[Application of the biofeedback method in the treatment of dysphonia (literature review)]. / Primenenie metoda biologicheskoi obratnoi svyazi pri lechenii disfonii (obzor literatury).

The literature review describes the experience of using the biofeedback method in the treatment of dysphonia of various etiologies. Indications for the use of this method and its effectiveness in a certain contingent of patients are discussed.

[Treatment of laryngeal pathology associated with gastroesophageal reflux disease]. / Lechenie patologii gortani, assotsiirovannoi s gastroezofageal'noi reflyuksnoi bolezn'yu.

OBJECTIVE: To increase the effectiveness of the treatment of laryngeal pathology associated with gastroesophageal reflux disease (GERD), to determine the indications for the appointment of anti-inflammatory therapy to these patients. MATERIAL AND METHODS: 120 patients were examined and treated, 58 of them men and 62 women, aged 30 to 82 years with GERD-associated laryngeal pathology. Three groups of patients were formed, comparable in age and gender, in accordance with the type of pachydermia in interarytenoid region; type 1 (40 patients) - pachydermia did not go beyond the middle of the interarytenoid cartilage (according to G.F. Ivanchenko), less than 3 mm, without signs of perifocal inflammation; type 2 (40 patients) - pachydermia of large size, extending beyond the middle of the interarytenoid cartilage with a spread to the entire interarytenoid region (according to G.F. Ivanchenko), often in combination with hyperkeratosis or epithelial dysplasia; type 3 (30 patients) - pachydermia of large size in combination with severe perifocal inflammation. All patients received antireflux therapy. Each group is divided into two subgroups: patients who did not receive anti-inflammatory therapy, and patients who received anti-inflammatory therapy, the basis of which was inhalation with degassed alkaline mineral water, as well as according to indications acetylcysteine, benzyldimethylammonium chloride 0.01% or hydroxymethylquinoxalindioxide, with severe swelling of the mucous membrane - budesonide. All patients completed the questionnaire "Reflux Symptoms Scale" before and after treatment. RESULTS: In group 2 patients (with type 2 pachydermia), the effectiveness of anti-inflammatory therapy was 75%. Of the 20 patients in this group, after inhaled therapy, 4 patients had pachydermia in interarytenoid region disappeared, 11 patients had type 1 pachydermia visualized, 5 (25%) patients had no pronounced dynamics. In group 3 patients (with type 3 pachydermia), the effectiveness of inhaled treatment was 100%, out of 15 patients after inhaled therapy, type 2 pachydermia was diagnosed in 8 patients, type 1 pachydermia - in 7 patients. In 4 patients, complex therapy led to the complete disappearance of reflux-associated laryngeal granulomas without surgical treatment. The effectiveness of inhaled therapy in relation to patient complaints after a month was 87%, while the effectiveness of treatment of patients without inhalation was 45%. CONCLUSIONS: Indications for the appointment of inhaled anti-inflammatory therapy in patients with reflux-associated pathology of the larynx are the presence of complaints of hoarseness, dryness, tickling, lump in the throat and chronic cough, endolaryngoscopic signs of exacerbation of chronic inflammation of the mucous membrane of the posterior larynx.

[Screening for laryngeal disease in patients with gastroesophageal reflux disease]. / Skrining zabolevanii gortani u patsientov s gastroezofageal'noi reflyuksnoi bolezn'yu.

OBJECTIVE: To improve the diagnosis of laryngeal disease in patients with gastroesophageal reflux disease (GERD). MATERIAL AND METHODS: 171 patients (89 (52%) men, 82 (48%) women) with non-erosive (39 (23%) people) and erosive (132 (77%) people) forms of GERD were examined. None of the patients made active complaints about the condition of the larynx and pharynx. The examination included a questionnaire, examination by an otorhinolaryngologist, and videoendolaryngoscopy. RESULTS: The survey revealed the presence of symptoms of otorhinolaryngological pathology in 74% of patients. Videolaryngoscopy revealed no laryngeal pathology in 55 (32%) patients, and signs of GERD-associated laryngitis were detected in 116 (68%) patients. The most common pathology was pachydermia in interarytenoid region - in 89 people, laryngeal granuloma was detected in 7 patients, leukoplakia - in 2 patients, chronic edematous polypous laryngitis - in 2 patients, benign laryngeal formations - in 9 patients. In patients with GERD (erosive and non-erosive forms), an asymptomatic course of chronic laryngitis associated with this pathology was observed in 44% of cases. In 52% of patients, pachydermia in interarytenoid region was diagnosed, of which every second had pronounced hyperplasia and folding of the mucous membrane in interarytenoid region, which must be differentiated from laryngeal cancer (in this case, patients should be under the dynamic supervision of an otorhinolaryngologist). Other precancerous formations of the larynx (granulomas and leukoplakia) were found in 5% of patients. Benign neoplasms of the larynx (polyps and cysts) were also detected in 5% of cases. CONCLUSIONS: Despite the high frequency of detection of otorhinolaryngological diseases in the examined patients with gastroesophageal reflux disease, none of the patients presented complaints related to the pathology of the larynx, which indicates the need for active detection of this pathology in this category of patients by questioning, questioning, as well as examination by an otorhinolaryngologist.

