Voice improvement in patients with recurrent respiratory papillomatosis after combined treatment with cidofovir and CO2 laser surgery.

Mechanical debulking of laryngeal papillomas is associated with voice disorders due to impairment of the vocal fold's mucosa. Intraepithelial injection of cidofovir reduces damage to the laryngeal structures and thus improves vocal parameters. The aim of our study was to compare vocal quality before and after cidofovir and CO2 laser treatment by means of objective phoniatric parameters and to obtain evidence concerning voice outcomes. The vocal parameters of 42 patients with RRP were assessed before and after intralesional cidofovir and CO2 laser debulking treatment (Lumenis AcuPulse 40 CO2 laser, wavelength 10.6 µm; Lumenis Ltd., Yokneam, Israel). The laser was used in SuperPulse™ mode with power tailored on the target structures (average 7 W). The depth of tissue penetration was 1 mm with a single burst of energy lasting 0.3 ms. Most of the patients had previously undergone traditional surgery (1-105 procedures); in 7/42, the video stroboscopic examination revealed extensive scar tissue covering the mucosa of the vocal folds, limiting the mucosal wave. The significance level for all calculations was p < 0.05. Statistical analysis was performed using Statistica 10 by StatSoft Polska. The methodology included subjective voice evaluation (GRBAS), videostroboscopy, analysis of the acoustic laryngeal tone (MDVP), spectrographic analysis, and voice handicap index (VHI). The GRBAS scale during spontaneous conversation revealed better phonation results after cidofovir treatment in all 42 patients. Scars were not observed in the presented group. In the MDVP laryngeal tone analysis before surgery parameters defining the amplitude and frequency of laryngeal tone were significantly elevated compared to the state after surgery. After treatment, both jitter and shimmer were reduced in all subjects. Even more pronounced changes were observed in the spectrographic analysis. In all analyzed patients, there was a significant reduction in VHI scores showing improvement in voice self-assessment. A satisfactory improvement in voice quality was observed in all RRP patients treated with cidofovir and CO2 laser.

Thyroplasty in unilateral vocal fold paresis with coexisting hereditary hemorrhagic telenagiectasia: A case report.

RATIONALE: The coincidence of an idiopathic unilateral vocal fold paresis and hereditary hemorrhagic telenagiectasia (HHT) is extremely rare and has not been described in the available literature yet. PATIENTS CONCERNS: A 55-year-old female was admitted to hospital due to acute onset of hoarseness, voice fatigue, and effort dyspnea. In the past, the patient was diagnosed with HHT and on admission presented characteristic vascular lesions in the oral cavity. She reported also experiencing a moderate epistaxis at least once per month. DIAGNOSES: The otolaryngological examination (fiberolaryngoscopy, phoniatric examination) revealed unchanged mobility and morphology of the right vocal fold and paresis of the left vocal fold in intermediate position. Computed tomography and magnetic resonance imaging of head, neck, and chest were inconclusive and showed no pathologic findings. INTERVENTIONS: The unilateral paresis was treated for 12 months as idiopathic, with extensive rehabilitation. However, no improvement was observed. As a patient suffering from HHT is a challenge for anesthesiologists in terms of general anesthesia, the decision to perform type I thyroplasty (medialization) in local anesthesia was made. OUTCOMES: There were no complications intraoperatively or in postoperative period. The implemented treatment was successful, as the voice quality improved both in perceptual evaluation (GRBAS scale) and acoustic analysis (F0, jitter, shimmer, NHR). LESSONS: A routine surgical treatment in patients with HHT is a challenge. However, in this case, it was uneventful and successful, thus it can be recommended in other patients with similar background.

Phenotype-genotype discordance in congenital malformations with communication disorders resembling trisomy 18 (Edwards syndrome).

