Background: Despite significant improvements in functional speech rehabilitation of patients with cleft palate during the past decades, speech-supporting surgery belongs to the standard repertoire of secondary cleft surgery. However, there are few objective comparisons between the various surgical techniques regarding indication, predictability of the functional speech outcome and the real outcome. Methods: From 2006 to 2011, speech-assisted surgery was performed in 40 patients with velopharyngeal insufficiency. These patients had the following diagnoses: 17 unilateral total cleft lip and palate, 10 isolated cleft palate and 13 syndromal submucosal clefts with 22q11 deletion syndrome. Indication and selection of the surgical technique were performed by logopedic-perceptive examination and imaging diagnostics (nasopharyngoscopy, videofluoroscopy) depending on mobility of the lateral pharyngeal walls (velopharyngoplasty [VPP] n = 17, levatorplasty n = 13). Of these 40 patients, 30 patients could be examined at least one year after operation. Out of the 10 non-examined patients six could be contacted and were satisfied, but could not take part in the survey because of time problems and two have moved overseas, so that the negative selection was only two patients (5%). All investigated patients underwent a clinical examination with standardised evaluation of speech function (GOS.SP.ASS according to Sell et al., 1994), a nasopharyngoscopy, a videofluoroscopy and a real-time MRI during speech. Results: In all 30 patients, a significant postoperative improvement of speech could be achieved, with no difference in the extent of improvement regarding the diagnosis (complete cleft lip and palate versus palatal cleft, nonsyndromic versus syndromic cleft) or selected surgical technique (VPP versus LVP). However, it was highly significant that LVP significantly improved the velar mobility compared to VPP. In 10 patients (33.3%), the postoperative result was so good that no further logopedic treatment was necessary. In another 10 patients (33.3%) there was still speech therapy performed but was going to be completed. The last third of the patient was improved, but still in treatment. In three of these patients (10%) after VPP, a secondary correction of the velopharyngeal flap was recommended for further optimisation and in seven patients (23.3%) it was recommended to perform additionally the other speech-assisted surgery. Only in one patient (3.3%) the velopharyngeal insufficiency could not be improved satisfyingly. Conclusion: The presented study shows that exact and interdisciplinary preoperative diagnostics are necessary for an exact analysis of the velopharyngeal problem, for setting up the correct indication and for the selection of the right surgical technique. In this way, a very good improvement could be achieved in almost all cases and even a normalisation of velopharyngeal function in two thirds of the patients. Interestingly, the velopharyngeal problem was found to be so complex in nearly a quarter of the patients that the indication had to be made for a combination of two different speech-assisted surgical techniques.

BACKGROUND:The audiological treatment of children with aural atresia makes high demands on physicians and acousticians. Conventional hearing systems are often not tolerated by children and therefore do not meet the needs of the early and efficient therapy of hearing disorders. Aim of the present study was the evaluation of the audiological functional gain in children with uni- and bilateral aural atresia provided with the middle ear implant Vibrant Soundbridge(®) (VSB(®)) below the age of 6 years as well as the analysis of parents' satisfaction assessed with questionnaires.MATERIAL AND METHODS:The VSB(®) was implanted in 16 children, 13 with unilateral and 3 with bilateral aural atresia, with the mean age of 2;11±1;6 years. 3 months after the first fitting of the audio processor, pure-tone audiometry via free field testing with and without the hearing system was performed. Furthermore, parents completed a standardized questionnaire to evaluate their satisfaction with the VSB(®) treatment quality. The questionnaire included items on the acceptance by children, handling, listening effort, behavior, satisfaction, quality of life, aesthetics, and the length of daily use.RESULTS:The use of the VSB(®) resulted in a significantly improved hearing level: 20 dB on average (Z=- 3.06; p=0.002; n=12). The analysis of parents' questionnaire demonstrated high or very high satisfaction with VSB(®) in all subjects. Primarily, the length of daily use of the VSB(®) was significantly higher than that of the hearing system used before with 10.0±2.1 vs. 2.7±2.2 h per day (Z=- 3.06; p=0.002; n=14).CONCLUSION:The VSB(®) presented a good alternative for audiological treatment of uni- and bilateral aural atresia at toddler and pre-school age.

