What are hormones, and how do they affect behavior?

Introduction

Cell-to-cell communication among the trillions of cells that make up multicellular animals relies primarily on the specialized tissues of the nervous and endocrine systems. These two systems are intricately connected, with the former having evolved from the latter during the past 500 million years of animal life. The endocrine system consists of specialized ductless glands located throughout the animal body that produce and secrete hormones directly into the bloodstream. Hormones are chemical messengers that usually are composed of protein or steroid subunits. The bloodstream transports the hormones to various target body tissues, where the hormones contact cell membranes and trigger a sequence of enzyme reactions that ultimately result in the activation or inactivation of genes located on chromosomes in the cell nucleus.

A gene is a segment of a chromosome that is composed of deoxyribonucleic acid (DNA). The DNA nucleotide sequence of the gene encodes a molecule of messenger ribonucleic acid (mRNA) which, in turn, encodes a specific protein for the given gene. If the control sequence of a gene is activated, then ribonucleic acid (RNA) and protein will be produced. If the control sequence of a gene is inactivated, then RNA and protein will not be produced. Hormones target the genes in specific cells to start or stop the manufacture of certain proteins. Within cells and the entire organism, proteins perform important functions. Therefore, hormones control the production of proteins by genes and, as a result, control many activities of the entire animal.

The nervous system, which in vertebrate animals has evolved to become more elaborate than the endocrine system, consists of billions of neurons (nerve cells) that conduct electrical impulses throughout the body. Neurons transmit information, contract and relax muscles, and detect pressures, temperature, and pain. Neuron networks are most dense in the brain (where there are 100 billion neurons) and spinal cord, where much of the electrical information is centralized, relayed, and analyzed. Neurons must communicate electrical information across the gaps, or synapses, that separate them. To accomplish this goal, the transmitting neuron releases hormones called neurotransmitters, which diffuse across the synapse to the receiving neuron, thereby instructing the receiving neuron to continue or stop the conduction of the electrical message. There are many different types of neurotransmitters, just as there are many different types of regular hormones.

Nervous System-Endocrine System Interactions

The link between the nervous and endocrine systems lies in two glands located between the cerebrum and the brain stem, the hypothalamus and the hypophysis (the pituitary gland). Electrical impulses from neurons in the cerebral cortex may activate the hypothalamus to release hormones that activate the hypophysis to release its hormones, which in turn activate or inactivate other endocrine glands throughout the body. These glands include the thyroid, parathyroids, thymus, pancreas, adrenals, and reproductive organs. This entire system operates by negative feedback homeostasis
so that, once information is transferred and specific bodily functions are achieved, nervous or hormonal signals travel back to the hypothalamus to terminate any further action.

Animal behavior occurs as a result of the actions of the nervous and endocrine systems. There is a complex interplay among these two body systems, the environment, and an individual’s genetic makeup in terms of the cause-and-effect, stimulus-response events that constitute behavior. An animal receives external information via its special senses (eyes, ears, nose, mouth) and somatic sense organs (touch, pain, temperature, pressure). This external information travels along sensory neurons toward the brain and spinal cord, where the information is analyzed and a motor response to the external stimulus is initiated. Some of these motor responses will be directed toward the sense organs, locomotory muscles, and organs such as the heart and intestines. Other impulses will be directed toward the hypothalamus, which controls body cycles such as all endocrine system hormones, heart rate, sleep-wake cycles, and hunger.

When the hypothalamus releases the hormone corticoliberin, the pituitary gland (the hypophysis) releases the hormones thyrotropin (which activates the thyroid gland), prolactin (which stimulates milk production in the female breast), and growth hormone (which triggers growth in children and metabolic changes in adults). When the thyroid gland is activated, hormones such as thyroxine and triiodothyronine are released to accelerate cellular metabolism, an event that may occur in certain situations such as stress or fight-or-flight encounters.

If the pituitary gland releasesadrenocorticotropic hormone (ACTH), the adrenal glands will be activated to release their hormones. The adrenal cortex produces and secretes a variety of hormones, such as aldosterone, which regulates the blood-salt balance directly and blood pressure indirectly; cortisol, which accelerates body metabolism; and androgens, or sex hormones. All of these are steroid hormones, which are involved in rapidly preparing the body for strenuous performance. Even more pronounced are the effects of the adrenal medulla, which produces and secretes the hormone neurotransmitters epinephrine and norepinephrine; these two hormones accelerate heart, muscle, and nerve action as well as stimulate the release of fat and sugar into the bloodstream for quick energy, all of which are extremely important for spontaneous activity such as fighting with or fleeing from enemies. The control of sugar storage and release from the liver by the pancreatic hormones insulin and glucagon also are important in this process.

The Effects of Hormones on Behavior

The study of hormones and their effects on individual and group behaviors is of immense interest to psychologists. Hormones represent the biochemical control signals for much of animal and human behaviors. Understanding precisely how hormones affect individuals, both psychologically and physiologically, could be of great value in comprehending many different human behaviors, in treating abnormal behaviors, and in helping individuals cope psychologically with disease and stress. The hormonal control of behavior in humans and in many other animal species has been extensively studied, although much research remains to be performed. Hormones have been clearly linked to reproductive behavior, sex-specific behavioral characteristics, territoriality and mating behaviors, physiological responses to certain external stimuli, and stress.

The pineal gland, located in the posterior cerebrum, releases the hormone melatonin, which regulates the body’s circadian rhythms
and possibly its sexual cycles as well. Melatonin is normally synthesized and secreted beginning shortly after dusk throughout the night and ending around dawn. It thus corresponds with the individual’s normal sleep-wake cycle. Melatonin may play an important role in humans adapting to shift work. It is promoted as a nutritional supplement to help people get a good night’s sleep.

Hormones and Reproduction

The most extensive research involving hormonal effects on behavior has been conducted on reproductive behavior. Among the most powerful behavior-influencing hormones are the pituitary gonadotropins luteinizing hormone (LH) and follicle-stimulating hormone (FSH). These two hormones target the reproductive organs of both male and female children and stimulate these organs to initiate sexual development and the production of sexual steroid hormones—estrogen and progesterone in women, testosterone in men. These sex hormones are responsible not only for the maturation of the reproductive organs but also for secondary sexual characteristics such as male aggression and female nesting behavior.

Reproductive patterns vary from species to species in occurrence, repetition of occurrence, and behaviors associated with courtship, mating, and caring for young. The achievement of reproductive maturity and reproductive readiness in a given species is subject to that species’ circadian rhythm, a phenomenon regulated by hormones released from the hypothalamus, hypophysis, and pineal gland. These three endocrine glands are influenced primarily by the earth’s twenty-four-hour rotation period and the twenty-eight-day lunar cycle. Furthermore, genetically programmed hormonal changes at specific times during one’s life cycle also play a major role in the occurrence of reproductive behaviors.

In female vertebrates, LH, FSH, and estrogen are responsible for the maturation of the ovaries, the completion of meiosis (chromosome halving) and the release of eggs for fertilization, and secondary sexual characteristics. The secondary sexual characteristics involve physiological and closely related behavioral changes. In bird species, these changes include the construction of a nest and receptivity to dominant males during courtship rituals. In mammals, these same hormones are involved in female receptivity to dominant males during courtship. Physiological changes in mammals include the deposition of fat in various body regions, such as the breasts and buttocks, and increased vascularization (more blood vessel growth) in the skin. Females of most mammal and bird species go into heat, or estrus, one or several times per year, based on hormonally regulated changes in reproductive organs. Female humans follow a lunar menstrual cycle in which LH, FSH, estrogen, and progesterone oscilla in production rates. These hormonal variations influence female body temperature and behavior accordingly.

Male sexual behavior is controlled predominantly by testosterone produced in the testicles and male androgens produced in the adrenal cortex. These steroid hormones cause muscle buildup, increased hair, and aggressive behavior. As a consequence, such steroids are often used (illegally) by athletes to improve their performance. In a number of mammal and bird species, elevation of sex steroids causes increased coloration, which serves both as an attractant for females and as an antagonistic signal to competitor males. The aggressive behavior that is stimulated by the male sex steroid hormones thus plays a dual role in courtship and mating rituals and in territorial behavior, phenomena that are tightly linked in determining the biological success of the individual.

Pheromones
are hormones released from the reproductive organs and skin glands. These hormones target the sense organs of other individuals and affect the behavior of these individuals. Sex pheromones, for example, attract males to females and vice versa. Other pheromones enable a male to mark his territory and to detect the intrusion of competitor males into his territory. Others enable an infant to imprint on its mother. Such hormones number in the hundreds, but only a few dozen have been studied in detail. Pheromones released by males serve as territorial markers, as is evidenced by most mammalian males spraying urine on objects in their own territory. Exchanges of pheromones between males and females are important stimulants for courtship and mating. In some species, the release of pheromones—or even the sight of a potential mate—will trigger hormonally controlled ovulation in the female. Furthermore, in several species, such as elephant seals and lions, the takeover of a harem by a new dominant male, a process that usually involves the murder of the previous male’s offspring, stimulates the harem females to ovulate. The diversity of reproductive behaviors that is regulated by hormones seems to be almost as great as the number of species.

Hormones and Stress

The fight-or-flight response is a hormone-controlled situation in which the body must pool all its available resources within a relatively short time span. The detection of danger by any of the special senses (sight, smell, hearing) triggers the hypothalamus to activate the pituitary gland to release adrenocorticotropic hormone, which causes the adrenal gland to release its highly motivating hormones and neurotransmitters. Many body systems are subsequently affected, especially the heart and circulatory system, the central nervous system, the digestive system, and even the immune system. One reason the fight-or-flight response is of major interest to psychologists is its link to stress.

