Translation and Validation of the Dysphagia Handicap Index in Polish-Speaking Patients.

Dysphagia Handicap Index (DHI) is a self-assessment questionnaire which consists of 25 statements to examine three aspects of dysphagia patients' quality of life (QoL): functional, physical, and emotional. The patient can get a maximum score of 100 points. The study goal was to validate and translate the Polish version of the DHI (PL-DHI). One hundred and seventy-eight (178) individuals with oropharyngeal dysphagia with different etiology and 35 (thirty-five) asymptomatic adults with no history of swallowing disorders filled out the PL-DHI. Internal consistency was determined using Cronbach alpha coefficient, which was high for the total PL-DHI score (0.962). The reproducibility was high (r-Spearman correlation coefficient was 0.97 for total PL-DHI score). The PL-DHI's total score and its subscales were significantly higher in the dysphagia patients study group (SG) than in the healthy controls group (CG) (SG median: 36; CG median: 4). A strong correlation was observed between the PL-DHI score and the self-reported dysphagia severity measure (Spearman's correlation coefficient was 0.859, p < 0.001). The Polish DHI is a reliable and valid questionnaire for assessing dysphagia patients' QoL.

The Dysphagia Handicap Index (DHI)-Normative Values. Systematic Review and Meta-Analysis.

As the dysphagia handicap index (DHI) becomes more commonly used in clinical practice as a diagnostic tool, it is essential to establish the normative value of DHI. The main purpose of this study is to determine the normative value of DHI among subjects who had no history of dysphagia or neurological disease as well as no history of head or neck malignancy. A systematic literature search was performed using PubMed, Scopus and ScienceDirect to access relevant databases and to locate outcome studies. Eligibility criteria included type of publication, participant characteristics and report of outcomes. Data analysis were conducted using meta-analysis method. Five articles were included for the final analysis. The normative value of DHI was 2.49 with confidence interval of 0.51-4.48 for a group of 323 subjects, age range of 20-86 years.

Laryngeal stroboscopy-Normative values for amplitude, open quotient, asymmetry and phase difference in young adults.

OBJECTIVE: To provide the normative values for laryngeal stroboscopy (LS) concerning amplitude, open quotient, asymmetry and phase difference in healthy, young subjects. STUDY DESIGN: Prospective case-control study. SETTING: Patients treated at a single institute. METHODS: A total of 68 healthy subjects were included in the study (35 women, 33 men), aged 18-35 years. After obtaining LS recordings, image processing was performed to attain parameters of vocal fold vibration. RESULTS: In women, the location of the maximum vibration amplitude is approximately in the 1/3 posterior part of the glottis, while in men, the location is moved to the glottis centre. In males, the relative amplitude vibration of the vocal folds in the 1/3 anterior part of the glottis was significantly higher than in females (P = 0.029). Women showed significantly higher open quotients (OQ) at the posterior part of the glottis than the male subjects (P < 0.001) and men presented significantly higher OQ at the anterior part of the glottis than the females (P < 0.001). The average OQ values for both sexes were almost the same. Females showed significantly higher relative glottal gap area (P = 0.044). Women presented a significantly lower amplitude asymmetry than men (P = 0.002). The weighted absolute left-right phase difference reached up to 24° and remained insignificantly higher in the men than the women (P = 0.142). CONCLUSIONS: The study provides normative values for LS in young adults for the measurement of therapy outcomes in patients with voice disorders and realisation of evidence-based medicine. The LS parametrisation is easy to perform in clinical practice.

The differential diagnosis of parotid gland tumors with high-resolution ultrasound in otolaryngological practice.

