No abstract

Up to about 40 years ago, the therapy of large tumors of the oral cavity often resulted in severe disfigurement and dysfunctions. Modern resection and reconstruction techniques now enable tumors of this type to be removed in such a way that virtually normal eating and speech functions are restored and traces of the extensive surgery are barely noticeable in many patients. After rehabilitation, most of these patients seem objectively to have a high quality of life, but it is less clear whether their subjective experience is the same. In a three-part empirical study the "limitations of quality of life" (LQL) of 50 patients with large tumors of the oral cavity were investigated at four points of time: preoperatively as well as 1, 4 and 12 months postoperatively. Our self constructed questionnaire for LQL includes 241 questions covering 19 fields of limitation. The results were compared with those of a group of patients after total laryngectomy (n = 34) and a group of patients "without cancer" (n = 40). One year after surgery the limitations of quality of life of patients with large tumors of the oral cavity are still large but seem less so than those of patients after total laryngectomy. However, objectively marginal problems such as a change of body image through a minor disfigurement, slightly indistinct articulation, or a prolonged period of accustomization to dentures are experienced as a severe strain by many patients. The apparent hypersensitivity of many patients to minor discomfort is seen as an effect of the demands made by modern society for fast, subtle adaptive processes. The second part of the study deals with the coping strategies applied by patients, and the third part is focused on a search for variables which could serve as preoperative indicators of the individual ability to bear the burden of illness and therapy.

In the search for the causes of developmental stuttering the findings have constantly proved contradictory. Despite the huge body of knowledge about stuttering its cause is still considered to be unknown; the psychological background is recognized as important, but stuttering is currently regarded as a pure neurological problem. It is generally agreed that therapy should be multidimensional but in fact there is a widespread opinion that the dysfunction has genetic roots. This surprising lack of agreement is blocking the advance of research and the development of therapeutic approaches. In addition, there are serious shortcomings in the currently favored methodology of stuttering research: evidence-based medicine and practice have reduced the amount of high-grade evidence research data to such an extent that much useful information has been lost; the relevance of functional magnetic resonance imaging is controversial, and the hope that one day genetic engineering will correct stuttering-related mutations without severe side effects is unrealistic. A change of approach to research and therapy is required. If this cannot be found on the basis of a generally accepted notion of the cause of stuttering, it must emerge from the search for the best existing therapeutic approach. Conclusion: The present paper offers an evaluation of the basic finding of modern outcome research that the factor of a specific therapeutic approach has less impact on outcome than the common factors, especially the clinician-client relationship. In Speech Language Pathology, and notably in stuttering research and clinical practice, it would be wise to implement this understanding in the form of empathy-based therapies. The requirements for developing the skills for this approach are discussed.

The psychosocial effects of disfigurements and dysfunctions after combined surgical and radio-oncological therapy of patients with large tumors of the oral cavity (n = 50) are investigated in a three-part study. Part 1 compared the "limitations of quality of life" (LQL) of these patients with those of patients after total laryngectomy (n = 34) and with a group of patients "without cancer" (n = 40). This second part records the coping strategies of the three groups of patients and relates them to the following variables: anxiety (STAI), depression (D-S'), despair (H-scale), self-image (GT), locus of control (KKG), intellectual capacity (shortend SPM) and psychosocial burden in early childhood (new questionnaire). The coping strategies of "compliance" and "self-encouragement" were used most often. Patients with a higher psychosocial burden in early childhood often chose defensive strategies (distrust, cognitive avoidance, distraction, reinforced control of emotions). Only few patients used strategies of healthy regression ("coasting values", A. Maslow). It seems that no specific single coping strategy (in particular not the frequently recommended "positive thinking") but an individualized selection of different strategies is of special value to patients. The self-esteem of the patient was identified as a crucial factor in increasing the effectiveness of coping strategies. The surgeon can support patients in their self-esteem by showing a genuine interest not only in their state of health but also in their personal background. The third part of the study is focused on a search for variables which could serve as preoperative indicators of the individual ability to bear the burden of illness and therapy.

Objectives:  To examine the ambiguity tolerance, i.e. the ability to perceive new, contradictory and complex situations as positive challenges, of pre‐lingually deafened adolescents who received a cochlear implant after their eighth birthday and to identify those dimensions of ambiguity tolerance which correlate significantly with specific variables of their oral communication. Design and setting:  Clinical survey at an academic tertiary referral center. Participants and main outcome measures:  A questionnaire concerning communication and subjectively perceived changes compared to the pre‐cochlear implant situation was completed by 13 pre‐lingually deafened patients aged between 13 and 23 years, who received their cochlear implants between the ages of 8 and 17 years. The results were correlated with the ‘Inventory for Measuring Ambiguity Tolerance’. Results:  The patients showed a lower ambiguity tolerance with a total score of 134.5 than the normative group with a score of 143.1. There was a positive correlation between the total score for ambiguity tolerance and the frequency of ‘use of oral speech’, as well as between the subscale ‘ambiguity tolerance towards apparently insoluble problems’ and all five areas of oral communication that were investigated. Comparison of two variables of oral communication, which shows a significant difference pre‐ and postoperatively, yields a positive correlation with the subscale ‘ambiguity tolerance towards the parental image’. Conclusions:  Pre‐lingually deafened juveniles with cochlear implant who increasingly use oral communication seem to regard the limits of a cochlear implant as an interesting challenge rather than an insoluble problem.