Stress is overexcitation of the nervous and endocrine systems. It is caused by the body’s repeated exposure to danger, excessive physical exertion, or environmental pressures that affect the individual psychologically. Stress is a major problem for humans in a fast-paced technological society. The physiological and behavioral manifestations of stress are very evident. There is considerable evidence that stress is associated with heart disease, cancer, weakened immune systems, asthma, allergies, accelerated aging, susceptibility to infections, learning disorders, behavioral abnormalities, insanity, and violent crime. The demands that are placed on individuals in fast-paced, overpopulated societies are so great that many people exhibit a near-continuous fight-or-flight response. This response, in which the body prepares for maximum physical exertion in a short time span, is the physiological basis of stress. It is not intended to be maintained for long periods of time; if it is not relieved, irreparable effects begin to accumulate throughout the body, particularly within the nervous system. Medical psychologists seek to understand the hormonal basis of physiological stress to treat stress-prone individuals.

Hormones and Aging

Another hormone that greatly influences human behavior and development is human growth hormone (HGH). This hormone is produced by the anterior pituitary (adenohypophysis) gland under the control of the hypothalamus. HGH production peaks during adolescence, corresponding to the growth spurt. Although it is produced throughout life, it declines with age in all species studied to date. In humans, HGH production tends to drop quickly beginning in the thirties so that by age sixty, HGH production is only about 25 percent of what it was earlier in life, and it continues to decline until death. The decrease in HGH production with age has been tied to thinning of skin and wrinkle formation, muscle wasting, sleep problems, cognitive and mood changes, decreased cardiac and kidney function, lessening of sexual performance, and weakening of bones, contributing to osteoporosis. Nutritional supplements including the amino acids arginine, lysine, and glutamine are being investigated as growth hormone releasers, which may then decrease signs of aging.

Hormone Treatment of Health Problems

The ultimate goals of hormone studies are to arrive at an understanding of the physiological basis of behavior and to develop treatments for behavioral abnormalities. Synthetic hormones can be manufactured in the laboratory. Their mass production could provide solutions to many psychological problems such as stress, deviant behavior, and sexual dysfunction. Synthetic hormones already are being used as birth control mechanisms aimed at fooling the female body’s reproductive hormonal systems.

Ongoing research focuses on the importance of many hormones, especially on understanding their functions and how they might be used in the treatment of common disorders. Two hormones produced by the hypothalamus and released by the posterior pituitary (neurohypophysis) gland are vasopressin (antidiuretic hormone) and oxytocin. Vasopressin keeps the kidneys from losing too much water and helps maintain the body’s fluid balance. Variants of vasopressin that decrease blood pressure, identified by Maurice Manning, may lead to a new class of drugs to control high blood pressure. Oxytocin induces labor by causing uterine contractions and also promotes the production of milk for breastfeeding. Manning and Walter Chan are working to develop oxytocin receptor antagonists that may be used to prevent premature births.

The Past, Present, and Future of Hormones

The activities of all living organisms are functionally dependent on the biochemical reactions that make up life itself. Since the evolution of the first eukaryotic cells more than one billion years ago, hormones have been used in cell-to-cell communication. In vertebrate animals (fish, amphibians, reptiles, birds, and mammals), endocrine systems have evolved into highly complicated nervous systems. These nervous systems are even evident in the invertebrate arthropods (crustaceans, spiders, and so on), especially among the social insects, such as ants. The endocrine and nervous systems are intricately interconnected in the control of animal physiology and behavior.

Psychologists are interested in the chemical basis of human behavior and therefore are interested in human and mammalian hormones. Such hormones control a variety of behaviors, such as maternal imprinting (in which an infant and mother bond to each other), courtship and mating, territoriality, and physiological responses to stress and danger. Animal behaviorists and psychologists study the connection between hormones and behavior in humans, primates, and other closely related mammalian species. They identify similarities in behaviors and hormones among a variety of species. They also recognize the occurrence of abnormal behaviors, such as antisocial behavior and sexual deviance, and possible hormonal imbalances that contribute to these behavioral anomalies.

Although the biochemistry of hormones and their effects on various behaviors have been established in considerable detail, numerous behaviors that are probably under hormonal influence have yet to be critically analyzed. Among them are many subtle pheromones that affect a person’s interactions with other people, imprinting pheromones that trigger attraction and bonding between individuals, and hormones that link together a variety of bodily functions. These hormones may number in the hundreds, and they represent a challenging avenue for further research. Unraveling the relationships between hormones and behavior can enable researchers to gain a greater understanding of the human mind and its link to the rest of the body and to other individuals. These studies offer potential treatments for behavioral abnormalities and for mental disturbances created by the physiologically disruptive effects of drug use, a major problem in American society. They also offer great promise in the alleviation of stress, another major social and medical problem.

Bibliography

Borer, Katarina T. Exercise Endocrinology. Champaign, Ill.: Human Kinetics, 2003. Print.

Bronson, Phyllis J. Moods, Emotions, and Aging: Hormones and the Mind-Body Connection. Lanham: Rowman and Littlefield, 2013. Print.

Ellison, Peter T., and Peter B. Gray, eds. Endocrinology of Social Relationships. Cambridge, Mass.: Harvard University Press, 2009. Print.

Kraemer, W. J., and Alan D. Rogol, eds. The Endocrine System in Sports and Exercise. Malden, Mass.: Blackwell, 2005. Print.

Lovallo, William R. Stress and Health: Biological and Psychological Interactions. 2d ed. Thousand Oaks, Calif.: Sage, 2005. Print.

Neal, J. Matthew. How the Endocrine System Works. Malden, Mass.: Blackwell Science, 2001. Print.

Neave, Nick. Hormones and Behaviour: A Psychological Approach. New York: Cambridge University Press, 2008. Print.

Simonsen, Davis. Hormones and Behavior. New York: Nova Biomedical, 2013. Print.

Svare, Bruce B. Hormones and Aggressive Behavior. New York: Springer Verlag, 2013. Print.

What is the meaning of the poem "On Killing a Tree"?

I don't know that there is a single, correct interpretation for a poem like this. As such, I believe it will be most helpful to look at the idea or principle the poem presents, and then see if it is relevant in other contexts apart from trees.

The poem has four stanzas (plus a couple introductory lines) and, coincidentally, also has four elements to it, each expressed by its own stanza. They are: 1) the tree itself, 2) the ineffective attempt at killing the tree, 3) the roots, and 4) the successful killing of the tree.

Working with these, the poem can briefly be summarized as: trees are quite resilient; even chopping them down isn't enough to kill them; as long as the roots survive, so will the tree; trees can only be truly killed by ripping the roots from the ground—the source of sustenance and safety.

With the poem simply summarized, it becomes pretty clear that the idea behind the poem is the durability and capability of living things to recover from even grievous wounds, so long as they have a safe, nurturing "root" intact.

There are a lot of directions you can take this. To me, the ones that jump out are things that could be described as "living" yet aren't organisms in the biological sense—namely, communities or the human spirit.

Communities, much like trees, slowly grow and expand over the years from just a small starting point (stanza 1). Further, removing some members of the community, though often devastating, is not so much that it cannot be recovered from, given time (stanza 2). Because communities are typically founded not by coincidence, but by a group coming to together with shared needs or beliefs, there is usually a root cause (see what I did there?) that holds the community together more than any single member (stanza 3). If one destroys these roots of the community, even if all the members remain, the community will eventually wither and fall apart (stanza 4).

The other interpretation I mentioned, the human spirit, can also be understood with regard to the idea Patel presents in the poem. People have suffered tremendously and needlessly throughout history—I don't imagine I need to give examples—but there are just as many stories of people in those situations that somehow endure and recover (not just physically, but emotionally and mentally as well). Many have scars, just as a once chopped down tree would, but they have recovered nonetheless (stanza 2). To truly break someone, you must destroy their hope, crush their spirit. And that is not as easily done, especially if they have support from others. How much more difficult is it to endure when on your own? This system of nurturing and support is represented by the earth, and our connection to it is the roots (stanza 3). The world can be a terrible place, and without a connection to keep us sturdy and grounded, our spirit is exposed to the elements. And once we are separated, once we are alone:

Then the matter
Of scorching and choking
In sun and air,
Browning, hardening,
Twisting, withering,
And then it is done.

In the same way a tree is dependent on its roots to survive, so too is the human spirit dependent on others for support. The world is too taxing and painful to survive without it (stanza 4).

That turned rather grim. Whoops.

These are, of course, not the only possible answers. But hopefully they're enough to work from and to get an idea of what the author could have been talking about. 

The fine arts were defined as crafts during the Middle Ages. How were they redefined during the Renaissance?

During the Middle Ages almost all art production was in the service of religion and the Church. The general belief was that man must never put himself above God, the ultimate Creator. The Middle Ages view of art was that it was inspired solely by God and thus the human maker of that art was only following a plan or template given by the deity. Thus, the majority of the artwork in the Middle Ages was not signed (many works still considered ‘craft’ today are anonymous--think quilts, pottery, clothing, etc.).

With the Renaissance came a loosening of the strictures of religion across society; with that came the redefinition of humans as individuals, rather than merely members of God’s flock (a movement known as ‘Humanism’). Following these philosophical developments came a relaxing of the restrictions on artistic subject matter. Artists could make pieces that had entirely secular content. Early forms of capitalism were beginning to advance during the Renaissance, and artists came to need individual recognition to market themselves and their work. The idea of the artist as a singular creative worker began to take hold, subsequently redefining what it meant to make art, inventing the artist as a category separate from craftsman, and paving the way for the wildly inflated art markets of today.

List the steps for building internally consistent compensation systems.

Your question asks about the steps for building internally-consistent compensations systems.  Well-planned compensation systems have multiple aspects and are strategically crucial to successful human-resource management. 

The literature in business strategy and human resource management currently links business strategy and compensation.  The strategic and contextual factors of compensation represent intrinsic and extrinsic motivational outcomes for employees and businesses.  What follows is a summary of the steps for building internally-consistent compensation systems.

