The Role of Telemedicine in Voice Therapy.

Introduction: During the COVID-19 pandemic, our institution adopted telemedicine for voice therapy (VT) as an alternative to in-person sessions, which has been integrated into our routine practice following the pandemic. This study aims to explore factors influencing completion rates among the 2 methods. Method: A retrospective chart review at a single tertiary care institution between 2019 and 2021 was conducted. Patient zip codes were used to determine Neighborhood Atlas® Area Deprivation Index (ADI) scores and travel distance to our institution. Demographic data, Voice Handicap Index (VHI) scores, and completion status were extracted. Results: Between 2019 and 2021, 521 patients were referred to VT at our institution, with 29% opting for telemedicine VT (TVT) sessions and 71% choosing in-person sessions. Seventy-four percent was female, and average age was 57.1 years (range:10-89 years old). No statistically significant differences were observed between the 2 groups regarding sex, age, employment status, or insurance type. Participants in the TVT group demonstrated notably higher completion rates compared to the in-person group [70.0% vs 31.6% (P < .001)]. The TVT group also comprised of a higher percentage of white patients, reported longer travel distances and times to reach therapy, but had comparable ADI scores to the in-person group. Moreover, there were no significant differences in pretreatment VHI scores between the 2 groups or between those who completed therapy versus those who did not (P = .501). Conclusion: Our findings indicate that patients utilizing the telemedicine platform had significantly higher VT completion rates compared to patients appearing in person. These results highlight the importance of being able to offer telemedicine-based options in the management of voice patients.

Inactivation of the paraventricular nucleus attenuates the cardiogenic sympathetic afferent reflex in the spontaneously hypertensive rat.

BACKGROUND: Myocardial ischemia causes the release of bradykinin, which stimulates cardiac afferents, causing sympathetic excitation and chest pain. Glutamatergic activation of the paraventricular hypothalamic nucleus (PVN) in the spontaneously hypertensive rat (SHR) drives elevated basal sympathetic activity. Thus, we tested the hypothesis that inactivation of the PVN attenuates the elevated reflex response to epicardial bradykinin in the SHR and that ionotropic PVN glutamate receptors mediate the elevated reflex. METHODS: We recorded the arterial pressure and renal sympathetic nerve activity (RSNA) response to epicardial bradykinin application in anesthetized SHR and Wistar Kyoto (WKY) rats before and after PVN microinjection of GABA A agonist muscimol or ionotropic glutamate receptor antagonist kynurenic acid. RESULTS: Muscimol significantly decreased the arterial pressure response to bradykinin from 180.4 ±â€Š5.8 to 119.5 ±â€Š6.9 mmHg in the SHR and from 111.8 ±â€Š7.0 to 84.2 ±â€Š8.3 mmHg in the WKY and the RSNA response from 186.2 ±â€Š7.1 to 142.7 ±â€Š7.3% of baseline in the SHR and from 201.0 ±â€Š11.5 to 160.2 ±â€Š9.3% of baseline in the WKY. Kynurenic acid significantly decreased the arterial pressure response in the SHR from 164.5 ±â€Š5.0 to 126.2 ±â€Š7.7 mmHg and the RSNA response from 189.9 ±â€Š13.7to 168.5 ±â€Š12.7% of baseline but had no effect in the WKY. CONCLUSION: These results suggest that tonic PVN activity is critical for the full manifestation of the CSAR in both the WKY and SHR. Glutamatergic PVN activity contributes to the augmented CSAR observed in the SHR.