A trajectory, we know, is the path followed by an object moving under the action of certain force... more A trajectory, we know, is the path followed by an object moving under the action of certain forces. Our questions are: What are the forces governing the trajectory of Pediatric Otolaryngology? And how will they determine our care of patients?
Objectives: To determine the economic effect on the US economy of the cost of caring for people w... more Objectives: To determine the economic effect on the US economy of the cost of caring for people with communication disorders as well as the cost of lost or degraded employment opportunities for people with such disorders, including disorders of hearing, voice, speech, and language. Study Design: Survey of available historical and contemporary governmental and scholarly data concerning work force distribution and the epidemiology of disorders of hearing, voice, speech, and language. Method: Analysis of epidemiological and economic data for industrialized countries, North America, and the United States. Results: Communication disorders are estimated to have a prevalence of 5% to 10%. People with communication disorders may be more economically disadvantaged than those with less severe disabilities. The data suggest that people with severe speech disabilities are more often found to be unemployed or in a lower economic class than people with hearing loss or other disabilities. Communication disorders may cost the United States from $154 billion to $186 billion per year, which is equal to 2.5% to 3% of the Gross National Product. Conclusions: Communication disorders reduce the economic output of the United States, whose economy has become dependent on communication-based employment. This trend will increase during the next century. The economic cost and the prevalence rates of communication disorders in the United States indicate that they will be a major public health challenge for the 21st century.
OBJECTIVE: To determine the applicability and external validity of randomized control studies (RC... more OBJECTIVE: To determine the applicability and external validity of randomized control studies (RCTs) in the light of patient susceptibilities and vulnerabilities to the sequelae of otitis media with effusion (OME) and tonsillar pharyngitis (T&A) and the composition of their cohorts. STUDY DESIGN: RCTs for OME and T&A were analyzed to determine which intrinsic and extrinsic susceptibilities to the oto-laryngic disease and its sequelae were included or excluded and the composition of the cohort. METHODS: A Medline and a Science Direct search were performed for all RCTs concerning OME and T&A through 2007. The articles selected to be included in this study are the OME RCTs that reported language and/or hearing outcomes and the T&A RCT studies in which the outcome measure was infection, alleviation of airway obstruction, and/or quality of life. These were analyzed for their inclusion or exclusion of intrinsic and extrinsic susceptibilities to the otolaryngic disease and their sequelae and the composition of the cohort. The pertinent otolaryngologic literature was assessed to determine applicable risk factors. RESULTS: The analysis of the inclusion or exclusion of risk factors showed that for OME 0 percent were included and 16 percent were excluded, and there were no data for 84 percent. The T&A findings were similar in that 1 percent of risk factors were included, 8 percent excluded, and there were no data for 92 percent. Both the OME and the T&A cohorts data were similar in that approximately half of the suitable candidates completed the study; 25 percent of the OME and 13 percent of the T&A enrolled subjects were either withdrawn or placed into a different experimental group. On the average, with data available, it took 4.6 years to recruit the OME sample and 5.5 years to recruit the T&A sample. CONCLUSION: The results of RCTs for these conditions are only applicable to narrowly defined and highly circumscribed populations. They cannot be generalized to the entire patient population because of their limited external validity. Future RCT protocols should be designed to control for the intrinsic and ex-trinsic susceptibilities that result in a propensity to acquire the disease and/or an exacerbation of the disease's sequelae. These studies would determine the most effective strategies for preventing disorders and/or their deleterious sequelae.
A defining characteristic of the human being is our highly developed linguistic communication sys... more A defining characteristic of the human being is our highly developed linguistic communication system. Communication -of which language is a major mode for human beings -is today more than any other time in history, paramount for the optimal survival of the individual . This is manifest not only in social interactions and psychological fitness but, critically, in economic productivity. A century ago most made their livings through manual labor, and an individual's economic survival was, in the main, not dependent on good communication skills. Today, over 90% of all employment in the developed nations is based upon communication abilities [3], which has made all the more important the linguistic competence of each individual. And we know that developing countries are on the same trajectory of converting from manual to communication societies, like the currently developed nations.
The development of the inner ear of vertebrates has been examined in various ways. During the 19t... more The development of the inner ear of vertebrates has been examined in various ways. During the 19th and early 20th centuries Boettcher ( 8 ) . Retzius (41), Held (21) and others studied the morphological developn~ent of the membranous labyrinth. hIore recently, Bast and Anson (5) have made major contributions to the understanding of the morphological development' of the ear. There have been two detailed morphological studies on the development of the inner ear of the rodent (57, 58). All of these studies have demonstrated that cytological differentiation appears first at the base of the cochlea and proceeds to the apex over several days.
