[Report from the 2nd Educational Conference on "Acoustics in audiology"].
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Biomedical subjects
Publications and source records attributed to A Obrebowski.
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Following a long period of experience acquired in assessing occupation-related voice disorders, the proposals of objective measures, facilitating the certification of occupational disease of the voice organ in accordance with the binding legal regulations, are presented. The importance of documentary evidence of at least two years of treatment and phoniatric rehabilitation is stressed. A need to prevent occupation-related voice disorders through phoniatric diagnostic procedures is highlighted.
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Between 1990-2000 15 cases of unilateral Bell paresis of the VIIth nerve were treated using local injection of hydrocortisone in the region of the foramen stylomastoideum. Paralelly were administered iontophoresis, galvanisation of the facial mimic muscles together with vasodilating drugs. Early introduced treatment gave complete return of facialis function. The usefulness of treatment monitoring with topodiagnostic tests is stressed.
In 30 children, aged 10-16 years and suffering from simple obesity, significantly lowered odour detection thresholds were noted. The thresholds were lower than the average for a given age group in around 20% of obese children in cases of odours stimulating olfactory nerve and in around 57% in cases of substances stimulating olfactory and trigeminal nerves. Odour identification thresholds were similarly affected, with identification of olfactory nerve plus trigeminal nerve stimulating odours affected more than twice as frequently. In 77% cases also the electrogustometric thresholds were found below the normal range values when anode was used as the stimulating electrode. The detected alterations may be linked to metabolic disturbances, which accompany simple obesity.
A rapid course of Wegener's disease with a sudden sensorineural hearing loss was described. The definitive diagnosis was established post mortem.
Swallowing disorders in oral and pharyngeal phase after surgery of mouth, pharynx or larynx are very often interrelated with speech and voice disorders. The results of diagnostic methods of dysphagia and voice/speech disorders based on own material of patients after total laryngectomy, partial tongue resection and cleft palate surgery were presented. Attention was also paid to other etiological factors of swallowing disorders observed in phoniatric practice.
Factors influencing results of objective hearing examination in children, i.e. auditory evoked potentials, based on own experiences are presented. "Cross-check" principle as well as observation of dynamic changes concerning development of communicative process should be taken into the consideration.
The critical assessment of the existing regulations of professional voice evaluation are presented. The necessity of the use of essential phoniatric principles is stressed in order to make respective legal decision more realistic and responsible.
Own experience in microsurgery of vocal folds are presented. The necessity and importance of photographic and acoustic documentation (MDVP) as well as phoniatric pre- and postoperative rehabilitation are stressed.
Electrophysiological examinations of hearing (ABR, SP) in 60 children with insulin-dependent diabetes mellitus and 39 children with obesitas simplex were done. In both groups with normal hearing threshold in pure tone audiometry disturbances in intrastem conduction were noticed.
In 60 children and youngsters aged 14-19 (average 16.5) with insulin dependent diabetes (lasting on average 5.5 years) and normal hearing in pure tone audiometry electrophysiological examinations (ABR, SP) were performed; 48% of the cases revealed changes in latencies of I, III, V waves, especially as an elongation of I and V waves. In the peripheral interlatencie (III-I; V-I) shortening and in V-III elongation were observed. In SP examination most often shortening of N1 (67%) and P2 (87%) were found. Statistically significant dependence of latency changes on the state of metabolic balance was stated. It was not found referring to the duration of diabetes, age and gender of the patients.
The authors describe a rare case of Goldenhar-Gorlin Syndrome, also called oculoauriculovertebral dysplasia (OAV) or hemifacial microsomia. Goldenhar's syndrome was accompanied by hearing loss caused by deformity of the auricle and atresia of the external auditory canal.
There has been described a case of the right arytenoid cartilage subluxation in a 11-year-old girl who underwent several intubations and bronchoscopies as a newborn and an infant. The voice has gone hoarse owing to those interventions. Videolaryngoscopy revealed anterior and medial dislocation of the right arytenoid cartilage accompanied by the immobility in the cricoarytenoid joint, right vocal movement being preserved. Voice therapy was not successful as the parents lost their interest, considering the present child's voice to be normal.
In a 49-year-old woman carcinoma planoepithelialie akeratodes of the right vocal cord was diagnosed. The lesion was removed with the Kleinasser's microsurgery procedure. During telecobaltotherapy, temporary oedema of the face and the neck as well as dysphagia appeared. Myxoedema due to insufficiency of the thyroid was diagnosed after four months since the end of the radiotherapy. Substitutional treatment resulted in the hormonal and clinical improvement of the patient.
The necessity of the early detection of hearing loss in children in order to start possibly early the acoustic stimulation of hearing organ is pointed out. The suggestions of the hearing screening based on the register of risk factors, behavioral audiometry, impedance audiometry and electrophysiological examination (evoked otoacoustic emission, evoked brain stem response audiometry) are presented.
A set of 7 word tests with different number of nasal phonemes was prepared. These tests are adjusted to technical possibilities of nasal resonance examination by means of own construction apparatus. The VII-th test consisting only oral speech sounds appeared to be most important for estimating physiological nasal resonance characteristic for the Polish language and gave individual timbre of the voice. For Polish language these resonance rate is 15.2%. It is useful as reference data to evaluate patients with pathological nasal resonance. The VII-th test together with the V-th one which contain 6.3% of nasal consonants, and the VI-th with 33.3% of them were used for detailed evaluation of nasal resonance.
Some principles of medical assessment in phoniatric and audiological diseases are critically discussed. The necessity of preliminary qualifying examination to voice profession is underline. Attention is paid to the importance of adequate medical documents in judgement of professional voice and hearing diseases.