values above or below the normal scores. The IEMG activity was shown to have high sensitivity and specificity in the identification of synkinesis.
[...]

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Vocal Symptoms and Associated Risk Factors between Male and Female University Teachers

Int Arch Otorhinolaryngol
DOI: 10.1055/s-0037-1606604

Introduction Many recent studies on teachers warn of the adverse effects that voice problems have on work performance. However, only a few of these studies included university teachers. Objective To compare the vocal symptoms and risk factors between male and female university teachers in a private institution within the city of São Paulo. Methods In a cross-sectional survey, a voice self-evaluation form prepared by the Ministry of Labor in Brazil was administered to 846 university teachers at a private institution in the city of São Paulo. Results The percentage of hoarseness, vocal tract discomfort, neck pain and foreign body sensation was significantly higher in female than in male subjects. A significantly higher percentage of males participated in other professional activities in addition to teaching, reported working in a calm environment compared with working in a moderately or severely tense and stressful environment, and rated themselves as calm, slightly stressed and anxious or moderately stressed and anxious rather than very stressed and anxious. A significantly higher percentage of females spent most of their time teaching compared with performing other professional activities, and rated themselves as chatty or impulsive. Conclusion Among university teachers, a significantly higher percentage of females than males reported hoarseness, vocal tract discomfort, neck pain and foreign body sensation. Some risk factors related to work organization, workplace environment, voice care and quality of life variables were related to this higher prevalence in females.
[...]

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Efficacy of Drainless Total Thyroidectomy in Intrathyroidal Lesions of Thyroid

Int Arch Otorhinolaryngol
DOI: 10.1055/s-0037-1606183

Introduction There is difference of opinion about the placement of the drain in thyroid surgeries, and, to the best of our knowledge, the efficacy of drainless total thyroidectomy regarding various parameters of thyroid lesions has not been well-established. Objective To report our experience with drainless total thyroidectomy, and to define an appropriate patient population for its performance. Methods This is a retrospective case analysis of the patients who underwent total thyroidectomy for intrathyroidal lesions with or without central neck dissection in a tertiary referral hospital (number = 74). The patients, who had undergone total thyroidectomy without any drain insertion, were analyzed, and the relationships among various parameters of thyroid lesions were noted in relation to seroma and hematoma formation. Results Seroma formation was noted only in 5 out of 74 patents (6.75%). All of the seromas that occurred were observed in patients with thyroid lesions < 4 cm, and 4 out of 5 seromas were observed in patients with a malignant pathology. There was no statistically significant difference in seroma formation between patients younger or older than 50 years of age.The nature of the lesion, whether benign or malignant, did not affect the formation of seroma. Of interest is the fact that none of the 10 patients who had central neck dissection performed as part of their treatment developed seroma. Conclusions Drainless total thyroidectomy is safe across all age groups for patients harboring either benign or malignant thyroid pathologies. However, caution is to be observed in opting for drainless total thyroidectomy in patients with large lesions (> 5 cm)
[...]

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Changing Trends in the Treatment of Mandibular Fracture

Int Arch Otorhinolaryngol
DOI: 10.1055/s-0037-1606645

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Evaluation of the Facial Recess and Cochlea on the Temporal Bone of Stillbirths regarding the Percutaneous Cochlear Implant

Int Arch Otorhinolaryngol
DOI: 10.1055/s-0037-1606612

Introduction The literature shows that there are anatomical changes on the temporal bone anatomy during the first four years of life in children. Therefore, we decided to evaluate the temporal bone anatomy regarding the cochlear implant surgery in stillbirths between 32 and 40 weeks of gestational age using computed tomography to simulate the trajectory of the drill to the scala timpani avoiding vital structures. Objectives To measure the distances of the simulated trajectory to the facial recess, cochlea, ossicular chain and tympanic membrane, while performing the minimally invasive cochlear implant technique, using the Improvise imaging software (Vanderbilt University, Nashville, TN, US). Methods An experimental study with 9 stillbirth specimens, with gestational ages ranging between 32 and 40 weeks, undergoing tomographic evaluation with individualization and reconstruction of the labyrinth, facial nerve, ossicular chain, tympanic membrane and cochlea followed by drill path definition to the scala tympani. Improvise was used for the computed tomography (CT) evaluation and for the reconstruction of the structures and trajectory of the drill. Results Range of the distance of the trajectory to the facial nerve: 0.58 to 1.71 mm. to the ossicular chain: 0.38 to 1.49 mm; to the tympanic membrane: 0.85 to 1.96 mm; total range of the distance of the trajectory: 5.92 to 12.65 mm. Conclusion The measurements of the relationship between the drill and the anatomical structures of the middle ear and the simulation of the trajectory showed that the middle ear cavity at 32 weeks was big enough for surgical procedures such as cochlear implants. Although cochlear implantation at birth is not an indication yet, this study shows that the technique may be an option in the future.
[...]

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Papillary Thyroid Carcinoma within Thyroglossal Duct Cyst: Case Series and Literature Review

Int Arch Otorhinolaryngol
DOI: 10.1055/s-0037-1606277

Introduction Thyroglossal duct cyst (TGDC) is the most common congenital anomaly of the neck, and approximately 7% of all the adult population presents it. Ectopic thyroid tissue is found in the thyroglossal duct cyst wall in up to 65% of cases. This thyroid tissue has the potential to develop some type of malignancy, the most common of which is the papillary carcinoma of the thyroid. There are just over 270 cases of thyroglossal duct cyst malignancy reported in the literature. Objectives We aimed to study our population of patients in order to identify cases with thyroglossal duct cyst malignancy. Methods A retrospective chart review was conducted in the section of otolaryngology/head and neck surgery at a hospital in Karachi, Pakistan, from January of 2004 to December of 2014 on patients with the diagnosis of thyroglossal duct cyst. Results Fifty-eight patients were diagnosed with TGDC, two of whom also presented with thyroglossal duct cyst carcinoma. Both patients revealed papillary thyroid carcinoma on histopathology. Case 1 had an open biopsy before undergoing definitive surgery. Both patients underwent subsequent total thyroidectomy after Sistrunk procedure, and case 2 had selective neck dissection revealing lymph node metastasis. Conclusion Thyroglossal duct cyst carcinoma is a rare finding that comes as a surprise to both the patient and the surgeon. We report 2 out of 58 cases diagnosed with thyroglossal duct cyst carcinoma.
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An Analysis of Anatomic Variations of the Sphenoid Sinus and Its Relationship to the Internal Carotid Artery

Int Arch Otorhinolaryngol
DOI: 10.1055/s-0037-1607336

Introduction The sphenoid sinus (SS) has a high variability; its anatomical relations and variations must be well understood prior to the expanded endoscopic surgery (EES) at the skull base via the endonasal transsphenoidal approach. A feared complication is injury to the internal carotid artery (ICA). Objective To evaluate the anatomic variations of the SS and its relationship to the ICA using computed tomography (CT). Methods Cross-sectional retrospective study. Analysis of 90 patients' CT scans on axial, coronal and sagittal planes with 1 mm slices, evaluating lateral and posterior extensions of pneumatization of the SS, deviation of the sphenoid septum, presence of septations and their relationship to the parasellar and paraclival segments of the internal carotid artery (psICA and pcICA, respectively). Results The association between the protrusions of the psICA and the pcICA was statistically significant (p < 0.001), as was the association between the lateral extension of pneumatization of the SS and the protrusion of the psICA (p = 0.014). The presence of the posterior extension of pneumatization of the SS and protrusion of the pcICA occurred in 46% of the cases. Deviation of the sphenoid septum in the direction of the pcICA was present in 14% and dehiscence of the pcICA was seen in 3.6% of the cases. Conclusion Using the CT scan to recognize the type of extensions of pneumatization of the SS, the deviation of the sphenoid septum, and the presence of septations is beneficial to identify accurately the ICA and to reduce the risk of injury to it.
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Probable Association of Hearing Loss, Hypertension and Diabetes Mellitus in the Elderly

