Voice Improvement after Voice Therapy in Female Patients with Unilateral Vocal Fold Paralysis after Thyroid Surgery.

INTRODUCTION: Dysphonic voice is present in patients with unilateral vocal fold paralysis (UVFP). The aim of this study was to present outcomes following rehabilitation of patients with UVFP, performed according to a voice therapy protocol. METHODS: This prospective study comprised 27 women with UVFP who underwent pre- and post-voice therapy assessment. The mean age of patients was 53.19 ± 10.06 years. The protocol included the following: (1) multidimensional assessment of voice quality before treatment; (2) digital laryngeal manipulation voice therapy; (3) voice therapy evaluation which implied repeated multidimensional assessment of voice. RESULTS: The results showed improvement in voice quality following voice therapy with regard to the parameters of the objective voice analysis (maximum fundamental frequency of voice, minimum intensity of voice, jitter, shimmer, harmonics-to-noise ratio, and signal-to-noise ratio, p ˂ 0.05), maximum phonation time, subjective analysis of voice, as well as self-assessment of voice quality on all the subscales and overall score (p ˂ 0.001). CONCLUSION: Implementing a protocol provides clear guidelines at each stage of the treatment. Voice therapy performed using digital laryngeal manipulation improves the majority of the acoustic and perceptual characteristics of the voice.

Comparison of Voice Handicap Index in Patients with Esophageal and Tracheoesophageal Speech after Total Laryngectomy.

BACKGROUND: Successful speech rehabilitation has a great impact on the quality of life in totally laryngectomized patients. OBJECTIVES: The aim of this paper was to compare the self-assessed voice handicap of totally laryngectomized patients with two different methods of alaryngeal speech - esophageal (ES) and tracheoesophageal speech (TES). METHOD: The research comprised 83 totally laryngectomized, disease-free patients, split into two groups. The first group included 43 participants with successfully rehabilitated ES, and the second group included 40 participants with successfully established TES after secondary implantation of Provox 2TM voice prosthesis. All subjects filled in the Serbian version of the Voice Handicap Index (VHI-30). The results (overall score and three VHI subscales) were analyzed and compared with those of the subjects of both groups. The impact of age in the subgroups (<65 years old and ≥65 years old) and previous irradiation on the examined VHI values were also analyzed. RESULTS: The median value of the overall VHI score in the participants with TES was 29.03 ± 23.479 (range: 0-97), and in the participants with ES it was 64.51 ± 21.089 (range: 19-99). The VHI scores (overall and three VHI subscales) were significantly higher in participants with ES compared to those with TES (p < 0.01), indicating a larger voice handicap. No significant difference was found in the overall VHI score and VHI subgroups in terms of age subgroups and previous irradiation (p > 0.05). CONCLUSIONS: Our data reveal a significantly higher voice handicap in participants with ES compared to the TES group, with a large interindividual variation within both groups. VHI values are not significantly different between the two age subgroups, nor are they significantly influenced by irradiation.

Clinical stage of laryngeal carcinoma and lost time at the moment of diagnosis with 15-year-long interval. Are there any changes?

PURPOSE: Despite the fact that laryngeal cancer causes symptoms early, the patients often present with advanced disease. The aim of this paper was to determine how much time had been lost from the beginning of the symptoms to establishing the diagnosis, and what was the clinical stage of the laryngeal cancer at the time of diagnosis in two examination years (2001 and 2016). METHODS: The research involved 108 patients of both genders, 54 during each examination year, with whom the diagnosis of laryngeal carcinoma was established. The charts of the patients were reviewed, and the data were analyzed and compared. RESULTS: The median lost time from the time when the symptoms started to the time of diagnosis was 8.22 months during 2001 versus 8.77 months during 2016, with no statistically significant difference (p=0.774). Early clinical T stage of the disease in 2001 was present in 57.4% of the cases and 70.4% in 2016, with no statistically significant difference (p=0.161). Early clinical TNM stage in 2001 was in 48.1%, and 64.8% in 2016, with no statistically significant difference (p=0.081). Tracheotomy at the time of establishing the diagnosis was necessary in statistically significantly greater number of patients in 2001 compared to 2016 (59.3% versus 31.5% ;p=0.004). CONCLUSION: The diagnosis of laryngeal carcinoma is established late, with a long lost time. Favourable is the statistically significant decrease in the number of patients who require tracheotomy at the time of establishing the diagnosis with a 15-year-long interval.