OBJECTIVE: To determine the applicability and external validity of randomized control studies (RC... more OBJECTIVE: To determine the applicability and external validity of randomized control studies (RCTs) in the light of patient susceptibilities and vulnerabilities to the sequelae of otitis media with effusion (OME) and tonsillar pharyngitis (T&A) and the composition of their cohorts. STUDY DESIGN: RCTs for OME and T&A were analyzed to determine which intrinsic and extrinsic susceptibilities to the oto-laryngic disease and its sequelae were included or excluded and the composition of the cohort. METHODS: A Medline and a Science Direct search were performed for all RCTs concerning OME and T&A through 2007. The articles selected to be included in this study are the OME RCTs that reported language and/or hearing outcomes and the T&A RCT studies in which the outcome measure was infection, alleviation of airway obstruction, and/or quality of life. These were analyzed for their inclusion or exclusion of intrinsic and extrinsic susceptibilities to the otolaryngic disease and their sequelae and the composition of the cohort. The pertinent otolaryngologic literature was assessed to determine applicable risk factors. RESULTS: The analysis of the inclusion or exclusion of risk factors showed that for OME 0 percent were included and 16 percent were excluded, and there were no data for 84 percent. The T&A findings were similar in that 1 percent of risk factors were included, 8 percent excluded, and there were no data for 92 percent. Both the OME and the T&A cohorts data were similar in that approximately half of the suitable candidates completed the study; 25 percent of the OME and 13 percent of the T&A enrolled subjects were either withdrawn or placed into a different experimental group. On the average, with data available, it took 4.6 years to recruit the OME sample and 5.5 years to recruit the T&A sample. CONCLUSION: The results of RCTs for these conditions are only applicable to narrowly defined and highly circumscribed populations. They cannot be generalized to the entire patient population because of their limited external validity. Future RCT protocols should be designed to control for the intrinsic and ex-trinsic susceptibilities that result in a propensity to acquire the disease and/or an exacerbation of the disease's sequelae. These studies would determine the most effective strategies for preventing disorders and/or their deleterious sequelae.
The relationship among otitis media, auditory sensitivity, and emerging language was examined in ... more The relationship among otitis media, auditory sensitivity, and emerging language was examined in a group of 1-year-old children who were prospectively followed since birth. Pneumatic otoscopy was used to document the otologic status of the children's ears at each medical visit. There were 13 babies with normal ratings in each ear at 80% more of their visits (designated as "otitis free") and 12 babies with bilaterally positive otoscopy results at 30% or more of their first year visits (designated "otitis positive"). In comparison to the otitis free infants, the group of otitis positive babies demonstrated reduced auditory sensitivity as measured by auditory brain stem response (ABR) and poorer expressive language abilities. However, differences in receptive language were not detected. These results suggest that otitis media may have an impact on auditory sensitivity and developing language as early as 1 year of age.
International Journal of Pediatric Otorhinolaryngology, 2002
... Department of Neuropathology at BGH), Raymond Dannenhoffer, Ph.D. (Administrative Coordinator... more ... Department of Neuropathology at BGH), Raymond Dannenhoffer, Ph.D. (Administrative Coordinator, Depart-ment of Anatomy and Cell Biology, SUNYAB), Louis Bakay, MD, Kevin Matthew (Anatomy Lab, SUNYAB), Joanne Pantano, MSRN, Dawn Holler, Theresa Legier-ski ...
The Annals of otology, rhinology, and laryngology, 1989
The auditory brain stem responses (ABRs) to 500- and 2,000-Hz bone-conducted (BC) tones were reco... more The auditory brain stem responses (ABRs) to 500- and 2,000-Hz bone-conducted (BC) tones were recorded from 48 infants with ears exhibiting various external and middle ear states (normal, otitis media, auditory meatal atresia). Amplitudes were greater, wave V latencies longer, and detectability better for responses to 500-Hz BC tones compared to 2,000-Hz BC tones. Overall, most (94% to 100%) infants with normal cochlear sensitivity demonstrate ABRs to 20-dB normal hearing level (nHL) 500-Hz BC tones and 30-dB nHL 2,000-Hz BC tones. In cases in which masking is difficult (eg, bilateral atresia), infant ipsilateral/contralateral ABR asymmetries may help determine from which cochlea a response to the BC tones originates. In conclusion, two-channel ABR recordings to BC tones appear to be feasible for demonstrating normal cochlear sensitivity in infants.
