Autoavaliação de sintomas relacionados à voz em indivíduos com câncer de tireoide antes, imediatamente após e no pós-operatório tardio de tireoidectomia / Self-assessment of voice-related symptoms in individuals with thyroid cancer before, immediately after, and in the late postoperative period of thyroidectomy

RESUMO Objetivo Verificar autopercepção de sintomas vocais, de fadiga vocal e relacionados à tireoidectomia em indivíduos com câncer de tireoide, nos momentos pré-operatório, pós-operatório imediato e pós-operatório tardio, e analisar a influência do gênero. Métodos Trata-se de um estudo de intervenção antes e após com 20 indivíduos com câncer de tireoide, média de 46 anos de idade, avaliados em três momentos: pré-cirurgia (M1), imediatamente após cirurgia (M2) e no pós-operatório tardio (M3) da tireoidectomia. Os indivíduos responderam aos instrumentos Escala de Sintomas Vocais, Índice de Fadiga Vocal e Thyroidectomy-Related Voice and Symptom Questionnaire. Os dados foram analisados ​​de forma descritiva e inferencial. Resultados Na autoavaliação de sintomas vocais físicos e orofaringolaríngeos relacionados à tireoidectomia, o M3 apresentou valores estatisticamente menores que o M1 (p=0,006 e p=0,028, respectivamente) e o M2 (p<0,001 e p=0,004, respectivamente). Para os sintomas totais (p=0,001) e vocais (p=0,001) relacionados à tireoidectomia, os valores do M3 foram significativamente menores que os do M2. Na autoavaliação de sintomas vocais dos domínios total e limitação, o M1 (p<0,001; p<0,001) e o M3 (p=0,013; p=0,001) apresentaram valores significativamente menores que o M2. Indivíduos do gênero masculino apresentaram percepção de sintomas de fadiga no domínio fadiga e limitação vocal (p=0,035) e percepção de sintomas relacionados à tireoidectomia nos domínios total (p=0,044) e sintomas vocais (p=0,012) significativamente menores do que os do gênero feminino, independentemente do momento. Conclusão Sintomas vocais físicos e relacionados à tireoidectomia diminuem no pós-operatório tardio; sintomas vocais totais e limitação aumentam no pós-operatório imediato e diminuem no tardio. Mulheres têm maior percepção de fadiga e limitação vocal e de sintomas totais e vocais relacionados à tireoidectomia.

ABSTRACT Purpose To verify the self-perception of symptoms and vocal fatigue related to thyroidectomy in individuals with thyroid cancer in the pre, immediate post and late post-operative moments, and to analyze the influence of gender. Methods Intervention study before and after with 20 individuals, mean age 46 years, evaluated before surgery (M1), immediately after surgery (M2) and in the late postoperative period (M3) of thyroidectomy. Individuals answered the instruments: Voice Symptoms Scale, Vocal Fatigue Index and Thyroidectomy-Related Voice and Symptom Questionnaire. Data were analyzed descriptively and inferentially. Results In self-assessment of vocal symptoms of the total domains and limitation, M1 (p<0.001; p<0.001, respectively) and M3 (p=0.013; p=0.001, respectively) had significantly lower values than the M2. For the physical domain of self-assessment of vocal symptoms, the M3 showed statistically lower values than the M1 (p=0.006) and the M2 (p<0.001) assessments. Depending on the moment, the oropharyngolaryngeal symptoms in M3 had significantly lower values ​​than M2 (p=0.004) and M1 (p=0.028). Male scores were significantly lower than female scores in the self-assessment of fatigue symptoms in the fatigue and vocal limitation domain (p=0.035), regardless of the time of assessment. Conclusion Physical vocal symptoms and thyroidectomy-related symptoms decrease in the late postoperative period; total vocal symptoms and limitation increasing in the immediate postoperative period and decrease in the late postoperative period. Women have a higher perception of vocal fatigue and limitation, and of total and vocal symptoms related to thyroidectomy.

