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Zeszyty Naukowe Politechniki Pozna��skiej. Architektura, Urbanistyka, Architektura wn��trz, 6, 5-19

The article presents specific spatial needs, in particular concerning residential architecture in Poland, in view of the global issue of ageing societies.

Zeszyty Naukowe Politechniki Poznańskiej. Architektura, Urbanistyka, Architektura wnętrz, 1, 5-16

Phoniatricians usually have the key role when dealing with a voice disorder, supported by logopedists/speech-language pathologists. Cooperation with other medical or non-medical disciplines may contribute when needed. Fundamentals, general goals and the structure of voice therapy are followed by a survey of specific methods and techniques. No matter what kind of technique is used, treatment strategy is inevitably based on pathophysiological mechanisms of a disorder and the patient’s state as a whole. Voice therapy is a dynamic process and not an application procedure for a stable phonatory pattern or a list of exercises for every patient. This integrative model for treatment of voice disorders includes additional skills and knowledge of mechanisms of applications, stages of behavioural treatment, phases of motor learning, stages of voice therapy and steps of a given technique. Functional disorders of the singing voice (dysodia) require additional and specific expertise, especially in emergency situations in the frame of cancellation policy regarding the opera and theatre business. Drug treatment and physiotherapy/osteopathy as more therapeutic approaches to voice disorders are presented, as well as phonosurgical procedures, i.e. functional surgical interventions aiming exclusively, or in part, at improvement, restoration or preservation of vocal function. Methods comprise of phonomicrosurgery (endoscopic microsurgery), laryngeal injection and laryngeal framework surgery that modify the cartilaginous framework of the larynx (laryngoplastic phonosurgery, open-neck surgery). Pacing and reinnervation are also discussed as alternatives in bilateral vocal fold palsies, and vocal rehabilitation after head and neck surgery, including the use of personalised computer speech synthesis for laryngectomised patients, is considered. Indications for tracheostomy and tracheostoma care refer to clinical practice. The prognosis of voice rehabilitation depends on the various factors that are included in voice production and should be considered accordingly.

The basic principles for the prevention of dysphonia are avoidance of vocal overload, elimination of voice abuse and physiological voice production. The importance of evaluation of the prodromal symptoms and the influence of medication on voice production are also stressed. The prevention of voice disorders in the developmental period after excluding organic changes should be multidimensional. In the prevention of professional voice disorders, attention should be paid to the contra-indications for performing.

Patient Female, 6 FINAL DIAGNOSIS: Phenotype-genotype discordance in congenital malformations with communication disorders resembling trisomy 18 (Edwards syndrome) Symptoms: - Medication - Clinical Procedure: - Specialty: Otolaryngology. Objective Congenital defects. Background Communication process disorders are very frequent in rare cases of chromosomal aberrations (deletions, insertions, and trisomies) such as Down syndrome (trisomy 21), Turner syndrome, Edwards syndrome (trisomy 18), or Patau syndrome (trisomy 13). Sometimes phenotype may delusively correspond to the characteristic features of a given syndrome, but genotype tests do not confirm its presence. Case report We present the case of a 6-year-old girl admitted to the Clinic of Phoniatrics and Audiology for the assessment of communication in the course of congenital malformations with phenotype characteristic for trisomy 18 (Edwards syndrome). Immediately upon birth, dysmorphic changes suggesting trisomy 18 (Edwards syndrome) were observed, but trisomy 18 was excluded after karyotype test results were normal (46, XX). Conclusions DISTURBED ARTICULATION WAS DIAGNOSED: deformed linguo-dental and palatal sounds, interdental realization with flat tongue of the /s/, /z/, /c/, /dz/, /ś/, /ź/, /c/, /dz/ sounds (sigmatismus interdentalis). Hearing loss was confirmed.

Objectives: Developmental dyslexia in children can affect auditory and linguistic skills. Due to the impairment of hearing discrimination, attention, memory and perception, dyslexia causes the inability to process and interpret linguistic and verbal information effectively. Standard audiological examination is much less useful than low redundancy speech tests and electro-physiological examination, which are the only objective measures of central auditory processing. The aim of the study was to assess the usefulness of low redundancy speech tests and dichotic tests in the diagnosis of developmental dyslexia in children. Methods: Ten children aged 7–15 years were tested by a dichotic numeral test, a dichotic verbal minimal-pair test, and a Calearo test. Results: The experiments demonstrated that the dyslectic group achieved worse results in the above tests compared to the control group. This suggests information exchange disorders between the hemispheres, a lack of synchronization of acoustic percep...

