Perceptual and acoustic voice analysis in patients with glottis cancer after endoscopic laser cordectomy.

<b>Introduction:</b> Treatment of glottis cancer, despite oncological safety, should consider postoperative voice quality. CO₂ laser endoscopic cordectomy allows radical removal of the tumor while maintaining respiratory, defensive and phonatory functions. <br><b>The aim:</b> The aim of the study is perceptual and acoustic evaluation of voice in patients after endoscopic CO2 III-Va laser cordectomy due to glottis cancer. <br><b>Material and method:</b> The study included 30 men after CO₂ cordectomy. 13 (43%) patients underwent type III cordectomy, 6 (20%) - type IV; 11 (37%) - type Va. Voice quality has been assessed 6 months after the surgery. Control group included 30 healthy men of the same age. GRBAS scale has been used in perceptual evaluation of voice. Acoustic analysis has been performed using DiagnoScope Specjalista software. Narrowband spectrography and Maximum Phonation Time (MPT) measure has been performed. <br><b>Results:</b> In study group, voice has been classified as G₁R₁B₀A₀S₀ after type III cordectomy; as G₁R₁B₁A₁S₂ in type IV and as G₂R₁B₁A₀S₃ in type Va. Acoustic evaluation revealed the highest values of F0, Jitter, Shimmer and NHR after Va cordectomy as well as non-harmonic components in narrowband spectrography and reduction of MPT. <br><b>Conclusions:</b> Postoperative voice quality depends on the type of cordectomy. Perceptual assessment indicates that type IV and Va cordectomy cause intensification of voice disorders. Parameters of acoustic evaluation increase with the extent of the procedure. The presence of non-harmonic components in narrowband spectrography increases with the extent of cordectomy, such as the reduction of MPT. Preservation of anterior commissure influences good voice quality in perceptual and acoustic assessment.

Phonatory compensation in patients with larynx cancer after CO2 laser cordectomy.

INTRODUCTION: CO2 laser endoscopic cordectomy is the method of laryngeal cancer treatment. The type of cordectomy (I-VI) depends on the extent of the tumor. Endoscopic laser surgery provides more satisfactory phonation conditions in comparison to open surgical procedures. THE AIM: The aim of the study was to classify phonatory compensation mechanisms after CO2 laser cordectomy using the HSDI. M aterial and methods: The study included 30 men treated and diagnosed at the Department of Otolaryngology and Department of Clinical Phonoaudiology and Logopedics, Medical University of Bialystok. The control included 30 men with no pathological changes in the larynx. Type III, IV and Va CO2 laser cordectomy have been for glottis cancer treatment. Postoperative evaluation has been conducted 6 months after the surgery. HSDI has been used in larynx visualization. R esults: Type I compensation occurs most frequently in patients after type III cordectomy. Advanced glottis cancer, as an indication for type IV and V cordectomy, leads to epiglottic hyperfunction and phonation involving vestibular folds - type II and III compensation. Type IV compensation is most frequent in type IV cordectomy. C onclusions: The type compensation is connected with the extent of glottis resection. In cordectomy including anterior commissure and the part of opposite fold (type Va), supraglottic hyperfunction with the participation of vestibular folds (type II and III compensation) has been recorded. Transmuscular cordectomy (type III) most often resulted in type I compensation. Type III-Va cordectomy caused reduction or absence of MW, decrease in amplitude and aperiodicity of vibrations in HSDI.

[Activity of vestibular organs in women with postmenopausal osteoporosis]. / Czynnosc narzadu przedsionkowego u kobiet z osteoporoza pomenopauzalna.