Clinical stage of laryngeal carcinoma and lost time at the moment of diagnosis with 15-year-long interval. Are there any changes?

PURPOSE: Despite the fact that laryngeal cancer causes symptoms early, the patients often present with advanced disease. The aim of this paper was to determine how much time had been lost from the beginning of the symptoms to establishing the diagnosis, and what was the clinical stage of the laryngeal cancer at the time of diagnosis in two examination years (2001 and 2016). METHODS: The research involved 108 patients of both genders, 54 during each examination year, with whom the diagnosis of laryngeal carcinoma was established. The charts of the patients were reviewed, and the data were analyzed and compared. RESULTS: The median lost time from the time when the symptoms started to the time of diagnosis was 8.22 months during 2001 versus 8.77 months during 2016, with no statistically significant difference (p=0.774). Early clinical T stage of the disease in 2001 was present in 57.4% of the cases and 70.4% in 2016, with no statistically significant difference (p=0.161). Early clinical TNM stage in 2001 was in 48.1%, and 64.8% in 2016, with no statistically significant difference (p=0.081). Tracheotomy at the time of establishing the diagnosis was necessary in statistically significantly greater number of patients in 2001 compared to 2016 (59.3% versus 31.5% ;p=0.004). CONCLUSION: The diagnosis of laryngeal carcinoma is established late, with a long lost time. Favourable is the statistically significant decrease in the number of patients who require tracheotomy at the time of establishing the diagnosis with a 15-year-long interval.

Endoscopic repair of cerebrospinal fluid rhinorrhea.

INTRODUCTION: Nasal liquorrhea indicates a cerebrospinal fluid fistula, an open communication between the intracranial cerebrospinal fluid and the nasal cavity. It can be traumatic and spontaneous. OBJECTIVE: The aim of this study was to assess the outcome of endoscopic repair of cerebrospinal fluid fistula using fluorescein. METHODS: This retrospective study included 30 patients of both sexes, with a mean age of 48.7 years, treated in the period from 2007 to 2015. All patients underwent lumbar administration of 5% sodium fluorescein solution preoperatively. Fistula was closed using three-layer graft and fibrin glue. RESULTS: Cerebrospinal fluid fistulas were commonly located in the ethmoid (37%) and sphenoid sinus (33%). Most patients presented with traumatic cerebrospinal fluid fistulas (2/3 of patients). The reported success rate for the first repair attempt was 97%. Complications occurred in three patients: one patient presented with acute hydrocephalus, one with reversible encephalopathy syndrome on the fifth postoperative day with bilateral loss of vision, and one patient was diagnosed with hydrocephalus two years after the repair of cerebrospinal fluid fistula. CONCLUSION: Endoscopic diagnosis and repair of cerebrospinal fluid fistulas using fluorescein intrathecally has high success rate and low complication rate.

Laryngotracheal stenosis and restenosis. What has the influence on the final outcome?

The aim of this study is to analyze the impact of various parameters on the course and treatment outcome in patients with laryngotracheal stenosis and recurrent stenosis. Two groups of patients were compared: Group I included 29 patients with primary stenosis, and Group II included 22 patients with recurrent stenosis. The most frequent etiological factor for the development of stenosis was prolonged endotracheal intubation (79.3:77.3%), with subglottic-tracheal (44.8:45.5%) and tracheal (48.3:36.4%) localization being the most affected. Subglottic-tracheal stenosis was more common in men. There were no significant differences between the groups in regard to the grade of lumen obstruction and the length of the resected segment. In male patients, the length of the resected stenotic segment was significantly longer. Subglottic-tracheal stenoses were longer than tracheal ones. Various surgical procedures were performed, with additional management of recurrent laryngeal nerve paralysis, if necessary. Laryngotracheal reconstruction (LTR) with costal cartilage grafting (CCG) was statistically significantly more often performed in Group II, while cricotracheal resection (CTR) was more common in Group I. The incidence of complications in Group I was 24.1%, and in Group II it was 31.8%. Satisfactory airway lumen with undisturbed breathing was achieved in 93.1% of patients in Group I, and in 95.3% in Group II. Since the success rate was similar in both groups of the patients, it could be concluded that treatment outcome depends less on the factors associated with the stenosis, and more on adequate choice of surgical procedure and surgical team know-how.

