Laryngeal findings and acoustic changes in light cigar smokers.

UNLABELLED: The aim of this prospective study was to look at the laryngeal findings and acoustic changes in light cigar smokers in comparison to nonsmokers, in the setting of a voice clinic. A total of 22 cigar smokers and 19 nonsmokers used as controls were enrolled in the study. Demographic data included age, number of years smoking, number of cigars per week, history of allergy, and history of reflux. The confounding effects of allergy and reflux were accounted for in the control group. Subjects underwent laryngeal endoscopy and acoustic analysis. On laryngeal endoscopy, the most common laryngeal finding was thick mucus. There was no significant difference in the prevalence of any of the laryngeal findings in cigar smokers vs. CONTROLS: In comparison with the control group, both the fundamental frequency and habitual pitch were significantly lower in cigar smokers (p value = 0.034 and 0.004, respectively). We conclude that cigar smokers have lower fundamental frequency and habitual pitch compared to nonsmokers.

Laryngeal findings and acoustic changes in hubble-bubble smokers.

The purpose of our investigation was to evaluate the laryngeal findings and acoustic changes in hubble-bubble smokers. A total of 42 subjects with history of hubble-bubble smoking were recruited for this study. A corresponding group with a history of cigarette smoking and controls were matched. All subjects underwent laryngeal video-endostroboscopic evaluation and acoustic analysis. In the hubble-bubble smoking group, 61.9% were males. The average age was 30.02 +/- 9.48 years and the average number of years of smoking was 8.09 +/- 6.45 years. Three subjects had dysphonia at the time of examination. The incidence of benign lesions of the vocal folds in the hubble-bubble group was 21.5%, with edema being the most common at 16.7% followed by cyst at 4.8%. The incidence of laryngeal findings was significantly higher in the hubble-bubble group compared to controls. In the cigarette-smoking group, the most common finding was vocal fold cyst in 14.8% followed by polyps in 7.4%, and edema, sulcus vocalis and granuloma. These findings were not significantly different from the hubble-bubble group except for the thick mucus, which was significantly higher in the latter. There were no significant changes in any of the acoustic parameters between hubble-bubble smokers and controls except for the VTI and MPT, which were significantly lower in the hubble-bubble group. In comparison with the cigarette-smoking group, hubble-bubble smokers had significantly higher Fundamental frequency and habitual pitch (p value 0.042 and 0.008, respectively). The laryngeal findings in hubble-bubble smokers are comparable to cigarette smokers. These laryngeal findings are not translated acoustically, as all the acoustic parameters are within normal range compared to controls.

Primary malignant melanoma of the trachea.

Tracheal melanomas represent the rarest type of extracutaneous melanomas. The clinical manifestation is similar to other tracheal tumors and ranges from symptoms of airway obstruction such as dyspnea and stridor to other nonspecific symptoms such as hoarseness, cough and hemoptysis. Bronchoscopy is required to draw the origin of the lesion biopsy is needed to establish histologic diagnosis. Treatment consists of either palliative surgery aiming at restoring the airway or tracheal resection and end to end anastmosis. We would like to present here below a rare case of tracheal melanoma and discuss the various diagnostic and therapeutic means.

How frequent is adenoid obstruction? Impact on the diagnostic approach.

BACKGROUND: The rate of adenoidectomy has increased over the past years. The initial assessment methods are sometimes overused. The aims of the present study were to evaluate the use of these methods, estimate the incidence of obstructive adenoid and refine the approach to this problem. METHODS: This is a prospective observational study. All children referred for chronic nasal obstruction had anterior rhinoscopy and a routine physical examination. The palatal airway was assessed on lateral nasopharyngeal roentgenograms when these were requested. The degree of obstruction was measured on endoscopy when performed. The efficacy of each method was evaluated, as well as its necessity. The incidence of obstructive adenoid was calculated. RESULTS: A total of 213 patients aged 6 months-13 years (mean 5.1 years, median 4 years) were enrolled. One hundred patients had radiological evaluation while 65 had endoscopy during their initial assessment. Endoscopy was the most efficacious in reaching a proper diagnosis (100%) followed by clinical assessment (84.2%), and radiology (75%). The necessity of endoscopy, however, was 63.1% and that of radiology 63% within their respective groups. The incidence of obstructive adenoid was 57.7% (1.6% choanal). Clinical assessment, therefore, could have been sufficient in 41.8%, radiology in 44.1%; and endoscopy in 12.2% of the studied population to reach a proper diagnosis. CONCLUSIONS: Clinical assessment is crucial to evaluate chronic nasal obstruction. The lateral nasopharyngeal roentgenogram provides objective evaluation of the adenoid but its limitations should be considered. Nasal endoscopy may substitute for radiology but should be reserved for unusual cases.