Diagnosis and treatment of 18 cases of Chiari malformation with hoarseness / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate the diagnosis and treatment of Chiari malformation patients with hoarseness and other otorhinolaryngological symptoms. Methods: The clinical data of 18 patients of Chiari malformation with hoarseness were retrospectively collected, which was composed of 5 men and 13 women, aged 3-71 with median age of 52. All the patients were admitted to the Affiliated Hospital of Qingdao University from January 1989 to January 2020. All patients underwent brain MRI and laryngoscopy. The patient's symptoms and first diagnosis department, diagnosis time, total course of disease, hoarseness course, diagnosis and treatment, and postoperative recovery time were summarized. Follow-up time was 3-16 years, with median follow-up time of 6.5 years. Descriptive methods were used for analysis. Results: The first visit departments of 18 patients included neurology (9 cases), otorhinolaryngology head and neck surgery (5 cases), pediatrics (2 cases), orthopedics (1 case) and respiratory department (1 case). Except for the 7 cases in neurology department, the other 11 patients were not diagnosed in time. The disease duration of 18 patients with Chiari malformation ranged from 2 months to 5 years, and hoarseness was present from 20 days to 5 years. After diagnosis, 9 patients underwent posterior fossa decompression surgery, and 1 of them underwent syrinx drainage at the same time. The symptoms of 8 cases improved significantly after operation, with the improvement time from 1 to 30 days. In addition, 9 patients chose conservative treatment, among whom 8 had no improvement in symptoms and 6 progressed. Conclusions: Posterior fossa decompression is an effective treatment for Chiari malformation, and the prognosis is good. Timely diagnosis and treatment can improve the prognosis of patients.

Long-term outcomes of lateral vocal fold autologous fat injection for unilateral vocal fold paralysis / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate the long-term outcomes of patients with unilateral vocal fold paralysis resulting in dysphonia treated with lateral vocal fold autologous fat injection. To analyze the factors that may affect the long-term efficacy of the procedure. Methods: From July 2003 to June 2020, 163 patients (86 males and 77 females), aged 9-73 years (mean (34.50±12.94) years) with unilateral vocal fold paralysis resulting in dysphonia underwent transoral laryngoscopic injection of autologous fat into the lateral vocal folds. Subjective auditory perception assessment (GRBAS scale), objective acoustic assessment, voice handicap index (VHI) evaluation and stroboscopic laryngoscopy were compared before and after the surgery. Patients were followed up for 1 to 18 years, with median follow-up time of 6 years. SPSS 22.0 software was used for statistical analysis. Results: Of 163 patients, 17 patients (10.4%) had mild hoarseness (G1) and 146 patients (89.6%) had moderate to severe hoarseness (G2-3). Stroboscopic laryngoscopy revealed an arch-shaped vocal fold on the affected side, fixed in the paramedian position or abduction position, with obvious glottic closure fissure. Postoperatively, voice recovered to normal (G0) in 139 patients (85.3%), mild hoarseness (G1) in 18 patients (11.0%) and moderate hoarseness (G2) in 6 patients (3.7%). Of these, 131 patients (80.4%) showed significant improvement in hoarseness, 29 patients (17.8%) showed mild improvement and 3 patients (1.8%) showed no significant improvement in hoarseness. Objective acoustic parameters of Jitter, Shimmer, NHR and MPT improved significantly, as did VHI scores. Stroboscopic laryngoscopy showed medialization of the affected vocal folds, improved vocal fold closure and normal or nearly normal vocal fold mucosal waves. With a fat injection volume of 3.0-4.5 ml, the patient's subjective auditory perception scores of G, R, B and A improved more significantly within 3 months after surgery, and both VHI and MPT were significantly better since 1 year after surgery. With bilateral vocal fold injection, the B and A scores improved significantly from 1 month postoperatively compared to unilateral injections(unilateral vs. bilateral injection 1 month post-operation, tB scores=1.42,tA scores=1.51,P<0.05). Conclusions: The long-term efficacy of autologous fat injection in the paraglottic space for the treatment of unilateral vocal fold paralysis was stable. The efficacy of the surgery was related to the amount of fat injected, unilateral or bilateral of the injection.