Parkison's disease causes damage to the central nervous system resulting in bradykinesia, muscle rigidity, rest tremor and dysarthric speech. In clinical terms dysarthria denotes the dysfunction of articulation, phonation and respiration. It is brought about by the impairment of neural paths innervating the speech apparatus, thus causing a decreased ability to communicate. The study was conducted by the Center for Speech and Language Processing (CSLP), Adam Mickiewicz University, Poznan and the Chair and Department of Phoniatrics and Audiology, the Medical University, Poznan within the interdisciplinary research project grant called "Speech and Language Virtual Therapist for Individuals with Parkinson's Disease". Apart from traditional voice and speech therapies, one of the ways of treating speech disturbances accompanying Parkinson's disease is an innovative Lee Silverman Voice Treatment (LSVT). The purpose of this innovative method introduced by dr L. Ramig and colleagues in 1987-1988, is to teach the patient to speak loud. As a result of co-operation between CLSP and the Center for Spoken Language Research (CSLR) at the University of Colorado, Boulder, USA, a Polish version of LSVT Virtual Therapist computer programme was created (LSVTVT). The programme is based on the principles of LSVT. The positive outcomes of the therapy give hope to Parkinson's disease patients with dysarthria, as well as to speech therapists.

Summary Introduction Indirect laryngoscopy development and progress initiated in 1854 by the autolaryngoscopy of the famous singing voice teacher Manuel Garcia in ENT speciality is connected with the names of L. Tuerck and J.N. Czermak, the last one being called the father of laryngoscopy. In 1878 M. Oertel used for the first time stroboscopic light in indirect laryngoscopy. The perception of stroboscopic picture is based on the Talbot principle. Object of the paper Two apparatuses used for the evaluation of larynx function in the Poznan ENT Department before the II World War are presented: – Polylaryngoscop enabling evaluation the indirect laryngoscopy simultaneously by several individuals. – Mechanical stroboscop of Oertel type with perforated disc moved by electrical engine. Conclusion For 130 years laryngostroboscopy belongs to the basic examination methods of larynx phonatory function.

INTRODUCTION The purpose of speech audiometry is to extend the diagnostics of central auditory processes. First audiometric tests were monaural tests introduced in the fifties by Bocca and Calearo to diagnose Central Auditory Processing Disorders (CAPD). Monaural tests are characterized by low redundancy, which allows for deciphering a given word or phrase only if the amount of accessible information exceeds a required minimum. Until now, a new monaural filtered speech test has been drawn up at the Department of Phoniatrics and Audiology. The purpose of the research was to draw up and assess the effectiveness of monaural low redundancy tests, in which the acoustic signal has been compressed or noise has been added. MATERIALS AND METHOD 35 people with normal hearing, aged 16-60, have been examined. The test material included: a compressed speech test, in which the speech signal has been accelerated by 25% with the use of Cool Edit Pro 2.0; the pauses between the words have not been shortened a speech-in-noise test, in which the noise has been added with the use of Cool Edit Pro 2.0. The signal/noise ratio has been set at the level of 10 dB. The examination has been conducted at three different volume levels: 25, 35 and 45 dB. CONCLUSIONS Best results have been achieved at the volume level of 45 dB (above hearing threshold); There were differences in results at volume levels 25 dB and 35 dB in compressed speech test and at volume level 25 dB in speech in noise. Both tests have shown the influence of age on the test result which suggests undiagnosed CAPD among people (with normal hearing) aged over 55.