Vocal symptoms and acoustic changes in relation to the expanded disability status scale, duration and stage of disease in patients with multiple sclerosis.

Vocal symptoms and acoustic measures of patients with multiple sclerosis (MS) are investigated in relation to the duration of the disease, stage of the disease and the degree of disability. Eighty-two patients were enrolled in this study (40 MS, 42 controls). In the MS group, the most common vocal symptoms were vocal breaks and vocal fatigue present in 10. None of the patients in the control group had voice breaks. In the male group, there was a significant decrease in the fundamental frequency, habitual pitch and maximum phonation time with a significant increase in Shimmer. In the female group, there was a significant decrease in the maximum phonation time only. There was no correlation between vocal symptoms and acoustic measures versus duration of the disease and extent of disability except for vocal fatigue which significantly associated with EDSS (expanded disability status scale) score. Patients with MS may develop vocal symptoms irrespective of the EDSS score, duration and stage of the disease. Vocal fatigue and vocal breaks are more common than hoarseness.

Vocal changes following radiotherapy to the head and neck for non-laryngeal tumors.

To investigate vocal changes in patients following the neck irradiation for non-laryngeal tumors sparing the glottic region. Fifteen patients were enrolled for the study. Phonatory effort and voice evaluation were reported. Perceptual evaluation and acoustic analysis were performed. Men/women ratio was 6/9. The mean age was 54 years with a range from 24 to 84. The most common primary site of tumor was the nasopharynx and tongue. The mean phonatory effort was significantly greater in the irradiated group versus controls (0.54 vs. 0.08 with a P value 0.01). Fifteen percent reported their voice as being poor and almost 85% as being fair. All the parameters of the GRABS perceptual evaluation were significantly worse in the irradiated group. There were no statistically significant differences between all the acoustic variables in both groups except for an decrease in the Habitual pitch in the irradiated patients. Radiation therapy to head and neck region can affect voice even if the radiation beams spare the vocal folds.

Killer cell immunoglobulin-like receptor (KIR) genotypes in patients with recurrent tonsillitis.

AIMS: This study represents the first report on the distribution of killer cell immunoglobulin-like receptor (KIR) genotype among recurrent tonsillitis patients. We recruited 34 Lebanese pediatric patients diagnosed with recurrent tonsillitis and had their DNA typed using sequence-specific primer technique for the presence of 16 KIR loci. RESULTS: We observed that 25 different KIR genotypes were present similar to the general control population with the same KIR gene content. There was no statistically significant difference in the distribution of the activating and inhibitory KIR genes between the two categories. Like in the general control population, we noted a predominance of the AB genotype; however, the KIR genotypic distribution among the tonsillitis patients was much more heterogeneous with even new genotypes not reported in the control group. CONCLUSIONS: Although the sample size is small, this first study observes an interesting heterogeneous KIR gene profile in recurrent tonsillitis that warrants larger and further research in the area for the true biological and clinical significance of this observation.

Vocal technique in a group of Middle Eastern singers.

OBJECTIVE: We aimed to report on the vocal technique in a group of Middle Eastern singers. SUBJECTS AND METHOD: A total of 78 Middle Eastern singers were assessed. Demographic data included age, gender, training status and number of years of singing. All singers had laryngeal videoendostroboscopy. Description and grading of posture, tension, type of breathing, type of phonation, resonance and tone quality are reported. Proportions and means (+/- SD) were used to describe the sample for categorical and continuous variables respectively. Associations between endostroboscopy and voice technique were determined by chi(2) or Fisher's exact test. RESULTS: There were 43 males and 35 females with an age ranging between 16 and 32 years and a mean of 23 +/- 4 years. Of these, 88.5% were nontrained singers and 50% had more than 3 years of singing experience. Around 80% of Middle Eastern singers rely on either thoracic or clavicular breathing. Posture was average in 68% and moderate tension was present in 63% of the cases. Two thirds had a bright voice, 61% were hypernasal and almost 46% had a strained phonation. There was a significant correlation between posture and tension. CONCLUSION: Middle Eastern singing relies more on thoracic breathing and is characterized by tension.

Formant frequencies in Middle Eastern singers.

