RESUMO
INTRODUCTION: The conventional rigid-90° and rigid-70° laryngostroboscopy has been so far considered the gold standard in assessing the vibratory behavior of the vocal folds and the glottal closure configuration during phonation. Meanwhile, this rigid laryngostroboscopy is more and more replaced by flexible chip-on-tip systems. The aim of this study was to evaluate the influence of these different endoscopic techniques on glottal closure configuration and on visibility of the complete focal fold length including anterior commissure during phonation. METHODS: Twenty-one euphonic subjects were enrolled (mean age 34.6 ± 9.5; m = 10, f = 11). They were examined with the three laryngoscopic techniques (conventional rigid-90°, rigid-70°, and flexible chip-on-tip laryngoscopy during low and high voice pitch with soft and loud voice intensity). For evaluating the degree of glottal closure, a modified classification of Södersten et al. was applied and the visibility of the anterior commissure was evaluated. The correlation of the three endoscopic techniques was assessed with Cohen and Fleiss' kappa. RESULTS: In even low loud phonation, the rigid-90° and rigid-70° endoscopies revealed a complete closure of the glottis in only 47.6% of subjects but with flexible endoscopy in 81%. The complete vocal fold length with anterior commissure was best visible with flexible endoscopy in 90.5% in low-soft and high-soft phonation. The rigid-90° endoscopy showed a slight agreement in comparison with the flexible endoscopy in regard to the types of vocal fold closure with a Cohen's kappa coefficient k = 0.199. The rigid-90° endoscopy showed an almost perfect agreement with k = 0.84 when compared to the rigid-70° endoscopy. The flexible endoscopy compared to the rigid-70° endoscopy showed a fair agreement with k = 0.346. CONCLUSION: We found mainly corresponding results in both rigid-90° and rigid-70° endoscopic techniques which can be explained by the same transoral approach with the tongue pulled out, whereas the flexible transnasal endoscopy mainly gives a better view on the anterior commissure. The influence of transorally or transnasally guided endoscopic techniques needs to be considered in interpretation of laryngostroboscopic parameters like vocal fold closure and supraglottal hyperactivity.
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Laringoscopia , Qualidade da Voz , Humanos , Adulto , Laringoscopia/métodos , Prega Vocal , Glote , Fonação , LínguaRESUMO
PURPOSE: Since the introduction of transcutaneous-transcricoidal needle approaches, electromyography (EMG) of the posterior cricoarytenoid muscle (PCA) became easier to perform and teach. Among the Neurolaryngology working group of the European Laryngological Society, several centers have adopted PCA EMG as part of their routine EMG workup in vocal fold immobility collectively gathering long-term experience. The purpose is to give an update and an extension to already existing guidelines on laryngeal EMG with specific regard to PCA EMG. METHODS: Consensus of all co-authors is based on continuous exchange of ideas and on joint laryngeal EMG workshop experiences over at least 7 years. A Delphi method of consensus development was used, i.e., the manuscript was circulated among the co-authors until full agreement was achieved. RESULTS: Step-by-step instructions on how to perform and interpret PCA EMG are provided. CONCLUSIONS: Further research should include the establishment of normal values for PCA and thyroarytenoid muscle (TA) EMG as well as studies on the nature of some unusual activation pattern commonly seen in chronically lesioned PCA.
