Normative Values for the Spanish Version of the Voice Symptom Scale (VoiSS)

Objective: The aim of this study was to establish normative values for the Voice Symptom Scale (VoiSS) in the Spanish community population (without voice problems), using a sample from a large area of southeastern Spain. Method: The sample consisted of 115 adults from ages 16 to 87, 60 of whom were women and 55 were men. Participants included the family members of patients who attended the Otorhinolaryngology (ENT) and Speech Therapy Clinic at a referral hospital in the region of Murcia, Spain, and some of the clinic's staff. All the participants reported never having suffered from any voice disorder before. Results: The normative values obtained in this study for the VoiSS were 14.61 (SD=8.18) for the total score, 7.57 (SD = 5.42) for the Impairment subscale, 1.04 (SD = 1.65) for the Emotional subscale, and 5.99 (SD = 3.61) for the Physical subscale. The percentile values were also obtained for the VoiSS scale and for its three subscales. Conclusions: This study presents normative values for the VoiSS scale that have not previously been obtained in Spain. These values can be used as a reference to detect possible voice disorders.

Objetivo: El objetivo de este estudio fue establecer valores normativos para la escala Voice Symptom Scale (VoiSS) en población comunitaria española (sin problemas de voz), utilizando una muestra de un área extensa del sureste de España. Metodología: La muestra estuvo compuesta por 115 personas (60 mujeres y 55 hombres) con edades comprendidas entre los 16 y 87 años. Los participantes eran familiares que acompañaron a los pacientes a las sesiones clínicas de ORL y de Logopedia de un hospital de referencia de la Región de Murcia, así como personal del hospital. Todos declararon no padecer ningún trastorno de la voz. Resultados: Los valores normativos obtenidos en este estudio para el VoiSS fueron 14.61 (SD=8.18) para la puntuación total, 7.57 (SD = 5.42) para la subescala Limitación, 1.04 (SD = 1.65) para la subescala Emocional y 5.99 (SD = 3.61) para la subescala Física. Los valores percentílicos se obtuvieron también para la escala VoiSS y para sus tres subescalas. Conclusiones: Este estudio presenta valores normativos para la escala VoiSS que no han sido todavía obtenidos en España. Estos valores pueden utilizarse como referencia para detectar posibles trastornos de voz.

Audiological, Phonatory and Cardiac Correlates of Individuals Exposed to Low-Frequency Noise or at Risk of Vibroacoustic Disease

Abstract Introduction Low-frequency noise (LFN) is hazardous to hearing. Long-term exposure to LFN may lead to vibroacoustic disease (VAD), which not only affects a specific organ but the physiological function of entire systems, such as the auditory, phonatory, respiratory, and cardiac systems. Moreover, VAD may lead to many psychological problems and hence affect the quality of life. Objective To investigate the adverse effects of LFN on hearing, acoustic and perceptual correlates of the voice, blood pressure, cardiac rate, and anxiety level. Method A total of 20 subjects exposed to LFN and 20 not exposed to LFN were included, and a detailed case history was recorded. The patients were submitted to pure tone audiometry, otoscopic examination, acoustic and perceptual analyses of the voice, maximum phonation time, and an assessment of the s/z ratio. We also assessed blood pressure, and the results of a voice-related quality of life questionnaire and of the Hamilton anxiety rating scale. Results The results indicate that LFN had an adverse impact on the high-frequency threshold. The present study found a significant difference in shimmer and harmonics-to-noise ratio (HNR) values. Few subjects had high blood pressure and showed the sign of anxiety on the Hamilton anxiety rating scale. Conclusion Low-frequency noise has adverse effects on entire systems of the body and causes many psychological issues, which, in turn negatively affect quality of life.

