Electromyography of the posterior cricoarytenoid muscles: a consensus guideline.

PURPOSE: Since the introduction of transcutaneous-transcricoidal needle approaches, electromyography (EMG) of the posterior cricoarytenoid muscle (PCA) became easier to perform and teach. Among the Neurolaryngology working group of the European Laryngological Society, several centers have adopted PCA EMG as part of their routine EMG workup in vocal fold immobility collectively gathering long-term experience. The purpose is to give an update and an extension to already existing guidelines on laryngeal EMG with specific regard to PCA EMG. METHODS: Consensus of all co-authors is based on continuous exchange of ideas and on joint laryngeal EMG workshop experiences over at least 7 years. A Delphi method of consensus development was used, i.e., the manuscript was circulated among the co-authors until full agreement was achieved. RESULTS: Step-by-step instructions on how to perform and interpret PCA EMG are provided. CONCLUSIONS: Further research should include the establishment of normal values for PCA and thyroarytenoid muscle (TA) EMG as well as studies on the nature of some unusual activation pattern commonly seen in chronically lesioned PCA.

Promising Technique for Facial Nerve Reconstruction in Extended Parotidectomy.

INTRODUCTION: Malignant tumors of the parotid gland account scarcely for 5% of all head and neck tumors. Most of these neoplasms have a high tendency for recurrence, local infiltration, perineural extension, and metastasis. Although uncommon, these malignant tumors require complex surgical treatment sometimes involving a total parotidectomy including a complete facial nerve resection. Severe functional and aesthetic facial defects are the result of a complete sacrifice or injury to isolated branches becoming an uncomfortable distress for patients and a major challenge for reconstructive surgeons. CASE REPORT: A case of a 54-year-old, systemically healthy male patient with a 4 month complaint of pain and swelling on the right side of the face is presented. The patient reported a rapid increase in the size of the lesion over the past 2 months. Imaging tests and histopathological analysis reported an adenoid cystic carcinoma. A complete parotidectomy was carried out with an intraoperative notice of facial nerve infiltration requiring a second intervention for nerve and defect reconstruction. A free ALT flap with vascularized nerve grafts was the surgical choice. A 6 month follow-up showed partial facial movement recovery and the facial defect mended. CONCLUSION: It is of critical importance to restore function to patients with facial nerve injury. Vascularized nerve grafts, in many clinical and experimental studies, have shown to result in better nerve regeneration than conventional non-vascularized nerve grafts. Nevertheless, there are factors that may affect the degree, speed and regeneration rate regarding the free fasciocutaneous flap. In complex head and neck defects following a total parotidectomy, the extended free fasciocutaneous ALT (anterior-lateral thigh) flap with a vascularized nerve graft is ideally suited for the reconstruction of the injured site. Donor-site morbidity is low and additional surgical time is minimal compared with the time of a single ALT flap transfer.

[Designing a new tool for hearing exploration]. / Diseño de una nueva herramienta para la exploración auditiva.

INTRODUCTION: Many presbycusic patients have difficulty in understanding certain words. This could be justified because certain sounds in Spanish are more difficult to perceive, particularly the sounds with energy in the high frequencies. We propose to use a sentence as a tool to check this theory. MATERIALS AND METHOD: All the Spanish sounds were analyzed, measuring the degree of acoustic energy in all the frequencies. The conclusions drawn from the comparison of the results allowed the design of the tool that is proposed here. RESULTS: We established a gradient of perception difficulty, occlusive consonants being the least perceptible, followed by fricative, and finally all those segments with harmony and a clear formant structure. The Spanish sentence "Ana vio ese coche rojizo fino" is proposed as the tool for this study. This sentence has some as it comprises certain peculiarities that makes it particularly useful for this purpose. It will allow us to check whether understanding deteriorates as we move from beginning to end, helping evaluate the importance of high frequencies for intelligibility. CONCLUSIONS: A positive result could help in the design of amplification systems to improve speech intelligibility. In addition, the exploratory tool could allow neuro-acoustic exploration, useful in the central auditory pathology studies.

