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1.
Int. arch. otorhinolaryngol. (Impr.) ; 24(1): 53-61, Jan.-Mar. 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1090553

RESUMO

Abstract Introduction The increase in life expectancy is an incentive to the development of researches with the elderly population aiming at actions that may ensure healthy and active aging. Objective To analyze the profile of laryngeal microsurgery performed in patients > 60 years old. Methods A retrospective observational study, with a cross-sectional design. A retrospective analysis of the medical records of elderly patients submitted to laryngeal microsurgery was performed at a private hospital in Curitiba, state of Paraná, Brazil, between January 2004 and December 2016. Were included all of the patients > 60 years old that underwent laryngeal microsurgery during this period. Results During the studied period, 213 laryngeal microsurgeries were performed in 181 patients > 60 years old. There was a preponderance of male patients. The mean age was 67.6 years old. Squamous cell carcinoma (SCC) was the most prevalent disorder (26%), followed by Reinke edema (20%), papillomatosis (14%), polyps (11%), leukoplakia (8%), minor structural alterations (8%), associated lesions (9%), and others (4%). Men presented a higher probability of SCC diagnosis, regardless of the age group, while Reinke edema was more frequently observed in women. A directly proportional relation between the frequency of laryngeal cancer and age increase was also observed. No significant differences were observed in professional voice users. Conclusion Further researches are required to properly comprehend the factors associ- ated with laryngeal lesions and determine prevention and treatment approaches.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Doenças da Laringe/cirurgia , Doenças da Laringe/epidemiologia , Laringe/cirurgia , Microcirurgia , Papiloma/cirurgia , Riscos Ocupacionais , Envelhecimento/fisiologia , Carcinoma de Células Escamosas/cirurgia , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/epidemiologia , Fatores Sexuais , Edema Laríngeo/cirurgia , Edema Laríngeo/epidemiologia , Neoplasias Laríngeas/cirurgia , Neoplasias Laríngeas/epidemiologia , Registros Médicos , Estudos Transversais , Estudos Retrospectivos , Fatores Etários
2.
Otolaryngol Head Neck Surg ; 162(3): 322-325, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31959050

RESUMO

OBJECTIVE: The objective of this study was to determine the prevalence of benign vocal fold lesions (BVFLs) in patients with chronic cough over a 1-year period. STUDY DESIGN: Case series with chart review. SETTING: Tertiary academic medical center. SUBJECTS AND METHODS: A retrospective cohort study of patients with chronic cough seen in our tertiary multidisciplinary cough clinic from 2016 to 2017 was conducted. Patient characteristics, presence of BVFLs by laryngoscopy, and Leicester Cough Questionnaire (LCQ) were recorded. RESULTS: A total of 419 patients were included (average age: 61 years), and 67% of patients were female. Ten percent of patients had BVFLs: granuloma (5%), leukoplakia (3%), nodules (2%), and polyps (1%). Median cough duration was 2.9 years (interquartile range [IQR], 0.7-8.5); no significant difference in median cough duration was observed between patients with BVFLs and those with no lesions (2.6 vs 3.0 years, P = .86). In total, 178 patients (42%) had available LCQ data: median score of 10.2 (IQR, 7.9-13.9); no significant difference in median LCQ was observed between patients with BVFLs and those with no lesions (10.5 vs 10.1, P = .54). CONCLUSION: Prevalence of BVFLs in our cohort of patients with chronic cough was 10%, with posterior glottic lesions-granuloma-being the most common (5%). Prevalence of midmembranous lesions was as follows: vocal fold nodules (2%) and vocal fold polyps (1%). BVFLs were not associated with longer cough duration or more severe cough. We cannot determine a causative or noncausative relationship between BVFLs and chronic cough at this time due to lack of a control group.


