[Chronic laryngitis--associated factors and voice assessment]. / Chronische Laryngitis--assoziierte Faktoren und subjektive Stimmeinschätzung.

BACKGROUND: Chronic laryngitis may be a predisposing factor for laryngeal carcinoma. METHOD: 100 consecutive chronic laryngitis patients were assessed for associated factors for this disease. Voice assessment was undertaken, including objective measurement, subjective assessment of sound and a self-assessment by questionnaire--the so-called Voice Handicap Index (VHI). When laryngostroboscopy of the vocal cords was suspicious, then microlaryngoscopy with biopsy and histological examination was undertaken. RESULTS: The main associated factors were found to be nicotine abuse (50 patients), gastro-esophageal/laryngo-esophageal reflux (35 patients) and inhaled corticosteroid therapy (25 patients). Subjectively, all patients considered their voices to be relatively healthy (VHI less than 15). Objective voice parameters and subjectively listening were of no prognostic significance. Indirect microscopic examination could diagnose chronic laryngitis in 31 of cases, rising to 69 when leucoplakia was present. In 6 patients the mucosal wave was found stroboscopically to be abnormal. Additionally these patients underwent direct laryngoscopy and biopsy. On histological examination one of them had a high grade dysplasia and two of them had a carcinoma in situ. CONCLUSION: Patients with chronic laryngitis or development of vocal cord leucoplakia often abuse nicotine, use inhaled corticosteroids for bronchial asthma or suffer from acid reflux. As many patients with chronic laryngitis/leucoplakia subjectively often do not experience any voice limitations, stroboscopic investigation is useful for the early recognition of malignant change.

Smoking, carcinophobia and Voice Handicap Index.

OBJECTIVE: This study focuses on the relation of smoking, carcinophobia and voice handicap in dysphonic patients. PATIENTS AND METHODS: Fifty-four German-speaking outpatient voice clinic attendees suffering from dysphonia of benign origin took part in this study. All patients completed the German version of the Voice Handicap Index (VHI) and were asked about their fear of suffering from laryngeal cancer without prior information about their diagnosis. RESULTS: Smokers did not fear to suffer from laryngeal cancer more than nonsmokers. However, former smokers were slightly more often found to be carcinophobic than nonsmokers. There was neither a significant difference in VHI scores comparing smokers to non- and former smokers nor when comparing carcinophobic to noncarcinophobic patients. CONCLUSION: Smoking may cause laryngeal cancer and influence the voice but does not affect patients' handicap due to dysphonia as measured by the VHI. Smoking habits do not influence the development of carcinophobia and carcinophobic dysphonic patients do not experience their voice problem differently than dysphonic patients without cancerophobia as measured by the VHI.

The clinical characteristics and impact of laryngopharyngeal reflux disease on health-related quality of life.

BACKGROUND AND OBJECTIVES: Although it is accepted that reflux of stomach acid causes gastroesophageal reflux disease (GERD), it is less well understood that it also contributes to the clinical signs and symptoms of laryngitis in the form of laryngopharyngeal reflux (LPR). Study objectives were to identify what is known about the impact of LPR on health-related quality of life (HRQL) compared with the impact of GERD on HRQL and to assess whether currently available HRQL instruments adequately measure this impact or if a new disease-specific instrument should be recommended. METHODS: The authors combined a systematic literature review with prospective patient evaluation via focus groups. The review, using MEDLINE, focused on clinical characteristics and HRQL measurement and impact. Focus groups involving a total of 30 patients with LPR provided input on clinical manifestations of the disease and its HRQL impact. RESULTS: Information gleaned from the literature indicates that less than 40% of patients presenting with symptoms of laryngitis directly attributable to reflux also report experiencing the classic symptoms of heartburn and acid regurgitation associated with GERD. Reflux laryngitis is thus a distinct clinical entity from GERD and may have a unique impact on HRQL. Although multiple instruments are available to assess the impact of GERD on HRQL, no specific instruments are available for LPR. Focus group discussions identified voice problems, chronic cough, throat clearing, and swallowing difficulties to be key concerns of patients with LPR. These manifestations negatively impact HRQL as described by the focus group participants, notably in role functioning, physical well-being, and emotional well-being. CONCLUSIONS: A disease-specific instrument to assess the impact of LPR on HRQL would contribute to clinical care and the evaluation of new therapies. This instrument would ideally be sensitive to the variety of LPR's symptomatic presentations.

[Psychosomatic aspects of pseudocroup]. / Psychosomatische Aspekte des Pseudokrupps.

Based on 14 paediatric case histories we present a hypothesis--to our knowledge for the first time--concerning the role of psychogenetic factors for the occurrence of pseudocroup attacks. Anxieties, insecurity and impaired ability to communicate with each other characterize the relationship of the patient and his mother. The developing independence of the child is hindered. The frightening pseudocroup attack tightens mother and child close together, allows a regression to an early childhood state of mother-child relationship, and demonstrates in a pathological way their interdependence and the dangers of autonomy.