The cochlear implantation program in Poznań started in January 1994. Within 8 years, 151 patients were implanted (149 cochlear and 2 auditory brain-stem implants). The implanted group comprised 111 children and 40 adults. We have extended the lower age limit for cochlear implant candidates, and the youngest implanted patient was 18-months-old at the time of surgery. We have also implanted six multi-handicapped subjects. All patients were implanted with different nucleus devices (22, 24 M, 24 K, 24 Contour, 24 Double Array and 24 ABI). Insertion of the Nucleus 24 Contour electrode carrier requires a little larger cochleostomy in comparison with conventional straight array. After insertion, the intraoperative measurements are taken (impedance telemetry, electrically evoked stapedius reflex and NRT). The day after surgery, each patient undergoes an X-ray examination (the cochleogram or cochlear view). The calculated length of the electrode array insertion was 12.75-24.0 mm (mean: 22.05 mm) and the degree of electrode rotation was 180-540 degrees (mean: 292.82 degrees). After speech processor switch-on, we performed NRT measurements. Our results indicated that the NRT threshold was in 51.4% of the dynamic range within the group of examined patients. The adults' progress of rehabilitation was checked during individual sessions. The rehabilitation of children included two rehabilitation schedules: continuous ones and weekly rehabilitation camps. The progress of the recovery process of implanted children enabled them to change their school profile from hearing impaired to mainstream. Voice rehabilitation is often monitored by acoustic analysis using the Multi Dimensional Voice Program (MDVP).

We examined the senses of smell and taste in 240 patients with verified hypersensitivity reactions of the respiratory tract. Olfactometry was performed according to Elsberg and Levy's method and followed by electrogustometry. The examinations revealed that the incidence of smell and taste disorders in patients with allergic rhinitis is 21.4% and 31.2%, respectively. No significant relationships between smell and taste dysfunction were found. We evaluated statistically positive correlations between the olfactory and gustatory thresholds compared with 78 qualitative and quantitative factors assessed in the study. There was a statistically significant relationship between the olfactory thresholds and levels of eosinophils in blood and in nasal discharge. acid reaction of the nasal mucosa, coexisting nasal polyps and X-ray changes in the ethmoid sinuses. There was a positive influence of pharmacotherapy as well as specific desensitization and surgery on the impairment of the sense of smell in allergic rhinitis.

Bei 12 Kindern im Alter von 5 bis 18 Jahren mit angeborener Hypertrophie der Nebennierenrinde wurden sowohl in quantitativen als auch qualitativen Untersuchungen bei mehr als der HAlfte sehr niedrige Gerachwahrnehmungsund Gerucherkennungsschwellen bei gleichzeitig niedriger Schwelle der Geschmacksempfindung festgestellt. Die Ergebnisse deuten auf eine Uberempfindlichkeit des Geruchs- und Geschmackssinnes bei angeborener Hypertrophie der Nebennierenrinde hin.

The material of this investigation comprised a group of 18 patients with deep hypoacousis (over 70 dB) or complete deafness which, depending on the onset of the deafness, was divided into the 3 categories: congenital, early childhood to 3rd year of life, and postlingual. All of them underwent ENT, phoniatric and stroboscopy examinations; in 10, X-ray tomography of the larynx was also performed. The status of hearing ability was assessed by audiometric examinations using pure tones in air and bone conductions. The acoustic examinations comprising spectrographic and tonographic analyses were performed on an appropriate linguistic material including vowels, isolated words, sentences and reading text. The measurement of Fo was performed on isolated vowels. In order to characterise the degree and kind of periodicity disturbances the following parameters were estimated: the medium value of fundamental frequency, the range of Fo variability, the maximal change of period length from cycle to cycle, and its medium value (jitter). The results of the acoustic examinations revealed different degrees and kinds of periodicity disturbances depending on the depth of the hypoacousis and its onset.

The purpose of this study was the audiological evaluation of low birth weight children as well as to investigate any possible relation between very low birth weight and the associated risk factors and the subsequent hearing loss. A group of 110 children was examined audiologically. The prenatal, perinatal and postnatal risk factors were related to the audiological diagnosis. Depending on the patient's age, audiological examination consisted of auditory brainstem responses, pure tone audiometry and impedance audiometry. The presence of more than two risk factors in the perinatal and postnatal categories was connected with profound hearing loss in later life. No such relation was found with the cumulation of the prenatal risk factors. In our material the greatest risk of the acquired profound hearing loss and deafness occurring in low birth weight children was connected with the general physical status of the neonates and the treatment programme in the neonatal intensive care unit.

Many factors influence the speech rehabilitation progress, including: duration of deafness, aetiology, communication mode before implantation, family support. Meningitis can affect not only the cochlear hair cells, but also the upper stages of hearing paths or even other parts of the central nervous system. In the literature we can find the sentence: ‘Rate of neurologic sequelae in children who have had meningitis ranges from 20% to 30% and the prevalence of potentially subtle entities such as learning disability, perceptual and attention deficits, and behavioural problems may be even more pervasive.’ The aim of this study was to compare radiological and surgical observations with the evaluation of speech rehabilitation progress in patients implanted due to post-meningitic deafness.

