Laryngeal paralysis secondary to cervical bite injuries in five dogs.

CASE HISTORIES: Medical records of a veterinary hospital in Belgium were reviewed for dogs (n = 5) that presented between 2016 and 2019 with laryngeal paralysis secondary to bite wounds to the cervical region received while fighting with other dogs. The time elapsed between the trauma and presentation was from a few hours up to 5 days. CLINICAL FINDINGS AND TREATMENT: Bilateral laryngeal paralysis was identified in three dogs and unilateral laryngeal paralysis in two dogs via endoscopic assessment of laryngeal function. The primary concomitant lesions included tracheal injury in 3/5 dogs and oesophageal injury in 1/5 dogs. One dog with bilateral laryngeal paralysis was treated medically as no signs of dyspnoea were present. Surgical management was elected in 4/5 dogs based on evaluation of their clinical status and lesions revealed by endoscopic examination of upper gastrointestinal and respiratory tracts. Dogs underwent surgical procedures that were determined to be appropriate for treatment of the lesions identified on clinical examination, diagnostic imaging, and endoscopy. The cervical region was explored through a ventral midline approach in 2/4 cases, to close tracheal perforations. Temporary tracheostomy was performed in 2/4 cases. Procedures to correct brachycephalic airway obstructive syndrome were performed in 2/4 cases. Cricoarytenoid lateralisation was performed in 2/4 dogs. Dogs were hospitalised for 2-10 days and received antimicrobial therapy before surgery and for 2-3 weeks after surgery. Physical examination and respiratory function were normal in 3/5 dogs 4-6 months after discharge. Information regarding outcomes for two cases was obtained from the owners by telephone assessment 1-6 months after surgery. The owner of each dog reported the respiratory function to be excellent. DIAGNOSIS: Uni- or bilateral, transient or permanent laryngeal paralysis with concomitant oesophageal, tracheal, or laryngeal lesions following cervical dog bite injuries diagnosed by endoscopic examination of upper gastrointestinal and respiratory tracts. CLINICAL RELEVANCE: This case series describes the diagnosis and management of dogs with laryngeal paralysis secondary to cervical dog bite injuries. To the authors' knowledge, this is the first published report documenting bilateral laryngeal paralysis secondary to cervical dog bite injuries. Clinicians should be aware of this pathology and the importance of investigating laryngeal function in dogs presenting with cervical bites, particularly those with inspiratory dyspnoea. Upper airway and digestive endoscopy are recommended for complete assessment of cervical traumatic injuries.

Effect of two isolated vocal facilitating techniques glottal fry and yawn-sigh on the phonation of female speech-language pathology students: A pilot study.

OBJECTIVE: The purpose of this study was to determine the effect of two isolated vocal facilitating techniques, glottal fry and yawn-sigh, on the phonation of vocally healthy female speech-language pathology (SLP) students. STUDY DESIGN: A multigroup pretest-posttest design was used. METHODS: A group of thirty-six healthy female SLP students with a mean age of 18.1 years were assigned into three groups: a glottal fry group (practicing the facilitating technique glottal fry across 18 weeks, n=12), a yawn-sigh group (practicing the facilitating technique yawn-sigh across 18 weeks, n=12) and a control group (receiving no facilitating techniques, n=12). To compare vocal measures before and after this training period, an identical objective voice assessment protocol (maximum performance task, acoustic analysis, voice range profile and Dysphonia Severity Index) was performed in the three groups. Groups were compared over time using linear mixed models. Within-group effects of time were determined using post hoc pairwise comparisons. RESULTS: Glottal fry resulted in a significant decrease in lowest and highest intensity. Yawn-sigh resulted in a significant increase in fundamental frequency, a significant decrease in shimmer and noise-to-harmonic ratio, and a significant increase in highest intensity. CONCLUSIONS: Yawn-sigh may have a positive effect on the phonation of female vocally healthy future SLPs, whereas results are less supportive for using glottal fry in training this population's voice.