Int Arch Otorhinolaryngol
DOI: 10.1055/s-0037-1606644

Introduction The aging process causes changes in body structure in a continuous manner, and contributes to clinical disorders. Life expectancy is increasing, especially in developing countries. Objective To assess the prevalence of hearing loss and its possible association with hypertension and diabetes mellitus (DM) in the elderly. Methods A cross-sectional study with 519 elderly individuals aged over 60 years who underwent an audiological evaluation (pure tone audiometry), and answered a comorbidity questionnaire that included questions about age, gender, tinnitus and medical history, with data concerning DM. The dependent variable was the presence of hearing loss. The independent variables were age, gender, DM and hypertension. The variables were presented in absolute numbers and proportions, and enabled us to estimate the prevalence. The statistical analysis was performed through multiple logistic regression with 95% confidence intervals and values of p < 0.05 for the hearing loss and its associated factors. Results A total of 519 subjects of both genders with a median age of 69 years were evaluated, and the individuals who did not attend the audiometric test were excluded from the study, so the final sample was composed of 498 subjects. Sensorineural hearing loss was more prevalent (66.26%) of most frequently with bilateral hearing loss of 91.56% and 26.50% with mild degree. The statistical analysis showed that the variable DM was associated with the high frequency of hearing loss in the elderly, and according to the multiple logistic regression, the risk factors are independent of the hearing loss only for age and exposure to occupational noise. Conclusions There was a statistically significant difference between hearing loss at high frequencies and the risk factors, that is, age and DM.
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Outcomes of Automated Auditory Evoked Potential Performed in Different Settings and the Factors Associated with Referred Cases

Int Arch Otorhinolaryngol
DOI: 10.1055/s-0037-1607334

Introduction For the population with risk factors for hearing loss, the first option to assess the hearing status is the performance of the automated brainstem auditory evoked potential (BAEP) test because of its efficacy in identifying retrocochlear hearing loss. Objective To verify the outcomes of automated BAEP performed in different settings as well as the factors associated with the prevalence of hearing impairment. Methods Cross-sectional study conducted from October of 2014 to May of 2015. The sample consisted of 161 infants with at least one risk factor for hearing loss who underwent automated BAEP during the hospital stay or at the outpatient clinic. After 30 days, the altered cases were referred for BAEP diagnosis. Results One hundred and thirty-eight infants (86%) had a result of "pass" and 23 (14%) of "failure" in the automated BAEP. There was no statistically significant difference in the rate of "referred" results between examinations performed in different settings. The infants' ages did not influence the number of abnormal cases. All of the 23 infants who presented a "referred" result in the automated BAEP, unilateral or bilateral, were sent for BAEP diagnosis, and out of these, 9 (39%) remained with at least some degree of alteration. The average age of diagnosis was 2.7 months. Conclusion The results of the automated BAEP were similar when performed during hospitalization or after discharge. Neither the age at the examination nor the gender of the patient influenced the prevalence of hearing loss.
[...]

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Hyoid Bone Suspension as a Part of Multilevel Surgery for Obstructive Sleep Apnea Syndrome

Int Arch Otorhinolaryngol
DOI: 10.1055/s-0037-1607227

Introduction Since oropharyngeal surgery alone is often insufficient to treat obstructive sleep apnea (OSA), advances have been developed in hypopharyngeal surgery. Objective To assess hyoid suspension surgery as part of a multilevel OSA surgery, also including palatal surgery. Methods The study included patients with OSA symptoms with apnea hypopnea index (AHI) > 15. They were scheduled for hyoid suspension after a nasoendoscopy during Müller maneuver and drug induced sleep endoscopy (DISE). All patients had body mass index (BMI) < 35 kg/m2. Hyoidothyroidopexy combined with tonsillectomy and palatal suspension was performed in all cases. Results The mean AHI dropped significantly (p < 0.0001) from 68.4 ± 25.3 preoperatively to 25.6 ± 9.52 postoperatively. The mean lowest oxygen (O2) saturation level increased significantly from 66.8 ± 11.3 to 83.2 ± 2.86 (p < 0.0001). In addition, the snoring score significantly decreased (p < 0.0001) from a preoperative mean of 3.4 ± 0.54 to 2 ± 0.7 at 6 months postoperatively. In regard to the Epworth sleepiness scale (ESS), it showed significant improvements (p < 0.0001) as its mean diminished from 13.8 ± 5.4 preoperatively to 5.2 ± 1.6 postoperatively. Conclusion Hyoidothyroidopexy using absorbable suture seems to produce a good outcome in treating OSA. It could be effectively and safely combined with other palatal procedures in the multilevel surgery for OSA.
[...]

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Assessment of Pulmonary Function before and after Sinus Surgery in Lung Transplant Recipients

Int Arch Otorhinolaryngol
DOI: 10.1055/s-0037-1606600

Introduction The association between sinus and lung diseases is well known. However, there are scarce studies regarding the effects of sinus surgery on pulmonary function in lung transplant recipients. The present study describes our experience with sinus surgery in lung transplant recipients with chronic rhinosinusitis. Objectives To assess the impact of sinus surgery for chronic rhinosinusitis on pulmonary function and on inpatient hospitalization days due to lower respiratory tract infection in lung transplant recipients. Methods A retrospective study conducted between 2006 and 2012 on a sample of lung transplant recipients undergoing sinus surgery for chronic rhinosinusitis. Pulmonary function, measured by forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1), as well as inpatient hospitalization days due to lower respiratory tract infection, were compared 6 months before and 6 months after sinus surgery. Results The FEV1 values increased significantly, and the inpatient hospitalization days due to bronchopneumonia decreased significantly 6 months after sinus surgery. The preoperative and postoperative median FEV1 values were 2.35 and 2.68 respectively (p = 0.0056). The median number of inpatient hospitalization days due to bronchopneumonia 6 months before and 6 months after surgery were 32.82 and 5.41 respectively (p = 0.0013). Conclusion In this sample of lung transplant recipients with chronic rhinosinusitis, sinus surgery led to an improvement in pulmonary function and a decrease in inpatient hospitalization days due to bronchopneumonia.
[...]

