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The traditional trial paradigm is often criticized as being slow, inefficient, and costly. Statistical approaches that leverage external trial data have emerged to make trials more efficient by augmenting the sample size. However, these approaches assume that external data are from previously conducted trials, leaving a rich source of untapped real-world data (RWD) that cannot yet be effectively leveraged. We propose a semi-supervised mixture (SS-MIX) multisource exchangeability model (MEM); a flexible, two-step Bayesian approach for incorporating RWD into randomized controlled trial analyses. The first step is a SS-MIX model on a modified propensity score and the second step is a MEM. The first step targets a representative subgroup of individuals from the trial population and the second step avoids borrowing when there are substantial differences in outcomes among the trial sample and the representative observational sample. When comparing the proposed approach to competing borrowing approaches in a simulation study, we find that our approach borrows efficiently when the trial and RWD are consistent, while mitigating bias when the trial and external data differ on either measured or unmeasured covariates. We illustrate the proposed approach with an application to a randomized controlled trial investigating intravenous hyperimmune immunoglobulin in hospitalized patients with influenza, while leveraging data from an external observational study to supplement a subgroup analysis by influenza subtype.
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PURPOSE: This study examines the relationship between chronic cough and vagal hypersensitivity by measuring baseline esophageal motility, with interest in the upper esophageal sphincter (UES). MATERIALS AND METHODS: Patients undergoing workup for dysphagia were assigned to a chronic cough or control group based on self-reported symptoms. Differences in demographics, medical comorbidities, and high resolution esophageal manometry findings were obtained retrospectively. RESULTS: 62.5% of our cohort had chronic cough (30/48). There were no significant differences between the two groups with respect to sex, age, and race/ethnicity. Laryngopharyngeal reflux (LPR) was the only statistically significant predictor of CC (OR 74.04, p = 0.010). Cough patients had upper esophageal sphincter relaxation duration (734 ms) significantly longer than the non-cough patients (582 ms; p = 0.03), though both groups had similar upper esophageal mean basal pressure, mean residual pressure, relaxation time-to-nadir, and recovery time. No significant difference was found in the median intrabolus pressure and UES motility mean peak pressure between groups. CONCLUSION: Subtle differences in high-resolution manometry between patients with and without cough suggest, in line with previous studies, baseline alterations of upper esophageal function may manifest in patients with chronic cough through an undetermined mechanism that may include underlying vagal hypersensitivity. These findings encourage further manometric study examining the relationship between UES dysfunction and chronic cough.
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Effects of the tumor microenvironment (TME) stromal cells on progression in thyroid cancer are largely unexplored. Elucidating the effects and underlying mechanisms may facilitate the development of targeting therapy for aggressive cases of this disease. In this study, we investigated the impact of TME stromal cells on cancer stem-like cells (CSCs) in patient-relevant contexts where applying in vitro assays and xenograft models uncovered contributions of TME stromal cells to thyroid cancer progression. We found that TME stromal cells can enhance CSC self-renewal and invasiveness mainly via the phosphatidylinositol 3-kinase (PI3K)/protein kinase B (Akt) pathway. The disruption of Akt signaling could diminish the impact of TME stromal cells on CSC aggressiveness in vitro and reduce CSC tumorigenesis and metastasis in xenografts. Notably, disrupting Akt signaling did not cause detectable alterations in tumor histology and gene expression of major stromal components while it produced therapeutic benefits. In addition, using a clinical cohort, we discovered that papillary thyroid carcinomas with lymph node metastasis are more likely to have elevated Akt signaling compared with the ones without metastasis, suggesting the relevance of Akt-targeting. Overall, our results identify PI3K/Akt pathway-engaged contributions of TME stromal cells to thyroid tumor disease progression, illuminating TME Akt signaling as a therapeutic target in aggressive thyroid cancer.
