青少年恒前牙外伤的临床观察

目的 探讨青少年恒前牙外伤的原因、临床特点，更好地指导青少年恒牙保健。方法对1995～2006年间在本科就诊的128例儿童恒前牙外伤患者的临床资料进行回顾性调查，分析其外伤类型、外伤原因、受伤方式、伤牙数目、外伤后就诊时间等。在此基础上总结其发病规律。结果 8～10岁受伤人数最多，男女比例1．98：1，在各种类型的外伤中，以冠折为最多见；外伤后多在2小时以上，24小时以内就诊。结论 应加强青少年保健知识的普及，防止恒牙外伤的发生。一旦发生牙外伤，应及早治疗。     

Observations on the ability of the nose to warm and humidify inspired air

The major function of the nose is to warm and humidify air before it reaches to the lungs for gas exchange. Conditioning of inspired air is achieved through evaporation of water from the epithelial surface. The continuous need to condition air leads to a hyperosmolar environment on the surface of the epithelium. As ventilation increases, the hyperosmolar surface moves more distally, covering a larger surface area of the airway, and stimulates epithelial cells to release mediators that lead to inflammation. This inflammation is not identical to allergic inflammation, but causes both short-term and long-term changes in the epithelium. In the short-term, it increases paracellular water transport in an attempt to enhance conditioning, and it stimulates sensory nerves to initiate neural reflexes. It also disrupts channels in the cellular membrane, which might permit greater penetration of foreign proteins, such as allergens, leading to further inflammatory cascades. The long-term inflammation induced over time by the hyperosmolar milieu could worsen the ability of the nose to condition air, requiring more of the conditioning to occur in the lower airway and leading to adverse consequences for the respiratory system.     

Comparison of the mechanical performance of ossiculoplasty using a prosthetic malleus-to-stapes head with a tympanic membrane-to-stapes head assembly in a human cadaveric middle ear model.

HYPOTHESIS: Ossiculoplasty using prosthetic reconstruction with a malleus assembly to the stapes head will result in better transmission of vibrations from the eardrum to the stapes footplate than reconstruction with a tympanic membrane assembly to the stapes head. Both types of reconstruction will be affected by tension of the prosthesis. BACKGROUND: Theories (and some clinical studies) that the shape of the normal tympanic membrane is important suggest that prosthetic reconstruction to the malleus performs better than reconstruction to the tympanic membrane. This has not been previously tested by directly measuring vibration responses in the human ear. Our previous work suggests that tympanic membrane assembly to the stapes head type prostheses performed best under low tension. This had not been previously tested for malleus assembly to the stapes head type prostheses. METHODS: Hydroxyapatite prostheses were used to reconstruct a missing incus defect in a fresh cadaveric human ear model. Two types of prostheses were used, one from the stapes head to the malleus (malleus assembly to the stapes head), the other from the stapes head to the tympanic membrane (tympanic membrane assembly to the stapes head). Stapes footplate center responses were measured using a laser Doppler vibrometer in response to calibrated acoustic frequency sweeps. RESULTS: Tension had a very significant effect on both types of prostheses in the lower frequencies. Loose tension was best overall. The malleus assembly to the stapes head type prostheses consistently performed better than the tympanic membrane assembly to the stapes head type prostheses when stratified for tension. CONCLUSION: Tension has a significant effect on prosthesis function. Malleus assembly to the stapes head type prostheses generally result in better transmission of vibrations to the stapes footplate than tympanic membrane assembly to the stapes head type prostheses.     

Speaking clearly for the hard of hearing. III: An attempt to determine the contribution of speaking rate to differences in intelligibility between clear and conversational speech

Previous studies (Picheny, Durlach, & Braida, 1985, 1986) have demonstrated that substantial intelligibility differences exist for hearing-impaired listeners for speech spoken clearly compared to speech spoken conversationally. This paper presents the results of a probe experiment intended to determine the contribution of speaking rate to the intelligibility differences. Clear sentences were processed to have the durational properties of conversational speech, and conversational sentences were processed to have the durational properties of clear speech. Intelligibility testing with hearing-impaired listeners revealed both sets of materials to be degraded after processing. However, the degradation could not be attributable to processing artifacts because reprocessing the materials to restore their original durations produced intelligibility scores close to those observed for the unprocessed materials. We conclude that the simple processing to alter the relative durations of the speech materials was not adequate to assess the contribution of speaking rate to the intelligibility differences; further studies are proposed to address this question.     