Etiology of Hoarseness of Voice Based on FOL

Background: Hoarseness (dysphonia) is the reason for about 1% of all consultations in primary care. Numerous conditions can cause hoarseness, ranging from simple inflammatory processes to more serious systemic, neurologic, or cancerous conditions involving the larynx. Evaluation of a patient with hoarseness includes a careful history, physical examination, and in many cases, laryngoscopy. This study aimed to analyze the etiology of hoarseness of voice based on a fiberoptic laryngoscope (FOL). Material & Methods: This cross-sectional study was conducted in the Department of ENT, in Bangabandhu Sheikh Mujib Medical College Hospital, Faridpur for 2 years; from January 2017 to December 2018. A total of 75 subjects fulfilling the inclusion criteria were enrolled as study subjects. Data were processed and analyzed using the software SPSS (Statistical Package for Social Sciences) version 11.5. Results: In this study, most of the patients (18, 24.0%) belonged to the age group of 41-50 years, followed by 16 (21.33%) patients in the 61-70 years of age group, and then 15 (20.0%) patients were in 21-30 years of age group. None was from 0-10 years and only 2 (2.66%) patients belonged to the 11-20 years age group. Concerning the sex of the patients, 62 (83.0%) patients were male and the rest 13 (17.0%) were female indicating male predominance. 40 (53.33%) respondents had a smoking habit, and the rest 35 (46.66%) patients did not have a smoking habit. Regarding occupation, most of the patients (24, 32.0%) were farmers, followed by 19 (25.33%) were businessmen, and 10 (13.33%) patients were service holders. Concerning the findings, most of the patients (20, 26.66%) had growth of larynx, followed by 11 (14.66%) patients had polyp/cyst, 10 (13.33%) patients had paresis, 8 (10.66%) patients had nodule, 6 (8.0%) patients had edema, 4 (5.33%) patients had chronic laryngitis, 3 (4.0%) patients had keratosis/leukoplakia and another 3 (4.0%) patients had a phonatory gap. Conclusion: Hoarseness of voice is a symptom, not a diagnosis, and therefore warrants a careful determination of the underlying cause in every case. Fiber optic laryngoscopy was an excellent tool for the diagnosis of hoarseness. Causes of hoarseness included growth in the larynx, polyp/cyst, nodules, edema, chronic laryngitis, keratosis/leukoplakia, and phonatory gaps in this study.

Descritores de qualidade vocal soprosa, rugosa e saudável no senso comum / Descriptors of breathy, rough, and healthy voice quality in common sense

RESUMO Objetivo Identificar os termos referidos pela população em geral para a qualidade vocal saudável, rugosa e soprosa. Métodos foi realizado um teste, de modo presencial, com 50 participantes sem vínculos acadêmicos ou profissionais com a Fonoaudiologia. A tarefa consistia em ouvir três vozes e defini-las livremente. A primeira voz apresentada era predominantemente soprosa; a segunda, predominantemente rugosa e a terceira, vocalmente saudável. Apresentou-se a emissão sustentada da vogal /Ɛ/ e a contagem de 1 a 10. Cada participante deveria responder ao comando: "Ouça essa voz. Com qual termo você a nomearia?", digitando a resposta em uma linha disposta na tela do PowerPoint. Resultados para a voz saudável, o termo que mais se repetiu foi "normal" (36%); outros termos foram: "limpa", "comum", "padrão", "clara", "límpida", "firme", "boa", "som aberto", "definida". Para a voz rugosa, 25 participantes (50%) responderam com o termo "rouca" e os demais se dividiram em termos como "ruidosa", "chiada", "voz de fumante", "grave", "idosa", "cavernosa", "anormal", entre outros termos similares. Para a voz soprosa, 24 participantes (48%) usaram o termo "cansada"; cinco atribuíram o adjetivo "fraca"; três responderam com o termo "sem fôlego"; houve duas correspondências aos termos "arrastada" e "doente" e os demais participantes responderam com termos semelhantes: "exausta", "preguiçosa", "sonolenta", "fatigada" e afins. Conclusão os termos "normal" para voz saudável, "rouca" para voz rugosa e "cansada" para voz soprosa possibilitam a percepção mais usual desses parâmetros clínicos de qualidade vocal, para indivíduos alheios à linguagem técnico-científica da Fonoaudiologia

ABSTRACT Purpose Identify the terms mentioned by the general population for healthy, rough and breathy vocal quality. Methods A test was carried out with 50 participants, in person, without academic or professional ties with Speech Therapy. The task was to hear three voices and define them freely. The first voice presented was predominantly breathy; the second, predominantly rough and the third, vocally healthy. The sustained emission of the vowel / Ɛ / and the count from one to ten were presented. Each participant should respond to the command: "Listen to that voice. Which term would you name it?", Typing the answer on a line displayed on the PowerPoint screen. Results For the healthy voice, the term that was repeated the most was "normal" (36%), other terms were: "clean", "common", "standard", "clear", "clear", "firm", "good", "open sound", "defined". For the rough voice, twenty-five participants (50%) responded with the term "hoarse" and the others were divided into terms such as "noisy", "smoker's voice", "deep", "elderly", "cavernous", "abnormal", among other similar terms. For the breathy voice, twenty-four participants (48%) used the term "tired"; five participants assigned the adjective "weak"; three responded with the term "out of breath"; there were two correspondences to the terms "dragged" and "sick"; and the other participants responded with terms similar: "exhausted", "lazy", "sleepy", "fatigued" and the like. Conclusion The terms "normal" for a healthy voice, "hoarse" for a rough voice and "tired" for a breathy voice, allow a more usual perception of these clinical parameters of vocal quality, for individuals outside the technical-scientific language of Speech Therapy.