Transient evoked otoacoustic emissions in young children with otitis media with effusion before and after surgery.

OBJECTIVE: Otitis media with effusion (OME) is one of the commonest causes of acquired hearing loss in children with increasing incidence. In young children the diagnosis is restricted to clinical trials and tympanometry whereas evaluation of the auditory function is impossible due to noncompliance during pure tone audiometry. For this purpose, measurement of otoacoustic emissions, especially transient evoked ones (TEOAE), can be applied. The aim of this study is to evaluate the parameters of TEOAE in young children with OME prior and after surgery. METHODS: Prospective study included 50 children with OME, both sexes, aged 2-5 years. Preoperatively tympanometric examination was performed and TEOAE were recorded. Surgery was performed under general anesthesia and included myringotomy with/without ventilation tube insertion. Measurements of TEOAEs (correlation percentage, signal to noise ratio and amplitude) were repeated on the first and six day postoperatively as well as 6 weeks and 6 months postoperatively. RESULTS: The preoperative TEOAEs were not recorded in 93.5%, with values of all TEOAE parameters being the most affected on highest frequencies. Significant changes of all TEOAE parameters were found 6 weeks postoperatively with further improvement 6 months postoperatively. Statistically highly significant difference of TEOAE between examinees with and without inserted ventilation tubes was established only in regard to preoperative results. CONCLUSION: In small children with OME, application of TEOAEs in follow-up of surgical effects is a method of choice for hearing screening due to its objectivity, simplicity and ease of use even after insertion of ventilation tubes. Follow-ups of TEOAE correlation percentage and signal to noise ratio reflect the condition earlier than follow-ups of TEOAE amplitude.

Surgical treatment of primary tracheal dyskinesia in a 14-month-old child--case report.

The primary form of tracheal dyskinesia in early childhood is a rare congenital malformation of unknown origin. The degree of the posterior membranous tracheal wall involvement determines the intensity of obstruction and the severity of the clinical picture. The aim of this paper is to present a case of a 14-month-old child with severe tracheal dyskinesia that required surgical treatment. Fascia lata graft fixated with fibrin glue was used in strengthening the posterior tracheal wall. Three years following the surgery, the child is without breathing difficulties. In severe cases of primary dyskinesia, surgical treatment using fascia lata graft, fixated with fibrin glue is recommended in strengthening the posterior tracheal wall.

[Otitis media in children--a parallelism between the state-of-the-art knowledge and the context of real clinical practice].

INTRODUCTION: Inflammation of the middle ear is the most common illness among children. It is commonly recurrent by its nature, causing transient or long-term hearing reduction. From the clinical aspect, the problem of recrudescence and chronicity of childhood otitis media is enormous. There are controversies and nonuniformities in defining the cause, conservative and surgical treatment, prevention, mostly due to morphofunctional specificities and dynamic developmental features of the tubotympanomastoid complex. Some open questions are as follows: is recurrent otitis media in childhood really recurrent, or we are dealing with clinical manifestations of exacerbation of the chronic process (chronic from the very beginning), which are the factors predisposing and/or reflecting inflammatory processes in the middle ear, which are the potentials of real clinical practice, which are the modalities of prevention of inflammatory processes in the middle ear in children, is there a parallelism between the real clinical, therapeutic practice and current knowledge of the etiopathogenesis of otitis media in children? DISCUSSION: This study reviews current knowledge and identifies potential etiopathogenetic factors in the development of inflammatory processes of the tubotympanomastoid complex. Special attention was given to external predisposing factors, as well as internal factors which include genetic, immunobiochemical, factors of increased adherence of pathogens and Eustachian tube dysfunction. The study also deals with the potentials of diagnostic morphofunctional procedures, as well as modalities of the real clinical practice. CONCLUSION: An open question remains with regard to the parallelism between real clinical therapeutic potentials and state-of-the-art knowledge, as well as the role of preventive procedures in the field of inflammatory processes of the tubotympanic complex in children.

