Bedside preoperative predictors of difficult laryngeal exposure in microlaryngeal surgery.

PURPOSE: Successful microlaryngeal surgery relies on an adequate laryngeal exposure. Recognizing the likelihood of challenging exposure prior to microlaryngeal surgery may assist in selecting the appropriate surgical approach and even prompt consideration of alternative treatment options. We aim to apply the mini-Laryngoscore, a preoperative assessment tool, to our study population and incorporate novel variables to optimize the prediction model. METHODS: This single-center prospective cohort study included 80 consecutive patients undergoing elective microlaryngeal surgery, from January 1, to June 30, 2023. Each patient underwent a presurgical evaluation of 15 parameters and an intraoperative scoring of the anterior commissure visualization. These parameters were assessed for their association with difficult laryngeal exposure, using multiple logistic regression analysis. We created a novel prediction model for DLE and compared it with the existing model, the mini-Laryngoscore. RESULTS: Out of 80 patients, 24 (30%) patients had difficult laryngeal exposure, including 3 cases (3.8%) in which visualization of the anterior commissure was not possible. A large neck diameter (OR, 1.4; CI 1.1-1.9) and the presence of upper teeth (OR, 8.9; CI 1.3-62.8) were independent risk factors for a difficult laryngeal exposure, while a larger interincisors gap was the only independent protector factor (OR, 0.3; CI 0.1-0.8). The logistic regression model combining these three independent risk factors displayed a high discriminative value AUC = 0.89 (CI 0.81-0.97). The predictive performance of the mini-Laryngoscore was 0.73 (CI 0.62-0.85). CONCLUSION: Combining two parameters from the mini-Laryngoscore (upper jaw dental state and interincisors gap distance) with neck circumference measurement can accurately predict the risk of difficult laryngeal exposure.

Validation of an AI-assisted Treatment Outcome Measure for Gender-Affirming Voice Care: Comparing AI Accuracy to Listener's Perception of Voice Femininity.

OBJECTIVES: There is currently a lack of objective treatment outcome measures for transgender individuals undergoing gender-affirming voice care. Recently, Bensoussan et al developed an AI model that is able to generate a voice femininity rating based on a short voice sample provided through a smartphone application. The purpose of this study was to examine the feasibility of using this model as a treatment outcome measure by comparing its performance to human listeners. Additionally, we examined the effect of two different training datasets on the model's accuracy and performance when presented with external data. METHODS: 100 voice recordings from 50 cisgender males and 50 cisgender females were retrospectively collected from patients presenting at a university voice clinic for reasons other than dysphonia. The recordings were evaluated by expert and naïve human listeners, who rated each voice based on how sure they were the voice belonged to a female speaker (% voice femininity [R]). Human ratings were compared to ratings generated by (1) the AI model trained on a high-quality low-quantity dataset (voices from the Perceptual Voice Quality Database) (PVQD model), and (2) the AI model trained on a low-quality high-quantity dataset (voices from the Mozilla Common Voice database) (Mozilla model). Ambiguity scores were calculated as the absolute value of the difference between the rating and certainty (0 or 100%). RESULTS: Both expert and naïve listeners achieved 100% accuracy in identifying voice gender based on a binary classification (female >50% voice femininity [R]). In comparison, the Mozilla-trained model achieved 92% accuracy and the previously published PVQD model achieved 84% accuracy in determining voice gender (female >50% AI voice femininity). While both AI models correlated with human ratings, the Mozilla-trained model showed a stronger correlation as well as lower overall rating ambiguity than the PVQD-trained model. The Mozilla model also appeared to handle pitch information in a similar way to human raters. CONCLUSIONS: The AI model predicted voice gender with high accuracy when compared to human listeners and has potential as a useful outcome measure for transgender individuals receiving gender-affirming voice training. The Mozilla-trained model performed better than the PVQD-trained model, indicating that for binary classification tasks, the quantity of data may influence accuracy more than the quality of the data used for training the voice AI models.

Acute vestibular syndrome and hearing loss mimicking labyrinthitis as initial presentation of multiple sclerosis.