The aim of the study is to define the utility of ultrasound (US) in differentiating benign from malignant parotid tumors as well as pleomorphic adenomas (PA) from monomorphic adenoma (MA). Seventy-two consecutive parotid gland tumors were analysed with high-resolution ultrasonography (12 MHz) with color Doppler imagining. The histopathological diagnosis was confirmed after parotidectomy for each lesion. The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) for the US were established. Receiver operating characteristic curves were constructed to determine the predictive values of echogenicity, heterogeneity, and vascularity on color Doppler. Area under the curve (AUC) was calculated for each parameter considered. The analysed material included 27 MA, 26 PA, 1 basal cell adenoma, 8 inflammatory conditions, and 10 malignant neoplasms. The sensitivity, specificity, and accuracy of US in differentiation of malignant from benign lesions in the parotid gland were 60, 95.2, and 90.3%, respectively. The predictive values were: PPV 66.8% and NPV 93.6%. Differentiating diagnoses between PA and MA with US resulted in a sensitivity of 61.5%, specificity of 81.5%, and accuracy of 73.1%. The predictive values were: PPV 50% and NPV 68.8%, respectively. For distinguishing malignant from benign tumors, the highest AUC values noted were for heterogeneity and vascularization (0.8 and 0.743, respectively). The AUC values were the highest for hypoechogenicity and vascularization in separating PA from MA (0.718 and 0.685, respectively).

Personality traits in singers performing various music styles and with different singing status.

OBJECTIVES: Objective was to find personality traits in singers performing various music styles and with different singing status. MATERIAL AND METHODS: The study consisted of 87 singers (66 females, 21 males; age: M±SD 25.5±8.2 years; 40 students, 22 professionals and 25 amateurs; 38 classical singers, 42 contemporary commercial music [CCM] singers; 55 solo singers and 22 choral singers). Participants filled in the NEO Five-Factor Inventory questionnaire and demographic information form. RESULTS: Median values compared to the Polish general population, suggest that solo, CCM, student and professional singers have a high level of conscientiousness. Those who sing in a choir, classical music, amateurs and students have relatively high level of agreeableness. High level of extraversion is observed among CCM singers and students. Students score higher on extraversion then professionals (p < 0.001). Professionals score higher on extraversion then amateurs (p < 0.01). Professionals less frequently than amateurs and students score high on agreeableness (p < 0.001). High scores on conscientiousness are significantly higher among professionals and students compared to amateurs (p < 0.001 in both cases). Solo singers have higher level of conscientiousness (p < 0.001) and openness (p < 0.001) and lower neuroticism (p < 0.01) than choral singers. Classical singers more often than CCM singers score low on openness (p < 0.01) and high on agreeableness (p < 0.01). CONCLUSIONS: Classical singers have lower level of openness and higher level of agreeableness than CCM singers. Neuroticism is higher among choir than solo singers and conscientiousness is higher among solo than choir singers. Amateurs had the highest level of neuroticism and the lowest level of conscientiousness as compared with professional singers and students. Int J Occup Med Environ Health. 2023;36(4):541-50.

The Dysphonia Severity Index (DSI)-Normative Values. Systematic Review and Meta-Analysis.

INTRODUCTION: As the dysphonia severity index (DSI) is used in clinical practice as a diagnostic tool, a thorough systematic review of the literature is required to assess the normative value of DSI. The main propose of present study was to determine the normative value of DSI among subjects whose voices were judged as normal. METHODS: A systematic literature search was performed using PubMed to access relevant databases and to locate outcome studies. Eligibility criteria included type of publication, participant characteristics and report of outcomes. Data analysis was conducted using meta-analysis method. RESULTS: Fourteen articles were included for the final analysis. The normative value of DSI equals 3.05 with confidential range 2.13-3.98 was received for group of 1330 of healthy subjects whose voices were judged as normal, with range age 17.3-94 years. CONCLUSIONS: As DSI value is stable over subject groups and used as a diagnostic tool for adults a thorough systematic review of the literature is required to assess the normative value of DSI. Mean normative value of the DSI was found to be 3.05 with the DSI confidence levels between 2.13 and 3.98, which is lower than given previously.

[Analysis of causes and treatment of hearing loss in children from Department of Infant Diseases the Children's Memorial Health Institute, Warsaw]. / Analiza przyczyn niedosluchu oraz zastosowanego leczenia u dzieci w materiale Kliniki Niemowlecej Instytutu "Pomnik - Centrum Zdrowia Dziecka" w Warszawie.

