Prevalence of occupational voice disorders in teachers.

INTRODUCTION: In Italy the number of teachers among private and public schools is around one million. Voice disorders are thought to be one of the major occupational hazards of school teaching; in fact the teachers often use their voice with high-intensity, in noisy classes, for a long time and without suitable breaks. The aim of the study was to assess the prevalence of voice problems in teachers of Naples district, identifying risk factors for developing voice pathology. METHODS: In this study we evaluated 504 teachers (322 F-182 M) with an age ranging between 24 and 62 years, randomly choiced in 28 schools of the district of Naples submitted to a questionnaire to determine the prevalence of voice disorders. In our study we have also introduced a comparison group of not-teachers workers of 402 subjects (244 F-158 M); they were in the same age range as the teacher sample (range: 22-65 years). The control group was also submitted to a questionnaire regarding sociodemographic characteristics, smoking and alcohol use, a self-report of voice problems, voice symptoms, frequency of acute and chronic voice problems, absenteeism due to voice problems. RESULTS: The prevalence of reporting a current voice problem was significantly greater in teachers compared with not-teachers (8.7% vs 2.9%), as the prevalence of voice disorders during their lifetime too (51.4% vs 25.9%), chi2 = 86.672, p < 0.001. Women, compared with men had a higher lifetime prevalence of voice disorders. An other important data evidenced, is that 116 workers of the teachers group (23.01%) have been forced, during their professional activity, to miss job for problems related to voice; only 22 subjects of control group (5.47%) instead, missed job for voice troubles. DISCUSSION AND CONCLUSIONS: This study confirms that teachers have a higher rate of self-reported voice problems than subjects working in other occupations. Teachers, compared with not-teachers, were significantly more likely to have experienced multiple voice symptoms including hoarseness, discomfort while using their voice, difficulty projecting their voice and tiring or change in voice quality after short use. Large proportion of these problems may be preventable and prevention programs need to be developed and evaluated. Italian teachers do not receive any preventive voice training; that, in combination with poor hygienic work conditions, could increase health problems. Thus, voice training of teachers and teacher college students in some cases should be considered as a useful tool to prevent voice disorders.

The first case of osteoma in the false vocal fold.

OBJECTIVES: This article reports the first evidence of a larynx osteoma of the false vocal fold. STUDY DESIGN: Case report and literature review. METHODS: Case report and review of previously published cases of larynx osteomas. RESULTS: A 79-year-old patient was referred to our institution for dysphagia and hoarseness. Fibrolaryngoscopy showed a regular surface tumefaction of the false fold and the left ventricle, with preserved cordal motility. Patient underwent direct laryngoscopy with CO(2) laser excision of the lesion. Pathologic examination of the lesion (1.6cmx1cm) showed features consistent with an osteoma. Complete regression of symptoms was observed after surgery, with no lesions found on routine 1-year follow-up. CONCLUSIONS: Osteomas are benign, slow growing tumors of the craniofacial bone area, very rarely located in the larynx. Although the etiology is unknown, accepted theories point to embryologic, post-traumatic and infectious causes. Surgical excision is indicated only in symptomatic cases. This case report is the fourth evidence of laryngeal osteoma and, to our knowledge, the first finding of a false vocal fold osteoma.

Epidemiological study on vocal disorders in paediatric age.

