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Speech physiology consists of the articulatory structures, including the respiratory system, the larynx and various vocal tract articulators, plus the sensory organs, which provide auditory, somatosensory and visual inputs that map the feature space in which speech is produced and perceived. In this chapter the focus is on the neurophysiology of the articulatory structures. The acoustic characteristics of speech sounds are determined by changes in the length and tension of muscles, coordinated, at the lowest level, by interlinked clusters of motor neurons and interneurons in the brainstem which are themselves directed by excitation from cortical and midbrain structures. This chapter provides a brief foundation to these systems and structures, taking a functional perspective. The progressive nature of research into the anatomy and physiology of speech continues to generate new discoveries, and advances in modelling and mapping of biomechanical and neural control promise new avenues for phonetic research.
Osteonecrosis is a benign condition characterised by necrotic exposed bone, and is associated with bisphosphonate use. Osteonecrosis of the external auditory canal is rare, with only a few reported cases.
Method:
Two case reports of temporal bone osteonecrosis are presented.
Results:
A 64-year-old man with a history of immunoglobulin G kappa multiple myeloma developed a right external auditory canal ulcer 6 years after commencement on clodronate. A 72-year-old woman taking alendronate for osteoporosis, initially diagnosed and treated for right-sided otitis externa, was found to have underlying exposed bone in the right external auditory canal, with a computed tomography scan confirming destruction of the temporal bone.
Conclusion:
With increasing use of both oral and intravenous bisphosphonates in the community for benign conditions such as osteoporosis and for malignant conditions such as breast cancer and multiple myeloma, the diagnosis of bisphosphonate-associated osteonecrosis should always be considered in patients with a temporal bone lesion, and a relevant drug history taken.
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