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Otitis Externa in Secondary Care: A Change in Our Practice Following a Full Cycle Audit

Int Arch Otorhinolaryngol
DOI: 10.1055/s-0037-1606621

Introduction Patients presenting with otitis externa are a common thing in otolaryngology units. However, the practice has not been standardized due to a lack of consensus over the management of this condition in secondary care. The National Institute for Health and Care Excellence (NICE) guideline has been published targeting the general practitioners, but it may be relevant in cases of hospital first-time attenders. Objective To conduct an audit of the investigative and prescription practice for hospital first-time attenders in our department against the NICE guideline for otitis externa. Methods The case notes of the patients presenting with otitis externa were reviewed. The data collation included the performance of ear swabs and choice of eardrops. Results An initial audit showed that ear swabs were sent in 14 out of 19 cases, of which 11 grew either Pseudomonas aeruginosa or Staphylococcus aureus (organisms that are sensitive to empirical treatment). A re-audit showed higher adherence to NICE recommendations, with ear swabs sent in only 3 out of 25 cases. The initial audit also demonstrated Sofradex (Sanofi-Aventis, Paris, France) as the most popular empirical eardrop. Following our recommendation, the re-audit showed that Betnesol-N (GSK, Brentford, UK) was administered in 24 out of 25 cases. Conclusion We recommend Betnesol-N due to its cost-effectiveness. Ear swabs should be reserved for refractory cases only. Posters and email reminders are effective means of disseminating information within the hospital.
[...]

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Sudden Sensorineural Hearing Loss: Comparative Study of Different Treatment Modalities

Int Arch Otorhinolaryngol
DOI: 10.1055/s-0037-1605376

Introduction Idiopathic sudden sensorineural hearing loss (ISSNHL) is hearing loss of at least 30 dB in at least 3 contiguous frequencies within at least 72 hours. There are many different theories to explain it, and many different modalities are used for its management, such as: systemic steroids (SSs), intratympanic steroid injection (ITSI), hyperbaric oxygen therapy (HOT), antiviral drugs, and vasodilators or vasoactive substances. Objectives This study aims to evaluate the efficacy of the combination of the most common treatment modalities of ISSNHL and to compare the results if HOT was not one of the treatment modalities administered. Methods The study was conducted with 22 ISSNHL patients with ages ranging from 34 to 58 years. The patients were divided into 2 groups; group A included 11 patients managed by SSs, ITSI, antiviral therapy, and HOT simultaneously, and group B included 11 patients exposed to the aforementioned modalities, with the exception of HOT. Results After one month, all of the patients in group A showed total improvement in hearing in all frequencies, with pure tone average (PTA) of 18.1 ± 2.2, while in group B, 5/11 (45.5%) patients showed total improvement, and 6 /11 (54.5%) patients showed partial improvement, with a total mean PTA of 28.1 ± 8.7. Conclusion The early administration of HOT in combination with other clinically approved modalities (SSs, ITSI, antiviral therapy) provides better results than the administration of the same modalities, with the exception of HOT, in the treatment of ISSNHL.
[...]

Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

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Applicability of Evoked Auditory Brainstem Responses with Complex Stimuli in Adults with Hearing Loss

Int Arch Otorhinolaryngol
DOI: 10.1055/s-0037-1605341

Introduction The use of the speech-evoked auditory brainstem response (ABR) shows how the brainstem operates up to the subcortex in a more complex manner than when the click-evoked ABR is used. Objective To study the applicability of the speech-evoked ABR in adults with hearing loss. Methods The sample was composed of a study group of 11 subjects, with ages ranging between 18 and 59 years, and auditory thresholds within normal standards, with loss of up to 65 dB at high frequencies or up to moderately severe symmetric sensorineural hearing loss. The sample underwent a basic audiological assessment, as well as speech-evoked ABR and click-evoked ABR, in which waves I, III and V, and V, A, C, D, E, F were respectively marked. The electrophysiological assessments were performed using the SmartEP device (Intelligent Hearing Systems, Miami, FL, US). Results For the speech-evoked ABR, the reference values were used in the identification and analysis of the study group. Those values found for the study group were: V = 8.56; A = 10.97; C = 21.33; D = 29.51; E = 37.93; F = 46.96; and O = 55.97. In the comparison between groups, the study group presented an increase in latency only in wave C. Conclusion The speech-evoked ABR can be performed in subjects with up to moderately severe hearing loss, and the test proved to be appropriate, because, unlike the click-evoked ABR, the former does not suffer influence of peripheral hearing loss.
[...]

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More

As we celebrate and honor those who made the ultimate sacrifice for our country, one veteran is thankful to find new peace following his struggles with crippling PTSD. But state-of-the-art technology being used at a dentists office in Wellington is helping him to cope with his symptoms.

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Removal of a Frontal Sinus Osteoma and Reconstruction by a Custom-Made Implant with Neuronavigation Assistance

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1607066

The authors report the surgical treatment of an extensive right frontal sinus osteoma assisted by neuronavigation and reconstruction by a hydroxyapatite custom-made implant. The patient presents with ptosis, hypoglobus, and proptosis of the right eye, without any visual impairment. Computed tomographic (CT) scan showed a very large bony mass involving right frontal sinus and displacing the orbital roof. A stereolithographic model–guided planning was carried out to obtain a practical simulation of the surgical operation and it was submitted to a new CT scan to acquire the reference point to realize the neuronavigation assistance, and to achieve the template to realize the hydroxyapatite custom-made implant. Intraoperatively, with the help of neuronavigation assistance, osteotomies were performed by piezoelectric device. The reconstruction was made using a hydroxyapatite custom-made implant. The procedure was damage free, the bony mass was excised, and the orbital roof was repaired without any adverse effects. Postsurgical CT scan and scintigraphy showed a good reconstruction and a good-quality osteoblasts activity on the borders of the implant. Osteoma is a benign slow-growing bone tumor, usually involving the frontal sinus. Navigational assistance offers a very important help to perform safe osteotomies. Hydroxyapatite custom-made implant seems to be an excellent reconstructive method.
[...]

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Thromboprophylaxis in Head and Neck Microvascular Reconstruction

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1607068

Head and neck patients undergoing microvascular reconstruction are at high risk for thromboembolism. While the prevention of thromboembolism has become an essential aspect of care, within the field of microsurgery, concern for anastomotic complications have hindered the creation of an accepted regimen. The aim of this review was to evaluate the risks and benefits of prophylactic agents for thromboprophylaxis. A literature search was conducted in MEDLINE, Cochrane Library, and PubMed/NCBI databases. Articles discussing thromboprophylaxis in otolaryngology, head and neck surgery, or microvascular reconstruction were considered in the review from the past 30 years. The majority of patients undergoing microvascular surgery have multiple risk factors for thrombus formation. Several consensus guidelines exist for the prophylaxis in patients who are critically ill, undergoing surgery, or with malignancy. Significant evidence supports the routine use of mechanical means, such as early mobilization and pneumatic compression along with subcutaneous heparin. Low-molecular-weight heparin is also frequently utilized, although results are largely divided. Data on aspirin remain equivocal. Studies on microvascular failure and flap loss have demonstrated little to no association with chemoprophylaxis. The evidence for postoperative thromboprophylaxis regimens in patients undergoing head and neck free tissue transfer is variable. Multiple studies have supported the use of unfractionated heparin or low-molecular-weight heparin. There appears to be an expert consensus for the combined use of mechanical prophylactic methods and chemical prophylaxis. Prospective randomized trials are required to validate the most effective combination of chemoprophylaxis agents.
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Pseudoaneurysm Following Endoscopic-Assisted Repair of Subcondylar Fracture

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1607064

Pseudoaneurysms are a known complication following facial trauma and orthognathic surgery. Few reports exist of this clinical entity following traditional open techniques of repair, and none have been associated with endoscopic-assisted open reduction and internal fixation (ORIF) of a subcondylar fracture. We present a case of a 33-year-old man who developed pseudoaneurysm after endoscopic-assisted ORIF as well as a review of the literature on this topic. While uncommon, this is a potential complication that should be recognized with the use of endoscopic-assisted repair of mandibular fractures.
[...]