Complications and outcome of a new modified Maquet technique for treatment of cranial cruciate ligament rupture in 82 dogs.

OBJECTIVES: To describe the complications, short and long-term outcome and owner satisfaction of dogs with cranial cruciate ligament rupture treated with a recently described new osteotomy for the modified Maquet technique (N-MMT). MATERIALS AND METHODS: Medical records and radiographs of 82 dogs (84 stifles) were reviewed. Details regarding short-term outcome and complications were recorded from the medical records. Long-term follow-up information was obtained by telephone interview. Historical data and complications were statistically analysed. RESULTS: Major complications occurred in 34/84 stifles. Intra-operative complications occurred in 26/84 stifles, all of which were fissures or fractures of the cortical hinge. Twenty-one of these fractures or fissures were repaired with a figure-of-eight wire. The second most common major complication was late meniscal tears in 3/84 stifles. One dog sustained a complete tibial fracture. Non-displaced fracture of the cortical hinge was the most common postoperative minor complication, which occurred in 5/84 stifles. The median preoperative lameness score was 3 out of 6. Final in-hospital re-evaluation of limb function was available in 58 dogs. The median lameness score at that time was 0 out of 6. Development of osteotomy related complications was not associated with a significant change in the postoperative lameness score. CLINICAL SIGNIFICANCE: Subjectively assessed clinical outcome with the N-MMT was good to excellent in this cohort of dogs. However, a high rate of intra- and postoperative complications of the N-MMT procedure was also present in these dogs.

Biomechanical testing of a ß-tricalcium phosphate wedge for advancement of the tibial tuberosity.

OBJECTIVES: to evaluate in vitro the strength of different compositions of beta-tricalcium phosphate (ß-TCP) wedges in comparison with titanium foam and cages. To study the response to cyclic loading of the strongest ß-TCP wedge, titanium foam and titanium cage. METHODS: Compression test: Twenty-five tibiae were prepared for tibial tuberosity advancement using the modified Maquet technique. Five groups were defined depending on the material used to maintain the tibial tuberosity: Group 1=titanium cage; Group 2=wedges of porous titanium foam with 50% porosity (OrthoFoam®); Group 3=blocks of biphasic synthetic bone (60% hydroxyapatite [HAP] and 40% ß-TCP, porosity 80%); Group 4=blocks of biphasic synthetic bone (60% HAP and 40% ß-TCP, porosity 70%) and Group 5=blocks of biphasic synthetic bone (65% HAP and 35% ß-TCP, porosity 60%). Loads to failure were calculated for each implant. Cyclic study: Five additional tibiaes of group 1, 2 and 5 were fatigue tested from 100 to 500 N at a rate of 4 Hz for 200,000 cycles or until failure. RESULTS: Compression test: For the five groups, the mean load at failure was 1895 N, 1917 N, 178 N, 562 N and 1370 N respectively. Cyclical study: All samples in the three groups tested withstood 200,000 cycles without failure. CLINICAL SIGNIFICANCE: The ideal implant to maintain tibial tuberosity advancement after the modified Maquet technique would be absorbable and allow osteoconduction and osteoinduction. As such, ß-TCP wedges have many advantages and our study shows that they can withstand loads in the patellar tendon up to 500 N over 200,000 cycles in vitro and deserve more investigation.

The impact of menopause and hormone therapy on voice and nasal resonance.

In an initial study it was shown that (without hormonal influences) middle-aged (premenopausal) women show a smaller frequency and intensity range and a lower fundamental frequency of the voice compared to young women. To investigate the impact of menopause on voice and nasal resonance a cross-sectional non-randomized study design was used. Vocal characteristics and nasal resonance in premenopausal and postmenopausal women without hormone therapy (HT) were compared. Postmenopausal women without HT showed a significantly lower speaking fundamental frequency (SFF) and were able to phonate lower compared to postmenopausal women with HT. The mean difference in SFF was 14 Hz. HT can also counteract the menopausal changes in SFF. The lower SFF did not result in vocal complaints. Further research about the impact of menopause and HT on voice should concentrate on elite professional voice users.