PURPOSE: This work was conducted to describe the formant frequencies in a group of Middle Eastern singers and to look for the presence of the singer's formant described in operatic singers. MATERIAL: A total of 13 Middle Eastern singers were enrolled in this study. There were 5 men and 8 women. METHOD: Descriptive analysis was performed to report the various formants (F1, F2, F3, and F4) in both speaking and singing. The Wilcoxon test was used to compare the means of the formants under both conditions. RESULTS: For both sexes combined, for the /a/ vowel, F1 singing was significantly lower than F1 speaking (P = .05) and F3 singing was significantly higher than F3 speaking (P = .046). For the /u/ vowel, only F2 singing was significantly higher than F2 speaking (P = .012). For the /i/ vowel, both F2 and F3 singing were significantly lower than F2 and F3 speaking, respectively (P = .006 and .012, respectively). There was no clustering of the formants in any of the Middle Eastern sung vowels. CONCLUSION: Formant frequencies for the vowels /a/, /i/, and /u/ differ between Middle Eastern singing vs speaking. There is absence of the singer's formant.

Status of the remaining parotid duct and gland following superficial parotidectomy.

The changes in Stensen's duct and remaining parotid tissue following superficial parotidectomy have not been studied previously. The aim of this clinical case control study is to describe these changes using sialography and CT-sialography techniques. Fourteen superficial parotidectomy cases underwent parotid sialography bilaterally. CT sialography was also done. Stensen's duct was patent in 11 cases (79%), and non-patent in three cases (21%). Its angle in relation to our reference line was 20 degrees in operated cases versus 37 degrees for the non-operated cases. Following superficial parotidectomy, the remaining parotid tissues usually remain functional and retain drainage through Stensen's duct. Furthermore, superficial parotidectomy changes the direction of this duct. Parotid sialography and CT sialography can still be used to study the status of remaining parotid tissue following superficial parotidectomy. The post-surgical changes should be reviewed with care before interpreting these studies.

Can zinc be an adjuvant therapy for juvenile onset recurrent respiratory papillomatosis?

OBJECTIVES: To report a severe case of juvenile onset recurrent respiratory papillomatosis (JORRP) controlled by zinc replacement therapy. To review the contemporary adjuvant therapies used in JORRP. METHODS: The trial of zinc was described in terms of its effect on the inter-surgical interval, site score and clinical symptoms. Long-term follow-up with dose adjustment was detailed. Articles reporting trials of adjuvant therapies over the past 20 years were reviewed in terms of regimen used, mode of assessment, side effects and final outcome. RESULTS: Zinc was effective in decreasing the severity of the disease, the rate of relapse and the need for surgery. There was an obvious relation between the dose used and the degree of improvement. Prolonged treatment seems to be needed to sustain the positive effect. No side effects were noticed over a 45-month follow-up period. The literature does support the role of zinc in modulating the immune system. Eight adjuvant therapies were reviewed as published in 40 reports. Interferon was the most used substance. It is definitely effective but often associated with relapse upon discontinuation. The effect of cidofovir was favorable yet not dramatic as initially expected. Other less commonly used therapies showed humble effects. The HspE7 vaccine seems to be promising awaiting further trials. CONCLUSIONS: Zinc replacement therapy may benefit JORRP patients with zinc deficiency and should be investigated in more cases. Several adjuvant therapies are available for use in JORRP. They are generally beneficial though mostly not curative.

The transvestibular approach: a new horizon in rhinoplasty.

The lower lateral cartilage has intricate anatomical elements that define shape, projection, and relations with other nasal tip structures. Good exposure of the lower lateral cartilages is an essential step in rhinoplasty. Conservative surgical techniques are essential to get natural long-term results. Different endonasal techniques have limitations in visualizing the lateral and intermediate crura, predisposing patients to asymmetries in reduction and rearrangement. In this article, a new endonasal rhinoplasty approach is described. Using a marginal incision, the vestibular skin is elevated and the endonasal surface of the lower lateral cartilage is exposed, permitting precise reduction, rearrangement, and placement of interdomal suspension sutures and lateral crural spanning sutures. This article discusses the surgical steps and results of my experience using this approach. This transvestibular approach is a new, dependable, and simple method that should allow rhinoplastic surgeons to perform this operation with predictable results and limited variables.

Does Helicobacter pylori colonize the nasopharynx of children and contribute to their middle ear disease?