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Proteínas Proto-Oncogênicas c-akt , Neoplasias da Glândula Tireoide , Humanos , Proteínas Proto-Oncogênicas c-akt/metabolismo , Fosfatidilinositol 3-Quinases/metabolismo , Microambiente Tumoral , Transdução de Sinais , Neoplasias da Glândula Tireoide/patologia , Fosfatidilinositol 3-Quinase/metabolismo , Linhagem Celular TumoralRESUMO
OBJECTIVE: To determine if an anti-reflux induction program relieves laryngopharyngeal reflux (LPR) symptoms more effectively than medication and behavioral changes alone. STUDY DESIGN: Retrospective study. SETTING: Tertiary care academic center. SUBJECTS AND METHODS: A database was populated with patients treated for LPR. Patients were included in the study group if they completed a two-week anti-reflux program (diet, alkaline water, medications, behavioral modifications). Patients were included in the control group if they completed anti-reflux medications and behavioral modifications only. Patients completed the voice handicap index (VHI), reflux symptom index (RSI), cough severity index (CSI), dyspnea index (DI) and eating assessment tool (EAT-10) surveys and underwent laryngoscopy for examination and reflux finding score (RFS) quantification. RESULTS: Of 105 study group patients, 96 (91%) reported subjective improvement in their LPR symptoms after an average 32-day first follow-up and their RSI and CSI scores improved significantly. No significant differences were found in VHI, DI, or EAT-10 scores. Fifteen study patients who had previously failed adequate high-dose medication trials reported improvement and their CSI and EAT-10 scores improved significantly. Ninety-five percent of patients with a chief complaint of cough reported improvement and their CSI scores improved significantly from 12.3 to 8.2. Among 81 controls, only 39 (48%) patients reported improvement after an average 62-day first follow-up. Their RSI scores did not significantly change. CONCLUSION: The anti-reflux program yielded rapid and substantial results for a large cohort of patients with LPR. It compared favorably with medication and behavioral modification alone. It was effective in improving cough and treating patients who had previously failed medications alone.
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Terapia Cognitivo-Comportamental/métodos , Dietoterapia/métodos , Refluxo Laringofaríngeo/terapia , Inibidores da Bomba de Prótons/uso terapêutico , Centros Médicos Acadêmicos , Adulto , Idoso , California , Estudos de Coortes , Terapia Combinada , Bases de Dados Factuais , Feminino , Humanos , Refluxo Laringofaríngeo/diagnóstico , Laringoscopia/métodos , Masculino , Pessoa de Meia-Idade , Prognóstico , Qualidade de Vida , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
OBJECTIVE: Mature vocal fold nodules and fibrous phono-traumatic lesions that have failed standard voice therapy can be challenging. Autologous platelet-rich plasma (PRP) is rich in growth factors and easily obtained from a simple blood draw. Growth factor injection into the vocal folds may reverse the scar and inflammation in recalcitrant, bilateral phono-traumatic lesions such as mature vocal fold nodules. This study reports the short-term (3months) voice results after PRP injection in 11 subjects with recalcitrant, bilateral phono-traumatic lesions that have failed voice therapy. MATERIALS AND METHODS: Serial autologous PRP injections were used to treat 11 patients with recalcitrant, bilateral phono-traumatic lesions in an office setting. All had prior conservative voice therapy or surgery and were deemed failures. Pre and post-treatment video stroboscopy, Voice Handicap Index (VHI-10), and Cepstral Spectral Index of Dysphonia (CSID) before and after treatment (3months) were tabulated and compared. An expert rater blinded to the treatment condition rated the stroboscopy and voice results. RESULTS: At 3months postinjection, 9 of the 11 patients reported improved VHI-10 and noted sustained voice improvement after PRP injections. Median VHI-10 changed from 20 to 13 (P < 0.05 paired t test). The CSID scores changed from 17 to 5 (NS P > 0.05, paired t test). Nine of 11 patients reported improved vocal effort and stamina. Stroboscopy ratings were better after treatment than before treatment in 7 of the 11 subjects. CONCLUSION: Short-term improvements in voice may occur in patients with recalcitrant, bilateral phono-traumatic lesions following PRP injection. PRP injections into the vocal folds may be a new treatment for nonsurgical intervention in patients with recalcitrant, bilateral phono-traumatic lesions. LEVEL OF EVIDENCE: II.