Assuntos
Tosse , Doenças da Laringe/diagnóstico , Prega Vocal/patologia , Doença Crônica , Feminino , Humanos , Doenças da Laringe/epidemiologia , Laringoscopia , Masculino , Pessoa de Meia-Idade , Ohio/epidemiologia , Prevalência , Estudos Retrospectivos , Inquéritos e Questionários
3.
Int J Pediatr Otorhinolaryngol ; 130: 109815, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31846823

RESUMO

OBJECTIVE: to describe the frequency and predictive factors associated with laryngeal scarring caused by surgical treatment of recurrent respiratory papillomatosis (RRP) in children. INTRODUCTION: RRP is an important cause of hoarseness and respiratory obstruction in children. The current standard of care for RRP is the systematic and repetitive surgical interventions. The repetitive surgeries may increase the risk of sequelae. A larger number of surgeries, the surgical technique used, and disease severity are related to an increased risk of scarring. MATERIAL AND METHODS: A retrospective, descriptive review of the medical charts of patients with RRP younger than 18 years was conducted. Between 2014 and 2017, 79 patients were identified; five patients were excluded. Demographic and clinical data were recorded and analyzed. The patients were divided into two groups, one with and the other without surgical sequelae, for comparison to identify sequela-associated factors. RESULTS: 75 patients, 40 (53.3%) male, were analyzed. Age at symptom onset ranged from 2 months to 13 years. Median age at the time of diagnosis was 42 months. Overall, 44% presented with disseminated disease. A median of nine (range, 1 to 86) surgeries were performed in each patient with a median of two (range, 0.6 to 10) of the average number of surgeries per year per patient. 29 patients (38.7%) had laryngeal sequelae. When comparing the patients with and without sequelae, statistically significant differences were found in the variables of dissemination during the course of the disease, overall number of surgeries and mean number of surgeries per year, history and number of previous surgeries at an outside institution, urgent surgeries, and CO2 laser use. Patients who underwent more than 10 surgeries or who had a history of previous surgeries at an outside institution had a higher frequency of laryngeal scarring in multivariate analysis. CONCLUSION: Scarring secondary to surgical treatment for RRP is common. Surgery-related variables seem to be predisposing factors. A greater number of surgeries and surgeries performed at less specialized centers are strongly related to this complication. Future studies with a larger sample size are necessary to determine whether other factors are involved.


Assuntos
Doenças da Laringe/epidemiologia , Infecções por Papillomavirus/cirurgia , Complicações Pós-Operatórias/epidemiologia , Infecções Respiratórias/cirurgia , Adolescente , Fatores Etários , Criança , Pré-Escolar , Progressão da Doença , Feminino , Rouquidão , Humanos , Masculino , Infecções por Papillomavirus/complicações , Infecções Respiratórias/complicações , Estudos Retrospectivos , Resultado do Tratamento
4.
Medicine (Baltimore) ; 98(31): e16686, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374053

RESUMO

This study provided the baseline for establishing policies for community health promotion programs to propose the clusters of multiple health risk factors and identify the risks of laryngeal disorders according to the clusters by using the national level survey representing the South Korean population. This study targeted 5941 people who completed the 5th Korean National Health and Nutrition Examination Survey. The independent variables were age, sex, smoking, high-risk drinking, education level, occupation, household income, and self-reported voice problems. The identify cluster relationship with laryngeal disorders by conducting 2-way cluster analysis and multinomial logit analysis. The prevalence of laryngeal disorder was 6.7%. The results of analysis, 3 clusters were automatically extracted. Multinomial logistic regression analysis showed that sociodemographic factors, health risk behaviors, and health status clusters were significantly related to the risk of laryngeal disorders. The males who were smoking, high-risk drinking, college graduate and above, high income, and non-manual workers had a higher risk of laryngeal disorders than females who were non-smokers, non-drinkers, 60 years old and older, economically inactive, and high school graduate. The results of this study suggested that it may be effective to classify population according to sociodemographic and health behaviors and develop health education materials and health promotion program accordingly in order to prevent laryngeal disorders.


Assuntos
Comportamentos de Risco à Saúde , Doenças da Laringe/epidemiologia , Fatores Socioeconômicos , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Análise por Conglomerados , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , República da Coreia/epidemiologia , Fatores de Risco , Distribuição por Sexo , Fumar/epidemiologia
5.
Am J Med Sci ; 357(2): 93-102, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30665498