Outcomes of laryngotracheal reconstruction with anterior and posterior costal cartilage grafts in severe pediatric subglottic stenosis or laryngeal web / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate outcomes of laryngotracheal reconstruction (LTR)with anterior and posterior costal cartilage grafts in severe pediatric subglottic stenosis (SGS) or laryngeal web (LW). Methods: A review of patients with severe subglottic stenosis or laryngeal web between January 2020 and January 2022 was performed. Demographic features including gender, age at diagnosis, age at surgery, etiology, airway support, and other comorbidities were collected preoperatively. Patients were evaluated in surgical site, breathing, swallowing, phonation and complications postoperatively.Descriptive analysis was used in this research. Results: Eight patients were included: six with grade Ⅲ SGS following Cotton-Myer grading scale, and two with type Ⅲ LW following Cohen's classification. All patients underwent LTR with anterior and posterior costal cartilage grafts. Five patients underwent single-stage LTR (ssLTR), and three patients underwent double-stage LTR (dsLTR). Seven out of eight patients were able to successfully extubate or decannulate with normal swallowing function; four patients had mild hoarseness, and three had moderate hoarseness. One patient failed in extubation, and underwent tracheotomy. Conclusions: LTR with anterior and posterior costal cartilage grafts is an effective and safe treatment for severe SGS or LW. Careful preoperative assessment of disease severity and overall medical status will help selection between ssLTR and dsLTR, thereby maximizing patient outcomes for both modalities.

Differential diagnosis and surgical management in chondrosarcoma of the jugular foramen / 中华耳鼻咽喉头颈外科杂志

Objective: To explore the diagnosis, surgical management and outcome of jugular foramen chondrosarcoma (CSA). Methods: Fifteen patients with jugular foramen CSA hospitalized in the Department of Otorhinolaryngology Head and Neck Surgery of Chinese PLA General Hospital from December 2002 to February 2020 were retrospectively collected,of whom 2 were male and 13 were female, aging from 22 to 61 years old. The clinical symptoms and signs, imaging features, differential diagnosis, surgical approaches, function of facial nerve and cranial nerves IX to XII, and surgical outcomes were analyzed. Results: Patients with jugular foramen CSA mainly presented with facial paralysis, hearing loss, hoarseness, cough, tinnitus and local mass. Computed tomography (CT) and magnetic resonance (MR) could provide important information for diagnosis. CT showed irregular destruction on bone margin of the jugular foramen. MR demonstrated iso or hypointense on T1WI, hyperintense on T2WI and heterogeneous contrast-enhancement. Surgical approaches were chosen upon the sizes and scopes of the tumors. Inferior temporal fossa A approach was adopted in 12 cases, inferior temporal fossa B approach in 2 cases and mastoid combined parotid approach in 1 case. Five patients with facial nerve involved received great auricular nerve graft. The House Brackmann (H-B) grading scale was used to evaluate the facial nerve function. Preoperative facial nerve function ranked grade Ⅴ in 4 cases and grade Ⅵ in 1 case. Postoperative facial nerve function improved to grade Ⅲ in 2 cases and grade Ⅵ in 3 cases. Five patients presented with cranial nerves Ⅸ and Ⅹ palsies. Hoarseness and cough of 2 cases improved after operation, while the other 3 cases did not. All the patients were diagnosed CSA by histopathology and immunohistochemistry, with immunohistochemical staining showing vimentin and S-100 positive, but cytokeratin negative in tumor cells. All patients survived during 28 to 234 months' follow-up. Two patients suffered from tumor recurrence 7 years after surgery and received revision surgery. No complications such as cerebrospinal fluid leakage and intracranial infection occurred after operation. Conclusions: Jugular foramen CSA lacks characteristic symptoms or signs. Imaging is helpful to differential diagnosis. Surgery is the primary treatment of jugular foramen CSA. Patients with facial paralysis should receive surgery in time as to restore the facial nerve. Long-term follow-up is necessary after surgery in case of recurrence.