Osteoporosis is a systemic disease characterized by low bone mass and alterations in the microstructure of the skeleton. It is a worldwide disease, most prevalent in women over the age of 70. It is estimated that approximately 15-18% of women over 50 years of age are affected by osteoporosis and further 37-50% of women have decreased bone mass. The percentage of men suffering from this disease is about 40-50% lower. Untreated osteoporosis causes pathologic bone fractures, in particular fractures of the femoral neck, deformations and pain. THE AIM OF THIS WORK: was to evaluate the activity of the vestibular organ in people with advanced osteoporosis, and then to compare the results with a group of people of the same age, not suffering from osteoporosis, and a group of young healthy people. THE STUDY: involved 196 women qualified into the following study groups: I group (control group)--100 healthy women aged 50-61 without osteoporotic symptoms, II group (study group)--96 women aged 51-63 with postmenopausal osteoporosis. METHODS: The study included evaluation of the character and intensity of vertigo, Romberg, Mann test, static and dynamic posturography, ENG with eyes open and closed, Fitzgerald-Hallpike caloric test in all the women. CONCLUSIONS: It was found that postmenopausal osteoporosis tends to have central nervous system disorders, peripheral vestibular disorders occur sporadically.

[The voice and speech quality in laryngectomy patients rehabilitated with second generation voice prosthesis]. / Jakosc glosu i mowy u chorych po calkowitym usunieciu krtani, rehabilitowanych chirurgicznie z zastosowaniem protez glosowych drugiej generacji.

UNLABELLED: Voice rehabilitation with the application of voice prostheses is a method of choice in surgical rehabilitation of patients following total laryngectomy. THE AIM OF THE STUDY: To compare voice quality and fistula speech with use of second generation voice prostheses to voice and esophageal speech in patients rehabilitated with vocal method. MATERIAL AND METHODS: The following study comprised 37 patients with fistula speech (group I). The assessment of voice quality included subjective and objective examination and acoustic analysis of fistula speech and aesophageal. Examination results were compared with data obtained in 15 patients with oesophageal voice of similar age and gender composition (group II). The acoustic analysis was performed using IRIS Medicom software. Fo values and Jitter, Shimmer, HNR parameters were analysed. RESULTS: All examined patients with fistula speech demonstrated a permanent capacity of speaking, which enabled efficient verbal communication. Average values obtained during 'perception test' located this type of phonation between good and very good speech. Formant recordings in narrow-band spectrographs indicated relatively normal supraglottal articulation which is a factor conditioning good speech comprehension. During subjective assessment, fistula voice and speech were moderately loud, dull, hoarse, uttered in unrestrained, breathed way rather than being forced. Persistence of the pathologic phonation was confirmed by acoustic voice evaluation parameters (Jitter, Shimmer, HNR and Fo). CONCLUSION: Examination findings confirm better voice quality obtained in rehabilitation with second generation voice prostheses as compared to oesophageal voice and speech resulting from natural rehabilitation process.

[CO2 laser treatment of rhinophyma]. / Rhinophyma--leczenie za pomoca lasera CO2.

UNLABELLED: Treatment of the advanced form of rhinophyma causing severe nasal deformity and nasal breathing impairment is reserved mainly for surgical methods. Laser techniques among them play particular role. The aim of the study was to present short series of patients suffering from severe form of rhinophyma, who were treated with CO2 laser, emphasizing the advantages and disadvantages of the method used. MATERIAL AND METHOD: Three male patients, aged 51-69, with advanced form of rhinophyma were treated in our clinic with CO2 laser. The total removal of pathologic tissue was performed during 2-3 sessions of laser therapy with an interval 4-8 weeks in-between. RESULTS: The follow-up ranged from 4-12 months. Satisfactory cosmetic and functional result was achieved in all patients. Full reepithelization of the wound took place within 4-6 weeks. Intensive bleeding from dilated vessels during the procedure that required bipolar electrocautery occurred in two cases. There were no postoperative complication in the studied group. CONCLUSIONS: The CO2 laser is relatively save and precise surgical tool for rhinophyma ablation. If the resection is not to aggressive, healing process is quick and without excessive scaring. Unfortunately the "dry field" conditions are not always possible to achieve during operation, due to limited coagulative properties of the CO2 laser towards dilated blood vessels. In advanced stages of rhinophyma to increase safety of the procedure, several sessions of the laser therapy might be necessary to remove all the hypertrophic tissue.

