The Effect of Vocal Hygiene Training Via Videoconference in Teachers' Voices.

PURPOSE: Voice disorders are frequently seen among teachers. Intense and inappropriate use of the voice is the most frequent reason. In the literature, studies supporting the positive effect of voice hygiene behaviors to the voice in teachers exist. In the v pandemic era that we pass through, it's being observed that teaching via videoconference is becoming widespread all around the world. The primary aim of this study is to evaluate the risk factors for self-assessed "not normal" voice in teachers, in the light of their demographic and vocational information and voice hygiene behaviors. Our second aim in this study is to evaluate the effect of voice hygiene training via videoconference on teachers' voice. We believe this will contribute in shaping today's therapy modalities in vocal training. MATERIALS AND METHODS: One hundred nine teachers, working as primary, secondary or high school teacher actively in different cities in Turkey, between 25 and 55 years of age participated and self-assessed their voice by filling the survey including demographic, occupational, medical history and voice symptoms and vocal behaviors data as well as Voice Handicap Index (VHI)-10 ve voice self rating scale (VSRS). The teachers with VHI-10 score below 5 and VSRS score "normal" were assumed to have "Normal Voice." The teachers with VHI-10 score 5 or above and VSRS "Not Normal" (mild, moderate or severe) (N = 52) were assigned to "Voice Hygiene Group" and were invited to videoconference for a voice hygiene session. Four weeks after this session, the survey, VHI-10 and VSRS were repeated and the results were compared. RESULTS: In the first phase of the study, risk factors for not being in "Normal Voice" group for the teachers have been assessed. "Having chronic disease" and "having experienced voice problem before" have been found to be risk factors. In the second phase of the study, 52 teachers have been invited to online "Voice Hygiene" videoconference session; only 18 teachers have attended in total of three attempts of sessions. When vocal behaviors before and after the videoconference were compared, positive changes have been observed in five vocal behaviors including "avoiding smoking," "drinking enough water daily," "eating healthy food," "avoiding excessive meals," "avoiding frequent throat clearing," however VHI-10 and VSRS scores have not showed a meaningful change. Only one teacher has progressed to "normal voice" from "Voice Hygiene Group." CONCLUSION: We believe further controlled studies with more participants adherent to videoconference sessions will be needed in order to shape today's therapy modalities.

Intratympanic Dexamethasone via Saturated Gelfoam for Idiopathic Sudden Sensorineural Hearing Loss.

The duration of contact time of intratympanic steroids at the round window is a variable that can potentially affect the ultimate concentration within the cochlea. By placing Gelfoam saturated with dexamethasone directly over the round window, contact time is prolonged and potentially increases the dexamethasone concentration within the cochlea. This technique is simple, readily available with standard instruments and ingredients, and easily done in the office.

Evaluation of Dyspnea Outcomes After Endoscopic Airway Surgery for Laryngotracheal Stenosis.