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OBJECTIVES: The objective of this study was to establish normative data and cut-off scores for the Children Voice Handicap Index-10 (CVHI-10) and the Children Voice Handicap Index-10 for Parents (CVHI-10-P) METHODS: For normative data, CVHI-10 and CVHI-10-P questionnaires originally developed in the Italian language were completed by 201 children without dysphonia and with no history of voice disorders, and by 1 of their parents. The results were analyzed for mean, standard deviation (SD), and standard error of the mean (SEM) for both questionnaires. For cut-off values determination, data from 49 dysphonic children and from 1 of their parents were also used. This analysis was based on the sensitivity and specificity indicators of the questionnaires using the "receiver operating characteristic" (ROC) curve. RESULTS: Analysis of the questionnaires related to healthy children revealed a mean of 0.26 (SD 0.74; SEM 0.06) for CVHI-10 and a mean of 0.15 (SD 0.49; SEM 0.04) for CVHI-10-P for the normative values. ROC curve analysis allowed us to establish the cut-off scores of 2.5 for CVHI-10 and 1.5 for CVHI-10-P. CONCLUSIONS: This study offers normative data for CVHI-10 and CVHI-10-P and provides cut-off values for both questionnaires to distinguish healthy and pathologic responders.
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Black Americans (BAs) with head and neck cancer (HNC) have worse survival outcomes compared to the White patients. While HNC disparities in patient outcomes for BAs have been well recognized, the specific drivers of the inferior outcomes remain poorly understood. Here, we investigated the biologic features of patient tumor specimens obtained during the surgical treatment of oral cancers and performed a follow-up study of the patients' post-surgery recurrences and metastases with the aim to explore whether tumor biologic features could be associated with the poorer outcomes among BA patients compared with White American (WA) patients. We examined the tumor stemness traits and stromal properties as well as the post-surgery recurrence and metastasis of oral cancers among BA and WA patients. It was found that high levels of tumor self-renewal, invasion, tumorigenesis, metastasis, and tumor-promoting stromal characteristics were linked to post-surgery recurrence and metastasis. There were more BA than WA patients demonstrating high stemness traits and strong tumor-promoting stromal features in association with post-surgery tumor recurrences and metastases, although the investigated cases displayed clinically comparable TNM stages and histological grades. These findings demonstrated that the differences in tumor stemness and stromal property among cancers with comparable clinical diagnoses contribute to the outcome disparity in HNCs. More research is needed to understand the genetic and molecular basis of the biologic characteristics underlying the inferior outcomes among BA patients, so that targeting strategies can be developed to reduce HNC disparity.
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INTRODUCTION: Improving the voice of patients with vocal atrophy, scar, and sulcus vocalis remains challenging. Platelet-rich plasma (PRP) is an autologous biological suitable for regenerative medicine. Office-based injections of PRP may serve as a source of improved wound healing. MATERIALS AND METHODS: Thirty two office based injections of PRP were performed in 14 patients with scar, sulcus, and vocal atrophy (12 scars, 1 sulcus, and 1 atrophy). PRP was prepared using 20 cc blood draw and double centrifugation method. Injection laryngoplasty was performed using trans cervical or indirect trans oral technique (10 trans cervical, 22 trans-oral). Volume of PRP use was 0.5-0.7 cc per side. Injections varied from 1 to 3 injections at monthly intervals. Videostroboscopy, Voice Handicap Index (VHI-10), and an objective analysis of the voice using Cepstral Peak Prominence (Cepstral Spectral Index of Dysphonia) were recorded. An expert rater speech pathologist rated the audio and stroboscopy results. RESULTS: Median follow-up was 15 months. No patients were made worse. The mean VHI-10 before the injection was 23. VHI-10 after the injection was 12.5 (P < 0.01). The mean Cepstral Spectral Index of Dysphonia score for CAPE-V sentence was 42.5 before the injection and 23.5 (P < 0.01) after the injection. The expert rater thought the post treatment was better (9/14 acoustic, 10/14 stroboscopy). Eleven of the 14 patients thought the intervention was worthwhile to repeat. The other 3 patients thought the improvement was transient. CONCLUSION: Office PRP injection into the vocal fold of patients with scar, sulcus, and atrophy may result in short term voice improvements. It is a biological worth considering.