[The surgical dilation of glottic rima with laser surgery in paralysis dysphonia]. / Operacyjne poszerzenie szpary glosni z zastosowaniem lasera CO2 W dysfonii porazennej.

UNLABELLED: Vocal cord paralysis, a complication after strumectomy, affects about 1% of treated patients. Patients with unilateral paralysis are usually treated with foniatric and conservative therapy. Bilateral vocal cord paralysis with the paramedial placement of vocal folds usually requires surgical treatment. Trachoetomy is often done because of dyspnoe. The surgical procedures widening of glottis are performed in case no improvement after conservative therapy. MATERIAL AND METHOD: In 1989 Denis and Kashima first described the method of CO2 laser posterior cordectomy This method seems to be an effective and reliable surgical procedure. 36 patients with bilateral vocal cord paralysis underwent CO2 laser posterior cordectomy The follow-up period ranged from 6 to 36 months. All patients were decannulated by the third day after surgery. RESULT: The subjective evaluation of patients concerning treatment was satisfied. CONCLUSIONS: The operation resulted in significant improvement in the field of respiratory function of the larynx and a slight objective aggrevation in the quality of voice.

[Submucosal bipolar radiofrequency therapy for treatment of turbinate hypertrophy]. / Zastosowanie bipolarnej termoterapii sródmiazszowej w leczeniu przerostów malzowin nosowych.

Disturbance of nasal airflow occurs in about 30% of human population. Turbinate hypertrophy is frequently the base of many nasal obturative diseases. The aim of this study was to determine short- term and long term effects of the radiofrequency therapy (RFT) for patients with turbinate hypertrophy. Forty- one patients with inferior turbinate hypertrophy (19 females and 22 males) were enrolled in this study prospectively. The examination included: rhinoscopy, subiective visual analogue scale (VAS) score, in which a patient described his symptoms in points from 0, (always very good nasal airflow) to 10 points (always total obstruction) and anterior rhinomanometry. The clinical assessment was before radiofrequency-turbinectomy and within the days 7 to 25 afther this therapy (follow-up 1) and 12 months later (follow-up 2). RFT was performed in local anesthesia (1% Lidocain) by means of CELON. Rhinoscopy before RFT revealed turbinate hypertrophy, which was decreased in the follow-up examination. Subjective improvement of nasal airflow was felt by 39 patients (95%) at follow-up 1. At follow-up 2 fifteen patients (37%) reported a decreased nasal airflow when compared with the follow-up 1. Rhinomanometric results were better at follow-up 1 for the left side (p = 0,0003), the right side (p = 0,0002) and both sides altogether (p = 0,0001). The improvement continued at follow-up 2 for the left side (p = 0,0004), the right side (p = 0,001) and both sides (p = 0,001) when compared with rhinomanometry before RFT. There were not statistically significant differences between the rhinomanometric results at follow-up 1 and follow-up 2. Bipolar radiofrequency thermal ablation is an effective method for the therapy of turbinate hypertrophy.

[The assessment of nasal surgery and uvulopalatopharyngoplasy (UPPP) in the treatment of patients with mild and moderate obstructive sleep apnea (OSA)]. / Ocena skutecznosci operacji poprawiajacych droznosc nosa i uwulopalatofaryngoplastyki (UPPP) w leczeniu chorych z lagodna i srednio zaawansowana postacia zespolu bezdechów obturacyjnych podczas snu (OSA).