Acute vestibular syndrome is most often caused by vestibular neuritis or stroke, although demyelinating diseases may be responsible for 4% of all AVS episodes. The authors present the case of a previously healthy 17-year-old female patient complaining of spontaneous vertigo and right-sided hearing loss. Otoneurological examination suggested a peripheral vestibular cause and video head impulse test revealed a reduced vestibulo-ocular reflex gain. The presence of sensorineural hearing loss raised the suspicion of a central cause and prompted imaging evaluation. A brain MRI evidenced demyelinating lesions in the right middle cerebellar peduncle and the patient was ultimately diagnosed with Multiple Sclerosis.

Management of laryngeal candidiasis: an evidence-based approach for the otolaryngologist.

PURPOSE: The authors aim to review available reports regarding laryngeal candidiasis and describe the existing evidence on the demographics, clinical manifestations, diagnosis, therapeutic options, and outcomes of this infection. METHODS: A review of articles on laryngeal candidiasis was conducted using PubMed® database from its inception through July 2019. RESULTS: Patients were mainly females presenting with complaints of dysphonia and associated gastroesophageal reflux history or inhaled corticosteroids use; although local predisposing factors were common, most patients were immunocompetent. The main anatomical affected subsite was the glottis with the presence of leukoplastic lesions. The diagnostic approach remains controversial, since some authors recommend prompt lesion biopsy and others rely on empirical antifungal treatment that showed effective results regarding symptoms and lesions resolution. CONCLUSION: Laryngeal Candida infection is thought to be a rare condition, with limited available literature. The correct diagnosis is difficult for the otolaryngologist and a high level of suspicion is required. The authors emphasize the need to include this condition into the differential diagnosis in patients with predisposing factors presenting with suspected lesions. In addition, the conservative diagnostic approach with antifungal treatment seems to provide effective outcomes, although comparative clinical studies between diagnostic options are lacking.

The effects on the acoustic parameters and auditory-perceptive characteristics of voice in children submitted to adenoidectomy with or without tonsillectomy.

OBJECTIVES: To analyse the possible changes on the acoustic parameters and auditory-perceptive characteristics of children's voice after adenoidectomy with or without tonsillectomy. METHODS: Prospective cohort study of children aged 5-12 years at one month before surgery (t0) and one (t1), three (t3) and six (t6) months after adenoidectomy with or without tonsillectomy. On each assessment the acoustic parameters (fundamental frequency, jitter %, shimmer % and harmonics-to-noise ratio) and auditory-perceptive analysis (nasal resonance, loudness, pitch, GRBAS scale and maximum phonation time) were recorded. RESULTS: A total of 51 children were considered for data analysis. Nasal resonance revealed a significant decrease in the number of cases with hyponasality, from 86.3% at t0 to 12.8% at t1 (p < 0.001), 2.3% at t3 (p < 0.001) and 2.8% at t6 (p < 0.001). This improvement was maintained during the late follow-up time with no significant difference on nasal resonance between t0 and t3 (p = 0.250) and t3 and t6 (p = 0.250). All children with alteration on the GRBAS scale before the procedure showed a normal voice quality after the surgery. Regarding the acoustic parameters none showed a significant change with the surgery. CONCLUSIONS: The results suggest that adenoidectomy with or without tonsillectomy is a safe procedure concerning voice alterations and can improve voice quality and nasal resonance in a sustained manner.

The concepts and applications of tissue engineering in otorhinolaryngology.

INTRODUCTION: Tissue engineering is a rapidly developing field that, making biological substitutes for the repair and regeneration of damaged tissues, will play an important role in the future of otorhinolaryngology. OBJECTIVE: In this article we explain the principles of regenerative medicine and its potential applications in Otorhinolaryngology. MATERIALS AND METHODS: The authors searched the published literature on this topic, chose relevant references, and extracted and systematized the data. RESULTS AND CONCLUSION: There are some exciting possibilities for future treatments in otorhinolaryngology applying the concepts of tissue engineering.