[Chronic catarrhal laryngitis in singers]. / Khronicheskii kataral'nyi laringit u vokalistov.

The article deals with optimization of treatment policy for singers with chronic catarrhal laryngitis. The survey sample is 51 singers with chronic catarrhal laryngitis of the age from 29 to 54 and the length of time worked from 8 to 22 years. The following methods are used: anamnesis, microbiological investigation, voice evaluation according to Visual Analog Scale (VAS), microlaryngoscopy, videolaryngostroboscopy, voice acoustic analysis (MDVP Kay Pentax system), statistical processing of results. It is shown that the cause of chronic catarrhal laryngitis in professional singers is non-bacterial irritants that provoke the appearance of an inflammatory process in the larynx, as well as uncontrolled use of drugs that irritate and dry out the mucous membrane and imperfect vocal technique. Pathogenic flora as an etiologic factor in the occurrence of laryngitis does not play an important role. A comprehensive treatment scheme for chronic catarrhal laryngitis using inhalation therapy and drugs that improve trophic processes in the laryngeal mucosa, which allows to increase the effectiveness of treatment and achieve stable remission of the disease, is suggested.

[Etiopathogenetic treatment of professional singers with vocal nodules]. / Étiopatogeneticheskoe lechenie uzelkov golosovykh skladok u professional'nykh vokalistov.

The article deals with optimization of treatment policy for professional singers. The survey sample is 67 singers with vocal nodules of the age from 24 to 42 and the length of time worked from 3 to 28 years. The following methods are used: questionnaire survey (professional anamnesis, voice evaluation according to Visual Analog Scale (VAS), Spielberg-Hanin test), microlaryngoscopy, video endolaringostroboscopy, voice acoustic analysis (MDVP Kay Pentax system). The algorithm and evaluation criteria of vocal nodules treatment efficiency for the singers taking into account the specific character of their professional activity are proposed.

[The clinical and functional condition of the larynx in the patients of the elder age group presenting with chronic oedematous polypoidal laryngitis]. / Kliniko-funktsional'noe sostoianie gortani u patsientov starshei vozrastnoi gruppy s khronicheskim otechno-polipoznym laringitom.

This article was designed to report the results of the evaluation of the clinical and functional condition of the larynx in the patients of the elder age group presenting with chronic oedematous polypoidal laryngitis before and after their surgical treatment. A total of 60 patients at the age from 60 to 72 years were available for the examination; all of them had a concomitant somatic or ENT pathology. The clinical and functional conditions of the larynx in the patients of the elder age group were studied, with special reference to those suffering from chronic oedematous polypoidal laryngitis before the surgical intervention, that determined the overall clinical picture of the disease characterized in the first place by the predominance of the severe polypoid process with the combination of the organic and functional laryngeal pathology. The specific clinical and functional features of the larynx were identified after the surgical treatment that exerted the appreciable influence on the postoperative course of the disease and the duration of dysphonia. The peculiarities of postoperative laryngitis are described. Its catarrhal form was diagnosed in 42% of the patients. The strong inflammatory reaction with exudation and formation of fibrin films was documented in 58% of the patients while 83% of them exhibited formation of the functional component of dysphonia that required the application of the additional therapeutic measures for the complete restoration of the vocal function taking into consideration the age-related alteration of the larynx together with the long-term postoperative observation of the patients.

[The comparative assessment of the vocal function in the professional voice users and non-occupational voice users in the late adulthood]. / Sravnitel'naia otsenka golosovoi funktsii u professionalov golosa pozhilogo vozrasta i lits negolosovykh professii.

The objective of the present study was to evaluate the clinical and functional condition of the voice apparatus in the elderly patients and to elaborate recommendations for the prevention of disturbances of the vocal function in the professional voice users. This comprehensive study involved 95 patients including the active professional voice users (n=48) and 45 non-occupational voice users at the age from 61 to 82 years with the employment history varying from 32 to 51 years. The study was designed to obtain the voice characteristics by means of the subjective auditory assessment, microlaryngoscopy, video laryngostroboscopy, determination of maximum phonation time (MPT), and computer-assisted acoustic analysis of the voice with the use of the MDVP Kay Pentaxy system. The level of anxiety of the patients was estimated based on the results of the HADS questionnaire study. It is concluded that the majority of the disturbances of the vocal function in the professional voice users have the functional nature. It is concluded that the method of neuro-muscular electrophonopedic stimulation (NMEPS) of laryngeal muscles is the method of choice for the diagnostics of the vocal function of the voice users in the late adulthood. It is recommended that the professional vocal load for such subjects should not exceed 12-14 hours per week. Rational psychotherapy must constitute an important component of the system of measures intended to support the working capacity of the voice users belonging to this age group.