Pain reduction by fibrin sealant in older children and adult tonsillectomy

OBJECTIVES: Because tonsillectomy is a painful procedure in adults, this study was performed to see whether the addition of fibrin sealant (Tisseel) to the tonsillar fossa at the completion of tonsillectomy would reduce pain in adults and allow them to return to work sooner. STUDY DESIGN: Forty adult patients over the age of 12 were entered into a prospective randomized study to see whether the addition of fibrin sealant (Tisseel) to the tonsillar fossa at the completion of tonsillectomy for recurrent tonsillitis would reduce the time the patient needed to take narcotic analgesics after surgery. METHODS: Fifteen adults had a traditional complete tonsillectomy by means of a needle point Bovie and served as a control group. Twenty-five (adults had the same procedure with the addition of Tisseel to see how long they required narcotic analgesics postoperatively and when they were able to resume normal activities. RESULTS: The control group took narcotics for an average of 10.3 days, whereas the addition of Tisseel reduced the time to 8.16 days (P = .0058). This significant reduction of time allowed adults to return to work and other activities sooner. CONCLUSION: Because the time required to return to work is often of paramount interest to patients having surgery, Tisseel should be considered a safe addition to older children and adult tonsillectomy in patients who are not allergic to bovine products because it will allow an earlier return to normal activities.     

Use and misuse of norm-referenced tests in clinical assessment: a hypothetical case

The purposes of this paper are to discuss concepts that are fundamental to proper use of norm-referenced tests in clinical assessment, to consider common errors in the use of such tests, and to suggest alternatives to norm-referenced testing for certain assessment purposes. A hypothetical client is used to illustrate the following errors: the use of age-equivalent scores as the sole summary of test results, the use of individual items to formulate therapy objectives, and the failure to consider the possible effects of measurement error when difference scores are used to assess progress or to examine patterns of impairment.     

Children with cerebral palsy and the need for speech therapy

This paper is an attempt to bring up to date the importance of speech therapy as regards the help given to cerebral palsy. While recognising the importance of physiotherapy, it tries to show that a new approach to the language problems of the physically handicapped child, enables one to have a greater understanding and therefore to respond better to the needs of the cerebral palsy.     

Reconstructive laryngectomy

Reconstructive laryngectomy, the aim of which is to leave the patient without a tracheostoma, thus preserving the normal pneumophonic function relative to vocal articulation, is a link between the various techniques suggested for conservative laryngeal surgery and classic total laryngectomy. The aim of this technique is to restore continuity to the airways, so that the patient is able to breathe naturally and subsequently can speak without having to resort to the use of esophageal voice.     

A registry for the collection of data in cochlear implant patients

The need to optimize the use of all the information that modern technological tools have made available to the physician ENT/audiologist has increasingly emerged within the Italian scientific community. Towards this purpose, it is necessary to create a registry of the patients using cochlear implants (CIs). This registry will include a homogeneous summary of the information deriving from multiple sources related to daily clinical practice, in order to assess auditory benefits, safety and reliability in patients with cochlear implants, and organization over the national territory. The primary objectives relative to the above-mentioned analysis are to assess the impact of the use of cochlear implants on patient health, to ensure traceability of the devices currently used, monitoring their safety and reliability over time, to guarantee access of the technique in clinical and organizational conditions that can allow the best possible benefits. The aspects concerning implementation of the registry were discussed extensively during the first meetings of the Working Group (WG). In particular, owing to the complexity and high costs related mainly to the development of the technological aspects and the need to involve technological partners external to the WG, and to respect current privacy laws, the WG members decided that the project should be limited to proposal of a paper registry to be implemented at a later stage, possibly within the framework of successive research projects. During meetings, the WG members discussed various aspects of implementation of the registry, and in particular the scientific features connected to objectives, inclusion criteria, and structure of the forms needed for data collection and organizational aspects. A registry is proposed herein.     