Diseño de una nueva herramienta para la exploración auditiva / Designing a new tool for hearing exploration

Introducción. Muchos pacientes presbiacúsicos presentan dificultad para entender ciertas palabras, hecho que podría estar justificado porque determinados sonidos en español presentan una dificultad mayor de perceptibilidad, en concreto los de energía en altas frecuencias. Se propone utilizar una oración como herramienta para comprobar la hipótesis de partida. Material y método. Se analizaron todos los sonidos del español, midiendo el grado de energía acústica que presenta cada una de las frecuencias. Las conclusiones extraídas de la comparación de sus resultados permitieron el diseño de la herramienta que aquí se propone. Resultados. Se establece una gradación de dificultad perceptiva, por lo que se puede decir que las oclusivas aparecen como los sonidos menos perceptibles, seguido de las fricativas y, finalmente, todos los segmentos que presentan armonicidad y una estructura formántica definida. Como herramienta para la práctica clínica, se propone la frase española «Ana vio ese coche rojizo fino», frase que cumple una serie de particularidades que la hacen especialmente útil para tal fin. Esta oración permitirá comprobar si la comprensión se va deteriorando a medida que se avanza desde la primera a la última de sus secciones, y así poder suponer que la capacidad para detectar auditivamente la presencia de energía reforzada en las altas frecuencias es indispensable para la inteligibilidad. Conclusiones. Un resultado positivo podría tener como consecuencia el diseño de sistemas de amplificación que mejoren la inteligibilidad de la palabra. Además, el hecho de tener una herramienta exploratoria podría permitir la exploración neuroacústica, de utilidad en el estudio de la enfermedad auditiva

Introduction. Many presbycusic patients have difficulty in understanding certain words. This could be justified because certain sounds in Spanish are more difficult to perceive, particularly the sounds with energy in the high frequencies. We propose to use a sentence as a tool to check this theory. Materials and method. All the Spanish sounds were analyzed, measuring the degree of acoustic energy in all the frequencies. The conclusions drawn from the comparison of the results allowed the design of the tool that is proposed here. Results. We established a gradient of perception difficulty, occlusive consonants being the least perceptible, followed by fricative, and finally all those segments with harmony and a clear formant structure. The Spanish sentence «Ana vio ese coche rojizo fino» is proposed as the tool for this study. This sentence has some as it comprises certain peculiarities that makes it particularly useful for this purpose. It will allow us to check whether understanding deteriorates as we move from beginning to end, helping evaluate the importance of high frequencies for intelligibility. Conclusions. A positive result could help in the design of amplification systems to improve speech intelligibility. In addition, the exploratory tool could allow neuro-acoustic exploration, useful in the central auditory pathology studies

[Analysis of changes in the spectrogram following endotracheal intubation]. / Análisis de los cambios en el espectrograma tras la intubación endotraqueal.

INTRODUCTION AND OBJECTIVES: Voice alteration is a common event following endotracheal intubation. The objective of this study is to describe strobolaryngoscopic and spectrogram changes after endotracheal intubation, and attempt to identify a relationship between these changes and also with anaesthetic variables. MATERIAL AND METHOD: Thirty-eight patients who underwent endotracheal intubation for otological surgery were studied prospectively. None of these subjects had a history of voice problems or prior cervical surgery, and they did not consume alcohol or tobacco. The patients were studied prior to the operation and 3 hours, 24 hours, and 7 days after surgery. Laryngeal morphology was explored by strobolaryngoscopy. The vocal output was examined by means of the GRABS scale, acoustic analysis and spectrogram. RESULTS: Strobolaryngoscopy was normal 24 hours after surgery in all but 2 subjects, in whom it later returned to normal. Spectrography, acoustic analysis (jitter and shimmer), and GRABS scale all showed an initial worsening of voice production after surgery when compared to pre-operative values, followed by a recovery of normal values 1 week after surgery. No statistical correlation was found between voice output and anaesthetic variables. CONCLUSIONS: Although there are temporary voice changes in subjects undergoing endotracheal intubation during the early post-operative period, these recover to normal parameters within 7 days after surgery. These changes occur even in the absence of strobolaryngoscopic changes.

Análisis de los cambios en el espectrograma tras la intubación endotraqueal / Analysis of changes in the spectrogram following endotracheal intubation