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Traumatic Anterosuperior Dislocation of the Intact Mandibular Condyle into the Temporal Fossa

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1607067

Temporomandibular joint (TMJ) dislocation, or luxation, occurs when the condyle crosses the articular eminence in such a way that it does not return to its correct anatomical position, unless aided by a reduction in external forces for TMJ. The diagnosis of condylar luxation is clinical; however, image exams are important in classifying the types of condylar luxation and associated fractures. Displacement of the TMJ can occur due to either an exaggerated mouth opening or a forced opening and occasionally is associated with a high-impact trauma to the jaw, the latter being an extremely rare condition. Few cases of anterosuperior dislocation of the intact mandibular condyles into the temporal fossa (ADIMC) have been documented in medical literature, many of which are associated with craniofacial trauma. This study describes the case of an ADIMC of the left side combined with facial fractures, as well as the treatment performed. A review of cases found in the literature from 1969 to 2017 was conducted through a detailed bibliographical study.
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Cartilage Graft Donor Site Morbidity following Rhinoplasty and Nasal Reconstruction

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1607065

Although surgical techniques for rhinoplasty and nasal reconstruction are well established, prospective research on postoperative morbidity remains limited. The aim of this pilot study was to assess costal and auricular cartilage donor site pain and morbidity in patients undergoing rhinoplasty and nasal reconstruction. In this prospective cohort study, we enrolled 55 patients undergoing nasal surgery that required costal or auricular cartilage harvest from February 2015 through May 2016. Each patient was given a symptom-specific patient survey that assessed general pain, nasal pain, graft donor site pain, graft donor site itching, color variation, skin stiffness and thickness, and graft donor site appearance at 1, 4, and 12 weeks after surgery. Our patient group was 55% female (n = 30); the mean age was 47 years. Rib cartilage graft patients had significantly greater nasal pain than cartilage donor site pain. There was no significant difference in rib versus ear cartilage donor site pain. Nearly all patients reported that they were not at all concerned about their scar appearance or ear shape and appearance. No prior studies compare cartilage donor site morbidity in patients undergoing nasal surgery. Our findings challenge the conventional wisdom that utilizing auricular and costal cartilage results in high levels of donor site pain. Surgeons should have a low threshold to harvest rib or ear cartilage when it can improve surgical outcome.
[...]

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A Novel Approach for the Management and Prevention of Self-Induced Masticatory Lingual Trauma in the Neurologically Injured Patient

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1606300

Self-induced masticatory trauma is an unfortunate complication of a variety of neurologic disorders, including epileptic seizures, cerebral palsy, mental retardation, psychiatric disease, and brain trauma, in addition to other described etiologies. While single or occasional occurrences of tongue biting are relatively benign, recurrent self-injury can pose major issues and predispose a patient to chronic, severe complications. To prevent the complications associated with ongoing trauma to the tongue, steps must be taken to protect individuals from chronic self-injurious behavior. Often, these interventions cause significant morbidity to the patient, such as elective removal of the dentition or complications in gaining access to the oral cavity/airway associated with maxillomandibular fixation. In the neurologically impaired patient, immobilization of the jaws is frequently associated with higher rates of agitation, aspiration, or development of complicating infections of the gingival tissues. We report a case of self-induced masticatory trauma managed with the fabrication of a custom-fabricated oral appliance. This treatment modality successfully prevents the recurrence or incidence of self-induced masticatory trauma to the tongue. The benefits of this modality are that it allows access to the oral cavity, prevents immobilization of the jaws, has minimal to no morbidity, and is completely reversible.
[...]

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Figi’s Issues Recall Alert Due to Undeclared Allergen (Milk) in Dark Chocolate Gingersnaps

Figi's Companies, Inc of Marshfield, WI is recalling the following 2 products that are related to the GKI FOODS LLC Dark Chocolate Products recall because it may contain undeclared milk allergen. People who have an allergy or severe sensitivity to milk run the risk of serious or life- threatening allergic reaction if they consume these products.

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Osseointegrated Implants and Prosthetic Reconstruction Following Skull Base Surgery

Seminars in Plastic Surgery 2017; 31: 214-221
DOI: 10.1055/s-0037-1607201

Rehabilitation following ablative skull base surgery remains a challenging task, given the complexity of the anatomical region, despite the recent advances in reconstructive surgery. Remnant defects following resection of skull base tumors are often not amenable to primary closure. As such, numerous techniques have been described for reconstruction, including local rotational muscle flaps, pedicled flaps with skin paddle, or even free tissue transfer. However, not all patients are appropriate surgical candidates and therefore may instead benefit from nonsurgical options for functional and aesthetic restoration. Osseointegrated implants and biocompatible prostheses provide a viable alternative for such a patient population. The purpose of this review serves to highlight current options for prosthetic rehabilitation of skull base defects and describe their indications, advantages, and disadvantages.
[...]

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Locoregional and Microvascular Free Tissue Reconstruction of the Lateral Skull Base

Seminars in Plastic Surgery 2017; 31: 197-202
DOI: 10.1055/s-0037-1606556

The goals of reconstruction following any oncologic extirpation are preservation of function, restoration of cosmesis, and avoidance of morbidity. Anatomically, the lateral skull base is complex and conceptually intricate due to its three-dimensional morphology. The temporal bone articulates with five other cranial bones and forms many sutures and foramina through which pass critical neural and vascular structures. Remnant defects following resection of lateral skull base tumors are often not amenable to primary closure. As such, numerous techniques have been described for reconstruction including local rotational muscle flaps, pedicled flaps with skin paddle, or free tissue transfer. In this review, the advantages and disadvantages of each reconstructive method will be discussed as well as their potential complications.
[...]

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Skull Base Reconstruction

Seminars in Plastic Surgery 2017; 31: 175-176
DOI: 10.1055/s-0037-1607277

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Yadranko Ducic, MD

Seminars in Plastic Surgery 2017; 31: 173-174
DOI: 10.1055/s-0037-1607276

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Skull Base Trauma: Clinical Considerations in Evaluation and Diagnosis and Review of Management Techniques and Surgical Approaches

Seminars in Plastic Surgery 2017; 31: 177-188
DOI: 10.1055/s-0037-1607275

Traumatic injuries to the skull base can involve critical neurovascular structures and present with symptoms and signs that must be recognized by physicians tasked with management of trauma patients. This article provides a review of skull base anatomy and outlines demographic features in skull base trauma. The manifestations of various skull base injuries, including CSF leaks, facial paralysis, anosmia, and cranial nerve injury, are discussed, as are appropriate diagnostic and radiographic testing in patients with such injuries. While conservative management is sometimes appropriate in skull base trauma, surgical access to the skull base for reconstruction of traumatic injuries may be required. A variety of specific surgical approaches to the anterior cranial fossa are discussed, including the classic anterior craniofacial approach as well as less invasive and newer endoscope-assisted approaches to the traumatized skull base.
[...]

