Clinical features, health-related quality of life, and adult voice in juvenile-onset recurrent respiratory papillomatosis.

OBJECTIVES/HYPOTHESIS: To determine clinical features, health-related quality of life, and adult voice in patients with a history of juvenile-onset recurrent respiratory papillomatosis (JORRP). STUDY DESIGN: Case-control study. METHODS: All 32 patients with JORRP treated at Helsinki University Hospital between 1975 and 1994 were invited to an outpatient visit in spring 2008, and 18 of them (56%) entered the study. Each patient had an age- and gender-matched control subject with similar smoking habits. Videolaryngostroboscopy was performed and voice quality determined by acoustic and perceptual analysis. Voice-quality characteristics of the whole patient group and the recurrence-free patients were examined separately. Subjective voice-related disability was studied with voice handicap index (VHI) and health-related quality of life with a 15D questionnaire. RESULTS: Acoustic analysis showed that patients had statistically significantly higher values in percent jitter, percent shimmer, and noise-to-harmonics ratio. Perceptual analysis indicated higher scores for patients in overall grade, roughness, breathiness, and strain. Acoustic and perceptual values for recurrence-free patients (n = 14) were also significantly higher than those for their matched paired controls. No statistically significant differences emerged for handicap related to voice or to health-related quality of life. Four study patients (22%) had undergone tracheotomy, indicating severity of juvenile-onset disease. CONCLUSIONS: JORRP is a risk factor for permanent laryngeal pathology and voice-disturbances in adulthood.

Voice quality of prepubescent children with quiescent recurrent respiratory papillomatosis.

OBJECTIVE: The purpose of this study was to assess the long-term impact of recurrent respiratory papillomatosis (RRP) and its treatment on voice quality in prepubescent children. STUDY DESIGN: Case-control study. METHODS: Prepubescent children with RRP in remission for at least 12 [according to MM section] months were asked to participate. Remission was documented by absence of papillomas on fiberoptic flexible laryngoscopy. An age- and sex-matched control was selected for each patient enrolled. Voice was evaluated using the voice-related quality of life (V-RQOL) questionnaire, perceptual evaluations of voice quality by speech-language pathologists using the GRBAS (grade of hoarseness, roughness, breathiness, asthenia, strain) scale, and acoustic analysis (fundamental frequency, maximal phonation time, and relative average perturbation) using the Visi-Pitch II 3300. RESULTS: Medical records of 84 patients were reviewed and 15 met study criteria. Five agreed to participate but one was excluded due to the presence of papillomas. The four study patients and four matched controls were between 9- and 11-years old. On the V-RQOL questionnaire, each control rated V-RQOL as normal (10/50) and the average patient group score was within the normal range (11.5/50). On perceptual evaluations, the patient's voices were more hoarse, breathy, and rough compared to controls'. Acoustic analysis showed that patients' voices had a lower average fundamental frequency (F(0)) (200 Hz compared to 243 Hz for controls) and a higher relative average perturbation (RAP) (1.10 compared to 0.77), although only one patient's voice actually had elevated RAP (2.89), which had a large impact on raising the average score for the patient group. The average maximal phonation times were similar for the two groups (7.8s for patients and 7.4s for controls) but lower than average normal scores reported in the literature. CONCLUSIONS: Although children with RRP do not perceive their voice quality to have a negative impact on V-RQOL, speech-language pathologist evaluations and acoustic measurements show objective differences between the voices of children with quiescent RRP and those of normal, healthy controls.

Postoperative course after papilloma resection: effects of written disclosure of the experience in subjects with different alexithymia levels.

OBJECTIVE: The aim of the investigation was to assess the effects on postoperative course after bladder papilloma resection of a technique for the written disclosure of traumatic events in interaction with individual differences in alexithymia. METHODS: Forty subjects were administered a general questionnaire and the Toronto Alexithymia Scale (TAS-20) the second day after admittance. Twenty subjects were asked to write for 3 days, 20 minutes a day, about their experience of being in the hospital, following instructions developed by J. W. Pennebaker and coworkers. The postoperative course was assessed objectively by the duration of stay in hospital and subjectively by subjects completing the Symptom Check List 90 (SCL-90) the day before leaving the hospital. RESULTS: Subjects who wrote stayed fewer days in hospital and had lower SCL-90 scores. The same effect was shown by low alexithymia levels. Study of interactions showed that the effect of writing was apparent only in subjects high in alexithymia, whereas subjects low in alexithymia showed a favorable course independent of writing. CONCLUSIONS: Writing about one's thoughts and feelings about being in hospital for a surgical operation has beneficial effects on postoperative course. This holds particularly true for high alexithymic subjects, who obtain through writing the same outcome as low alexithymic subjects.

Quality of life issues in recurrent respiratory papillomatosis.

Twenty-six adult patients attending the Royal National Throat, Nose, and Ear Hospital with Recurrent Respiratory Papillomatosis completed two postal questionnaires. One was the generic Short Form-36 (SF-36) quality of life instrument. Severely affected patients had lower scores in all dimensions of this instrument, with large differences from normal controls in dimensions of pain, physical limitation, and energy/vitality. The second questionnaire was newly devised, and designed to ask about a wide variety of larynx-specific symptoms. Answers by patients were compared with those of normal controls, and symptoms selected as significantly more likely to be reported by patients were studied further. Correlation was seen with clinical parameters, and questions likely to be responsive to clinical change in disease burden were identified.

Anesthetic management of children with recurrent, viral laryngeal papillomatosis: a case report.

The authors report the case of a 4-year-old boy who required anesthetic care during laser excision of respiratory papillomatosis. The perioperative issues surrounding this disease process are discussed including anesthetic induction in the patient with a compromised airway, maintenance anesthetic techniques, methods used for ventilation during laser surgery of the upper airway, and infectious disease risks to the operating room personnel. In addition, the psychological and emotional impacts of recurrent surgical procedures during childhood are addressed.