Few studies analyzed the diffusion of vocal alterations especially in childhood. Aim of our study was to quantify the numbers of subjects, in paediatric age, in which dysphonia was diagnosed in our department of Phoniatrics, during a period of 5 years, (January 2002-December 2006), and also to evaluate the influence of some potential risk factors. In the considered period it emerged that the diagnosis of dysphonia was made in 312 children (17.2% of the patients affected from dysphonia), aged between 2 and 16-years-old, with a major prevalence amongst males (57%) than females (43%). On the contrary in the adult population the prevalence was: 23% in males and 77% in females. In paediatric population, the most affected range of age is the one between 8 and 14, in both male and female gender (59.6%). In 82.4% of the cases there were vocal fold lesions. The 90.3% of children with vocal fold alterations presented lesions secondary to vocal abuse and misuse and classifiable as functional dysphonia. The proportion of functional dysphonia in our sample was 92%. The 65% of children belonged to large families with more than two children, and the 30% had a family history of dysphonia (brothers, parents). The study of the behavioural characteristics has shown aggressive and hyperactive attitudes in 83% of the cases. Since in the ethiopathogenesis of the childhood dysphonia the tendency to vocal abuse has a predominant role, it would be useful to encourage the diffusion of programmes of information to show the risks linked to this abuse in children, in order to prevent the development of dysphonia in paediatric age.

Conservative laser microsurgery for T1 glottic carcinoma.

OBJECTIVE: The purpose of the study was to assess whether partial cordectomy or complete cordectomy with narrow free margins is a safe oncological procedure for T1 glottic carcinoma. We also studied surgical margins and the involvement of anterior commissure. METHODS: Thirty-one T1 glottic carcinomas underwent endoscopic CO(2) laser excision of the lesion based on the depth of infiltration by the tumor with 1-2mm free margins. If detecting free margins was not macroscopically possible, additional biopsies along all the uncertain margins of the excision's residual area were taken. After excision, the specimen was mounted on a plastic support, flattened and then held in place with fine needles. It was then oriented and mapped. The pathologist measured the lesion's point of maximum infiltration and its distance from the free margins. RESULTS: Local and ultimate control at 36 months was 95% and 100%, respectively. We performed 29 partial and two complete cordectomies. Complete resection of the lesion was obtained in 90.4% of the cases. Re-resection was necessary in 9.6% of the cases due to positive margins. The anterior commissure was affected in 38.7% of the cases, and was the site of maximum infiltration in 9.6% of the cases. The mean maximum infiltration was 0.93mm in the anterior commissure, 2.18mm in the anterior 1/3rd of the vocal cord, 1.71mm in the middle 1/3rd of the vocal cord and 1.5mm in the posterior 1/3rd of the vocal cord. In 83.9% of the cases (p<0.01), the anterior 1/3rd of the vocal cord was the section most frequently involved. In 19 patients (61.3%) (p<0.01), the anterior 1/3rd of the vocal cord was also the area with the highest incidence of maximum infiltration by the tumor. CONCLUSION: We concluded that.

Intranasal flunisolide treatment in children with adenoidal hypertrophy.

Adenoidal hypertrophy (AH) represents one of the most frequent indications for surgery in children and it has been proposed that treatment with intranasal corticosteroids can decrease the size of AH. Therefore, the aim of the study is to evaluate the effect of the use of intranasal flunisolide among children affected by AH. 178 children with AH were evaluated in this randomised and controlled study. Inclusion criteria for the study required that each patient had to have a III or IV degree of AH on the initial endoscopic examination. Children were treated with intranasal flunisolide or isotonic saline solution for 8 weeks. After treatment, endoscopy was performed to re-evaluate AH degree. Flunisolide treatment was associated with significant (p less than 0.04) reduction of AH degree. There was moreover a consistent reduction of children (46 out of 58) proposed to adenoidectomy. No clinically important adverse events were reported. In conclusion, this preliminary study demonstrates that an 8-week treatment with intranasal flunisolide is significantly associated with reduction of AH, thus preventing the recurrence to adenoidectomy, and is safe.

[Canalith repositioning maneuver: proposal of a new therapy for benign paroxysmal positional vertigo of the posterior semicircular canal]. / La manovra di riposizionamento dei canaliti. Proposta di un nuovo trattamento riabilitativo per la vertigine parossistica posizionale benigna del canale semicircolare posteriore.