Hoarseness due to aortic arch aneurysms

Abstract Objective: To give an overview of the Ortner's syndrome caused by an aortic arch aneurysm. Methods: By comprehensive retrieval of the pertinent literature published in the past two decades, 75 reports including 86 patients were collected and recruited into this study along with a recent case of our own. Results: The aortic arch aneurysms causing hoarseness were most commonly mycotic aneurysms. In this patient setting, in addition to the left recurrent laryngeal nerve, trachea was the most commonly affected structure by the aortic arch aneurysm. Surgical/interventional/hybrid treatments led to a hoarseness-relieving rate of 64.3%, much higher than that of patients receiving conservative treatment. However, hoarseness recovery took longer time in the surgically treated patients than in the interventionally treated patients. Conclusion: The surgical and interventional treatments offered similar hoarseness-relieving effects. Surgical or interventional treatment is warranted in such patients for both treatment of arch aneurysms and relief of hoarseness.

Comparative study of prophylactic dexamethasone versus placebo for reducing post-operative sore throat after tracheal intubation: a prospective, randomised, double blinded clinical study

Background: Tracheal intubation for elective surgical procedures can result in pathological changes, trauma and nerve damage which may account for postoperative sore throat, hoarseness and cough. Dexamethasone is a very potent long acting glucocorticoid with analgesic, anti-inflammatory and antiemetic effects which helps to reduce post-operative sore throat.Methods: A prospective double blinded randomized study was conducted involving 80 patients, dividing them into 2 groups. Group D received dexamethasone 0.1 mg/kg and group S received an equivalent volume of normal saline (placebo) intravenously before induction. Intubation was performed by an experienced anesthesiologist. Anesthesia induction and maintenance dosage were standardized for all patients. The incidence and severity of sore throat, hoarseness and cough were recorded at 1, 6 and 24 hours postoperatively by using four-point scale.Results: The overall incidence of sore throat and hoarseness was significantly reduced in dexamethasone group compared to placebo (normal saline) group. Incidence and severity of sore throat and hoarseness were assessed at 1 hour, 6 hours and 24 hours interval and found out that they were reduced in dexamethasone group compared to placebo group which was statistically significant at all intervals. But incidence and severity of cough reduced significantly only in the first hour. It was comparable at 6 and 24 hours between the groups.Conclusions: Dexamethasone was effective in reducing the incidence and severity of sore throat and hoarseness at 1, 6 and 24 hours. Incidence of postoperative cough was reduced significantly at 1 hour in the dexamethasone group.

A Study on the Outcome of Treatment among Patients with Hoarseness in a Tertiary Care Centre

Hoarseness is defined as the perceived rough, harsh or breathy quality of voice. Since both benign and malignant lesions can produce hoarseness, timely evaluation is very important because delay in the diagnosis of malignancy can adversely affect the outcome. We wanted to study the treatment and its outcome in patients with hoarseness of various aetiologies, and compare the response to treatment between various groups.METHODSThis was a longitudinal study conducted in the Department of ENT in a tertiary care centre in south India. In patients with hoarseness, history was elicited, clinical examination was done, and perceptual evaluation of voice was made using GRBAS (Grade, Roughness, Breathiness, Asthenia, Strain) scale. Direct laryngoscopy and biopsy were done whenever suspicious lesions were seen. Early laryngeal cancer was treated with radiotherapy, while advanced cases were treated with chemoradiation. Other cases were treated with medications, Video Laryngeal Surgery (VLS) or voice therapy, according to the diagnosis. Patients were kept under follow up; reassessment was done after six months regarding improvement/ persistence/ deterioration of previous symptoms. Laryngoscopy and perceptual evaluation of voice were repeated, and the data collected was analysed.RESULTSOn treatment, the lesion subsided completely, and hoarseness got relieved in all the cases of laryngitis, trauma, vocal nodule, vocal polyp and cyst, while the lesion subsided partially, and hoarseness improved in vocal cord palsy, papilloma and carcinoma of glottis. The response to treatment was better in benign lesions when compared to malignant lesions (P value < 0.0001) and better in glottic malignancies when compared to malignancies at other nearby sites (P value <0.001).CONCLUSIONSMost of the benign conditions that caused hoarseness subsided and voice became normal with medications, video laryngeal surgery and voice therapy, while hoarseness persisted to some extent after treatment with radiotherapy or chemoradiation in most of the patients with malignancy.

A Prospective Study to Determine Clinico-Etiological Factors in Hoarseness of Voice.