Alternatively activated macrophages and impaired phagocytosis of S. aureus in chronic rhinosinusitis.

BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) is characterized by biased Th2 inflammation and CRS without nasal polyps (CRSsNP) by a Th1 immune response. Colonization by Staphylococcus aureus is increased in CRSwNP. We aimed to determine macrophage phenotypes in nasal mucosa of CRSwNP and CRSsNP and to examine phagocytosis of S. aureus in these pathologies. METHODS: Macrophage phenotyping was performed by immunohistochemical staining on nasal mucosa sections from 28 patients; in addition flow cytometry analysis was performed. Tissue homogenate protein levels of IFN-γ, IL-5, IL-6, IL-1ß, TGF-ß, eosinophil cationic protein (ECP) and total IgE were analyzed and correlated with macrophage subtypes. Phagocytosis of S. aureus was analyzed by flow cytometry. Survival of S. aureus in Thp1 cells in the presence of polarizing cytokines was studied in vitro. RESULTS: By immunohistochemical analysis more M2 macrophages were present in CRSwNP than in CRSsNP. This also was positively correlated with increased levels of IL-5, ECP and locally produced IgE and decreased levels of IL-6, IL-1ß and IFN-γ. FACS analysis of dissociated nasal tissue confirmed the presence of increased numbers of M2 macrophages (CD206(+) HLADR(+) CD14(+) CD11c(+) CD20(-) ) in CRSwNP as compared to controls, while the number of M1 macrophages (CD206(-) HLADR(+) CD14(+) CD11c(int) CD16(-) CD20(-) ) was not different. Phagocytosis of S. aureus by human tissue derived macrophages was reduced in CRSwNP as compared to macrophages from the control inferior turbinates. CONCLUSIONS: Decreased phagocytosis of S. aureus and an M2 activation phenotype in CRSwNP could potentially contribute to persistence of chronic inflammation in CRSwNP.

Rhinosinusitis and asthma: a link for asthma severity.

The term rhinosinusitis describes an inflammation of the mucosal lining of the nose and sinuses; however, recent evidence points to the need to differentiate patients with chronic rhinosinusitis without nasal polyps from those with nasal polyps. Asthma comorbidity is especially common in nasal polyp disease and may be associated with aspirin-exacerbated respiratory disease. Of interest, asthma comorbidity is uncommon in some parts of the world but common in others. A further analysis of the inflammatory patterns also revealed that nasal polyps do not represent one single entity; interleukin (IL)-5-positive nasal polyps can be differentiated from IL-5-negative forms by different inflammatory patterns (predominance of eosinophils vs neutrophils). Staphylococcus aureus superantigens frequently colonize IL-5-positive nasal polyps and may amplify the eosinophilic inflammation, induce a polyclonal local IgE formation, and increase the risk of asthma comorbidity. Recent findings in severe asthma patients confirm the role of superantigens in lower airway disease.

Why do we prefer the external approach?

Open structure rhinoplasty (OSR) is an old technique that has gained in popularity amongst plastic surgeons and otolaryngologists over the past twenty years. Opponents of the external approach cite potential problems such as unnecessary scaring, reduction of tip support, extended operative time and excessive post-operative tip swelling. However, even relatively inexperienced rhinoplastic surgeons embrace this approach, especially in cases with more complex tip deformities and skeletal abnormalities. Concerns about scarring and post-operative tissue reaction due to the more "aggressive" external approach make it necessary to consider the indications for the open approach carefully. Various incisions have been described for open rhinoplasty to reduce scarring, such as the Z, V, reverse V, and W incisions. There should be a strong emphasis on post-operative care in open approach rhinoplasty since open structure rhinoplasty is generally considered to be a more traumatic technique than the endonasal approach. Careful incision and dissection of the skin flap in the right surgical plane and proper suturing are essential to avoid short- and long-term complications. In conclusion, the external approach is preferable in selected cases where extended exposure (asymmetry cases, for example), per-operative assessment (revision cases), grafting and suturing are required. It allows the surgeon to work bimanually during reconstruction and the better per-operative evaluation reduces the revision rate.