The audiological treatment of children with aural atresia makes high demands on physicians and acousticians. Conventional hearing systems are often not tolerated by children and therefore do not meet the needs of the early and efficient therapy of hearing disorders. Aim of the present study was the evaluation of the audiological functional gain in children with uni- and bilateral aural atresia provided with the middle ear implant Vibrant Soundbridge(®) (VSB(®)) below the age of 6 years as well as the analysis of parents' satisfaction assessed with questionnaires.The VSB(®) was implanted in 16 children, 13 with unilateral and 3 with bilateral aural atresia, with the mean age of 2;11±1;6 years. 3 months after the first fitting of the audio processor, pure-tone audiometry via free field testing with and without the hearing system was performed. Furthermore, parents completed a standardized questionnaire to evaluate their satisfaction with the VSB(®) treatment quality. The questionnaire included items on the acceptance by children, handling, listening effort, behavior, satisfaction, quality of life, aesthetics, and the length of daily use.The use of the VSB(®) resulted in a significantly improved hearing level: 20 dB on average (Z=- 3.06; p=0.002; n=12). The analysis of parents' questionnaire demonstrated high or very high satisfaction with VSB(®) in all subjects. Primarily, the length of daily use of the VSB(®) was significantly higher than that of the hearing system used before with 10.0±2.1 vs. 2.7±2.2 h per day (Z=- 3.06; p=0.002; n=14).The VSB(®) presented a good alternative for audiological treatment of uni- and bilateral aural atresia at toddler and pre-school age.

Background: Speech supporting surgery (SSS) belong to the standard repertoire of cleft surgery. However, there are few objectives about different surgical techniques with respect to indication, outcome predictability and clinical results.

OBJECTIVE:Accumulation of secretions in hypopharynx, aditus vestibule, and trachea is often found in cases of severe dysphagia and is considered a cardinal trait of high clinical and therapeutic importance. For the graduation of the severity level of accumulated secretions, a short version of the 4-point Murray secretion scale is available, which is also integrated into the protocol of the fiberoptic endoscopic evaluation of swallowing (FEES) according to the Langmore standard. This study aimed at the validation of the German translation of this short version in order to facilitate a uniform, standardized evaluation of the accumulation of secretions in dysphagic patients in the German language area. MATERIAL AND METHODS:For the examination of reliability and validity, a reference standard was defined by 2 dysphagia experts on the basis of 40 video files of the FEES examination, 10 videos for each of the severity grades. Afterwards, these videos were rated independently by 4 raters and re-rated in a new randomized order 2 weeks later. RESULTS:Both the intra-rater reliability (τ>0,830***) and the inter-rater reliability (Kendalls W>0,890***) were highly significant and can be considered good. The same is valid for the correlation of ratings with the reference standard (τ=0,969***). CONCLUSIONS:The German translation of the short version of the 4-point Murray secretion scale is recommendable as a reliable and valid instrument for the graduation of the cardinal trait of oropharyngeal dysphagia and also as an evidence-based instrument for standardized use in the German language area.

Zusammenfassung Hintergrund: Die fiberoptisch endoskopische Evaluation des Schluckvorgangs (FEES) ist, durchgeführt nach Langmore-Protokoll, international als Goldstandard in der apparativen Schluckdiagnostik etabliert. Zur Dokumentation und Qualitätssicherung wird die Videoaufzeichnung der FEES empfohlen. Doch häufig erfolgt dies z. B. bei Bedside-Diagnostik nicht aufgrund eingeschränkter Verfügbarkeit portabler Aufzeichnungssysteme. Ziel der vorgelegten Studie ist daher der Vergleich der Qualitätssicherung einer FEES mit und ohne Videoaufzeichnung anhand der Beurteilung des Kardinalmerkmals einer Schluckstörung, der Penetration bzw. Aspiration, definiert nach der Penetrations-Aspirations-Skala (PAS) nach Rosenbek. Material und Methoden: Anhand von 80 Videosequenzen, beurteilt durch 4 unabhängige Rater in 2 Beurteilungsmodi A) „Echtzeit“, B) „Bild-für-Bild“, erfolgte eine Überprüfung der Übereinstimmung der Penetrations- und Aspirationsgrade mit definiertem Referenzstandard. Ergebnisse: Bei der Intra- und Interrater-Reliabilität zeigten sich höhere Übereinstimmungen im Beurteilungsmodus B als bei A. Auch die Übereinstimmungsvalidität mit dem Referenzstandard zeigte für B deutlich höhere Korrelationswerte als für A, mit jeweils signifikanten Unterschieden zugunsten von B, dem Beurteilungsmodus, der die Auswertung anhand videoaufgezeichneter FEES darstellt. Schlussfolgerung: Die vorliegenden Studienergebnisse unterstreichen die Notwendigkeit der Videoaufzeichnung einer FEES-Diagnostik bei nachgewiesen besserer Beurteilungsreliabilität und -validität, mind. in der Beurteilung der Penetration bzw. Aspiration.