1. Gather background information regarding current compensation systems in the specific industry.

2.  Define the compensation philosophy.

3. Create internal, external, and individual equity by doing an internal analysis.  

• Determine benchmark jobs,


• Develop job analyses and evaluations based on work and worker-oriented activities, tools used, tangibles and intangibles, work performance, job context, and personal requirements of each job,


• Rank and group positions, and


• Create benchmark positions.


• Do salary surveys and employee censuses.


• Verify work locations, and 


• Determine direct and indirect compensation for each position: base and merit pay, production programs, pay for time off, employees assistant programs and benefits, incentives, deferred pay, etc.

4. Select data source for external comparisons of step three, factor comparisons and weigh comparisons of the individual, internal, and external data in following areas.

• Skill


• Effort  


• Responsibilities

6. Link surveys and comparisons to compensation philosophy and adjust as necessary.

7. Ensure equity in the analysis by employing a non-biased review of all findings and comparisons.

9. Apply statistical determinants to the adjusted compensation philosophy, and adjust as necessary.

10. Create market pay line for benchmark positions.

11. Develop a pay-structure outline by grading jobs within each benchmark to the compensation philosophy and the market pay line.

12. Calculate pay ranges for benchmark positions.

13. Calculate the gross cost of benchmark positions.

14. Present findings and recommendations to the necessary decisions makers and adjust the compensation as necessary.

15. Implement and evaluate the compensation in the following areas.

• Policy for compensation updates, effective dates, roles and responsibilities, and security and information access to compensation structures.

16. Identify and communicate the revised compensation system to the appropriate stakeholders.

17. Train the appropriate stakeholders on the revised compensation system.

18. Create evaluation benchmarks and comparisons, and timeline for doing each.

18. Review evaluations benchmarks and comparison, and adjust the compensation system as necessary.

While it may seem less complicated to streamline these steps, no business is static, so the compensation system should not be either.  To create an internally consistent compensation system, each step should be completed, further defined, and documented.  As times change, and the business expands, contracts, or stabilizes, so should compensation to create internal, external, and personal equity to reduce attrition and better manage the cost of employ acquisition and retention.

Did Alexander Hamilton support a loose interpretation of the Constitution?

Yes, Alexander Hamilton and the Federalists did generally support the idea of a loose interpretation or construction of the Constitution.  They differed from the Democratic-Republicans, led by Thomas Jefferson, who wanted to interpret the Constitution strictly.  The Federalists supported loose construction because they were in favor of having a stronger central government.

In the early United States, the two main political parties disagreed about how to determine if the national government had the right to do something.  The Democratic-Republicans wanted to interpret the Constitution very strictly.  They wanted to say that the government only had the right to do something if the Constitution explicitly said it had that right.  This would have limited the powers of the federal government severely.  By contrast, the Federalists wanted a stronger central government that could do more things.  Therefore, they wanted to interpret the Constitution loosely.  They wanted to say that the central government could do things unless the Constitution said it could not. 

For example, in 1791, there was an argument over whether the US government could set up a national bank.  The Constitution does not say that the government can do this, but it also does not forbid the government from setting up a bank.  The Federalists, led by Hamilton, wanted to set up such a bank because they thought it would help the national economy.  The Democratic-Republicans thought this would be unconstitutional.  The Federalists won and the bank was created.  From this, we can see that Hamilton did indeed support a loose interpretation of the Constitution.

How are the details in John Updike's "Ex-Basketball Player" used effectively?

I have always really liked this poem, and I'm glad that your question asks about the use of its details.  This poem's details are the reason that I like the poem so much.  I don't typically like poems that have obscure, flowery, overly developed metaphors.  That's probably why I don't like metaphysical poetry.  "Ex-Basketball Player" is a completely different kind of poem, because the details of the poem are so concrete.  The details are specific instead of vague. Take the opening stanza for example. 

Pearl Avenue runs past the high-school lot,

Bends with the trolley tracks, and stops, cut off

Before it has a chance to go two blocks,

At Colonel McComsky Plaza. Berth’s Garage

Is on the corner facing west, and there,

Most days, you'll find Flick Webb, who helps Berth out.

A specific street is named.  Then in a short, unadorned sequence, the reader is told that the road bends and stops two blocks short of a garage. We are told which way the garage faces and who can be found there.  The details are easy to read and understand, which makes the poem immediately accessible. The rest of the poem follows this same concept of using simple, concrete details.  We are told that Flick played for the Wizards, scored a specific number of points, and now only dribbles inner tubes.  Considering that the poem is about a simple, small town basketball hero, the simple, concrete details effectively help the poem tell Flick's story.  

How do I write a literary essay about how Macbeth's hallucinations (such as the prophecies and dagger) affect him and his behavior?

The first important thing you need to remember in writing a literary essay is that it has to be formed around a thesis statement.  Your thesis comes from your topic.  In this case, you want to write about the cause and effect of the hallucinations, or how Macbeth’s fear and guilt lead him to act hastily.  It does partly depend on what you think is a hallucination.  Are the witches real?  In your case, you might want to argue that they are not, based on what your teacher said.

Your thesis might be something like this.

Driven by guilt and fear, Macbeth allows his hallucinations to guide him to hasty and unwise actions.

An example of this, of course, is the witches’ first presentation to Macbeth that he would be king. Your teacher presents the witches’ prophecies as part of the hallucination. Banquo was there too, but that doesn’t mean that Macbeth didn’t hallucinate this reaction.  Macbeth at first seems disturbed by the witches’ words.

Third Witch

All hail, Macbeth, thou shalt be king hereafter!

BANQUO

Good sir, why do you start; and seem to fear
Things that do sound so fair? I' the name of truth,
Are ye fantastical, or that indeed
Which outwardly ye show? (Act 1, Scene 3)

You could argue either that Banquo is part of the hallucination or that he was reacting to something else.  Either way, Macbeth has a strong reaction to the prophecies. He seems to go from being a loyal solider to deciding he wants to be king, whatever the cost.  Notice that you need to use quotations to support your arguments in a literary essay, such as I did here.  Think of it as a persuasive essay where the support is textual evidence.

A second significant hallucination has Macbeth alone.  He is trying to decide what to do about Duncan and sees an imaginary dagger floating in the air. He takes this as a sign that he does need to kill the king.

Is this a dagger which I see before me,
The handle toward my hand? Come, let me clutch thee.
I have thee not, and yet I see thee still.
Art thou not, fatal vision, sensible
To feeling as to sight? or art thou but
A dagger of the mind, a false creation,
Proceeding from the heat-oppressed brain? (Act 2, Scene 1)

Macbeth is again spurred into action by this hallucination.  He dithers about whether or not to kill Duncan, but he considers this dagger as evidence that he was meant to kill Duncan to become king.  As you explain the meaning of the dagger, be sure to use this quote or another part of it as evidence.

Perhaps my favorite example of a hallucination is Macbeth’s seeing Banquo’s ghost at the dinner party. 

MACBETH

The table's full.

LENNOX

Here is a place reserved, sir.

MACBETH

Where?

LENNOX

Here, my good lord. What is't that moves your highness?

MACBETH

Which of you have done this? (Act 3, Scene 4)

This manifestation of Macbeth’s guilt results in the party ending quickly with Lady Macbeth making excuses for her husband. Yet the ghost demonstrates that Macbeth is driven by guilt as well as ambition. This will influence his actions from here on, but he has felt guilty since killing Duncan.  He begins to suspect everyone and everything, and it leads to his downfall. He kills Macduff’s entire family, but is unable to kill Macduff, and he makes an aggressive and foolish last stand against Malcolm’s army.

What is behaviorism?

Introduction

Behaviorism was founded in 1912 by the American psychologist John Broadus Watson
. Watson’s position was formed as a reaction to the then-current focus of psychology on consciousness and the method of research known as introspection, which he considered to be highly subjective. Using the research of the Nobel Prize–winning Russian physiologist Ivan Petrovich Pavlov, Watson argued that psychology could become a natural science only by truly adopting the methods of science. What he meant was that psychology must have an empirical, objective subject matter and that the events to be investigated as possible causes of behavior must also be described objectively and verified empirically through experimental research. This latter point meant that introspection would have to be abandoned, for it was unscientific. Watson presented the goals of psychology as the prediction and control of behavior rather than as the understanding of the mind and the consciousness.

Watson’s behaviorism was an extension ofPavlov’s discovery of the conditioning
of stimulus-response reflexive relationships. The term “reflex” refers to the connection between some environmental event, or stimulus, and the response that it elicits. The response is involuntary and relatively simple, and no prior learning is necessary for the response to occur when the stimulus is presented. Pavlov had already demonstrated experimentally how previously neutral parts of the environment could become effective in stimulating or eliciting an animal’s salivation response. By repeatedly pairing a bell with food powder, which elicited salivation, and then presenting the bell alone, Pavlov showed that the bell by itself could then elicit salivation. This process, alternately termed classical, Pavlovian, or respondent conditioning, in turn offered Watson an explanation for behavior that relied on observable elements, thus eliminating the need to use unobservable and hypothetical mental explanations.

Watson’s significant contribution resulted from his attempt to show how Pavlov’s discovery of the conditioning process with animals could also explain the behavior of human beings. Watson assumed that human behavior and the behavior of animals were both governed by the same laws of nature. Given this assumption, the objective methods of study that were appropriate for the scientific study of nonhuman animals were therefore appropriate for the study of human beings as well. Watson demonstrated the application of these methods in the famous but ethically controversial case study of
Little Albert, in which Watson and his graduate student, Rosalie Rayner, showed how human emotional responses could be conditioned to previously neutral environmental stimuli. They began their study by showing that Albert, who was eleven months old at the time, initially approached and smiled when he was shown a live rat. At a time when the rat was not present, Watson struck a metal bar with a hammer. Albert then flinched and began to cry. Next, the rat and the loud, unexpected sound were presented together on seven occasions. On these occasions, Albert reacted to the sound of the hammer striking the metal bar by withdrawing from the rat, moving away from the sound, whimpering, and then crying. Finally, the rat alone was shown to Albert. Now, when only the rat was placed before Albert, he would instantly move away from the rat, whimper, and then cry. Watson and Rayner had demonstrated through the process of classical conditioning that the once-neutral object, the rat, would now elicit a strong emotional response.

