Voice Therapy Efficacy in Pediatric Professional Voice Users With Vocal Fold Nodules: A Preliminary Study.

INTRODUCTION: Vocal fold nodules are the most common diagnosis in children with dysphonia. It is also frequently seen in professional voice users who uses their voice as an occupational tool. It can be caused by excessive or hyperfunctional use of the voice leading to phonotrauma. Children who learn the Quran by heart and recite it use their voices excessively and it causes voice problems. Voice therapy can play an important role in regulating phonotraumatic behaviors and improving voice quality, thereby replacing surgical intervention in some cases or acting as a complementary therapy to improve eventual therapeutic outcomes. OBJECTIVES: Our aim was to find the efficacy of group voice therapy compared to individual voice therapy in a group of pediatric professional voice users who go to the same religious school. METHODS: To determine group therapy efficacy, 24 students between the age of nine and 14, were evaluated and 16 of them had vocal fold nodules. Therapy sessions started with 16 students whose ages ranged from nine to 14 with a mean of 11,3 ± 1,4 years old. They were divided into two groups: group and individual therapy groups. Treatment comprised both direct and indirect voice therapy and lasted 6 weeks. Three of the participants were dropped out due to absence. Pre- and post-therapy measures were collected from 13 participants using perceptual evaluation, videostroboscopy measures, and the pediatric voice handicap index to determine the efficacy of group voice therapy compared to individual voice therapy with a group of pediatric professional voice users with vocal fold nodules. RESULTS: As a result of our study, eight of participants were found to have healthy vocal folds; the s/z ratio was significantly different between groups and within group therapy participants pre- and post-therapy. No significant difference was found in other parameters; except noise harmonic ratio (NHR). NHR was found significantly different between pre- and post-therapy when individual therapy and group therapy were compared. Although both treatments were shown to be beneficial in the management of vocal fold nodules, individual therapy was found to be somewhat more effective. CONCLUSION: In pediatric voice therapy, group therapy is an effective option to reach out to more individuals with voice disorders. It can be beneficial for time management and cost effectiveness in voice therapy.

Voice Onset Time in Patients Using Speech Prosthesis After Total Laryngectomy.

AIM: Our study was carried out to investigate the presence of known differences in voice and articulation quality after total laryngectomy. Patients provided phonation with tracheoesophageal speech prosthesis. We recorded patients' voice onset time (VOT) values - an important parameter of acoustic analysis. METHODS: The study included 18 patients with total laryngectomy who received valvular speech prosthesis via a primary or secondary tracheoesophageal fistula between 2009 and 2011 at the Istanbul Training and Research Hospital Otorhinolaryngology Clinic. Twenty healthy male volunteers were included as the control group. All subjects produced the /pa/, /ta/, /ka/ syllables three times, and the VOT values were determined by recording the voices on a computer. RESULTS: A total of 38 male patients, 18 of which were patients with total laryngectomy and tracheoesophageal speech prosthesis (aged between 46 and 75 years, mean: 59) and 20 controls (aged between 50 and 70 years, mean: 58), were included in the study. The age distribution of the groups did not differ statistically (P > 0.05). In the total laryngectomy and tracheoesophageal speech prosthesis group, the VOT mean values of the /ka/ syllable were significantly lower than the control group, whereas the /pa/ (P = 0.848) and /ta/ VOT mean values (P = 0.809) were similar between groups. CONCLUSIONS: This study shows that there is no significant difference in the articulation of voiceless plosives, except for the /ka/ sound, between patients using speech prostheses after total laryngectomy and controls. For standardization of these measured values and their use in clinical practice, it may be beneficial to support this study with studies that involve more patients and examine different indicators showing the quality and intelligibility of other voice characteristics.

Inflammatory complications of vocal fold injection with hyaluronic acid: a multiinstitutional study

Background/aim: This study aimed to assess the inflammatory adverse reactions of vocal fold injection laryngoplasty with hyaluronic acid. Materials and methods: This study was a retrospective chart review of patients who underwent vocal fold injection augmentation with HA injection from January 2005 to September 2016 in nine different institutions. Demographic data, indication for injection, injection techniques, types of injection material, settings of procedure, and complications were reviewed. The types of complication, onset time, and management of complications were also noted. Results: In all, 467 patients were identified. The majority of patients had been injected under general anesthesia (n = 382, 84.7%). For injection material, two different types of hyaluronic acid were used: hyaluronic acid alone or hyaluronic acid with dextranomer. Complications occurred in nine patients (1.9%). The majority of complications were inflammatory reactions (n = 7, 1.47%). Main symptoms were dysphonia and/or dyspnea with an onset of 0 h to 3 weeks after the hyaluronic acid injection. Three patients were hospitalized, one of which was also intubated and observed in the intensive care unit for 24 h. Systemic steroids and antibiotics were the main medical treatment in the majority of cases. There was no statistical difference in complication rates between patients who received hyaluronic acid and those who received hyaluronic acid with dextranomer (P = 0.220). Conclusion: Hyaluronic acid can be considered as a safe substance for the injection of vocal folds with a low risk of inflammatory reaction.