Hoarseness of voice is a very common symptom and needs thorough clinical examination and investigation to determine the underlying cause in every patient. The spectrum of the symptom ranges from minor infections to life threating malignancies. Acute onset causes may be due to secondary viral infections, voice abuse, smoking, trauma to the larynx during thyroid surgeries. Chronic onset may be due to vocal polyp, vocal cord nodules, laryngeal papillomatosis, laryngeal neoplasms, tumours of the vocal cord, functional dysphonia, smoking, gastro-oesophageal reflux, malignancy of thyroid, oesophagus, lungs and neurological involvement by systemic disease like diabetes and TB. We wanted to evaluate the common causes of hoarseness of voice.METHODSThis was a longitudinal study conducted among 100 patients with benign laryngeal lesions attending the Department of ENT-HNS of Rajarajeswari Medical College and Hospital, from 1st December 2015 to 31st November 2016. A detailed history including information on patient’s demographics, clinical presentation, history of trauma, along with history of associated medical and surgical condition was obtained. A thorough systemic examination and laryngeal examination was done.RESULTSMale:Female ratio was noted to be 1.7:1. Labourers constituted the single largest group of patients comprising of about 36% of cases. Three fourth of patients were from the rural area. Duration of hoarseness ranged from 1 day (acute onset) to 5 yrs. (mean - 3 months). Septic foci in oral cavity and oropharynx were noted in 42% cases. Apart from change in voice other common symptoms were cough, fever and vocal fatigue. Signs of chronic laryngitis were noted in majority of the cases (22%).CONCLUSIONSThe spectrum of etiological factors for hoarseness varies from minor functional voice disorders to major pathological conditions such as malignancy. Septic foci are important predisposing factor for chronic laryngitis.

Clinicopathological Evaluation of the Patients with Hoarseness of Voice.

Hoarseness is one of the commonest symptoms which brings the patient to physician. Any change in quality of voice must be evaluated thoroughly and promptly as it may underlie some infective or neoplastic lesion which can be managed better if diagnosed at an early stage.METHODSThe study was conducted in Pt. J.N.M. Medical College, Raipur, for period of 1.5 years in which 81 patients with hoarseness were selected. After complete general and ENT examination, required investigations were done. Data was collected, tabulated and compared. Out of the total of 81 patients, 58 were males and 23 were females. Carcinoma laryngo-pharynx was found to be the most common cause of hoarseness. Most of the cases were from middle age group i.e. 50 to 60 years. Associated tobacco addiction in any form was very common in all the patients.RESULTSHoarseness of voice can be an alarming symptom in adult patients, particularly when it is present in males with chronic history of addiction. One should be very cautious during investigations as it leads to malignancy most of the time. Early diagnosis and treatment give good prognosis and better outcome to the patient.CONCLUSIONSHoarseness of voice is just a symptom with a very diverse aetiology. Proper diagnosis through detailed history and prompt examination leads to early diagnosis and management as well.

Clinical outcomes of vocal fold immobility after tracheal intubation / 北京大学学报(医学版)

OBJECTIVE@#To assess the incidence of postoperative vocal cord immobility in patients following endotracheal intubation underwent general anesthesia.@*METHODS@#We retrospectively enrolled patients who underwent surgical procedures with endotracheal intubation under general anesthesia from January 2014 to December 2018 in Peking University First Hospital. Demographic and treatment data were obtained for patients with hoarseness and vocal cord fixation. The incidence of postoperative hoarseness and vocal cord fixation were presented and clinical outcomes were further analyzed.@*RESULTS@#A total of 85 998 patients following tracheal intubation and general anesthesia were enrolled in this study. Hoarseness was observed in 222 (0.26%) patients postoperatively. Sixteen patients (73%) were accomplished with symptoms of choking on water, dysphonia and sore throat. Twenty-nine patients with persistent hoarseness on the third postoperative day needed further treatment by otolaryngologists. Among them, seven patients had pharyngolaryngitis and twenty-two patients (0.026%) were demonstrated postoperative vocal cord immobility. There were seventeen patients (77%) with left-side vocal cord fixation and five patients (23%) with right-side vocal cord fixation. Nine patients were identified with arytenoid dislocation. Seven patients had left vocal cord fixation and two patients had right-side vocal cord fixation. Seven patients were intubated under the guidance of visual laryngoscope. One patient was confirmed difficult airway and intubated with light wand. One patient was inserted with laryngeal mask airway. One patient was suspected to have hoarseness caused by gastric tube before anesthesia. One patient showed simultaneously left recurrent laryngeal nerve abnormality on laryngeal electromyography result. The symptom of hoarseness ranged between 6 and 31 days. Three patients underwent closed reduction under local anesthesia and one patient demonstrated spontaneous recovery. Among the remaining thirteen patients with vocal cord immobility, two patients were demonstrated vocal cord paralysis. Eleven patients underwent neck surgery, thyroid surgery and cardiothoracic surgery and further examinations including laryn-geal electromyography and computed tomography help to determine the diagnosis were not performed. All patients were treated with inhaled corticosteroid conservatively. Five patients had significant improvement of symptom and almost regained normal voice. One patient had slight improvement and sixteen patients were not relieved before discharge.@*CONCLUSION@#Patients with hoarseness and vocal fold immobility after endotracheal intubation should be treated properly and immediately.