Watson attempted to present an objective, behavioristic account of the full range of human behavior in Behaviorism (1924), written for a popular audience. In it, he proposed that the stimulus-response reflex was the essential building block of all human behaviors. A collection of separate elemental reflexive responses, unlearned and as yet unconditioned, could become integrated into a complex habit through the regular presentation of the appropriate stimuli in the physical and social environment by parents, siblings, teachers, and others. The result would be, in Watson’s words, “habits, such as tennis, fencing, shoe-making, mother-reactions, religious reactions, and the like.” The process by which these habits were formed was presumably the conditioning process discovered by Pavlov. In addition, Watson attempted to show that the conditioning of neutral environmental stimuli to existing reflexive responses could also account for thinking and the personality.

B. F. Skinner and Radical Behaviorism

A different form of behaviorism came from the work of the American psychologist B. F. Skinner
. Skinner, too, focused his research on behavior and searched for lawful relationships between behavior and environment. Skinner’s thinking began with an acceptance of Watson’s stimulus-response approach, but he ultimately took behaviorism in a fundamentally different direction. The first presentation of Skinner’s approach was in The Behavior of Organisms (1938). In this book, Skinner described the methods and results of systematic research that demonstrated the key points of what was later to become known as radical behaviorism:

•Stimulus-response relationships, or reflexes, include only a narrow range of behavior.

•Classical, or Pavlovian, conditioning could not account for the development of new behavior or the complexity of human behavior.

•Behavior does show lawful relationships with the environment.

•The consequences immediately following a behavior determine the future strength of that behavior.

•New behavior can be acquired by the process of shaping (from existing behavior, elemental forms can be strengthened by consequences that follow the step-by-step approximations until the new behavior is present).

•Once acquired, behavior is maintained by a particular arrangement of environmental consequences.

•Certain events are present when a behavior is strengthened.

•Often, one of those antecedent events is by design especially correlated with the behavior and the consequence that makes that behavior stronger in the future.

•At a later time, the presence of that antecedent event by itself will make the behavior more likely to occur.

Skinner named the process used to investigate these behavior-environment relationships operant conditioning. Skinner called the behavior in this process operant behavior because it operates or acts on the environment, thus producing consequences or changes in that environment. Consequences in turn affect the behavior for the future. Skinner was able to detect the relationship between present consequences and future behavior by observing and measuring the behavior of interest over long periods of time, a method he used initially with rats and later with pigeons. The behavior was observed both at the time that the attendant consequences occurred and continuously subsequent to the consequences.

Skinner observed two effects of consequences on the future strength of behavior. Some consequences reinforced the behavior, thus strengthening it, while other consequences punished the behavior, thus weakening it. It is important to note that for Skinner and his followers, the consequences of behavior that serve as reinforcers or punishers are defined only in terms of their effects on the future strength of a behavior. Events or things in themselves are not reinforcers or punishers. For example, a harsh command to a learner in the classroom (“Sit down and get to work!”) is assumed by many teachers to “punish” wandering around the room and inattentiveness to seatwork. Yet in countless instances the teacher’s consequence serves only to strengthen or maintain the learner’s wandering and inattentiveness. In this case, the teacher’s remarks function as a reinforcer irrespective of what the teacher believes.

Skinner also showed that once a behavior has been acquired and was maintained, the occurrence of the behavior can be made more or less probable by the presentation or removal of events that precede the behavior. These antecedent events—for example, the ringing of a telephone—have been reliably present when one picks up the telephone and says “Hello.” On the other hand, if one picks up the telephone and says “Hello” when the telephone has not rung, the voice of another person responding to the greeting is extremely unlikely. The term for this process is stimulus control, defined as the effect that events preceding a behavior can have on the likelihood of that behavior occurring. Stimulus control comes about because of the presence of particular events when a behavior is reinforced.

The Causes of Behavior

For Skinner, the causes of behavior lie in humans’ genetic endowment and the environment in which they live. The specific ways in which the environment causes behavior can be seen in the experimentally derived principles noted previously.

Skinner’s approach differs sharply from most psychological theories, which put the causes of behavior inside the person. Skinner believed that these internal causes were not scientific explanations but rather behaviors themselves in need of explanation, or else explanations taken from disciplines other than psychology.

Skinner regarded the “mind” as an unscientific explanation because of its status as an inference from the behavior that it was supposed to explain. While psychological theory has, since the 1970s, redefined the mind in two broad ways, Skinner noted that the redefining did not solve the problems posed by the requirements of science. In one definition, mental processes became cognitive processes, a metaphor based on computer operations; humans are said to “process” information by “ encoding, decoding, storing, and retrieving” it. However, all these hypothesized activities remain inferences from the behavior that they are said to explain. There is no independent observation of these hypothetical activities.

In the other definition, the mind was translated to mean the brain, which can be studied scientifically. Thus, the physiology of the brain is thought to explain behavior. Neither Skinner nor other radical behaviorists deny the role of the brain in a complete understanding of behavior. However, psychology and brain physiology look for the causes of behavior at different levels of observation. Psychology is viewed as a separate discipline with its own methods of scientific investigation leading to the discovery of distinct psychological explanations for behavior. In addition, research results suggest that rather than brain physiology explaining behavior, changes in both behavior and the brain appear to result from changes in the environment. Changes in behavior are correlated with changes in the brain, but changes at both levels appear to be the result of the environment.

Thoughts and feelings are also considered to be causes of behavior. One thinks about talking with a friend and then goes to the telephone and dials the number. These two people talk together on the telephone regularly because they feel affection for each other. Yet the “thinking” or “feeling” referred to as causes for the actions involved in dialing the telephone and talking with each other are themselves viewed as responses in need of explanation. What gave rise to thinking in early development, and what now makes thoughts of this particular friend so strong? How have feelings of affection become associated with this friend? From the radical behaviorist perspective, both the thoughts and the feeling are explained by the principles of operant or classical conditioning.

Radical Behaviorism and Complex Human Behavior

Some of the facts of human experience include talking, thinking, seeing, problem solving, conceptualizing, and creating new ideas and things. A common point of view holds that behaviorism either rejects or neglects these aspects of human experience. However, a fuller reading of Skinner’s works reveals that he offered a serious examination of these topics and demonstrated that behavioral principles could account for their presence in the repertoire of human behavior.

For example, Skinner’s examination of verbal behavior resulted in his book Verbal Behavior (1957), in which he showed that behavioral principles are capable of explaining the acquisition and continuation of behaviors such as talking, reading, and thinking. Basic processes such as imitation, reinforcement, shaping, and stimulus control are all shown to have likely roles in the various aspects of verbal behavior.

Behaviorism’s analysis of verbal behavior is directly related to the more complex forms of human behavior often referred to as higher mental processes. For example, radical behaviorism views thinking as an activity derived from talking out loud. Parents and teachers encourage children to talk to themselves, initially by encouraging whispering, then moving the lips as in speaking but without making sounds. What results, then, is talking privately, “in our own heads.” In a similar fashion, a parent asks a child to “think before you act” and a teacher asks learners to “think through” the solution to a problem in mathematics or ethics. The social environment thus encourages people to think, often shows them how to do so, and then reinforces the behavior when the overt results of their thinking are praised or given high scores.

More complex behavior-environment relationships, such as those found in concept formation, have also been analyzed in terms of the principles of behaviorism. The term “concept” is defined as a characteristic that is common to a number of objects that are otherwise different from one another. People are said to have concepts in their heads that produce the behaviors they observe. A radical behavioral analysis, however, views concepts as the appropriate response to the common characteristic. The appropriate response has been reinforced only when it occurs in the presence of the specific characteristic. For example, a child is said to understand the concept of “red” when the child reliably says “red” in response to the question “What color are these objects?” in the presence of a red hat, red fire truck, red tomato, and red crayon.

Applications of the Principles of Behaviorism

The behaviorism of Watson has resulted in applications in psychology and many other disciplines, most notably in the form of the psychological treatment known as systematic desensitization, created by South African psychiatrist Joseph Wolpe. Systematic desensitization was designed to reverse the outcome of the classical conditioning process, in which extremely intense negative emotional responses such as fear or anxiety are elicited by everyday aspects of the environment. Such an outcome is referred to as a phobia. The treatment first requires training in relaxation. The second component of treatment takes a person through a hierarchy of steps, beginning with a setting very distant from the feared stimulus and ending with the problem setting. At each step, the individual is asked to signal when he or she experiences fear or anxiety and then is instructed to relax. Movement through the hierarchy is repeated until the person can experience each step, including the one that includes the feared stimulus, and report feeling relaxed at every step. This treatment has been employed both in the clinic and in real-life settings. Systematic desensitization has been shown to be an effective intervention for fears associated with dental treatment and flying, for example, as well as the intense anxiety that accompanies social phobia and panic disorder.

Another application of Skinner’s behavioral principles is the field of applied behavioral analysis, which was introduced first in educational settings. Applications in education have occurred at every level, from preschool to university classrooms. Equally important has been repeated successful application to learners with autism, severe and profound delays in behavioral development, and attention-deficit disorder, both with and without hyperactive behavior.

Applications of behavioral principles have been shown to be effective across behaviors, settings, individuals, and teachers. They have also been shown to be effective in reducing behaviors that pose a threat to public health, including smoking, overeating, essential hypertension, and domestic violence. Finally, behavioral principles have found application in the arena of public safety. For example, researchers using techniques based on Skinner’s science of behavior have increased seat-belt usage by automobile drivers.