Olfactory and Gustatory Functions after Anterior Palatoplasty in Patients with Primary Snoring.

OBJECTIVE: In this study, we investigated the chemical senses (namely, olfaction), the 4 basic tastes, and umami taste in patients who underwent anterior palatoplasty (AP) for primary snoring. STUDY DESIGN: Prospective clinical study. SETTING: Multicenter, tertiary care hospitals. SUBJECTS AND METHODS: The age range of the 28 participants was 22 to 47 years, and all had been diagnosed with primary snoring by polysomnography. Orthonasal and retronasal olfactory testing was performed using the respective "Sniffin' Sticks." Tests for the 4 basic tastes (sweet, sour, salty, and bitter) and umami were performed before and 6 months after AP. RESULTS: The changes between the preoperative and postoperative results for the 4 basic tastes, which were applied to the anterior tongue region, were not significant. Retronasal olfactory function improved significantly 6 months after AP (P = .007). After AP, umami scores for the soft palate but not those of the anterior and posterior tongue decreased significantly (P = .001). CONCLUSION: Patients scheduled for AP should be properly informed about potential postoperative taste and flavor changes. They should also be warned of a possible loss of appetite due to a postoperative decrease in the umami taste sensation of the soft palate.

A novel muscle for electroneurography in peripheral facial palsy: occipitalis.

Electroneurography (ENoG) is one of the most objective tests in grading the damage and prediction of prognosis in peripheral facial palsy (PFP). We aimed to determine temporal changes of ENoG recorded over occipitalis muscle in acute idiopathic PFP. Consecutive 21 patients with unilateral acute idiopathic PFP and age- and sex-matched 15 healthy volunteers were included in the study. Nasal and occipital ENoG values were recorded once in the control group and the same procedure was repeated daily between the second and eight days of the disorder in the PFP group. Occipital ENoG value began to increase on the third day while nasal ENoG value was still within the normal range (27.04 vs 7.69 %, p = 0.0001). In the fourth, fifth and sixth days, occipital ENoG value was significantly high compared to nasal ENoG value (p = 0.0001 for each day) whereas nasal and occipital ENoG values were very similar in the seventh and eighth days (p = 0.181 and p = 0.584, respectively). Our study presents further support for technical possibility of occipital ENoG which may reflect the degree of fiber degeneration earlier than the nasalis muscle in PFP.

Hypopharyngeal and parapharyngeal space metastasis of papillary thyroid carcinoma: a case report.

BACKGROUND: Carcinoma of the thyroid gland is one of the most commonly encountered endocrine malignancies. Papillary carcinoma is the most common histological type, and its spread is usually lymphatic. About 30-80% patients with papillary carcinoma develop lymphatic metastases. CASE REPORT: We present here the case of a 70-year-old female patient who had undergone total thyroidectomy 10 years previously, with a histological diagnosis of papillary thyroid carcinoma. A neck dissection was performed ten years after the primary operation due to a mass in the parapharyngeal space and hypopharynx. The mass was diagnosed histologically as papillary thyroid cancer metastasis after the operation. CONCLUSION: Lymphatic and vascular metastases of papillary thyroid carcinoma separately to the parapharyngeal space and hypopharynx have rarely been reported. In our case, both hypopharyngeal and parapharyngeal space involvement were presented, which is a very rare condition.

Lower lateral crural reverse plasty.

The lateral crus plays a significant role in the aesthetic appearance of the nose. Excessive concavities of the lower lateral crura can lead to heavy aesthetic disfigurement of the nasal tip and to insufficiencies of the external nasal valve. The lateral crus of the alar cartilage may also cause a concavity of the alar rim and even collapse of the alar rim in severe cases. Surgical techniques performed on the lateral crus help to treat both functional and aesthetic deformities of the lateral nasal tip. We present a reverse plasty technique for the lateral crus, and we evaluated the advantages and disadvantages of the technique.

Analysis of the vertebrobasilar system in patients with obstructive sleep apnea.