UNLABELLED: The role of nasal patency in the pathogenesis of OSA is not fully understood. There are conflicting data in the literature considering the influence of the nasal resistance on RDI. The aim of the study was to assess if the surgical procedures aimed at increasing nasal patency performed simultaneously with UPPP (uvulopalatopharyngoplasty) may improve it's effectiveness. MATERIAL AND METHODS: 20 patients with mild to moderate OSA (RDI < 30) were qualified for the study. Their BMI was less than 30, and total nasal resistance assessed by anterior rhinomanometry exceeded 0,45 kPa/l/s in each patient. The UPPP and nasal surgery (septoplasty, mucoplasty or CO2 laser mucotomy) were performed as a one surgical procedure in all patients. RESULTS: The effectiveness of simultaneously performed UPPP and nasal surgery reached 55% in the group of unselected mild to moderate OSA patients. Snoring volume decreased to the level that did not disturb sleep of others in 75% of patients. CONCLUSIONS: Nasal surgery minimally increased the effectiveness of UPPP in the treatment of unselected mild to moderate OSA patients. These surgical procedures caused noticeable decrease of snoring volume that was corroborated both subjectively and objectively. At the same time snoring was more reduced than RDI in studied group of patients.

[Voice prosthesis in patients after total laryngectomy]. / Zastosowanie protez glosowych w rehabilitacji glosu u pacjentów po calkowitym usunieciu krtani.

The aim of the study is to present the role of voice prostheses in the voice rehabilitation in patients who underwent total laryngectomy. 7 patients with laryngeal cancer were included in the study. All patients are males aged 41-72 years (mean age 58) treated in the Department of Otolaryngology Medical Academy of Bialystok from November 2001 to March 2002. The voice prostheses were placed during the total laryngectomy in 5 patients. In 2 patients the voice prosthesis was placed in the period of 1.5 to 2 years after laryngectomy. The voice prostheses type Provox 2 were used in all cases. In 2 cases the prosthesis was in size of 8 mm, in 5 cases--10 mm. The control group included 7 patients after total laryngectomy without placing the voice prostheses. These patients developed oesophageal speech. All patients underwent phoniatric measurements during 12 to 30 days after the surgical procedure. The data indicate that patients who developed oesophageal speech, their voice in the range of subjective measurements is understandable but it is necessary to emphasize that the voice is harsh, low without fluency of the speech result from the intervals essential to accumulate the air in the oesophagus. The patients with voice prostheses have dull voice but more fluent and louder. The clarity of the voice of the patients with voice prostheses is significantly higher. According to the objective measurements all parameters are better in the oesophageal speech.

[Multiple meningioma in 53 years old woman manifested only by unilateral hearing loss]. / Mnogie oponiaki u 53-letniej kobiety objawiajace sie jednostronnym niedosluchem odbiorczym.

Meningioma is the most common intracranial tumour and comprises over half of extramedullar tumours of spinal canal. The causes of meningiomas occurrence are mostly unknown. Genetic factors, hormonal disorders, injuries, viral induction and ionizing radiation may play certain role in its developing. There are several histological types of meningiomas; endothelial or syncytial--the most common form (64%), fibrilplastic--12%, anaplastic--11%, transitory--7%, angioplastic--%, psammoma--3%, angiomatous--1%, warty--very rarely. Authors have presented the case of a 53-year-old farmer treated in the Department of Otolaryngology Medical Academy in Bialystok due to lipoma located behind the ear. The lipoma was removed surgically under local anaesthesia. Post-operative course was uncomplicated. During laryngologic examination sensorineural hearing loss of left ear was established. Broaden audiologic and otoneurologic diagnostics revealed sensorineural hearing loss of left ear ranged between 20 to 80 dB when impedance was normal. Constant latent polydirectional nystagmus, pathologic vibratory test and asymmetric optokinetic nystagmus were confirmed in ENG exam. Magnetic resonance was performed as the central nervous system pathology was suspected. During the exam, 4 tumours of similar morphology located paracerebrally were fond. The tumours were bounded by wide base with dura matter and corresponded to meningiomas. After neurosurgical consultation, the patient was classified to surgical treatment. Frontotemporal dextral craniotomy was performed and partial meningiomas were removed. Post-operative course was uncomplicated. Transiently, narrowed visual field was observed. Audiologic parameters did not undergo change for the worse.

[Delayed treatment of laryngeal and hypopharynx cancer in the North-Eastern part of Poland in years 1986-1999]. / Przyczyny opóznien w leczeniu raka krtani i gardla dolnego w regionie pólnocno-wschodnim Polski w latach 1986-1999.