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Disfonia , Prega Vocal , Humanos , Prega Vocal/cirurgia , Disfonia/diagnóstico , Disfonia/etiologia , Disfonia/terapia , Cicatriz/diagnóstico , Cicatriz/etiologia , Cicatriz/terapia , Qualidade da Voz , Atrofia/patologia , Resultado do TratamentoRESUMO
OBJECTIVE: This study aimed to determine the long-term outcomes of patients with chronic refractory cough (CRC) following treatment for cough suppression therapy (CST). Currently, there is a lack of objective data regarding the long-term outcome of behavioral treatment for CRC. METHODS: From the charts of 106 adult patients diagnosed with CRC, 24 patients were identified as having long-term data at least 3 months post-CST in the form of otolaryngologic examination, Voice Handicap Index-10 (VHI-10), and Cough Severity Index (CSI) scores. Patients underwent otolaryngologic evaluation and completed the VHI-10 and CSI assessments during pretreatment, posttreatment, and long-term follow-up visits. Patients were also divided into two groups based on their number of comorbidities. RESULTS: Twenty of the 24 patients had significant reduction in cough severity after completing CST (P < 0.001). A significant difference was also found in CSI scores from pretherapy to the long-term follow-up visits (P = 0.001). No significant difference was found in CSI scores from posttherapy to long-term follow-up visits (P = 0.93). No significant difference was found in VHI-10 scores over time (P = 0.83). No correlation was found between changes in cough and voice severity and number of comorbidities at the tested level. CONCLUSIONS: Findings of no significant change in CRC over the long term compared to posttherapy measures suggest that patients were able to maintain improvement in cough over the long term despite various comorbidities. The current results suggest that CST represents a satisfactory approach to treating CRC and provides patients with an ongoing tool to maintain reduced cough severity. No significant correlations between number of comorbidities and mean CSI or VHI-10 scores were found over the long term.
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OBJECTIVES: To determine the prevalence of separate and combined voice and swallowing impairments before and after total thyroidectomy and to delineate risk factors for these symptoms. METHODS: Retrospective review of 592 consecutive patients who underwent total thyroidectomy from July 2003 to August 2015. RESULTS: Combined voice and swallowing problems occurred preoperatively in 4.7% (11/234), 3.3% (3/92), and 6.0% (16/266) of patients with malignancy, hyperthyroidism, and benign euthyroid disease, respectively. Postoperatively, prevalence was 5.1%, 2.2%, and 1.9%, respectively. Benign euthyroid disease (20.7%) had the greatest risk of preoperative dysphagia (P = 0.003) and the largest glands (P < 0.001). Comparing before and after surgery, the cancer and benign euthyroid groups had decreased dysphagia (cancer: 11.5% vs. 6.0%, P = 0.034; benign: 20.7% vs. 3.8%, P < 0.001) but increased dysphonia (cancer: 19.2% vs. 28.6%, P = 0.017; benign: 15.8% vs. 27.1%, P = 0.002). Overall, 23/592 (3.9%) developed new dysphagia and 122/592 (20.6%) developed new dysphonia after surgery. Intraoperative recurrent laryngeal nerve transection occurred in 12 cases (2.0%). CONCLUSIONS: Total thyroidectomy resolved dysphagia but increased dysphonia in benign and malignant euthyroid patients. Voice and swallowing problems following thyroidectomy occurred more frequently than intraoperative recurrent laryngeal nerve transection, confirming symptoms often occur in the absence of suspected nerve injury.