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Músculos Laríngeos , Prega Vocal , Consenso , Eletromiografia/métodos , Humanos , Músculos Laríngeos/fisiologiaRESUMO
INTRODUCTION: Voice diagnostics including voice range profile (VRP) measurement and acoustic voice analysis is essential in laryngology and phoniatrics. Due to COVID-19 pandemic, wearing of 2 or 3 filtering face piece (FFP2/3) masks is recommended when high-risk aerosol-generating procedures like singing and speaking are being performed. Goal of this study was to compare VRP parameters when performed without and with FFP2/3 masks. Further, formant analysis for sustained vowels, singer's formant, and analysis of reading standard text samples were performed without/with FFP2/3 masks. METHODS: Twenty subjects (6 males and 14 females) were enrolled in this study with an average age of 36 ± 16 years (mean ± SD). Fourteen patients were rated as euphonic/not hoarse and 6 patients as mildly hoarse. All subjects underwent the VRP measurements, vowel, and text recordings without/with FFP2/3 mask using the software DiVAS by XION medical (Berlin, Germany). Voice range of singing voice, equivalent of voice extension measure (eVEM), fundamental frequency (F0), sound pressure level (SPL) of soft speaking and shouting were calculated and analyzed. Maximum phonation time (MPT) and jitter-% were included for Dysphonia Severity Index (DSI) measurement. Analyses of singer's formant were performed. Spectral analyses of sustained vowels /a:/, /i:/, and /u:/ (first = F1 and second = F2 formants), intensity of long-term average spectrum, and alpha-ratio were calculated using the freeware praat. RESULTS: For all subjects, the mean values of routine voice parameters without/with mask were analyzed: no significant differences were found in results of singing voice range, eVEM, SPL, and frequency of soft speaking/shouting, except significantly lower mean SPL of shouting with FFP2/3 mask, in particular that of the female subjects (p = 0.002). Results of MPT, jitter, and DSI without/with FFP2/3 mask showed no significant differences. Further mean values analyzed without/with mask were ratio singer's formant/loud singing, with lower ratio with FFP2/3 mask (p = 0.001), and F1 and F2 of /a:/, /i:/, /u:/, with no significant differences of the results, with the exception of F2 of /i:/ with lower value with FFP2/3 mask (p = 0.005). With the exceptions mentioned, the t test revealed no significant differences for each of the routine parameters tested in the recordings without and with wearing a FFP2/3 mask. CONCLUSION: It can be concluded that VRP measurements including DSI performed with FFP2/3 masks provide reliable data in clinical routine with respect to voice condition/constitution. Spectral analyses of sustained vowel, text, and singer's formant will be affected by wearing FFP2/3 masks.
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Acústica , Máscaras , Voz , Adulto , COVID-19 , Teste para COVID-19 , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Fonação , Acústica da Fala , Adulto JovemRESUMO
PURPOSE: In clinical practice, laryngo(strobo)scopy (LS) is still mainly used for diagnostics and management of unilateral vocal fold paralysis (UFVP), although only laryngeal electromyography (LEMG) can provide information on causes of vocal fold immobility, especially on possible synkinetic reinnervation after recurrent laryngeal nerve (RLN) injury. The goal of this retrospective study was the evaluation whether signs of synkinetic reinnervation in LS can be objectified in comparison to LEMG data. METHODS: Between 1/2015 and 2/2018, 50 patients with laryngostroboscopically suspected UVFP received routine LEMG examination. The LEMG findings were retrospectively compared with LS findings. The LEMG data analysis focused on the diagnosis of synkinetic reinnervation of the TA/LCA and/or PCA. The digital LS recordings were retrospectively re-evaluated by phoniatricians considering 22 selected laryngostroboscopic parameters. RESULTS: LEMG revealed synkinesis in 23 (46%) and absence of synkinesis in 27 (54%) patients. None of the 22 parameters showed significant association between patients with synkinetic reinnervation and LS findings. The only laryngostroboscopic parameter that was significantly associated with a silent LEMG signal compared to single fiber activity in LEMG was a length difference on the side of the UVFP (p-value 0.0001; OR 14.5 (95% CI 3.047-66.81; Sensitivity 0.5; Specificity 0.9355). CONCLUSION: Our findings show that synkinesis cannot be diagnosed using only LS. This study underlines the importance of LEMG in clinical routine for detection of laryngeal synkinesis in patients with UVFP before any further therapeutic steps are initiated to avoid later therapy failure.
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Sincinesia , Paralisia das Pregas Vocais , Eletromiografia , Humanos , Estudos Retrospectivos , Sincinesia/diagnóstico , Sincinesia/etiologia , Paralisia das Pregas Vocais/diagnóstico , Prega VocalRESUMO
OBJECTIVES: The goal of the retrospective study was to investigate the 3-month-outcome after treatment of patients with early unilateral vocal fold paralysis (UVFP) with either standard voice therapy (VT) or selective electrical stimulation of the larynx (SES). DESIGN: Non-randomised retrospective study. SETTING: 1519 patients who underwent thyroid surgery between 2015 and 2018 were analysed according vocal fold mobility; UVFP patients were treated either by VT or SES. PARTICIPANTS: 51 UVFP patients. MAIN OUTCOME MEASURES: 51 UVFP patients have been advised regarding treatment options like either VT (group 1) or SES (group 2). The patients of group 1 (n = 26) and 2 (n = 25) were re-assessed up to 3 months post-operatively regarding UVFP persistence/recovery and perceptive voice sound quality. At follow-ups, perceptual analysis of voice sound (using roughness=R/breathiness=B/hoarseness=H scale) and endoscopic laryngoscopy have been performed. Position of immobile vocal fold, shape of glottal closure and RBH parameters have been considered for statistical analyses. RESULTS: Restitution of UVFP with regular respiratory vocal fold mobility of both vocal folds occurred in 53.8% of group 1 (VT), and in 40.0% of group 2 (SES) after 3 months of therapy between both groups. No difference could be seen for RBH, type of glottal closure and position of ailing vocal folds in patients with persisting UVFP within both groups and between the groups. CONCLUSIONS: The study reveals that SES can achieve similar functional outcome in early UVFP. Thus, it should be considered as an equivalent therapy alternative to VT for treatment of early UVFP patients since no significant difference in vocal outcome and glottal configuration between the two groups could be demonstrated.
