Vocal Folds Leukoplakia: The Efficacy of Vitamin A in the Initial Treatment

Abstract Introduction Laryngeal leukoplakia corresponds to a white lesion in the mucosa developed by the deposit of keratin in the epithelium, potentiated by chronic smoking. It is considered a preneoplastic lesion. Surgery is the most adopted treatment; however, non-surgical treatment is advocated by some authors. Objective To evaluate the effectiveness of vitamin A in the management of vocal fold leukoplakia. Methods Patients with videolaryngoscopy diagnosis of vocal fold leukoplakia were selected. The endoscopic images were photographed and with the aid of the ImageJ software (National Institutes of Health, Bethesda, MD, USA), the proportion of the size of the leukoplakia was calculated. Eligible patients were prescribed 50,000U of vitamin A, twice daily for 2 months, at which point videolaryngostroboscopy was repeated for comparative analysis between pre and posttreatment. The efficacy of the treatment was classified as: outcome I - complete improvement of the lesion, outcome II - partial improvement, and outcome III - no difference or increased lesion size. Results Fifteen patients (eight women, seven men) were included, six of whom had bilateral lesions. Smoking was reported in 86.8% of patients. Complete improvement of the lesion was found in 7 cases (33.4%, outcome I), partial improvement in 6 (28.6%, outcome II), and worsening of the injury in 8 (38.1%, outcome III). Of the latter, 6 underwent microsurgery; histopathology indicated absence of dysplasia in 3, and mild dysplasia in 3. Conclusions In this study, the treatment with vitamin A at a dose of 100,000 IU daily for 2 months was effective in reducing the laryngeal leukoplakia size in 62% of cases.

Vocal Folds Leukoplakia: The Efficacy of Vitamin A in the Initial Treatment.

Introduction Laryngeal leukoplakia corresponds to a white lesion in the mucosa developed by the deposit of keratin in the epithelium, potentiated by chronic smoking. It is considered a preneoplastic lesion. Surgery is the most adopted treatment; however, non-surgical treatment is advocated by some authors. Objective To evaluate the effectiveness of vitamin A in the management of vocal fold leukoplakia. Methods Patients with videolaryngoscopy diagnosis of vocal fold leukoplakia were selected. The endoscopic images were photographed and with the aid of the ImageJ software (National Institutes of Health, Bethesda, MD, USA), the proportion of the size of the leukoplakia was calculated. Eligible patients were prescribed 50,000U of vitamin A, twice daily for 2 months, at which point videolaryngostroboscopy was repeated for comparative analysis between pre and posttreatment. The efficacy of the treatment was classified as: outcome I - complete improvement of the lesion, outcome II - partial improvement, and outcome III - no difference or increased lesion size. Results Fifteen patients (eight women, seven men) were included, six of whom had bilateral lesions. Smoking was reported in 86.8% of patients. Complete improvement of the lesion was found in 7 cases (33.4%, outcome I), partial improvement in 6 (28.6%, outcome II), and worsening of the injury in 8 (38.1%, outcome III). Of the latter, 6 underwent microsurgery; histopathology indicated absence of dysplasia in 3, and mild dysplasia in 3. Conclusions In this study, the treatment with vitamin A at a dose of 100,000 IU daily for 2 months was effective in reducing the laryngeal leukoplakia size in 62% of cases.

A triple blind, placebo controlled, randomised controlled trial of betahistine dihydrochloride in the treatment of primary tinnitus.

OBJECTIVES: To evaluate the effectiveness of betahistine in the treatment of primary tinnitus. DESIGN: To evaluate the effectiveness of betahistine in the treatment of primary tinnitus. SETTING: Universidade estadual Paulista Julio de Mesquita Filho, Botucatu Medical School, São paulo, Brazil. PARTICIPANTS: Adult patients with primary tinnitus who had not undergone treatment for tinnitus in the last 6 months were included. Patients with profound sensorineural deafness, hearing aid users and patients with metabolic, neurological, psychiatric or decompensated cardiovascular diseases were excluded. STUDY GROUPS: in the betahistine group, patients received betahistine 24 mg every 12 h for 90 days; in the control group, patients received placebo tablets every 12 h for 90 days. MEAN OUTCOME MEASURES: Primary outcome measure: Tinnitus Handicap Inventory (THI). SECONDARY OUTCOME MEASURES: Clinical Global Impression Improvement (CGI-I) and a question of 'Yes' or 'No' to participants about their perception of improvement in symptoms. RESULTS: Of 284 participants initially identified, 62 were randomised (betahistine group n = 31; control group n = 31). Median age (IQR) 54 (48-60) years, with a balanced number of men and women. There was no difference in THI outcome between the study groups (median difference, -2 points; 95% CI, -8 to 6 points); the THI after the intervention was a median (IQR) 4 (-4 to 14) lower points in the betahistine group, and a median (IQR) 2 (-6 to 10) in the control group. There was no statistical difference in secondary outcome measures. Adverse events were mild and there was no statistical difference between groups. CONCLUSIONS: Betahistine dihydrochloride was ineffective in the treatment of primary tinnitus in adults.