OBJECTIVE: There is growing interest in studying the presence of HP in the upper aerodigestive tract. It was shown in several pilot studies that it colonizes the area, while other authors found no evidence of its presence there and a third group of authors believed that it had only a transient presence there. In this study we investigated a possible role for HP in middle ear disease in children. MATERIAL AND METHODS: Consecutive patients undergoing myringotomy and adenoidectomy for chronic otitis media with effusion or recurrent otitis media were enrolled. Middle ear fluids were cultured on three types of agar plate (Brucella + laked horse blood; Brucella + sheep blood; and chocolate). A double polymerase chain reaction (PCR) was run to detect urease-C and adhesion subunit genes. Rapid urease enzyme testing and PCR were used on the adenoid specimens. Parents were interviewed regarding symptoms suggestive of gastroesophageal reflux in their children. RESULTS: Eighteen patients were enrolled in the study (mean age 4.4 years; age range 3-8 years) with an equal gender distribution. All 28 middle ear fluid cultures were negative in all 3 media. Twenty-one of the 28 samples contained DNA, yet PCR revealed that none of them belonged to HP. Ten of the 13 adenoid specimens obtained were positive on rapid urease testing, but none on PCR. Seven of the 18 patients had at least 1 symptom suggestive of gastroesophageal reflux during the 6 months preceding the study but this did not have an impact on any of the results. CONCLUSION: There was no evidence from this study that Helicobacter pylori (HP) colonizes the nasopharynx of children with middle ear disease, whether dyspeptic or not. There is also no apparent role for this bacterium in middle ear pathology.

When bone becomes marble: Head and neck manifestations of osteopetrosis.

Osteopetrosis is a genetically determined bone disease resulting from malfunction of osteoclastic activity, leading to excessive deposition of immature bone. This may result in complete agenesis of the paranasal sinuses, oral complications and multiple cranial neuropathies. The case of a 12-year-old boy with osteopetrosis is presented.

Is Helicobacter pylori really present in the adenoids of children?

Adenoid hyperplasia is a common cause of nasal obstruction in the pediatric age group. Recently, the adenoids were shown to harbor Helicobacter pylori (HP) based only on the rapid urease test (RUT). We conducted this pilot study to identify the presence of HP in the adenoids histologically and assess the reliability of both the RUT and histology in detecting HP in an extragastric location, using nested (two-steps) polymerase chain reaction (nPCR). Consecutive patients undergoing adenoidectomy for obstructive adenoid hyperplasia were enrolled. Adenoid specimens were subjected to the RUT. Histological sections stained with hematoxylin and eosin, Giemsa and Warthin-Starry were examined. We then used nPCR to detect the presence of HP in the studied specimens. Twenty-five patients (3-10 years; mean of 5.5 years) were enrolled. Twenty-one (84%) adenoids were positive by the RUT. Seventeen (68%) had bacteria on histological sections; four (16%) contained HP-like organisms. However, all specimens were negative by nPCR. No patient had a history of symptoms suggestive of laryngopharyngeal reflux within 6 months of the study. In conclusion, the children enrolled in this study did not have HP in their adenoids. High false positive results can occur with the RUT when used on adenoid tissues. It is not possible to rely solely on morphology to detect HP in an extragastric location. The nPCR remains the best way to identify HP accurately, but does not imply its presence in an active role.

The effect of hemodialysis on voice: an acoustic analysis.

Because respiration is part of the well-coordinated process necessary for phonation, this study was conducted with the purpose of analyzing the effect of chronic hemodialysis on voice characteristics of patients with chronic renal failure. A total of 57 patients were recruited for the study, including 31 males and 26 females ranging in age from 16 to 85 years. Patients underwent evaluation of their voice directly before and after hemodialysis using the Kay Elemetric VISI Pitch (Model 330; Kay Elemetric Corporation, Lincoln Park, New Jersey). The vocal acoustic parameters studied include habitual pitch, pitch range, relative average perturbation, shimmer, noise-to-harmonic ratio, voice turbulence index, maximum phonation time, and voice energy. The data were analyzed using the paired t-test for the total sample and the nonparametric test for the female and male subgroups. The total sample analysis showed a statistically significant increase in the habitual pitch after the hemodialyis (p < 0.05), with a borderline increase in the pitch range and maximum phonation time (p < 0.10). In the female group, there was a statistically significant increase in the habitual pitch and a borderline increase in the relative average perturbation. In the male group, there was a significant increase in the habitual pitch with a borderline increase in maximum phonation time. Discussion of the after-mentioned results is presented.

Kikuchi Fujimoto disease: case report and review of the literature.

We report a case of Kikuchi Fujimoto disease in a 34-y-old woman, with emphasis on the clinical picture and pathologic findings.