Validación de un instrumento de medición de cuidados según dependencia y riesgo en pacientes en terapia de hemodiálisis crónica / Validation of an Instrument to Measure Care According to Patient Dependency and Risk in Chronic Hemodialysis Therapy / Validação de um instrumento de medição de cuidados segundo dependência e risco em pacientes em terapia de hemodiálise crônica

Los instrumentos de categorización de pacientes son útiles porque permiten asignar los profesionales y recursos materiales de acuerdo con el perfil real de los pacientes. El objetivo del presente estudio es adecuar y validar el instrumento "Categorización de usuarios según dependencia y riesgo de cuidados" (CUDYR) en hemodiálisis crónica (HDC). El instrumento para pacientes en HDC se denominó "CUDYR-DIAL" y quedó constituido por dos subescalas y catorce ítems. La muestra estuvo conformada por 150 pacientes seleccionados en forma estratificada y al azar de cinco unidades de diálisis, a los que se les aplicó un total de 620 veces el CUDYR-DIAL. Se encontró que todos los ítems muestran correlaciones significativas (> 0,3) con el puntaje total obtenido en la escala, y que la confiabilidad de la escala se mantiene estable al ir eliminando uno a uno los ítems, fluctuando entre 0,86 y 0,87. La confiabilidad total del instrumento muestra un alfa de Cronbach de 0,878. Los usuarios en HDC presentan cuatro perfiles de dependencia (parcial a total) y riesgo (mediano a alto). Se concluye que el instrumento CUDYR-DIAL presenta una buena confiabilidad y constituye un aporte para la categorización de pacientes en HDC según dependencia y riesgo.

Instruments to categorize patients are useful because they make it possible to allocate professionals and material resources according to the actual profile of the patient. The purpose of this study was to adapt and validate an instrument known as "Categorizing Users According to Care Dependency and Risk" (CUDYR) in Chronic Hemodialysis (CHD). The instrument for patients in CHD was called "CUDYRDIAL" and was comprised of two subscales and fourteen items. The sample consisted of 150 patients from five dialysis units who were selected in a stratified manner, at random. The CUDYR-DIAL instrument was applied to them a total of 620 times. All the items showed significant correlations (> 0.3) with the total score on the scale, and the reliability of the scale remained stable when the items were eliminated one by one, fluctuating between 0.86 and 0.87. The overall reliability of the instrument shows a Cronbach's alpha of 0.878. Users in HDC fit four profiles in terms of dependency (partial to complete) and risk (medium to high). It was concluded the reliability of the CUDYR-DIAL instrument is good and it represents a contribution to categorizing patients according HDC dependence and risk.

Os instrumentos de categorização de pacientes são úteis porque permitem designar os profissionais e recursos materiais de acordo com o perfil real dos pacientes. O objetivo do presente estudo é adequar e validar o instrumento "Categorização de usuários segundo dependência e risco de cuidados" (CUDYR) em hemodiálise crônica (HDC). O instrumento para pacientes em HDC se denominou "CUDYRDIAL" e ficou constituído por duas subescalas e quatorze itens. A amostra foi conformada por 150 pacientes selecionados em forma estratificada e aleatória de cinco unidades de diálise, aos quais foi aplicado um total de 620 vezes o CUDYR-DIAL. Constatou-se que todos os itens mostram correlações significativas (> 0,3) com a pontuação total obtida na escala, e que a confiabilidade da escala se mantém estável ao ir eliminando um a um os itens, flutuando entre 0,86 e 0,87. A confiabilidade total do instrumento mostra um alfa de Cronbach de 0,878. Os usuários em HDC apresentam quatro perfis de dependência (parcial a total) e risco (médio a alto). Conclui-se que o instrumento CUDYR-DIAL apresenta uma boa confiabilidade e constitui uma contribuição para a categorização de pacientes em HDC segundo dependência e risco.

Softwares e hardwares de análise acústica da voz e da fala / Softwares and hardwares of acoustic analysis of voice and speech

Este artigo consiste numa revisão sobre as funcionalidades de softwares e hardwares de análise acústica da voz e da fala. Numa primeira fase foi feita a pesquisa e seleção daqueles que o mercado disponibiliza e que são mais utilizados pelos profissionais de saúde destas áreas. Em seguida, reuniram-se dados sobre os parâmetros mais pertinentes, no que respeita à análise da voz e da fala, síntese da fala e intervenção terapêutica. Recolheram-se também informações sobre as especificidades técnicas de cada um. Numa última fase foram reportados os softwares e hardwares mais indicados para as práticas clínica, pedagógica e científica...