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Endoscopic Endonasal Reconstructive Methods to the Anterior Skull Base

Seminars in Plastic Surgery 2017; 31: 203-213
DOI: 10.1055/s-0037-1607274

The success of expanded endoscopic endonasal approaches (EEAs) to the anterior skull base, sellar, and parasellar regions has been greatly aided by the advancement in reconstructive techniques. In particular, the pedicled vascularized flaps have been developed and effectively cover skull base defects of varying sizes with a significant reduction in postoperative CSF leaks. There are two aims to this review: (1) We will provide our current, simplified reconstruction algorithm. (2) We will describe, in detail, the relevant anatomy, indications/contraindications, and surgical technique, with a particular emphasis on the nasoseptal flap (NSF). The inferior turbinate flap (ITF), middle turbinate flap (MTF), pericranial flap (PCF), and temporoparietal fascial flap (TPFF) will also be described. The NSF should be the primary option for reconstruction of majority of skull base defects following endonasal endoscopic surgery. In general, for the planum, cribriform, and upper two-thirds of the clivus, the NSF is ideal. For the lower-third of the clivus, the NSF may not be adequate and may require additional reconstructive options. Although limited in reach or more technically challenging, these reconstructive flaps should still be considered and kept in the surgical algorithm.
[...]

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Open Anterior Skull Base Reconstruction: A Contemporary Review

Seminars in Plastic Surgery 2017; 31: 189-196
DOI: 10.1055/s-0037-1607273

Skull base extirpative and reconstructive surgery has undergone significant changes due to technological and operative advances. While endoscopic resection and reconstruction will continue to advance skull base surgery for the foreseeable future, traditional open surgical approaches and reconstructive techniques are still contemporarily employed as best practices in certain tumors or patient-specific anatomical cases. Skull base surgeons should strive to maintain a working knowledge and technical skill set to manage these challenging cases where endoscopic techniques have previously failed, are insufficient from anatomical constraints, or tumor biology with margin control supersedes the more minimally invasive approach. This review focuses on the reconstructive techniques available to the open skull base surgeon as an adjunct to the endoscopic reconstructive options. Anatomic considerations, factors relating to the defect or patient, reconstructive options of nonvascular grafts, local and regional flaps, and free tissue transfer are outlined using the literature and author's experience. Future directions in virtual surgical planning and emerging technologies will continue to enhance open and endoscopic skull base surgeon's preparation, performance, and outcomes in this continually developing interdisciplinary field.
[...]

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Calvarial Reconstruction

Seminars in Plastic Surgery 2017; 31: 222-226
DOI: 10.1055/s-0037-1606557

Calvarial reconstruction is a challenge to reconstructive surgeons, especially considering protection of intracranial contents. In recent years, the advent of multiple reconstructive materials adds tools to the surgical armamentarium. Options include autologous split calvarial and rib grafts and alloplastic materials such as titanium mesh, methyl methacrylate, calcium hydroxyapatite, and polyetheretherketone. The most important aspect of cranial reconstruction still lies in finding the most aesthetic, safe, and reliable means of filling a defect.
[...]

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Complications of Skull Base Surgery

Seminars in Plastic Surgery 2017; 31: 227-230
DOI: 10.1055/s-0037-1607203

Approaches to surgical management of skull base pathology and reconstruction of skull base defects have evolved over the past several decades. The goal, however, remains the same—to effectively address the pathology with minimal complications. In this article, the authors try to explore multiple complications of skull base surgery, discussing their incidence, natural course, and prevention. This will prove beneficial in optimal management of patients with a myriad of skull base disorders.
[...]

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Auditive Verarbeitungs- und Wahrnehmungsstörung: Ist die Diagnose schon bei Erstklässlern möglich?

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-120580

Hintergrund Signifikante Leistungsunterschiede zwischen Kindern mit und ohne auditive Verarbeitungs- und Wahrnehmungsstörungen (AVWS) im 2., 3. und 4. Grundschuljahr wurden in einer eklektischen AVWS-Testbatterie für die meisten Diagnoseinstrumente festgestellt. Die aktuelle Studie erfolgte mit der Fragestellung, ob dies auch für Kinder der 1. Schulklassenstufe zutrifft. Material und Methoden Leistungen von 41 Kindern mit und von 37 ohne AVWS im 1. Regelgrundschuljahr (Alter: 6–8 Jahre) wurden in 14 spezifisch auditiven Tests miteinander verglichen. Ergebnisse Statistisch signifikante Gruppenunterschiede wurden in 12 Diagnoseinstrumenten aufgedeckt; lediglich in 2 PaTSy-Subtests (Tonfrequenzen; Tonintensitäten) war das nicht der Fall. Bzgl. der monauralen Ordnungsschwelle blieb die Signifikanz nach Bonferroni-Korrektur knapp erhalten. Non-AVWS-Kinder bewältigten die PaTSy-Subtests in 86–89 %, AVWS-Kinder in 73–83 % aller Fälle. Die Testwerte von Jungen bzw. Mädchen mit AVWS waren im Vergleich zu denen von Jungen bzw. Mädchen ohne AVWS durchweg reduziert. Schlussfolgerungen Auch Erstklässler mit „AVWS" ließen sich von solchen ohne „AVWS" statistisch signifikant unterscheiden. In der Tendenz waren bei Erstklässlern mit AVWS dieselben Leistungen gemindert wie bei Grundschülern in höheren Klassenstufen. Der Einsatz sprachfreier audiologischer Verfahren zur klinischen Diagnose von AVWS erscheint für die Altersgruppe 6–8 Jahre jedoch fragwürdig.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Reduktion postoperativer Schmerzen durch Manuelle Medizin bei Erwachsenen nach Tonsillektomie

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-119885

Hintergrund Postoperativer Schmerz nach Tonsillektomie (TE) kann in der Regel durch die Gabe von Analgetika aus der Gruppe der nicht steroidalen Antirheumatika (NSAR) suffizient behandelt werden. Bei einigen Patienten besteht jedoch eine außergewöhnlich therapieresistente Schmerzsymptomatik, welche zudem häufig einseitig stärker ausgeprägt ist. Unsere klinisch praktische Erfahrung hat gezeigt, dass bei diesen Patienten häufig eine Blockierung der oberen Kopfgelenke vorliegt, die durch Manuelle Medizin (MM) erfolgreich therapiert werden kann. In dieser prospektiven, randomisierten, placebo-kontrollierten, einfach verblindeten Studie sollte deshalb untersucht werden, ob sich der schmerzlindernde Effekt dieser Therapie statistisch nachweisen lässt. Material und Methoden 52 erwachsene Patienten mit außergewöhnlich starken (VAS > 4) und / oder einseitigen Schmerzen nach TE (1. bis 4. Tag postoperativ) wurden hinsichtlich des Schmerzverlaufs mittels Visueller Analogskala (VAS) zu 4 Zeitpunkten untersucht: direkt vor (t0) und sofort nach der MM (t1), dann 4 Stunden nach MM (t2) sowie 24 Stunden nach MM (t3). Ergebnisse Die Ergebnisse zeigen eine signifikant höhere Schmerzreduktion (jeweils als Differenz zu t0) in der Verum- als in der Placebogruppe zum Zeitpunkt t1 und t3 (t1: p = 0,012, t3: p = 0,012, beides Bonferroni-adjustiert). Zum Zeitpunkt t2 war die Differenz mit p = 0,54 nicht signifikant. Schlussfolgerungen Anhand der Studie konnte die Wirksamkeit von Manueller Medizin zur Schmerzreduktion bei erwachsenen Patienten mit außergewöhnlich starken bzw. einseitigen Schmerzen nach TE und Hypomobilität der Halswirbelsäule nachgewiesen werden.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Eine seltene Differentialdiagnose des jugulotympanalen Paraganglioms

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-118006

[...]