PATIENT: Female, 6 FINAL DIAGNOSIS: Phenotype-genotype discordance in congenital malformations with communication disorders resembling trisomy 18 (Edwards syndrome) Symptoms: - MEDICATION: - Clinical Procedure: - Specialty: Otolaryngology. OBJECTIVE: Congenital defects. BACKGROUND: Communication process disorders are very frequent in rare cases of chromosomal aberrations (deletions, insertions, and trisomies) such as Down syndrome (trisomy 21), Turner syndrome, Edwards syndrome (trisomy 18), or Patau syndrome (trisomy 13). Sometimes phenotype may delusively correspond to the characteristic features of a given syndrome, but genotype tests do not confirm its presence. CASE REPORT: We present the case of a 6-year-old girl admitted to the Clinic of Phoniatrics and Audiology for the assessment of communication in the course of congenital malformations with phenotype characteristic for trisomy 18 (Edwards syndrome). Immediately upon birth, dysmorphic changes suggesting trisomy 18 (Edwards syndrome) were observed, but trisomy 18 was excluded after karyotype test results were normal (46, XX). CONCLUSIONS: DISTURBED ARTICULATION WAS DIAGNOSED: deformed linguo-dental and palatal sounds, interdental realization with flat tongue of the /s/, /z/, /c/, /dz/, /s/, /z/, /c/, /dz/ sounds (sigmatismus interdentalis). Hearing loss was confirmed.

Affective temperament in women with functional aphonia.

OBJECTIVES: The aim of the present study was to assess the affective temperament in women with functional aphonia. STUDY DESIGN: Cross-sectional. METHODS: Forty-one women with functional aphonia underwent an examination of affective temperament by means of the Temperament Evaluation of Memphis, Pisa and San Diego Autoquestionnaire. RESULTS: Compared with the reference group, women with functional aphonia show significantly higher rates of depressive and anxious temperament. CONCLUSIONS: The results of the present study are concordant with the previous findings, indicating elevated levels of depressive and anxious symptoms in aphonic patients. Implications for the therapy of functional aphonia as well as considerations for further studies are discussed.

[The application of the manual physiotherapy treatment for patient with after trauma dysphonia]. / Zastosowanie manualnych technik fizjoterapeutycznych w rehabilitacji dysfonii pourazowej.

UNLABELLED: As a result of laryngeal injures an abnormal phonation is frequently observed. It is the consequence of structural and functional changes of the laryngeal tissues directly and indirectly responsible for the voice emission. Physiotherapy enables the normalization of the tension and function of the anatomical structures changed after trauma. THE AIM OF THE STUDY: Presentation of the results of the physiotherapy and voice rehabilitation treatment established for patient with voice disorders, occurred after cranio-cerebral trauma. MATERIAL AND METHODS: The 47 year old man two years after cranio-cerebral trauma was presented, which voice was hoarse, produced with a strong neck and shoulder girdle muscle tension. Phonation time was significantly shortened. During the manual examination the abnormal of mobility, range of movement and soft tissue tension in neck, head and upper trunk area has been observed. The systematic rehabilitation program was started 2 years after injury and it was continued for four months. The individual program contains physiotherapy, osteopathic and speech therapy treatment. The phoniatric examination was performed before and after rehabilitation RESULTS: After four months of treatment and after self-therapy exercises the significant changes were observed. Patient's voice became no more strain, but stronger and socially effective. CONCLUSIONS: The application of an individual therapy which contained osteopathic manual muscle-fascial techniques allows a subjective and objective improvement of voice in a examined patient. This procedure is an effective complement to logopedic and phoniatric therapy for patients after trauma of the larynx.

[The smokers voice self assessment based on Voice Handicap Index (VHI)]. / Samoocena glosu u palaczy w oparciu o Wskaznik Niesprawnosci Glosu (VHI).

Complex voice assessment due to European Laryngeal Society proposals (2000) contains voice self estimation based on the Polish version of the Voice Handicap Index (VHI). This study focuses on the relation between voice handicap and smoking in dysphonic patients, who are using voice professionally. Thirty outpatient (25 female and 5 male, aged 40 to 55 years) voice department attendees suffering from professional dysphonia took part in this study. All patients after phoniatric examination completed the Polish version of the Voice Handicap Index (VHI). The questions concern functional, emotional and physical complains due to dysphonia. Most of smokers did not complain of dysphonia related problems comparing to non smokers. Even the scores of functional and emotional scales of VHI in smokers shown better results (less handicap) than in nonsmokers. Smoking does not affect patients handicap due to dysphonia measured in the Voice Handicap Index.

[Further research on speech tests]. / Dalsze badania nad testami mowy utrudnionej.