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Terapia por Estimulação Elétrica , Complicações Pós-Operatórias/terapia , Tireoidectomia , Paralisia das Pregas Vocais/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Qualidade da VozRESUMO
PURPOSE: Persistent unilateral vocal fold paralysis (UFVP) with glottal insufficiency often requires type I medialization thyroplasty (MT). Previous implants cannot be adjusted postoperatively if necessary. The newly developed APrevent® VOIS implant (VOIS) can provide postoperative re-adjustment to avoid revision MT. The objective of this pilot study is to evaluate the VOIS intraoperatively concerning voice improvement, surgical feasibility and device handling. METHODS: During routine MT, VOIS was applied short time in eight patients before the regular implantation of the Titanium Vocal Fold Medialization Implant (TVFMI™). In all patients, perceptual voice sound analysis using R(oughness)-B(reathiness)-H(oarseness)-scale, measurement of M(aximum)-P(honation)-T(ime) and glottal closure in videolaryngoscopy were performed before and after implanting VOIS/TVFMI™. Acoustic analyses of voice recordings were performed using freeware praat. Surgical feasibility, operative handling and device fitting of VOIS and TVFMI™ were assessed by the surgeon using V(isual)-A(nalog)-S(cale). Data were statistically analyzed with paired t test. RESULT: All patients showed significant improvement of voice sound parameters after VOIS/TVFMI™ implantation. The mean RBH-scale improved from preoperative R = 2.1, B = 2.3, H = 2.5 to R = 0.6, B = 0.3, H = 0.8 after VOIS and R = 0.5, B = 0.3, H = 0.8 after TVFMI™ implantation. The mean MPT increased from preoperative 7.9 to 14.6 s after VOIS and 13.8 s after TVFMI™ implantation. VOIS/TVFMI™ achieved complete glottal closure in 7/8 patients. The satisfaction with intraoperative device fitting and device handling of VOIS was as good as that of TVFMI™. CONCLUSION: The novel APrevent® VOIS implant showed similar intraoperative voice improvement compared to routinely used TVFMI™ without adverse device events and with safe device fitting.
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Laringoplastia/métodos , Laringe Artificial , Implantação de Prótese/métodos , Paralisia das Pregas Vocais/cirurgia , Adulto , Idoso , Estudos de Viabilidade , Feminino , Glote/cirurgia , Humanos , Cuidados Intraoperatórios , Doenças da Laringe/etiologia , Doenças da Laringe/cirurgia , Laringoplastia/instrumentação , Masculino , Pessoa de Meia-Idade , Doenças Faríngeas/etiologia , Doenças Faríngeas/cirurgia , Modalidades de Fisioterapia , Projetos Piloto , Cuidados Pré-Operatórios , Implantação de Prótese/instrumentação , Acústica da Fala , Paralisia das Pregas Vocais/diagnóstico , Paralisia das Pregas Vocais/etiologia , Prega Vocal/cirurgia , Qualidade da VozRESUMO
PURPOSE: This paper describes a first attempt to quantify LEMG data based on turn number calculation. The results obtained for both healthy and ailing thyroarytenoid (TA) muscles of patients with unilateral vocal fold immobility (UVFI) were compared with the respective qualitative evaluation concerning volitional activity to determine whether the two types of analyses deliver similar results. METHODS: LEMG data obtained from 44 adults with UVFI were considered for the study. Semiquantitative evaluation of TA volitional activity and turn number were assessed for the ailing and the healthy TA and the difference in percentage was calculated. Paired data were compared with the Wilcoxon signed-rank test. The volitional activity assessment and the turn number evaluation were compared with the Kruskal-Wallis test, and their relationship was tested with the Kendall rank correlation. RESULTS: Datasets of 27 patients were considered compatible with turns/s calculation. The results showed that complete paralysis correlated with no turns; single fiber volitional activity with 62-208 turns/s, strongly decreased volitional activity with 198-501 turns/s; and dense volitional activity with 441-1234 turns/s. On the ailing VF only, the Kruskal-Wallis test showed a statistically significant difference (p = 0.0001), and the Kendall rank correlation a positive relationship (r = 0.853,p ≤ 0.0001) between the volitional activity rating and the turn number assessment. CONCLUSIONS: Our preliminary results showed that turn number evaluation is an effective tool to confirm LEMG qualitative analysis, and that, in combination with laryngostroboscopy and voice assessment, can help improving the accuracy of the diagnosis and prognosis and the effectiveness of the chosen therapy.