A trajectory, we know, is the path followed by an object moving under the action of certain force... more A trajectory, we know, is the path followed by an object moving under the action of certain forces. Our questions are: What are the forces governing the trajectory of Pediatric Otolaryngology? And how will they determine our care of patients?
Objectives: To determine the economic effect on the US economy of the cost of caring for people w... more Objectives: To determine the economic effect on the US economy of the cost of caring for people with communication disorders as well as the cost of lost or degraded employment opportunities for people with such disorders, including disorders of hearing, voice, speech, and language. Study Design: Survey of available historical and contemporary governmental and scholarly data concerning work force distribution and the epidemiology of disorders of hearing, voice, speech, and language. Method: Analysis of epidemiological and economic data for industrialized countries, North America, and the United States. Results: Communication disorders are estimated to have a prevalence of 5% to 10%. People with communication disorders may be more economically disadvantaged than those with less severe disabilities. The data suggest that people with severe speech disabilities are more often found to be unemployed or in a lower economic class than people with hearing loss or other disabilities. Communication disorders may cost the United States from $154 billion to $186 billion per year, which is equal to 2.5% to 3% of the Gross National Product. Conclusions: Communication disorders reduce the economic output of the United States, whose economy has become dependent on communication-based employment. This trend will increase during the next century. The economic cost and the prevalence rates of communication disorders in the United States indicate that they will be a major public health challenge for the 21st century.
OBJECTIVE: To determine the applicability and external validity of randomized control studies (RC... more OBJECTIVE: To determine the applicability and external validity of randomized control studies (RCTs) in the light of patient susceptibilities and vulnerabilities to the sequelae of otitis media with effusion (OME) and tonsillar pharyngitis (T&A) and the composition of their cohorts. STUDY DESIGN: RCTs for OME and T&A were analyzed to determine which intrinsic and extrinsic susceptibilities to the oto-laryngic disease and its sequelae were included or excluded and the composition of the cohort. METHODS: A Medline and a Science Direct search were performed for all RCTs concerning OME and T&A through 2007. The articles selected to be included in this study are the OME RCTs that reported language and/or hearing outcomes and the T&A RCT studies in which the outcome measure was infection, alleviation of airway obstruction, and/or quality of life. These were analyzed for their inclusion or exclusion of intrinsic and extrinsic susceptibilities to the otolaryngic disease and their sequelae and the composition of the cohort. The pertinent otolaryngologic literature was assessed to determine applicable risk factors. RESULTS: The analysis of the inclusion or exclusion of risk factors showed that for OME 0 percent were included and 16 percent were excluded, and there were no data for 84 percent. The T&A findings were similar in that 1 percent of risk factors were included, 8 percent excluded, and there were no data for 92 percent. Both the OME and the T&A cohorts data were similar in that approximately half of the suitable candidates completed the study; 25 percent of the OME and 13 percent of the T&A enrolled subjects were either withdrawn or placed into a different experimental group. On the average, with data available, it took 4.6 years to recruit the OME sample and 5.5 years to recruit the T&A sample. CONCLUSION: The results of RCTs for these conditions are only applicable to narrowly defined and highly circumscribed populations. They cannot be generalized to the entire patient population because of their limited external validity. Future RCT protocols should be designed to control for the intrinsic and ex-trinsic susceptibilities that result in a propensity to acquire the disease and/or an exacerbation of the disease's sequelae. These studies would determine the most effective strategies for preventing disorders and/or their deleterious sequelae.
A defining characteristic of the human being is our highly developed linguistic communication sys... more A defining characteristic of the human being is our highly developed linguistic communication system. Communication -of which language is a major mode for human beings -is today more than any other time in history, paramount for the optimal survival of the individual . This is manifest not only in social interactions and psychological fitness but, critically, in economic productivity. A century ago most made their livings through manual labor, and an individual's economic survival was, in the main, not dependent on good communication skills. Today, over 90% of all employment in the developed nations is based upon communication abilities [3], which has made all the more important the linguistic competence of each individual. And we know that developing countries are on the same trajectory of converting from manual to communication societies, like the currently developed nations.
The development of the inner ear of vertebrates has been examined in various ways. During the 19t... more The development of the inner ear of vertebrates has been examined in various ways. During the 19th and early 20th centuries Boettcher ( 8 ) . Retzius (41), Held (21) and others studied the morphological developn~ent of the membranous labyrinth. hIore recently, Bast and Anson (5) have made major contributions to the understanding of the morphological development' of the ear. There have been two detailed morphological studies on the development of the inner ear of the rodent (57, 58). All of these studies have demonstrated that cytological differentiation appears first at the base of the cochlea and proceeds to the apex over several days.