Accumulation of secretions in the hypopharynx, aditus laryngis and trachea constitute a cardinal trait of oropharyngeal dysphagia. For the evaluation of the degree of severity a 4-point secretion scale by Murray et al. is used internationally in a long and a short version. However, a validated German translation of the long version of this scale does not yet exist. Also, it has not yet been scientifically proven that both versions of the scale are equally valid. This study aimed at the validation of the German translation of the long version of the secretion scale by Murray et al. and at a comparison of reliability and validity of the short and long versions. A total of 40 videos of fiberoptic endoscopic evaluation of swallowing (FEESA (R)), 10 for each severity level, were rated by 4 otorhinolaryngologists (ENT specialists) independently and with different randomizations for examination of the reliability and validity. Two rating sessions for each of the scale versions were conducted. Intrarater and interrater reliability as well as the agreement of the ratings with a reference standard were analyzed. Both the intrarater reliability (Spearman correlations: rho s > 0.840***) and the interrater reliability (Krippendorff's alpha: alpha > 0.850) yielded very good results and the concurrent validity was highly significant (rho s > 0.981***). The German translation of the secretion scale by Murray et al. can be considered reliable and valid, with comparable test accuracy of the short and long versions. Hence, the scale can be recommend for the graduation of pharyngolaryngotracheal secretions and should be integrated into the standardized evaluation of FEESA (R) diagnostics for clinical and scientific purposes.

Hintergrund:Sekretansammlungen im Hypopharynx, Aditus laryngis und der Trachea finden sich häufig bei schweren Schluckstörungen und bilden damit ein Kardinalmerkmal von hoher klinischer und therapeutischer Relevanz. Zur Einteilung des Schweregrads akkumulierter Sekrete bietet sich die Verwendung der Kurzversion der 4-Punkte-Sekretbeurteilungsskala nach Murray an, so wie sie im Protokoll für die fiberoptisch endoskopische Evaluation des Schluckvorgangs (FEES) nach Langmore integriert zu finden ist. Ziel dieser Studie war die Validierung der deutschen Übersetzung dieser Kurzversion, um eine einheitliche und standardisierte Bewertung von Sekretansammlungen schluckgestörter Patienten im deutschen Sprachraum zu erreichen. Material und Methoden:Zur Reliabilitäts- und Validitätsüberprüfung wurden von 2 Dysphagieexperten 40 Videosequenzen von FEES-Untersuchungen, 10 pro Schweregrad, als Referenzstandard definiert und von 4 Ratern unabhängig voneinander beurteilt. Ein Re-Rating erfolgte in neuer Randomisierung im Abstand von 2 Wochen. Ergebnisse:Die Intrarater-Reliabilität (τ>0,830***) und die Interrater-Reliabilität (Kendalls W>0,890***) zeigten sich sehr gut und hoch signifikant, wie auch die Korrelation mit dem Referenzstandard (τ=0,969***), sodass auch die Übereinstimmungsvalidität als sehr gut zu werten ist. Schlussfolgerungen:Die deutsche Fassung der Kurzversion der 4-Punkte-Sekretbeurteilungsskala nach Murray ist als reliables und valides Instrument zur Graduierung des Kardinalmerkmals einer oropharyngealen Schluckstörung und auch als evidenzbasiertes Instrument empfehlenswert zur einheitlichen Verwendung im deutschen Sprachraum.

