Adult Laryngeal Ossified Hemangioma: Difficulties in Differential Diagnosis.

Adult laryngeal hemangiomas are uncommon and often poorly symptomatic. The authors describe a laryngeal hemangioma with acute airway obstruction and radiologic findings suggesting a chondrosarcoma-like neoplasm, while pathologic features were consistent with an ossified hemangioma. The presence of fields of bone metaplasia into a classical cavernous hemangioma is an unusual phenomenon which, to our knowledge, was never previously described in the larynx. Difficulties concerning the differential diagnosis and modality of treatment are also discussed.

Validation of the Acoustic Voice Quality Index (AVQI) Version 03.01 in Italian.

OBJECTIVE: The aim of the present study is to validate the Acoustic Voice Quality Index version 03.01 in the Italian language (AVQIv3-IT). METHODS: A total of 150 native Italian speakers with normal voices (n = 50) and with various voice disorders (n = 100) were enrolled. Voice samples of a sustained vowel (SV) [a:] and five phonetically balanced continuous speech (CS) samples were recorded. The most appropriate syllable number for a standardized voiced CS approximating 3 seconds was identified. Perceptual evaluations of the overall voice quality were performed by three expert voice clinicians using the G score of the GRBAS scale. AVQIs were calculated using a 3 seconds mid-vowel selection of the SV [a:] and the standardized syllable number of the CS. Finally, concurrent validity and diagnostic accuracy of AVQIv3-IT were analysed. RESULTS: The most appropriate syllable number for a standardized CS approximating 3 seconds in Italian was identified as 25. The perceptual ratings showed robust intra- and inter-rater reliability. A strong correlation was found between AVQI scores and overall voice quality perceptual evaluations (r = 0.81, P < 0.001). The best diagnostic outcome for AVQIv3-IT was found for a threshold of 2.35 (sensitivity of 90% and specificity of 92%). CONCLUSIONS: AVQIv3-IT was demonstrated to be a valid and robust tool for quantifying overall acoustic voice quality in the Italian speaking population.

Respiratory presentation of diffuse idiopathic skeletal hyperostosis (DISH): Management and review of the literature.

Background: Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by the ossification of entheses. When localized in the cervical paravertebral region, typical signs and symptoms include stiffness, pain, loss of range of motion, and difficulty swallowing.Clinical Presentation: The authors present two less typical respiratory manifestations of DISH due to cervical osteophytes protrusion and obstruction of the upper airway. The first patient was treated conservatively (application of CPAP during nighttime), while the second required emergency intubation and a combined ENT-neurosurgical operation for the removal of osteophytes.Clinical Relevance: Even though dysphagic symptoms are more frequent, DISH may be a cause of airway obstruction and should be included in the differential diagnosis of respiratory distress and OSA.

Acoustic Analysis of Normal Voice Patterns in Italian Adults by Using Praat.

This study was designed to identify the physiological vocal parameters of Italian adult subjects by means of Praat software, differentiated by gender and age. The vocal parameters analyzed were mean pitch, Jitter local %, Jitter local absolute, Jitter rap, Jitter ppq5, Jitter ddp, Shimmer local %, Shimmer local dB, Shimmer apq3, Shimmer apq5, Shimmer apq11, Shimmer dda, Harmonicity Mean autocorrelation, Harmonicity Mean noise-to-harmonics ratio, Harmonicity Mean harmonics-to-noise ratio, and the maximum phonatory time. The volunteers were 123 (58 men and 65 women) and were recruited among students and employees of the University of Eastern Piedmont and of the University Hospital Maggiore della Carità Novara, among family members and researchers' acquaintances. The group of subjects was divided according to gender and age categories, ie, 18-30, 31-40, 41-50, 51-60, and 61-70 years. The voice samples were recorded in the same silent room to minimize the differences in background noise. The measurement was repeated twice on different days to evaluate the reproducibility of the vocal analysis with the Praat software. The comparisons of the vocal values obtained were carried out by stratifying the group of volunteers both by gender and age. After analyzing the variables for skewness, kurtosis, normality distribution through Shapiro-Wilk test, and the equality of variances by Levene test, parametric or nonparametric statistical tests were used when appropriated assuming a confidence level of 0.05. The Bland-Altman test has been used to evaluate the data reproducibility. The analysis of the stratified data for both gender and age showed a good repeatability of all the vocal parameters (except the maximum phonatory time in the age groups 18-30, 31-40, and 41-50 of the women where the Pvalue was less than 0.05). Gender differences were significant in all the vocal parameters, in particular, the variables related to the fundamental frequency and jitter local absolute were statistically significant in all categories. From the analysis of the data of the participants divided by age groups grouped there emerged a substantial difference among individuals belonging to different ages (with the exception of men aged between 18 and 50 years), thus making it impossible to compare and defining an important difference in vocal parameters throughout life.