Georg Thieme Verlag KG Stuttgart · New York

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Langzeitergebnisse und Patientenzufriedenheit nach Tympanoplastik mit Titan-Clip-Prothesen

Laryngo-Rhino-Otol 2017; 96: 698-703
DOI: 10.1055/s-0042-12450

Ziel der vorliegenden Arbeit ist die Evaluation der Langzeitergebnisse nach Ossikelkettenrekonstruktion mittels Titan-Clip Prothesen. Hierzu wurde eine retrospektive Analyse mit prospektivem Follow-up bei allen Patienten durchgeführt, bei denen in den Jahren 2002–2013 ein Clip-PORP implantiert wurde. Es erfolgten audiologische Messungen, otoskopische Untersuchungen sowie die Evaluation der Lebensqualität mittels Glasgow Benefit Inventory. 48 Patienten (51 Ohren, 29 Männer, 19 Frauen, Durchschnittsalter 44,1 Jahre) konnten für das Follow-up rekrutiert werden, der Nachbeobachtungszeitraum lag im Mittel bei 6,3 Jahren. Die Schallleitungskomponente wurde insgesamt (0,5–4 kHz) von präoperativ 22,8 dB auf 14,6 dB postoperativ reduziert (p≤0,001). Häufigste Operationsindikation waren Cholesteatome und -Rezidive (52%), gefolgt von chronischen Otitiden (12%), Radikalhöhlenrevisionen (8%) und Schallleitungsstörungen nach Voroperation (14%). In 47 Fällen war das Trommelfell verschlossen (92,2%), 4x (7,8%) bestand ein Defekt. Die Prothese war 39 Mal (75%) in situ, 6x (11,8%) lag eine Protrusion bzw. 2x (4%) eine Verkippung vor, 1x (2%) war die Prothese fehlend und 3x (5,9%) konnte es nicht beurteilt werden. Die postinterventionelle Patientenzufriedenheit wurde insgesamt positiv bewertet (8,4 Punkte), ebenso die allgemeine Unterskala während bei den Unterskalen soziale Unterstützung und körperliche Gesundheit keine Veränderung auftraten. Zusammenfassend ist die Ossikuloplastik mittels Titan-Clip Prothesen ein sicheres und etabliertes Verfahren. Auch langfristig werden gute und stabile audiologische Messresultate durch Reduktion der Schallleitungskomponente aufgezeigt. Die subjektive Lebensqualität ist insgesamt nachhaltig verbessert.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Chirurgie der inneren Nase

Laryngo-Rhino-Otol 2017; 96: 743-745
DOI: 10.1055/s-0043-114740

Georg Thieme Verlag KG Stuttgart · New York

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Leserbrief zu Ernst, A, P. Schlattmann, F. Waldfahrer, M. Westhofen Die Behandlung des M. Menière mit Betahistin: Kritische Anmerkungen zur BEMED-Studie. Laryngo-Rhino-Otol 2017; 96 (08): 519–521

Laryngo-Rhino-Otol 2017; 96: 674-674
DOI: 10.1055/s-0043-119253

Georg Thieme Verlag KG Stuttgart · New York

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Hörverbesserung durch Tympanoplastik

Laryngo-Rhino-Otol 2017; 96: 718-740
DOI: 10.1055/s-0043-114744

Die grundlegenden Techniken der Tympanoplastik wurden Anfang der 1950er Jahre entwickelt und seitdem verfeinert und modifiziert; die Grundprinzipien haben aber auch heute noch ihre Bedeutung. Als Transplantatmaterialien finden überwiegend Knorpel und Perichondrium Verwendung. Zur Ossikelrekonstruktion haben sich insbesondere Titanprothesen als vorteilhaft erwiesen.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Antwort auf den Leserbrief von Schaaf/Hesse zum Artikel „Die Behandlung des M. Menière mit Betahistin: Kritische Anmerkungen zur BEMED-Studie“ (Laryngo-Rhino-Otol 2017; 96 (08): 519–521)

Laryngo-Rhino-Otol 2017; 96: 675-675
DOI: 10.1055/s-0043-119254

Georg Thieme Verlag KG Stuttgart · New York

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Leitlinien in der Praxis: Die neue S3-Leitlinie „Nicht erholsamer Schlaf/Schlafstörungen“ – Kapitel „Schlafbezogene Atmungsstörungen“

Laryngo-Rhino-Otol 2017; 96: 685-690
DOI: 10.1055/s-0043-114750

Zu den schlafbezogenen Atmungsstörungen zählen die zentrale Schlafapnoe (ZSA), die obstruktive Schlafapnoe (OSA) und die schlafbezogene Hypoventilation bzw. Hypoxämie. Sie sind häufig und von zunehmender klinischer Relevanz. Das Kapitel zu dieser Krankheitsgruppe aus der S3-Leitlinie „Nicht erholsamer Schlaf/Schlafstörungen" der Deutschen Gesellschaft für Schlafmedizin wurde am 29. November 2016 aktualisiert und bietet Neuerungen zu Epidemiologie, Diagnostik, Therapie und Systematik. Zur Epidemiologie wird die deutlich erhöhte Mortalität schwangerer Frauen mit OSA herausgestellt. In der Diagnostik der OSA wird betont, dass die Polygrafie unter bestimmten Voraussetzungen ausreichen kann. Änderungen der diagnostischen Empfehlungen zur ZSA erlauben nun die Diagnosestellung auch bei geringer Apnoerate unter der Voraussetzung einer typischen klinischen Situation. Entscheidende therapeutische Unterschiede haben sich bei der ZSA mit Herzinsuffizienz ergeben. Ferner wird differenziert zwischen schlafbezogener Hypoventilation und schlafbezogener Hypoxämie. Das Obesitas-Hypoventilations-Syndrom wird insgesamt breiter besprochen. Der vorliegende Artikel fasst die Änderungen zusammen und kommentiert sie.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Stimmlippenzyste

Laryngo-Rhino-Otol 2017; 96: 676-677
DOI: 10.1055/s-0043-114751

Georg Thieme Verlag KG Stuttgart · New York

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Behandlungsfehler, wenn Patient nicht wieder kommt

Laryngo-Rhino-Otol 2017; 96: 716-717
DOI: 10.1055/s-0043-114745

Georg Thieme Verlag KG Stuttgart · New York

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Ein neues Lagerungsmanöver zur Behandlung einer Form von Schwankschwindel auf der Basis eines modifizierten Modells der Macula utriculi

Laryngo-Rhino-Otol 2017; 96: 678-684
DOI: 10.1055/s-0043-118632

Schwindel ist eines der Hauptsymptome unseres Fachgebietes, das in vielen Fällen interdisziplinär abgeklärt werden muss. In den letzten Jahren haben sich die diagnostischen Möglichkeiten, ausgehend von den seit Jahren bewährten Lagerungen und der kalorischen Prüfung, erheblich erweitert, so dass heute wesentlich differenzierter die zugrunde liegenden Störungen erkannt werden können. Gleichwohl sind sowohl in diagnostischer als auch therapeutischer Sicht immer noch viele Fragen offen. In dem nachfolgenden Artikel stellt der Kollege Koch ein neues Lagerungsmanöver als Therapieoption vor, das er bei vorwiegend älteren Patienten angewendet hat, die einen diffusen Schwankschwindel beim Gehen und Stehen, nicht jedoch im Sitzen oder Liegen hatten. Ausgehend von seinen Behandlungserfolgen schlägt er als Erklärung eine Modifikation des gängigen Modells der Macula utriculi vor, die ein weiterer Beitrag in der aktuellen Diskussion zum Thema „Schwindel" sein sollen. Zur weiteren Aufklärung wäre es interessant zu untersuchen, ob die von dem Autor vorgestellte Patientengruppe im Video-Kopfimpulstest verdeckte Sakkaden aufweisen.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Fragen für die Facharztprüfung

Laryngo-Rhino-Otol 2017; 96: 741-742
DOI: 10.1055/s-0043-114746

Georg Thieme Verlag KG Stuttgart · New York

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Eine rasch zunehmende Raumforderung der Schilddrüse

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-119758

[...]