MICHAL KARLIK, Department of Phoniatrics and Audiology, University School of Medical Sciences, Poznan, Poland WOLF-PETER SOLLMAN, Department of Neurosurgery, Braunschweig, Germany WITOLD SZYFTER, Department of Otolaryngology University School of Medical Sciences, Poznan, Poland STANISLAV SEDLAK, Department of Otolaryngology, Prague, Czech Republic ANTONI PRUSZEWICZ, Department of Phoniatrics and Audiology, University School of Medical Sciences, Poznan, Poland

Parkison's disease causes damage to the central nervous system resulting in bradykinesia, muscle rigidity, rest tremor and dysarthric speech. In clinical terms dysarthria denotes the dysfunction of articulation, phonation and respiration. It is brought about by the impairment of neural paths innervating the speech apparatus, thus causing a decreased ability to communicate. The study was conducted by the Center for Speech and Language Processing (CSLP), Adam Mickiewicz University, Poznań and the Chair and Department of Phoniatrics and Audiology, the Medical University, Poznań within the interdisciplinary research project grant called "Speech and Language Virtual Therapist for Individuals with Parkinson's Disease". Apart from traditional voice and speech therapies, one of the ways of treating speech disturbances accompanying Parkinson's disease is an innovative Lee Silverman Voice Treatment (LSVT). The purpose of this innovative method introduced by dr L. Ramig and colleagues in 1987-1988, is to teach the patient to speak loud. As a result of co-operation between CLSP and the Center for Spoken Language Research (CSLR) at the University of Colorado, Boulder, USA, a Polish version of LSVT Virtual Therapist computer programme was created (LSVTVT). The programme is based on the principles of LSVT. The positive outcomes of the therapy give hope to Parkinson's disease patients with dysarthria, as well as to speech therapists.

The Arnold-Chiari malformation is very rare hindbrain abnormalities characterized by herniation of the hindbrain through the foramen magnum. It usually does not present until adulthood, and then its symptoms may be varied and subtle. Patient 49 years was diagnosed in Foniatrics and Audiology Clinic because of tinnitus in left ear lasting 3 months. She underwent audiological diagnostic, that did not reveal any abnormalities, except for electrogustometry and hyporeflexia of stapedial reflex and labyrinth on the left side. In MRI scan we have noticed hindbrain abnormalities characteristic for Chiari type I malformation. Treatment consisted of immediate supportive care as needed but without surgical decompression, which was found unnecessary.

The purpose of speech audiometry is to extend the diagnostics of central auditory processes. First audiometric tests were monaural tests introduced in the fifties by Bocca and Calearo to diagnose Central Auditory Processing Disorders (CAPD). Monaural tests are characterized by low redundancy, which allows for deciphering a given word or phrase only if the amount of accessible information exceeds a required minimum. Until now, a new monaural filtered speech test has been drawn up at the Department of Phoniatrics and Audiology. The purpose of the research was to draw up and assess the effectiveness of monaural low redundancy tests, in which the acoustic signal has been compressed or noise has been added.35 people with normal hearing, aged 16-60, have been examined. The test material included: a compressed speech test, in which the speech signal has been accelerated by 25% with the use of Cool Edit Pro 2.0; the pauses between the words have not been shortened a speech-in-noise test, in which the noise has been added with the use of Cool Edit Pro 2.0. The signal/noise ratio has been set at the level of 10 dB. The examination has been conducted at three different volume levels: 25, 35 and 45 dB.Best results have been achieved at the volume level of 45 dB (above hearing threshold); There were differences in results at volume levels 25 dB and 35 dB in compressed speech test and at volume level 25 dB in speech in noise. Both tests have shown the influence of age on the test result which suggests undiagnosed CAPD among people (with normal hearing) aged over 55.

Laryngocele is an abnormal saccule dilatation of the ventricle in direct communication with the laryngeal lumen. It is usually filled by air and mostly asymptomatic. This case is reported due to its rarity. A bilateral internal laryngocele with open nasality in 66-year-old man is described. Patient has been observed for 8 years with stable course of the disease and good general condition. Because the squamous cell carcinoma is known to occur in association with laryngocele necessity of control evaluation is very important. The etiology, classification, evaluation is discussed.

