[Disorders of auditory processing and perception. Consensus statement].
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Biomedical subjects
Publications and source records attributed to C von Deuster.
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Diagnostic audiological tests performed in ten children from 1985 to 1991 showed remarkable differences between the results of behavioral audiometry (free field or pure tone audiometry) and those of auditory evoked response audiometry. Auditory brainstem response (ABR) was absent in seven children with sensory neural hearing loss. Neuropsychological evaluation was performed on four children, neuropsychological observation was performed on two children, pediatric examination was performed on three children and one child showed signs of neuropediatric disorder. The results of neuropsychological evaluation showed moderate to severe learning disabilities (sensory integration disorders, learning disorders) in all four children tested. Available neuropsychological observation also indicated the presence of sensory integration disorders in two children. Two children had multiple handicaps with cerebral abnormalities, two further children were diagnosed as suffering from "minimal cerebral dysfunction," one of which was mentally retarded. The fact that ABRs were absent in seven children indicates that a response desynchronisation in the auditory pathway may exist in these disorders. Thus, ABR might not be a reliable method for audiological testing in children with learning disabilities or other cerebral dysfunctions, but serves as an adjunct to conventional testing methods.
It is very difficult to give a valid classification of functional voice disorders. Many patients with voice disorder initially consult an ENT specialist. Important aspects of differential diagnosis are presented based on a study of the literature which should help the ENT specialist discriminate between hyperfunctional and hypofunctional dysphonia, which is very important for therapy. An early tentative diagnosis should be followed by a phoniatric examination.
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An essential precondition for normal speech development is an intact peripheral and central hearing capacity. Disturbances of auditory perception can be the cause of speech defects. There are many methods to examine sound discriminating capacity. Most of them are statistically not verified or standardized. We developed a testing method which consists of 44 figured word pairs. We suggest how to differentiate between children with impaired auditory perception from children without this disturbance. Visual perception and visuomotor function were examined by the Marianne Frostig Developmental Test of VIsual Perception and the Bender-Gestalt-Test (Göttinger Form-reproduktions-Test). We found disturbances all the more the auditory perception was impaired. We investigated handedness and cerebral dominance by the Hand-Dominanz-Test (Steingrüber, Lienert). Righthandedness was most clearly pronounced in the control group (normal speaking children), less so in stammerers without weakness in sound discrimination and weakest in stammerers with this latter defect.
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Intention of paedaudiology is to detect and to evaluate hearing loss in children. In new born and small infants, in children with behavioral disorders and multiple disabilities, the clinical techniques of audiometry are often not useful. The brainstem audiometry is a reliable alternative and not so cost intensive and time consuming as it is often assumed. Encouraging is this technique in regard of hearing aids: prevention of attaching unnecessary hearing aids, ruling out not appropriate fitted hearing aids and proper habilitation of unilateral hearing loss.
Stammering as a frequent speech disorder in infancy results from many causes. For instance, it is possible that a child with normal peripheral hearing may be unable to distinguish sounds by tone and therefore will repeat them incorrectly. A testing method is presented in which paired pictures are used which differ by the phonologic opposition of some stammered sounds. The results of the test in 100 children who stammer are reported. Further investigations give evidence that other perceptual disorders can be found in supposed agnosias.
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Disturbances of voice during pregnancy are not uncommon. Non-inflammatory changes of the larynx (or laryngopathia gravidarum) occur but disappear spontaneously after parturition. Two cases of permanent deep voices in women due to pregnancy have been described in the literature. A similar case of this rare afflication is described in one of our patients. However, review of these cases indicates that such mutations of voice due to pregnancy represent an independent clinical problem which should be differentiated from true laryngopathia gravidarum.
Three months following smallpox vaccination, a child was found to have profound sensory deafness. A medical-legal opinion in 1962 found no relationship between vaccination and deafness. However, when subsequent judgement appeal was made, the legality of the initial decision had to be justified. The consequence of the case, supported by available publication, indicated that a close temporal probability between vaccination and postvaccinial cerebral complication was required to justify any further legal claim. This was not considered to be a factor in the present case since the discovery of a goitre in the patient in association with an iodine dysfunction uncovered a Pendred's syndrome as the cause for the patient's hearing loss.