The vocal quality in female student teachers during the 3 years of study.

The purpose of the present cross-sectional study was to determine the objective vocal quality and the vocal characteristics (vocal risk factors, vocal and corporal complaints) in 143 female student teachers during the 3 years of study. The objective vocal quality was measured by means of the Dysphonia Severity Index (DSI). Perceptual voice assessment, the Voice Handicap Index, questionnaires addressing vocal risks, and vocal and corporal complaints during and/or after voice usage were performed. Student teachers have a normal perceptual and objective vocal quality corresponding with a DSI% of 76. The analysis of variance revealed a significant improvement of the vocal quality between the first and the third year of study. No psychosocial handicapping effect of the voice was observed, though there are some vocal complaints and almost all student teachers reported the presence of corporal pain during and/or after speaking. Especially sore throat and headache were mentioned as the most present corporal pain symptoms. Due to the decreased awareness and the multifactorial genesis of the potential vocal risk factors, the student teachers are at risk for developing an occupational dysphonia during their teaching career. Because teaching is a high-risk profession for the development of voice problems, the incorporation of a direct vocal training technique to increase vocal endurance during teaching together with a vocal hygiene program, dietetics, and a stress management training program during the 3 years of study is needed to prevent occupational dysphonia.

The impact of the menopause on the voice

During lifetime the female larynx is very sensitive tosex hormone fluctuations. In the menopause the serum levels of estrogens and progesterone decrease dramatically so that the ratio of estrogens-progesterone to androgens changes in aid of the last hormone. This article gives an overview of the recent literature about the impact of the menopause on the larynx and the vocal quality. Secondly the effect of hormone replacement therapy in the menopause on the larynx and the vocal performance is discussed. Most research in postmenopausal women show that the larynx is an estrogen-target. In the larynx of postmenopausal women mucosal changes are observed. These laryngeal changes can result in altered acoustic characteristics of the voice. The most important acoustic characteristics of the voice are changes in the fundamental frequency and the frequency range of the voice. The first reports in the literature about the role of hormone replacement therapy in the larynx point out a tendency of a positive, organ-conserving effect of hormone treatment on the larynx and probably the voice. However, more research is necessary to confirm these findings. A better understanding of the relation between sex hormones and the female larynx will make it possible to develop strategies to improve the vocal quality of postmenopausal women (AU)

A lo largo de la vida, la laringe femenina es muy sensible a fluctuaciones sexuales hormonales. En la menopausia los valores de estrógenos y de progesterona disminuyen drásticamente, de tal modo que la relación de estrógenos-progesterona en andrógenos cambia en beneficio de esta última. En primer lugar, este artículo da una descripción de la literatura reciente sobre el impacto de la menopausia en la laringe y en la calidad vocal. En segundo lugar, analiza el efecto de la terapia hormonal de reemplazo de la menopausia en la laringe y en el funcionamiento vocal. La mayoría de investigaciones en mujeres posmenopáusicas muestran que la laringe es un estrógeno. En la mucosa de la laringe de las mujeres posmenopáusicas se observan cambios. Estos cambios pueden causar una alteración de las características acústicas de la voz. Estas alteraciones son cambios en la frecuencia en general y en la gama de frecuencias de la voz. Los primeros informes en la literatura sobre el papel de la terapia hormonal de reemplazo en la laringe indican una tendencia aun efecto positivo que conserva órganos de tratamiento hormonal en la laringe y, probablemente, en la voz. Sin embargo, son necesarias más investigaciones para confirmar estos hallazgos. Un mejor entendimiento de la relación entre hormonas sexuales y la laringe femenina permitirá desarrollar estrategias para mejorar la calidad vocal de las mujeres posmenopáusicas (AU)

Vocal quality in university teachers: a pilot study.

