Vocal Fold Fat injection for Glottic Insufficiency: Systematic Review.

Vocal fold fat injection is a technique for treating glottic insufficiency (GI) resulting from various conditions. The use of fat as a graft has several advantages over other grafts. Similar pliability, and vibratory characteristics as a normal vocal fold, not causing foreign body reactions, having the potential to contain stem cells, and often can be done in the office. Long-term results, however, are unpredictable. The objective of this study is to carry out a systematic review of published articles using the technique of fat injection in the vocal folds. STUDY DESIGN: Systematic review. REVIEW METHODS: A literature search was conducted utilizing the combination of the following keywords "vocal folds fat injection," "laryngoplasty," and "autologous fat injection vocal folds." The criteria inclusion of the study for the systematic review were based on PICOTS (population, intervention, comparison outcome, timing, and setting) and Preferred Reporting Items for Systematic Reviews and Meta-analyses statements. Outcomes reviewed included technique, study duration, perceptual and acoustic analysis, and quality of life preoperation and 1-year postoperation. RESULTS: A systematic review on PubMed, Cochrane, and Embase databases included 13 studies analyzing the data of 472 patients, that had fat injection laryngoplasty for treatment of GI. The causes of GI varied substantially across studies. Considerable heterogeneity across studies was found, including technique for harvest, processing the fat, site of injection, and acoustic analysis. In the studies that measured maximum phonation time (MPT) there was a significant improvement in a follow-up of at least 1 year after the injection. The patient's perception of vocal quality, measured by the Voice Handicap Index, also showed significant improvement in several studies after fat injection laryngoplasty. CONCLUSION: Fat injection laryngoplasty seems to be safe and effective for GI for at least 12 months. Multiple studies show favorable outcomes, but the lack of control groups, the heterogeneity in inclusion criteria, nonstandardized techniques, and objective voice evaluations limit this evaluation.

Dysphonia in Performers: Prevalence of Vocal Lesions and Voice Emergencies in a Private Otorhinolaryngology Practice.

OBJECTIVE: To determine the prevalence of abnormal laryngeal findings during videostroboscopy in performers presenting to clinic or when having an acute vocal emergency. STUDY DESIGN: Retrospective study of professional singers and actors who presented for a vocal evaluation. SUBJECTS AND METHODS: A chart review of singers or professional actors who presented in a private otorhinolaryngology clinic between 2014 and 2016. The prevalence of laryngeal lesions noted on stroboscopy were reviewed. The RFS (reflux finding score) was calculated and the exams that presented RFS greater than or equal to seven were considered suspicious of laryngopharyngeal reflux (LPR). RESULTS: A total of 140 records of actors and singers were evaluated either for routine evaluation or for an acute emergency. Sulcus vocalis was the most prevalent lesion 36% (n = 33), followed by cyst 27% (n = 25) and acute laryngitis, 14% (n = 13). Thirty-seven (26.4%) performers were treated for emergence due to dysphonia, Emergency dysphonia, mostly due to viral infection, was treated with steroids and speech therapy, with improvement of symptoms after treatment. Of these professionals, 83.8% (31) presented with a structural lesion or infection in the vocal folds, while 16.2% presented with dysphonia, which required emergency care without a structural lesion in the vocal folds. (P<0.05) Eighty-nine percent (33) of the professionals presenting with a voice emergency with dysphonia (37) were treated with corticosteroids. Thirty-three percent (n = 47) of the professionals presented with RFS scores ≥7. Nineteen professionals (40%) with signs of LPR were treated for emergency due to dysphonia. The professionals with signs of LPR had more emergency dysphonia than those who did not suspect LPR. (19.4%) (P = 0.008). CONCLUSION: Vocal emergencies in professionals are common in a private laryngology practice and require specialized assessment. The most prevalent lesions in the study were vocal sulcus. LPR is common in this group as noted both by findings with videostroboscopy and the RFS.

Laryngopharyngeal Reflux: Diagnosis, Treatment, and Latest Research

Introduction: Laryngopharyngeal reflux (LPR) is a highly prevalent disease and commonly encountered in the otolaryngologist's office. Objective: To review the literature on the diagnosis and treatment of LPR. Data Synthesis LPR is associated with symptoms of laryngeal irritation such as throat clearing, coughing, and hoarseness. The main diagnostic methods currently used are laryngoscopy and pH monitoring. The most common laryngoscopic signs are redness and swelling of the throat. However, these findings are not specific of LPR and may be related to other causes or can even be found in healthy individuals. Furthermore, the role of pH monitoring in the diagnosis of LPR is controversial. A therapeutic trial with proton pump inhibitors (PPIs) has been suggested to be cost-effective and useful for the diagnosis of LPR. However, the recommendations of PPI therapy for patients with a suspicion of LPR are based on the results of uncontrolled studies, and high placebo response rates suggest a much more complex and multifactorial pathophysiology of LPR than simple acid reflux. Molecular studies have tried to identify biomarkers of reflux such as interleukins, carbonic anhydrase, E-cadherin, and mucin. Conclusion: Laryngoscopy and pH monitoring have failed as reliable tests for the diagnosis of LPR. Empirical therapy with PPIs is widely accepted as a diagnostic test and for the treatment of LPR. However, further research is needed to develop a definitive diagnostic test for LPR...

