Dysphonia in Pediatric Professional Voice Users: Is It Just Nodules?

OBJECTIVES/HYPOTHESIS: Professional voice users of any age are often concerned about nodules, particularly in pediatric singers. However, an accurate diagnosis allows formulation of an optimal management plan and a successful continuation of these young patients' careers. There is very little literature regarding pediatric professional singers; we aimed to share our experience of over a decade of referrals to our tertiary pediatric voice clinic. STUDY DESIGN: This was a retrospective review. METHODS: A retrospective review was undertaken of all consecutive patients aged 0-18 years who self-identified as professional voice users and attended our tertiary pediatric voice clinic between December 2010 and December 2021. We analyzed demographics, professional singing status, diagnosis, management, and clinical voice scores. The patients were subdivided into those aged 0-9, 10-16, and 17-18 years. RESULTS: A total of 113 pediatric professional voice users attended the tertiary voice clinic in the study period. The commonest self-reported voice use was as a singer. Within the 0-9 years age group, there was a strong male predominance (22 males and three females) and mostly organic (52%) causes. For ages 10-16 years, there was a noted female predominance (15 males and 29 females). In the 17-18 years age group, there was a strong female predominance (10 males and 34 females), with predominantly functional diagnoses (48%). Of significance, only five of the 113 patients had nodules (4.4%). CONCLUSIONS: We present a large data set of pediatric professional voice users and demonstrate the numerous underlying diagnoses for their dysphonia, particularly functional disorders. Our experience highlights the need for adequate vocal training for pediatric professional voice users and the need for a multidisciplinary diagnostic and management approach.

iPSCs in NK Cell Manufacturing and NKEV Development.

Natural killer (NK) cell immunotherapies for cancer can complement existing T cell therapies while benefiting from advancements already made in the immunotherapy field. For NK cell manufacturing, induced pluripotent stem cells (iPSCs) offer advantages including eliminating donor variation and providing an ideal platform for genome engineering. At the same time, extracellular vesicles (EVs) have become a major research interest, and purified NK cell extracellular vesicles (NKEVs) have been shown to reproduce the key functions of their parent NK cells. NKEVs have the potential to be developed into a standalone therapeutic with reduced complexity and immunogenicity compared to cell therapies. This review explores the role iPSC technology can play in both NK cell manufacturing and NKEV development.

Turnover and activity-dependent transcriptional control of NompC in the Drosophila ear.

Across their lives, biological sensors maintain near-constant functional outputs despite countless exogenous and endogenous perturbations. This sensory homeostasis is the product of multiple dynamic equilibria, the breakdown of which contributes to age-related decline. The mechanisms of homeostatic maintenance, however, are still poorly understood. The ears of vertebrates and insects are characterized by exquisite sensitivities but also by marked functional vulnerabilities. Being under the permanent load of thermal and acoustic noise, auditory transducer channels exemplify the homeostatic challenge. We show that (1) NompC-dependent mechanotransducers in the ear of the fruit fly Drosophila melanogaster undergo continual replacement with estimated turnover times of 9.1 hr; (2) a de novo synthesis of NompC can restore transducer function in the adult ears of congenitally hearing-impaired flies; (3) key components of the auditory transduction chain, including NompC, are under activity-dependent transcriptional control, likely forming a transducer-operated mechanosensory gain control system that extends beyond hearing organs.

Non-aesthetic uses of botulinum toxin in the head and neck.

INTRODUCTION: The use of botulinum toxin in the specialty of aesthetic surgery in the head and neck is well known. However, it has also been used for other conditions affecting the head and neck, and in recent years its use, as well as the number of relevant applications, has expanded enormously. REVIEW: This article presents a summary of the current range of uses in the laryngeal, pharyngeal, cervical, oromandibular and facial muscles and salivary glands. We highlight particular conditions focusing on dystonia (laryngeal, craniocervical, oromandibular and cervical), multiple system atrophy, migraines, facial nerve palsy, post-laryngectomy, cricopharyngeal dysphagia, Zenker's diverticulum, retrograde cricopharyngeal dysfunction disorder, sialorrhea and gustatory sweating (Frey's syndrome). CONCLUSION: This article should aid the ear, nose and throat surgeon garner knowledge about the range of uses for botulinum toxin in the head and neck.

From Voice Clinic to Operating Room: Are We Out of Tune?