UNLABELLED: The aim was to identify the frequency of different causes of congenital hearing loss and to investigate the age of treatment intervention. MATERIAL: 197 children with hearing loss, hospitalized in the Department of Infant Diseases between 2007-2009. METHODS: Three-level audiological examinations, clinical investigations, specific tests for selected congenital infections and GJB2 mutations, neuroimaging. RESULTS: In 14 children with negative screening test hearing loss was confirmed; in 14 with positive was excluded; in 5 newborns screening test was not performed. In 179/197 the confirmation of hearing impairment was obtained up to 6 months (90%). Sensorineural (176/197), bilateral (157/197) hearing loss dominated; conductive and mixed was in 21/197. In 97/176 children with sensorineural hearing loss, congenital CMV infection was confirmed; in 47/176 - GJB2 mutations; in 21 simultaneous CMV infection and GJB2 mutation; in 26 the reason was not identified. The hearing aids were applied in 128, in 76 up to 6 months; the cochlear implants received 36, mainly in the 1st. and 2nd. year of life. The improvement of hearing was obtained in 33. CONCLUSIONS: 1. Early identification of infants with hearing loss allows for an earlier introducing of comprehensive treatment and improvement of hearing. 2. The significant proportion of children with hearing loss in the course of congenital cytomegalovirus infection indicates the need to carry out tests to identify infection in newborns with abnormal hearing screening test. 3. Cochlear implants are now in Poland the standard method of treatment in partial and complete deafness in children, also the youngest.

[Management of recurrent sinonasal inverted papilloma in the experience of ENT Department Medical University of Warsaw]. / Postepowanie w przypadkach wznowy brodawczaka odwróconego nosa i zatok przynosowych po leczeniu operacyjnym w materiale Kliniki Otolaryngologii Warszawskiego Uniwersytetu Medycznego.

INTRODUCTION: Inverted papilloma is benign epidermal neoplasm of not recognized etiology. The lesion is estimated to represent 0.5-4% of sinonasal tumors. Generally inverted papilloma is unilateral, arises from the lateral nasal wall and characterizes with local destruction and rapid growth. The tumor can possibly undergo malignant transformation. The treatment of choice is surgery, recently endoscopic approach is considered to be superior to the open approach. THE AIM OF STUDY: was evaluation of recurrent inverted papilloma treatment results in the experience of Otolaryngology Department, Medical University of Warsaw, from 1982 to 2009. MATERIAL: The group of 124 patient (66 men and 58 women) aged from 26 to 79 with inverted papilloma operated between 1982 and 2009 were enrolled in the study. Follow up was from 6 months to 27 years. RESULTS: Most common primary localization of the tumor was combined lateral nasal wall and maxillary sinus (42%). In 37% the lesion involved unilaterally the lateral nasal wall, maxillary sinus and ethmoid sinuses, rarely it was localized only in the lateral nasal wall (16.1%) and exclusively in the nasal septum (4.8%). All the patients were treated surgically, 46% of patients underwent endoscopic procedure, 37.1% lateral rhinotomy, 15% Denker rhinotomy and 1.6% midfacial degloving. Recurrence was observed in 15.3% including 57.9% after endoscopic surgery, 26% after Denker operation and 15.8% after lateral rhinotomy. Malignant transformation was observed in 5 patient (4%). All the patients with recurrent inverted papilloma were treated surgically, 5.3% of patient underwent midfacial degloving, 5.3% Caldwell-Luc operation, 10.5% endoscopic procedure, 26.3% Denker operation and 52.6% lateral rhinotomy. CONCLUSIONS: 1. Endonasal and open approach should be considered in the surgical treatment of recurrent inverted papilloma. 2. Endoscopic approach is preferred in the recent years but qualification for each method should depend on lesion localization, extent and volume. 3. Regular follow-up enables early recurrence diagnosis and treatment.

Normative values for singing voice handicap index - systematic review and meta-analysis.

INTRODUCTION: There are no official diagnostic protocols for singing voice assessment. In this publication, on the basis of a literature review, standards for the singing voice handicap index exclusively dedicated to voice disorders in singing have been given. OBJECTIVE: The study aims to determine the normative values for the singing voice handicap index. METHODS: The study is a systematic review and a meta-analysis. A systematic literature search was performed using PubMed to access relevant databases and to locate outcome studies. The "inclusion" criteria were as follows: English language, original papers and human studies retrospective and prospective papers, cross-sectional and case-control studies. RESULTS: Eight articles were included for the final analysis. The normative value for the singing voice handicap index was 20.35 with a confidential range of 10.6-30.1 for a group of 729 healthy subjects whose voices were judged as normal, with an age range of 16-64 years. CONCLUSION: The mean normative value of the singing voice handicap index was 20.35 with the confidence levels between 10.6 and 30.1.