INTRODUCTION: The purpose of speech audiometry is to extend the diagnostics of central auditory processes. First audiometric tests were monaural tests introduced in the fifties by Bocca and Calearo to diagnose Central Auditory Processing Disorders (CAPD). Monaural tests are characterized by low redundancy, which allows for deciphering a given word or phrase only if the amount of accessible information exceeds a required minimum. Until now, a new monaural filtered speech test has been drawn up at the Department of Phoniatrics and Audiology. The purpose of the research was to draw up and assess the effectiveness of monaural low redundancy tests, in which the acoustic signal has been compressed or noise has been added. MATERIALS AND METHOD: 35 people with normal hearing, aged 16-60, have been examined. The test material included: a compressed speech test, in which the speech signal has been accelerated by 25% with the use of Cool Edit Pro 2.0; the pauses between the words have not been shortened a speech-in-noise test, in which the noise has been added with the use of Cool Edit Pro 2.0. The signal/noise ratio has been set at the level of 10 dB. The examination has been conducted at three different volume levels: 25, 35 and 45 dB. CONCLUSIONS: Best results have been achieved at the volume level of 45 dB (above hearing threshold); There were differences in results at volume levels 25 dB and 35 dB in compressed speech test and at volume level 25 dB in speech in noise. Both tests have shown the influence of age on the test result which suggests undiagnosed CAPD among people (with normal hearing) aged over 55.

[Polish language dychotomic tests for speech audiometry Part 2: A study of people with normal hearing from various age groups]. / Testy utrudnione w audiometrii mowy dla jezyka polskiego (czesc II). Badania osób z prawidlowym sluchem w róznych grupach wiekowych.

INTRODUCTION: Evaluation of the objective results in the clinical examination of central auditory disorders requires the use of reliable language tests which provide the means for the estimation of patients' audio-verbal communicative skills. MATERIALS AND METHODS: The authors present a new set of more difficult language tests in Polish, including a filtered speech test, numeral and verbal dichotic tests and the normal Calearo test. The tests were evaluated on a group of people with good hearing from various age groups. CONCLUSIONS: The presented tests are the only existing ones created for the Polish language which expand the diagnostic possibilities in the case of central auditory processing disorders. It was found that there is a right ear predominance in dichotic tests, which grows together with the patient's age. This observation can be very beneficial in practice, allowing for hearing aids to be better fitted.

[Case reports of congenital laryngeal cysts in children]. / Opisy przypadków wrodzonych torbieli krtani u dzieci.

INTRODUCTION: Congenital laryngeal cysts occur as a result of embryological development anomalies. They are usually situated on the lateral wall of the larynx, in the supraglottic region or on the epiglottis. They are mostly diagnosed in childhood. They are present in 2.4% of population and represent only 7% of all benign laryngeal lesions. Needle aspiration or marsupialization does not give long term results. The most effective and minimally invasive way of treatment is complete excision of the cyst. MATERIALS AND METHODS: Authors present 2 cases of congenital laryngeal cysts in children. Diagnosis was made during direct laryngoscopy. CT and MR confirmed the cystic nature of the lesions. Endoscopic excision with suspension microlaryngoscopy was performed in both children. RESULTS AND CONCLUSIONS: In both cases microlaryngeal surgery after diagnostic aspiration was an effective and permanent treatment of congenital laryngeal cyst. It enabled total excision of the lesion and provided the correct function of larynx.

[Dychotomic tests in Polish for speech audiometry part 1: preparing material for the tests]. / Testy utrudnione w audiometrii mowy dla jezyka polskiego Czesc I: przygotowanie materialu testowego.

INTRODUCTION: Dychotomic tests in speech audiometry are extremely beneficial, especially in diagnosing central auditory processing disorders. MATERIALS AND METHODS: Basing on new articulatory lists (NLA-93), the authors have prepared a new set of language tests, including filtered speech test, numeral and verbal dichotic tests and Calearo test. CONCLUSIONS: The phonetic characteristics of the tests are presented, with special attention paid to their phonetic balance.

[Subjective assessment of voice functions among teachers taking part in the rehabilitation program]. / Subiektywna ocena czynnosci glosowej u nauczycieli uczestniczacych w programie rehabilitacyjnym.

INTRODUCTION: In daily phoniatric practice, apart from laryngoscopy, another simple and useful method of examining the voice organ is perceptual voice assessment based on the GRBAS scale. An extension to this examination can be the Voice Handicap Index test (VHI). MATERIALS AND METHODS: 79 female teachers taking part in a 7-week-long rehabilitation course on voice emission techniques. Before and after the course the participants were subject to phoniatric examination including laryngovideostroboscopy, GRBAS scale assessment and determining the voice handicap index (VHI). RESULTS: After the course, a substantial improvement has been observed in voice emission, perceptual assessment and the VHI test. It has been observed that there is a statistically significant correlation between GRBAS and VHI results and mean phonation time (MPT) measured before and after the course. CONCLUSIONS: The VHI test should be included in complex analysis of the effects of intensive rehabilitation.