Clinical features and management analysis of 11 cases of laryngocele / 中华耳鼻咽喉头颈外科杂志

Objective: To summarize clinical features and our experience of the diagnosis and treatment of laryngocele. Methods: Clinical data of 11 laryngocele patients in department of Otorhinolaryngology Head and Neck Surgery of the Second Affiliated Hospital of Shanxi Medical University from January 2012 to December 2021 were retrospectively reviewed, including 9 men and 2 women, aged from 12 to 75 years, with median age of 56 years. Electronic laryngoscope was performed in 10 of all patients, laryngeal CT in 10 and cervical color ultrasound in 5 before operation.All the operations were performed under general anesthesia, and the external cervical approach was used for external and combined laryngocele. The internal laryngocele was resected by low temperature plasma through transoral endoscopy. Patients were followed up regularly after operation to evaluate the effect. Clinical feature, types of lesions, imaging findings, surgical approaches and follow-up results were analyzed through descriptive statistical method. Results: Eleven laryngocele patients were divided into mixed type (n=6), internal type (n=4) and external type (n=1).Nine patients presented with hoarseness or dysphonia, 7 with cervical mass and 1 with airway obstruction. Surgical resections were done through external cervical approach (n=7)or transoral endoscopic approach (n=4). All the operations were successful and no complication occurred. All cases were followed up from 17 to 110 months. No recurrence was encountered. Conclusions: Laryngocele is a rare lesion with atypical clinical presentation. Preoperative imaging including CT scan and electronic laryngoscope is essential to evaluate the location, and extent of the lesion, and to make the surgical plan.Complete surgical excision is required. Surgical resection is the only effective method for the treatment of laryngocele.

Consensus recommendations on the evaluation and treatment of laryngotracheal anomalies in infants and young children / 临床耳鼻咽喉头颈外科杂志

Infants with laryngotracheal anomalies are clinically manifested as stridor or noisy breathing, choking, hoarseness, feeding difficulties, and cyanotic spells, followed by developmental and growth retardation and other health issues; in severe cases, patients may present with severe dyspnea, which is associated with high mortality. A timely diagnosis as well as appropriate strategy for laryngotracheal anomalies is still challenging for pediatric otolaryngologists. This consensus statement, evolved from expert opinion by the members of the Pediatric Otorhinolaryngology Professional Committee of the Pediatrician Branch of the Chinese Medical Doctor Association, provides comprehensive recommendations and standardized guidance for otolaryngologists who manage infants and young children with laryngotracheal anomalies in evaluation and treatment based on symptomatology, physical and laboratory examinations.

Effect of proton pump inhibitors on Reflux Symptom Index (RSI) and Reflux Finding Score (RFS) in patients with laryngopharyngeal reflux: A systematic review and meta-analysis

Objectives@#The purpose of this study was to determine the efficacy of proton pump inhibitor (PPI) therapy in treating the symptoms and laryngeal findings of laryngopharyngeal reflux (LPR). @*Methods@#Placebo-controlled, randomized clinical trials published after June 2001 to January 2021 which used PPI as the sole intervention and the RSI or RFS as outcome measures were eligible for inclusion. Studies that were published prior to June 2001, those which only made use of questionnaires other than the RSI or RFS, those which used PPI in combination with other treatments, or those with unavailable full-text manuscripts were excluded. These studies were identified from MEDLINE, Scopus, Cochrane Library, Embase, and HERDIN Plus databases which were searched from May 21 to 26, 2020. The primary outcome was the mean difference between baseline/pre-treatment and post-treatment RSI scores for both PPI and placebo groups. The secondary outcome was the mean difference between pre-treatment and post-treatment RFS scores for PPI and placebo groups. Aggregate results of these outcomes were analyzed using forest plots. Heterogeneity was determined through prediction intervals. Risk of bias of individual studies was assessed using the Cochrane Collaboration’s Tool in Assessing Risk of Bias. @*Results@#Nine randomized control trials were included with a total of 737 patients randomized and 595 patients analyzed – 294 from the PPI group and 301 from the placebo group. There were notable variations among the studies in terms of choice of PPI, dosage and frequency. Out of nine studies, four used both RSI and RFS in their analysis. Two studies used RSI alone and three used the RFS in combination with symptom questionnaires other than the RSI. There was a significant decrease in the RSI of the PPI group versus the placebo group with a mean difference of -2.83 (95% CI, -5.13 to -0.53, p = .02). However, there was no significant decrease in the RFS between PPI and placebo groups with a mean difference of -0.84 (95% CI, -2.66 to 0.98, p = .37). For two clinical trials which only reported post-treatment RFS, there was also no significant difference between the two treatment groups with a mean difference of 1.27 (95% CI, -0.22 to 2.76, p = .10). @*Conclusion@#This meta-analysis found that, although a statistically significant benefit in RSI was noted with PPI therapy, this difference may not translate to a clinically significant change in symptoms; therefore, there is insufficient evidence to recommend for or against the treatment of LPR with PPIs.