Georg Thieme Verlag KG Stuttgart · New York

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Akuter progredienter Exophtalmus

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-119756

Georg Thieme Verlag KG Stuttgart · New York

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Nasenmuschelplastik: Welche Technik hat die Nase vorn?

Laryngo-Rhino-Otol 2017; 96: 672-673
DOI: 10.1055/s-0043-108954

Georg Thieme Verlag KG Stuttgart · New York

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Ballondilatation der Eustachischen Röhre unter lokaler Betäubung

Laryngo-Rhino-Otol 2017; 96: 671-672
DOI: 10.1055/s-0043-117012

Georg Thieme Verlag KG Stuttgart · New York

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Kombinierte Antibiotikatherapie wirksamer bei Paukenröhrchen und Otorrhoe

Laryngo-Rhino-Otol 2017; 96: 670-671
DOI: 10.1055/s-0043-117014

Georg Thieme Verlag KG Stuttgart · New York

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Kommentar der Schriftleitung

Laryngo-Rhino-Otol 2017; 96: 666-667
DOI: 10.1055/s-0043-114755

Liebe Leserinnen und Leser,die aktuelle Ausgabe der Laryngo-Rhino-Otologie bietet einen umfangreichen Strauß zu verschiedenen relevanten Themen unseres schönen Faches.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Hörrehabilitation durch Cochlea-Implantation nach Vestibularisschwannom-Entfernung?

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-119546

Ausgewertet wurden in einer Qualitätssicherungsanalyse 10 Patienten mit einem individuellen Behandlungsversuch nach einer simultanen oder konsekutiven Cochlea-Implantation nach translabyrinthärer Vestibularisschwannomentfernung im Kleinhirnbrückenwinkel. Die Ergebnisse zeigen, dass die Mehrzahl der Patienten mit einseitiger Ertaubung durch die stereophone Hörrehabilitation profitiert. Durch eine schonende chirurgische Präparationstechnik im Bereich des inneren Gehörgangs kann die morphologisch-funktionelle Integrität der neurovaskulären Strukturen gewährleistet werden.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Not All Pacifiers Are Created Equal: A Mechanical Examination of Pacifiers and Their Influence on Suck Patterning

Purpose

Many pacifier companies advertise that their product is the "best choice" to support proper sucking, feeding, and dental development; however, very little evidence exists to support these claims. As the primary differences across pacifiers are structural and mechanical, the goals of this study were to measure such properties of commercially available pacifiers and to examine how these properties alter suck patterning in healthy, full-term infants.

Method

Seven commonly utilized pacifiers were mechanically tested for pull and compression stiffness levels and categorized into nipple shape types based on their aspect ratio. Next, 3 pacifiers (Soothie, GumDrop, and Freeflow) with the most salient differences in pull stiffness levels with 2 different pacifier nipple types were tested clinically on 16 full-term infants (≤ 6 months old) while measuring non-nutritive suck (NNS).

Results

A repeated measures analysis of variance revealed significant differences between NNS burst duration (p = .002), NNS cycles per burst (p = .002), and NNS cycles per minute (p = .006) and pacifier type. With each significant dependent measure, pairwise comparisons showed that the GumDrop and Freeflow pacifiers differed significantly on these measures.

Conclusions

Pacifier compression, pull stiffness, and nipple shape type yield different NNS dynamics. These findings motivate further investigation into pacifier properties and suck patterning in young infants.

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A Review of Phonological Development of Mandarin-Speaking Children

Purpose

Research into the phonological development of Chinese children is in its infancy compared with the relatively extensive data available on the English-speaking population. This article provided a comprehensive review of empirical studies on the acquisition of Mandarin phonology.

Method

Studies over the past 45 years that describe phonological development in Mandarin-speaking children were located through electronic databases, citation searches, keyword searches through online search engines, and manual searches of libraries. The research design of the studies was reviewed, and findings of acceptable studies were summarized.

Results

After reviewing the abstracts of 798 studies, a total of 12 that met the inclusion criteria were retained. These studies are discussed with reference to the demographic background of participants, geographic regions, aspects of speech sounds measured, data collection tools, transcription systems used, reliability, and the main findings.

Conclusions

The general developmental patterns reported were consistent. The methodological design varied substantially. These discrepancies, however, provide insights for further systematic investigations into phonological development in Mandarin.

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Training Direct-Care Staff to Provide Communication Intervention to Adults With Intellectual Disability: A Systematic Review

Purpose

The aim of this review was to summarize and evaluate studies on training direct-care staff to provide communication intervention to adults with intellectual disability.

Method

Systematic searches identified 22 studies. These were summarized and evaluated in terms of (a) participants; (b) settings; (c) training aims and procedures; (d) research designs; (e) reliability, integrity, and social validity; (f) outcomes; (g) generalization and follow-up; and (h) certainty of evidence.

Results

A total of 437 staff and 254+ adults with intellectual disability participated. Staff training most frequently involved combinations of verbal instruction, role play, modeling, practice, and feedback. Reliability was assessed in 18 studies with acceptable standards for most of these studies. Treatment integrity and social validity were assessed in 1 and 3 studies, respectively, with positive outcomes. Generalization and maintenance were assessed in 5 and 8 studies, respectively, with predominantly positive outcomes. Most studies reported positive outcomes for staff and positive or mixed outcomes for the adults with intellectual disability. Certainty of evidence was rated as conclusive in 1 study, suggestive in 14 studies, and inconclusive in 7 studies.

Conclusions

There is sufficient evidence to conclude that direct-care staff can be taught to provide effective communication intervention to adults with intellectual disability. Professionals involved in providing training and support to direct-care staff could expect positive outcomes from multicomponent training programs that include opportunities for practice and feedback.

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Impact of Performance Feedback in Family-Centered and Culturally Responsive Interview Instruction

Purpose

Conducting culturally responsive and family-centered diagnostic interviews is an important part of speech and language services. However, there is limited information on the effective ways to teach speech-language pathology graduate students to acquire these skills. The purpose of this study was to examine the effect of performance feedback on graduate students' use of ethnographic principles, open-ended questions, and restating and summarizing comments in caregiver interviews.

Method

A randomized controlled crossover design (n = 26) was used to examine the differential effects of students receiving performance feedback or general feedback on role-play interviews. Ethnographic principles, open-ended questions, and restating and summarizing comments were measured at 3 time points: after class instruction (Groups 1 and 2), after the first feedback type allocation (Group 1: performance feedback; Group 2: general feedback), and after the second feedback type allocation (Group 1: general feedback; Group 2: performance feedback).