Este artículo es una revisión de la funcionalidad del software y hardware acústico análisis del habla y voz. Inicialmente la investigación se llevó a cabo y seleccionar los que el mercado ofrece y que son utilizados principalmente por programas de salud profesionales en estas áreas. A continuación, los datos recogidos en los parámetros más relevantes en relación con el análisis del enfoque de voz y el habla terapêutica, síntesis del habla y intervención terapéutica. También se recopiló información sobre las características técnicas de cada uno. En la fase final se informó de software y hardware más adecuadopara la práctica clínica, educativa y científica...

This article consists in a review of the software and hardware features of acoustic analysis of voice and speech. Initially, it was reported the systems that are available in the market and the ones that are most commonly used by health care professionals in these areas. Then the most relevant parameters were gathered, for the analysis of voice and speech, speech synthesis and therapeutic intervention. It was also collected information about the technical specifi cations of each. Finally, the software and hardware that best suited pedagogical, clinical and scientific practices were reported...

Redes sociales y apoyo social percibido en pacientes en hemodiálisis crónica / Social Network and social support perceived in patientes in chronic hemodialysis

Estudio descriptivo, transversal, se realizó en el año 2001 y su objetivo fue conocer las características de las redes sociales y la percepción de apoyo social a una población de pacientes chilenos en hemodiálisis crónica. Se aplicó un instrumento elaborado por los autores a 84 pacientes con las siguientes características: 62 años de edad promedio,52 por ciento mujeres, 59,5 por ciento con dos años o más en diálisis. Los resultados muestran que el 97,5 por ciento vive acompañado, y de estos 83,5 por ciento vive con familiares. Un 72,2 por ciento son jubilados y dueñas de casa; sólo 27,8 realiza trabajo remunerado. El 59, por ciento declara tener amigos. Respecto a la percepción de apoyo social, el 92,4 por ciento refiere sentir que cuenta siempre con apoyo de su familia. De los pacientes que declaran tener amigos, el 55,7 por ciento siente que cuenta con su apoyo principalmente emocional. El 48 por ciento conoce instituciones de ayuda al enfermo renal, pero menos de la mitad recurre a ellas por ayuda económica. El 73 por ciento de los pacientes no siente que su enfermedad sea carga para sus familiares y el 90 por ciento se siente importante para ellos. Se concluye que la mayoría vive acompañada por familiares y se sienten apoyados y comprendidos por estos. Por otra parte, ni las amistades ni las instituciones de ayuda al enfermo renal son percibidas como una importante red de apoyo.

Primary columellar angiosarcoma: a case report.

Angiosarcoma of the head and neck, a rare malignancy, is associated with a high degree of invasiveness and poor survival. A high level of suspicion followed by histopathologic and immunohistochemical studies is warranted in order to arrive at a well-timed and accurate diagnosis. We report the case of a 56-year-old man who developed an unusually small neoplasm in the nasal columella. Rapid diagnosis allowed for simple treatment with surgical excision, a rare circumstance because most of these tumors require extensive surgery. Close long-term follow-up of patients with angiosarcoma of the head and neck is vitally important.

Apoyo social percibido por un grupo de pacientes sometidos a hemodiálisis crónica / Social support as perceived by patients under chronic haemodialysis

Estudio descriptivo, transversal exploratorio que pretende describir y analizar el Apoyo Social Percibido (ASP) por pacientes en hemodiálisis crónica (HDC) de la Unidad de Dialisis de la Pontificia Universidad Católica de Chile, y establecer si existe relación entre ASP y algunas de las características sociodemográficas y/o grado de independencia. Se definió ASP como la sensación psicológica de potencial disponibilidad de apoyo desde las redes sociales, en cuanto a entrega y disponibilidad de éste. Se aplicó la Escala de ASP de Zimer et al y el Indice de Katz a 75 pacientes, 50.7/100 mujeres y 82.7/100 adultos. Los resultados muestran que en general las mujeres perciben mayor apoyo social, principalmente de la familia y otros significativos. Los hombres perciben mayor apoyo de los amigos. Destaca el hecho de que en la medida que aumenta la edad y el número de años en HDC, disminuye la percepción de apoyo social.