Voice handicap and voice-related quality of life in COVID-19 patients.

OBJECTIVES: Identifying voice handicap and voice-related quality of life in patients presenting pulmonary impairment associated with COVID-19 infection, comparing pulmonary parameters between these patients and individuals in the control group, as well as correlating pulmonary parameters to self-assessment questionnaires (IDV-10 and QVV). METHODS: Thirty-five (35) patients presenting pulmonary impairment with COVID-19 infection were herein selected and compared to 35 individuals who were not affected by COVID-19 infection. Two self-assessment questionnaires were applied (vocal handicap index and voice quality of life protocol). Maximum phonation time Forced Expiratory Pressure (PEF) and Forced Inspiratory Pressure (PIF) were measured and videolaryngoscopy was performed. RESULTS: There was statistically significant difference in scores recorded in voice self-assessment questionnaires (IDV-10 and QVV), Expiratory Pressure (PEF) and Forced Inspiratory Pressure (PIF) between patients with pulmonary impairment associated with COVID-19 infection and those in the control group. Correlation between PEF/PIF and scores recorded in voice self-assessment questionnaires was also observed. CONCLUSION: Pulmonary impairment associated with COVID-19 infection has worsened voice handicap and voice-related quality of life in the assessed patients, as well as reduced their forced expiratory and inspiratory pressure in comparison to the control group.

Cochlear Implants after Meningitis and Otosclerosis: A Comparison between Cochlear Ossification and Speech Perception Tests.

(1) Background: Performance after Cochlear Implantation (CI) can vary depending on numerous factors. This study aims to investigate how meningitis or otosclerosis can influence CI performance. (2) Methods: Retrospective analysis of CI performance in patients with etiological diagnosis of meningitis or otosclerosis, comparing the etiologies and analyzing the image findings, along with electrode array insertion status and technique. (3) Results: Speech recognition in CI patients with otosclerosis improves faster than in patients with meningitis. Other features such as radiological findings, degree of cochlear ossification, surgical technique used and total or partial insertion of electrodes do not seem to be directly related to speech recognition test performance. (4) Conclusions: Patients should be warned that their postoperative results have a strong correlation with the disease that caused their hearing loss and that, in cases of meningitis, a longer duration of speech-language training may be necessary to reach satisfactory results.

Cochlear Implantation in Children with Auditory Neuropathy: Meta-Analysis.

BACKGROUND: Auditory neuropathy (AN) is a nosological entity of unknown etiology, which is associated with fluctuations in rates of speech discrimination. Its diagnosis is based on presence of otoacoustic emissions and lack of, or abnormal, brainstem auditory evoked potential. With respect to treatment, we have variable results in the literature about development of speech perception and skills, in children with AN and cochlear implant (CI) rehabilitation. OBJECTIVES: Comparatively assessing results recorded for the development of auditory and speech skills in children with auditory neuropathy spectrum disorder (ANSD), who were subjected to cochlear implantation, in comparison to results recorded for children with sensorineural hearing loss associated with other causes was the objective of this study. METHOD: A systematic literature review with meta-analysis was performed, with studies published from 1975 to 2023. RESULTS: Nineteen studies were included in the systematic review, and eight were selected for the meta-analysis, which showed there was no evidence allowing the conclusion that the two groups were different from each other about results in speech performance after 1 year of CI placement. CONCLUSION: Therefore, this study shows that CI provides the comparable benefit to children with ANSD in comparison to children with neurosensory hearing loss associated with other causes in their speech development.

Surgical Treatment Applied to Bilateral Vocal Fold Paralysis in Adults: Systematic Review.

