ABSTRACT
OBJECTIVES: vocal cord paralysis is considered a rare complication of carotid endarterectomy (CEA), but alteration in voice quality may be more common. The aim of this prospective study was to evaluate the effect of CEA on voice quality and to correlate any changes with the extent of the dissection. DESIGN-MATERIAL-METHODS: thirty-five patients who underwent CEA were divided in two groups, according to the level of surgical dissection performed. The high-level dissection group was comprised of those patients that required mobilisation of hypoglossal nerve and division of the posterior belly of digastric muscle. The low-level dissection group included the rest. All the patients' voices were recorded and analysed digitally before CEA, one and three months after the operation. Voice data were measured for standard deviation of fundamental frequency, jitter, shimmer and normalised noise energy (NNE). All patients underwent a laryngeal examination pre- and post-operation. RESULTS: none of the patients had any vocal cord dysfunction on laryngoscopy. Significant changes of voice quality (jitter, shimmer, NNE) were noticed in the high-level dissection group (p<0.05) one month after the operation. Two months later, the voice changes had subsided, but still significant disturbances remained (jitter, shimmer). CONCLUSIONS: voice-related disturbances are far more common following CEA than is generally believed and, although they seem to for the most part temporary, they deserve attention. Specifically, high-level surgical dissection seems to be a risk factor of postoperative vocal impairment.
Subject(s)
Carotid Stenosis/surgery , Endarterectomy, Carotid/adverse effects , Outcome Assessment, Health Care , Postoperative Complications , Voice Disorders/etiology , Aged , Carotid Stenosis/pathology , Female , Follow-Up Studies , Humans , Laryngoscopy , Male , Middle Aged , Prospective Studies , Speech Acoustics , Voice Disorders/pathologyABSTRACT
The effect of changes in runway width on the perception of glide-slope has been the subject of extensive investigations. Despite considerable research, an explanation of this effect has been elusive. A mathematical model for glide-slope perception was published recently based on the premise that a desirable goal of perception is to form a perception with minimal uncertainty. One of the qualitative predictions of that model was that changes in the aspect ratio of the runway would affect the perceived glide-slope. In this article, the predictions of the model are quantified and are shown to be in close agreement with experimental results in the literature.
Subject(s)
Aviation/instrumentation , Models, Psychological , Optical Illusions , Size Perception , Visual Perception , Aerospace Medicine , Aircraft , Data Display , Depth Perception , Distance Perception , Ergonomics , Humans , Judgment , OrientationABSTRACT
A rare case of a secondary achalasia or pseudoachalasia due to a mesenchymal tumour of the oesophagus is presented. A 67-year-old Caucasian man had symptoms including dysphagia, odynophagia, and weight loss for 8 months. Radiological examination revealed no signs of neoplasia but an exploratory laparotomy revealed the presence of a mesenchymal tumour of the oesophagus. Tucker's criteria constitute an important tool in the differential diagnosis of secondary achalasia from primary achalasia with clinical value, but in this case, exploratory laparotomy rather than non-invasive diagnostic procedures provided the final and definite diagnosis.
