[Factors predicting Voice Handicap Index]. / Indice de Incapacidad Vocal: factores predictivos.

OBJECTIVE: To assess factors that may be predictive of patient perception of dysphonia severity, as quantified by the Voice Handicap Index (VHI) score. MATERIAL AND METHODS: A prospective study is carried out in 81 voice samples from patients diagnosed with benign vocal fold lesions. Variables assessed for predictive value to VHI score are maximum fonation time, narrow band spectrogram, jitter, shimmer, HNR, NNE, F0 and the auditory perceptual evaluation of severity of dysphonia GRABS. RESULTS: HNR, F0 and B and S parameters of GRABS were predictors of total VHI score, functional and emotional subscales. No parameter was found to predict the physical subscale. CONCLUSIONS: VHI score is correlated with the perceived breathy voice and its acoustic attributes, such as signal-to-noise ratio. In other studies, patient perception of dysphonia is independent of many factors commonly assessed during the evaluation of voice disorders. It is reasonable to assume that the severity of glottic gap caused by benign vocal folds lesions is related to a low signal-to-noise ratio and the breathy phonation as its perceptual correlate. The physical subscale appears to be an independent element in the assessment of the patient perception of dysphonia.

[Perceptual evaluation of dysphonia: correlation with acoustic parameters and reliability]. / Evaluación perceptual de la disfonía: correlación con los parámetros acústicos y fiabilidad.

The perceptual GRBAS scale for analysis of voice quality is quite important clinically in voices that cannot be effectively analyzed with a voicing parameter method like vocalizations with strong subharmonics and modulations and in chaotic or random voices. In the present study, two experiments were performed: Firstly, GRBAS/acoustical correlations were investigated in 107 pathological voices. Secondly, the GRBAS interrater and intrarater agreement. The severity of dysphonia was assesed better by breath related parameters and low fundamental frequencies. The presence of subharmonics in the power spectrum had not a significant relationship with the degree of roughness. A (asthenic) and S (strain) scales. The results of this study show that GRBAS test-retest reliability and intrerrater agreement is high.

[Induction chemotherapy using vinorelbine, cisplatin, and UFT in advanced pharyngeo-laryngeal carcinomas: results of a phase II study]. / Quimioterapia de inducción con vinorelbine, cisplatino y UFT en carcinomas avanzados faringo-laríngeos: resultados de un estudio fase II.

OBJECTIVE: To evaluate the results of an induction chemotherapy protocol with Vinorelbine, UFT and Cisplatin (UFTVP). METHODS: 93 patients with laryngo-pharyngeal squamous cell carcinoma in stage III or IV were prospectively entered into a protocol to receive four cycles of UFTVP. Responders followed definitive radiation therapy. Nonresponders underwent conventional surgery with postoperative radiation. RESULTS: Following chemotherapy nodal response (complete in 28% and partial in 33%) was less than that the primary site (complete in 60% and partial in 30%), p = 0.002. With a median follow-up of 62 months, the Kaplan-Meier 5-year survival was 45%. Successful larynx preservation was achieved in 50% of patients with laryngeal cancer and in 29% of patients with hypopharyngeal cancer. Lymph node metastases and pharyngeal localization were found to be significant negative factors with regards to survival. CONCLUSIONS: UFTVP is an active regime of chemotherapy in advanced squamous cell carcinoma of the pharynx and larynx. Results differ according to the localization, having significantly better rates of survival and organ preservation in the laryngeal cancers that in those of the pharynx.

[Quantitative spectral evaluation of vocal hypofunction]. / Evaluación espectral cuantitativa de la hipofunción vocal.

The purpose of this study was to explore the interaction between voice asthenicity and the acoustic prediction of vocal hypofunction. One hundred and seven phonatory samples of Reinke's edema were categorized by listeners using GRBAS scale. Seven frequency and time domain parameters were used to predict perceptual severity of asthenicity. Logistic regresion analysis showed that a useful measure for the prediction of asthenicity was the loss of harmonic components in the middle and upper portion of the spectrum. A spectral classification of vocal hypofunction is proposed.

A review on clinical management and pharmacological therapy on hereditary haemorrhagic telangiectasia (HHT).

Hereditary Haemorrhagic Telangiectasia (HHT) or Rendu-Osler-Weber syndrome, is an autosomal dominant rare disease characterized by localized angiodysplasia. This is manifested as epistaxis, mucocutaneous and gastrointestinal telangiectases, and arteriovenous malformations in the pulmonary, cerebral or hepatic circulation. The prevalence is between 1 in 5,000 to 8,000, although it is higher in some regions. The most frequent clinical manifestation of HHT is epistaxis, normally from light to moderate from the 4(th) decade of life. However, many patients show severe epistaxis which may interfere with their quality of life. The epistaxis is due to telangiectasia on the nasal mucosa. These are focally dilated postcapilar venules, which in advanced phases show many layers of smooth muscle cells without elastic fibers, and very frequently directly connect with dilated arterioles. As a consequence of these vascular alterations, telangiectases are very sensitive to slight trauma and even to the friction with the air when breathing, which gives rise to nose bleeds. Unfortunately, there is no optimal pharmacological treatment for the epistaxis in HHT. The use of antifibrinolytic agents for the treatment of HHT has been studied recently by our group as an effective relief for nasal and gastric haemorrhages. This work represents a systematic review and the beginning of a systematic laboratory work we are now conducting in our lab to screen for "orphan drugs" as therapeutic agents in HHT. In this context, the use of hormones, immunosuppresants and anti-angiogenic agents are under preclinical study in our laboratory.