[Vocal Changes and Laryngeal Modifications in the Elderly (Presbyphonia and Presbylarynx)]. / Stimm- und Kehlkopfveränderungen im Alter (Presbyphonie und Presbylarynx).

In about 20 % of the population older than 60 years of age, voice problems (presbyphonia) are manifest, often combined with hearing deficits (presbyacusis), swallowing disorders (presbyphagia), dizziness (presbyvertigo) and/or impaired vision (presbyopia).The singing voice is afflicted more often, earlier and more severely than the speaking voice. But it is not just the vocal quality and capacity that are affected. Due to reduced pulmonary function, the breathing impetus is also weakened. As a result of the descending of the larynx, resonance properties of the vocal tract change in seniors, and there is increased risk of aspiration.Vocal deficits are caused by age-related morphological changes in the larynx (presbylarynx). These alterations concern both the ectolaryngeal skeleton and the endolaryngeal soft tissues (particularly the vocal folds). The vocalis muscle atrophies and becomes hypotonic, which becomes clinically apparent as vocal fold bowing and spindle-shaped glottic chink with loss of air during phonation. The laryngeal mucosa dries out (laryngitis sicca).Vocal rehabilitation in the elderly includes both general and voice-specific therapeutic options. Underlying internal and neurological diseases (e. g. reflux, neurodegenerative or cerebrovascular affections), as well as side effects of drugs must be considered. A healthy lifestyle without pathogenic agents promotes good function of phonatory and respiratory organs. As far as voice therapy is concerned, glottal attack exercises can improve glottal closure during phonation, and relaxation exercises may reduce supraglottic hyperfunctional compression. In special cases with large glottic chink, phonosurgical augmentation of the vocal folds may enhance glottal closure and vocal strength. Vocal hygiene (e. g. regular airway moisturisation) complements voice exercises.In the elderly, singing has proven pychosocial benefits (improvement of well-being and social participation) and verified positive immunological effects (salivary IgA increase).

Evaluation of Customized Prosthesis for Irregularly Formed Tracheostoma After Laryngectomy.

BACKGROUND: After laryngectomy, the tracheostoma forms the functional center for breathing and phonation. An occasionally occurring but typical problem can arise from an oversized and/or irregularly formed tracheostoma, hampering the temporary occlusion necessary for sufficient speech production. As an alternative to a surgical correction of the tracheostoma, an individually adjusted stoma silicone prosthesis may be used. MATERIALS AND METHODS: Twenty-one patients suffering from irregularly formed tracheostoma after laryngectomy followed by insertion of a speech valve were provided with a silicone tracheostomal prosthesis. They underwent subjective assessment of voice quality and breathing function according to a standardized general questionnaire and to the Voice Handicap Index (VHI). Furthermore, a clinical evaluation was performed including detection of peristomal leakage and phonation time. RESULTS AND DISCUSSION: Patients described a significant improvement of voice production with the tracheostomal prosthesis (averagely graded as 1.9 with and 3.2 without prosthesis, P = .0026). Breathing was also slightly improved by the prosthesis with an average grade of 1.7 compared to 2.3 with a conventional cannula (P = .063). There was a strong correlation between self-evaluation and the total score of the VHI after insertion of the prosthesis (P < .0001). Minor local skin reactions caused by the adhesive were described by 5 of the 21 patients. CONCLUSIONS: A tracheostomal prosthesis represents an efficient alternative to surgical revision of irregularly formed tracheostoma after laryngectomy, enhancing voice production and breathing function.

Waardenburg syndrome type I with heterochromia iridis and circumscribed hypopigmentation of the skin.

We report a 3-year-old girl with autosomal dominant inherited Waardenburg syndrome type I showing circumscribed hypopigmentation of the skin, heterochromia iridis, sensorineural deafness, and dental aberrations. Clinical diagnosis was confirmed by the identification of an underlying missense mutation (C811T) in the PAX3 gene. Early diagnosis of Waardenburg syndrome among children with pigment anomalies enables a successful interdisciplinary medical care.

Do you know where your fillers go? An ultrastructural investigation of the lips.

AIM: To investigate the exact location and position of hyaluronic acid fillers in the perioral region by ultrasound and optical coherence tomography. INTRODUCTION: To date, there are few in vivo investigations in humans on the exact positioning of injectable hyaluronic acid fillers, and severe complications such as hematoma and thromboembolism are rarely addressed. MATERIALS AND METHODS: There were nine female patients investigated in this pilot study. All of them were periorally injected with hyaluronic acid. The exact product, amount, and locations, as well as the injection techniques, were recorded and compared. Before, immediately after, and 18 days after injection, photo documentation as well as high-resolution ultrasonography and optical coherence tomography of the lip surface were performed. RESULTS: Minor bruising occurred, which resolved within 7 to 9 days. On day 18, no more hemorrhage could be detected. Injected material distributed well in the tissue, and no embolism or thrombosis occurred. However, the injected material came close (up to 1 mm) to important structures such as blood vessels. Lip wrinkles improved, and the lip surface was smoother and more even. CONCLUSION: Hyaluronic acid injections can improve aesthetics and reduce fine wrinkles of the lips. In the patients investigated in this study, compression of structures such as vessels and nerve fibers did not occur, nor did any severe complications result from injection. However, one must be aware of serious complications (eg, hematoma, thromboembolism) and the important anatomic structures (eg, orbicularis oris muscle, vessels, and nerves), and injecting physicians should always have hyaluronidase as a rescue medication at hand. SUMMARY: Hyaluronic acid is a suitable tool for lip augmentation and reduction of fine lines; however, one must be aware of anatomic structures when injecting filler material into the lips and perioral area, and be familiar with the injection techniques.