Bibliography

Alberto, Paul A., and Anne C. Troutman. Applied Behavior Analysis for Teachers. 9th ed. Boston: Pearson, 2013. Print.

Baum, William J. Understanding Behaviorism: Behavior, Culture, and Evolution. 2nd ed. Malden: Blackwell, 2005. Print.

Johnson, Kent R., and T. V. Joe Layng. “Breaking the Structuralist Barrier: Literacy and Numeracy with Fluency.” American Psychologist 47.11 (1992): 1475–90. Print.

Ledoux, Stephen F. "Behaviorism at 100." American Scientist Jan.–Feb. 2012: 60–65. Print.

Moore, Jay. "Three Views of Behaviorism." Psychological Record 63.3 (2013): 681–91. Print.

Nye, Robert D. The Legacy of B. F. Skinner: Concepts and Perspectives, Controversies and Misunderstandings. Pacific Grove: Brooks, 1992. Print.

Pierce, W. David, and Carl D. Cheney. Behavior Analysis and Learning. 5th ed. New York: Psychology, 2013. Print.

Skinner, B. F. About Behaviorism. 1974. London: Penguin, 1993. Print.

Skinner, B. F. Walden Two. 1948. Indianapolis: Hackett, 2005. Print.

Staddon, John. The New Behaviorism. 2nd ed. New York: Psychology, 2014. Print.

Watson, John B. Behaviorism. Rev. ed. Chicago: U of Chicago P, 1930. Print.

In Invisible Man, chapter one, which was originally published before the rest of the novel as a short story called “Battle Royal,” can be seen...

The Battle Royal section of Ralph Ellison’s Invisible Man does in fact serve as a rite of passage and an initiation into an unequal American society for the young, unnamed protagonist. The Battle Royal functions this way because the young man gets his first taste of violent discrimination. This section foreshadows the violence that runs throughout the novel, the violence that will mark the better part of the protagonist’s life:

“So I gulped it down, blood, saliva and all, and continued. (What powers of endurance I had during those days! What enthusiasm! What a belief in the rightness of things!).... I closed my ears and swallowed blood until I was nauseated” (30).

He does not realize it at the moment, but the violence he faces in this passage is an initiation into his brutal realities as an “invisible” man, as a black man marginalized by society. The narrator acknowledges this in his parenthetical asides in this passage.

Moreover, the ceremonial feel of the scene imitates rites of passages such as graduations. Indeed, at the battle royal, the narrator gives the same speech that he gave at his high school graduation:

“On my graduation day I delivered an oration in which I showed that humility was the secret, indeed, the very essence of progress.... It was a great success. Everyone praised me and I was invited to give the speech at a gathering of the town's leading white citizens. It was a triumph for our whole community.” (17).

This is a mocking graduation ceremony in which young black men assault one another for wealthy white men’s entertainment, and the perverse pomp and circumstance that surrounds the event highlights the ceremonial feel of the battle royal.

Thus, this opening chapter functions as both a rite of passage and an initiation ceremony in that it prepares the narrator for the struggles that he will experience as a young black man in a racially stratified society.

"Oh, that I had forever remained in my native wood, nor known nor felt beyond the sensations of hunger, thirst, and heat!" How does this statement...

This passage enlightens the theme of creation by Man as God. As God created Adam, gave him life, and placed him in the Garden of Eden, Victor Frankenstein brought his Creature to life, allowing him sensations as well as a spirit, and the Creature eventually finds himself alone in the woods, his own Garden of Eden. But in Victor’s case, he deserted his creation. As Adam and Eve ate from the Tree of Knowledge of Good and Evil, the Creature learned to know what kind of world he lived in, and what fellow creatures were in that world with him. However, in keeping with the Enlightenment theory of tabula rasa, that people are born a “blank slate” and it is the environment and society that teach us good and evil, the Creature started out as blank though basically good. He expected good in the world, but all he found was rejection and hate. In other words, it is Victor Frankenstein who is the monster, not the Creature. The Creature simply reflected back on the world what the world gave him. He recognizes that it would have been better if he had never been brought to life, both for himself and for others.

What are Koch's postulates?

Definition

Koch’s postulates are a set of experimental guidelines used to determine if a particular microorganism is the causative agent of a particular disease.

Historical Overview

In the nineteenth century, Robert Koch, a German physician and
bacteriologist, played a significant role in determining the etiology (cause) of
an infectious disease. Through his work with Bacillus anthracis
(the causative agent of anthrax), he linked a specific
microorganism to a specific infectious disease. Koch conducted experiments showing
that B. anthracis was always present in diseased animals, that
healthy animals inoculated with the bacterium would develop the disease, and that
cultivation of the bacterium in artificial media followed by inoculation resulted
in the disease.

Koch also discovered the causative organisms for several other diseases,
including tuberculosis and cholera. In describing the etiology of
tuberculosis, Koch proposed a set of guidelines for establishing a cause and
effect relationship between a given microorganism and a specific disease. These
scientific criteria are known as Koch’s postulates.

The Postulates

Koch’s postulates are a set of four experimental criteria used to establish the
etiology of a disease. The first criterion states that the pathogen must
be present in all infected persons and absent in all healthy persons. The second
criterion states that the pathogen must be isolated from the diseased person and
cultivated in the laboratory. The third criterion states that the cultivated
pathogen must cause the disease in a healthy person after inoculation. The fourth
criterion states that the pathogen must be isolated again from the infected person
and identified as identical to the original isolate.

Exceptions

There are some exceptions to Koch’s postulates. Certain pathogens and
fastidious microorganisms have complex and unusual growth requirements and can
survive only within living host cells. Such microorganisms cannot be cultured on
artificial media. Numerous pathogens infect a specific species only while others
become transformed in vitro. Some infectious diseases have unclear origins while
others cause multiple disease conditions. Many infections develop from the
combined effects of several different microorganisms. Various diseases do not
originate from a microorganism and may be the result of poor nutrition,
chromosomal abnormality, organ failure, or environmental influences. These
exceptions have stimulated the need for modifications to Koch’s postulates.

Impact

Koch’s contributions were invaluable in the advancement of medical microbiology and in the understanding of the nature of a disease. Koch’s postulates still provide the essential principles for determining the causative agents of emerging infectious diseases and the basic foundation within which to address disease and public health.

Bibliography

Daniel, Wayne W. Biostatistics: A Foundation for Analysis in the Health Sciences. 9th ed. Hoboken, N.J.: John Wiley & Sons, 2009.

Engelkirk, Paul G., and Gwendolyn R. W. Burton. Burton’s Microbiology for the Health Sciences. 8th ed. Baltimore: Lippincott Williams & Wilkins, 2007.

Hardy, Simon P. Human Microbiology. New York: Taylor and Francis, 2003.

Murray, Patrick R., Ken S. Rosenthal, and Michael A. Pfaller. Medical Microbiology. 6th ed. Philadelphia: Mosby/Elsevier, 2009.

Straus, Eugene, and Alex Straus. Medical Marvels: The One Hundred Greatest Advances in Medicine. Amherst, N.Y.: Prometheus Books, 2006.

Tortora, Gerard J., Berdell R. Funke, and Christine L. Case. “Koch’s Postulates.” In Microbiology: An Introduction. 10th ed. San Francisco: Benjamin Cummings, 2010.

How are the ideas of Rousseau influencing our world today?

Jean-Jacques Rousseau (1712-1778) was an important political thinker who was very influential in the Enlightenment movement. His greatest impact on the world today has to be his influence on democratic government. He believed that people granted the government some of their personal freedoms in exchange for the safety and security that a government can provide. This is known as social contract theory. Rousseau also believed in individual freedoms and felt a government must work for the people in protecting civil liberties. These theories were presented in his seminal work, The Social Contract (1762).

It should also be mentioned that Rousseau believed that morality and virtue were being corrupted by the progression of science and technology. These ideas were presented in an earlier work called Discourse on the Arts and Sciences (1750). This is an important concept for today's society as people meet the challenge of adapting to a rapidly evolving digital world. This may be an area to explore further in answering this question. Over time, it is amazing how much things change, but at the same time remain the same.

What are three contrasts between Marc Antony and Brutus?

Antony is opportunistic, ambitious and ruthless, while Brutus is optimistic, honorable and naïve.

Antony wants power.  Although he was loyal to Caesar, he took advantage of his death easily and quickly.  Brutus is not at all power-hungry.  He only cares about Rome.  He believes that he can protect Rome from Caesar by killing Caesar.

Antony is ruthless.  He is willing to kill anyone to get what he wants.  A good example of this is the proscription, where he easily condemns men to exile and death, even family members.  Antony does not think twice, because it is what needs to be done to win the war.

Brutus, on the other hand, believes in limiting violence to what they must do.  He wants Caesar’s death to be clean and seem like a tyrant-killing and not a murder.  Killing a tyrant is justified, in Brutus’s mind.  He believes they are liberators and the Romans are slaves to Caesar.

Let us be sacrificers, but not butchers, Caius.
We all stand up against the spirit of Caesar;
And in the spirit of men there is no blood:
O, that we then could come by Caesar's spirit,
And not dismember Caesar! But, alas,
Caesar must bleed for it! (Act 2, Scene 1)

Antony is not naïve.  He takes action when he needs to.  He carefully whips the crowd into a frenzy at Caesar’s funeral, and makes sure that he trades on their affection for Caesar.  Antony realized that Octavius might be a problem. He made sure he was not there when he gave the speech.  He did not want to share the credit.  Brutus had no idea that this would happen.  He made a mistake in leaving Antony alive, and a bigger one in not listening to Cassius and letting him speak at the funeral. 

Antony acknowledges that Brutus is honorable.