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.

Protocolo de Rastreio do Risco de Disfonia para Atores de Teatro Musical: resultados preliminares / Dysphonia Risk Screening Protocol for Musical Theatre Actors: a preliminary study

RESUMO Objetivo Propor o Protocolo de Rastreio do Risco de Disfonia para Atores do Teatro Musical (PRRD-TM), verificar sua aplicabilidade em associação ao Protocolo de Rastreio do Risco de Disfonia Geral (PRRD-G), correlacionar escores finais de ambos, e desses com o escore total, e comparar o risco de disfonia entre atores com e sem queixa vocal. Método Estudo transversal observacional com 34 atores de teatro musical adultos, ambos os sexos, com e sem queixa vocal, profissionais ou estudantes. Os questionários foram aplicados individualmente. A análise estatística possibilitou verificar a correlação entre os escores de risco de disfonia e para comparação entre os grupos com e sem queixa vocal. Resultados A maioria dos participantes era do gênero masculino, jovens adultos, atores profissionais e sem queixa vocal. Observou-se elevado risco de disfonia, evidenciado pela aplicação do PRRD-G, com escores médios compatíveis com valores encontrados em indivíduos com disfonia, e reforçado pelos índices encontrados com aplicação do PRRD-TM. Observou-se correlação moderada e diretamente proporcional entre os escores dos dois questionários e desses com o escore total. Escores mais elevados do PRRD-G foram encontrados no grupo que apresentou queixa vocal. Conclusão O PRRD-TM mostrou-se viável e de fácil aplicabilidade e apresentou correlação positiva com o escore do PRRD-G e com o escore total. Elevado risco de disfonia foi evidenciado em indivíduos com queixa vocal. Apesar do escore específico do PRRD-TM não diferenciar atores de teatro musical com e sem queixa vocal, tanto o escore do PRRD-G quanto o escore total realizaram tal diferenciação.

ABSTRACT Purpose To propose the Dysphonia Risk Screening Protocol for Musical Theatre Actors (DRSP-MTA), to verify its applicability in association with the General Dysphonia Risk Screening Protocol (G-DRSP), to correlate the final scores of both, and these with the total risk score, and to compare the risk of dysphonia measured in musical theater actors with and without vocal complaint. Methods An observational cross-sectional study with 34 musical theater actors, adults, of both genders, with and without vocal complaints and regardless of whether they are professionals or students. The questionnaires were applied individually. Statistical analysis made it possible to verify the correlation between the dysphonia risk scores and to compare the groups with and without vocal complaint. Results Most of the participants were male, young adults, professional actors and without vocal complaint. There was a high risk of dysphonia, evidenced by the application of G-DRSP, with means scores compatible with values found in individuals with dysphonia, and reinforced by the indices found with DRSP-MTA application. There was a moderate and directly proportional correlation between the two questionnaire scores; and a correlation of both with the total risk score. Higher G-DRSP scores were observed in the vocal complaint group. Conclusion DRSP-MTA was feasible and easy to apply and was positively correlated with the total score and G-DRSP score. A high risk of dysphonia was evidenced in individuals with vocal complaints. Although the specific DRSP-MTA score did not differentiate musical theatre actors with and without vocal complaints, the G-DRSP score and the total risk score performed such differentiation.

