Management of Laryngopharyngeal Reflux in Asia

Objectives@#. This study was conducted to investigate the current practices of Asian otolaryngologists for laryngopharyngeal reflux (LPR). @*Methods@#. An online survey about LPR was sent to 2,000 members of Asian otolaryngological societies, and a subgroup analysis was performed between Western and Eastern Asian otolaryngologists. The survey was conducted by the Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies. @*Results@#. Among approximately 1,600 Asian otolaryngologists, 146 completed the survey (62 from Western Asian countries, 84 from Eastern Asian countries). A substantial majority (73.3%) of the otolaryngologists considered LPR and gastroesophageal reflux disease to be different diseases. The symptoms thought to be closely related to LPR were coughing after lying down, throat clearing, and globus sensation. The findings thought to be closely related to LPR were posterior commissure granulations and hypertrophy, arytenoids, and laryngeal erythema. The respondents indicated that they mostly diagnosed LPR (70%) after an empirical therapeutic trial of proton pump inhibitors (PPIs). Although multichannel intraluminal impedance-pH (MII-pH) monitoring is a useful tool for diagnosing nonacid or mixed LPR, 78% of Asian otolaryngologists never or very rarely used MII-pH. Eastern Asian otolaryngologists more frequently used once-daily PPIs (64.3% vs. 45.2%, P=0.021), whereas Western Asian otolaryngologists preferred to use twice-daily PPIs (58.1% vs. 39.3%, P=0.025). The poor dietary habits of patients were considered to be the main reason for therapeutic failure by Asian otolaryngologists (53.8%). Only 48.6% of Asian otolaryngologists considered themselves to be adequately knowledgeable and skilled regarding LPR. @*Conclusion@#. Significant differences exist between Western and Eastern Asian otolaryngologists in the diagnosis and treatment of LPR. Future consensus statements are needed to establish diagnostic criteria and therapeutic regimens.

[Internal evaluation department of speech therapy, Tehran University of Medical Sciences]

Internal evaluation is an important part of organization monitoring. One of the Ministry of Health's policies is to encourage educational departments to conduct internal evaluations. The aim of internal evaluation of department of speech therapy was appraising its education, research and treatment qualities and determining its strengths, weaknesses, opportunities and threats [SWOTs] to identify the ways of overcoming weakness and threats. This descriptive cross-sectional study was conducted in 10 phases to evaluate 10 factors. Participants were undergraduate, graduate, and postgraduate students, academic staff, director of the department along with the patients. The internal evaluation software for educational and research centers released by Center of Medical Education Studies and Development was modified and utilized. Data was analyzed by calculating mean of means. Mean of means from highest to lowest scores were respectively as follows: the quality of diagnosis, treatment and dealing with patients 4.15 out of 5; as well as the quality of academic staff 3.5 were in the range of desirable category; qualities of management and organizational structure 3.34, graduate students 3.21, teaching and learning processes 3.1, missions and goals 3.09, instructional methods and curriculum models 2.99, educational and research equipments 2.9, students 2.76 and research 2.67 were within the range of rather desirable category. Total score was 3.17 [63.4%] which was within the range of rather desirable category. The department of speech therapy was in rather desirable state before merger. That result was appropriate according to the department's conditions and supplies.

[ role of sex in glottic closure pattern in people with normal voice]

Glottic closure pattern is one of the most important stroboscopic signs in judging the normality of laryngeal function. According to the recent researches, complete glottic closure is not the only pattern in normal phonation. The aim of this study was to investigate the glottic closure pattern in normal subjects and to understand the role of sex in having different glottic closure patterns. In a cross-sectional study, 80 subjects [58 females and 22 males; mean age of 21.19 years] were randomly selected from a population of 218 students. After taking a full medical history and performing perceptual and voice self assessment, subjects without any vocal disorders were recruited. Videolaryngoscopic assessment was performed during producing the vowel sound /i/ in habitual, high, low, loud and soft levels of phonation. Glottic closure patterns were analyzed in different phonation and also were compared between males and females. Although complete closure was the most frequent pattern, Y posterior chink was the second pattern in males [20.2%] and females [39.4%] in all phonation. The results revealed significant difference between males and females in glottic closure pattern [p=0.001]. Moreover, significant differences were observed in habitual [p=0.004], high [p=0.006] and soft [p=0.02] phonations between males and females; however, the differences in low [p=0.7] and loud [p=0.19] phonations between males and females were not significant. Y posterior chink, as well as complete closure, are likely to be normal findings in people with normal voice. Besides, gender has a significant influence on glottic closure pattern

[Comparison of voice perceptual charactheristics between speech -language pathologists' dysphonic and normal voiced adult's view]

In recent years, several tools for assessment of quality of patients life have been designed especially for dysphonics. Nowadays, we have useful assessments in health system that are referred for numerous clinical decisions. In this way, this investigation compares clinician and patient perception in dysphonic and normal voiced for first time. This study was carried out on 30 dysphonic and 30 subjects with normal voice. Their age, sex and job were same. In two groups, Consensus Auditory - Perceptual Evaluation of Voice [CAPE-V] was used for evaluation of clinician perception and Voice Handicap Index - 30 [VHI-30] for assessment of patient perception. After collecting data, they were analyzed by Mann- witney and Wilcoxon tests. The research revealed that mean of total and each section score of VHI-30 have significant difference between dysphonic and control group [p<0.01]. Comparison of total and every parameter score of CAPE-V and speed also indicated significant difference between two groups [p<0.01]. Study of reliability shows weak reliability [r=0.34] between clinician and patient perception of voice in dysphonics. Dysphonic patients percept their voice problem different and severe rather than clinicians that show physical, psychological and social affects of dysphonia. This research confirms that patient -based assessment of voice is necessary to be part of common assessments of dysphonia

Fundamental frequency, jitter, and shimmer of adult stutters and nonstutters' voice

Objective measurement is general and acoustic measurements in particular have become a substantial aspect of stuttering assessment during the last few decades. Measurements do not replace the perceptual judgment, but they allow a more precise diagnosis, provide more evidence for therapeutic interventions, and are useful as feedback for patients in therapy. The purpose of this investigation was to compare some adult male stutterers' and nonstutterers' acoustic features. Adult male stutterers and nonstutterers participated this case-control study. Their fluent reading of 20 sentences in Farsi, prolongation of vowels/a/ and/i/, and rhythmic counting from 1 to 20 were analyed with Dr. Speech software. There were no significant differences between two groups in fundamental frequency [f[0]] and standard deviation of f0 in three speech samples [vowels/a/ and/i/, reading 20 sentences, and rhythmic counting from 1 to 20]. No significant difference were between two groups for jitter and shimmer. Non significant differences between two groups are somewhat due to investigation of this parameters in fluent speech of stutterers and nonstutterers