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Transtornos de Deglutição , Disfonia , Traumatismos do Nervo Laríngeo Recorrente , Humanos , Disfonia/diagnóstico , Disfonia/epidemiologia , Disfonia/etiologia , Traumatismos do Nervo Laríngeo Recorrente/diagnóstico , Traumatismos do Nervo Laríngeo Recorrente/epidemiologia , Traumatismos do Nervo Laríngeo Recorrente/etiologia , Glândula Tireoide , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/epidemiologia , Transtornos de Deglutição/etiologia , Incidência , Tireoidectomia/efeitos adversos , Nervo Laríngeo RecorrenteRESUMO
OBJECTIVE: The purpose of this study was to identify voice risk factors for female kindergarten teachers and nurses in Heraklion, Crete. PATIENTS AND METHODS: A questionnaire consisting of voice use and lifestyle activities was given to 200 kindergarten teachers in Heraklion, Crete, of which 151 were returned (75.5%). A group of 89 nurses served as the control group. Both groups also completed the Greek version of the Voice Handicap Index (VHI-G). RESULTS: Kindergarten teachers sing more often, speak loudly more often when they are at work and present with more infections of the upper respiratory tract compared to nurses. They talk less than 30 min per day on the phone, drink less alcohol and water and smoke less in comparison with nurses. The median VHI-G score for the kindergarten teachers was significantly higher than that for the nurses. CONCLUSION: The results suggest that there is a difference in the factors that may be responsible for the appearance of voice problems in kindergarten teachers and in nurses. For kindergarten teachers, the risk factors for voice disorders are primarily related to vocal load factors and for nurses appear to be lifestyle-related more than voice use alone.
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Docentes , Doenças Profissionais/etiologia , Distúrbios da Voz/etiologia , Adulto , Avaliação da Deficiência , Feminino , Grécia , Humanos , Pessoa de Meia-Idade , Recursos Humanos de Enfermagem Hospitalar , Fatores de Risco , Canto , Acústica da Fala , Inquéritos e Questionários , Qualidade da VozRESUMO
OBJECTIVES: Patients with chronic cough are some of the most challenging to treat. This preliminary study is the first to examine the effects of a single exercise muscle strength training program to reduce cough severity in patients who failed other treatments. METHODS: A total of 19 females were included in this study, ranging from age 24 to 80. The maximum phonation time (MPT), laryngeal airway resistance (LAR), maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP), Voice Handicap Index-10, (VHI-10) and the Cough Severity Index (CSI) values were obtained pre- and post-treatment. ANOVA two-factor without replication was used to compare values pre- and post-treatment. RESULTS: MIP (Mean of 62.00 to a mean of 78.53) and MEP (Mean of 90.00 to a mean of 112.16) showed significant increase post-treatment. In addition, LAR (Mean of 73.30 to a mean of 60.67) and CSI (Mean of 19.37 to a mean of 15.00) significantly decreased post-treatment. General changes in pre- and post-treatment values were identified with MPT (Mean of 14.89 to a mean of 16.17) and VHI-10 (Mean of 8.00 to a mean of 6.76). A follow-up questionnaire indicated that the majority of patients felt their cough was better after 4 weeks. CONCLUSIONS: Muscle strength training provides a tool to aid in the control of cough for patients who are refractory to medical and other behavioral treatments. Improvement in cough may be associated with a reduction in subglottic pressure and increased air flow resulting in lower laryngeal airway resistance.
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OBJECTIVES: Chronic cough is a complaint of up to 46% of patients referred to specialist clinics. Patients with cough often report hoarseness at the time of the cough diagnosis. When the cough fails to resolve with standard medications, referrals to other specialists including otolaryngologists are made. This is the first study to report the specific diagnosis and length of time it took to obtain a specific voice disorder diagnosis in patients with chronic cough. STUDY DESIGN: Case Series METHODS: The charts of 105 patients referred to the Loma Linda Voice and Swallowing Center were reviewed. The first complaint of cough and/or hoarseness and the specific voice disorder diagnosis following otolaryngologic evaluation were identified. Voice disorders were divided into neurogenic or other/functional disorders and common comorbidities were identified. Statistical analysis between diagnostic groups, gender, and age were obtained. RESULTS: The specific voice disorders in the cohort were identified. There was a high prevalence of neurogenic voice disorders (n = 85, 81%). There were significant relationships between chronic cough and the two most common neurogenic voice disorders, vocal fold paresis and vocal fold atrophy. The average length of time between complaint of hoarseness and the specific voice disorder diagnosis was 32.3 months. Most patients (86%) complained of voice problems after diagnosis of chronic cough. A significant association was found in prevalence of asthma (OR = 4.52, P = 0.02) and dyspnea (OR = 4.24, P = 0.02) in the cohort who presented first with voice complaints and later developed chronic cough. CONCLUSIONS: There is a high incidence of neurogenic voice disorders accompanying patients with chronic cough. Understanding the relationship between chronic cough and hoarseness provides the clinician with specific diagnostic information in the treatment of both disorders.