RESUMO

Sarcoidosis is a chronic inflammatory disease of uncertain etiology characterized by the formation of noncaseating granulomas. The thorax is involved in 95% of cases, but any organ can be involved. Sinonasal or laryngeal involvement is uncommon and can be difficult to diagnose. The reported incidence of sarcoidosis in the upper airway clearly depends on study characteristics, and this creates uncertainty about the actual incidence. In a large prospective study in the United States, upper respiratory tract involvement occurred in 3% of the patients. Some patients have upper airway involvement without thoracic disease, and this presentation may cause delays in diagnosis. These patients have nonspecific symptoms which range from minimal nasal stuffiness to life-threatening upper airway obstruction. Currently, there is no established standard therapy for the management of upper airway sarcoidosis. These patients often respond poorly to nasal and/or inhaled corticosteroids and require long courses of oral corticosteroids. Patients with poor responses to oral corticosteroids or severe side effects may respond to tumor necrosis factor alpha inhibitors. In this review, we will discuss the clinical presentation, pathogenesis, diagnostic tests, drug treatment, surgical management options and the challenges clinicians have managing these patients.


Assuntos
Doenças da Laringe , Doenças Nasais , Sarcoidose , Humanos , Doenças da Laringe/diagnóstico , Doenças da Laringe/epidemiologia , Doenças da Laringe/etiologia , Doenças da Laringe/terapia , Doenças Nasais/diagnóstico , Doenças Nasais/epidemiologia , Doenças Nasais/etiologia , Doenças Nasais/terapia , Doenças dos Seios Paranasais/diagnóstico , Doenças dos Seios Paranasais/epidemiologia , Doenças dos Seios Paranasais/etiologia , Doenças dos Seios Paranasais/terapia , Sarcoidose/diagnóstico , Sarcoidose/epidemiologia , Sarcoidose/etiologia , Sarcoidose/terapia
6.
Otolaryngol Head Neck Surg ; 160(2): 295-301, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30351192

RESUMO

OBJECTIVE: To determine the prevalence of minor structural alterations (MSA) in the vocal fold cover in a population submitted to extralaryngeal site surgery and to characterize them according to morphological and epidemiological parameters. STUDY DESIGN: This was a cross-sectional and observational study. SETTING: Tertiary referral medical center. SUBJECTS AND METHODS: A total of 147 patients underwent general anesthesia for extralaryngeal site surgery indicated for a procedure extraneous to the study and irrespective of the presence of vocal complaint. Next, detection and morphological characterization of MSAs in the vocal fold cover were performed by means of suspension microlaryngoscopy with laryngeal inspection and palpation without surgical intervention related to this procedure. The laryngeal findings were compared with variables from a clinical and demographic characteristics questionnaire given to these individuals. RESULTS: A 21.1% prevalence of MSAs was identified in the sample, which included a majority of individuals without vocal complaint (95.9%). Of these, 5.4% of individuals had laryngeal microdiaphragms, 16.3% sulcus vocalis, and 4.1% epidermoid cysts. No pouch sulcus or mucosal bridges were found. The identification of these alterations occurred mainly after 10 years of age, without effects of sex, vocal abuse, or upper airway conditions. The most common combination of MSAs was bilateral sulcus vocalis. CONCLUSIONS: The prevalence of MSAs in laryngeal coverage in this predominantly vocally asymptomatic population was 21.1%, with identification of sulcus vocalis, epidermoid cyst, and laryngeal microdiaphragm. Age was the only clinical or demographic characteristic associated with these alterations.


Assuntos
Doenças da Laringe/epidemiologia , Doenças da Laringe/patologia , Prega Vocal/patologia , Prega Vocal/cirurgia , Adulto , Distribuição por Idade , Estudos Transversais , Feminino , Humanos , Doenças da Laringe/cirurgia , Laringoscopia/métodos , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Valores de Referência , Medição de Risco , Amostragem , Distribuição por Sexo , Centros de Atenção Terciária
7.
Auris Nasus Larynx ; 46(4): 570-575, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30581074