Alteração vocal em idosos ativos e fatores associados / Vocal alteration in active elderly and associated factors

RESUMO Objetivo Verificar a suspeição de alteração vocal em idosos ativos e a associação com aspectos sociodemográficos, hábitos de vida relacionados à voz e desvantagem vocal. Métodos Estudo observacional transversal realizado com 254 idosos usuários de academias públicas do município de Belo Horizonte (MG). A coleta de dados incluiu uma entrevista, contendo informações sociodemográficas, hábitos de vida relacionados à voz e autorrelato de rouquidão, além da aplicação dos protocolos Índice de Desvantagem Vocal (IDV-10) e Rastreamento de Alteração Vocal em Idosos (RAVI). O resultado do RAVI foi considerado a variável resposta. Os dados foram submetidos à análise descritiva e de associação, por meio dos testes Qui-quadrado de Pearson e Regressão de Poisson, com variância robusta (nível de significância de 5%). Resultados Verificou-se que a maioria dos idosos era do sexo feminino (83,5%), na faixa etária de 60 a 70 anos (65,4%), aposentada (84,9%) e sem companheiros (61,8%). Segundo o protocolo RAVI, 44,5% dos idosos apresentaram suspeição de alteração vocal. Na análise multivariada, as variáveis autorrelato de rouquidão e desvantagem vocal apresentaram associação com a suspeição de alteração vocal mensurada pelo RAVI. Conclusão Foi elevada a suspeição de alteração vocal em idosos ativos, sendo maior entre os idosos com autorrelato de rouquidão e com desvantagem vocal.

ABSTRACT Purpose To verify suspected vocal alterations in active elderly and its association with sociodemographic, voice-related lifestyle habits and vocal handicap aspects. Methods Cross-sectional observational study conducted with 254 elderly users of public health gyms in Belo Horizonte municipality. Data collection included an interview containing sociodemographic information, voice-related life habits and hoarseness self-report, in addition to the application of protocols: vocal handicap index (IDV-10) and screening for voice disorders (RAVI in Portuguese). The result of RAVI was considered the outcome variable. The data were subject to descriptive and association analysis using Pearson's Chi-square and Poisson Regression tests with Robust variance (5% significance level). Results It was found that the majority of the elderly are female (83.5%), aged 60 to 70 years (65.4%), retired (84.9%) and without a partner (61.8%). According to the RAVI protocol, 44.5% of them are suspected of voice alteration. Through multivariate analysis, the self-reported variables of hoarseness and vocal handicap showed association with suspected vocal changes measured by RAVI. Conclusion The vocal alteration suspicion was high in the elderly actives. The suspicion of vocal alteration was higher among the elderly with self-reported hoarseness and with vocal handicap.

Ortner's syndrome

Inferior laryngeal nerve palsy is a relatively common entity. Nevertheless, an occurrence as a result of a cardiovascular pathology is rare. In this case, it is called Ortner's syndrome (OS). Aortic diseases are responsible for more than half of cases. Supraaortic vessels disorders are rare causes of OS. In our new report, a non-smoker and non-drinker 70-year-old woman presented with a history of dysphonia since childhood. On direct laryngoscopy, a left vocal cord paralysis was detected and a contrast-enhanced computed tomography showed an aberrant right subclavian artery originating from the left portion of the aortic arch. Its course to its usual site runs behind the esophagus, being also called arteria lusoria. In this particular case, two unusual situations appear together, which contributes to the rarity of the event.(AU)

Hoarseness and vocal tract discomfort and associated risk factors in air traffic controllers / Rouquidão, desconforto do trato vocal e fatores de risco associados em controladores de tráfego aéreo

Abstract Introduction: An air traffic controller is a professional who performs air traffic control functions in air traffic control units and is responsible for controlling the various stages of a flight. Objective: To compare hoarseness and vocal tract discomfort and their risk factors among air traffic controllers in the approach control of São Paulo. Methods: In a cross-sectional survey, a voice self-evaluation adapted from to self-evaluation prepared by the Brazilian Ministry of Labor for teachers was administered to 76 air traffic controllers at approach control of São Paulo, Brazil. Results: The percentage of hoarseness and vocal tract discomfort was 19.7% and 38.2%, respectively. In relation to air pollution, the percentages of hoarseness and vocal tract discomfort were higher among those who consider their working environment to be intolerable than among those in a comfortable or disturbing environment. The percentage of hoarseness was higher among those who seek medical advice due to vocal complaints and among those who experience difficulty using their voice at work than among those who experience mild or no difficulty. The percentage of vocal tract discomfort was higher among those in a very tense and stressful environment than among those who consider their work environment to be mild or moderately tense and stressful. The percentage of vocal tract discomfort was higher among those who describe themselves as very tense and stressed or tense and stressed than among those who describe themselves as calm. Additionally, the percentage of vocal tract discomfort was higher among those who care about their health. Conclusion: Among air traffic controllers, the percentage of vocal tract discomfort was almost twice that of hoarseness. Both symptoms are prevalent among air traffic controllers who considered their workplace intolerable in terms of air pollution. Vocal tract discomfort was related to a tense and stressful environment, and hoarseness was related to difficulty using the voice at work.