Normative Value of SVHI-10. Systematic Review and Meta-Analysis.

OBJECTIVE: The study aimed to determine the normative value of SVHI-10. STUDY DESIGN: The study is a systematic review and a meta-analysis. METHODS: A systematic literature search was performed using PubMed and ScienceDirect to access relevant databases and to locate outcome studies. Eligibility criteria included type of publication, participant characteristics, and report of outcomes. Data analysis was conducted using the meta-analysis method. RESULTS: Six articles were included for the final analysis. The normative values for the SVHI-10 for a group of 528 subjects were 8.38 with confidence levels of 7.43-9.34 (age range 16-83). CONCLUSIONS: Based on the results of the meta-analysis the SVHI-10 can be used as a screening tool for a group of singers. In the future, it would be worthwhile to carry out a subordinate analysis to determine the SVHI-10 range for mild voice disorders or severe voice disorders in singing.

Morphology, Vibratory Function, and Vascular Pattern for Predicting Malignancy in Vocal Fold Leukoplakia.

BACKGROUND: The study evaluates clinical features of vocal fold (VF) leukoplakia in predicting its benign or malignant nature. MATERIALS: 57 patients with 84 lesions were evaluated before undergoing laryngeal microsurgery. The texture, color, thickness and size of the leukoplakia, along with an assessment of the surrounding mucosa vascularization using narrow-band imaging (NBI), and VF vibratory function were analyzed. Receiver-operating characteristic curves were constructed to determine the predictive value of each feature and area under the curve (AUC) was calculated. RESULTS: Histopathological examination revealed high-grade dysplasia or invasive cancer in 13 of VF leukoplakia. Seventy-one lesions were nondysplastic or low-grade dysplasia. Nonhomogenous color, irregular texture, and prominent thickness predicted malignancy with statistical significance (P < 0.05). AUC was 0.793, 0.793, and 0.679, respectively. Absence of a mucosal wave on laryngovideostroboscopy was significant for the detection of malignancy (P < 0.001) with an AUC of 0.927. The NBI diagnosis of horizontal vessel loops was significant with the highest AUC of 0.993. CONCLUSIONS: The comprehensive clinical evaluation of VF leukoplakia with laryngovideostroboscopy and NBI creates the opportunity to differentiate between low- and high-risk malignancy lesions. The perpendicular vascular pattern and the limited or absent mucosal wave appear to be the most powerful indicators of malignancy.

[Complications of percutaneous dilational tracheotomy--case report]. / Powiklania tracheotomii przezskórnej--opis przypadku.

INTRODUCTION: Tracheotomy is one of the most oldest operations in surgery. Percutaneous dilational tracheotomy has become increasingly popular as an alternative to standard tracheotomy over the last 30 years. It is particularly useful in patients who require prolonged mechanical ventilation, in the intensive care units. Percutaneous tracheotomy is a technique that can be performed at the bedside. It is cost effective, minimally invasive and can be done rapidly. CASE REPORT: We report a case of subglottic stenosis after percutaneous tracheotomy. A 56- year old obese man with chronic obstructive lung disease, insulin-independent diabetes, arterial hypertention and atrial fibrillation was admitted to the ENT Department because of stridor. 3 months earlier he had undergone percutaneous dilational tracheotomy due to respiratory failure. Laryngostroboscopy and a CT scan were performed, and showed 25 mm subglottic airway obstruction of the trachea. DISCUSSION: The incidence of asymptomatic subglottic tracheal stenosis after decannulation of percutaneous tracheotomy patients has been reported in over 25% with to 2% case reports of symptomatic stenosis. Although percutaneous dilational tracheotomy is considered as a safe procedure, there is a high incidence of tracheal stenosis.

Voice Profile Recovery and Quality of Life Changes After Microdirect Laryngoscopy in Three Categories of Glottis Lesions: Benign, Precancerous, and Malignant.