This was the noblest Roman of them all:
All the conspirators save only he
Did that they did in envy of great Caesar;
He only, in a general honest thought
And common good to all, made one of them.
His life was gentle, and the elements
So mix'd in him that Nature might stand up
And say to all the world 'This was a man!' (Act 5, Scene 5)

In many ways, Antony and Brutus are opposites.  Brutus is an optimist, thinking things will turn out okay.  Antony takes advantage of opportunities as soon as they arise.  For all of Brutus’s nobility, Antony is ambitious.  He hopes to gain personally from his rise to power.  Antony is also ruthless, willing to do whatever it takes while Brutus naively tries to do the right thing.

What is audiology?

Science and Profession

The field of audiology has become an indispensable adjunct in the objective diagnosis of hearing loss and auditory disorders. The scope of audiology practice is rather extensive and includes broad categorical services. According to the US Department of Labor, the audiologist “specializes in diagnostic evaluation of hearing, prevention, habilitative and rehabilitative services for auditory problems and research related to hearing and attendant disorders.” Among other functions, the audiologist
determines range, nature, and degree of hearing function . . . using electroacoustic instrumentation; . . . coordinates audiometric results with other diagnostic data, such as educational, medical, social, and behavioral information; . . . differentiates between organic and nonorganic hearing disabilities through evaluation of total response pattern and use of acoustic tests; . . . [and] plans, directs, conducts, or participates in conservation, habilitative and rehabilitative programs, including hearing aid selection and orientation, counseling guidance, auditory training, speech reading, language rehabilitation, and speech conservation.

Audiologists may have primary affiliations in private practice, clinics and hospitals, military installations, universities and colleges, or public and private school systems.

Because of the significant advances that have been made in providing differential diagnosis of impaired auditory behavior, the number of institutions providing audiology programs increased dramatically in the latter half of the twentieth century. Although the highest degree offered in audiology at many institutions is the PhD, a number of schools offer a professional doctorate of audiology, which stresses clinical diagnosis, auditory prosthetic evaluation, and rehabilitative practice.

A number of professional audiology organizations exist to provide resources and support to those in the field. The membership of the American Speech-Language-Hearing Association (ASHA) consists of speech pathologists and audiologists, with the former having significantly greater numbers. In 1988, James Jerger and other prominent audiologists in the United States formed the American Academy of Audiology. Its members consist exclusively of audiologists holding a master’s or PhD degree in that field.

Diagnostic and Treatment Techniques

One of the most common services associated with the practice of audiology is the basic assessment of the auditory system relative to pure-tone air conduction thresholds. This is a procedure in which the patient’s ability to detect the presence of a tone delivered through earphones or a speaker is determined. Additionally, speech threshold detection is determined by assessing the patient’s ability to identify correctly 50 percent of a list of two-syllable words. Measurements of the acoustic reflex provide information about hearing loss, as do reflex-eliciting auditory tests. The acoustic reflex is the contraction of the stapedial muscle produced by a strong acoustic signal. The strength of the response and the level at which it is elicited are important diagnostic indicators of system malfunction, as is the absence of a reflex response. The degree to which the reflex response deviates in morphology and amplitude from normal is diagnostically significant. Communication handicap inventories also are an essential part of the basic assessment procedure. Such inventories provide useful information as to the degree of social handicap as a concomitant part of hearing impairment. Serial communication inventories serve as indicators of the effectiveness of habilitative or rehabilitative programs designed to enhance communicative skills. The term “basic” is applied to indicate a routine assessment of auditory function. Basic assessment does not provide the preponderance of clinical evidence needed to determine the site of injury or disease or to suggest its medical or surgical management.

Another service associated with audiology is an extended evaluation of the auditory system, which is composed of all anatomical structures that contribute to human hearing. Such an evaluation may include the determination of air conduction, bone conduction, and speech thresholds, as well as the administration of word and sentence recognition tests. Air conduction tests are performed by placing calibrated headphones over the patient’s ears and presenting a broad range of discrete frequencies. In practice, that frequency range extends from 250 to 8,000 hertz. Even though the normal human ear is capable of perceiving a much broader frequency range (from 20 hertz to 20,000 hertz), the range between 250 hertz and 8,000 hertz contains all the essential frequencies needed to understand speech. Bone conduction thresholds are determined by placing a vibrator, or bone oscillator, at the mastoid bone and presenting the same frequency range. Often, differences in the patient’s response to air-conducted and bone-conducted signals provide essential diagnostic information and suggest the site of injury or disease.

Speech threshold and word or sentence evaluations provide the clinician with performance scores that indicate the degree to which speech understanding has been compromised by the hearing disorder. Such measurements also indicate the probability of understanding connected discourse in communicative situations. There are a number of speech tests that provide information about the status of the auditory system. The most commonly used speech stimuli are two-syllable words to determine an individual’s speech reception threshold and one-syllable words to assess the auditory system’s discrimination function.

Another standard audiological practice is a comprehensive behavioral evaluation to determine the sensorineural site of lesion, that is, the place in the auditory system from which the hearing disorder originates. For most hearing disorders affecting auditory performance, it is critical that this site be located. It may be found in the peripheral system (the cochlea), which contains specialized sensory tissue that responds to sound pressure changes. The problem could also lie in the ascending auditory pathway, including its terminal projection in the auditory cortex of the brain. To arrive at an accurate diagnosis, the audiologist employs a number of advanced tests, such as sophisticated acoustic reflex tests, tests of frequency discrimination (the ability to detect differences between two or more signals), tests of intensity discrimination, and tests of auditory adaptation. The latter is a clinical procedure in which one determines whether a continuous sound decays over time to the point of inaudibility; such abnormal decay of the test signal indicates possible malfunction of the neural pathway of the auditory system. The results of these several tests increase significantly the probability that the site of lesion can be found.

One of the most promising clinical advances in audiology has been the development of evoked response audiometry (ERA). ERA is best defined as the measurement of neuroelectrical activity generated in the brain stem or of higher orders of brain function elicited by an acoustic signal. Acoustic signals, clicks, and tone pips are submitted to the external auditory ear. If the signals are detected by the auditory system, there is a change in neuroelectrical activity for each signal presented. A computer stores these minute changes in activity. When a sufficient number of acoustic signals have been processed, the computer prints out a response pattern consistent with the transmission of the electrical response from cochlear and subsequent responses as the signal travels to the brain. Response patterns have been classified as first (from the cochlea, zero to two milliseconds), fast (from the acoustic nerve and auditory brain stem, two to ten milliseconds), slow (from the primary and secondary areas of the cerebral cortex, fifty to three hundred milliseconds), and late (from the primary and associated areas of the cerebral cortex, more than three hundred milliseconds). More recent terminology of these time-related events refers to them as early, middle, and late responses.

Evoked potential measurement is significant because it offers a method of auditory assessment for those patients unwilling or unable to give reliable voluntary responses to acoustic stimuli. For example, evoked response audiometry provides a means of detecting hearing impairment in the neonate and very young. It also provides a clinical method of determining normal or abnormal hearing function for those who are intellectually disabled. Evoked responses to acoustic stimuli aid in the diagnosis of various types of tumors or neuromas that affect the transmission of auditory signals to the brain. If such lesion sites are detected early, it may be possible to remove them surgically and save the patient’s hearing. Certainly, early detection of retrocochlear pathology increases the probability that surgical intervention will preserve auditory system performance.

In 1978, D. T. Kemp published a germinal paper identifying the presence of otoacoustic emissions. Spontaneous emissions are generated within the cochlea and can be measured by a probe microphone assembly inserted into the external ear canal. Not all individuals have spontaneous otoacoustic emissions that can be measured by current probe microphone systems. Evoked otoacoustic emissions can be measured, however, in individuals having normal hearing or hearing loss of no more than forty to forty-five decibels. Such emissions are evoked by presenting a series of clicks or other compatible acoustic stimuli to the patient’s auditory system. The cochleomechanical activity induced by these acoustic signals is “picked up” by a probe microphone and processed by a computer. The graphic information obtained has proven to be of significant benefit in the screening of neonates and the very young. The literature would seem to suggest that otoacoustic emission measurement is fast, reliable, and repeatable. Research is under way to assess the range of losses that can be measured and the most appropriate stimuli to be employed in order to gain specific bits of information about cochlear behavior.

Auditory prosthetic evaluations have become common practice in audiology. When tests for hearing function determine that a hearing impairment exists, medical referral is mandatory for appropriate clinical management. For a sizable number of hearing-impaired individuals, however, medical or surgical intervention will not alter the hearing loss. For cases in which hearing impairment is a permanent sensorineural condition, a hearing aid or assistive listening device (or both) is often the preferred treatment modality in the rehabilitative process. To determine the appropriate electroacoustic characteristics of the hearing aid device to compensate best for the hearing deficit, special tests are conducted. Such tests may measure differences in word and speech understanding with and without the hearing aid. Another important test measures the degree of comfort or discomfort resulting from the sound level that is produced by the hearing aid device; if such a test is not performed, the patient may reject the hearing aid because it is too loud and unpleasant. Other tests designed to help determine the appropriate level of amplified sound involve narrow-band noise thresholds and various environmental sounds to which the patient may be periodically exposed during the activities of daily living. The use of environmental sound recordings provides the audiologist with objective indications of the electroacoustic responses that will yield maximum speech discrimination in the presence of specific background noises.

Audiology has helped many children and adults with hearing impairment through the use of hearing aids and the practice of aural rehabilitation. The selection and fitting of hearing aid devices have become important parts of the professional responsibilities of the clinical audiologist. With the many advances in hearing aid technology that have occurred, the audiologist has been given a much broader array of electroacoustic devices from which to select the one that offers the best correspondence with a patient’s needs. For example, some commercial hearing aid systems can be digitally programmed to meet the specific acoustic requirements of the hearing-impaired individual. In some cases, programmable hearing aids provide more than one acoustic response at the immediate command of the user. Should the device fail to meet the acoustic requirements of the patient, it can be reprogrammed in a short period of time to achieve a better correlation with the patient’s need for amplification.