Resumo Introdução: O controlador de tráfego aéreo é um profissional que executa funções de controle de tráfego aéreo em unidades de controle de tráfego aéreo e são responsáveis por controlar as várias fases de um voo. Objetivo: Comparar a rouquidão e o desconforto no trato vocal e seus fatores de risco em controladores de tráfego aéreo no centro de controle de aproximação de São Paulo. Método: Em um estudo transversal, uma autoavaliação de voz adaptada da autoavaliação preparada pelo Ministério do Trabalho para professores foi administrada a 76 profissionais do centro de controle de aproximação de São Paulo, Brasil. Resultados: A porcentagem de rouquidão e desconforto no trato vocal foi de 19,7% e 38,2%, respectivamente. Em relação à poluição do ar, as porcentagens de rouquidão e desconforto no trato vocal foram maiores entre aqueles que consideram seu ambiente de trabalho como intolerável do que entre aqueles em um ambiente confortável ou incômodo. A porcentagem de rouquidão foi maior entre aqueles que procuram assistência médica devido a queixas vocais e entre aqueles que têm dificuldade de usar a voz no trabalho do que entre aqueles que experimentam dificuldade leve ou não apresentam dificuldades. A porcentagem de desconforto no trato vocal foi maior entre aqueles em um ambiente muito tenso e estressante do que entre aqueles que consideram seu ambiente de trabalho leve ou moderadamente tenso e estressante. A porcentagem de desconforto no trato vocal foi maior entre aqueles que se descrevem como muito tensos e estressados ou tensos e estressados do que entre aqueles que se descrevem como calmos. Além disso, a porcentagem de desconforto no trato vocal foi maior entre aqueles que se preocupam com sua saúde. Conclusão: Entre os controladores de tráfego aéreo, a porcentagem de desconforto no trato vocal foi quase o dobro da rouquidão. Ambos os sintomas são prevalentes entre os controladores de tráfego aéreo que consideram o seu local de trabalho intolerável em termos de poluição do ar. O desconforto no trato vocal foi associado a um ambiente tenso e estressante e a rouquidão foi associada à dificuldade de usar a voz no trabalho.

Evaluation of efficacy of intravenous magnesium sulphate versus dexamethasone for prevention of postoperative sore throat in patients undergoing lumbar spine surgery in prone position: a prospective randomized double blind placebo controlled study

Background: Endotracheal intubation is associated with postoperative sore throat. The aim was to evaluate the efficacy of intravenous magnesium sulphate versus dexamethasone for prevention of postoperative sore throat in patients undergoing lumbar surgery in prone position.Methods: 150 patients of ASA physical status I and II in the age group of 18 to 70 years were divided into three groups of 50 each. group I (magnesium sulphate) received intravenous magnesium sulphate 30 mg. kg-1 in a total of 50 ml of normal saline for 10 minutes after intubation, group II (dexamethasone group) received intravenous dexamethasone 8 mg in 50 mL normal saline for 10 minutes after intubation and group III (placebo group) received 50 ml of normal saline for 10 minutes after intubation. The incidence and severity of postoperative sore throat and hoarseness was assessed by an anesthesiologist unaware of the group allocation, on arrival in the post anesthesia care unit at 0 h, and at 1 h, 6 h, 12 h, and 24 h thereafter.Results: Both incidence and severity of sore throat and incidence of hoarseness was more in placebo group than magnesium sulphate group and dexamethasone group and was statistically significant (p<0.05) and was comparable between magnesium sulphate and dexamethasone groups.Conclusions: Endotracheal intubation is associated with sore throat and hoarseness of voice. Magnesium sulphate and dexamethasone given intravenously reduce the incidence and severity of sore throat and hoarseness associated with endotracheal intubation.