Amplificador de voz: efeitos na dose e na intensidade vocal de professoras sem disfonia / Voice amplifier: effects on dose and vocal intensity of teachers without dysphonia

RESUMO Objetivo Analisar a interferência do uso do amplificador de voz na dose vocal de professoras não disfônicas. Método Trata-se de um estudo experimental, comparativo intrassujeitos, composto por 20 professoras do ensino fundamental da Rede Municipal de Ensino de Belo Horizonte/MG. Após o consentimento as participantes, foram solicitadas a responder o questionário de Escala de Sintomas Vocais - ESV e posteriormente participaram de dois momentos do estudo, selecionados aleatoriamente. No primeiro momento as participantes utilizaram somente o dosímetro vocal e no segundo momento utilizaram o dosímetro vocal e o amplificador de voz. As medições foram registradas pelo aparelho durante 1h40m, na sala de aula que as professoras lecionavam. O espaço entre as duas medições foi de uma semana, sendo mantidas a mesma sala, mesmo horário e mesma disciplina lecionada, em ambos os momentos. Resultados O parâmetro intensidade foi o único que apresentou diferença com o uso de amplificação de voz. Conclusão O uso da amplificação de voz durante a docência de professoras não disfônicas não interfere nos parâmetros acústicos de frequência fundamental, e nas medidas de dose vocal. A intensidade da voz é menor quando o professor faz uso de amplificação vocal.

ABSTRACT Purpose Analyze the interference of using the voice amplifier in vocal dose of non-dysphonic teachers. Methods This is an experimental study comparing people from the same ambience compound for 20 teachers from municipal elementary school in Belo Horizonte/MG. After consent, the participants were requested to answer the vocal symptom scale questionnaire (ESV) and later participated in two different moments of the study, for which they randomly selected. In the first moment, the participants used only the vocal dosimeter and in the second, they used the vocal dosimeter and the voice amplifier. The measurements were recorded by the device for 1h40m, in the classroom that the teachers taught. The time between the two measurements was one week, with the same room, the same time and the same discipline being taught, at both times. Results The intensity parameter was the only one that showed difference with the use of the voice amplifier. Conclusion Use voice amplification while non-dysphonic teachers are teaching doesn't affect the fundamental frequency and vocal dose measure in the acoustics parameters. The vocal intensity is smaller when teacher uses the vocal amplification.

Pansori today: aesthetic demands vs. vocal health / Pansori hoy: demandas estéticas vs. salud vocal

Introduction:Pansori is a traditional Korean dramatic art form, which likely ap-peared in the mid-eighteenth century in the southern region of Korea. In pansorithere is a strong inclination toward preserving tradition, especially in regard to train-ing, which is generally considered particularly demanding in terms of risks to vo-cal health. Nevertheless ­as highlighted by recent studies­ some innovations took place in pansori characteristics and performances in the last few decades.Objective: We hypothesize that these innovations have impacted the attitudes of singers and teachers towards pansori training and vocal health issues, and that a new approach to voice training in pansori might be recommended.Method: Starting with recent evolutions of pansori and considering previous studies, we discuss how these changes might produce innovations ­or at least a demand for innovation­ in pansori's training. We also try to capture the viewpoint of pansori stu-dents and performers, through an anonymous survey.Results: Although further investigation is required, the results suggest that a new approach in teaching pansori is emerging and it is increasingly requested by the train-ee performers, despite some criticisms from traditionalists.Conclusion: Unlike previously thought, perhaps a more scientific and health-con-scious approach to pansori voice training will be something from which many pansorisingers can benefit.