[Treatment of chronic tonsillitis in singers].

A total of 74 professional vocalists aged from 20 to 64 years with different forms of chronic tonsillitis were examined. Results of the study were used to develop recommendations for the treatment of chronic tonsillitis in patients of this category.

[Inhalation therapy of laryngeal inflammation].

Inhalation therapy is a highly effective method of local anti-inflammatory therapy in combined treatment of anti-inflammatory laryngeal diseases. Schemes of inhalation therapy in different laryngeal diseases are presented basing on the experience with examination and treatment of 140 patients.

[Most frequent errors in diagnosis and treatment of vocal dysfunction].

Vocal disturbances can be a symptom as laryngeal diseases, and a primary clinical manifestation of an endocrine, neurological or systemic disease, tumors located in the base of the skull, neck, chest. Main causes of the misdiagnosis of vocal disturbances lie in misinterpretation of the results of acoustic study of voice, incomplete case history and inadequately made laryngoscopy. Efficacy of vocal disturbance treatment depends on staged, etiopathogenetic approach with consideration of individual features of the patient. Patients with recurrent and lingering laryngeal diseases should be referred to specialized clinics.

[Phenomenon of calcification of the stylohyoid ligament]. / Fenomen obyzvestvleniia shilopod"iazychnoi sviazki.

Patients with continuous pain in the pharynx were examined roentgenologically for calcification of the stylohyoid ligaments and the styloid process. Symptoms and surgical outcomes are described in cases with calcification of the stylohyoid process and muscle. Surgical treatment eliminated pain, noise in the ears, chronic pharyngeal inflammation. No recurrences occurred. Histological examination of the removed stylohyoid ligaments detected calcificated hyalin plaques in these ligaments.

[The role of spectral computer analysis in determination of a singer's voice type and prevention of vocal disease in singers]. / Rol' spektral'nogo i profilaktike zabolevanii golosovogo apparata u vokalistov.

The type of voice usually corresponds to anatomic parameters of the larynx but there are cases when such correspondence is not observed. A singer's voice is characterized by pitch, depth and tembre of the sound, which, acoustically, present variation of three sound parameters: frequency of vibrations, their amplitude and compound sound, its spectrum. A spectral computer analysis of voice has been performed in 68 singers aged 24 to 65 years with singing history of 3 to 43 years. The diagnosis of the voice type was made by the frequency of the basic tone and formant composition of sound at primary, i.e. most convenient for the singer tones, and transitional notes of the range. Tessutura at which maximal number of overtones and the highest formant sound intensity were registered was the best for the singer.

[Treatment of vocal fold nodules in singers]. / Lechenie pri uzelkakh golosovykh skladok u vokalistov.

Vocal nodules (singer's nodules) are a typical professional disease of the vocal apparatus. This disease occurs more frequently in 20- to 50-year-old singers. The nodules form because of vascular disorders secondary to overstrain of the vocal apparatus in phonation and disorders of vegetative innervation. 43 opera singers were treated whose age and singing history ranged from 22 to 57 years and 3 to 26 years, respectively. The treatment combined psychotherapy, medicines with phlogenzym as a basic drug, physiotherapy and phonopedia. Phlogenzym allows to avoid "silence regimen", surgical intervention. This improves treatment efficacy, shortens the time of disability for singers.

[Analysis of the causes of vocal tract diseases in singers]. / Analiz prichin vozniknoveniia zabolevanii golosovogo apparata u pevtsov.

The etiology of vocal apparatus diseases in opera singers is due to both specific features of their theatrical activity and conventions of opera genre in particular. A hundred and twenty seven vocalists (soloists and choristers) aged 23 to 70 years with service length of 3 to 40 years were examined. Both the status of the vocal apparatus itself and comorbidity were found to affect the occurrence of occupational diseases of the larynx. Of great importance are the quality of vocal background of a singer, his/her age, length of service, the even distribution of vocal load during a month and a season, the volume of additional work (concert and pedagogical activities), the correspondence of parts to his/her techniques and actor's capacities, and living and social conditions. The pattern of vocal apparatus diseases also depends on the type of a singer's voice and on the status of his/her nervous system. This study-based recommendations for singers and theater managers administrators reduced the incidence rates of laryngeal diseases in the followed-up professional opera singers by 15-20%.