RESUMO

OBJECTIVE: The aim of this study was to investigate the presence of human papillomavirus (HPV) in biopsy specimens from juvenile and adult patients with histopathological diagnosis of recurrent respiratory papillomatosis (RRP) treated in two public hospitals in Rio de Janeiro, Brazil. METHODS: We performed the detection and genotyping of HPV by PCR technique for the types 6, 11, 16, and 18 in biopsy specimens from 41 RRP patients. RESULTS: The juvenile onset RRP (JoRRP) corresponded to 61% and the adult onset RRP (AoRRP) corresponded to 39% of the study group. Prevalence of males was observed in both the adult (81.3%) and the juvenile (56%) groups. Lesions in the larynx were more frequent in the glottis (46%). Genotyping analysis only revealed patients with HPV-6 (34.1%), HPV-11(17.1%), and co-infection HPV-6 and -11 (48.8%). RRP severity was significantly associated with the JoRRP (p<0.001), with extralaryngeal disease and more surgeries. However, no significant association between RRP severity and HPV types was found. One co-infected patient in the JoRRP died due to the evolution of the disease with lung involvement. CONCLUSION: These results show the strong association of HPV-6 and/or HPV-11 types with RRP and could complement the diagnosis, prognosis, and therapies for these patients. In addition, the HPV vaccination should be encouraged to prevent the disease.


Assuntos
Doenças da Laringe/epidemiologia , Pneumopatias/epidemiologia , Infecções por Papillomavirus/epidemiologia , Infecções Respiratórias/epidemiologia , Doenças da Traqueia/epidemiologia , Adolescente , Adulto , Brasil/epidemiologia , Feminino , Genótipo , Papillomavirus Humano 11/genética , Papillomavirus Humano 16/genética , Papillomavirus Humano 18/genética , Papillomavirus Humano 6/genética , Humanos , Doenças da Laringe/virologia , Pneumopatias/virologia , Masculino , Infecções por Papillomavirus/virologia , Reação em Cadeia da Polimerase , Prevalência , Infecções Respiratórias/virologia , Estudos Retrospectivos , Risco , Doenças da Traqueia/virologia
9.
Braz J Otorhinolaryngol ; 85(1): 3-10, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29030129

RESUMO

INTRODUCTION: Dysphonia is a common symptom after thyroidectomy. OBJECTIVE: To analyze the vocal symptoms, auditory-perceptual and acoustic vocal, videolaryngoscopy, the surgical procedures and histopathological findings in patients undergoing thyroidectomy. METHODS: Prospective study. Patients submitted to thyroidectomy were evaluated as follows: anamnesis, laryngoscopy, and acoustic vocal assessments. Moments: pre-operative, 1st post (15 days), 2nd post (1 month), 3rd post (3 months), and 4th post (6 months). RESULTS: Among the 151 patients (130 women; 21 men). Type of surgery: lobectomy+isthmectomy n=40, total thyroidectomy n=88, thyroidectomy+lymph node dissection n=23. Vocal symptoms were reported by 42 patients in the 1st post (27.8%) decreasing to 7.2% after 6 months. In the acoustic analysis, f0 and APQ were decreased in women. Videolaryngoscopies showed that 144 patients (95.3%) had normal exams in the preoperative moment. Vocal fold palsies were diagnosed in 34 paralyzes at the 1st post, 32 recurrent laryngeal nerve (lobectomy+isthmectomy n=6; total thyroidectomy n=17; thyroidectomy+lymph node dissection n=9) and 2 superior laryngeal nerve (lobectomy+isthmectomy n=1; Total thyroidectomy+lymph node dissection n=1). After 6 months, 10 patients persisted with paralysis of the recurrent laryngeal nerve (6.6%). Histopathology and correlation with vocal fold palsy: colloid nodular goiter (n=76; palsy n=13), thyroiditis (n=8; palsy n=0), and carcinoma (n=67; palsy n=21). CONCLUSION: Vocal symptoms, reported by 27.8% of the patients on the 1st post decreased to 7% in 6 months. In the acoustic analysis, f0 and APQ were decreased. Transient paralysis of the vocal folds secondary to recurrent and superior laryngeal nerve injury occurred in, respectively, 21% and 1.3% of the patients, decreasing to 6.6% and 0% after 6 months.