INTRODUCTION: Bilateral vocal fold paralysis is a condition accounting for great mortality and significant worsening in patients' quality of life. Treatment applied to these patients seek balance among breathing, airway protection and voice quality. AIM: Critically and systematically reviewing the current literature on the topic in order to set the best technique to restore breathing comfort, without the need of tracheostomy, in patients with bilateral vocal fold paralysis. Furthermore, it seeks the surgical type technique accounting for the best breathing rate and for the smallest changes in voice parameters. MATERIALS AND METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses method methodology and population, interventions, comparatives, outcomes and study design criteria were used as systematic search in the biggest databases and in the grey literature. The following meshes were used for the search: surgical interventions, surgical treatment, bilateral vocal cord paralysis, bilateral vocal fold paralysis, tracheostomy, decannulation, voice, and dysphonia. The selected studies should have followed the randomized clinical-trial type or be longitudinal observational controlled prospective studies (cohort studies). RESULTS: In total, 3,548 articles were found. After duplicate studies were removed from the selection, the inclusion and exclusion criteria were applied and 06 articles were selected for qualitative analysis. CONCLUSIONS: The assessed surgical procedures showed good cost-benefit to treat bilateral vocal fold paralysis, either because they improved the breathing function in most patients and allowed decannulation in patients with tracheostomy, or because they accounted for small changes to both voice parameters or deglutition. However, none of the described techniques has shown respiratory and functional outcomes better than those recorded for the other ones. The decision on what surgery to perform still must be made based on the judgement of an experienced surgeon.

Association between dysphagia and tongue strength in patients with amyotrophic lateral sclerosis / Associação entre disfagia e força da língua em pacientes com esclerose lateral amiotrófica

Abstract Introduction Amyotrophic lateral sclerosis is the most common motor neuron disease in adults despite it being rare. It is a neurodegenerative disease in which dysphagia is a common and debilitating symptom. Dysphagia can be assessed by complementary exams, such as fiberoptic endoscopic evaluation of swallowing and the tongue strength test, as this is one of the main muscles involved in swallowing. Objective To compare the results of tongue strength and endurance measured by the Iowa oral performance instrument with the findings of the fiberoptic endoscopic evaluation of swallowing examination in patients affected by amyotrophic lateral sclerosis. Methods Cross-sectional study, carried out in a tertiary hospital specialized in treatment and rehabilitation. Twenty-five patients diagnosed with amyotrophic lateral sclerosis underwent dysphagia questionnaires, fiberoptic endoscopic evaluation of swallowing examination and tongue strength and resistance test with the Iowa oral performance instrument to assess the presence of dysphagia. Results Forty-eight percent of the sample had dysphagia at the fiberoptic endoscopic evaluation of swallowing and 76% had an altered tongue strength test. Ninety percent of patients with dysphagia had an average tongue pressure lower than 34.2 KPa. The tongue strength test showed sensitivity of 91.67% and specificity of 38.46% and accuracy of 64%. There was a statistically significant relationship between tongue strength and dysphagia and between tongue resistance and dysphagia. Conclusion Tongue strength tests, such as the Iowa oral performance instrument, proved to be effective in assessing dysphagia. This result should encourage further research to facilitate the early diagnosis of dysphagia.

Resumo Introdução A esclerose lateral amiotrófica é a doença do neurônio motor mais comum nos adultos, a despeito da baixa incidência e da raridade. É uma doença neurodegenerativa na qual a disfagia é um sintoma comum e debilitante. A disfagia pode ser avaliada por exames complementares como a videoendoscopia da deglutição e testes de força de língua, uma vez que se trata de um dos principais músculos envolvidos na deglutição. Objetivo Comparar os resultados da força e resistência da língua aferidos pelo Iowa Oral Performance Instrument com os achados do exame à videoendoscopia da deglutição, em pacientes acometidos por esclerose lateral amiotrófica. Método Estudo transversal, feito em um hospital terciário especializado em tratamento e reabilitação. Vinte e cinco pacientes com diagnóstico de esclerose lateral amiotrófica foram submetidos a questionários de disfagia, exame de videoendoscopia da deglutição e teste de força e resistência de língua com o Iowa Oral Performance Instrument para avaliar a presença de disfagia. Resultado Quarenta e oito por cento da amostra apresentavam disfagia à videoendoscopia da deglutição e 76% apresentavam teste de força de língua alterado. Noventa por cento dos pacientes com disfagia apresentaram pressão de língua média inferior a 34,2 KPa. O teste de força de língua apresentou sensibilidade de 91,67% e especificidade de 38,46% e acurácia de 64%. Houve relação estatisticamente significante entre força da língua e disfagia e entre resistência da língua e disfagia. Conclusão Testes de força de língua, como o Iowa Oral Performance Instrument, mostrou‐se eficaz para avaliar disfagia, mostrou sua associação com a força e resistência da língua. Esse resultado deve fomentar a feitura de novas pesquisas para facilitar o diagnóstico precoce da disfagia.