Use of Preoperative Inhaled Budesonide to Reduce Postoperative Sorethroat Incidence after Endotracheal Intubation

Introduction: Post-operative sore throat (POST) andhoarseness of voice are common complaints from patientsreceiving tracheal intubation. Budesonide is used to reduceall these complications and metered dose delivery of drugis considered as simple and less time consuming with highpatient acceptability. The present study was study was plannedto assess the effect of use of preoperative inhaled budesonideto reduce postoperative sorethroat incidence after endotrachealintubation.Material and methods: All the patients scheduled to undergoshort elective laproscopic surgeries, lasting <2hrs undergeneral anaesthesia with endotracheal intubation will beincluded in this study. The patients were selected randomlyinto two equal groups as follows: Group A- 20 patientsreceived 200μg budesonide inhalation suspension, using ametered dose inhaler 10 min before intubation, which wasrepeated 6hrs after extubation. Group B- 20 patients with nosuch interventions was performed before intubation or afterextubation. Post-operative sore throat was assessed at 2,6,12and 24hrs. All the results were categorized and summarized.Results: Incidence of POST was significantly higher amongsubjects of Group B in comparison to subjects of group A atdifferent time intervals.Conclusion: Administration of budesonide significantlyreduced the incidence of postoperative cough hoarseness ofvoice and POST among subjects undergoing laparoscopiccholecystectomy

Laryngeal and vocal alterations after thyroidectomy / Alterações laríngeas e vocais após tireoidectomia

Abstract Introduction: Dysphonia is a common symptom after thyroidectomy. Objective: To analyze the vocal symptoms, auditory-perceptual and acoustic vocal, videolaryngoscopy, the surgical procedures and histopathological findings in patients undergoing thyroidectomy. Methods: Prospective study. Patients submitted to thyroidectomy were evaluated as follows: anamnesis, laryngoscopy, and acoustic vocal assessments. Moments: pre-operative, 1st post (15 days), 2nd post (1 month), 3rd post (3 months), and 4th post (6 months). Results: Among the 151 patients (130 women; 21 men). Type of surgery: lobectomy + isthmectomy n = 40, total thyroidectomy n = 88, thyroidectomy + lymph node dissection n = 23. Vocal symptoms were reported by 42 patients in the 1st post (27.8%) decreasing to 7.2% after 6 months. In the acoustic analysis, f0 and APQ were decreased in women. Videolaryngoscopies showed that 144 patients (95.3%) had normal exams in the preoperative moment. Vocal fold palsies were diagnosed in 34 paralyzes at the 1st post, 32 recurrent laryngeal nerve (lobectomy + isthmectomy n = 6; total thyroidectomy n = 17; thyroidectomy + lymph node dissection n = 9) and 2 superior laryngeal nerve (lobectomy + isthmectomy n = 1; Total thyroidectomy + lymph node dissection n = 1). After 6 months, 10 patients persisted with paralysis of the recurrent laryngeal nerve (6.6%). Histopathology and correlation with vocal fold palsy: colloid nodular goiter (n = 76; palsy n = 13), thyroiditis (n = 8; palsy n = 0), and carcinoma (n = 67; palsy n = 21). Conclusion: Vocal symptoms, reported by 27.8% of the patients on the 1st post decreased to 7% in 6 months. In the acoustic analysis, f0 and APQ were decreased. Transient paralysis of the vocal folds secondary to recurrent and superior laryngeal nerve injury occurred in, respectively, 21% and 1.3% of the patients, decreasing to 6.6% and 0% after 6 months.

Resumo Introdução: A disfonia é um sintoma comum após a tireoidectomia. Objetivo: Analisar os sintomas vocais, auditivo-perceptivos e acústica vocal, videolaringoscopia, procedimento cirúrgico e achados histopatológicos em pacientes submetidos à tireoidectomia. Método: Estudo prospectivo. Pacientes submetidos à tireoidectomia foram avaliados da seguinte forma: anamnese, laringoscopia e avaliações vocais acústicas. Momentos: pré-operatório, 1ª avaliação pós (15 dias), 2ª avaliação pós (1 mês), 3ª avaliação pós (3 meses) e 4ª avaliação pós-operatória (6 meses). Resultados: Dos 151 pacientes, 130 eram mulheres e 21, homens. Tipos de cirurgia: lobectomia + istmectomia n = 40, tireoidectomia total n = 88, tireoidectomia + dissecção de linfonodo n = 23. Sintomas vocais foram relatados por 42 pacientes na 1ª avaliação pós-operatória (27,8%), reduzidos para 7,2% após 6 meses. Na análise acústica, f0 e APQ estavam diminuídos nas mulheres. As videolaringoscopias mostraram que 144 pacientes (95,3%) tiveram exames normais no momento pré-operatório. Paralisia das cordas vocais foi diagnosticada em 34 pacientes na 1ª avaliação pós-operatória, 32 do nervo laríngeo recorrente (lobectomia + istmectomia - n = 6; tireoidectomia total - n = 17; tireoidectomia total + dissecção de linfonodos - n = 9) e 2 do nervo laríngeo superior (lobectomia + istmectomia - n = 1; tireoidectomia total + dissecção de linfonodos - n = 1). Após 6 meses, 10 pacientes persistiram com paralisia do nervo laríngeo recorrente (6,6%). Histopatologia e correlação com paralisia das cordas vocais: bócio coloide nodular (n = 76; paralisia n = 13), tireoidite (n = 8; paralisia n = 0) e carcinoma (n = 67; paralisia n = 21). Conclusão: Os sintomas vocais, relatados por 27,8% dos pacientes na 1ª avaliação pós-operatória, diminuíram para 7% em 6 meses. Na análise acústica, f0 e APQ diminuíram. A paralisia transitória de cordas vocais secundária à lesão do nervo laríngeo recorrente e nervo laríngeo superior ocorreu, respectivamente, em 21% e 1,3% dos pacientes, reduziu-se para 6,6% e 0% após 6 meses.

