Intensive Care Society of Ireland

The Union Européen des Médecins Spécialistes (UEMS) has been promoting harmonization of specialist training programs in Europe. Anticipating a future contribution to a European standard for training specialists for tertiary care of children with otorhinolaryngology (ORL)-related problems this Round Table was organized by ESPO. The presentations refer to six European countries. The number of ORL specialists (including pediatric ORL specialists) appeared to vary from +/-8 to +/-1 per 100,000 inhabitants, suggesting significant differences as far as their contribution to health care is concerned. Numbers for pediatricians vary from 12 to 3 and for family doctors from 50 to 100 per 100,000. In two countries pediatric ORL has the status of an official sub-specialty for tertiary care, requiring at least 2 years of additional training for qualified ORL specialists. In three other countries specific centers for pediatric ORL are present, although the sub-specialty has no official status. In the last a center for pediatric otorhinolaryngology has not yet been established and facilities for training in pediatric ORL are not available. For each country various aspects of current practice of tertiary ORL care for children are presented. It is concluded that a European standard for pediatric ORL could be most useful, if it would not only refer to current diagnostic and therapeutic skills but also to relevant scientific knowledge and skills. However, it should be recognized that the relevance of today's standards is restricted, as medicine and medical technology are rapidly developing.

The harmonics-to-noise ratio (HNR) of the voiced speech signal has implicitly been used to infer information regarding the turbulent noise level at the glottis. However, two problems exist for inferring glottal noise attributes from the HNR of the speech wave form: (i) the measure is fundamental frequency (f0) dependent for equal levels of glottal noise, and (ii) any deviation from signal periodicity affects the ratio, not just turbulent noise. An alternative harmonics-to-noise ratio formulation [glottal related HNR (GHNR')] is proposed to overcome the former problem. In GHNR' a mean over the spectral range of interest of the HNRs at specific harmonic/between-harmonic frequencies (expressed in linear scale) is calculated. For the latter issue [(ii)] two spectral tilt measures are shown, using synthesis data, to be sensitive to glottal noise while at the same time being comparatively insensitive to other glottal aperiodicities. The theoretical development predicts that the spectral tilt measures reduce as noise levels increase. A conventional HNR estimator, GHNR' and two spectral tilt measures are applied to a data set of 13 pathological and 12 normal voice samples. One of the tilt measures and GHNR' are shown to provide statistically significant differentiating power over a conventional HNR estimator.

The design of ventilation tubes or grommets is thought to have a considerable influence on their performance. A computational model (finite element method) was used to investigate the significance of four design parameters of a commonly used design of ventilation tube. The design parameters were: the length of the shaft, the diameter of the flanges, the thickness of the flanges, and the material type. A statistical analysis technique, known as a factorial analysis of variance, was used to examine the importance of the four design parameters on the dynamical behaviour of the middle ear with the implant in situ and on the magnitude of stress induced at the implant/tympanic membrane interface. We predicted that the ventilation tube alters the frequency response of the middle ear; specifically the shaft length and the thickness of the flanges were found to have a significant effect upon the vibratory pattern at the umbo. A reduced length of tube and an increased size of flange were also found to be significant for minimising membrane stress (both with P<0.001). Thus, design parameters of critical influence on optimising performance were identified.

Acute mastoiditis, a destructive bacterial infection of the mastoid bone and air cell system, is relatively uncommon today but remains a potentially serious condition. There is a lack of information in the literature regarding the long term otological problems that children may face following an episode of this condition.

International study day on Congenital Diaphragmatic Hernia National Maternity Hospital Holles St