Supraglottic stenosis as a late complication of radiotherapy: a case report.

Nasopharyngeal carcinoma is rare and affect mainly men between the fourth and sixth decades of life. The clinic is characterized to be nonspecific and the main complaints or findings related to this disease are: cervical mass, aural dysfunction, and headache. The basis of treatment is radiotherapy that involves a wide field of irradiation of normal tissues, which usually generates sequelae with direct implications for quality of life. We report a case of a nasopharyngeal carcinoma treated with radiotherapy and chemotherapy that evolved, after 8 years, into supraglottic stenosis. We emphasize the relevance of clinical follow-up after radiotherapy, particularly due to the late sequelae and the relevance of using radiotherapy devices with a more focal cancer field, in order to minimize complications.

Is There a Difference between the Preoperative and Postoperative Serum Levels of Interleukin-6 and Tumor Necrosis Factor-α in Children Submitted to Adenotonsillectomy?

Abstract Introduction Palatine and pharyngeal tonsils are the first line of defense against pathogens. Clinically, two alterations may require surgical removal of the tonsils: hypertrophy and recurrent tonsillitis. The two conditions probably result from a dysfunction of the immune system. Objective To evaluate possible differences in the plasma levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-10 (IL-10) in patients submitted to adenotonsillectomy. Methods Prospective, longitudinal study with 25 children undergoing adenotonsillectomy separated into 3 different groups: recurrent tonsillitis (RT), composed of 7 patients; recurrent hypertrophy tonsillitis (RTTH), with 8 patients; and the tonsillar hypertrophy (TH) group, with 10 patients. Ten healthy control children (SD) were also included in the study. Peripheral blood was collected, and plasma was separated to measure the levels of TNF-α, IL-6, and IL-10. The Mann-Whitney test was used for statistical analysis. Results The plasma level of IL-6 was higher in the RT (p= 0.0394) and TH (p= 0.0009) groups, compared with the control group. The TH group also had higher levels of IL-6 than the RT group (p= 0.039). The IL-6/IL-10 ratio was higher in the RT (p= 0.029) and TH (p= 0.0005) groups compared with the control group. Between the RT and RTTH groups, the IL-6/IL-10 ratio was higher in the RT group, with a statistically significant difference (p= 0.0091). Conclusion Patients with a history of chronic tonsillitis had higher levels of IL-6, compared with the control group.

Is There a Difference between the Preoperative and Postoperative Serum Levels of Interleukin-6 and Tumor Necrosis Factor-α in Children Submitted to Adenotonsillectomy?

Introduction Palatine and pharyngeal tonsils are the first line of defense against pathogens. Clinically, two alterations may require surgical removal of the tonsils: hypertrophy and recurrent tonsillitis. The two conditions probably result from a dysfunction of the immune system. Objective To evaluate possible differences in the plasma levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-10 (IL-10) in patients submitted to adenotonsillectomy. Methods Prospective, longitudinal study with 25 children undergoing adenotonsillectomy separated into 3 different groups: recurrent tonsillitis (RT), composed of 7 patients; recurrent hypertrophy tonsillitis (RTTH), with 8 patients; and the tonsillar hypertrophy (TH) group, with 10 patients. Ten healthy control children (SD) were also included in the study. Peripheral blood was collected, and plasma was separated to measure the levels of TNF-α, IL-6, and IL-10. The Mann-Whitney test was used for statistical analysis. Results The plasma level of IL-6 was higher in the RT ( p = 0.0394) and TH ( p = 0.0009) groups, compared with the control group. The TH group also had higher levels of IL-6 than the RT group ( p = 0.039). The IL-6/IL-10 ratio was higher in the RT ( p = 0.029) and TH ( p = 0.0005) groups compared with the control group. Between the RT and RTTH groups, the IL-6/IL-10 ratio was higher in the RT group, with a statistically significant difference ( p = 0.0091). Conclusion Patients with a history of chronic tonsillitis had higher levels of IL-6, compared with the control group.

Laryngeal Findings in Duchenne Muscular Dystrophy.