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OBJECTIVES: Over the past 30 years laryngology fellowships have grown in number and diversity. This study investigated the career trajectories of recent laryngology fellowship graduates with the purpose of informing residents considering fellowship. STUDY DESIGN: Cross-sectional survey. SETTING: Academic medical center. METHODS: The directors of all 27 US laryngology fellowships that graduated/recruited fellows from 2010 to 2019 were contacted, and a list of former fellows was compiled. A short survey was administered in person or via email or phone. Additional data was gathered through internet searches. RESULTS: One hundred eighty-three fellows were identified having completed American laryngology fellowships between 2010 and 2019 (100M:83F). Fifteen percent now practice internationally and 68% are in academic practice. A higher proportion of women than men enter laryngology fellowship after otolaryngology residency. One hundred twenty-nine fellows responded to our survey. Two-thirds of former fellows report current participation in laryngology research. Seventy-two percent of former fellows are still in their first job after fellowship and 53% believe they have their ideal practice. Women were more likely to enter academics than men after laryngology fellowship. Responders were overwhelmingly satisfied with their fellowship experience, with 95% saying they would choose to pursue fellowship training again. CONCLUSIONS: Most former laryngology fellows enter academia, contribute to laryngology research, practice away from their training institution, and believe they have found their ideal practice. The results of this study may be useful to residents considering fellowship training, centers considering establishing laryngology fellowships, and practices recruiting fellowship graduates.
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Internato e Residência , Otolaringologia , Centros Médicos Acadêmicos , Estudos Transversais , Educação de Pós-Graduação em Medicina/métodos , Bolsas de Estudo , Feminino , Humanos , Masculino , Otolaringologia/educação , Inquéritos e Questionários , Estados UnidosRESUMO
OBJECTIVES: To describe voice and airway outcomes and complications experienced by patients with laryngotracheal stenosis following Montgomery T-tube placement. METHODS: Retrospective chart review of all patients with laryngotracheal stenosis and Montgomery T-tube placement treated at a tertiary referral center from 2012 to 2021. RESULTS: Eighteen patients met criteria with laryngotracheal stenosis, seven including the level of the glottis and 11 without glottal involvement. Eleven were completely aphonic before T-tube placement and the remainder had severe dysphonia. There was improvement of Voice Handicap Index-10, Reflux Symptom Index, and GRBAS grade following T-tube placement in patients compared to their preoperative values. Improvement of grade was greater in patients without glottal involvement. Complications of chronic indwelling T-tube included granulation in 14 patients (78%), tracheitis in two patients (11%), and mucus plugging in three patients (17%) with one T-tube related mortality. Five patients were eventually decannulated, six returned to tracheostomy tube, and seven retained the T-tube at last follow-up (average: 30 months, range: 4-80 months). CONCLUSIONS: Montgomery T-tube placement improves voice in patients with severe dysphonia secondary to laryngotracheal stenosis with and without glottal involvement though the degree of improvement is greater in patients without glottal involvement. T-tube can help reestablish long-term laryngotracheal continuity in patients with no other surgical options. The potential benefits in phonation should be weighed against the possibility of rare but serious adverse events.