The authors estimated larynx and hypopharynx cancer in patients treated in the Department of Otolaryngology Medical Academy in Bialystok between 1996-1999 and compared the observed state to the data from 1986-1995. At the same time, we tried to determine the causes of delayed treatment based on patients' reports and medical case histories divided according to patients and medical procedures. As in years: 1986-1995, a significant percentage of tumour progression as also observed in the present day. The T3 and T4 tumour comprised about 65% of all larynx and hypopharynx cancers in particular five-year periods. The T1 and T2 tumours included only 34% of the cases. Clinical evaluation of the lymph nodes showed that high grade of tumour progression was accompanied by unilateral or bilateral lymph node metastases (N2 and N3--about 67%). Among the causes of the delayed treatment, patients' ignorance of the first symptoms (43-51%) and ignoring follow-up visit (30-32%) are being still the most dominant ones. According to medical procedures the delay ensued mostly because the effect of apparent improvement after the treatment (36%) and, unfortunately, due to wrong diagnosis (30-31%). Nowadays, it seems to be more difficult to obtain medical advice, specifically as far as specialists are concerned.

[Epidemiologic analysis of patients with laryngeal and hypopharyngeal cancer treated in the Department of Otolaryngology in Bialystok from 1986-1999]. / Analiza epidemiologiczna chorych na raka krtani i gardla dolnego leczonych w Klinice Otolaryngologii AM w Bialymstoku w latach 1986-1999.

Epidemiological analysis of patients with the larynx cancer, who were treated in the Department of Otolaryngology in Bialystok from 1996 to 1999 was performed. The following aspects were assessed: a) number of patients, b) gender, c) age, d) place of living, e) primary site of the tumour. The results in years 1996-1999 were compared with the earlier published results in years 1986-1994. Altogether 1431 patients (1340-93.6% males and 91-6.4% females) in that period and there were similar numbers of hospitalizations every year. Among patients there were 28-33% farmers, 41-46% labourers, 5-9% white collar workers, the others were old age pensioners. 55-59% patients came from the rural areas and 41-45% patients from urban areas. The most common site of the primary tumour was the supraglottic region (831-58.1%), then glottis (421-29.4%) and rarely in the subglottic region (5-0.3%). Hypopharynx was the tumor primary site in 174 (12.2%) patients. The analysis showed that the numbers of patients with cancer of the larynx or hypopharynx are similar in each year. A constant increase in number of female patients; coming from the rural area, farmers or labourers was found. Increasing incidence rate of supraglottic tumours and little decrease in the number of glottic tumours were also found.

Modified neck dissections--efficiency of surgical treatment and clinical observations.

BACKGROUND: The evaluation of affected lymph node number, the site of metastatic lymph nodes, and spread of neoplastic infiltration beyond the lymph capsule is considered useful in prognosis. The aim of the study was to estimate the frequency of neck nodal metastases occurrence depending on the site of origin, the grade of larynx cancer progression, and clinical condition of neck lymph nodes. MATERIAL/METHODS: The study comprised 315 patients with larynx cancer who underwent surgery in 1994-1999. Laryngectomy was the most frequent procedure, performed in 254 patients, while partial laryngectomy was performed in 61 patients. There were 630 bilateral neck dissections; type I of modified radical surgery in 27 cases, type II in 45 cases, and type III in 558 cases. RESULTS: Neck nodal metastases were detected most rarely in cases of glottic cancer (16%), and most frequently in transglottic cancer (56%). Most frequently, the nodal metastases affected the II level of the lymph node groups regardless of the site. Recurrences to the neck lymph nodes were observed in 3.3% of the cases where the removed lymph nodes did not reveal any metastatic changes in histopathological examinations. CONCLUSIONS: Postoperative results of the neck lymph node histopathological examination point to the necessity of lymphadenectomy in the II-V levels. Selective lymphadenectomy is not advisable due to the possibility of metastases to all levels of the neck lymph nodes regardless of the primary tumor site.