Introducción y objetivos: La aparición de alteraciones vocales tras la intubación endotraqueal es un hecho frecuente. El objetivo de este estudio es describir los cambios laringostroboscópicos y del espectrograma después de una intubación e intentar correlacionar los hallazgos entre sí y con algunas variables anestésicas. Material y método: Se estudió prospectivamente a 38 pacientes que se sometieron a anestesia general con intubación endotraqueal por cirugía otológica. Ninguno de ellos tenía antecedentes de problemas fonatorios o cirugía cervical, ni tampoco consumían alcohol o tabaco. Se estudió a los pacientes tanto antes como 3 horas, 24 horas y 7 días después de la cirugía. Se exploró la laringe mediante laringostroboscopia. La voz de los sujetos se analizó con escala GRABS, análisis acústico y espectrografía. Resultados: La exploración laringostroboscópica fue normal en todos los pacientes salvo en 2 sujetos a las 24 horas de la intubación, que se normalizó posteriormente. Tanto en la escala GRABS como en el espectrograma y el análisis acústico (jitter y shimmer), se observó un empeoramiento de la voz en las mediciones iniciales en relación con las preoperatorias, seguido de un ulterior retorno a los valores normales a los 7 días de la cirugía. No se pudo encontrar correlación estadística entre las variables anestésicas y los resultados vocales de los individuos estudiados. Conclusiones: Existen cambios temporales en la fonación medida mediante la escala GRABS y el espectrograma, en sujetos sometidos a intubación endotraqueal, que tornan a los valores previos dentro de los primeros 7 días tras la intervención. Dichos cambios ocurren aun en ausencia de alteraciones laringostroboscópicas

Introduction and objectives: Voice alteration is a common event following endotracheal intubation. The objective of this study is to describe strobolaryngoscopic and spectrogram changes after endotracheal intubation, and attempt to identify a relationship between these changes and also with anaesthetic variables. Material and method: Thirty-eight patients who underwent endotracheal intubation for otological surgery were studied prospectively. None of these subjects had a history of voice problems or prior cervical surgery, and they did not consume alcohol or tobacco. The patients were studied prior to the operation and 3 hours, 24 hours, and 7 days after surgery. Laryngeal morphology was explored by strobolaryngoscopy. The vocal output was examined by means of the GRABS scale, acoustic analysis and spectrogram. Results: Strobolaryngoscopy was normal 24 hours after surgery in all but 2 subjects, in whom it later returned to normal. Spectrography, acoustic analysis (jitter and shimmer), and GRABS scale all showed an initial worsening of voice production after surgery when compared to pre-operative values, followed by a recovery of normal values 1 week after surgery. No statistical correlation was found between voice output and anaesthetic variables. Conclusions: Although there are temporary voice changes in subjects undergoing endotracheal intubation during the early post-operative period, these recover to normal parameters within 7 days after surgery. These changes occur even in the absence of strobolaryngoscopic changes

Otosyphilis mimics immune disorders of the inner ear.

Syphilis is a well established cause of hearing loss. Sensorineural hearing loss may develop in the congenital or acquired form. The clinical course of the early acquired and late congenital forms are similar: sudden or rapidly progressive bilateral sensorineural hearing loss with mild vestibular symptoms. Cochleovestibular involvement in early acquired syphilis has been related to a basilar meningitis with lymphocytic infiltration of the labyrinth and VIIIth nerve. However, neurosyphilis and inner ear syphilis are not the same disease. Prompt diagnosis and treatment with corticosteroids and penicillin are mandatory to reduce the immune response and fibrosis of the labyrinth and the endolymphatic sac. Unfortunately, early acquired syphilis is frequently overlooked in the differential diagnosis of other forms of sensorineural hearing loss, particularly autoimmune inner ear disease. Given the increasing number of luetic infection cases, especially in immunocompromised patients, this condition should be considered in any sexually active patients affected by sudden hearing loss. Cases of inner ear syphilis are presented. Immunopathology of luetic inner ear infection is discussed and compared with immune disorders of the inner ear.

Sudden presentation of immune-mediated inner ear disease: characterization and acceptance of a cochleovestibular dysfunction.

Since the McCabe report, growing indirect evidence has accumulated to indicate the implication of immune mechanisms in the pathogenesis of immune-mediated inner-ear disease (IMIED). A clinical study of a group of patients affected by this condition was performed in order to characterize the immune group, based on a recently reported profile, and compared with the vascular, viral and idiopathic aetiologies of sudden deafness. Patients affected by immune-mediated inner-ear disease had the best and the earliest recovery rate of hearing (p = 0.0028 and p = 0.017, respectively). However, this group of patients also had the higher rate of recurrence (p = 0.034), supporting the typical clinical course of the autoimmune disorders. On the basis of the results the criteria used in the diagnosis of the sudden presentation of the immune-mediated inner ear disease could be accepted leading to the characterization of this condition. Likewise, the role of the supporting cells in the pathogenesis of the IMIED is discussed.