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Post-lingual deaf adults can develop some vocal abnormalities similar to those developed in pre-lingual deaf individuals. The aim of this work was to study the effect of cochlear implantation followed by post-operative rehabilitation on voice acoustics in post-lingual hearing impaired adults with different durations of hearing loss. The study included 35 post-lingual hearing impaired adults who underwent cochlear implantation. Patients were divided into two groups according to the duration of their hearing loss. Each group was further divided into two subgroups according to whether they received auditory rehabilitation or not. Using the Multi-Dimensional Voice Program (MDVP) parameters, comparisons were made between each subgroup of patients and the normal MDVP Saudi database, and between subgroups of patients. Most of the patients in the two groups reported significant improvement in their MDVP results post-implantation. Further, significantly deviant MDVP parameters were reported in the group of patients with longer duration of hearing loss. Patients who received rehabilitation significantly improved more than those who did not. In conclusion, it appears that cochlear implantation improves the auditory control of voice production in post-lingual deaf adults. Also, it is obvious that cochlear implantation at an early stage of hearing loss gives better results on voice control, especially if augmented with auditory rehabilitation.
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Implante Coclear , Perda Auditiva Neurossensorial/reabilitação , Audição/fisiologia , Cuidados Pós-Operatórios/métodos , Recuperação de Função Fisiológica/fisiologia , Acústica da Fala , Qualidade da Voz/fisiologia , Adulto , Feminino , Seguimentos , Perda Auditiva Neurossensorial/fisiopatologia , Perda Auditiva Neurossensorial/cirurgia , Humanos , Masculino , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVE: Compare long-term voice outcomes in patients treated with FIM or BML for nonparalytic dysphonia. There is controversy whether fat injection medialization (FIM) is a durable alternative to bilateral medialization laryngoplasty (BML) for nonparalytic dysphonia (atrophy, sulcus, scar, paresis). Both interventions yield improved voice quality, yet comparison of patients' long-term perceptions of their voice after these procedures has not been performed. METHODS: Retrospective review of patients who underwent FIM or BML for nonparalytic dysphonia was performed from 2008-2018. Charts were reviewed for demographic information, preoperative diagnosis, intervention, Voice Handicap Index-10 (VHI-10), and follow-up time. RESULTS: Forty-nine patients met our criteria. Fifty procedures were performed (25 FIM, 25 BML). One patient underwent BML with subsequent FIM. There was no significant difference in pre-treatment or post-treatment VHI-10 scores between both groups (Pre-FIM 21 Post-FIM 10.28; Pre-BML 22.48, Post-BML 10.88). Total median follow-up time was 11.3 months (FIM 14.8 months, BML 9.5 months). Using VHI-10 scores recorded at each patient's latest follow-up visit, both groups demonstrated significant decrease (P < .05) compared to preoperative scores: VHI-10 decreased by a mean delta of 10.72 in the FIM group and 11.6 in the BML group. There was no significant difference in pre, post and change in VHI between groups. CONCLUSIONS: In patients with nonparalytic dysphonia, FIM is a durable alternative to BML. Patients treated in both groups gained substantial improvement in vocal function. For both treatment groups, we should anticipate less than complete satisfaction with surgery and revision procedures in a minority of patients. LEVEL OF EVIDENCE: IV.
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OBJECTIVES//HYPOTHESIS: To determine changes in voice severity when treating chronic cough refractory to medical treatment with cough suppression therapy (CST) in patients with chronic cough and voice complaints. Chronic cough has been reported to be refractory to medical treatment and frequently co-occurs with voice disorders. The possible effects of CST on self-assessed changes in chronic cough and voice disorders have not been demonstrated. STUDY DESIGN: Retrospective analysis of the effects of cough suppression therapy (CST) on self-assessed changes in chronic cough and voice disorder severity in patients with both chronic cough and voice disorders. METHODS: Forty-three adult patients with the primary complaint of chronic refractory cough underwent pre- and post-treatment diagnostic examinations, completed pre- and post-treatment Voice Handicap Index-10 (VHI-10) and Cough Severity Index assessments, and were treated by a licensed speech-language pathologist using CST. Twenty-seven subjects were assigned to the cough (C) group and 16 to the cough-voice (CV) group based on the severity of their VHI-10 scores. RESULTS: Post-test analysis showed significant improvement in cough severity for both groups and significant improvement in voice severity for the CV group. The VHI-10 scores for the C group did not change significantly. The median number of treatment sessions was 3, with a range of 1-13 sessions. Correlation between changes in severity and number of treatment sessions was not found to be significant at the tested level. CONCLUSIONS: CST represents a unifying approach for treatment of patients with CRC and comorbid voice disorders. CST offered cross-over effects to the voice when subjects were treated for their primary complaint of chronic cough. This treatment of the primary complaint improves function in systems that share a common pathway. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:2747-2751, 2021.