INTRODUCTION: Some studies have demonstrated that the intrinsic muscles of the larynx show no signs of damage to the muscle fiber and raise a possibility of preservation of the laryngeal muscles in muscular dystrophies. A cross-sectional study was implemented with a case series of patients with Duchenne muscular dystrophy. METHODS: This study was carried out through a medical assessment through anamnesis and medical records, perceptual-auditory evaluation of the voice in 15 patients, and videolaryngoscopic evaluation in 11 patients. RESULTS: All patients had the maximum phonation time of the vowel /e/ decreased, 7 (46.7%) had reduced loudness while 10 (66.7%) had vocal asthenia. There were no changes in muscular tone and mobility in the videolaryngoscopy. DISCUSSION: Patients with Duchene muscular dystrophy do not present abnormalities suggestive of the involvement of the intrinsic muscles of the larynx but have vocal worsening due to pulmonary impairment.

Association between dysphagia and tongue strength in patients with amyotrophic lateral sclerosis.

INTRODUCTION: Amyotrophic lateral sclerosis is the most common motor neuron disease in adults despite it being rare. It is a neurodegenerative disease in which dysphagia is a common and debilitating symptom. Dysphagia can be assessed by complementary exams, such as fiberoptic endoscopic evaluation of swallowing and the tongue strength test, as this is one of the main muscles involved in swallowing. OBJECTIVE: To compare the results of tongue strength and endurance measured by the Iowa oral performance instrument with the findings of the fiberoptic endoscopic evaluation of swallowing examination in patients affected by amyotrophic lateral sclerosis. METHODS: Cross-sectional study, carried out in a tertiary hospital specialized in treatment and rehabilitation. Twenty-five patients diagnosed with amyotrophic lateral sclerosis underwent dysphagia questionnaires, fiberoptic endoscopic evaluation of swallowing examination and tongue strength and resistance test with the Iowa oral performance instrument to assess the presence of dysphagia. RESULTS: Forty-eight percent of the sample had dysphagia at the fiberoptic endoscopic evaluation of swallowing and 76% had an altered tongue strength test. Ninety percent of patients with dysphagia had an average tongue pressure lower than 34.2KPa. The tongue strength test showed sensitivity of 91.67% and specificity of 38.46% and accuracy of 64%. There was a statistically significant relationship between tongue strength and dysphagia and between tongue resistance and dysphagia. CONCLUSION: Tongue strength tests, such as the Iowa oral performance instrument, proved to be effective in assessing dysphagia. This result should encourage further research to facilitate the early diagnosis of dysphagia.

Is there benefit from the use of cochlear implants and hearing aids in cognition for older adults? A systematic review.

Objectives: The aim of the study was to assess whether hearing aids (HA) and cochlear implants (CI) bring benefits to cognition or mitigate cognitive decline in older adults. Methods: This is a systematic literature review registered on the International Prospective Register of Systematic Reviews (PROSPERO) and based on the criteria recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The Population, Intervention, Comparison, Outcome, and Study type (PICOS) strategy was used to define eligibility. Studies that met the criteria were included in the qualitative synthesis. We assessed the risk of bias through the Joanna Briggs Institute Critical Appraisal Checklists. Results: A total of 3,239 articles, found in eight databases, addressed the relationship between HA, CI, and cognition. We selected 30 experimental articles reporting measures of cognitive outcomes for older adults to include in the qualitative analysis. Of those, 23 studies reported a significant improvement in outcome and seven reported no significant change. Conclusions: This systematic review indicates that CI and HA can bring benefits to cognition in older adults. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021273690.

Supraglottic stenosis as a late complication of radiotherapy: a case report

ABSTRACT Nasopharyngeal carcinoma is rare and affect mainly men between the fourth and sixth decades of life. The clinic is characterized to be nonspecific and the main complaints or findings related to this disease are: cervical mass, aural dysfunction, and headache. The basis of treatment is radiotherapy that involves a wide field of irradiation of normal tissues, which usually generates sequelae with direct implications for quality of life. We report a case of a nasopharyngeal carcinoma treated with radiotherapy and chemotherapy that evolved, after 8 years, into supraglottic stenosis. We emphasize the relevance of clinical follow-up after radiotherapy, particularly due to the late sequelae and the relevance of using radiotherapy devices with a more focal cancer field, in order to minimize complications.