Assuntos
Doenças da Laringe/etiologia , Complicações Pós-Operatórias , Tireoidectomia/efeitos adversos , Distúrbios da Voz/etiologia , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Criança , Feminino , Humanos , Doenças da Laringe/epidemiologia , Doenças da Laringe/fisiopatologia , Traumatismos do Nervo Laríngeo/epidemiologia , Traumatismos do Nervo Laríngeo/etiologia , Traumatismos do Nervo Laríngeo/fisiopatologia , Laringoscopia/métodos , Laringe/lesões , Laringe/patologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Estudos Prospectivos , Fatores Sexuais , Fatores de Tempo , Paralisia das Pregas Vocais/epidemiologia , Paralisia das Pregas Vocais/etiologia , Paralisia das Pregas Vocais/fisiopatologia , Distúrbios da Voz/epidemiologia , Distúrbios da Voz/fisiopatologia , Qualidade da Voz/fisiologia , Adulto Jovem
10.
Eur Arch Otorhinolaryngol ; 276(1): 159-165, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30474701

RESUMO

BACKGROUND: Mucosal bridges (MBs) are rare laryngeal lesions that may cause dysphonia of varying degrees. We propose the existence of a third variant of MB besides thin and thick MBs, and have termed this as an incomplete mucosal bridge (IMB). The concept of an IMB has not been previously discussed in literature. Thin and thick MBs are attached anteriorly and posteriorly on the membranous vocal fold and may cause dysphonia because of their separate vibratory characteristics from the main vocal fold. We propose the presence of an entity named as IMB, which is typically identified by palpation of a slit on the superior surface of the membranous vocal fold. AIM: To propose and describe the existence of IMBs. Furthermore, to study the percentage of various types of MBs found while performing microlaryngeal surgeries (MLS) for benign glottic lesions, over a 9-year period at our Voice Clinic. METHOD: An IMB may be described as a MB that does not open at its medial edge. Thus it appears as an epithelial slit on the surface of the vocal fold. On palpating this slit with a microflap elevator, a flat pocket lying just below and parallel to the vocal fold epithelium is identified. These pockets are always directed medially (never laterally) and just stop short of opening up at the medial edge. These IMBs differ from sulci and focal pit as sulci and focal pits are not covered with a hood of epithelium. Our operative records of all MLS performed for benign glottic lesions were audited from 2009 to 2017 for cases of MBs. RESULTS: A total of 1728 MLS for benign glottic lesions were performed from 2009 to 2017 and 27 MBs were identified in 23 patients, 16 being male. A total of 11 IMBs were identified in 10 patients, with 1 case revealing a bilateral IMB. Other associated lesions were cysts, sulci, and polyps. A total of 14 thin MBs were identified in 11 patients with 3 cases revealing these bilaterally. Two thick MBs were identified in two separate cases, with one case having a bilobed hemorrhagic polyp attached to the thick MB. CONCLUSION: Our study found MBs in 1.33% of patients being operated for benign glottic lesions. The incidence of MBs in this group was 1.56% with IMBs accounting for 0.63%, thin MBs accounting for 0.81% and thick MBs in 0.11%. We recommend all patients undergoing MLS be actively palpated for the presence of mucosal bridges including IMBs especially if a small slit is found on the surface of the vocal fold. This is vital for accurate identification and documentation of all the lesions responsible for the patients voice quality. Ours is an ongoing study and we propose to analyze the vocal outcomes associated with surgical management of these IMBs.


Assuntos
Doenças da Laringe/diagnóstico , Mucosa Respiratória/patologia , Prega Vocal/patologia , Disfonia/etiologia , Feminino , Humanos , Incidência , Índia/epidemiologia , Doenças da Laringe/epidemiologia , Doenças da Laringe/patologia , Doenças da Laringe/cirurgia , Masculino , Microcirurgia , Mucosa Respiratória/cirurgia , Estudos Retrospectivos , Prega Vocal/cirurgia
11.
J Voice ; 33(1): 58-65, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29523383

RESUMO

OBJECTIVE: Professional singers are more likely to develop laryngeal pathologies and symptoms associated with misuse and overuse of the voice. However, different studies have shown conflicting evidence. We aim to perform a systematic review and quantitative meta-analysis to determine the prevalence and risk of laryngeal pathologies and symptoms among professional singers. METHODS: Four electronic databases (MEDLINE, PubMed, EMBASE, and CINAHL) were searched, with no language restrictions. From 3368 potential studies, a total of 21 studies met our inclusion criteria. A systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. All cohort, case-control, or cross-sectional studies that reported the risk of laryngeal pathologies in singers were included. Data were pooled by a random effects model and the pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. RESULTS: There was a positive relationship between singing and laryngeal pathologies. There was an increased risk of hoarseness (OR: 2.00, 95% CI: 1.61-2.49), gastroesophageal reflux disease (GERD) (OR: 1.45, 95% CI: 1.19-1.77), Reinke edema (OR: 2.15, 95% CI: 1.08-4.30), and polyps (OR: 2.10, 95% CI: 1.06-4.14) in professional singers. CONCLUSION: Professional singers are at an increased risk of laryngeal pathologies and symptoms associated with vocal misuse and overuse, particularly hoarseness, GERD, edema, and polyps.