OBJECTIVE: The main purpose of this study was to determine the vocal quality of 20 male and 9 female university teachers using a multi-parameter approach. Secondly, the effect of an academic lecture on the voice profiles of the university teachers was measured. METHODOLOGY: All groups underwent subjective voice evaluations (perceptual evaluation, Voice Handicap Index, anamnesis of vocal complaints and vocal abuse) and objective voice evaluations (aerodynamic and acoustic parameters, vocal performance, and the Dysphonia Severity Index). The same voice assessment was performed after an academic lecture with a mean length of one and a half hours. RESULTS: The mean DSI score was + 2.2 for the male teachers and + 4.0 for the female teachers. The mean VHI score was 13. Perceptually, all voice parameters were rated as normal. The questionnaire revealed a relatively high amount of vocal abuse. No changes in the objective vocal parameters were found after the lecture. Perceptually, however, the voices of the university teachers were significantly less instable after the lecture. Although no negative changes in objective vocal quality were observed, 48% of the university teachers experienced subjective vocal changes. CONCLUSION: The authors concluded that university teachers are professional voice users with good vocal quality who suffer no handicapping effect from possible voice disorders. No important changes in the vocal profile after a teaching activity of one and a half hours were found, despite the high prevalence of voice complaints.

Important research questions in allergy and related diseases: 3-chronic rhinosinusitis and nasal polyposis - a GALEN study.

Chronic rhinosinusitis is one of the most common health care challenges, with significant direct medical costs and severe impact on lower airway disease and general health outcomes. The diagnosis of chronic rhinosinusitis (CRS) currently is based on clinical signs, nasal endoscopy and CT scanning, and therapeutic recommendations are focussing on 2 classes of drugs, corticosteroids and antibiotics. A better understanding of the pathogenesis and the factors amplifying mucosal inflammation therefore seems to be crucial for the development of new diagnostic and therapeutic tools. In an effort to extend knowledge in this area, the WP 2.7.2 of the GA(2)LEN network of excellence currently collects data and samples of 1000 CRS patients and 250 control subjects. The main objective of this project is to characterize patients with upper airway disease on the basis of clinical parameters, infectious agents, inflammatory mechanisms and remodeling processes. This collaborative research will result in better knowledge on patient phenotypes, pathomechanisms, and subtypes in chronic rhinosinusitis. This review summarizes the state of the art on chronic rhinosinusitis and nasal polyposis in different aspects of the disease. It defines potential gaps in the current research, and points to future research perspectives and targets.

Effect of psychological stress on female vocal quality. A multiparameter approach.

Psychological stress can influence vocal quality. The purpose of the present study was to determine the effect of stress on female vocal quality. In this experimental study 54 female voices were studied in a stress-inducing and a relaxed condition. In the stress-inducing condition the subjects were asked to read a passage while instructions were used to evoke stress. In the relaxed condition the same reading task but without specific instructions was used. Identical subjective and objective assessment techniques were used to determine vocal quality in the stressed and the relaxed conditions. In stress-inducing and challenging conditions the female voice is more breathy, strained and of a lower objective vocal quality characterized by lower fundamental frequency, lower frequency, intensity and aerodynamic capacity. This study indicates that stress-inducing and challenging conditions change vocal quality and vocal performance. Understanding of the effect of stress on voice production is relevant for clinical diagnostic situations, particularly in patients who present with a functional (nonorganic) voice disorder, as well as those patients who have some organic pathology but who also report exacerbation of symptoms during periods of increased life stress.

Long-term outcome of hyperfunctional voice disorders based on a multiparameter approach.