Laryngopharyngeal reflux: diagnosis, treatment, and latest research.

Introduction Laryngopharyngeal reflux (LPR) is a highly prevalent disease and commonly encountered in the otolaryngologist's office. Objective To review the literature on the diagnosis and treatment of LPR. Data Synthesis LPR is associated with symptoms of laryngeal irritation such as throat clearing, coughing, and hoarseness. The main diagnostic methods currently used are laryngoscopy and pH monitoring. The most common laryngoscopic signs are redness and swelling of the throat. However, these findings are not specific of LPR and may be related to other causes or can even be found in healthy individuals. Furthermore, the role of pH monitoring in the diagnosis of LPR is controversial. A therapeutic trial with proton pump inhibitors (PPIs) has been suggested to be cost-effective and useful for the diagnosis of LPR. However, the recommendations of PPI therapy for patients with a suspicion of LPR are based on the results of uncontrolled studies, and high placebo response rates suggest a much more complex and multifactorial pathophysiology of LPR than simple acid reflux. Molecular studies have tried to identify biomarkers of reflux such as interleukins, carbonic anhydrase, E-cadherin, and mucin. Conclusion Laryngoscopy and pH monitoring have failed as reliable tests for the diagnosis of LPR. Empirical therapy with PPIs is widely accepted as a diagnostic test and for the treatment of LPR. However, further research is needed to develop a definitive diagnostic test for LPR.

Histologic study of acute vocal fold wound healing after corticosteroid injection in a rabbit model.

OBJECTIVES: Injectable corticosteroids have been used in phonosurgery to prevent scarring of the vocal fold because of their effects on wound healing, and to ensure better voice quality. We histologically evaluated the effects of dexamethasone sodium phosphate infiltration on acute vocal fold wound healing in rabbits 3 and 7 days after surgically induced injury by quantification of the inflammatory reaction and collagen deposition. METHODS: A standardized surgical incision was made in the vocal folds of 12 rabbits, and 0.1 mL dexamethasone sodium phosphate (4 mg/mL) was injected into the left vocal fold. The right vocal fold was not injected and served as the control. The larynges were collected 3 and 7 days after surgery. For histologic analysis, the vocal folds were stained with hematoxylin-eosin for quantification of the inflammatory response and with picrosirius red for quantification of collagen deposition. RESULTS: There was no quantitative difference in the inflammatory response between vocal folds injected with the corticosteroid and control vocal folds. However, the rate of collagen deposition was significantly lower in the corticosteroid-treated group at 3 and 7 days after injury (p = 0.002). CONCLUSIONS: The present results suggest that dexamethasone reduces collagen deposition during acute vocal fold wound healing.

Injeção de corticosteróide em patologias vocais inflamatórias crônicas, revisão da literatura / Steroid injection in chronic inflammatory vocal fold disorders, literature review

Os corticosteróides são potentes inibidores da inflamação e da cicatrização. Administração local de esteróides diretamente na laringe tem sido relatada em diversas patologias laríngeas. OBJETIVO: O objetivo desse estudo é realizar uma revisão da literatura sobre o uso de infiltração de corticosteróide em pregas vocais, em pacientes com patologias vocais benignas, inflamatórias e crônicas de laringe. METODOLOGIA: Realizou-se uma busca eletrônica na base de dados Medline, selecionando-se estudos clínicos que utilizavam corticosteróides em patologias benignas da laringe. RESULTADOS: Os corticosteróides são indicados nas seguintes situações: 1) doenças inflamatórias agudas, principalmente naquelas relacionadas a edema que comprometa a via aérea; 2) doenças auto-imunes com alterações laríngeas; 3) estenose laríngea; 4) em lesões benignas inflamatórias das pregas vocais, como nódulos, pólipos e edema de Reinke, para diminuir o processo inflamatório pré-cirúrgico ou na tentativa de se evitar uma intervenção cirúrgica; 5) em fonocirurgia, com o objetivo de reduzir a formação de cicatriz. Seu uso pode ser profilático, visando à prevenção da formação de cicatriz ou terapêutico em uma cicatriz já formada. CONCLUSÃO: Os corticosteróides podem ser considerados uma opção terapêutica importante no manejo de várias patologias, principalmente aquelas de origem inflamatória que causam alterações vocais.