Assuntos
Doenças da Laringe/epidemiologia , Canto , Refluxo Gastroesofágico/epidemiologia , Humanos , Pólipos/epidemiologia , Prevalência
12.
Acta Otorhinolaryngol Ital ; 38(5): 424-430, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30498270

RESUMO

The aim of our study was to compare socio-demographic characteristics of vocal fold nodules, polyps and oedema. The study included patients diagnosed for the first time with vocal fold nodules, polyps and oedema at the Communication Disorders Care Center of Clinic for Otorhinolaryngology and Maxillofacial Surgery in Clinical Center of Serbia, Belgrade. Diagnosis was made on the basis of symptoms, clinical otorhinolaryngological and phoniatric examination and endovideolaryngostroboscopic findings. A self-administered questionnaire was used to collect the following data: socio-demographic status, exposure to occupational noise and air pollution, occupational voice demands, health habits, symptoms of the present voice problems and voice problems in the family. By multivariate logistic regression analyses, nodules and oedema were more frequent in women than men in comparison with polyps (p < 0.001). Patients with nodules and polyps were younger than those with oedema (p < 0.001). Patients with nodules were more frequently lecturers, singers and actors compared with polyp patients (p = 0.006), had occupational voice demands more frequently than patients with oedema (p = 0.037) and were less frequently smokers than patients with polyps (p = 0.043) and those with oedema (p < 0.001). Patients with oedema were more frequently current smokers than patients with nodules and those with polyps (p < 0.001). Hoarseness as the main symptom was more frequent among patients with nodules than among patients with polyps (p = 0.040) and those with oedema (p = 0.001).Voice problems in the family was more frequently reported by oedema patients than by patients with polyps (p = 0.005). These findings are in agreement with majority of previous studies and may be of help in investigations on the aetiology of the disease.


Assuntos
Edema/epidemiologia , Doenças da Laringe/epidemiologia , Pólipos/epidemiologia , Prega Vocal , Adulto , Demografia , Edema/etiologia , Feminino , Humanos , Doenças da Laringe/etiologia , Masculino , Pólipos/etiologia , Fatores Socioeconômicos
13.
Curr Opin Otolaryngol Head Neck Surg ; 26(6): 426-430, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30300211

RESUMO

PURPOSE OF REVIEW: Vocal nodules are a common presentation in children, representing the most common cause of dysphonia. RECENT FINDINGS: Children with siblings, ADHD, and of male sex are most likely to be affected. Female children, however, tend to have more likely progression into adolescence. Quality-of-life indices can aid in screening for vocal nodules whereas stroboscopy, and possibly, ultrasound are required for definitive diagnosis. SUMMARY: Management has not significantly changed over time and should begin with conservative behavioral and environmental modifications along with voice therapy in those more severely impacted. Though immediate outcomes vary somewhat depending on management direction, the overall prognosis seems to be good even with lack of intervention. It is most critical to ensure a definitive diagnosis, and offer management therapies that are appropriate for the level of impact the vocal nodules have on communication and voice production in the child.


Assuntos
Doenças da Laringe/diagnóstico , Doenças da Laringe/terapia , Prega Vocal/patologia , Criança , Disfonia/etiologia , Disfonia/terapia , Humanos , Doenças da Laringe/epidemiologia , Doenças da Laringe/etiologia , Qualidade de Vida , Prega Vocal/lesões
14.
Artigo em Chinês | MEDLINE | ID: mdl-30121995