The interface between dentistry and respiratory sleep disorders in children.

OBJECTIVE: To study the incidence of mouth breathing and its association with sleep disorders, dental caries, malocclusion and deleterious oral habits, in children. MATERIAL AND METHODS: 152 children (6 to 9 years), of both genders, were invited to perform clinical evaluation of the oral cavity and the application of the OSA-18. RESULTS: 89 presented mouth breathing (MB), being 45% with malocclusion, 56% with dental caries, 38% with tooth loss, 51% with bruxism and 52% with the habit of sucking finger or pacifier, compared to 40%, 40%, 21%, 27% and 43%, respectively, in the 63 children with nasal breathing (NB). 35 MB showed moderate to high risk for OSAS, while only 8 of the children showed moderate risk. The average score of OSA-18 was 50 (MB:57/NB:40), with 29 (19%) children showing moderate risk. Among these, 74% presented mouth breathing, 26% malocclusion, 61% dental caries, 35% tooth loss, 42% bruxism and 55% sucked finger or pacifier, and in the 14 (9%) with high risk, they were 100%, 75%, 58%, 50%, 67% and 67%, respectively. CONCLUSION: High frequencies of respiratory disorders with sleep repercussions associated with oral alterations were observed, reinforcing the correlation between mouth breathing and changes in stomatognathic system.

Outcomes of Automated Auditory Evoked Potential Performed in Different Settings and the Factors Associated with Referred Cases

Abstract Introduction For the population with risk factors for hearing loss, the first option to assess the hearing status is the performance of the automated brainstem auditory evoked potential (BAEP) test because of its efficacy in identifying retrocochlear hearing loss. Objective To verify the outcomes of automated BAEP performed in different settings as well as the factors associated with the prevalence of hearing impairment. Methods Cross-sectional study conducted from October of 2014 to May of 2015. The sample consisted of 161 infants with at least one risk factor for hearing loss who underwent automated BAEP during the hospital stay or at the outpatient clinic. After 30 days, the altered cases were referred for BAEP diagnosis. Results One hundred and thirty-eight infants (86%) had a result of "pass" and 23 (14%) of "failure" in the automated BAEP. There was no statistically significant difference in the rate of "referred" results between examinations performed in different settings. The infants' ages did not influence the number of abnormal cases. All of the 23 infants who presented a "referred" result in the automated BAEP, unilateral or bilateral, were sent for BAEP diagnosis, and out of these, 9 (39%) remained with at least some degree of alteration. The average age of diagnosis was 2.7 months. Conclusion The results of the automated BAEP were similar when performed during hospitalization or after discharge. Neither the age at the examination nor the gender of the patient influenced the prevalence of hearing loss.

Outcomes of Automated Auditory Evoked Potential Performed in Different Settings and the Factors Associated with Referred Cases.

Introduction For the population with risk factors for hearing loss, the first option to assess the hearing status is the performance of the automated brainstem auditory evoked potential (BAEP) test because of its efficacy in identifying retrocochlear hearing loss. Objective To verify the outcomes of automated BAEP performed in different settings as well as the factors associated with the prevalence of hearing impairment. Methods Cross-sectional study conducted from October of 2014 to May of 2015. The sample consisted of 161 infants with at least one risk factor for hearing loss who underwent automated BAEP during the hospital stay or at the outpatient clinic. After 30 days, the altered cases were referred for BAEP diagnosis. Results One hundred and thirty-eight infants (86%) had a result of "pass" and 23 (14%) of "failure" in the automated BAEP. There was no statistically significant difference in the rate of "referred" results between examinations performed in different settings. The infants' ages did not influence the number of abnormal cases. All of the 23 infants who presented a "referred" result in the automated BAEP, unilateral or bilateral, were sent for BAEP diagnosis, and out of these, 9 (39%) remained with at least some degree of alteration. The average age of diagnosis was 2.7 months. Conclusion The results of the automated BAEP were similar when performed during hospitalization or after discharge. Neither the age at the examination nor the gender of the patient influenced the prevalence of hearing loss.

pH salivary analysis of subjects suffering from Sjögren's syndrome and laryngopharyngeal reflux.