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Paralisia das Pregas Vocais , Adulto , Eletromiografia , Humanos , Músculos Laríngeos , Laringoscopia , Paralisia das Pregas Vocais/diagnóstico , Prega VocalRESUMO
PURPOSE: To describe the use of a myocutaneous serratus anterior free flap (SAFF) for tongue reconstruction after salvage subtotal (STG) and total glossectomy (TG). METHODS: In this prospective case series, seven patients underwent salvage STG or TG and reconstruction with a myocutaneous SAFF between 10/2015 and 02/2017. Functional and oncologic outcomes were prospectively evaluated. Donor side morbidity was determined using the Disabilities of the Arm, Shoulder and Hand (DASH) score. RESULTS: SAFF with mean skin paddles of 6.7 cm × 8.7 cm was used in five STG and two TG patients, respectively. There was a 100% flap survival and a mean DASH score of 10.8 reflected normal arm and shoulder function after surgery. One year after salvage surgery, 1 (14.3%) and 4 (57.1%) patients were tracheostomy and gastrostomy tube dependent. Gastrostomy tube dependence was significantly worse in patients with tumors of the base of tongue compared to other tumor sites (p = 0.030) and in patients who underwent transcervical compared to transoral tumor resection (p = 0.008). Local recurrence rate was 57.1% with a disease-free survival of 17.6 months. CONCLUSION: The myocutaneous SAFF represents a safe and reliable flap for tongue reconstruction after salvage glossectomy with satisfying functional outcomes and low donor side morbidity.
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Glossectomia , Retalho Miocutâneo , Terapia de Salvação , Neoplasias da Língua/cirurgia , Adulto , Idoso , Avaliação da Deficiência , Intervalo Livre de Doença , Feminino , Gastrostomia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estudos Prospectivos , Neoplasias da Língua/mortalidade , TraqueostomiaRESUMO
PURPOSE: Laryngeal electromyography (LEMG) has been considered as gold standard in diagnostics of vocal fold movement impairment, but is still not commonly implemented in clinical routine. Since the signal interpretation of LEMG signals (LEMGs) is often a subjective and semi-quantitative matter, the goal of this study was to evaluate the inter-rater reliability of neurolaryngologists on LEMGs of volitional muscle activity. METHODS: For this study, 52 representative LEMGs of 371 LEMG datasets were selected from a multicenter registry for a blinded evaluation by 7 experienced members of the neurolaryngology working group of the European Laryngological Society (ELS). For the measurement of the observer agreement between two raters, Cohen's Kappa statistic was calculated. For the interpretation of agreements of diagnoses among the seven examiners, we used the Fleiss' Kappa statistic. RESULT: When focusing on the categories "no activity", "single fiber pattern", and "strongly decreased recruitment pattern", the inter-rater agreement varied from Cohen's Kappa values between 0.48 and 0.84, indicating moderate to near-perfect agreement between the rater pairs. Calculating with Fleiss' Kappa, a value of 0.61 showed good agreement among the seven raters. For the rating categories, the Fleiss' Kappa value ranged from 0.52 to 0.74, which also showed a good agreement. CONCLUSION: A good inter-rater agreement between the participating neurolaryngologists was achieved in the interpretation of LEMGs. More instructional courses should be offered to broadly implement LEMG as a reliable diagnostic tool in evaluating vocal fold movement disorders in clinical routine and to develop future algorithms for therapy and computer-assisted examination.