The aim of the study was comparison of voice and life quality after microdirect laryngoscopy in three patient histopathological categories: benign, precancerous, and malignant glottic lesions. A totalnof 137 patients treated with microdirect laryngoscopy were included in the study. Each patient was evaluated with a multidimensional protocol before and 3, 6, and 12 months after treatment. Final 1-year evaluations were achieved in 74.5% (102). The assessment included laryngovideostroboscopy (LVS), perceptual (GRBAS) grading, aerodynamic measures including maximum phonation time and phonation quotient and acoustic measurements (Kay Elemetrics Multi-Speech program), Voice Handicap Index (VHI), Voice-Related Quality of Life questionnaire; and World Health Organization Quality of Life Scale-Brief Version (WHOQoL-BREF). An improvement in mean value of LVS ratings was obtained in all three groups; however, only in benign lesion group was it consistently statistically significant for each time period (P < 0.001). Perceptual evaluation revealed significant improvement of G, R, and B parameters in benign lesions for each time period. In malignant neoplasms R and B parameters improved 3 and 6 months post microsurgery. In patients with benign lesions the maximum phonation time increased, but the improvement was significant only after 3 months. The acoustic parameters improved in all three groups. VHI significantly improved in patients with benign lesions after 3 and 12 months. VHI in the malignant neoplasm group significantly worsened on the first follow-up visit. Considering quality of life (QoL) results, only in patients with benign lesions was there a significant improvement in overall assessment of their QoL and general health.

Contemporary Commercial Music Singing Students-Voice Quality and Vocal Function at the Beginning of Singing Training.

OBJECTIVE: The purpose of this study was to assess the voice quality and the vocal tract function in popular singing students at the beginning of their singing training at the High School of Music. DESIGN: This is a retrospective cross-sectional study. METHODS: The study consisted of 45 popular singing students (35 females and 10 males, mean age: 19.9 ± 2.8 years). They were assessed in the first 2 months of their 4-year singing training at the High School of Music, between 2013 and 2016. Voice quality and vocal tract function were evaluated using videolaryngostroboscopy, palpation of the vocal tract structures, the perceptual speaking and singing voice assessment, acoustic analysis, maximal phonation time, the Voice Handicap Index, and the Singing Voice Handicap Index (SVHI). RESULTS: Twenty-two percent of Contemporary Commercial Music singing students began their education in the High School, with vocal nodules. Palpation of the vocal tract structure showed in 50% correct motions and tension in speaking and in 39.3% in singing. Perceptual voice assessment showed in 80% proper speaking voice quality and in 82.4% proper singing voice quality. The mean vocal fundamental frequency while speaking in females was 214 Hz and in males was 116 Hz. Dysphonia Severity Index was at the level of 2, and maximum phonation time was 17.7 seconds. The Voice Handicap Index and the SVHI remained within the normal range: 7.5 and 19, respectively. Perceptual singing voice assessment correlated with the SVHI (P = 0.006). CONCLUSIONS: Twenty-two percent of the Contemporary Commercial Music singing students began their education in the High School, with organic vocal fold lesions.

Multiparametric Assessment of Voice Quality and Quality of Life in Patients Undergoing Microlaryngeal Surgery-Correlation Between Subjective and Objective Methods.

The aim of the study was to estimate voice defect and the quality of life deterioration in patients with different laryngeal pathologies qualified for microsurgery treatment. The results of videolaryngostroboscopy (VLS), perception, aerodynamics, acoustics, Dysphonia Severity Index, Voice Handicap Index (VHI), and the World Health Organization Quality of Life Scale Brief Version before microsurgery were analyzed. There were 151 patients enrolled in the study. There were 86 patients in group 1 (benign lesions), 34 in group 2 (premalignant conditions), and 31 in group 3 (malignant neoplasms). Significant differences were found in the mean values of VLS between group 1 and group 3 (P = 0.001), maximum phonation time between group 1 and group 2 (P = 0.001), and between group 2 and group 3 (P = 0.04), men's fundamental frequency between group 1 and group 2 (P = 0.03), and between group 1 and group 3 (P = 0.01), and shimmer between group 1 and group 3 (P = 0.01). The correlation between the methods was analyzed, and there was a strong to moderate correlation between VLS and perception (r = 0.57-0.73) in group 1 and group 2. The jitter and shimmer correlated moderately with perception in group 1: grade of hoarseness (G) (r = 0.52 and r = 0.57, respectively), breathiness (B) (r = 0.58), and asthenia (A) (r = 0.57 and r = 0.53, respectively). In group 3, the strongest correlation was observed between maximum phonation time and phonation quotient and G (r = 0.52; 0.58), B (r = 0.54; 0.55), and strain (S) (r = 0.63; 0.72). The VHI results and life quality outcomes were not significantly different between the groups. The VHI did not correlate with any voice measure method.