Importance: Endoscopic airway surgery is a frequently used procedure in the management of laryngotracheal stenosis (LTS); however, no established outcome measures are available to assess treatment response. Objective: To assess acoustics and aerodynamic measures and voice- and dyspnea-related quality of life (QOL) in adult patients with LTS who undergo endoscopic airway surgery. Design, Setting, and Participants: This case series compared preoperative measures and postoperative outcomes among adult patients who underwent endoscopic airway surgery for LTS from September 1, 2013, to September 30, 2015, at the tertiary care Johns Hopkins Voice Center. Patients were excluded if they did not undergo balloon dilation or if they had multilevel or glottic stenosis. The Phonatory Aerodynamic System was used to quantify laryngotracheal aerodynamic changes after surgery. Final follow-up was completed 2 to 6 weeks after surgery. Main Outcomes and Measures: The voice-related QOL instrument (V-RQOL), Dyspnea Index, and Clinical Chronic Obstructive Pulmonary Disease Questionnaire were completed before and after endoscopic surgery. Consensus auditory perceptual evaluation of voice, acoustic measurements, and aerodynamic outcomes were also assessed. Results: Fourteen patients (1 man and 13 women; mean [SD] age, 45.4 [4.3] years) were enrolled. The mean postoperative V-RQOL scores (n = 14) increased from 74.3 to 85.5 (mean of difference, 11.3; 95% CI, 2.2 to 20.3). The mean postoperative Dyspnea Index (n = 14) decreased from 26.9 to 6.6 (mean of difference, -20.3; 95% CI, -27.9 to -12.7); the mean postoperative Clinical Chronic Obstructive Pulmonary Disease Questionnaire scores (n = 9) decreased from 3.2 to 1.0 (mean of difference, -2.2; 95% CI, -3.4 to -0.9). Postoperative mean vital capacity (n = 14) increased from 2.5 to 3.1 L (mean of difference, 0.6 L; 95% CI, 0.3-1.0 L), whereas mean laryngeal resistance (n = 14) decreased from 73.9 to 46.4 cm H2O/L/s (mean of difference, -27.5 cm H2O/L/s; 95% CI, -44.8 to -10.3 cm H2O/L/s) postoperatively. Conclusions and Relevance: Patients demonstrate statistically and clinically significant improvement in dyspnea-related QOL, whereas a few patients showed a clinically significant improvement in V-RQOL. Dyspnea-related QOL outcomes should be added to airway surgeons' regular assessment of patients with LTS to measure treatment response and inform the decision to perform a second operation, whereas V-RQOL outcomes need additional prospective study with a larger sample size. The Phonatory Aerodynamic System is not an optimal method to quantify changes in laryngotracheal aerodynamics after intervention in LTS.

Risk Factors for Dysplasia in Recurrent Respiratory Papillomatosis in an Adult and Pediatric Population.

AIM: Recurrent respiratory papillomatosis (RRP) is classically described as a benign neoplasm of the larynx caused by the low-risk human papillomavirus (HPV) viral subtypes. Nevertheless, transformation to dysplasia and invasive carcinoma can occur. We aimed to assess the prevalence of dysplasia and carcinoma-ex-papilloma in both adult-onset and juvenile-onset RRP and identify patient risk factors for this dysplastic transformation. MATERIAL AND METHODS: Ten-year retrospective chart review of a tertiary otolaryngology referral center. Patients with papilloma were identified from a review of a pathology database and clinical records. Patient demographics, pathologic data, and treatment history, including use of cidofovir as an adjunctive therapy for papilloma, were extracted from electronic medical records. RESULTS: One hundred fifty-nine RRP patients were identified, 96 adult-onset (AORRP) and 63 juvenile-onset (JORRP) cases. Of this cohort, 139 (87%) had only benign papilloma as a pathologic diagnosis. In the AORRP cohort, 10 patients (10%) were diagnosed with dysplasia or carcinoma in situ in addition to papilloma, and 5 patients (5%) had malignant transformation to invasive carcinoma-ex-papilloma. There was a significantly higher age of disease onset for those with dysplasia or carcinoma versus those without dysplasia or carcinoma (56 vs 45 years old; P = .0005). Of the 63 JORRP patients, there were no cases of dysplasia but 3 (5%) cases of invasive carcinoma-ex-papilloma, all involving pulmonary disease. The JORRP patients with carcinoma-ex-papilloma had a younger average disease onset (2 vs 6 years old; P = .009) and a higher rate of tracheal involvement than those without carcinoma. Gender, smoking history, number of operations, or use of cidofovir showed no association with the development of dysplasia or carcinoma-ex-papillomatosis in either the AORRP or JORRP population. CONCLUSION: In a large series of RRP, age of disease onset is the strongest predictor of dysplastic transformation in the adult and pediatric population. Carcinoma-ex-papillomatosis was uniformly associated with pulmonary disease in the JORRP population in this series. No other demographic or behavioral factors, including adjunctive therapy with cidofovir, were statistically associated with dysplasia or carcinoma-ex-papilloma.

Laryngeal dysplasia, demographics, and treatment: a single-institution, 20-year review.

