Age-related hearing impairment (ARHI) is a representative geriatric condition. Our estimates of the size of the hearing-impaired elderly population in Japan have yielded a figure of 15 million according to population-based studies. Control of ARHI is one of the most important issues Japan currently faces. The negative impacts of ARHI on the individual or on society as a whole include decreased cognitive function, psychosocial impairments, increased social isolation, need for healthcare, and mortality. The effectiveness of intervention for ARHI, such as hearing aid usage, to prevent the development of dementia or depression is not known. As the elderly age further, the benefits of hearing aids are rarely recognized because of poor speech intelligibility. It is necessary to educate hearing-impaired individuals and the public about hearing training and rehabilitation using hearing aids.
Functional hearing loss (FHL) is a hearing problem without actual pathology, including auditory malingering and psychogenic hearing loss. Because most FHL children are considered to have psychogenic hearing loss, they are in particular need of psychological diagnosis and support. In our department, otolaryngologists and a clinical psychologist perform team treatment for FHL children, attempting treatment from both physical and mental aspects for purposes of research. In this study, earlier literature about psychological clinical features in FHL children was reviewed, and 126 examples were screened from the period from April 2000 to August 2014 and statistically reported. In addition, the FHL children were classified into three groups from the psychological viewpoint -auditory inattention group, repressive conversion group and over-adaptation group- and psychological treatments were discussed using examples.
This study analyzed relationships between collaborative narrative production and metaplay communication in the social play of 6 hearing-impaired children 6 years of age whose average hearing level was 71.6 dB (48.7-92.5 dB, 1 SD 19.4) as compared to that of 6 hearing preschoolers in the 3-4 years age range. The results revealed that the hearing-impaired subjects were more likely than the hearing subjects to delay in collaborative narrative production in which participants share themes and co-construct scenarios foreseeing developments. Collaborative narrative production was influenced more by metaplay communication than by the voice of the character played. The hearing-impaired subjects used metaplay communication less than the hearing subjects, but the mean length of utterance (MLU) in morphemes of metaplay indicated an equivalent level in both subject groups. Hearing-impaired subjects might have difficulty in understanding a panoramic view of a play storyline that changes from moment to moment because they have a problem sharing and communicating play themes. Therefore, metaplay communication of hearing-impaired subjects was inferred to be less advanced than expected from the length of utterance. These results suggest that metaplay communication is important language behavior which can construct narratives using meta cognition related to human behavior.
The aim of this study was to investigate the values of three acoustic parameters (PPQ, APQ and NHR) in 88 normal elementary school children between the 1st and 3rd grades. The procedure called for the children to vocalize sustained phonation of the vowel [a] for 5 seconds, until a constant pitch of voice was achieved; each child underwent 2 trials. Acoustic analysis was carried out using the Multi-Dimensional Voice Program 5105 of Kay Model 4500. The results revealed that the mean PPQ was higher in the 3rd grade children than in the 2nd year children, with the mean APQ significantly lower in the 2nd trial than in the 1st. Comparing these data to those obtained by Nishio et al. (2002) it is clear that there may exist parameters yielding higher or lower values in children than in adults, suggesting that the normal range in adults may differ from that of school children. The results also suggested that APQ values may change in elementary school children depending on learning effect.
We adapted a training method using good verbal memory to 36 primary school children with developmental dyslexia who showed difficulty in acquiring Hiragana/Katakana characters for at least one year. Before training started they manifested normal IQ and good delayed recall ability in the Rey Auditory Verbal Learning Test, and they stated their strong intention to practice the predetermined method. We conducted training according to the following three steps: 1) memorizing the Japanese kana syllabaries only as verbal sounds, 2) writing down the Japanese kana syllabaries, 3) retrieving kana characters with greater speed. Some children were further required to practice decomposing Yo-on. As a result, the children with developmental dyslexia became able to read/spell over 98% within seven weeks, a significant achievement. Also, they maintained their performance level after one year. Concerning fluency, they showed significantly shortened latency of their spelling. We postulate that the training method using good verbal memory was effective for acquiring both reading/spelling accuracy and fluency.
Phonation into a tube, also known as the "resonance tube method," consists of a group of exercises that make use of semi-occlusions of the vocal tract, including lip trills, tongue trills, and humming. These exercises were originally devised to treat velopharyngeal insufficiency, and were found to be useful also for voice training and therapy. The beneficial outcomes of these exercises have been reported for various kinds of voice disorders, and their efficacy has been theoretically proven by computer simulation. On the other hand, most studies on semi-occluded exercises used vocal tract models without adequate practical data. To address this problem, this study employed a stroboscope to visualize the shape of vocal fold vibration during phonation into a tube in patients with vocal fold nodules. Practical observations showed that vocal fold vibration amplitudes increase immediately. This result indicates that the exercises make the voice more efficient, as shown in the computer simulation. Although a larger sample pool and more extensive follow-up would be necessary in order to make a general and definitive conclusion, we positively recommend the resonance tube method for patients with vocal fold nodules because it is easy to access and continue at home.
A tracheostomy during the period of language acquisition is known to interfere with speech and articulation development. If bilabial click sounds are acquired as a substitute for consonants, it is difficult to establish normal articulatory development even when respiratory flow in the vocal tract is regained. In an attempt to prevent substitution with labial clicks and to prepare for normal laryngeal speech, we tested the introduction of electro-laryngeal speech to two prelingual state infants for whom a long-term tracheostomy was expected. Mechanical problems in terms of infantile manipulation exist with electro-larynges made for adults. However, these were overcome by minor modifications of the instrument. In both cases, vowels developed using the electro-larynges and they were naturally replaced by normal laryngeal articulation after respiratory airflow was established by tracheoplasty. Substituting laryngeal phonation by electro-larynx is expected to provide a starting point for articulatory development in infants with long-term tracheostomy.
A 70-year-old male presented with unexpected psychogenic stuttering. He suddenly began to stutter while he was hospitalized with pneumonia. At the initial consultation to our department, the primary symptoms were severe part-word repetitions. However, laryngopharyngeal abnormalities, dysarthria, aphasia and neurologic abnormality were not observed in clinical observations. Additionally, we identified psychological episodes as being responsible for the onset of stuttering. Therefore, as a treatment for stuttering, we employed speech rate control training combined with counseling once every few weeks. As the training proceeded, stuttering frequency gradually decreased and ultimately disappeared three-and-a-half months after the start of treatment. Based on the absence of lesions that could explain the sudden onset of stuttering during brain imaging evaluations, the presence of a psychological episode, and no possibility of other disease, we diagnosed sudden onset psychogenic stuttering.