OBJECTIVE: To determine the applicability and external validity of randomized control studies (RC... more OBJECTIVE: To determine the applicability and external validity of randomized control studies (RCTs) in the light of patient susceptibilities and vulnerabilities to the sequelae of otitis media with effusion (OME) and tonsillar pharyngitis (T&A) and the composition of their cohorts. STUDY DESIGN: RCTs for OME and T&A were analyzed to determine which intrinsic and extrinsic susceptibilities to the oto-laryngic disease and its sequelae were included or excluded and the composition of the cohort. METHODS: A Medline and a Science Direct search were performed for all RCTs concerning OME and T&A through 2007. The articles selected to be included in this study are the OME RCTs that reported language and/or hearing outcomes and the T&A RCT studies in which the outcome measure was infection, alleviation of airway obstruction, and/or quality of life. These were analyzed for their inclusion or exclusion of intrinsic and extrinsic susceptibilities to the otolaryngic disease and their sequelae and the composition of the cohort. The pertinent otolaryngologic literature was assessed to determine applicable risk factors. RESULTS: The analysis of the inclusion or exclusion of risk factors showed that for OME 0 percent were included and 16 percent were excluded, and there were no data for 84 percent. The T&A findings were similar in that 1 percent of risk factors were included, 8 percent excluded, and there were no data for 92 percent. Both the OME and the T&A cohorts data were similar in that approximately half of the suitable candidates completed the study; 25 percent of the OME and 13 percent of the T&A enrolled subjects were either withdrawn or placed into a different experimental group. On the average, with data available, it took 4.6 years to recruit the OME sample and 5.5 years to recruit the T&A sample. CONCLUSION: The results of RCTs for these conditions are only applicable to narrowly defined and highly circumscribed populations. They cannot be generalized to the entire patient population because of their limited external validity. Future RCT protocols should be designed to control for the intrinsic and ex-trinsic susceptibilities that result in a propensity to acquire the disease and/or an exacerbation of the disease's sequelae. These studies would determine the most effective strategies for preventing disorders and/or their deleterious sequelae.
The relationship among otitis media, auditory sensitivity, and emerging language was examined in ... more The relationship among otitis media, auditory sensitivity, and emerging language was examined in a group of 1-year-old children who were prospectively followed since birth. Pneumatic otoscopy was used to document the otologic status of the children's ears at each medical visit. There were 13 babies with normal ratings in each ear at 80% more of their visits (designated as "otitis free") and 12 babies with bilaterally positive otoscopy results at 30% or more of their first year visits (designated "otitis positive"). In comparison to the otitis free infants, the group of otitis positive babies demonstrated reduced auditory sensitivity as measured by auditory brain stem response (ABR) and poorer expressive language abilities. However, differences in receptive language were not detected. These results suggest that otitis media may have an impact on auditory sensitivity and developing language as early as 1 year of age.
International Journal of Pediatric Otorhinolaryngology, 2002
... Department of Neuropathology at BGH), Raymond Dannenhoffer, Ph.D. (Administrative Coordinator... more ... Department of Neuropathology at BGH), Raymond Dannenhoffer, Ph.D. (Administrative Coordinator, Depart-ment of Anatomy and Cell Biology, SUNYAB), Louis Bakay, MD, Kevin Matthew (Anatomy Lab, SUNYAB), Joanne Pantano, MSRN, Dawn Holler, Theresa Legier-ski ...
The Annals of otology, rhinology, and laryngology, 1989
The auditory brain stem responses (ABRs) to 500- and 2,000-Hz bone-conducted (BC) tones were reco... more The auditory brain stem responses (ABRs) to 500- and 2,000-Hz bone-conducted (BC) tones were recorded from 48 infants with ears exhibiting various external and middle ear states (normal, otitis media, auditory meatal atresia). Amplitudes were greater, wave V latencies longer, and detectability better for responses to 500-Hz BC tones compared to 2,000-Hz BC tones. Overall, most (94% to 100%) infants with normal cochlear sensitivity demonstrate ABRs to 20-dB normal hearing level (nHL) 500-Hz BC tones and 30-dB nHL 2,000-Hz BC tones. In cases in which masking is difficult (eg, bilateral atresia), infant ipsilateral/contralateral ABR asymmetries may help determine from which cochlea a response to the BC tones originates. In conclusion, two-channel ABR recordings to BC tones appear to be feasible for demonstrating normal cochlear sensitivity in infants.
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Papers by Robert Ruben