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Exercícios Respiratórios/métodos , Tosse/terapia , Índice de Gravidade de Doença , Distúrbios da Voz/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica/terapia , Tosse/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Distúrbios da Voz/etiologia , Distúrbios da Voz/terapia , Qualidade da Voz , Adulto JovemRESUMO
OBJECTIVE: Previous investigations have reported that a chronic cough that is refractory to medical therapies improves with behavioral therapies. However, the treatment parameters that may account for improvement in cough symptoms have not yet been objectively documented. The purpose of this study was to document changes in chronic refractory cough using a breath training protocol. METHODS: The charts of 27 patients with a long-term chronic cough (>6 months) refractory to various medical treatments were reviewed. These patients received 2-4 sessions of breath training therapy over a 6-month period. Treatment sessions consisted of breathing modification exercises such as those reported in the literature. Aerodynamic parameters including mean estimated subglottal air pressure, mean airflow rate, laryngeal airway resistance, and maximum phonation time were obtained before treatment and 6 months after therapy. Patients also completed the Cough Severity Index at the first visit and 6 months after treatment. RESULTS: Twenty four of the 27 patients (M:Fâ¯=â¯6:21), with a mean age of 62.4 (rangeâ¯=â¯28-78, medianâ¯=â¯66) had significant Cough Severity Index improvement from 16.74 to 10.04 (P< 0.001) after therapy. Maximum phonation time increased significantly from 12.00 to 16.38 seconds (P= 0.006); mean estimated subglottic air pressure decreased significantly from 7.58 to 6.36 cm H2O (P= 0.004); laryngeal airway resistance decreased significantly from 52.97 to 40.64 ppm (P= 0.013). CONCLUSION: This investigation provides evidence that patients who followed a protocol that focused on a breath training program reduced their chronic cough. Significant relationships between patient self-assessment of chronic cough and aerodynamic measures of subglottic pressure and glottal airway resistance were found in this group.
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Tosse , Laringe , Resistência das Vias Respiratórias , Tosse/diagnóstico , Tosse/terapia , Glote , Humanos , Fonação , RespiraçãoRESUMO
INTRODUCTION: In this pilot study, flexible high-speed video (HSV) technology with synchronized audio is used to visualize vocal fold behavior in a wind instrumentalist. Specifically, this study aims to contribute to describing the vocal fold behavior of a professional clarinet musician playing varying tones and melodies. METHOD: Vocal folds of a healthy 26-year-old professional clarinet musician were recorded utilizing a HSV camera coupled to a flexible endoscope, which allowed the synchronous recording of audio with vocal fold movement at the onset, playing, and offset of playing. Two raters experienced with analyzing vocal folds described vocal fold motion of each sample. Samples were processed through a software model to determine the vocal fold movement relative to their position at rest. Digital kymograms (DKGs) were additionally obtained to visualize vocal fold micromovements throughout each sample. RESULTS: At the onset of playing, the raters observed the vocal folds moving to a paramedian position. Vocal fold adduction varied according to the task performed and ranged from 58% to 77% of the original resting glottis width. The calculated changes in glottis width and DKGs were consistent with the descriptions by the raters. CONCLUSION: This study demonstrates the utility of flexible HSV in observing vocal fold motion before, during, and after events other than sustained phonation. The incomplete adducted vocal fold postures observed while playing the clarinet not only differ from phonation but also differ depending on task. These various postures may contribute to voice fatigue in wind instrumentalists or to various disorders experienced during their careers.