A retrospective evaluation of the etiology of unilateral vocal fold paralysis over the last 25 years.

Previous studies have shown that the etiology of laryngeal paralysis has changed over the last decades, with an increase in the incidence of cases attributable to thyroid surgery. The aim of this study was to evaluate longitudinal changes in the etiology of unilateral vocal fold paralysis (UVFP) in a single institution over the last 25 years. This retrospective study analyzed the etiology of UVFP between 1990 and 2015 by comparing a cohort of patients treated in 1990-1992 with a cohort treated in 2013-2015. The final analysis was based on data concerning 356 patients (38.8 % males; mean age 55.3 ± 20.4 years): 113 in the 1990-1992 cohort, and 243 in the 2013-2015 cohort. The main cause of UVFP in the population as a whole was thyroidectomy (41.3 %), followed by an idiopathic origin (25.3 %) and thoracic surgery (12.1 %); this was confirmed in both intra-group analyses. There was a statistically significant association between etiology and the sub-group periods: the prevalence of post-thyroidectomy UVFP was highly significantly lower in the 2013-2015 cohort (35.4 vs 54.0 %), and the prevalence of idiopathic cases was higher (28.4 vs 18.6 %). Etiology significantly related to gender in both cohorts (p value ≤0.001). In the 2013-2015 cohort, there was also a statistically significant relationship between etiology and age classes (p value 0.017), and the left side was more frequently affected than the right (67.1 vs 32.9 %). Our findings document changes in the etiological pattern of UVFP over the last 25 years, with a considerable decrease in post-thyroidectomy UVFP, and a growing predominance of idiopathic and post-thoracic surgery UVFP.

Acute otitis media-related facial nerve palsy in a child: a case report and a literary review.

BACKGROUND: Acute otitis media has become a rare cause of facial palsy in children. A high index of suspicion is essential to achieve the diagnosis and to properly treat this condition to avoid permanent neurological sequelae. CASE PRESENTATION: A case of acute otitis media-related facial nerve palsy in an 18 months-old child is described and a review of the recent literature about the clinical presentation, diagnosis, and management of this condition is performed. CONCLUSIONS: Facial paralysis is an uncommon complication of acute otitis media that requires appropriate care. As highlighted in our report, the treatment of facial nerve palsy secondary to otitis media should be conservative, using antibiotics and corticosteroids. The role of antiviral is still a matter of debate. Myringotomy and a ventilation tube should be added when spontaneous perforation of the tympanic membrane is not present. More aggressive surgical approach should be considered only when there is no significant improvement.

Semioccluded Vocal Tract Exercises Improve Self-Perceived Voice Quality in Healthy Actors.

PURPOSE: Semi-occluded vocal tract exercises (SOVTE) have shown to lead to more effective and efficient vocal production for individuals with voice disorders and for singers. The aim of the present study is to investigate the effects of a 10-minute SOVTE warm-up protocol on the actors' voice. METHODS: Twenty-seven professional theater actors (16 females) without voice complaints were audio-recorded while reading aloud, with their acting voice, a short dramatic passage at four time points. Recordings were made: the day before the show, just before and soon after the warm-up protocol which was performed prior to the show and soon after the show. The voice quality was acoustically and auditory-perceptually evaluated and quantified at each time point by blinded raters. Self-assessment parameters anonymously collected pre and post exercising were also analyzed. RESULTS: No statistically significant differences on perceptual ratings and acoustic parameters were found between pre/post exercise sessions and males/females. A statistically significant improvement was detected in the self-assessment parameters concerning comfort of production, sonorousness, vocal clarity and power. CONCLUSIONS: Vocal warm-up with the described SOVTE protocol was effective in determining a self-perceived improvement in comfort of production, voice quality and power, although objective evidence was missing. This straightforward protocol could thus be beneficial if routinely utilized by professional actors to facilitate the voice performance.

Multidimensional Assessment of the Effectiveness of Group Voice Therapy.

OBJECTIVE: Group voice therapy has been successfully used in patients with dysphonia, but there is little objectively documented evidence of its effects on voice quality and the self-perception of voice fatigue. The aim of this study was to investigate the effectiveness of group therapy in patients with functional dysphonia and minor anatomic vocal fold pathologies linked by appearance and history to voice use in an objective and multidimensional manner. STUDY DESIGN: This is a prospective longitudinal study. METHODS: Before and after treatment, 34 adult women underwent perceptual voice assessments using the grade of dysphonia, roughness, breathiness, asthenia, and strain (GRBAS) scale, Evaluation Vocale Assistée (EVA) system aerodynamic and acoustic assessments, and maximum phonation time measurements, and made subjective evaluations using the Voice Handicap Index. The pretreatment baseline values of the participants were obtained by means of two examinations separated by an interval of 1 week. The parameters belonging to each main dimension were clustered by means of Z-transformation, and the corresponding Z-scores were analyzed. RESULTS: Group therapy was associated with a statistically significant improvement in the perceptual (P = 0.008), acoustic (P = 0.040), aerodynamic (P = 0.009 and <0.001), and self-evaluation parameters (P = 0.011). CONCLUSIONS: Our findings provide evidence that group voice therapy can be associated with improvements in perceptual, acoustic, aerodynamic, and self-evaluated parameters in some patients with dysphonia. Controlled, randomized studies are needed in follow-up. This method of treatment may be a means of reducing the costs and waiting lists associated with rehabilitative treatment, and enhancing patients' motivation and compliance.

Validation of the Italian Voice Handicap Index-10.

OBJECTIVE: Time consuming is an important aspect in assessing dysphonic patients. So, the English version of the Voice Handicap Index (VHI-30), a self-administered questionnaire consisting of 30 items used to evaluate patients' self-perception of voice problems, was reduced to 10 items (VHI-10) for clinical purposes. In 2010, an Italian version of VHI-30 was validated, now the aims of this study were to analyze the psychometric properties of an Italian version of VHI-10 and to evaluate its validity in a cohort of patients affected by organic or functional dysphonia. STUDY DESIGN: Cross-sectional study. METHODS: The Italian version of the VHI-30 was submitted to 372 dysphonic participants and 120 healthy control subjects and was conducted again 2 weeks later. The 10 items constituting the VHI-10 were extracted from the VHI-30. For 73 dysphonic patients, the questionnaire was also administered after treatment. RESULTS: The scores of the control group were significantly lower with respect to all diagnostic subgroups (P<0.001). The Cronbach's α, test-retest, and Pearson's correlation index demonstrated high reliability and validity of the Italian VHI-10. The ratio of the VHI-10 and VHI-30 scores was higher than 0.333 in all subgroups. CONCLUSION: This study demonstrated that the Italian VHI-10 is a robust tool that can adequately represent and replace the VHI-30. The reported results support the use of the VHI-10 for the Italian population in clinical settings owing to its validity and rapid and simple use.