Narrow band imaging for risk stratification of glottic cancer within leukoplakia.

BACKGROUND: This study investigates relevance of narrow band imaging (NBI) in stratifying risk of malignant transformation within leukoplakia. METHODS: We conducted a prospective analysis that included 62 patients with 91 changes of leukoplakia on vocal folds. The NBI was obtained before microsurgery. Categorization of the lesion as benign was made when vessels of surrounding epithelium were classified as type I, II, or IV according to Ni classification. If there were visualized intraepithelial papillary capillary loops of type V, the lesion was classified as malignant. Results were compared to the histopathological diagnosis. RESULTS: The NBI assessment classified 75 lesions (82.4%) as benign and 16 (17.6%) as malignant. Histopathological results revealed the diagnosis of no dysplastic changes or low grade dysplasia in 77 cases (84.6%). Another 14 cases (15.4%) occurred with high-grade dysplasia, carcinoma in situ, and invasive cancer. Sensitivity, specificity, and accuracy of NBI in predicting malignancy within leukoplakia were 100%, 97.4%, and 97.8%, respectively. The kappa index was 0.92 (95% confidence interval 81.1%-100%). CONCLUSION: The noninvasive procedure of an NBI endoscopy may be recommended as an accurate method in predicting the risk of malignant transformation within the vocal fold leukoplakia and, therefore, would be useful in the clinic for planning the patient's therapy.

Narrow band imaging versus laryngovideostroboscopy in precancerous and malignant vocal fold lesions.

BACKGROUND: This is a comparative analysis of the diagnostic accuracy of narrow band imaging (NBI) and laryngovideostroboscopy (LVS) in the assessment of premalignant and malignant vocal fold lesions. METHODS: A prospective analysis was performed on 105 consecutive patients with vocal fold lesions. The NBI and LVS were obtained before the microsurgery. RESULTS: The NBI and LVS showed no significant differences in identifying premalignant and malignant pathologies. However, in analysis restricted to identification of only malignant lesions, the specificity (88.9% vs 20.6%), accuracy (90.5% vs 51.4%), and positive predictive value (PPV; 84.8% vs 45.1%) were significantly higher for NBI (P value < .001; .015; and .045, respectively). A comparison of LVS scored results relative to each NBI type revealed statistically significant differences (P < .001). A moderate positive correlation between NBI and LVS was demonstrated (P = .54). CONCLUSION: The NBI and LVS are useful, complementary tools in evaluating early potential vocal fold malignancies. The NBI was superior to LVS on several statistical analyses.

Severity of dysphonia in patients during first days after iatrogenic injury.

INTRODUCTION: The most common cause of vocal fold paralysis (VFP) is iatrogenic injury. Patients with symptoms of VFP present to the specialist after a couple of weeks or even months since the onset of symptoms. In the literature, the data regarding speech impairment during the first days after a iatrogenic injury is lacking. AIM: to evaluate the quality of voice during first days of vocal fold paralysis following a iatrogenic injury. MATERIALS AND METHODS: Twenty-five patients with iatrogenic vocal fold paralysis who presented for phoniatric consultation at the Department of Otolaryngology of the Medical University of Warsaw between May 2015 and December 2016 were enrolled in the study. The patients were examined 1-2 days since the onset of speech deterioration. In all patients, laryngeal videolaryngostroboscopy was performed, based on which the following were assessed: vocal fold mobility, mucosal wave, phonation closure, simultaneity and amplitude of vocal fold vibration. Acoustic analysis was performed, and the following acoustic parameters were evaluated: DSI, F0, Shimmer, Jitter, NHR. Also, the maximal phonation time of [a] sound (MPT a) was assessed and the voice perception analysis with the GRBAS scale was performed. The patients self-evaluated their voice using a 10-point VAS scale. RESULTS: Based on the videolaryngostroboscopy, phonatory insufficiency and asymmetrical vocal fold vibration were observed. On perception assessment with GRBAS scale, we noticed slight to mild degree hoarseness, breathiness of sound and weakened voice. In majority of patients, the maximal phonation time of [a] sound was significantly reduced. All patients showed abnormal acoustic parameters. None of them rated their voice as perfectly normal on VAS scale.