Evaluation of the objective results in the clinical examination of central auditory disorders requires the use of reliable language tests which provide the means for the estimation of patients' audio-verbal communicative skills.The authors present a new set of more difficult language tests in Polish, including a filtered speech test, numeral and verbal dichotic tests and the normal Calearo test. The tests were evaluated on a group of people with good hearing from various age groups.The presented tests are the only existing ones created for the Polish language which expand the diagnostic possibilities in the case of central auditory processing disorders. It was found that there is a right ear predominance in dichotic tests, which grows together with the patient's age. This observation can be very beneficial in practice, allowing for hearing aids to be better fitted.

In daily phoniatric practice, apart from laryngoscopy, another simple and useful method of examining the voice organ is perceptual voice assessment based on the GRBAS scale. An extension to this examination can be the Voice Handicap Index test (VHI).79 female teachers taking part in a 7-week-long rehabilitation course on voice emission techniques. Before and after the course the participants were subject to phoniatric examination including laryngovideostroboscopy, GRBAS scale assessment and determining the voice handicap index (VHI).After the course, a substantial improvement has been observed in voice emission, perceptual assessment and the VHI test. It has been observed that there is a statistically significant correlation between GRBAS and VHI results and mean phonation time (MPT) measured before and after the course.The VHI test should be included in complex analysis of the effects of intensive rehabilitation.

Dychotomic tests in speech audiometry are extremely beneficial, especially in diagnosing central auditory processing disorders.Basing on new articulatory lists (NLA-93), the authors have prepared a new set of language tests, including filtered speech test, numeral and verbal dichotic tests and Calearo test.The phonetic characteristics of the tests are presented, with special attention paid to their phonetic balance.

Introduction: Evaluation of the objective results in the clinical examination of central auditory disorders requires the use of reliable language tests which provide the means for the estimation of patients' audio-verbal communicative skills. Materials and methods: The authors present a new set of more difficult language tests in Polish, including a filtered speech test, numeral and verbal dichotic tests and a Calearo test. The tests were evaluated on a group of people with good hearing from various age groups.Conclusions: The presented tests are the only existing ones created for the Polish language, which expand the diagnostic possibilities in the case of central auditory processing disorders.It was found out that there is a right ear predominance in dichotic tests, which grows together with the patient's age. This observation can be very beneficial in practice, allowing for hearing aids to be better fitted.

Spirometric, phoniatric and acoustic investigations were performed in 13 patients after laser arytenoidectomy due to bilateral vocal cord paresis. Phoniatric examination included voice recording, average level and voice range, time of phonation, laryngoscopy and stroboscopy. Acoustic analysis covered harmonic structure of the voice, jitter, shimmer, noise component, basic frequency.

Basic principles, indications and limitations of BAHA implantation as well as different kinds of operation techniques are presented. The beginning and the development of BAHA use in Poland are mentioned together with some difficulties in broadening of this kind of implantation.

Hearing impaired children do not develop oral speech in the same time with the hearing ones. Cochlear implants may change this situation. Implanted deaf children may develop oral speech but only after long speech rehabilitation. Acquisition of language skills should be assesed correctly in every patient. It is important because this therapy is quite expensive. There are many quantitative and qualitative methods used all over the world. In some cases score is calculated as percentage of correctly repeated words. Sometimes it did not reflect true level of language development. 240 people were implanted in Poznań in years 1994-2004. Two years ago, evaluation of changes in the distinctness and discrimination of phonems of cochlear implants children was begun. We found differences between standard speech audiometry and distinctness and discrimination of phonems.

The aim of this paper was introduction of preliminary study of late auditory evoked potentials P300 and MMN insome central communication process disorders. The investigations were performed in the group of three children with development dysphasia and pseudobulbar dyzarthria. The registration of endogenic late cognitive potentials was performed using the alternate application of stimulus of pure tones 1 and 2 kHz, and logatoms (da)-(ga). In all patients the normal hearing threshold and the unilateral disturbances in registration of P300 and mismatch negativity (MMN) were found.

The aim of this work was to present own modification of Jacobson's The Voice Handicap Index, the self-estimation scale of the voice as a one part of the complex voice evaluation. The VHI contains three groups of questions of physical, emotional and functional subscales, which specify complaints during phonation scored in 4 points (0-4). The presented our own modification of the VHI may be useful in everyday clinical practice.