Assuntos
Eletromiografia/métodos , Otolaringologia/métodos , Paralisia das Pregas Vocais/diagnóstico , Prega Vocal , Algoritmos , Europa (Continente) , Humanos , Nervos Laríngeos/fisiopatologia , Variações Dependentes do Observador , Sistema de Registros , Reprodutibilidade dos Testes , Paralisia das Pregas Vocais/fisiopatologia , Prega Vocal/diagnóstico por imagem , Prega Vocal/inervação , Prega Vocal/fisiopatologiaRESUMO
Silicone is frequently used in clinical and medical fields for medical devices. Mixed biofilms composed of Candida and bacterial species causes frequently failure of medical silicone devices, In this in vitro study, we analyzed mixed biofilm formation of clinically isolated non-albicans Candida species and Staphylococcus epidermidis, including Candida tropicalis, Candida krusei and Candida parapsilosis under the influence of different growth media (RPMI 1640, BHI and TSB) and several culture variables (incubation period, feeding conditions and FBS). Our results showed that culture conditions strongly influence mixed biofilm formation. TSB and BHI resulted in larger amount of biofilm formations with stronger metabolic activity of biofilms. Growth conditions may also influence the biofilm formation, which was enhanced by longer incubation period, using a fed-batch system and FBS. Therefore, the potential influences of external environmental factors are very important for mixed biofilm formation with clinically isolated non-albicans Candida species and S. epidermidis, which should be considered when designing or studying the mixed biofilm under in vitro conditions.
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Biofilmes/crescimento & desenvolvimento , Candida/metabolismo , Meios de Cultura/química , Staphylococcus epidermidis/metabolismo , Técnicas de Cultura Celular por Lotes , Candida/crescimento & desenvolvimento , Candida/isolamento & purificação , Adesão Celular , Humanos , Silicones , Staphylococcus epidermidis/crescimento & desenvolvimento , Fatores de TempoRESUMO
ß-1,3-glucan plays a role in non-albicans Candida species biofilm formation and survival of biofilm Candida to stresses. In this study, we evaluated the antibiofilm activity of ß-1,3-glucanase, which can degrade poly-ß(1 â 3)-glucose of non-albicans Candida species biofilms, on single and mixed species biofilm of non-albicans Candida species, including Candida tropicalis, Candida parapsilosis and Candida krusei. Biofilm by all tested species in microplate were dispersed more than 60%. ß-1,3-glucanase also detached mixed species biofilm in microplate and on medical material surface. ß-1,3-glucanase had no effect on Candida planktonic growth as well as adhesion. However, further biofilm formation was inhibited with ß-1,3-glucanase added at 24 h after biofilm initiation. ß-1,3-glucanase markedly enhanced the antifungal susceptibility of amphotericin B. The examination using confocal laser scanning microscopy and scanning electron microscope confirmed the antibiofilm activity of ß-1,3-glucanase. Our findings demonstrate that ß-1,3-glucanase may be useful as an antibiofilm agent.
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Antifúngicos/farmacologia , Biofilmes/efeitos dos fármacos , Candida/efeitos dos fármacos , Glucana 1,3-beta-Glucosidase/farmacologia , Anfotericina B/farmacologia , Biofilmes/crescimento & desenvolvimento , Candida parapsilosis/efeitos dos fármacos , Candida tropicalis/efeitos dos fármacos , Comunicação Celular/efeitos dos fármacos , Técnicas de Cocultura , Combinação de Medicamentos , Testes de Sensibilidade Microbiana , Microscopia Confocal , Microscopia Eletrônica de Varredura , beta-Glucanas/metabolismoRESUMO
Fungal-bacterial multispecies biofilms play a major role in failure of medical silicone devices, such as voice prostheses in laryngectomiy. In this study, we determined the effect of Lactobacilli supernatant (cell free) on mixed biofilm formation of fungi and bacteria on silicone in vitro. Lactobacilli supernatant inhibited the adhesion (90 min) of mixed fungi and bacteria species with an efficiency of >90%. Mixed biofilm formation and the metabolic activity of the biofilms were inhibited by 72.23% and 58.36% by Lactobacilli supernatant. The examination using confocal laser scanning microscopy and scanning electron microscopy confirmed that Lactobacilli supernatant inhibited the growth of mixed biofilm and damaged the cells. Moreover, Lactobacilli supernatant also inhibited Candida yeast-to-hyphal transition. Therefore, Lactobacilli supernatant may serve as a possible antibiofilm agent to limit biofilm formation on voice prostheses.