IMPORTANCE: Laryngeal dysplasia is a common disease entity that remains clinically frustrating because functional outcomes are balanced against oncologic results. Understanding evolution in dysplasia demographics, treatment, and progression rates may inform better therapy in the future. OBJECTIVES: To review laryngeal dysplasia cases at a single institution during the last 20 years and identify changes in patient demographics, categorize treatment approaches, and review rates of progression to cancer. DESIGN, SETTING, AND PARTICIPANTS: In this retrospective medical record review, patients with laryngeal dysplasia treated at an academic medical center were identified on review of pathology records. INTERVENTIONS: Patients were organized by date of dysplasia diagnosis, divided into 2 groups (group 1, January 1, 1993, through December 31, 2002; group 2, January 1, 2003, through December 31, 2012), and compared against one another. MAIN OUTCOMES AND MEASURES: Age at diagnosis, sex, type of treatment, and progression to malignant disease were analyzed from one period to the next. RESULTS: A total of 107 patients were identified through review of pathology databases. Progression of dysplasia to cancer remained roughly stable across periods, at 8.8% and 8.0%, respectively. Mean age at diagnosis decreased from 68.7 to 61.7 years over time, with a statistically significant trend toward presentation at younger ages. The male to female ratio was 3.75 in group 1 and 3.17 in group 2, with a trend toward a greater proportion of females over time that did not reach statistical significance. Use of radiotherapy remained stable across groups, with increased use of microflap excision techniques and laser treatment (especially photoangiolytic lasers) in group 2. CONCLUSIONS AND RELEVANCE: Overall, progression of laryngeal dysplasia to cancer has remained stable during the past 20 years at a rate of approximately 8%. Although laryngeal dysplasia remains a disease predominantly found in males, there is a demographic trend toward diagnosis at earlier ages. Treatment choices may slowly be changing over time, although multi-institutional studies may be required to better categorize this shift.

Hyoid suspension surgery with UPPP for the treatment of hypopharyngeal airway obstruction in obstructive sleep apnea.

We report our experience with hyoid suspension surgery in patients with obstructive sleep apnea (OSA) diagnosed on the basis of polysomnographic criteria. We conducted a prospective, observational study of 20 patients--18 males and 2 females, aged 15 to 52 years (mean: 42.1)--who were treated at our tertiary care center. All patients underwent hyoid suspension surgery and uvulopalatopharyngoplasty (UPPP) in a single session. Postoperative success was defined as either (1) a reduction in the apnea-hypopnea index (AHI) from 20 or higher to less than 20 or (2) a reduction in AHI of at least 50%. Postoperative follow-up polysomnography indicated that surgery was successful in 18 of 20 patients (90%). No important complications were observed. We conclude that hyoid suspension surgery is an effective procedure with low morbidity for the treatment of OSA in selected patients with hypopharyngeal obstruction. We believe it is a good option for those patients who will not or cannot tolerate therapy with continuous positive airway pressure.

Bilateral multicanal benign paroxysmal positional vertigo coexisting with a vestibular schwannoma: case report.

We describe a rarely encountered case of coexisting bilateral multicanal benign paroxysmal positional vertigo (BPPV) and vestibular schwannoma in a 56-year-old woman. The patient had presented with a 10-year history of dizziness and imbalance, and her vestibular findings were perplexing. We decided on a working diagnosis of BPPV and began treatment. After several months of canalith repositioning maneuvers had failed to resolve her symptoms, we obtained magnetic resonance imaging, which revealed the presence of the vestibular schwannoma. This case serves as a reminder of the importance of differentiating between central and peripheral vestibular disorders, as well as central and anterior canal BPPV-induced down-beating nystagmus in order to establish the correct diagnosis and initiate appropriate treatment.

Safety of audiology direct access for medicare patients complaining of impaired hearing.