INTRODUCTION: To determine the consistency and accuracy of preoperative diagnosis in the voice clinic with intraoperative diagnosis and to suggest a standardized laryngeal examination protocol in the UK that is supported by evidence-based findings. METHOD: From January 2011-September 2014, 164 patients were referred to the Multidisciplinary Team voice clinic and diagnosed with laryngeal pathology that required phonosurgery. The visualization (videostrobolaryngoscopy) in clinic was performed using either rigid laryngoscope or a video-naso-laryngoscope. Intraoperatively, laryngeal visualization and surgical procedure was conducted using Storz Aida HD system, 10-mm rigid laryngoscope 0° or 5-mm rigid laryngoscope 0°/30° and a Zeiss S7 microscope. RESULTS: Of the 164 patients seen in the multidisciplinary voice clinic, 86 clinic diagnoses were confirmed intraoperatively (52.4%), 15 patients had the diagnosis confirmed intraoperatively with additional lesion found (9.1%). The clinic diagnosis changed intraoperatively in 63 cases (38.4%). 61 (37.2%) patients seen in the voice clinic were diagnosed with cyst, in 39.3% the diagnosis was confirmed intraoperatively with 5 cases (8.2%) having an additional diagnosis. Twenty (12.2%) patients were diagnosed with polyps, with 80% confirmation intraoperatively; 3 patients (10%) had an additional diagnosis. CONCLUSION: Videolaryngostroboscopy imaging of the larynx provides an outpatient tool for accurately diagnosing more than 50% of laryngeal pathologies when interpreted by multidisciplinary voice clinicians. However direct laryngeal examination under general anesthesia remains the gold standard when obtaining accurate diagnoses of laryngeal pathology. Patients diagnosed with nonorganic voice disorders should be considered for direct laryngoscopy under general anesthetic should they fail to respond to conservative management.

Too many tags spoil the metadata: investigating the knowledge management of scientific research with semantic web technologies.

Scientific research is increasingly characterised by the volume of documents and data that it produces, from experimental plans and raw data to reports and papers. Researchers frequently struggle to manage and curate these materials, both individually and collectively. Previous studies of Electronic Lab Notebooks (ELNs) in academia and industry have identified semantic web technologies as a means for organising scientific documents to improve current workflows and knowledge management practices. In this paper, we present a qualitative, user-centred study of researcher requirements and practices, based on a series of discipline-specific focus groups. We developed a prototype semantic ELN to serve as a discussion aid for these focus groups, and to help us explore the technical readiness of a range of semantic web technologies. While these technologies showed potential, existing tools for semantic annotation were not well-received by our focus groups, and need to be refined before they can be used to enhance current researcher practices. In addition, the seemingly simple notion of "tagging and searching" documents appears anything but; the researchers in our focus groups had extremely personal requirements for how they organise their work, so the successful incorporation of semantic web technologies into their practices must permit a significant degree of customisation and personalisation.

Management of laryngeal papillomatosis using coblation: another option of surgical intervention.

PURPOSE: Recurrent respiratory papillomatosis is a disease caused by the human papilloma virus (HPV). HPV is frequently localised in the larynx. The disease tends to recur and frequent intervention is usually required. Management modules include surgical intervention using microdebriders or laser ablation as well as adjuvant treatments which aim mainly at maintaining an adequate airway and secondly to manage dysphonia caused by the growth on the vocal folds. In this pilot study, another surgical modality is trialled using plasma-mediated radio-frequency ablation (coblation). METHODS: Retrospective study examining management of 15 adult patients diagnosed with recurrent laryngeal papillomatosis and surgically treated using coblation. One patient required multiple procedures. Pre-operative assessment in voice clinic evaluating voice quality and its impact on patients' life-quality using voice parameters and self-assessment questionnaires. Follow-up post-operatively using the same parameters from 4 to 6 weeks after surgery until up to 2 years later to check recurrence rate. No other adjuvant treatment was used and all patients received post-operative voice therapy. RESULTS: 78.6% of patients did not show evidence of recurrence during the study period. Improvement in voice handicap following first intervention is reported and recurrence rate in the rest of the sample reported. CONCLUSIONS: The results of this small sample seem to support the previous small studies' findings that coblation is a good excisional technique to use for removal of laryngeal papillomatosis. Recurrence rates seem to be slightly lower than rates reported in the literature for the other surgical modalities. LEVEL OF EVIDENCE: IV.

Sex and species specific hearing mechanisms in mosquito flagellar ears.