Partial laryngectomy and reconstruction with rotation of the epiglottis in the treatment of a rare laryngeal schwannoma: a case report.

BACKGROUND: Neurogenic tumors of the larynx are rare, with few cases having been reported in the literature. Schwannomas are responsible for 0.1% of all benign tumors of the larynx. They arise in the sheaths of the peripheral, autonomic, and cranial nerves. The objective of this report is to describe a case of a bulky laryngeal schwannoma, the surgical procedure for its removal, and the long-term patient follow-up. CASE PRESENTATION: A 19-year-old Brazilian woman presented to our institution with a complaint of progressive dyspnea over the preceding year, as well as dysphonia, dysphagia for solids, and globus pharyngeus. Direct rigid laryngoscopy showed a supraglottic tumor obstructing approximately 90% of the larynx. With the symptoms progressing to severe dyspnea, an emergency tracheostomy was performed. After infusion of intravenous contrast, magnetic resonance imaging revealed a mass lesion with intense, heterogeneous contrast enhancement along the posterior wall of the hypopharynx, blocking all of the lumen and measuring 2.8 cm and 2.2 cm at its largest diameters. The image suggested a neoplastic lesion. The patient underwent open surgery for tumor resection. Her postsurgical recovery was uncomplicated. Histopathology and immunohistochemistry revealed the tumor to be a laryngeal schwannoma. CONCLUSION: The definitive diagnosis of laryngeal lesions can be difficult, and histopathology plays a pivotal role. Laryngeal schwannomas are rare; however, tumors can become large and may ultimately lead to airway obstruction.

A 67-Year-Old Woman with Sudden Hearing Loss Associated with SARS-CoV-2 Infection.

BACKGROUND Few reports have described the association between coronavirus disease 2019 (COVID-19) and sudden hearing loss. The precise pathophysiological mechanism causing this symptom is unknown. This report describes a case of sudden hearing loss in a patient with COVID-19 pneumonia due to SARS-CoV-2 infection. CASE REPORT A 67-year-old woman with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), as confirmed by reverse transcription-polymerase chain reaction (RT-PCR) testing from nasopharyngeal and oropharyngeal swabs, was examined. She experienced sudden hearing loss in her right ear and disabling tinnitus. She underwent combined corticosteroid therapy (oral and intratympanic), resulting in an isolated improvement of 250 kHz in the right ear (from 60 dB, the threshold became 15 dB) and of 4, 6, and 8 kHz in the left ear (from 35 dB, 20 dB, and 35 dB, the thresholds became 15 dB, 5 dB and 20 dB, respectively). CONCLUSIONS Although rare, hearing loss appears to be a possible sequela to SARS-CoV-2 infection and deserves attention because it is a medical emergency requiring immediate clinical treatment. Additional studies are needed to assess the pathophysiological mechanisms involved in and the long-term characteristics of this type of hearing loss.

Correlation Between Clinical Diagnosis and Pathological Diagnosis in Laryngeal Lesions.

OBJECTIVES: To evaluate the degree of agreement between the clinical and the pathological diagnosis in patients undergoing laryngeal microsurgery due to epithelial or edematous lesions of the vocal folds. STUDY DESIGN: This is a retrospective study. METHODS: The study was developed in the ear, nose, and throat clinic of a tertiary hospital, through chart review. We included all patients who underwent microsurgery of the larynx, whose videolaryngoscopic tests showed vocal fold lesions, from January 2003 to August 2014. During the study period, we identified 48 patients with epithelial and edematous lesions. The patients were divided into two groups. In group A, patients with edematous lesions with clinical diagnosis of polyps and Reinke edema were included. Group B comprised patients with epithelial lesions, as leukoplakic injuries. A correlation between histopathological findings and clinical hypothesis between these two groups of lesions was performed. RESULTS: In group B, there was agreement in 88.9% of cases between the clinical and pathological diagnosis. In group A, compatibility occurred in only 46.4% of cases. We observed a statistically significant difference between the compatibility of the clinical and pathological diagnosis just in edematous lesions (P = 0.029). CONCLUSIONS: The study showed the limitation of the pathological examination on edematous laryngeal lesions. On the other hand, on the epithelial lesions, there was more agreement between those diagnosis.