BACKGROUND: Allowing Medicare beneficiaries to self-refer to audiologists for evaluation of hearing loss has been advocated as a cost-effective service delivery model. Resistance to audiology direct access is based, in part, on the concern that audiologists might miss significant otologic conditions. PURPOSE: To evaluate the relative safety of audiology direct access by comparing the treatment plans of audiologists and otolaryngologists in a large group of Medicare-eligible patients seeking hearing evaluation. RESEARCH DESIGN: Retrospective chart review study comparing assessment and treatment plans developed by audiologists and otolaryngologists. STUDY SAMPLE: 1550 records comprising all Medicare eligible patients referred to the Audiology Section of the Mayo Clinic Florida in 2007 with a primary complaint of hearing impairment. DATA COLLECTION AND ANALYSIS: Assessment and treatment plans were compiled from the electronic medical record and placed in a secured database. Records of patients seen jointly by audiology and otolaryngology practitioners (Group 1: 352 cases) were reviewed by four blinded reviewers, two otolaryngologists and two audiologists, who judged whether the audiologist treatment plan, if followed, would have missed conditions identified and addressed in the otolaryngologist's treatment plan. Records of patients seen by audiology but not otolaryngology (Group 2: 1198 cases) were evaluated by a neurotologist who judged whether the patient should have seen an otolaryngologist based on the audiologist's documentation and test results. Additionally, the audiologist and reviewing neurotologist judgments about hearing asymmetry were compared to two mathematical measures of hearing asymmetry (Charing Cross and AAO-HNS [American Academy of Otolaryngology-Head and Neck Surgery] calculations). RESULTS: In the analysis of Group 1 records, the jury of four judges found no audiology discrepant treatment plans in over 95% of cases. In no case where a judge identified a discrepancy in treatment plans did the audiologist plan risk missing conditions associated with significant mortality or morbidity that were subsequently identified by the otolaryngologist. In the analysis of Group 2 records, the neurotologist judged that audiology services alone were all that was required in 78% of cases. An additional 9% of cases were referred for subsequent medical evaluation. The majority of remaining patients had hearing asymmetries. Some were evaluated by otolaryngology for hearing asymmetry in the past with no interval changes, and others were consistent with noise exposure history. In 0.33% of cases, unexplained hearing asymmetry was potentially missed by the audiologist. Audiologists and the neurotologist demonstrated comparable accuracy in identifying Charing Cross and AAO-HNS pure-tone asymmetries. CONCLUSIONS: Of study patients evaluated for hearing problems in the one-year period of this study, the majority (95%) ultimately required audiological services, and in most of these cases, audiological services were the only hearing health-care services that were needed. Audiologist treatment plans did not differ substantially from otolaryngologist plans for the same condition; there was no convincing evidence that audiologists missed significant symptoms of otologic disease; and there was strong evidence that audiologists referred to otolaryngology when appropriate. These findings are consistent with the premise that audiology direct access would not pose a safety risk to Medicare beneficiaries complaining of hearing impairment.

Influence of the macroscopic features of vocal fold polyps on the quality of voice: a retrospective review of 101 cases.

We conducted a study to examine six macroscopic features of vocal fold polyps and to investigate their influence on quality of voice. We retrospectively reviewed the records of 101 consecutive patients with vocal fold polyps who had undergone microlaryngeal surgery for polyp removal after conservative measures had failed. All patients had undergone videolaryngostroboscopy and perceptual and acoustic voice analyses. The six macroscopic features of these vocal fold polyps were morphologic type, location, position, shape, size, and the presence or absence of a reactive lesion on the contralateral vocal fold. Among our statistically significant findings were that gelatinous polyps tended to be broad-based; polyps located on the superior surface tended to be hemorrhagic; small polyps were mostly located on the middle one-third of the vocal fold, and most of them were broad-based; and all of the polyps that were accompanied by reactive lesions on the contralateral vocal fold were located on the free edge. Moreover, jitter was found to be low in small polyps. Finally, noise-to-harmonics ratios were significantly higher in patients with anterior polyps and in those with pedunculated polyps. We conclude that each of the six macroscopic features of vocal fold polyps affected vocal function to a certain degree. We believe that our study provides additional information to otolaryngologists and speech language pathologists who deal with vocal fold polyps.

Changes after voice therapy in objective and subjective voice measurements of pediatric patients with vocal nodules.

The aim of this study was to analyze the efficiency of the voice therapy in children with vocal nodules by using the acoustic analysis and subjective assessment. Thirty-nine patients with vocal fold nodules, aged between 7 and 14, were included in the study. Each subject had voice therapy led by an experienced voice therapist once a week. All diagnostic and follow-up workouts were performed before the voice therapy and after the third or the sixth month. Transoral and/or transnasal videostroboscopic examination and acoustic analysis were achieved using multi-dimensional voice program (MDVP) and subjective analysis with GRBAS scale. As for the perceptual assessment, the difference was significant for four parameters out of five. A significant improvement was found in the acoustic analysis parameters of jitter, shimmer, and noise-to-harmonic ratio. The voice therapy which was planned according to patients' needs, age, compliance and response to therapy had positive effects on pediatric patients with vocal nodules. Acoustic analysis and GRBAS may be used successfully in the follow-up of pediatric vocal nodule treatment.

