Hematopoietic cell transplantation (HCT) is a potentially curative treatment for children

and adults with malignant and nonmalignant diseases. Despite increasing survival rates,

long-term morbidity after HCT is substantial. Neurocognitive dysfunction is a serious

cause of morbidity, yet little is known about neurocognitive dysfunction after HCT.

To address this gap, collaborative efforts of the Center for International Blood and

Marrow Transplant Research and the European Society for Blood and Marrow

Transplantation undertook an expert review of neurocognitive dysfunction after

HCT. In this review we define what constitutes neurocognitive dysfunction, characterize

its risk factors and sequelae, describe tools and methods to assess neurocognitive

function in HCT recipients, and discuss possible interventions for HCT patients with

this condition. This review aims to help clinicians understand the scope of this

health-related problem, highlight its impact on well-being of survivors, and help

determine factors that may improve identification of patients at risk for declines

in cognitive functioning after HCT. In particular, we review strategies for preventing

and treating neurocognitive dysfunction in HCT patients. Finally, we highlight the

need for well-designed studies to develop and test interventions aimed at preventing

and improving neurocognitive dysfunction and its sequelae after HCT.

• Total laryngectomy remains an important oncologic and rehabilitative technique.

• Dysphagia may be due to recurrence, diverticulum, stricture, or reduced propulsion.

• Tracheoesophageal speech remains the optimal rehabilitation for alaryngeal voice.

• TEP considerations include timing and pharyngoesophageal spasm prevention.

• Future research efforts will need to focus on dynamic laryngeal reconstruction.

Because management of hearing loss (HL) often requires multiple specialists,

a multidisciplinary clinic, Pediatric Hearing Management Clinic, (PHMC) was

established to coordinate care for children with newly diagnosed HL.

Retrospective review of patients seen in PHMC from February 2009 to April 2010.

Clinic information was available for 40/41 of the patients and was included in

the study. 37/41 had confirmed HL. HL was categorized into bilateral/symmetric

[15], bilateral/asymmetric [12] and unilateral [10]. Sixteen patients subsequently

received hearing amplification after PHMC visit. Follow up was successfully

established with otolaryngology in 23/32 (72%) patients, audiology in

29/40 (73%) patients, speech pathology in 11/12 (92%) patients, and

ophthalmology in 15/30 (50%) patients. Twenty-nine patients completed

evaluations of PHMC. The mean score in six total categories was 3.8/4.0

(4.0 as the highest satisfaction).

A multidisciplinary clinic approach provides a convenient and effective way

to coordinate care for children with HL.

Interest in a variety of neoplastic, functional, neurological, and age-related laryngeal

disorders has contributed to the development of laryngology as an established

subspecialty. Funding support plays a critical role in facilitating scholarship within

the field. Our objectives were to evaluate who is receiving funding from the NIH

for topics relevant to voice disorders, and further describe temporal trends in grants

awarded.

The NIH RePORTER database was searched for grants relevant to voice disorders.

Data were further organized by PI specialty, academic department, and funding totals.

Furthermore, PI scholarly impact, as measured by the h-index , was calculated.

A total of 830 funded fiscal years (for 232 unique projects) totaling $203 million have

supported projects examining voice disorders. A plurality of projects (32.8%) was

awarded to PIs in otolaryngology departments, followed by 17.2% to speech

pathology/communication sciences departments. Although year-to-year variation was

noted, otolaryngology departments received approximately 15% of funding annually.

Funded otolaryngologists had similar scholarly impact values to individuals in other

specialties.

The study of voice disorders involves an interdisciplinary approach, as PIs in numerous

specialties receive NIH funding support. As they receive a considerable proportion

of this funding and had similar h-indices compared to other specialties involved,

otolaryngologists have just as much scholarly impact despite being a smaller

specialty. As speech and language pathologists also comprised a significant

proportion of individuals in this analysis, enhanced cooperation and

encouragement of interdisciplinary scholarly initiatives may be beneficial.

Preservation of residual hearing in cochlear implantation is a main concern for

patients and otologists. New electrode arrays as well as development of minimally

invasive technique have allowed the expansion of indication criteria for cochlear

implantation. The loss of residual low-frequency hearing is thought to be the

result of many factors. Opinions differ in regards with the electrodes array

characteristics, the surgical implantation technique and the pharmacological

therapy used.

The aim of this research is to analyze the available information pertaining

to hearing preservation with cochlear implantation.

Both cochleostomy and round window approaches are adequate, but should rely

on the anatomic position of the round window membrane. No electrode design had

a higher rate of hearing preservation, either a standard or shorter length was used,

or a straight or contoured array. The speed of insertion has a significant impact

on hearing preservation and vestibular function. A slow insertion should be

used for all cochlear implant insertion, hearing preservation or not. However,

the optimal speed of insertion is still unclear. Moreover, the use of steroids

regardless of the route or the timing, along with intraoperative topical

steroids, had a positive impact on hearing preservation.

Classic atraumatic insertion maneuvers, very slow and delicate insertion and

the use of intraoperative corticosteroids improve hearing outcomes. Whichever

the surgeon's preferences, all surgical modifications are aimed at the same goal:

protection of the delicate intracochlear structures with preservation of residual

low-frequency hearing to improve speech perception abilities.

Children and adolescents with obstructive sleep apnea (OSA) may have consequences,

such as daytime sleepiness and learning, memory, and attention disorders, that may

interfere in oral language.

To verify, based on the literature, whether OSA in children was correlated to oral language

disorders.