Evaluation of binaural functions in bilateral cochlear implant users

Binaural abilities are difficult to assess, yet important to understand, in the course of rehabilitating bilateral cochlear implantees. One purpose of this research was to develop a binaural assessment methodology using direct electrical input to the cochlear implant, ‘‘direct connect assessment’’, pre-processed by appropriate headrelated transfer functions (HRTFs) to simulate the binaural cues for spatial release from masking and sound localization. A second purpose was to create and evaluate new, modified rules for adaptively measuring the speech reception threshold in noise with the Hearing In Noise Test (HINT) for use with cochlear implant subjects. A third purpose was to develop a new sound localization protocol whose difficulty is adjusted to the sound localization ability of the individual cochlear implant subject. These new protocols were combined with the direct connect method and evaluated in acoustic hearing subjects and cochlear implant subjects. HINT thresholds and sound localization scores measured in the sound field and with the direct connect method did not differ significantly and were highly correlated in both groups. Measures of spatial release from masking, head shadow effects, binaural squelch, and binaural summation derived from the thresholds also were comparable for both methods. The alternative adaptive rules for HINT were found to measure different points on the same performance-intensity function. These rules allowed all cochlear implant subjects in the study to be tested adaptively and their thresholds to be compared to norms. Sound localization was measured successfully in all subjects with a sector localization protocol whose difficulty is to be adjusted to the localization ability of the subject. This protocol reduced by one-third to one-half the time required to complete the assessment of the localization ability.     

The latency of auditory nerve brainstem evoked responses to air- and bone-conducted stimuli

The auditory nerve brainstem evoked responses (ABRs) to bone conduction (BC) stimuli are longer in latency than those to air conduction (AC). In order to study the mechanism of this difference, ABR wave I was recorded in experimental animals in response to low intensity (0–20 dB above their threshold) logon stimuli delivered by BC and by using the same bone vibrator to generate the air-conducted stimulus. The BC stimuli were delivered to skull bone, and directly to the contents of the cranial cavity (brain and cerebrospinal fluid) through a craniotomy. ABR wave I in response to BC stimuli delivered to skull bone was significantly longer in latency than that to BC delivered on the brain, while there was no latency difference between AC stimuli and BC to the brain. Furthermore, the vibration (measured with an accelerometer) recorded on the brain during BC stimulation of skull bone was always delayed compared to that measured on the skull. Thus there is a delay in the transfer of vibratory energy from the skull bone to the underlying contents of the cranial cavity. From there, the delayed vibrations of the contents of the cranial cavity are transmitted to the inner ear. This is probably the mechanism of the longer latency BC response compared to the AC response.     

Nasopharyngeal electrodes in auditory evoked response research

Auditory evoked responses recorded from central scalp electrodes referred to both ear and nasopharyngeal electrodes, were compared to those recorded from the commonly employed vertex to ear derivation. Consistent responses were recorded from both the central to ear and central to nasopharyngeal combinations which were morphologically quite similar to those from the vertex to ear combination. Minimal responses of prolonged latency were seen in ear to nasopharyngeal derivations.     

A miniature accelerometer for detecting glottal waveforms and nasalization.

A lightweight accelerometer has been used to obtain a waveform related to the glottal acoustic output when attached to the neck of a speaker, and to provide an indication of acoustic coupling to the nasal cavities when attached to the external surface of the nose. Examples of signals produced by the accelerometer are shown, and possible clinical applications are discussed.     

The decision-making process in child language assessment

The task of assessing a child's language for the purpose of intervention requires the ability to interpret information from a variety of sources. Knowing how that information is to be used during therapy plays an important part in deciding what type of information needs to be collected and how it will be interpreted. There needs to be a plan that will assist the speech therapist in analysing and interpreting most of the data that would be needed when making therapy-related diagnostic statements. A systems approach offers concepts and methods for devising a plan which will outline the necessary decisions. The purpose of this paper is to present, in a flow chart, the questions that need to be asked in the process of assessing a child's language development for the purpose of intervention; to indicate the type of information that would be needed to answer the questions; to state how the information would be interpreted; to suggest the type of tools that would be needed to collect this information; and to outline how the information can be presented so that a greater quantity of data can be summarised and interpreted in a systematic manner.     

Flow kinetics of the endolymph in caloric stimulation

From our experiment in fluid mechanics there is strong evidence that caloric nystagmus is caused by streaming endolymph in weightlessness as well as by gravity. Two different mechanisms are postulated: thermoconvection (dependent on gravity and head position) and thermo-induced change in volume (independent of those two factors). Our results indicate that tangential endolymph flow in the ampulla directed from crista to cupula leads to a nystagmus towards the examined ear, whereas the adverse flow leads to a nystagmus to the other side. Depending on the head position the flow due to thermoconvection is increased or decreased by the flow due to extension. In mathematical approaches we found the flow due to the thermoconvection to be somewhat higher than that due to fluid extension, but still in the range of micron/s.     