Medialization thyroplasty in glottis insufficiency due to unilateral vocal fold paralysis and after laser cordectomies - preliminary report.

Medialization thyroplasty (type I) is surgical procedure performed on the thyroid cartilage. The major indication for this surgery is significant glottis insufficiency due to unilateral vocal fold paresis. However the proce¬dure is also performed after vocal fold resections during cordectomy. THE AIM: The evaluation of voice results in patients after medialisation throplasty. MATERIAL AND METHODS: In Otolaryngology Department of Medical University of Warsaw there were performed so far 8 thyroplasty procedures under local anaesthesia with implantation of medical silicon protesis. 6 patients had unilat¬eral vocal fold paresis and the rest two underwent in the past laser cordectomy due to T1a vocal carcinoma. RESULTS: There were no complications during and post the surgery. The follow up examination in 1st , 3rd, 6th i 12th months postoperatively revealed for all patients significant improvement of glottal closure in laryngeal videostrobos¬copy. The voice quality improved both in perceptual evaluation (GRBAS scale) and acoustic analysis (F0, jitter, shim¬mer, NHR) in both patients groups. However the rate of improvement was much more significant in group with uni¬lateral vocal fold paresis. In all patients the maximum phonation time (MPT) increased. The self-evaluation of voice quality with Voice Handicap Index questionnaire confirmed also individual improvement. CONCLUSIONS: The speech rehabilitations is not successful in each patient with glottis insufficiency. The medialisation thyroplasty remains the standard procedure for permanent improvement of voice quality in those cases.

The predictive value of videostroboscopy in the assessment of premalignant lesions and early glottis cancers.

OBJECTIVE: To assess the sensitivity and specificity of larngovideostroboscopy (LVS) in the diagnosis of precancerous and malignant lesions of the vocal folds. MATERIAL AND METHODS: In 175 patients (128 men and 47 women), aged 19-88 years, mean age 61.5, who were admitted to the clinic with diagnosed premalignant conditions of vocal fold mucosa (leukoplakia, chronic hypertrophic inflammatory lesions) and thickening or tumor on the vocal fold, there was performed LVS before the laryngeal microsurgery. The LVS study included: localization of the leasion, movement of the vocal folds, mucosal wave, shape of glottis clousure, amplitude and symmetry of vocal fold vibration. In the evaluation, a point scale was applied for the individual functional parameters. The scale ranged from 0 to 14. Patients with impaired vocal fold motion or absent mucosal wave were positive on LVS for malignant lesions. Those with limitted mucosal wave were positive on LVS for dysplastic lesions. The results were compared with the final histopathological examination and the sensitivity, specificity, accuracy, positive (PPV) and negative (NPV) predictive value were calculated. RESULTS: On the basis of histopathological examination, benign lesions (normal or inflammatory mucosa) accounted for 20% of diagnoses, hypertrophy and parakeratosis for 28%, low and middle grade dysplasia accounted for 10% and malignant lesions (high-grade dysplasia, pre-invasive cancer, Invasive cancer) was diagnosed in 42% of patients. The overall mean score for LVS was 4.5 and 8.0, respectively for benign and malignant lesions. Sensitivity, specificity, accuracy, PPV and NPV of LVS in detecting malignant lesions were respectively - 95.6%, 23.8%, 61.1%, 57.6% and 83.3% and in detecting both premalignant and malignant lesions were respectively - 90.7%, 31.4%, 78.9%, 84.1% and 45.8%. CONCLUSIONS: Because of the high sensitivity of LVS in detecting precancerous and malignant lesions, this method is a very good tool for screening of pathology within the larynx.