We conducted a prospective study to evaluate the vertebrobasilar system in adults with and without obstructive sleep apnea (OSA). Our study population was made up of 48 patients with OSA and 21 healthy volunteers who served as controls; the OSA patients were subdivided into one group with mild or moderate OSA (n = 22) and another with severe OSA (n = 26). Each participant underwent Doppler ultrasonography three times to measure the diameter of the vertebral artery, the peak systolic velocity (PSV), the resistive index (RI), and the vertebral artery flow volume; the mean of the three measurements was calculated for each patient, for the OSA and control groups, and for various subgroups. No significant differences in vessel diameter, PSV, or RI were seen among any of the subgroups. Overall, the vertebral artery flow volume was slightly, but not significantly, higher in all patients with OSA (206 ml/min) than in the control group (177 ml/min); this difference might reflect the body's daytime response to the chronic apneic events experienced during sleep. The only statistically significant difference we found was in vertebral artery flow volume between the controls and the subgroup with mild or moderate OSA (p = 0.026); no difference was seen between the controls and the patients with severe OSA (p = 0.318). Likewise, no significant difference in any of the four parameters was seen when patients were subclassified by body mass index and arterial oxygen saturation level.

The effects of corticosteroid on tissue lactoferrin in patients with nasal polyposis.

BACKGROUND: Although, lactoferrin (LF) is the second most important antimicrobial and anti-inflammatory peptide after lysozyme in upper respiratory tract, little is known about its role in chronic rhinosinusitis (CRS). Recent studies pronounced that LF levels were significantly reduced in CRS with nasal polyposis (NP) compared with other subgroups. However, effects of systemic corticosteroid (CS) treatment, which is currently the main NP treatment modality, and subsequent surgical intervention on LF levels are still not known. This study was designed to evaluate the effects of CS treatment and surgical intervention on LF levels in patients with NP. METHODS: Patients with inflammatory NP who were scheduled to undergo CS treatment and a control group were included in this study. LF levels were determined from mucosal samples taken from both groups, before and after CS treatment, and also 1 month after surgical intervention. RESULTS: Twenty-seven patients with NP and 14 patients who underwent septoplasty were included in the study. Tissue LF levels were significantly lower in the NP group compared with the control group (p = 0.014). Tissue LF levels did not change significantly in NP patients after CS treatment. However, a significant reduction in tissue LF was detected 1 month after endoscopic sinus surgery. CONCLUSION: Tissue LF concentrations significantly decreased in patients with NP. CS treatment had no effect on tissue LF levels, whereas postendoscopic sinus surgery, tissue LF levels were getting lower because there was also a reduction in inflammatory load (whether from reduction in mucosa surface area or resolution of disease).

Topical glucocorticoid reduces the topical decongestant-induced histologic changes in an animal model nasal mucosa.

OBJECTIVES/HYPOTHESIS: To investigate the histologic consequences of simultaneous nasal glucocorticosteroid and xylometazoline HCl administration in the rabbit nasal mucosa. STUDY DESIGN: Prospective randomized study. METHODS: Twenty New Zealand male rabbits were randomly placed into three groups: group I, control (n = 6); group II, xylometazoline HCl (n = 8); or group III, xylometazoline HCl-fluticasone furoate (n = 6). Group I received no treatment. Groups II and III received two intranasal puffs of xylometazoline HCl 0.5 mg/mL twice daily or two puffs of xylometazoline HCl 0.5 mg/mL twice daily plus one puff of 27.5 µg fluticasone furoate twice daily to each nostril (110 µg), respectively. At the end of 3 weeks, the rabbits were sacrificed. The mucosa of the nasal cavities was excised. Specimen sections (5 µm) were stained with hematoxylin and eosin, mucicarmine, and Gomori one-step trichrome and were examined under a light microscope. The presence of edema, congestion, inflammatory cell infiltration, nasociliary loss, epithelial and nerve-ending degeneration, and goblet cell increase were evaluated semiquantitatively (grades 0-3). RESULTS: Statistically significant differences were detected between groups II and III in terms of edema, congestion, inflammatory cell infiltration, nasociliary loss, and epithelial degeneration (P = .006, P = .049, P = .015, P = .014, and P = .049, respectively). Nerve-ending degeneration, goblet cell increase, and quantitative goblet and neutrophil cell counts did not yield statistically significant differences between groups II and III (P = .137, P = .580, P = .770, and P = .616, respectively). CONCLUSIONS: The combined simultaneous intranasal administration of xylometazoline HCl and fluticasone furoate appears to be beneficial in minimizing the long-term usage-associated congestion, edema, inflammatory cell infiltration, epithelial degeneration, and nasociliary loss in the rabbit model nasal mucosa.

Determining the most suitable costal cartilage level for rhinoplasty: an experimental study.