Results

Statistically significant increases, with large effect sizes, were found in students' use of ethnographic principles, open-ended questions, and restating and summarizing comments following the performance feedback conditions.

Conclusion

These findings suggest that performance feedback is an effective and efficient instructional procedure to increase culturally responsive and family-centered interview skills through an ethnographic interview approach in preservice speech-language pathology students.

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Predicting the Future: A Case Study in Prognostication

Purpose

Clinicians are regularly asked to make long-term prognoses. The aim of the current report was to present one systematic approach to doing so. A case example from a malpractice case involving a child fitted with a cochlear implant was presented. Implantation occurred at age 17 months (activation 1 month later), but due to a procedural error, the implant was not functional for 19 months. The problem was ultimately rectified, but the legal case hinged largely on whether the child would be able to make up for the lost time.

Method

A review of the literature on long-term outcomes in children with cochlear implants was conducted. Using 4 studies measuring outcomes 7–10 years later, outcomes were compared between children implanted at age 17–18 months and those implanted at age 36–37 months.

Results

Analysis suggested no potential impact on nonverbal cognitive skills. However, analysis in the areas of speech perception, word comprehension, speech intelligibility, and reading suggested that after 7–10 years, this child would potentially continue to be approximately 1–2 years behind where she might otherwise have been.

Conclusions

This case illustrated the possibility of deriving a long-term prognosis using a systematic examination of the existing outcomes literature. Such an approach is consistent with our mandate to engage in evidence-based practice.

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A Clear Speech Approach to Accent Management

Purpose

A 5-session twice-weekly clear speech protocol with daily home practice was developed to enable Spanish-accented speakers of English to code-switch for increased listener ease of understanding. This study provides preliminary data to test the hypothesis that this protocol results in increased ease of understanding for native English listeners, not in decreased talker accentedness.

Method

Using a single-case experimental design, 6 adult native Spanish speakers with English proficiency participated in the protocol. Ease of understanding and accentedness were probed at least 5 times pretraining, at each training session, and once per week for 5 weeks posttraining. Thirty native English–speaking listeners assessed the probes using 7-point scales for each measure.

Results

Ease of understanding improved for all participants (mean improvement = 3.5 points; effect size range = 6.98 to 15.33). Accentedness improved for 4 of 6 participants (mean improvement = 2.3 points; effect size range = 4.04 to 10.48). At the outset, most participants expressed concern that this approach would highlight speech errors. Upon follow-up, all participants reported confidence in using the approach and found it helpful in daily communication.

Conclusions

Further research should explore the effects of this protocol on intelligibility and acoustic metrics and their relationship to ease of understanding and accentedness.

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Intensive Treatment for Persisting Rhotic Distortions: A Case Series

Purpose

The study explored changes in accuracy of American English rhotics as a result of an intensive 1-week therapy program for adolescents and young adults with residual speech sound errors that had not resolved with previous therapy.

Method

Four case reports are presented of individuals aged 13, 17, 21, and 22 years with residual /ɹ/ distortions. Each participant attended a 1-week intensive program consisting of pretreatment assessments, 14 hr of therapy, and posttreatment assessment. Treatment sessions included structured motor-based practice, ultrasound visual feedback of the tongue, and auditory speech perception training. To assess generalization, untreated words and sentences with rhotics were recorded before and after therapy; these were rated by listeners who were blind to when the recordings were taken.

Results

All participants showed measurable and statistically significant improvement in speech sound accuracy. Averaged across the 4 participants, rhotic accuracy at the word level improved from 35% to 83%. At the sentence level, rhotic accuracy increased from 11% pretreatment to 66% posttreatment in 1 week.

Conclusion

The promise of an intensive treatment program that includes motor-based practice, biofeedback, and auditory perception training is illustrated by the case presentations in which substantial improvements in speech sound accuracy were observed.

Supplemental Materials

http://ift.tt/2iA3f0l

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Using the Delphi Technique to Explore Complex Concepts in Speech-Language Pathology: An Illustrative Example From Children's Social Communication

Purpose

In recent years, there has been an increasing interest in expanding the research approaches that speech-language pathologists utilize, particularly for addressing complex questions. Consensus-building techniques can be useful for addressing such questions. The Delphi technique is a consensus-building process involving structured communication among members of an expert panel via independent responses to iterative rounds of questionnaires. The purpose of this research note is to describe and demonstrate the Delphi technique using an application to a complex problem in speech-language pathology, that is, the bases of social communication and pragmatics.

Method

The Delphi technique was described and illustrated via the following study: 10 expert speech-language pathologists participated in a 3-round Delphi study. Participants were asked to list the key features of social communication and pragmatics in Round 1. Questions for Rounds 2 and 3 were developed on the basis of the participants' responses to previous rounds.

Results

The Delphi technique was useful in bringing participants to consensus on the key features of social communication and pragmatics and offered a starting point for the continued exploration of this complex problem.

Conclusion

A discussion of the benefits and limitations of the technique is included, highlighting the utility of the technique to the field of speech-language pathology.

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Quantity Matters: Children With Dyslexia Are Impaired in a Small, but Not Large, Number of Exposures During Implicit Repeated Sequence Learning

Purpose

The present study investigated the onset of statistical learning and examined whether the number of exposures to a repeated sequence influences the learning performance of children with dyslexia on a serial reaction time task.

Method

Three groups of children (29 with dyslexia, 29 age-matched controls, and 30 reading level–matched controls) were administered a serial reaction time task, and their statistical learning performances after a small and a large number of exposures (40 vs. 180 exposures) were recorded and compared.

Results

Children with dyslexia showed impaired statistical learning after a small number of exposures to a sequence, but intact statistical learning after a large number of exposures. In contrast, the age-matched and reading level–matched control groups showed intact statistical learning after both small and large numbers of exposures. Children with dyslexia also exhibited a slower learning rate than either control group.

Conclusion

These results suggest that the amount of exposure to statistical patterns influences statistical learning performance in children with dyslexia.

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Flow and Grit by Design: Exploring Gamification in Facilitating Adherence to Swallowing Therapy

Purpose

Delivery of swallowing therapy is faced with challenges regarding access to in-clinic services and adherence to prescribed home programs. Mobile health (mHealth) technologies are being developed at a rapid pace to address these difficulties. Whereas some benefits to using these modern tools for therapy are obvious (e.g., electronic reminders), other advantages are not as well understood. One example is the potential for mHealth devices and apps to enhance adherence to treatment regimens.

Method

This article introduces a number of psychological concepts that relate to adherence and that can be leveraged by mHealth. Elements that contribute to flow (optimal experience) during an activity and those that reinforce grit (perseverance to achieve a long-term goal) can be used to engage patients in their own rehabilitation.

Results

The experience of flow can be targeted by presenting the rehabilitation exercise as an optimally challenging game, one that offers a match between challenge and ability. Grit can be supported by reinforcing routine and by varying the therapy experience using different games.

Conclusions

A combination of hardware and software design approaches have the potential to transform uninteresting and repetitive activities, such as those that make up swallowing therapy regimens, into engaging ones. The field of gamification, however, is still developing, and gamified mHealth apps will need to withstand scientific testing of their claims and demonstrate effectiveness in all phases of outcome research.

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