A new therapy is proposed for the treatment of Benign Paroxysmal Positional Vertigo (B.P.P.V.) of the Posterior Semicircular Canal (P.S.C.): the Canalith Repositioning Maneuver (C.R.M.). The need for a new maneuver to treat B.P.P.V. of the P.S.C. arises from the difficulties encountered in daily practice, under particular conditions (i.e. elderly, obese, traumatized patients and in the presence of rachis pain, etc.), to perform the most common rehabilitative techniques such as the Semont Maneuver and Epley's Canalith Repositioning Procedure (C.R.P.). The results achieved using this new technique on a group of 47 consecutive out-patients are presented and compared to those achieved using the Semont Maneuver in an analogous group of 23 patients. C.R.M. and the Semont Maneuver were performed once per treatment session and all patients were checked every 3 days until the symptoms of B.P.P.V. disappeared. Thereafter they were invited to return for check-up if signs of vertigo returned (follow-up 6-25 months). The two techniques proved equally effective: 87.5% of the cases were resolved with C.R.M., 82.6% with the Semont Maneuver. However, the C.R.M. provided other advantages as it resolved the problem immediately (i.e. in a single session) in 81% of the cases vs. 68.4% for the Semont Maneuver. In view of the Canalith theory, the action mechanism envisaged for all three maneuvers--C.R.M., the Semont Maneuver and the Epley C.R.P.--can be explained assuming that the canalith passes from the ampullar to the non ampullar branch of the (P.S.C.) passing finally through the Common Duct and into the Utricle. C.R.M. is a specific treatment for the B.P.P.V. of the P.S.C. and is simple to perform, well tolerated and quite effective. It is indicated in all cases of B.P.P.V. of the P.S.C. both as initial treatment and as alternative to other treatment methods which have proved ineffective or difficult to perform. Indeed, in therapy it is best to be quite skilled in more than one technique, availing oneself of a full range possibilities; in this way the cure can be tailored to the patient in each individual case and not vice versa.

[Anatomopathologic and clinical correlations of squamous carcinoma of the larynx and the hypopharynx]. / Correlazioni anatomopatologiche e cliniche nel carcinoma squamoso della laringe e dell'ipofaringe.

The most important problem in the diagnosis of neoplastic diseases is not only to identify its malignant nature but also the degree of aggressiveness since differences in prognosis and therapy exist in cancer as well. A short review of the literature regarding correlations between histologic degree of carcinoma and prognosis is presented. A total of 105 laryngectomy samples are presented taken by bilateral neck dissection following the principles employed for laryngeal or hypopharyngeal carcinoma. Reference is made to the following parameters: extension and site of primitive tumor; cellular (WHO), nuclear (Black) and structural (Carlon) gradings; histologic host response as judged by the presence and degree of lymphoid infiltration and fibrous stromal reactions around the primary tumor. Host response was related to structural grading. Regional nodes were studied for metastases. Nodal metastases were related to cellular, nuclear and structural grading. Clinical and statistical analysis proved that Carlon's grading, based on structural organization of the tumor, seen as a manifestation of its cellular cohesiveness, is a more discriminating system of malignancy than the others. The most organoid growth patterns (Structural grades 1 and 2) did not present any node metastases. They can be regarded as manifestations of "low grade malignancy tumors". The least organoid and non organoid growth patterns (Structural grades 3 and 4) showed higher levels of node metastases (Grade 3: 35.2%; Grade 4: 58%; p = 0.01). Necrosis was found only in Grades 3 and 4 and was associated with node metastases in 70%. Structural grading could be the guideline to better management of laryngeal carcinoma in terms of choice of surgical treatment (type of laryngectomy; neck dissection).

Objective tinnitus due to peritubal myoclonus. A case report.

A case of bilateral peritubal myoclonia with objective tinnitus in a 5-year-old child, under general anesthesia for phimosis surgery, is reported. After having shown the etiology, pathogeny and symptomatology of the peritubal myoclonic syndrome, the use of impedansometric research consisting of a spontaneous variation of 'compliance' is emphasized. The authors discuss the significance of differential diagnosis with the spontaneous variations of 'compliance' of vascular, respiratory and muscular origin.