Chronic nasopharyngeal and otitis media tuberculosis: diagnosis and management difficulties.

Nasopharyngeal and otitis media tuberculosis are rare extrapulmonary manifestations of Mycobacterium tuberculosis infection. We present a case of a middle-aged woman with manifestations of both conditions along with a description of the anatomical and temporal evolution of the disease. This case also highlights the difficulty of diagnosis and management of this condition, requiring a multidisciplinary approach. Extrapulmonary tuberculosis must be considered in the differential diagnosis of multiple head and neck conditions, including refractory chronic rhinosinusitis and otitis.

Mothers' psychopathology symptoms and mindful parenting in the postpartum period: The role of parental reflective functioning.

Postpartum psychopathology has an adverse impact on parenting behaviors and, consequently, on the mother-infant relationship. This study aimed to explore whether the relationship between maternal anxiety and depression symptomatology in the postpartum period and the ability of mothers to adopt a mindful parenting approach is indirect and can be explained by parental reflective functioning. Two hundred ninety five Portuguese mothers of infants aged up to 12 months completed self-report measures assessing anxiety/depression symptoms, mindful parenting, and parental reflective functioning. Mothers who reported clinically significant anxious and/or depressive symptomatology levels (21%) showed lower levels of mindful parenting and of certainty about the mental states as well as higher levels of prementalizing modes of mental states than mothers with normal symptomatology levels. An indirect effect of depressive symptomatology on mindful parenting through the two dimensions of parental reflective functioning and a direct effect of anxious symptomatology on mindful parenting were found. The results suggest that parental reflective functioning is an important explanatory mechanism of the relationship between depressive symptomatology and mindful parenting, as well as that anxious symptomatology is directly associated with mindful parenting. This study suggests that reducing anxious and depressive symptoms in the postpartum period can promote reflective and mindful parenting skills.

La sicopatología posterior al parto tiene un impacto adverso sobre las conductas de crianza y, consecuentemente, sobre la relación madre-infante. Este estudio se propuso explorar si la sintomatología materna de ansiedad/depresión en el período posterior al parto se asocia con la más débil habilidad de la madre para adoptar un acercamiento consciente a la crianza y si esta relación es indirecta y la explica el funcionamiento reflexivo del progenitor. Doscientas noventa y cinco madres portuguesas de infantes de edad hasta los 12 meses completaron medidas de auto reporte para evaluar los síntomas de ansiedad/depresión, la crianza consciente, así como el funcionamiento reflexivo del progenitor. El 21% de las madres reportaron niveles de sintomatología de ansiedad y/o depresión clínicamente significativos. Estas madres mostraron niveles más débiles de una crianza consciente y de certeza acerca de los estados mentales y niveles más fuertes de modos mentales de mentalización previa que las madres con niveles normales de sintomatología. Encontramos un efecto indirecto de sintomatología depresiva sobre la crianza consciente a través de dos dimensiones del funcionamiento reflexivo del progenitor y un efecto directo de sintomatología de ansiedad sobre la crianza consciente. Los resultados sugieren que el funcionamiento reflexivo del progenitor es un mecanismo importante de explicación de la relación entre la sintomatología depresiva y la crianza consciente, como también la sintomatología de la ansiedad está directamente asociada con la crianza consciente. Este estudio sugiere que reducir los síntomas de ansiedad y depresión en el período posterior al parto puede promover las habilidades de una crianza reflexiva y consciente.