Hearing is essential for the courtship of one of the major carriers of human disease, the mosquito. Males locate females through flight-tone recognition and both sexes engage in mid-air acoustic communications, which can take place within swarms containing thousands of individuals. Despite the importance of hearing for mosquitoes, its mechanisms are still largely unclear. We here report a multilevel analysis of auditory function across three disease-transmitting mosquitoes (Aedes aegypti, Anopheles gambiae and Culex quinquefasciatus). All ears tested display transduction-dependent power gain. Quantitative analyses of mechanotransducer function reveal sex-specific and species-specific variations, including male-specific, highly sensitive transducer populations. Systemic blocks of neurotransmission result in large-amplitude oscillations only in male flagellar receivers, indicating sexually dimorphic auditory gain control mechanisms. Our findings identify modifications of auditory function as a key feature in mosquito evolution. We propose that intra-swarm communication has been a driving force behind the observed sex-specific and species-specific diversity.

Electronic lab notebooks: can they replace paper?

Despite the increasingly digital nature of society there are some areas of research that remain firmly rooted in the past; in this case the laboratory notebook, the last remaining paper component of an experiment. Countless electronic laboratory notebooks (ELNs) have been created in an attempt to digitise record keeping processes in the lab, but none of them have become a 'key player' in the ELN market, due to the many adoption barriers that have been identified in previous research and further explored in the user studies presented here. The main issues identified are the cost of the current available ELNs, their ease of use (or lack of it) and their accessibility issues across different devices and operating systems. Evidence suggests that whilst scientists willingly make use of generic notebooking software, spreadsheets and other general office and scientific tools to aid their work, current ELNs are lacking in the required functionality to meet the needs of the researchers. In this paper we present our extensive research and user study results to propose an ELN built upon a pre-existing cloud notebook platform that makes use of accessible popular scientific software and semantic web technologies to help overcome the identified barriers to adoption.

The evolution of laryngeal reinnervation, the current state of science and thoughts for future treatments.

The treatment of unilateral vocal fold palsy (UVFP) or bilateral vocal fold palsy (BVFP) has been the subject of debate and experiment for 150 years. To date, dozens of different surgical methods have been described to reinnervate this most complex of organs, the larynx. As yet, there is no consensus on the most functionally effective method of reinnervation. However, it is a rapidly expanding area of research and remains an area of controversy. Indications for reinnervation for both UVFP and BVFP are still evolving and our understanding of the neuromuscular supply to the larynx continues to expand. What may have been considered unacceptable results from previous studies with one pathology may actually be of benefit in patients with different pathologies. This uncertainty of treatment options and potential outcomes can be confusing. In addition alternative techniques have been postulated as mainstays or adjuncts of treatment to the stalwart of reinnervation, neurorrhaphy. Determining what the correct treatment for an individual patient should be is still a gray area. With this in mind, this article reviews the evolution of laryngeal reinnervation, reviews the current state of the science, and suggests directions in which it might move in the future.

Long-term quantitative results of an Isshiki type 4 thyroplasty-a case study.

OBJECTIVE: We believe that we have described the first instance of long-term follow-up of a bilateral Isshiki type IV thyroplasty in a 58-year-old woman after bilateral superior laryngeal nerve (SLN) damage. METHOD: Comparison of voice handicap index-10 (VHI-10) questionnaire and electrolaryngographic measurements pre- and post-thyroplasty (type IV). RESULTS: VHI-10 scores reduced from 25 pre-thyroplasty to seven and five at 6 and 34 months, respectively. Mean, mode, and median dynamic frequency range (DFx-1) scores increased from 118, 125, and 124 Hz preoperatively to 144, 172, and 163 Hz at 6 months and 167, 167, and 169 Hz, at 34 months, respectively (a subjectively higher voice). Range of tones produced while speaking reduced from an 80% range of 2.48 octaves and 90% range of 3.52 octaves to scores of 1.46 and 2.75 octaves for 80% and 90%, respectively at 6 months and 0.82 and 1.73 octaves at 34 months (a more defined voice). Ninety percent spectrum of single tone production increased from 0.17 octaves preoperatively to 0.55 octaves at 6 months and 0.49 octaves at 34 months. DISCUSSION: Type IV thyroplasty is most commonly performed for the male-to-female transsexual patient. Bilateral SLN palsy can be effectively treated with this approach with good long-term results. CONCLUSION: Three-year follow-up for bilateral type IV thyroplasty reveals increased pitch, definition, and clarity but decreased range overall.

How I do it: securing tracheostomy tubes.

Securing a tracheostomy tube after insertion is essential to prevent accidental decannulation. Although this is uncommon, its associated mortality is high. Common practice involves suturing the lateral edges of the tube flanges to the skin. This can allow movement along the axis of the flanges. We describe a modification of the suture placement, which provides a more robust fixation.