Improving the quality of head and neck cancer care

The 2001 report by the Institute of Medicine (IOM) titled Crossing the Quality Chasm: A New Health System for the 21st Century highlighted the gap that exists between what we know to be effective, beneficial care and the care that is often delivered to an individual patient.(1) In the report, the IOM stated, "Between the health care we have and the care we could have lies not just a gap, but a chasm."(1)((p1)) The report, signifying a national initiative to improve the quality of care in the United States, articulated the following 6 aims for a new health care system: (1) to increase the safety of health care by avoiding injuries to patients through care intended to help them; (2) to provide effective services based on scientific knowledge and to avoid services of no proven benefit; (3) to deliver individualized treatment respectful of and responsive to the patient's preferences, needs, and values; (4) to deliver timely care by reducing wait times and harmful delays; (5) to increase efficiency by not wasting equipment, supplies, ideas, and energy; and (6) to deliver care that is equitable and does not vary by personal characteristics, patient sex, ethnicity, geography, and social economic status. The IOM also recognized a need to optimize quality cancer care in the United States.     

A multipurpose landmark for skull-base surgery: Henle's spine

OBJECTIVE: To determine whether Henle's spine could be used as a reliable and multipurpose landmark for the other important structures of the skull base. MATERIALS AND METHODS: Ninety-two specimens from 46 cadaveric adult dry skulls were studied. Two imaginary lines and a triangle were defined: a spinopterygoidal line extending from Henle's spine to the root of the medial pterygoid plate, a bispinal line extending from one Henle's spine to the contralateral one, and a parapetrosal triangle lying between the spinopterygoidal line, the bispinal line and the sagittal midline. The parapetrosal triangle encompasses nearly all the main structures of the skull base, including the petrosal internal carotid artery. RESULTS: Along the spinopterygoidal line the distance from Henle's spine to the spine of the sphenoid was found to be about 3 cm, to the foramen spinosum 3.5 cm, to the posterior and anterior margins of the foramen ovale 4 and 4.5 cm, to the root of the lateral pterygoid plate 5 cm, to the root of the medial pterygoid plate 5.5 cm, and to the vomer 6.5-7 cm. Along the bispinal line, the distance from Henle's spine to the stylomastoid foramen was found to be about 1.5 cm, to the lateral and medial margins of the jugular foramen 2.5 and 3.5 cm, to the external orifice of the hypoglossal canal 4 cm, and to the foramen magnum 5 cm. CONCLUSION: Henle's spine with its superficial and central position can be used to localize important anatomical structures during skull-base surgery.     

Akute Komplikationen in der Mittelohrchirurgie

Due to the unusual anatomical situation in the middle ear, there are a variety of possible complications that may occur during tympanoplasty. Dislocation of the ossicular chain with and without opening of the labyrinth, injuries to the facial nerve and hemorrhage from large arteries and veins may occur. Adequate management of these complications is necessary in order to avoid further damage for the patient. The first question in case of an acute complication is always whether it is possible to stop the operation. It is also important to determine the time to react, e.g. if an injury of the facial nerve is assumed, when a revision needs to be performed. It also should be considered to refer the patient to a colleague who is not as emotionally involved in the case as the primary surgeon.     

Effect of click spectrum and polarity on round window N1N2 response in the rat

The effect of the duration of click stimuli on the compound action potential recorded from the round window in the rat and the effect of low-pass filtering of short click sounds were studied. Thus the intensity functions of the round window N1 potential have a two-segment course and there is a difference in the response to rarefaction and condensation clicks, depending upon the content of low-frequency components in the click stimulus. The intensity function of the rat's response to broadband clicks does not show the same two-segment course as has been reported in experiments in other animals, and there is little difference between the response to condensation clicks and that to rarefaction clicks in this animal. However, when the duration of the click is increased or when broadband clicks are subjected to low-pass filtering, the intensity functions in response to condensation clicks do show a change in course, while the response to rarefaction clicks remains essentially unchanged. A similar change in the response to a broadband click can be induced by adding a low-pass-filtered click to the broadband click. The response to such a combination is not only a linear summation of the neural response to the individual components of the stimuli and the cochlear microphonics, but the low-frequency components that are added also affect the response to the broadband click, mainly by reducing the amplitude of the response.     

The dynamics of the spoken language and parental guidance

The aim of parental guidance of deaf children is to allow the parents to understand and adapt to the unusual language development of their child. The authors propose a system of explanation of the control of language which will lead to the development of confidence, relaxation and spontaneity--the three determining factors--as well as to enlightenment; it will act as a point of reference during their introduction to the physiology of language, and as a guideline for the attitude of rehabilitation which needs to be adopted.