UNLABELLED: Saliva is one of the components for the digestive homeostasis. Recent studies have shown that patients with laryngopharyngeal reflux (LPR) present a drop in salivary pH. Patients with Sjögren's syndrome (SS) are a potential clinical research model for xerostomia and its laryngeal and pharyngeal consequences. The aim was to evaluate the characteristics of saliva of patients with SS and LPR. METHODS: 19 patients with SS plus LPR, and 12 healthy controls had their saliva studied prospectively for volume and pH. Two salivary samples were obtained from each participant: whole unstimulated saliva(WUS) and whole stimulated saliva(WSS) while chewing parafilm M®. All the participants were females. RESULTS: Mean age was 60 years (study group) and 44 years (control). LPR was diagnosed on all 19 subjects. The mean pH of WUS was 7.53 (SS) and 7.57 (controls), raising to 7.87 and 7.83 respectively after stimulation. The mean salivary volume of patients with SS was 1.27 mL (WUS) and 3.78 mL (WSS), whereas controls had a significantly higher salivary volume both before and after stimuli. CONCLUSION: A very high prevalence of LPR was found in patients with SS, which is probably caused by a uniform drop in salivary volume and all its contents, rather than a specific deficiency in its components, as shown previously in patients without SS.

Análise do pH salivar de indivíduos com Síndrome de Sjögren e refluxo laringofaríngeo / pH salivary analysis of subjects suffering from Sjögren's Syndrome and laryngopharyngeal reflux

A saliva é fundamental para a homeostase digestiva. Alterações no seu volume e composição são correlacionadas com o refluxo laringofaríngeo (RLF). Estudos recentes demonstraram que pacientes com RLF apresentam acidificação do pH salivar. A síndrome de Sjögren (SS) foi eleita como modelo de hiposalivação, com objetivo de analisar as repercussões da diminuição salivar na laringe e faringe. CASUÍSTICA E MÉTODO: Estudo clínico transversal de 19 sujeitos com SS e RLF comparados com 12 indivíduos saudáveis. Obtidas amostras de saliva total não estimulada (STNE) e saliva total estimulada por mastigação de parafilm M® (STE). RESULTADOS: Todos os indivíduos eram mulheres, média de idade de 60 anos (estudo) e 44 anos. A prevalência de RLF foi 100 por cento. O pH médio na STNE foi 7,53 (grupo estudo) e 7,57(controle), aumentando para 7,87 e 7,93, respectivamente, após estimulação mecânica. Não houve diferença significante de pH entre os grupos. O volume salivar médio dos pacientes com SS foi 1,27mL (STNE) e 3,78mL (STE), sendo o volume salivar do grupo controle significativamente maior (4,02mL na STNE e 11,96mL na STE). CONCLUSÕES: Todos os indivíduos estudados apresentaram RLF, fato provavelmente relacionado à queda uniforme observada no volume salivar e de todos seus componentes, não sendo observadas mudanças no pH salivar no grupo estudado. Isso sugere fisiopatogenias diferentes do RLF para indivíduos com SS.

Saliva is one of the components for the digestive homeostasis. Recent studies have shown that patients with laryngopharyngeal reflux (LPR) present a drop in salivary pH. Patients with Sjögren's syndrome (SS) are a potential clinical research model for xerostomia and its laryngeal and pharyngeal consequences. The aim was to evaluate the characteristics of saliva of patients with SS and LPR. METHODS: 19 patients with SS plus LPR, and 12 healthy controls had their saliva studied prospectively for volume and pH. Two salivary samples were obtained from each participant: whole unstimulated saliva(WUS) and whole stimulated saliva(WSS) while chewing parafilm M®. All the participants were females. RESULTS: Mean age was 60 years (study group) and 44 years (control). LPR was diagnosed on all 19 subjects. The mean pH of WUS was 7.53 (SS) and 7.57 (controls), raising to 7.87 and 7.83 respectively after stimulation. The mean salivary volume of patients with SS was 1.27 mL (WUS) and 3.78 mL (WSS), whereas controls had a significantly higher salivary volume both before and after stimuli. CONCLUSION: A very high prevalence of LPR was found in patients with SS, which is probably caused by a uniform drop in salivary volume and all its contents, rather than a specific deficiency in its components, as shown previously in patients without SS.