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Bactérias/efeitos dos fármacos , Biofilmes/efeitos dos fármacos , Fungos/efeitos dos fármacos , Lactobacillus/fisiologia , Silicones , Biofilmes/crescimento & desenvolvimento , Candida/efeitos dos fármacos , Humanos , Laringe Artificial/microbiologia , Viabilidade Microbiana/efeitos dos fármacos , Microscopia Confocal , Microscopia Eletrônica de VarreduraRESUMO
Total laryngectomy is performed in advanced laryngeal and hypopharyngeal cancer stages and results in reduced quality of life due to the loss of voice and smell, permanent tracheostoma and occasionally dysphagia. Therefore, successful voice rehabilitation is highly beneficial for the patients' quality of life after surgery. Over the past decades, voice prostheses have evolved to the gold standard in rehabilitation and allow faster and superior voicing results after laryngectomy compared to esophageal speech. Polyspecies biofilm formation has become the limiting factor for device lifetimes and causes prosthesis dysfunction, leakage and in consequence pneumonia, if not replaced immediately. Although major improvements in prosthesis design have been made and scientific insight in the complexity of biofilm evolution and material interaction progresses, the microbial colonization continues to restrict device lifetimes, causing patient discomfort and elevated health costs. However, present scientific findings and advances in technology yield promising future approaches to improve the situation for laryngectomized patients.
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Biofilmes/crescimento & desenvolvimento , Laringe Artificial/microbiologia , Consórcios Microbianos/fisiologia , Infecções Relacionadas à Prótese/microbiologia , Bactérias/classificação , Bactérias/isolamento & purificação , Bactérias/ultraestrutura , Candida/classificação , Candida/isolamento & purificação , Candida/ultraestrutura , Humanos , Laringectomia/efeitos adversos , Microscopia Confocal , Microscopia Eletrônica de Varredura , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/prevenção & controleRESUMO
AIM: Biofilm formation on voice prostheses, which are used for voice rehabilitation in laryngectomized patients, is a main cause of device failure. The aim of this study was to assess whether the presence of periodontal pathogens in the biofilm on voice prostheses is related to that in the oral cavity and associated with the periodontal status of the patients. METHODS: Thirty-one laryngectomized patients were invited to participate, 13 of whom met exclusion criteria. The remaining 18 were classified according to the community periodontal index of treatment needs (community periodontal index of treatment needs (CPITN), grades 0-4). Biofilm samples from the oral cavity and voice prostheses were analysed by PCR-based hybridization for 11 pathogens. RESULTS: All dentate patients required periodontal treatment (CPITN-3: n = 4, CPITN-4: n = 8); the remaining six were edentulous. The diversity (i.e. number of bacterial species detected) of pathogens detected on the voice prostheses correlated significantly positively with the diversity of pathogens in the oral cavity and with clinical parameters. Furthermore, the diversity of pathogens differed significantly between dentate and edentulous patients. CONCLUSIONS: Results emphasize the oral cavity as an important source of bacteria for biofilm formation on voice prostheses. Whether these pathogens reduce the lifetime of the device by increased biofilm formation and/or increase the risk of silicone deterioration requires further study.
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Biofilmes/crescimento & desenvolvimento , Laringectomia , Laringe Artificial/microbiologia , Boca/microbiologia , Idoso , Idoso de 80 Anos ou mais , Aderência Bacteriana/fisiologia , Bacteroides/isolamento & purificação , Campylobacter rectus/isolamento & purificação , Capnocytophaga/isolamento & purificação , Cálculos Dentários/microbiologia , Placa Dentária/microbiologia , Feminino , Seguimentos , Fusobacterium nucleatum/isolamento & purificação , Humanos , Laringectomia/reabilitação , Masculino , Pessoa de Meia-Idade , Boca Edêntula/microbiologia , Peptostreptococcus/isolamento & purificação , Doenças Periodontais/microbiologia , Índice Periodontal , Bolsa Periodontal/microbiologia , Estudos Prospectivos , Falha de Prótese , Língua/microbiologia , Dente/microbiologia , Treponema denticola/isolamento & purificaçãoRESUMO
OBJECTIVE: Laryngeal pacing (LP) is a highly anticipated therapeutic option for patients suffering from bilateral vocal fold paralysis with synkinesis. Identification of candidate patients requires confirmation of a stimulable posterior cricoidarythenoid muscle (PCA) by neuromuscular electrical stimulation (NMES). A silicone endoscopic cap electrode (ECE50) was designed to be operated as an endoscopic extension tip for selective PCA stimulation and confirmation of a glottic opening movement in a setting comparable to a gastroscopy procedure. METHODS: A porcine animal model (n = 6) was applied to develop and test endoscopic cap prototypes in general anesthesia and sedation at a biomedical research center. Two ENT endoscopy experts evaluated and refined the cap design and performance in regard to procedure safety, endoscope handling, accessibility of the PCA by the transoral approach and selective muscle stimulation. RESULTS: Vocal fold opening movements could be evoked by the investigators in 9 of 12 PCA muscles to stimulate with similar electric parameters. The endoscopic approach using the ECE50 proved to be atraumatic and sufficiently controlled under sedation to locate the required hotspot for NMES of the PCA. CONCLUSION: The functionality of the novel endoscopic cap concept has been proven in a porcine model. It can be expected to be transferable to human application and to be of diagnostic importance in the screening and identification of LP candidate patients in future. LEVEL OF EVIDENCE: NA Laryngoscope, 133:2279-2284, 2023.
