Graft-vs-host disease as a cause of enlargement of the epiglottis in an immunocompromised child.

We report a rare case of dyspnea due to enlargement of the epiglottis in a severely immunocompromised patient. The child underwent a previous tracheostomy at another hospital because of respiratory distress under the diagnosis of acute epiglottitis. The patient was subsequently decannulated without incident. One year later, the child developed a new episode of dyspnea with inspiratory stridor. A new tracheostomy was neccessary, and a biopsy specimen of the enlarged epiglottis was taken to confirm the diagnosis of graft-vs-host disease. The therapeutic measures in these situations are discussed below, and a review of the current literature concerning the etiology and management of epiglottic enlargement is performed.

[Computer use in voice analysis: clinical applications]. / Los ordenadores en el análisis de la voz: aplicaciones clínicas.

Computers play an important role in voice analysis both in research and in the clinic. We have revised some basic concepts in signal digitization and some of the options present in the different voice analysis systems as: intensity and fundamental frequency measurement, perturbation calculation (jitter and shimmer) and spectrographic analysis. Clinical applications are outlined in conclusion.

[S/z ratio in glottic closure defects]. / El índice s/z en los defectos de cierre glótico.

The quotient between the maximum phonation time (MPT) of the sound /s/ and a vowel sound, measures the relation of resistances to the expiratory air flow. When the sound /s/ is emitted, resistance is located at the teeth, and when a vowel is phonated, the site of resistance is the glottis. Estimating the quotient instead of measuring only the MPT, we avoid the influence of respiratory alterations in the results. We evaluated the utility of the s/z ratio as a clinical indicator of laryngeal pathology in 72 patients with organic vocal cord pathology. We compared the results of the s/z ratio to the degree of glottic closure defect, measured by videolaryngostroboscopy. S/z ratio in 22 normal-speaking subjects was also measured. S/z ratio in normal-speaking subjects was nearly 1.0. When a glottic closure defect was present, the ratio was over 1.4. Organic lesions that difficult glottic closure, produce a decrease of air flow resistance and, therefore, a shortening of the MPT of the vowel sounds.