[Psychogenic hearing impairment in differential diagnosis of sudden hearing loss].

INTRODUCTION: Acute hearing impairment or deafhess may manifest as unilateral or bilateral. The etiopathogenetic substrate may be organic, functional and of unknown origin, the so-called idiopathic. The functional causes of impaired hearing and deafness also include psychogenic factors, where the essential dysfunction exists between the conscious simulation of hearing impairment and deafness for benefits versus psychogenic hearing impairment in conversion disorders where physical symptoms result as a symbolic expression of long-term psychological problems or conflicts. Acute hearing impairment, pseudohypacusis, as a symptom of conversion disorder, where hearing impairment is without evidence of organic cause, is a rare pseudosensory form of this disease. Numerous literature data indicate that these disorders are most common among children, whereas in adults only individual cases are reported. In otorhinolaryngological practice, other symptoms of conversion disorders are much more common (psychogenic aphonia and dysphonia, globus pharyngeus, sensation disorder in the head and neck region). CASE REPORT: The paper includes a detailed presentation of the diagnostic procedure, clinical course, differential diagnostic dilemmas and therapeutic procedure in cases of acute bilateral psychogenic hearing impairment in adolescents. CONCLUSION: Acute hearing impairment caused by organic substrate is irreversible in most cases, whereas in psychogenic hearing impairment the prognosis is excellent, particularly among children and adolescents. Identification of the etiologic factors of reversible hearing loss, including psychogenic ones, by the otorhinolaryngologist is of utmost importance in order to provide early differential diagnosis and timely inclusion of a psychiatrist and a clinical psychologist into the diagnostic-therapeutic.

[Difficulties and complications of using endo-extralaryngeal laterofixation of vocal cords in bilateral recurrent laryngeal nerve palsy].

INTRODUCTION: The aim of this study is to show our experience in using the endo-extralaryngeal laterofixation of vocal cords in treatment of bilateral recurrent laryngeal nerve palsy, and to point out the difficulties and complications of this procedure and the ways of their managing. MATERIAL AND METHODS: During the period from 2003 to 2006, 14 patients with bilateral palsy of the recurrent laryngeal nerve were treated with method of Lichtenberger's endo-extra laryngeal laterofixation of the vocal cord The patients were 12 female and 2 male from 26 to 78 (average 57.4) years old. The earliest intervention was performed 8 day after the onset of paresis and not later than 40 days. RESULTS: In 11/14 (78.6%) of the patients bilateral palsy of the recurrent laryngeal nerve occured as a result of thyroid gland surgery. At the admission 2 (14.3%) patients had tracheostomy while 12 (85.7%) had no tracheostomy. Edema was the most often complication of the endo extra laryngeal laterofixation and it appeared in 8/14 (57.1%) patients. The earliest swelling of the laryngeal tissue was recorded on the first postoperative day and the latest one started 7 days after the intervention. Edema developed in 7/11 (63.6%) after total thyreoidectomy, in 1/3 (33.3%) with traumatic injuries in the neck Because of progression of the edema which provoked narrowing of the airway at the laryngeal level tracheostoma was peformed in 2 patients. Inflammation of laryngeal tissue with sudden obstruction of the airway resulted in death in one patient. Malposition of the thread toward the midle part of the vocal cord happened very often if intervention was not performed in JET ventilation anesthesia. The vocal card function was repaired bilaterally in 2 patients and unilaterally in 1 patient (the total being 3 out of 14 patients, i.e. 21.4%) four months after the laterofixation, and the threads were removed. Lung functional test showed the increase in average value PEF% from 26.53 before to 39.43 after laterofixation, and PIF from 0.83 before to 1.19 after intervention. Resistance R% in the upper airway decreased from the average 257.95 as before to 215.83 after the intervention, while the index FEV1.0/PEF (ml/L/min) remained almost the same before 13.25 and after the intervention 13.50 and that showed that the upper airway obstruction, in spite of good clinical tolerance by the patients, still persisted in all patients after the laterofixation. CONCLUSIONS: Lichtenberger's endo-extra laryngeal laterofixation of the vocal cord is a good alternative method for bilateral palsy of the recurrent laryngeal nerve which provide sufficient upper airway without tracheostomy.