Auditory (aural) rehabilitation is also of clinical concern to the audiologist, and a major branch of audiological practice is in this field. In this context, rehabilitation refers to the development and conduct of special programs to assist the hearing impaired in using and understanding verbal language (speech) more efficiently. For example, for those children born with a severe auditory deficit, the early introduction of aural rehabilitation programs is of paramount importance to the development of verbal language. Consistent with the development of rehabilitation programs is the early detection of hearing impairment that cannot be ameliorated by surgical or medical intervention. From a rehabilitative point of view, early introduction of hearing aid amplification and supportive auditory and speech-reading training programs have been of inestimable value in speech and language development for the hearing-impaired child. In some of the major school systems throughout the United States, there is an “educational audiologist” whose task it is to develop and maintain special programs intended to assist hearing-impaired children.

Equally as important are auditory rehabilitation programs for the hearing-impaired adult. Hearing impairment is a rather insidious phenomenon, gradually worsening over time. Consequently, adult patients are somewhat unaware of hearing loss until they fail to recognize enough of speech sounds to understand intended messages. When speech understanding has been degraded by hearing impairment, rehabilitative programs stress the use of hearing aid amplification and the value of speech reading. Training programs may assist the adult in learning speech-reading skills or in adapting to a hearing aid device. It is important that the audiologist be aware of attitudes or behaviors that may restrict or limit a patient’s acceptance of and participation in programs designed to assist the hearing impaired.

Perspective and Prospects

Audiology, as a recognized academic discipline, originated during World War II. At that time, thousands of military personnel needed diagnostic and rehabilitative services for ear injuries incurred during active service. It was essential that an organized program be developed to meet the demand. Several military hospitals and selected universities and colleges undertook the task of developing programs to accomplish these diagnostic and rehabilitative tasks. One of the first textbooks dealing exclusively with audiological practice was authored by Hayes Newby in 1958, while he was teaching at Stanford University. Since that memorable introduction, hundreds of special texts have been published relative to various aspects of audiological practice.

Since the early pioneering days during World War II, the field of audiology and the clinical skills of audiologists have expanded appreciably. Significant advances in auditory disorder diagnosis and in prosthetic and rehabilitative care have been made. Although audiology is a relatively new academic and professional discipline, its contributions to the understanding and treatment of auditory system disorders have greatly advanced the understanding of its role in human communication.

Bibliography

Alpiner, Jerome G., and Patricia A. McCarthy, eds. Rehabilitative Audiology: Children and Adults. 3d ed. Philadelphia: Lippincott Williams & Wilkins, 2000.

Gelfand, Stanley A. Essentials of Audiology. 3d ed. New York: Thieme, 2009.

Hall, James W. Introduction to Audiology. Boston: Allyn & Bacon, 2013.

Jerger, James, ed. Pediatric Audiology. San Diego, Calif.: College-Hill Press, 1984.

Katz, Jack, ed. Handbook of Clinical Audiology. 6th ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins, 2009.

Lubinski, Rosemary, and Carol M. Frattali, eds. Professional Issues in Speech-Language Pathology and Audiology. San Diego, Calif.: Thomson/Delmar Learning, 2007.

Madell, Jane R., and Carol Flexer. Pediatric Audiology Casebook. New York: Thieme, 2011.

Mendel, Lisa Lucks, Jeffrey L. Danhauer, and Sadanand Singh. Singular’s Illustrated Dictionary of Audiology. San Diego, Calif.: Singular, 1999.

Newby, Hayes, and Gerald Popelka. Audiology. 6th ed. Englewood Cliffs, N.J.: Prentice Hall, 1992.

Roeser, Ross J. Roeser's Audiology Desk Reference. 2d ed. New York: Thieme, 2013.

What are mouth infections?

Definition

Infections of the mouth can range from minor to severe to life-threatening. They occur when the natural protective mechanisms of the oral cavity are breached. Organisms that cause mouth infections are those that normally reside in the oral cavity and those that have been introduced from other sources.

The healthiness of a person’s immune system, the integrity of natural
barriers, and the infectious capacity of the organism determine if an
infection will occur. Resident and foreign mouth
microorganisms can infect the tongue, gums, the roof of the mouth, tooth-supporting structures, and the inner lining of the cheeks and
lips (buccal mucosa). These infections are most often localized to the mouth but
can also spread to other areas of the body, including the heart. Mouth infections
are classified as fungal, viral, or bacterial.

Causes

Fungal
infections of the mouth include the infections listed
here.

Superficial oral infections. The most common fungus to cause
mouth infections is the Candida species. This fungus normally
resides in the mouth and invades the protective barriers when opportunities arise.
The most common species are C. albicans, C.
galbrata, and C. tropicalis. The resulting fungal
infection, thrush or pseudomembranous candidiasis, appears as
cream-colored patches on the tongue, buccal mucosa, or palate. Wiped-off patches
reveal surface redness. Hyperplastic candidiasis is a chronic superficial
infection that cannot be easily wiped away. Erythematous candidiasis appears as
red patches most commonly found on the roof of the mouth or under the tongue.
Angular cheilitis (perleche) affects the corners of the mouth, causing redness and
cracking of the skin.

Noncandidal fungal infections. These fungal infections tend to
deeply penetrate the mucosal layers of the mouth. They have the potential of
causing damage to oral tissue, and their presence typically indicates that the
body has other infections. Aspergillosis is the second most common
fungal mouth infection; it is caused by the Aspergillus group of
fungus. Aspergillosis is evidenced by ulcers on the roof of the mouth. The most
common species of Aspergillus that cause mouth disease are
A. flavus, A. terreus, and A.
fumigates. Histoplasmosis (Histoplasma capsulatum),
cryptococcosis (Cryptococcus neoformans), blastomycosis
(Blastomyces dermatitidis), zygomycosis
(Rhizopus), geotrichosis (Geotrichum
capitatum), and coccidioidomycosis (Coccidioides
immitis) are rare fungi that cause infections in the deep layers of
the mouth. These fungi can cause life-threatening illnesses. All but geotrichosis
appear as ulcers or nodules on the interior walls of the cheek, tongue, or roof of
the mouth. Much like Candida, geotrichosis infections appear as
cream-colored patches.

Bacterial mouth infections include the infections listed here.

Oral mucosal infections. Although hundreds of types of bacterial
organisms can potentially cause oral mucosal infections, there are several that
are most common. Streptococcus, Bacteroides,
Peptostreptococcus, oral anaerobic bacteria, and gram-negative
bacilli are the most common organisms that cause oral mucosal infections.

Gangrenous stomatitis. Gangrenous stomatitis, also known as noma, is a rapidly spreading infection of oral and facial tissues typically found in the presence of debilitating illnesses. Caused by multiple bacteria, this infection begins as a small vesicle found on the gum. Ulceration of the deeper layers causes eventual destruction of the mouth, facial tissues, and bones. Several types of bacteria can cause this polymicrobial disease, but the most commonly isolated organisms are Fusobacterium nucleatum, Borrelia vincentii, and Prevotella melaninogenica.

Oral syphilis. Syphilis is a sexually transmitted
disease caused by the bacterium Treponema pallidum. Oral lesions
are a manifestation of this systemic disease. In the primary form of the disease,
ulcers of the lips and tongue develop. Secondary syphilis rarely produces oral
ulcerations and is most likely to manifest as flat or raised red patches on the
roof of the mouth or tongue. Nodular lesions are rare and can be mistaken for
oral
cancer. Tertiary syphilis can gives rise to a rare mouth
lesion called gumma. Gumma is a painless mass that is surrounded by inflamed
tissue and forms on the tongue or on roof of the mouth. Uncommonly, gumma may
erode into oral blood vessels.

Oral tuberculosis. Caused by Mycobacteria tuberculosis, oral tuberculous lesions are rare. They may present as single ulcers or as a small mass on the gums or tongue. Difficult to diagnose, oral tuberculosis may invade and cause destruction to the bones of the face.

Bacterial salivary gland infections (sialadenitis). Located in
the cheeks at the angle of the jaw and under the tongue, the salivary
glands may become infected with bacteria, causing pain and
swelling. Although dozens of bacteria can cause salivary gland infections, the
most common are Staphylococcus aureus, Prevotella, Porphyromonas,
Fusobacterium, and Peptostreptococcus.

Bacterial gingivitis. Gingivitis is a common gum infection
caused by poor oral hygiene. Most commonly caused by
Streptococccus and Actinomyces, bacterial
gingivitis causes discoloration and thickening of the gums. A more severe form of
gingivitis known as acute necrotizing ulcerative
gingivitis, or Vincent’s angina, causes erosive lesions of the
gums. Prevotella, Fusobacterium,
Tannerella, and Treponema are the most common
varieties of bacteria that cause this form of gingivitis.

Bacterial periondontitis, periodontal abscess, and pericoronitis.
Like gingivitis, poor oral hygiene can lead to bacterial infections of the deep
supporting structures of the teeth. Although periodontitis
is typically an inflammatory disease, a more destructive form of periodontitis
caused by bacteria infiltration can develop, causing breakdown of the supporting
structures of the teeth and, ultimately, tooth loss. Pericoronitis is an infection
under the gum flaps of wisdom teeth or nonerupted teeth. Bacteria can become
trapped under the gums and cause local infection or an abscess. The
most common bacteria causing bacterial periondontitis and pericoronitis are
Actinobacillus, Treponema,
Prevotella, Porphyromona, and
Tannerella.

Viral mouth infections include the infections listed here.

Human herpes viral infections. Herpetic gingivostomatitis (oral
herpes) is the classic cold sore caused by human herpetic
virus 1 (HHV-1). Presenting as small vesicles on lips, gums, or the roof of the
mouth, HHV-1 can be isolated in about 80 percent of adults. Recurrent infections
are triggered by emotional stress, sunlight, and systemic illnesses. Herpetic
stomatitis is a condition in young children that likely represents the initial
herpes simplex
infection, causing fever and blisters on the tongue or
cheeks. Genital herpes(HHV-2) causes lesions similar to HHV-1, although it is less
commonly found in the oral cavity.