BACKGROUND:The Penetration-Aspiration Scale was developed by Rosenbek et al. to enable standardized documentation of this cardinal symptom of a swallowing disorder. OBJECTIVES:The objective was to create and validate a German version of the Penetration-Aspiration Scale according to the guidelines governing the translation of foreign language measurement tools. MATERIALS AND METHODS:Both reliability and validity were examined based on the ratings of 80 randomized endoscopically evaluated swallows, 10 for each severity level. Ratings were carried out by four independent raters: two with more than 3 years' experience with dysphagia and a further two with less than 3 years' experience. The swallows were rerated after 4 weeks. RESULTS:Both intrarater (Kendall's Tau: τs > 0.643; median 0.773; ps < 0.001) and interrater reliability were highly significant (two-way mixed single ICC coefficient of 0.799 for the first rating session and 0.728 for the second session; ps < 0.001). Results from the raters with less than 3 years' experience were significantly different from the reference standard in three out of four cases, whereas this was not the case for the more experienced raters. However, for each film, the median of the individual ratings from all four raters correlated almost perfectly with the reference standard (first rating session: τ = 0.894; second rating session: τ = 0.843; ps < 0.001). CONCLUSION:The German version of the Penetration-Aspiration Scale according to Rosenbek presented here was demonstrated to be both reliable and valid. Despite its dependency on the raters' experience, it can therefore be used as a graduation instrument for swallowing disorders in German-speaking countries and make an important contribution to evidence-based medicine in dysphagiology for both clinical and scientific use.

Sekretansammlungen im Hypopharynx, Aditus laryngis und Trachea bilden eines der Kardinalmerkmale einer oropharyngealen Schluckstörung. Zur Einschätzung des Schweregrades wird international die 4-Punkte-Sekretbeurteilungsskala nach Murray et al. eingesetzt, existierend in einer Lang- und einer Kurzversion.

Background: A fiberoptic endoscopic evaluation of swallowing (FEES) is well established internationally as gold standard of the instrument-based diagnostics if it is performed according to the Langmore-protocol. For the quality assurance of FEES, videotaping is recommended. However, often no videotaping is carried out due to a limited availability of portable recording systems, for instance, in the bedside diagnostics. This study aimed at the comparison of FEES quality assurance with and without videotaping by rating of the main finding in swallowing disorders, the penetration and aspiration, as defined in the penetration-aspiration scale by Rosenbek.Material and methods: An examination of agreement of penetration and aspiration ratings with the defined reference standard was conducted by means of 80 videotaped recordings. The ratings were carried out independently by 4 raters in 2 settings: A) real time and B) frame-by-frame.Results: As far as the interrater- and intrarater-reliability is concerned, the association between the ratings in the rating setting B were higher than those in the rating setting A. Furthermore, examination of the validity showed higher correlation in setting B than in setting A. The difference between correlations was significant in favor of setting B (videotaped FEES).Conclusion: The results of the present study, namely better rating reliability and validity in case of the penetration and aspiration, emphasize the importance of the videotaping of the FEES diagnostics, at least for the evaluation of penetration or aspiration.

Die Penetrations-Aspirations-Skala wurde von Rosenbek et al. zur standardisierten Dokumentation des Kardinalmerkmals einer Schluckstörung entwickelt.

BACKGROUND:A psychometrically constructed short test as a prerequisite for screening was developed on the basis of a revision of the Marburger Speech Screening to assess speech/language competence among children in Hessen (Germany).PARTICIPANTS AND METHODS:A total of 257 children (age 4.0 to 4.5 years) performed the test battery for speech/language competence; 214 children repeated the test 1 year later.RESULTS:Test scores correlated highly with scores of two competing language screenings (SSV, HASE) and with a combined score from four diagnostic tests of individual speech/language competences (Reynell III, patholinguistic diagnostics in impaired language development, PLAKSS, AWST-R). Validity was demonstrated by three comparisons: (1) Children with German family language had higher scores than children with another language. (2) The 3-month-older children achieved higher scores than younger children. (3) The difference between the children with German family language and those with another language was higher for the 3-month-older than for the younger children.CONCLUSION:The short test assesses the speech/language competence of 4-year-olds quickly, validly, and comprehensively.

Für eine flächendeckende Sprachstandserfassung in Hessen wurde das Kindersprachscreening (KiSS) entwickelt zur Identifikation von Kindern im Kindergartenalter mit sprachpädagogischem Förderbedarf und mit klinischem Abklärungsbedarf.