OBJECTIVE: The aim of this study was to compare the biomechanical properties of septal cartilage (SC) and costal cartilage (CC) grafts harvested from different ribs and to find at which level CC has characteristics closest to SC. STUDY DESIGN: Experimental cadaver study. SETTING: Istanbul Training and Research Hospital. MATERIAL AND METHOD: Cartilage grafts were harvested from the 6th, 7th, and 8th ribs and the SC of 10 fresh cadavers. Shaped cartilage grafts were subjected to a bending test. Results were measured, and the force-deflection curve was plotted. Flexural strength (σ(f)) and flexural modulus of elasticity (E(f)) were determined. Fractured surfaces were evaluated by scanning electron microscopy (SEM). RESULTS: According to F(max), it was determined that ribs 6, 7, and 8 have significantly more durability compared with the SC (Ps = .030, .004, and .001). With regard to deflection, there was no significant difference between the SC and the 6th and 7th ribs and between the 6th and 7th ribs (Ps = 1.000, .088, and .306), while a significant difference was found between the SC and the 8th rib (P = .001). According to σ(f), no differences were seen between the 6th and 7th rib (P = .782), while difference was detected between the 6th and 8th and the 7th and 8th ribs (p = .001). Similar trends were established in E(f) values as in σ(f.) These results were confirmed by SEM images. CONCLUSION: The 7th CC can be used as autograft because it shows similar properties to SC. However, the 6th CC is preferred if more flexibility is desired, and the 8th CC is preferred where more strength is needed.

Bilateral tonsillar adenoid cystic carcinoma.

Adenoid cystic carcinoma is a malignant epithelial tumor of the salivary glands. It accounts for less than 1% of all head and neck cancers and less than 10% of all salivary gland neoplasms. It shows slow and indolent growth rate, low probability of regional nodal metastases, high propensity for perineural invasion, multiple and/or delayed recurrences and high incidence of distant metastases. It is the most frequently encountered malignant tumor of the minor salivary glands. The oral cavity and the oropharynx are the most common sites followed by the parotid, submandibular gland, paranasal sinuses, larynx, trachea, and pharynx, in frequency order. In this report an adenoid cystic carcinoma of oral cavity localized in the left palatine tonsil and right peritonsillar tissue was presented.

Tensile characteristics of costal and septal cartilages used as graft materials.

OBJECTIVES: To determine the biomechanical characteristics of septal cartilage (SC) and costal cartilage (CC) taken from fresh cadavers using tensile testing and to establish CC graft material of a suitable thickness (ie, with tensile characteristics closest to those of SC). METHODS: Grafts of varying thickness were harvested from the central part of the seventh-rib CC and SC of 18 fresh cadavers. Tensile testing was performed with a 0.5-kilonewton load calibrated at 7 mm/min. The results were shown as a force-elongation curve. RESULTS: No significant difference according to tensile force was observed between the SC group and the 1.0-mm and 1.5-mm CC groups (P = .09 and P = .32, respectively). However, a significant difference was observed between the SC group and the 2.0-mm CC group (P = .04). Although the strength value of the CC group was 5.03 MPa, the modulus of elasticity was 1.33 MPa. In the SC group, the strength value was 12.42, but the modulus of elasticity was 1.39 MPa. The strength value of the SC group was higher than that of the CC group (P = .001), but the modulus of elasticity value of the CC group was higher than that of the SC group (P = .001). CONCLUSIONS: From the standpoint of tensile testing for preparing columellar struts, 1.0-mm and 1.5-mm CC have similar characteristics to SC and thus can be used instead of it. However, it is important to determine the thickness of CC by considering the expected characteristics of the established material and the forces that affect the area in the nose where the graft will be placed.

The effect of corticosteroid on metalloproteinase levels of nasal polyposis.

OBJECTIVES: The aim of this study was to investigate the effect of corticosteroid treatment on topical and systemic metalloproteinase levels of patients with nasal polyposis (NP). STUDY DESIGN: Prospective clinical trial. METHODS: The study included patients undergoing a paranasal sinus operation due to NP. Oral corticosteroid therapy was performed on all patients before endoscopic sinus surgery. Endoscopic and radiological evaluation were performed and nasal tissue specimens and venous blood samples were collected before (preop phase) and after corticosteroid treatment (periop phase) and also one month after surgery (postop phase). Endoscopic and computed tomography scan findings were scored adequately and all tissue and blood samples were examined cumulatively. RESULTS: The study included 27 patients with inflammatory NP. Preop tissue matrix metalloproteinase-2 (MMP-2) levels were found to be significantly lower than preop and postop concentrations. In contrast, periop serum MMP-2 levels were found to be significantly higher than preop and postop concentrations. Periop tissue inhibitor of metalloproteinase-1 (TIMP-1) levels were also found to be significantly lower than preop and postop concentrations, similar to MMP-2 tissue concentrations. However, there was no statistical difference among tissue MMP-9 concentrations of the three phases. In addition, there was also no statistical difference among serum MMP-9 levels of the three phases. CONCLUSIONS: Oral corticosteroid treatment especially reduces tissue MMP-2, then TIMP-1. Severity of nasal polyposis primarily correlates with increasing tissue MMP-2/TIMP-1 ratio, then MMP-9/TIMP-1. These results suggest that selective inhibition for MMP-2 and activation for TIMP-1 might be a novel therapeutic strategy for patients with nasal polyposis.