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Músculos Laríngeos , Paralisia das Pregas Vocais , Suínos , Humanos , Animais , Músculos Laríngeos/fisiologia , Paralisia das Pregas Vocais/cirurgia , Prega Vocal , Endoscopia , Eletrodos , Eletromiografia , Estimulação ElétricaRESUMO
It was the purpose of this study to evaluate the role of the serratus anterior free flap (SAFF) with its long thoracic nerve (LTN) as composite flap for dynamic facial reanimation. A total of 10 studies, published between 2004 and 2021, met inclusion criteria. Clinical data of 48 patients were used for the systematic review and analysis. One to three slips were used, mainly as one-stage procedures (n = 39; 81.3%), to create different force vectors. Single or double innervated muscle transfers were utilized in 32 (66.7%) and 16 (33.3%) cases with additionally harvested skin paddles in 4 (8.3%) patients. The LTN was mostly anastomosed to the ipsilateral masseteric nerve (45.8%; n = 22) or to remaining facial nerve branches (37.5%; n = 18), while cross-facial-nerve-grafting was rarely used (16.7%; n = 8). The SAFF as composite flap with different force vectors proved to be a good candidate for immediate dynamic facial reanimation after any midface defects.
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Paralisia Facial , Retalhos de Tecido Biológico , Transferência de Nervo , Procedimentos de Cirurgia Plástica , Humanos , Retalhos de Tecido Biológico/transplante , Nervo Facial/cirurgia , Transferência de Nervo/métodos , Face/cirurgia , Paralisia Facial/cirurgiaRESUMO
OBJECTIVES: Acute laryngitis is a common disease with self-limiting nature. Since the leading cause is attributed to viral infections and thus self-limiting, many affected individuals do not seek professional medical help. However, because the major symptom of hoarseness imposes a substantial burden in everyday life, it might be speculated that web-based search interest on this condition follows incidence rates, with highest peaks during winter months. The aim of this study was to evaluate global public health-information seeking behaviour on laryngitis-related search terms. METHODS: We utilized Google Trends to assess country-specific, representative laryngitis-related search terms for English and non-English speaking countries of both hemispheres. Extracted time series data from Australia, Brazil, Canada, Germany, the United Kingdom, and the United States of America, covering a timeframe between 2004 and 2019 were first assessed for reliability, followed by seasonality analysis using the cosinor model. RESULTS: Direct comparisons revealed different, representative laryngitis-related search terms for English- and non-English speaking countries. Extracted data showed a trend of higher reliability in countries with more inhabitants. Subsequent graphical analysis revealed winter peaks in all countries from both hemispheres. Cosinor analysis confirmed these seasonal variations to be significant (all P < 0.001). CONCLUSION: Public interest in laryngitis-related, online health information displayed seasonal variations in countries from both hemispheres, with highest interest during winter months. These findings emphasize the importance to optimize the distribution of reliable, web-based health education in order to prevent the spread of misinformation and to improve health literacy among general populations.