Steroids are potent inhibitors of inflammation and wound repair. Local administration of steroids directly into the larynx has been reported in many laryngeal diseases. AIM: The purpose of this study is to review related literature about the use of steroid injection in patients with benign, inflammatory and chronic vocal disease. METHODOLOGY: We performed an electronic survey in Medline database and selected clinical trials regarding steroid use in benign laryngeal diseases. RESULTS: Steroids are indicated in these situations: 1) acute inflammatory diseases, mainly when edema compromises the airways; 2) auto- immune disease with laryngeal involvement; 3) laryngeal stenosis; 4) benign lesions of the vocal folds, e.g., nodules, polyps and Reinke's edema, to reduce the inflammatory reactions before phonosurgery or in an attempt to avoid surgery; 5) In phonosurgery, aiming to reduce scarring. In this case, it could be used as a preventive measure in vocal fold scarring, or for scar treatment. CONCLUSION: Steroids may be considered an important therapeutic option in the management of many diseases, specially the inflammatory ones, associated with vocal changes.

Steroid injection in chronic inflammatory vocal fold disorders, literature review.

UNLABELLED: Steroids are potent inhibitors of inflammation and wound repair. Local administration of steroids directly into the larynx has been reported in many laryngeal diseases. AIM: The purpose of this study is to review related literature about the use of steroid injection in patients with benign, inflammatory and chronic vocal disease. METHODOLOGY: We performed an electronic survey in Medline database and selected clinical trials regarding steroid use in benign laryngeal diseases. RESULTS: Steroids are indicated in these situations: 1) acute inflammatory diseases, mainly when edema compromises the airways; 2) auto- immune disease with laryngeal involvement; 3) laryngeal stenosis; 4) benign lesions of the vocal folds, e.g., nodules, polyps and Reinke's edema, to reduce the inflammatory reactions before phonosurgery or in an attempt to avoid surgery; 5) In phonosurgery, aiming to reduce scarring. In this case, it could be used as a preventive measure in vocal fold scarring, or for scar treatment. CONCLUSION: Steroids may be considered an important therapeutic option in the management of many diseases, specially the inflammatory ones, associated with vocal changes.

Paraganglioma nasal: relato de caso / Nasal paraganglioma: a case report

Paragangliomas são neoplasias que surgem a partir do tecido paragangliônico do sistema nervoso autônomo. Os paragangliomas da cabeca e pescoco são bastante raros. Os tipos mais freqüentemente encontrados são o carotídeo, o júgulo-timpânico e o vagal. Paragangliomas do nariz e dos seios paranasais são muito infreqüentes. Os autores descrevem um caso de paraganglioma nasal em um paciente do sexo masculino, com 45 anos de idade, que foi submetido à exérese da lesão, e relatam os achados clínicos, critérios diagnósticos, tratamento, prognóstico e revisão da literatura. Consideramos importante o relato deste caso em vista da raridade da localizacão nasal dos paragangliomas.

Nasal paraganglioma: a case report.

Paragangliomas are tumors of the autonomic nervous system, arising from paraganglionic tissue. Paragangliomas of the head and neck region are very rare. In the head and neck, the most common sites of origin of this neoplasm are the carotid body, the jugular bulb and the vagal body. Paragangliomas of the nose and paranasal sinuses are very uncommon. The authors referred one case of nasal paraganglioma in a 45-year-old male patient, who was submitted to surgical excision, and included clinical findings, diagnostic criteria, treatment, prognosis and literature review. The importance of reporting this case refers to the rare incidence of paragangliomas in the nasal cavity and paranasal sinuses.

Adenoma pleomórfico de septo nasal: relato de caso / Pleomorphic adenoma of the nasal septum: a case report

As neoplasias nasais são bastante raras. Os tumores mais observados na cavidade nasal são papilomas epiteliais, angiomas, carcinoma de células transicionais, carcinoma pavimentoso e adenocarcinoma. O adenoma pleomórfico pertence ao grupo de tumores que aparecem com menor freqüência na fossa nasal, e é o tumor benigno glandular mais comum originado na cabeça e pescoço. A apresentação clínica típica dos pacientes com adenoma pleomórfico do septo nasal é de obstrução nasal unilateral, epistaxe e massa indolor na cavidade nasal. Em vista da raridade da apresentação clínica do adenoma pleomórfico nesta localização, os autores descrevem um caso de adenoma pleomórfico nasal em um paciente do sexo masculino, com 69 anos de idade, onde relatam os achados clínicos, critérios diagnósticos, tratamento, prognóstico e revisão da literatura.