SUMMARY: The purpose of this study is to determine the long-term voice outcome (6.1 years after a well-defined voice treatment program) of hyperfunctional voice disorders in 27 subjects. All patients showed a muscle tension pattern type I (MTP I). Perceptual ratings, aerodynamic and acoustical analyses, Voice Handicap Index (VHI) value, and a determination of the Dysphonia Severity Index (DSI) were performed. The laryngovideostroboscopic images indicated that 51% of the subjects still show pathological laryngological findings. The negative evolution of the DSI from -1 to -3.2 is in agreement with this finding. Analysis of the components of the DSI shows that the main responsible variable for this negative change is the lowest intensity (I-low) that increased with 8.1 dB, indicating that subjects generally speak too loud, which is a typical problem for vocal hyperfunction. The VHI-score indicates an unimportant psychosocial impact of the voice disorder. The more objective and laryngostroboscopic findings indicate a chronic situation for a substantial part of the subjects and even a worse situation for some of them. Whether the long-term voice outcome results can be changed with the insertion of several follow-up voice rehabilitation sessions over the years remains unanswered and is a subject for further research.

Differentiation of chronic sinus diseases by measurement of inflammatory mediators.

BACKGROUND: Chronic rhinosinusitis (CRS) clinically is a heterogeneous group of sinus diseases, which may cover different disease entities, or may represent a disease continuum. Studying inflammatory cells and mediators in clearly defined disease subgroups may lead to a better differentiation of chronic sinus diseases. METHODS: Sinonasal mucosal tissue from 10 nasal polyp (NP) patients, 13 cystic fibrosis patients (CF-NP), eight CRS subjects without polyps, and nine control patients were stained for CD3, CD25, CD68, CD20, myeloperoxidase (MPO), CD138 and tissue homogenates were assayed for eotaxin, interleukin (IL)-1beta, IL-2sRalpha, IL-5, interferon (IFN)-gamma, IL-8, transforming growth factor (TGF)-beta1, tumor necrosis factor-alpha, and MPO by enzyme-linked immunosorbent assay or UNICAP system. RESULTS: Nasal polyp and CF-NP showed increased numbers and activation of T cells, while only NP displayed an increase in plasma cells. Nasal polyp had significantly higher levels of eosinophilic markers [eosinophils, eotaxin, and eosinophil cationic protein (ECP)] compared with CRS, controls and CF-NP. Chronic rhinosinusitis was characterized by a Th1 polarization with high levels of IFN-gamma and TGF-beta, while NP showed a Th2 polarization with high IL-5 and immunoglobulin (Ig) E concentrations. Nasal polyp and CF-NP were discriminated by edema from CRS and controls, with CF-NP displaying a very prominent neutrophilic inflammation. CONCLUSION: Based on cellular and mediator profiles, we suggest that CRS, NP, and CF-NP are distinct disease entities within the group of chronic sinus diseases.

Surgical treatment of canine nasal aspergillosis by rhinotomy combined with enilconazole infusion and oral itraconazole.

OBJECTIVES: To evaluate the effectiveness of rhinotomy and surgical debridement associated with topical administration of 2 per cent enilconazole and oral itraconazole in dogs with severe or recurrent sinonasal aspergillosis. METHODS: A standard rhinotomy was performed on seven dogs. In the initial study, the bone flap was left attached cranially and replaced at the end of the procedure. In the main study group, the bone flap was discarded. Nasal passages were debrided and irrigated with enilconazole solution for one hour. Oral itraconazole was administered to four dogs for one month postoperatively. Follow-up rhinoscopy was performed in all dogs. RESULTS: All three dogs in the initial study had recurrence of the disease and two dogs had a second surgery to remove the flap. The main study group included four dogs in which the flap was initially removed, and the two dogs from the initial study that required a second surgery. At follow-up rhinoscopy, five dogs were free of aspergillus but had bacterial or inflammatory rhinitis and one dog had a small aspergilloma but was subsequently asymptomatic. Telephone follow-up revealed that four dogs were asymptomatic, one dog had intermittent sneezing and serous nasal discharge, and one dog had intermittent epistaxis. CLINICAL SIGNIFICANCE: Rhinotomy with removal of the flap combined with one-hour infusion of 2 per cent enilconazole and oral itraconazole resulted in satisfactory outcome in dogs with severe or recurrent aspergillosis.

Nasal polyps in patients with and without cystic fibrosis: a differentiation by innate markers and inflammatory mediators.