Assuntos
Laringite , Alemanha , Humanos , Infodemiologia , Internet , Laringite/diagnóstico , Laringite/epidemiologia , Reprodutibilidade dos Testes , Estações do Ano , Estados UnidosRESUMO
BACKGROUND: Adenotonsillectomy is one of the most common pediatric surgical procedures. Postoperative voice changes are a very common concern among patient's parents. Therefore, the aim of this study is to analyze acoustic voice parameters after adenotonsillectomy, tonsillectomy, and adenoidectomy in pediatric patients in a tertiary referral academic center. PATIENTS AND METHODS: All pediatric patients undergoing an adenotonsillectomy, tonsillectomy or adenoidectomy in a single center from 2002 to 2018 were included in the study. Change of fundamental frequency, jitter, shimmer, and harmonic-noise ratio at first, seventh and 30th postoperative day compared to preoperative values were the primary outcome parameters. Statistical analysis was performed using repeated measures analysis of variance model. RESULTS: A total of 1258 patients were included in the study. The mean age of patients at the time of surgery was 8.3 years (range 3.0-18.0 years). Around 698 were male (55.5%) and 560 female (44.5%). The values of fundamental frequency increased significantly after the first and seventh postoperative day (P = 0.001 both) but normalized 1 month after surgery (P = 0.962). At the first postoperative month, values of jitter and shimmer decreased significantly (P = 0.005 and P = 0.002, respectively). Measurements of harmonic-noise ratio revealed a significant increase 30 days after surgery (P = 0.004). CONCLUSION: Statistically significant differences in objective voice parameters within the first postoperative month after tonsillectomy, adenoidectomy, and adenotonsillectomy were observed. The fundamental frequency returned to normal 1 month after surgery. These findings can contribute in soothing the concerns of parents regarding postoperative voice changes.
Assuntos
Adenoidectomia , Tonsilectomia , Acústica , Adenoidectomia/efeitos adversos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Acústica da Fala , Tonsilectomia/efeitos adversos , Qualidade da VozRESUMO
OBJECTIVES: The present proof-of-principle study assessed whether daily use of a power-driven water flosser (Sonicare AirFloss; SAF) leads to bacterial colonization in the nozzle and/or the device, resulting in contaminated water-jet. MATERIAL AND METHODS: In five participants, saliva samples at baseline and water-jet samples of devices used daily with bottled water for 3 weeks (test) were collected. Additionally, water-jet samples from devices used daily with bottled water extra-orally for 3 weeks (positive control) and from brand new devices (negative control), as well as samples from newly opened and 1- and 3-week opened water bottles were collected. Colony forming units (CFU) were recorded after 48 h culturing and 20 oral pathogens were assessed by polymerase chain reaction-based analysis. RESULTS: Distinct inter-individual differences regarding the number of detected bacteria were observed; water-jet samples of test devices included both aerobic and anaerobic bacterial species, with some similarities to the saliva sample of the user. Water-jet samples from positive control devices showed limited number of aerobic and anaerobic bacterial species, while the samples from negative control devices did not show any bacterial species. Very few aerobic bacteria were detected only in the 3-week-old bottled water samples, while samples of newly and 1-week opened water bottles did not show any bacterial growth. CONCLUSIONS: The present proof-of-principle study showed that daily use of a power-driven water flosser for 3 weeks resulted in bacterial colonization in the nozzle and/or device with both aerobic and anaerobic, not only oral, species, that are transmitted via the water-jet.
Assuntos
Instrumentos Odontológicos/microbiologia , Higiene Bucal/instrumentação , Bactérias/genética , Dispositivos para o Cuidado Bucal Domiciliar , Água Potável , HumanosRESUMO
OBJECTIVE: Selective electrical surface stimulation (SES) of the larynx is not yet routinely considered therapy option in treatment of unilateral vocal fold paralysis (UVFP). Goal of this monocentric feasibility study was to provide systematic data on applicability of SES of intrinsic laryngeal muscles in UVFP under consideration of sensitivity and discomfort thresholds and nonselective side effects. METHODS: Thirty-two UVFP patients were included in the study. Symmetric triangular-shape, charge-balanced pulse widths (PWs) of 1, 10, 25, 50, 100, 250, and 500 milliseconds (ms) were tested with increasing amplitudes (AMPs). The stimulation was delivered as a train of five pulses using square surface electrodes. Selective laryngeal responses were examined by flexible laryngoscopy. Nonselective side effects (swallowing reflex, coughing, different severity degrees of unspecific strap muscle/platysma response) were judged by observation. RESULTS: Selective laryngeal response could be triggered in 28/32 (87.5%) patients during respiration/rest and in 26/32 (81.3%) patients during phonation. The most effective PWs for the selective eliciting of selective bilateral vocal fold adduction are comprised between 50 and 100 ms in combination with an average AMP comprised between 7.1 and 7.2 mA. CONCLUSION: Our results indicate that, in UVFP patients, PWs comprised between 50 and 100 ms in combination with a median AMP between 7.1 and 7.2 mA are expected to deliver in >75% of the cases a specific, effective, and safe bilateral adduction of the VF. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:E2566-E2572, 2021.