Perfil epidemiológico do câncer de laringe no Hospital de Clínicas de Porto Alegre / Epidemiological profile of laryngeal cancer at the Hospital de Clinicas, Porto Alegre/RS

Com o objetivo de dcumentar a distribuição e o padrão de comportamento deste tumor entre os pacientes com diagnóstico de câncer de laringe atendidos no Hospital de Clínicas de Porto Alegre entre 1990/96. Foram encontrados 242 casos, a maioria da raça branca (94,2 por cento). A divisião por faixa etária mostrou um pico de ocorrência na sétima década de vida e a porporção de homens em relação à mulheres foi de 15:1. O tipo histológico mais comum foicarcinoma epidermóide (98,76 por cento) e o sítio mais frequentemente acometido foi a glote (44,7 por cento) consequentemente, o sintoma mais comum na apresentação foi a disfonia (76,5 por cento). Os pacientes com tumores na supraglote apresentaram principalmente disfagia e aqueles com tumores transglóticos, dispnéia. Quanto ao estadiamento, 43,2 por cento estavam no estágio IV no momento do diagnóstico. Os tumores localizados na supraglote estão relacionados com pior prognóstico nesta amostra de 38,3 por cento dos pacientes com câncer na supraglote estavam no estágio IV, enquanto que a maioria dos tumores glóticos (74,2 por cento) estavam no estágio I. A cirurgia total foi o tratamento mais realizado. Concluindo, verificou-se que os casos de câncer de laringe que chegam ao HCPA são diagnosticados em estágio avançado, tornando o prognóstico bastante reservado

Dados epidemiológicos do câncer de colo uterino no Rio Grande do Sul / Epidemiological data of cervix neoplasies in Rio Grande do Sul, Brazil

O objetivo deste trabalho foi estudar a epidemiologia descritiva do câncer do colo uterino no Rio Grande do Sul, no período de 1980/94 e verificar a situação da prevenção secundária dessa neoplasia pela citologia. Foram construidas séries históricas com índices de mortalidade padronizados pela população mundial, a partir dos dados da Secretaria de Saúde e Meio Ambiente do Rio Grande do Sul e analisadas pelo coeficiente de correlação de Pearson para séries históricas. Os resultados foram comparados com séries anteriores publicadas na literatura e com dados do Instituto Nacional do Câncer do Brasil. Concluiu-se que a mortalidade por câncer de colo uterino no Rio Grande do Sul continua ascendente, apesar dos esforços da SSMA para sua prevenção pela citologia. São apresentadas sugestões para remediar essa situação no Rio Grande do Sul

O papel dos fatores genéticos na otite média / The role of genetic factors in otitis media

É sabido que a otite média aguda pode ser causada por fatores ambientais, como freqüentar creches, fumo passivo, curto período de amamentaçäo e baixas condiçöes sócio-econômicas. A revisäo das pesquisas recentes, contudo, sugere que fatores genéticos também contribuem de forma significativa para a ocorrência da otite média aguda, recorrente e da otite média crônica, com efusäo. Embora näo existam estudos genéticos específicos, há consistentes evidências em favor da transmissäo genética de uma suscetibilidade para otite média. A história familiar, características raciais, a freqüência de antígenos HLA e de marcadores genéticos, entre outros fatores, säo algumas das evidências que seräo apresentadas nesta revisäo de literatura.

Antidepressivos no tratamento farmacológico da bulimia nervosa / Antidepressants in the the treatment of Bulimia Nervosa

A bulimia nervosa tem sido tratada com antidepressivos, tais como os inibidores da recaptação da serotonina seletivos, tricíciclos e inibidores da monoaminoxidade irreversíveis e reversíveis. A fluoxetina e afluvoxamina, inibidores seletivos da recapatação da serotonina tem-se mostrado efetivos no tratamento da bulimia, diminuindo a compulsão de comer, com a vantagem adicional de diminuição do peso...

Papel do papilomavirus humano (HPV) na genese do carcinoma de colo de utero: suas implicacoes atuais no rastreio / Role of human papillomavirus (HPV) in the pathogenesis of uterine cervical cancer; implications for screening

Neste trabalho a literatura recente em relacao as seguintes questoes e revisada: 1) qual e a prevalencia HPV, em mulheres cujo exame citopatologico foi normal? 2) existe correlacao entre a morfologia citologica ou histologica e o tipo de HPV? 3) qual e a historia natural da infeccao pelo HPV do colo uterino? 4) quando determinar o tipo de HPV por biologia molecular? 5) que alteracoes nas estrategias de rastreamento populacional esses novos conhecimentos estao a exigir? e 6) que expectativa devemos ter em relacao as vacinas profilaticas e curativas em estudo?