[Optimization of an integrated approach to voice correction for endocrinopathies (analytical review)].

Dysphonia is a symptom of many endocrine pathologies. Hoarseness, voice fatigue, decrease of the voice pitch, reduce of the range are typical complaints for hypothyroidism, caused by an increased amount of polysaccharides and accumulation of fluid in the lamina propria of the vocal folds. An excess of growth hormone causes an overproduction of insulin-like growth factor-1, which leads to abnormalities in the craniofacial region and proliferation of the upper respiratory tract tissues, including thickening of the laryngeal cartilages, vocal folds and decreasing of the voice pitch. Hyperglycemia, changes in the balance of fluid and electrolytes in diabetes mellitus can indirectly affect the voice: xerostomia complicates phonation due to impaired hydration of the laryngeal mucosa, diabetic neuropathy often disrupts the work of the laryngeal muscles involved in voice formation. Voice changes are observed not only in endocrine disorders, but also during puberty, the phases of the menstrual cycle and during menopause. Laryngeal structures are modified under the influence of hormones and external factors, which generally changes pitch and intensity of the voice, timbre and resonance, articulation and prosodic characteristics. The purpose of this review is to summarize and systematize data on physiological and pathological voice changes in patients of different age groups and sex. The possibilities of a multidisciplinary approach to rational voice correction are demonstrated.

[The constitutional approach to the choice of the surgical strategy for the treatment of chronic post-traumatic laryngeal stenoses]. / Konstitutsional'nyi podkhod k vyboru khirurgicheskoi taktiki pri khronicheskikh posttravmaticheskikh stenozakh gortani.

We have developed the algorithm for the choice of the surgical strategy for the treatment of chronic post-traumatic laryngeal stenosis with the purpose of enhancing the effectiveness of the management of the patients presenting with this condition. The proposed approach envisages obtaining anthropometric characteristics of the patients, determination of the type of his (her) neck and constitution, construction of the regressive models of the clinically significant laryngometric parameters based on the results of the clinical observations including the dimensions of the glottal fissure and the position of the vocal folds, calculations of the size of the autotransplant and the length of the T-shaped tube based on the results of the mathematical analysis of the anthropo- and organometric characteristics of the concrete patient, the laryngoplastic and prosthetic treatment of the newly formed laryngo-tracheal passage. The present study included 71 patients at the age from 23 to 68 years presenting with chronic paralytic (31%) and combined (69%) laryngeal stenosis. They were examined with the use of computed tomography of the larynx and the trachea, anthropometric, endoscopic, and spirometric techniques. The following methods were used to treat the patients: extralaryngeal laterofixation of the vocal fold (n=22), extralaryngeal laterofixation of the vocal fold with the stenting using a T-shaped silicone tube (n=43), dissection of the scars remaining after the previous laryngoplastic interventions with the redressement of the innominate cartilage and laryngeal stenting (n=6). The inclusion of the proposed algorithm in the program of the surgical treatment of chronic post-traumatic laryngeal stenosis taking into consideration the individual characteristics of the neck and the body constitution of the concrete patients made it possible to provide successful medical rehabilitation for 68 (95.8%) patients presenting with chronic paralytic and combined laryngeal stenosis.

[The analysis of the effectiveness of the combined treatment of the patients presenting with laryngeal papillomatosis]. / Analiz éffektivnosti kombinirovannogo lecheniia bol'nykh papillomatozom gortani.

The objective of the present work was to evaluate the effectiveness of the application of the inducer of endogenous interferon synthesis in the course of the combined treatment of the adult patients presenting with laryngeal papillomatosis. A total of 50 patients with this pathology were admitted and examined at the ENT Clinics of I.M. Sechenov First Moscow State Medical University and M.F. Vladimirsky Moscow Regional Research Clinical Institute during 24 months. The patients comprising group 1 (n=25) were treated with the use of cold plasma surgery and the inducer of endogenous interferon synthesis while those included in group 2 (n=25) received only surgical treatment. It was shown that the combined treatment including the surgical step (cold plasma surgery) followed by the treatment with the inducer of endogenous interferon synthesis to prevent relapses makes it possible to reduce the number of secondary surgical interventions, increase the duration of the intervals between relapses, and decrease the content of types 6 and 11 human papilloma virus in the saliva.

[The Possibilities of Cell Technologies in the Treatment of Cicatricial Lesions of the Vocal Folds].

The article is a brief review of publications devoted to the problem of persistent dysphonia. The main cause of voice disorders is the scarring of the vocal folds resulting from trauma, surgical manipulation, inflammatory process. Treatment of cicatricial lesions of the vocal folds remains a challenge, as far as existing methods do not ensure the recovery of the ultrastructure of the vocal folds. The authors present modern data on the structure of the vocal folds at the cellular level. Considered pathologic processes occur in different stages of scarring. Applied technologies of phonosurgery and conservative treatment, their effectiveness and shortcomings are covered. Analysis of experimental research conducted in the world demonstrates the promise of using the methods of tissue engineering to treat scarring of the vocal folds and to restore the microstructure of the latter. Identified current issues remain unresolved, which leads to the need for further experimental and clinical studies in the treatment of this pathology.

[Mediafixation of the vocal cord through the external approach in the patients presenting with unilateral laryngeal paralysis].