La psychopathologie postpartum a un impact négatif sur les comportements de parentage et par conséquent sur la relation mère-bébé. Cette étude s'est donnée pour but d'explorer si la symptomatologie anxiété/dépression maternelle durant la période postpartum est liée à une moindre capacité des mères à adopter une approche attentive au parentage et si cette relation est indirecte et expliquée par le fonctionnement parental de réflexion. 295 mères portugaises de bébés âgés de 0 à 12 mois ont rempli des mesures d'auto-évaluations évaluant les symptômes d'anxiété/dépression, le parentage attentif, et le fonctionnement parental de réflexion. 21% des mères ont fait état de niveaux cliniquement élevés de symptomatologie anxieuse et/ou dépressive. Ces mères ont fait preuve de niveaux moins élevés de parentage attentif et de certitude sur les états mentaux et de niveaux plus élevés de mode de pré-mentalisation que les mères avec des niveaux normaux de symptomatologie. Un effet indirect de symptomatologie dépressive sur le parentage attentif à travers deux dimensions de fonctionnement de réflexion maternelle et un effet direct de symptomatologie anxieuse sur le parentage attentif ont été trouvés. Les résultats suggèrent que le fonctionnement de réflexion parentage est un mécanisme important d'explication de la relation entre la symptomatologie dépressive et le parentage attentif. Ils suggèrent également que la symptomatologie anxieuse est directement liée au parentage attentif. Cette étude suggère que la réduction des symptômes anxieux et dépressifs durant la période post-partum peut promouvoir des capacités de parentage de réflexion et d'attention.

Evaluation of vocal changes after vestibular rehabilitation in patients with balance disorders.

BACKGROUND: Although there are articles and studies that associate postural changes with changes in vocal quality, to the best of our knowledge, this was the first study investigating the association between balance disorders and voice. OBJECTIVE: This study aimed to determine whether patients with balance disorders present any clinical, acoustic, or endoscopic vocal changes, and if the correction of balance impairments, such as through vestibular rehabilitation, lead to improvement in vocal quality. METHODS: This was a prospective cohort study that analyzed vocal differences (clinical, videoendostroboscopic, audio-perceptual, and acoustic vocal parameters) in a sample of 43 patients with vestibular dysfunction at three different time points (pre-treatment, post-treatment, and 3 months' post-treatment) diagnosed by videonystagmography with changes in computerized dynamic posturography who were treated with vestibular rehabilitation. RESULTS: In pre-treatment, all of the patients presented supraglottic hyperfunction during videoendoscopic examination and abnormal values in the audio-perceptual scale. After treatment for balance disorders, there was a statistically significant improvement in some parameters of the videoendoscopic and audio-perceptual measures. These improvements were detected immediately after treatment and remained present until at least three months after treatment. CONCLUSIONS: The results suggested that the treatment for balance disorders results in changes in posture and consequently in voice quality.

Evaluation of Postural Changes Using Dynamic Posturography after Speech Rehabilitation in Patients with Voice Disorders: A Longitudinal Study.

BACKGROUND: The association between voice and body posture is consensual across the scientific literature and seems to be established both ways. Any changes in normal posture can influence the mechanisms of vocal production; on the other hand, vocal rehabilitation can influence posture. OBJECTIVES: This study aimed to evaluate the postural pattern in subjects with organic voice disorders before and after speech rehabilitation, using computerised dynamic posturography (CDP). METHODS: In this prospective cohort study, 21 patients affected by dysphonia caused by benign vocal fold lesions, never treated with speech therapy/vocal training, were submitted to a posturographic analysis using CDP before and after vocal rehabilitation/therapy. Each patient underwent an accurate voice and ear, nose, and throat (ENT) anamnesis, a general ENT examination, a rigid and flexible laryngoscopy, a videolaryngostroboscopy, an acoustic voice analysis including aerodynamic evaluation, and a perceptual evaluation of voice using the Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS) scale and the Voice Handicap Index (VHI) questionnaire, before and after vocal therapy. Fifteen healthy age- and sex-matched volunteers were also submitted to a posturographic analysis on the day of recruitment and 4 weeks later. RESULTS: All patients showed an improvement in voice quality after vocal training. The VHI decreased in all subjects, and the GRBAS scale showed a decrease in all parameters in each vowel (/a/, /i/, /e/) and in spontaneous speech (p < 0.001 for all). Posturographic results showed an improvement in equilibrium score, in conditions 2-6 and composite score. Strategic analysis results showed an improvement in conditions 1-6. CONCLUSIONS: The posturographic analysis showed a significant difference in the visual, vestibular, and proprioceptive component of posture after voice therapy. These results showed that dysphonic patients changed their postural patterns after an effective voice treatment, with an improvement in postural performance. It seems like modifications of breathing pattern and voice production techniques led to objective and measurable postural changes.