Evaluation of taste after underlay technique myringoplasty using whole-mouth gustatory test: smokers versus non-smokers.

The aim of this prospective non-randomized study was to evaluate the alterations in taste sensation after myringoplasty and to investigate the influence of smoking on taste. Ninety-six patients who underwent myringoplasty and 43 healthy controls were examined. Whole-mouth gustatory test solutions were sucrose (sweet); sodium chloride (salty taste); citrate (sour) taste; and quinine hydrochloride (bitter). Sucrose, citric acid, and sodium chloride recognition thresholds were high in the early postoperative period; however, they were regressed to the preoperative status in course of time. No difference was found between preoperative, early/late postoperative taste recognition thresholds of smoker and non-smoker patients. Underlay myringoplasty has little but transient effect on taste recognition in the early postoperative period. This impairment is completely recovered within 6 months. Furthermore, smoking has no effect on the taste recognition of patients with permanent tympanic membrane perforation and has no influence on the alterations in taste recognition thresholds after myringoplasty. We believe that this study will supply some additional aspects in the scope of taste disturbances due to ear surgery and smoking.

Melkersson-Rosenthal syndrome revisited as a misdiagnosed disease.

PURPOSE: We aimed to attract our college's attention to the Melkersson-Rosenthal syndrome (MRS), which has been an infrequently encountered subject in otolaryngology journals during the last 10 years. MATERIALS AND METHODS: A retrospective review of the last 10 years' patient database was performed to find patients with MRS. The medical files, treatment charts, and radiological and histopathological records of these patients were reviewed. RESULTS: The study group consisted of 3 MRS patients who had been misdiagnosed for 9, 10, and 16 years. Two of them have had the symptoms since adolescence. All of them presented orofacial edema and fissured tongue, whereas first two also had recurrent facial paralysis. Characteristic histopathological features were noted in 1 patient. Electromyography (EMG) was done in 1 patient who underwent facial decompressiom. All patients responded to either systemic or intralesional corticosteroid treatment. CONCLUSIONS: In the daily practice of an otolaryngologist, it is not usual to diagnose a patient as having MRS. We consider that this is partly because of misdiagnosis. We therefore believe that this study will supply an additional aspect to otolaryngologists, in the scope of recurrent facial paralysis and orofacial edema in both children and adults.

Three-dimensional computed tomography and surgical treatment for Eagle's syndrome.

Eagle's syndrome represents a group of symptoms that includes recurrent throat pain, globus pharyngeus, dysphagia, referred otalgia, and neck pain possibly caused by elongation of the styloid process or ossification of the stylohyoid or stylomandibular ligaments. The medical history and physical and radiologic examinations are the main guides to the precise diagnosis. The radiologic diagnostic modality of choice is three-dimensional computed tomography (3-D CT). We describe a case of bilaterally symptomatic Eagle's syndrome that was diagnosed by 3-D CT of the styloid processes and successfully treated with surgery via a transoral approach.

Current diagnosis and transoral surgical treatment of Eagle's syndrome.

PURPOSE: The purpose of this study was to discuss the current diagnosis of Eagle's syndrome and to present our experience in transoral surgical treatment of the syndrome. MATERIALS AND METHODS: Nineteen patients with Eagle's syndrome due to elongated styloid process were included in this clinical trial. Diagnostic work-up also consists of 3-dimensional computed tomography scanning in recent cases. Elongated styloid processes were resected via transoral approach under general anesthesia. RESULTS: Three-dimensional computed tomography scanning depicted how the preoperative estimation of the styloid length correlated with the true styloid length measure intraoperatively. No postoperative complications were encountered, while the chief symptoms of all patients regressed after surgery. CONCLUSIONS: Three-dimensional computed tomography scanning is an advanced technique that can measure the definitive length of styloid process and takes the physician straightforward to the exact diagnosis. The transoral approach is a safe surgical alternative that achieves adequate treatment of Eagle's syndrome.