[The characteristic of vocal fold molecular structure]. / Charakterystyka budowy molekularnej faldu glosowego.

INTRODUCTION: The authors present the layer structure of the vocal fold (by Hirano) indicating at the same time its clinical usefulness in laser chordectomy. MATERIALS AND METHODS: The authors describe the structure of the basement membrane sphere, i.e. the connection between the epithelium and the superficial layer of lamina propria, and the molecular structure of the extracellular matrix of mucosa. RESULTS: The biomechanical significance of fibre proteins and the extracellular matrix is emphasized with special attention paid to hialuronic acid and fibronectin. CONCLUSIONS: Knowing the ultra-structure of the epithelium mucosa connection helps in understanding the mechanism of F0 production. The disorders in cooperation of the biomolecules of lamina propria of the vocal folds can influence the biomechanics of phonation.

[The teachers health damage and pension related to occupational voice disease]. / Uszczerbek na zdrowiu i renta z tytulu choroby zawodowej narzadu glosu u nauczycieli.

The current regulations allow in special cases for the acknowledgement of the occupational disease among teachers who suffer from voice disorders. The physician who acts as the adjudicator in ZUS (National Insurance System) usually consults a phoniatrician and determines the percent of the permanent or long-term health damage, which can vary between 10-40%. The aim of the paper was to analyze the evidence which is taken into consideration while determining the percent of health damage and granting the occupational disease pension. The authors present proposition in detail the rules which govern the process of health damage calculation due to advancement of voice disorders, which can be very useful to adjudicating physicians in government and commercial insurance companies.

[Voice disorders in rheumatoid arthritis]. / Zaburzenia glosu w reumatoidalnym zapaleniu stawów.

UNLABELLED: The report presents three patients with coincidence of voice disorders and rheumatoid arthritis. Material consisted of 3 females aged 39, 48 and 74 years. Methods included phoniatric examination, videolaryngoscopy, stroboscopy and acoustic voice analysis MDVP). RESULTS: In the two youngest patients the laryngoscopic changes were located on vocal folds, mostly as yellow nodules. The appropriate mobility of both vocal folds was found. The MDVP analysis particularly revealed changes in parameters describing perturbation of amplitude in both cases. In the third case oedema in the region of the crico-arytenoid joints and vestibular folds were observed. MDVP analysis showed slight disturbances in the parameters describing frequency perturbation.

[Contraindication for cochlear implantation in Wildervanck's syndrome]. / Przeciwwskazania do wszczepu slimakowego w zespole Wildervancka.

A case of 4-year-old boy with Wildervanck's syndrome and associated profound sensorineural hearing loss is presented. The child was disqualified from cochlear implantation following the CT scan of petrous pyramids which revealed inner ear malformation. The authors emphasize role of CT imaging in the management of profound sensorineural hearing loss in children before final qualification for cochlear implantation.

[Voice evaluation after laryngeal trauma]. / Ocena glosu po urazach krtani.

The authors present phoniatric voice assessment in 9 cases of laryngeal trauma. Vocal cord immobilisation due to iatrogenic cricoarytenoid subluxation was particularly considered.

[Complex voice assessment--Polish version of the Voice Handicap Index (VHI)]. / W sprawie kompleksowej oceny glosu--wlasna modyfikacja testu samooceny niesprawnosci glosu (Voice Handicap Index).

The aim of this work was to present own modification of Jacobson's The Voice Handicap Index, the self-estimation scale of the voice as a one part of the complex voice evaluation. The VHI contains three groups of questions of physical, emotional and functional subscales, which specify complaints during phonation scored in 4 points (0-4). The presented our own modification of the VHI may be useful in everyday clinical practice.

[Effect of smoking on phonation]. / Wplyw palenia tytoniu na funkcje fonacyjna krtani.

The aim of this paper was presentation of voice estimation in smokers, who did not complain of voice disorders. The examination was performed in 20 patients with history of chronic tobacco using (at least 20 years). The videolaryngostroboscopy and acoustic voice analysis were performed. The specific changes as in organic dysphonia were found in larynx in both examinations. The most important finding in acoustic voice analysis was abnormal parameter describing vFo--Fundamental Frequency Variation and lower comparing to normal voices fundamental frequency.