Chickenpox and shingles are a result of HHV-3. This
vesicular rash occurs primarily in children age three to six years who have not
been vaccinated for the varicella virus and who are at risk for chickenpox.
Shingles or herpes zoster is the reactivation of the disease in adults, especially
persons age sixty years and older. Herpes zoster rarely occurs in those vaccinated
with the varicella vaccine. The vesicular lesions of shingles occur unilaterally
and localize in an area of the skin corresponding to a spinal nerve.

Mononucleosis is an infectious disease caused by
Epstein-Barr
virus or HHV-4. It infects the salivary glands, causing pain
and swelling. Occasionally, red spots (petechiae) on the roof of the mouth are
seen. Oral hairy leukoplakia is also caused by HHV-4. This disease manifests as
white patches on the sides of the tongue.

Cytomegalovirus infection caused by HHV-5 is typically found
in immunosuppressed persons. Although most commonly asymptomatic, cytomegalovirus
infection can cause swelling of the salivary glands and ulcerative lesions of the
oral mucosa. Oral Kaposi’s sarcoma (KS) shows raised, purple-colored tumors and is
caused by HHV-8.

Human papilloma virus (HPV). Condyloma acuminate is primarily
caused by human
papilloma virus (HPV)-6 and HPV-11. Condyloma, which causes
clusters of warty, pink, or whitish lesions on the tongue, roof of the mouth, and
gums, is seen primarily in the genital area. Focal epithelial hyperplasia, or Heck
disease, is caused by HPV-13 and HPV-32. These contagious lesions manifest as
multiple, smooth nodules and are found most often on the buccal mucosa. Verruca
vulgaris is caused by a variety of HPVs, but HPV-16 is the most common cause.
These contagious lesions manifest as hard, rough, pointy clusters of white lesions
and are found on the tongue, gums, and the roof of the mouth.

Coxsackie virus causes two primary types of disorders in the mouth, namely
hand, foot,
and mouth disease and herpangina.
Hand, foot, and mouth disease manifests as multiple vesicles surrounded by a red
base and are found on the cheeks, tongue, and the roof of the mouth. Herpangina
initially appears as painful small red lesions, which then become vesicles and,
eventually, ulcers. They are found primarily on the cheeks.

Caused by the Rubulavirus genus, mumps are a
viral
infection of the salivary glands of the cheek (parotid
glands). It is seen primarily in unvaccinated or “failed” vaccinated children age
five to nine years. Infected children have the characteristic chipmunk appearance
because of swollen parotid glands. Caused by the Morbillivirus
genus, measles is a highly infectious disease typically seen in
unvaccinated or failed vaccinated children less than five years of age. Koplik
spots are small, white lesions found on the buccal mucosa during the initial
stages of measles infection. Rubella is caused by the
Rubivirus genus. This contagious disease rarely causes mouth
infections. There are, however, cases reported in the literature in which children
have developed red spots on the buccal mucosa.

Risk Factors

Oral fungus infections are opportunistic diseases that mainly occur because of compromised
defense mechanisms. Medications such as corticosteroids, broad-spectrum
antibiotics, tricyclic antidepressants, and
immunosuppressive agents (chemotherapy) can cause superficial oral infections.
Additionally, a high carbohydrate diet, iron deficiency anemia, and ill-fitting
dentures have been implicated in causing oral candida. The noncandidal infections
that cause deeper mouth infections usually occur because of systemic diseases that
cause compromised immune systems. Systemic diseases such as diabetes, thyroid
disease, leukemia, advanced-stage cancer, and acquired immunodeficiency syndrome
(AIDS) allow fungi to grow in the oral cavity. The elderly, pregnant women, and
infants are also at risk of oral fungal infections because of compromised or
inadequate immune responses.

Bacterial oral mucosal and salivary gland infections, like fungal infections,
generally arise because of defective immune systems. The most common cases involve
persons who are undergoing chemotherapy or radiation therapy. Inflammation of the
mucosal surfaces (mucositis) causes a breakdown of the protective surfaces,
opening the door for oral bacteria. Because of compromised systemic defenses in
these diseases, bacterial infections develop. Malnutrition, dehydration, and
unsanitary conditions have been shown to contribute to these infections.

Gum and periodontal infections arise because of poor oral hygiene.
Immunosuppressive drugs, smoking, and systemic diseases such as diabetes, kidney
failure, and cancer increase the severity of disease.

Viral mouth infections can be contracted from person to person through saliva
droplets. Although any person may be at risk for contracting a virus, the
susceptibility and severity of the disease is largely dictated by the health of a
person’s immune system. Chronic disease and medications resulting in diminished
immunity may increase the prevalence and severity of the infection. Although there
are several forms noted worldwide, Kaposi’s sarcoma (KS) is mostly seen in
persons infected with the human immunodeficiency virus (HIV) in
the United States. Organ transplant recipients are also known to develop KS.

Symptoms

Infections of the mouth may cause mucosal redness, ulcerations, bad breath, oral bleeding, altered taste sensation, and facial swelling. More severe symptoms include mouth pain, difficulty swallowing, swollen lymph nodes of the neck, fever, fatigue, and destruction of facial tissue. Respiratory, gastrointestinal, urinary, and cardiac symptoms can result from the spread of bacteria to internal organs.

Screening and Diagnosis

The superficial fungal infections such as those caused by
Candida usually can be diagnosed through examination by a
health care provider. Observation is typically enough to make the diagnosis. In
unclear cases, a swab of the lesions can be sent to a laboratory for
identification. Deep infections should be checked through biopsy. A
culture of fungal lesions helps to direct treatment because antifungal
sensitivities are established through this mechanism.

Diagnosis of a mucosal bacterial mouth infection is achieved by a swab or
biopsy of the lesions. Bacterial and viral infections of the salivary glands,
gums, or periodontal structures are typically made by observation. Imaging studies
such as a computed tomography (CT) scan, magnetic resonance
imaging (MRI), or ultrasound may be needed to determine the
location of infected structures or of abscesses. In severe infections, rapid
determination of the type and location of infection is critical to affective
treatment.

Most viral mouth infections can be diagnosed by observation, but a biopsy or smear of the lesion may be required to identify the virus. Also, antibody levels in the blood may assist in confirming the diagnosis of some viral infections.

Treatment and Therapy

Given that mouth infections can be quite painful, symptomatic relief is important. Analgesics such as acetaminophen and ibuprofen are used for mild to moderate pain. Narcotic pain medication may be needed for severe pain. Oral topical anaesthetics such as dyconine and lidocaine can provide temporary relief of pain.

Superficial oral candidal infections are treated with topical antifungal medications. Nystatin and clotrimazole lozenges, mouth rinses, and creams are typically sufficient. Severe or resistant cases of oral candidiasis are treated with intravenous antiviral medications. Fluconazole, amphotercin B, myconazole, and itraconazole were the first antifungal medications available. Newer antifungal medications such as caspofungin, flucytosine, posaconazole, and voriconazole cause less side effects and more specificity of action against fungal species. Most important in treating fungal infections is treatment of underlying diseases.

Treatment of uncomplicated bacterial infections of the oral mucosa, salivary glands, gums, and periodontal structures is primarily directed at symptomatic relief. Mouth rinses containing antiseptic solutions or anesthetics are helpful in reducing pain and healing time. Complicated infections are treated with the removal of infected or damaged tissues and with antibiotics that are specific to the organism causing infection.

Although most viral oral lesions resolve without treatment, a few exceptions exist. Genital herpes, shingles, and cytomegalovirus are treated with antiviral agents. Oral hairy leukoplakia and condyloma can be treated with topical gels that break down the lesions. Large condyloma, epithelial hyperplasia, and Verruca vulgaris are treated by excision. KS is treated by correction of the underlying immunosuppression with highly active antiretroviral therapy (HAART). Many infected persons, however, need radiation or chemotherapy.

Prevention and Outcomes

The prevention of all mouth infections is achieved largely through the implementation of adequate oral hygiene and sanitary practices, especially when systemic disease is present. One should brush teeth and tongue twice daily; floss once a day; use antiseptic mouthwash once a day; rinse mouth after using antibiotics or other oral medications; visit a dentist for examinations and teeth cleaning twice yearly; wash hands frequently, especially after coming into contact with dirty objects and surfaces; avoid close contact with persons with communicable diseases; avoid or limit alcohol and sugar intake; stop smoking; consider the use of preventive antifungal, antibacterial, or antiviral treatments (persons with compromised immune systems); and complete vaccinations recommended by a physician.

Bibliography

Chow, Anthony W. “Infections of the Oral Cavity, Head, and Neck.” In Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, edited by Gerald L. Mandell, John F. Bennett, and Raphael Dolin. 7th ed. New York: Churchill Livingstone/Elsevier, 2010. A comprehensive guide to the features, diagnosis, and treatment of infections of the mouth, head, and neck

Epstein, Joel B. “Mucositis in the Cancer Patient and Immunosuppressed Host.” Infectious Disease Clinics of North America 21 (2007): 503-522. A study discussing the prevention, diagnosis, and treatment of mouth disease in persons with compromised immunity.

Gordon, Sara C., et al. “Viral Infections of the Mouth.” Available at http://emedicine.medscape.com/article/1079920-overview. A comprehensive review article discussing the pathophysiology, diagnosis, and treatment of viral mouth infections.

Scully, Crispian, and Maria R. Sposto. “Noncandidal Fungal Infections of the Mouth.” Available at http://emedicine.medscape.com/article/1077685-overview. The candida group is the most common type of fungal mouth infection. A review article describing the pathophysiology, diagnosis, and treatment of noncandidal mouth infections.