The first cochlear implant in the ENT Department in Poznań was introduced in adult patient in January 1994. One year later the first deaf child was implanted. During 10 years over 200 deaf people were operated on. Modifications of diagnostics, surgery and rehabilitation were presented. Lowering the age of the implantation, changes of audiological criteria, genetic diagnostic and possibility of implantation in multi-handicapped patients were emphasized. Almost all surgeries were performed through the posterior tympanotomy and in one cases through the middle fossa approach. In one child with total ossification in CT scans Nucleus Double Array was used. Speech rehabilitation bases on auditory-verbal therapy. Rehabilitation consists of individual sessions with speech therapist and group therapy. Logorytmics exercises were introduced.

A case of a 12-year-old boy with Parry-Romberg syndrome was presented. Speech and hearing disorders impairing communicative process and abnormalities in the ENT examination, ultrasonography of parotid salivary glands, radiological changes of sella turcica were particularly considered.

In 1978 Valvassori and Clemis have reported that enlarged vestibular aqueduct can cause progressive perceptive hearing loss and finally deafness.Analysis of CT scans of patients with cochlear implants. Analysis of radiological data of 120 implanted patients was performed. CT examinations were performed during qualification to cochlear implantation. Most of the CT scans were performed using high resolution computed tomography (HRCT). A special attention was paid to patients with progressive perceptive hearing loss and CT of two patients with "gusher" during CI surgery. In one case (6-years old girl with bilateral profound perceptive hearing loss diagnosed in 2nd year of age) an enlarged vestibular aqueduct was found radiologically. In the second case (16 years old girl with progressive perceptive hearing loss since 1st year of age) no enlarged vestibular aqueduct was detected. Diagnostics and treatment of enlarged vestibular aqueduct syndrome are presented.

The aim of this research is to develop and introduce into phoniatric diagnostic procedures the complex methodology of vocal function assessment, on the basis of comparison of subjective and objective voice estimation. The set of complex voice evaluation ought to include perceptual examination of the voice quality with quantitative GRBAS scale as a subjective method, vocal folds vibrations in videostroboscopy as a quasi-objective method and acoustic voice estimation in Multi Dimensional Voice Program (MDVP) as an objective method. The basic assumption of this report is to prove correlation existence for vocal folds vibration quality in videostroboscopy, parameters describing acoustic wave generating by vibration system in larynx (MDVP) and perceptual subjective voice assessment (GRBAS scale) in organic and functional voice disorders. Research was conducted on 100 subjects (65 with organic and 35 with functional voice disorder), aged 7-74 years randomly chosen from population of patients treated at the Department of Phoniatrics and Audiology, Karol Marcinkowski University School of Medical Sciences in Poznań in 1996-2001 and 60 subjects as a control group without any voice disorders according to phoniatric examination. The research methodology include perceptual voice evaluation based on Japanese (Hirano) GRBAS scale adapted to Polish language, in scale 0 to 3 as well as the vibrations of vocal folds in videostroboscopy with attempt at quantification (scale 1 to 3) of selected measure and for acoustic analysis of Multi Dimensional Voice Program (MDVP) for 17 estimated parameters. Due to results and statistic analysis the own, new scale of dysphonia severity was introduced.

The speech rehabilitation of pre- and perilingually deafened children with cochlear implants it is a very long process. It should be individualized for needs of every young patient. It is possible only after correct evaluation of speech level. There are many tests for this evaluation. Among them same are more known like TAPS test. Test of Auditory Perception of Speech (TAPS) was elaborated in English at Basel University in Swiss. It was translated to Polish at Adam Mickiewicz University and Karol Marcinkowski University School of Medical Sciences in Poznań. The authors present their own 7-years observations.

There are many tests prepared for speech evaluation for different age groups and with any disabilities. The percent of correct repeated mono- or bisyllabes words create the final result. Sometimes this score is lower than real oral communication skill of CI patient. In the years 1994-2002 in Poznań 158 cochlear implantations were performed. Since few months the evaluation of the distinctness and discrimination of phonems of cochlear implants children are being conducted. It was found some differences between distinctness and discrimination of phonems and discrimination of words. It means that scores achieved by children in standarized words--tests do not reflect the real level of speech development of each child.