Introducción: Pansori es una forma de arte dramático tradicional coreano que pro-bablemente apareció a mediados del siglo XVIII en la región sur de Corea. En pansorihay una fuerte inclinación a preservar la tradición, especialmente en lo que respecta al entrenamiento, que generalmente se considera particularmente exigente en térmi-nos de riesgos para la salud vocal. Sin embargo, como destacan estudios recientes, se produjeron algunas innovaciones en las características y actuaciones del pansori en las últimas décadas.Objetivo: Hipotetizamos que estas innovaciones han impactado las actitudes de can-tantes y profesores hacia la formación del pansori y los problemas de salud vocal, y que podría recomendarse un nuevo enfoque para el entrenamiento de la voz en pansori.Método: Comenzando con las evoluciones recientes de pansori y considerando es-tudios previos, discutimos cómo estos cambios pueden producir innovaciones, o al menos una demanda de innovación, en la formación de pansori. También tratamos de captar el punto de vista de los estudiantes e intérpretes de pansori, a través de una encuesta anónima.Resultados: Aunque se requiere más investigación, los resultados sugieren que está surgiendo un nuevo enfoque en la enseñanza del pansori y es cada vez más solicitado por los artistas en formación, a pesar de algunas críticas de los tradicionalistas.Conclusión: A diferencia de lo que se pensaba anteriormente, quizás un enfoque más científico y consciente de la salud para el entrenamiento de la voz en pansori será algo de lo que muchos cantantes de pansori puedan beneficiarse

Orientaciones filosóficas en la intervención fonoaudiológica de voz. El desafío actual de dar el alta / Philosophical orientations in voice therapy. The current challenge of discharge

El presente artículo corresponde a una reflexión sobre las orientaciones filosóficas en la terapia vocal actual. Cuando existe alguna alteración o trastorno vocal, se habla comunmente de un desequilibrio entre los subsistemas involucrados en el proceso fonatorio, es decir, fuelle (sistema respiratorio), fuente (pliegues vocales) y filtro (tracto vocal). Si no hay un correcto balance, entonces el sistema no tiene un correcto funcionamiento y pueden aparecer síntomas como ronquera, sensación de cuerpo extraño, prurito, fatiga vocal o bien disfonía o incluso afonía. Como con-secuencia de estas dificultades, se generan compensaciones que durante el proceso de la intervención fonoaudiológica el profesional debe volver a "equilibrar". Para lograr este objetivo, se desarrollan y analizan las diversas herramientas que entregan las filosofías de pensamiento a lo largo de la historia de la rehabilitación vocal, don-de se encuentran la orientación higiénica, psicológica, sintomatológica, fisiológica y ecléctica. En este mismo sentido, el profesional debe buscar lo que percibe como más idóneo para cada paciente o grupo a intervenir, centrado en mejorar la calidad vocal y las necesidades actuales de estos, basándose en el contexto mundial actual, con el objetivo de lograr un buen proceso de entrenamiento o rehabilitación y final-mente lograr el alta.

The present article corresponds to a reflection about the philosophical orientations in the current vocal therapy. When there are some vocal alterations or disorders, we usually talk about an imbalance between the sub-sysmtems involved in the fonatory process, which are bellows (respiratory system), source (vocal folds) and filter (vocal tract). When there is not a correct balance, the system does not work properly and as a consequence, it is possible to experiment symptoms such as hoarseness, foreign body sensation, pruritus, vocal fatigue, dysphonia or even aphonia. As a result of these difficulties, it is possible to generate compensations through the intervention of speech therapy. By virtue of this therapy the professional must 'balance'. In order to achieve this, it is necessary to develop and analyze the different tools that philoso-phical studies offer through the history of vocal rehabilitation. Some of these tools are hygienic orientation, psychological, symptomatological, physiological and eclec-tic. Thinking on that, the professional must search what it is most suitable for every patient or group of people that he/she will be working with. This must be focus on improving vocal quality and the actual necessities of the patient, based on the current global context. The final purpose of the professional is to achieve a good and healthy process of training and/or rehabilitation to accomplish medical discharge.

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.

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.

Lower Cranial Nerve Palsy Due to Vertebrobasilar Dolichoectasia

No abstract available.