The objective of the present work was to develop a method for the modification of the vocal cord during the treatment of the patients presenting with unilateral laryngeal paralysis taking into consideration individual peculiarities of stereotopometric characteristics of the larynx in the subjects of different gender, neck structure, and body constitution. The earlier proposed method of laryngostereotopometry was employed in this study. The following body features were measured prior to surgery: the total length, acromial diameter, chest circumference, neck length and circumference; the degree of the fissure of glottis closure was measured by transnasal fibrolaryngoscopy. The transplant was cut out of the quadrangular cartilage of the nasal septum in the form of a prism having the base shaped as an isosceles triangle with the base equal to the width of the fissure of glottis; the vertical and horizontal sizes of the transplant were calculated from the formulas of multiple linear regression analysis. The autotransplant was introduced through the "window" in the plate of the shield-like cartilage between its internal perichondrium and the thyroarytenoid muscle of the arytenoid cartilage of the paralysed vocal cord in the horizontal direction in front of the site of attachment of the vocal cord of arytenoids cartilage up to the projection of the anterior commissure with fixation to the shield-like cartilage by a ligature.

[Stereomorphometric characteristics of hyoid bone in adult humans with different variants of neck structure].

To demonstrate the individual variability of hyoid bone in 50 adult men and 50 women with a different variants of neck structure, the following methods were used: anthropometry, anatomical preparation and a stereomorphometry of 100 hyoid bone samples, the correlation and variation-statistical analysis using thoracic-height (T) and cervical (C) indexes. The results have shown that total degree of squares of values of correlation (R) of C with hyoid bone parameters and anthropometry exceeds similar value of T, which confirmed the necessity for subdivision of the individuals into three groups on the basis of C value: in men R=8.585, in women R=11.277; on the basis of T value -R=3.062 in men, R=4.484 in women. Among the groups, both in men and women, the sum of the squares of correlations of C with anthropometrical parameters and hyoid bone parameters - the maximum value was detected in the groups with an intermediate variant of the neck structure (3.354 and 7.409), the minimal value - in the group with a long and thin neck (1.666 and 3.717). The variation-statistical data are presented on the 7 hyoid bone parameters, which are most significant for morphologists and surgeons. Using the method of o-deviations of hyoid bone parameters with the consideration of the variants of neck structure, the zones of variability of the average values of hyoid bone were detected. The hypothesis is put forward, stating that the deviation of the average values by more than 3sigma is indicative of the unusual phenomenon and could be associated with pathology.

[A method for the correction of the length of the T-shaped tube in the treatment of patients presenting with chronic laryngeal stenosis].

A method for the selection of the length of the T-shaped tube is proposed for the treatment of patients with chronic laryngeal stenosis. The method includes measurements of the patient's body length, acromial diameter, circumference of the thoracic cage, the length and circumference of the neck and calculation of the lengths of the cranial, caudal, and extratracheal parts of the laryngo-tracheal tube by the formulas of multiple linear regression. The original method for stereotopometry of the larynx developed by the authors was used to determine the three-dimensional location of the larynx at the desired point of the system of coordinates and to obtain the topometric characteristic of its localization in adult subjects of different body constitution types, neck shape and length. Preliminary simulation of the T-shaped tube taking into consideration the patient's somatotype makes it possible to reduce the frequency of surgical interventions, rationalize their sequence, and increase the efficacy of rehabilitation of the patients.

[Surgical treatment of middle laryngostenoses of paralytic etiology via extralaryngeal approach].

A method of treatment of middle laryngostenosis of paralytic etiology with laterofixation of the vocal fold is proposed. The technique includes an extralaryngeal approach to the thyroid cartilage plate from the front, subpericartilaginous resection of the vocal process of the arytenoids cartilage with dissection of the internal cricothyroid muscle and most of the thyroarytenoid muscle; placement of a part of the autocartilage under the anterior third of the vocal fold; divertion of the elastic cone with the vocal fold by ligation and tightening ligatures on the autotransplant put on the plate of the thyroid cartilage. Laryngostereotopometry used by the authors allows three-dimensional localization of the necessary point in the larynx and its topometric characteristics of its position in persons with different figure and form of the neck.

[Clinico-anatomic rationale of chondroplastic laterofixation of the vocal cordin the treatment of median laryngostenoses].

Stereotopometry used in morphology for imaging three-dimentional organ structure is applied to study individual changeability and spatial relationships of laryngeal structures in adults depending on the type of constitution and form of the neck. Fifty preparations from male corpses with three types of constitution were studied. An original stereotopometer able to localize 106 points on external and internal laryngeal samples to each of three coordinate planes was introduced. The coordinates of certain points were pooled in variational series for characteristics of which the following parameters were determined: arithmetic middling (X), error in arithmetic middling (m), standard deviation (S), correlation coefficient (r). To characterize a constitution type and form of the neck, the following measures were used: length of the body, acromial diameter, chest perimeter, anterior length of the neck, cervical circumference. Morphometric data obtained were investigated with paired correlation analysis. The studies show a definite correlation between spatial relation of laryngeal structures and constitutional type and shape of the neck. This is essential in choice of reconstructive laryngoplasty regarding anthropometric data.