The Effect of Intracuff Pressure Adjustment on Postoperative Sore Throat and Hoarseness after Nitrous Oxide and Air Anesthesia / 간호학회지

PURPOSE: To investigate the differences in postoperative sore throat and hoarseness by adjustment of endotracheal tube cuff pressure (CP) during nitrous oxide (N2O) and air anesthesia. METHODS: A one-equivalent control group pretest-posttest design was used. Data were collected from August 8 to October 19, 2017 and analyzed using the independent t-test and repeated measures ANOVA. Eighty-four participants were enrolled and divided into three groups: 28 in the Control Group (CP adjusted every 30 minutes using N2O), 28 in Experimental Group 1 (CP adjusted every 10 minutes using N2O), and 28 in Experimental Group 2 (non-adjusted CP using air), all of whom underwent urologic, gynecologic, and orthopedic surgeries at the G University hospital. Sore throat was assessed using a numeric rating scale; hoarseness was evaluate using the Stout classification at 1, 6, and 24 hours after surgery. RESULTS: Scores for sore throat and hoarseness were significantly different between the groups at each measurement time, and scores were consistently higher in the control group. During subsequent measurements, sore throat and hoarseness scores were significantly lower at 6 hours. Cuff pressure changed significantly using air anesthesia (χ2=10.41, p=.015) up to 2 hours after induction. Severe sore throat and hoarseness was observed for up to 6 hours after surgery. CONCLUSION: Cuff pressure adjustment at short time intervals would be helpful in reducing postoperative sore throat and hoarseness. Nursing intervention focused on prevention of sore throat and hoarseness should be required up to 6 hours postoperatively in patients undergoing endotracheal intubation.

Lower Cranial Nerve Palsy Due to Vertebrobasilar Dolichoectasia

No abstract available.

Advances in syndrome and treatment of motor neuron disease with traditional Chinese medicine / 中国基层医药

Motor neuron disease(MND) is a group of progressive motor neuron diseases and the pathogenesis is not well defined.The pathologic hallmark of MND is death of lower motor neurons(consisting of anterior horn cells in the spinal cord and their brainstem homologues innervating bulbar muscles) and upper, or corticospinal, motor neurons.The clinical manifestations of MND are mucsle weakness, muscle atrophy, fasciculations, bulbar paralysis and positive pyramidal signs.Traditional Chinese medicine(TCM) named MND as flaccidity syndrome.Recently, some scholars have proposed that "MND" can be regarded as an independent research object of TCM.At present, symptomatic supportive treatment is the main treatment for MMD in western medicine, which can only slow the progress of the disease.TCM treatment for MND has advantages of more effective than western medicine, fewer adverse reactions and lower price.So TCM can be used as an effective method for combined treatment of MND.This article reviews the research progress of syndrome and treatment of MND with TCM.

Advances in syndrome and treatment of motor neuron disease with traditional Chinese medicine / 中国基层医药

Motor neuron disease(MND) is a group of progressive motor neuron diseases and the pathogenesis is not well defined.The pathologic hallmark of MND is death of lower motor neurons (consisting of anterior horn cells in the spinal cord and their brainstem homologues innervating bulbar muscles ) and upper, or corticospinal,motor neurons.The clinical manifestations of MND are mucsle weakness ,muscle atrophy,fasciculations,bulbar paralysis and positive pyramidal signs.Traditional Chinese medicine ( TCM) named MND as flaccidity syndrome.Recently,some scholars have proposed that "MND" can be regarded as an independent research object of TCM.At present,symptomatic supportive treatment is the main treatment for MMD in western medicine ,which can only slow the progress of the disease.TCM treatment for MND has advantages of more effective than western medicine ,fewer adverse reactions and lower price.So TCM can be used as an effective method for combined treatment of MND.This article reviews the research progress of syndrome and treatment of MND with TCM.