BACKGROUND: The dysfunction of the mucosal interface of the upper respiratory tract in cystic fibrosis (CF) patients is clinically visible by the development of nasal polyps (NP) at a young age. Innate defence markers and inflammatory mediators in NP from patients with CF were compared with non-cystic fibrosis nasal polyps (non-CF-NP) to determine a possible different immunological background in macroscopically similar tissue. METHODS: Surgical samples were obtained from patients with non-CF-NP, cystic fibrosis patients with nasal polyps (CF-NP) and control patients (CO). With real time PCR, the mRNA expression of human beta defensins (HBD) 2 and 3, toll-like receptors (TLR) 2 and 4 and the macrophage mannose receptor (MMR) were measured. On homogenates of the surgical samples eotaxin, myeloperoxidase (MPO), IL-5 and IL-8 protein content was measured using commercial ELISA kits; IgE and eosinophilic cationic protein (ECP) were measured by the Unicap system. RESULTS: In CF-NP we found a statistically significant higher mRNA expression of HBD 2 compared with non-CF-NP and CO and of TLR 2 compared with non-CF-NP. In the non-CF-NP group, MMR mRNA expression was significantly elevated compared with CO and CF-NP. For TLR 4 mRNA expression no statistically significant differences were found between groups. IL-5 was below detection level in all CO and CF-NP, but was measurable in 80% of the non-CF-NP. MPO and IL-8 concentrations were significantly higher in CF-NP compared with CO and non-CF-NP, whereas ECP, eotaxin and IgE were significantly higher in the non-CF-NP group. CONCLUSIONS: We here demonstrate that CF-NP and non-CF-NP not only differ in terms of inflammatory mediator profile, but also in terms of innate markers.

Vocal quality characteristics in children with cleft palate: a multiparameter approach.

The main purpose of the present study was to examine the vocal quality and to investigate the effects of gender on vocal quality in 28 children with a unilateral or bilateral cleft palate. In this study, the vocal quality was determined using videolaryngostroboscopic and perceptual evaluations, aerodynamic, voice range, acoustic, and dysphonia severity index (DSI) measurements. The DSI is based on the weighted combination of four voice measurements and ranges from +5 to -5 for, respectively, normal and severely dysphonic voices. Additional objectives were to compare the vocal quality characteristics of children with cleft palate with the available normative data and to investigate the impact of the cleft type on vocal quality. Gender-related vocal quality differences were found. The male cleft palate children showed an overall vocal quality of +0.62 with the presence of a perceptual slight grade of hoarseness and roughness. The female vocal quality had a DSI value of +2.4 reflecting a perceptually normal voice. Irrespective of the type of cleft, all subjects demonstrated a significantly lower DSI-value in comparison with the available normative data. The results of the present study have provided valuable insights into the vocal quality characteristics of cleft palate children.

Macrophage mannose receptor in chronic sinus disease.

BACKGROUND: The role of infectious agents in the onset and maintenance of chronic sinus disease is still not fully understood. Macrophage mannose receptor (MMR), an innate pattern recognizing receptor, capable of phagocytosis of invaders and signal transduction for proinflammatory mechanisms, might be of importance in immune interactions in chronic sinus disease. OBJECTIVE: We examined the MMR in sinonasal airway mucosa to evaluate its possible role in chronic rhinosinusitis (CS) and nasal polyposis (NPs). METHODS: Surgical samples from patients with sinonasal disease were investigated with real-time RT-PCR for quantification of MMR mRNA expression, and the presence and location of MMR-positive cells was analysed by immunohistochemistry. RESULTS: Quantification of MMR mRNA showed a statistically significant higher expression in NPs compared to CS without NP and controls. Immunohistochemistry revealed expression of MMR in all tissue samples; however, in NP we found an enhanced positive cellular staining including cell aggregates. CONCLUSIONS: We could demonstrate for the first time that the expression of MMR is significantly upregulated in NP compared to patients with CS without NP or turbinate tissue of controls. Macrophages expressing MMR, accumulated in cell aggregates in NPs, play a possible key role in pathogen-macrophage interaction in NP disease.