A literature review was carried out in the Lilacs, PubMed, Scopus, and Web of Science

databases using the descriptors “Child Language” AND “Obstructive Sleep Apnea”.

Articles that did not discuss the topic and included children with other comorbidities

rather than OSA were excluded.

In total, no articles were found at Lilacs, 37 at PubMed, 47 at Scopus, and 38 at Web

of Science databases. Based on the inclusion and exclusion criteria, six studies were

selected, all published from 2004 to 2014. Four articles demonstrated an association

between primary snoring/OSA and receptive language and four articles showed

an association with expressive language. It is noteworthy that the articles used

different tools and considered different levels of language.

The late diagnosis and treatment of obstructive sleep apnea is associated with a delay

in verbal skill acquisition. The professionals who work with children should be alert,

as most of the phonetic sounds are acquired during ages 3–7 years, which is also

the peak age for hypertrophy of the tonsils and childhood OSA.

Auditory verbal therapy (AVT) is one of the primary treatment approaches for developing

spoken language in children with hearing impairment (HI), but its outcomes have not been

thoroughly investigated. The current study aimed to systematically review past studies

investigating AVT outcomes in children with HI.

A systematic search was conducted in six databases. Fourteen articles that met the final

inclusion criteria were grouped under three categories based on the outcome

measures: receptive and expressive language development, auditory/speech perception

and mainstreaming.

Articles under “receptive and expressive language development” category indicated AVT

can even help children with HI beyond three years of age to develop age appropriate

language skills and catch up with their hearing peers. Articles under “auditory /speech

perception” category suggested that children receiving AVT can learn to recognize

words accurately even in the presence of background noise. Articles grouped

under “mainstreaming” category indicated that children receiving AVT can be

successfully mainstreamed.

Although studies suggest that AVT can have a positive impact on developing speech

and language skills in children with HI, it is difficult to generalize these findings due

to limited evidence. Future studies should utilize well-controlled group designs to minimize

the role of external variables as well as strengthen the evidence-base for AVT.

The impact of aging is as inevitable in the larynx as on all biologic systems.

The muscles of larynx have the potential to atrophy, the elastin fibers of

lamina propria thin with age, and mucous production diminishes. As a result,

vocal folds fail to approximate appropriately and the stress on once-robust vocal

folds increases. These changes present as poor voice quality, vocal tension,

tremor, and altered fundamental frequency. Rather than consider presbyphonia

as an immutable diagnosis, we must see it as an opportunity to elevate our

standard of care and set goals to work for therapeutic improvement of voice quality.

• In the elderly, a decline of the voice can lead to introversion and social

withdrawal. To compound communication difficulties, many peers of the

elderly suffer from age-related sensorineural hearing loss.

• Numerous quality-of-life studies have demonstrated and confirmed how

diminished and impaired vocal function causes a rapid deterioration of quality

of life in the elderly.

• Stroboscopy is an ideal diagnostic tool for evaluting the dysphonic elderly

patient and visualize subtleties in glottic insufficiency and decreased

mucosal wave, which hallmark findings in presbyphonia.

• Voice therapy, as well as surgical interventions centered on improving glottic

insufficiency, can help to improve voice quality in patients with presbyphonia.

Age-related hearing loss is a multifactorial condition that affects more than

one-third of the aging population. Left untreated it can increase the risk of

cognitive decline, dementia, social isolation, depression, and falls. Hearing

augmentation devices exhibit improved digital sound processing and Smartphone

connectivity. Stigma remains one of the prominent barriers and todays devices offer

in the canal models, miniature sizes, and camouflage with the hair or skin color.

Although rigorous scientific efforts are made in the research field of inner ear

regeneration and some clinical early phase studies do exist, to date, the clinical

availability is still some time away.

• Age-related hearing loss is a multifactorial condition that effects a major part

of the aging population.

• Left untreated, age-related hearing loss can lead to higher risks of

cognitive decline, dementia, social isolation, depression, and falls.

• Stigma remains a prominent barriers, so today’s devices offer in-the-canal

models, miniature size, and camouflage with hair or skin color.

• The mobile era has enabled self-screening, self-fitting, and t

ele-rehabilitation, and continues to produce other innovations that will

potentially improve accessibility.

• Although rigorous scientific efforts have been made in research on

inner ear regeneration and some early phase studies exist, the clinical implication

remains to be seen.

Research has reported the difference in a woman's voice across the different

stages of the menstrual cycle. A review of the studies in singers on the influence

of menstruation on the singing voice will enable a better understanding of these

changes.

A systematic literature search was carried out on PubMed, CINAHL,

Scopus, Cochrane, and regional electronic databases. The keywords

“menstrual cycle,” “voice change,” and “singer” were used in different

combinations. Only those articles that discussed the effect of menstrual

cycle on the singing voice were included in the final review.

Six studies in the English language were identified and included in the

review. Hormonal variations occur to a great extent during menstrual cycle,

and these variations can influence the voice of singers. A great variability

was found in the included studies. There are limited studies that have

been carried out exploring the relationship between menstrual cycle and the

singing voice.

Even though the studies included in the review point out toward the

changes in the singing voice associated with menstrual cycle, there is

a need for more studies to be carried out in diverse singing populations and

in different outcome measures.

Electrophysiologic hearing tests have been developed since the 1960s to determine

hearing thresholds objectively. They are now implemented in newborn

hearing screening. While they determine thresholds, interpretation requires

subjective pure-tone and speech audiometry to determine the type of hearing

loss. Each examination tests a different anatomic region, enabling the auditory

system to be explored from the organ of Corti to the auditory cortex.

Thus, the various objective audiometric examinations are complementary.