RESUMO

Objective: To investigate the pathogenic factors of vocal leukoplakia and its clinical and pathological features. Methods: Eighty-one patients with vocal cord leukoplakia who underwent surgery between February 2010 and December 2016 and 160 volunteers without pharyngeal symptoms designed as controls were included in this case control study. The clinicopathological characteristics of 81 patients were summarized and analyzed synthetically. Results: There was statistical significance in reflux symptom index(RSI), reflux finding score(RFS), smoking index, and drinking index between case group and control group(Z=-5.35, -4.82, -4.76, -2.44, P<0.05). The voice-using duration per day in case group was significantly longer than that of control group.There was no statistical significance in hospital anxiety and depression scale for anxiety(HADA) scores、hospital anxiety and depression scale for depression(HADD) scores between case group and control group(P>0.05). In 42 patients who received 24-hour dual probe pH monitoring the prevalence of pathologic LPR was 42.8%. In 81 patients, 39(48%)patients were pathologically diagnosed as squamous cell hyperplasia, 18(22%)patients as mild dysplasia, 12(15%)sides as moderate dysplasia , 10(12%)patients as severe dysplasia and 2(2%)patients as carcinoma in-situ. The average age of high-risk pathological vocal leukoplakia was significantly higher than that of low-risk leukoplakia(t=-2.73, P<0.01). The propotion of speckled leukoplakia in high-risk leukoplakia was significantly higher than that of low-risk leukoplakia(χ(2)=23.81, P<0.01). There was no statistical significance between high-risk leukoplakia and low-risk leukoplakia in the prevalence of pathologic LPR(P>0.05). The bilateral lesions, speckled leukoplakia were more likely to relapse(χ(2)=4.27, 12.17, P<0.05). The more serious the pathology, the more likely it was to relapse (Z=-2.168, P=0.03). There was no statistical significance between recurrence group and non-recurrence group in the prevalence of pathologic LPR(P>0.05). Conclusions: LPR, smoke constitute the risk factors of vocal cord leukoplakia. Drinking, voice abuse are related to vocal cord leukoplakia. Senile, speckled leukoplakia are more likely to be malignancy. A speckled leukoplakia, bilateral leukoplakia, severe pathological degree are important factors to predict recurrence.


Assuntos
Doenças da Laringe/etiologia , Leucoplasia/etiologia , Prega Vocal/patologia , Fatores Etários , Consumo de Bebidas Alcoólicas/efeitos adversos , Ansiedade/diagnóstico , Carcinoma in Situ/etiologia , Carcinoma in Situ/patologia , Estudos de Casos e Controles , Células Epiteliais , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/diagnóstico , Humanos , Hiperplasia/patologia , Doenças da Laringe/epidemiologia , Doenças da Laringe/patologia , Doenças da Laringe/psicologia , Neoplasias Laríngeas/etiologia , Neoplasias Laríngeas/patologia , Neoplasias Laríngeas/psicologia , Leucoplasia/epidemiologia , Leucoplasia/patologia , Leucoplasia/psicologia , Recidiva Local de Neoplasia , Prevalência , Fatores de Risco , Fumar/efeitos adversos , Fatores de Virulência , Distúrbios da Voz/complicações
15.
Artigo em Chinês | MEDLINE | ID: mdl-30121996

RESUMO

Objective: To observe the incidence and to determine the significance of laryngopharyngeal reflux (LPR) in laryngeal cancer and vocal leukoplakia. Methods: The patients who had been diagnosed as laryngeal cancer or vocal leukoplakia between January 2014 and June 2017 were included in this study. All of them received 24-hour multichannel intraluminal impedance-pH monitoring. The prevalence of LPR and numerous parameters from the 24-hour pH monitoring in laryngeal cancer patient and vocal leukoplakia patient groups were analyzed. The chi-square test was used for counting data, t test and Mann-Whitney U were used for measuring data. Results: In the 91 laryngeal cancer patients, the prevalence of pathologic LPR was 28.6%(26/91), the median number[P(25), P(75), P(95)]of acid reflux events was 0[0, 3, 5], time of acid exposure was 0[0, 14, 234]s, number of weakly acidic reflux events was 3[0, 6, 11]. In the 54 vocal leukoplakia patients, the prevalence of pathologic LPR was 29.6%(16/54), the number of acid reflux events was 0[0, 3, 4], time of acid exposure was 0[0, 13, 118]s, number of weakly acidic reflux events was 1.5[0, 5, 9]. The incidence of LPR did not vary in the laryngeal cancer patient and vocal leukoplakia patient groups, but were both higher than healthy Chinese volunteers according to a report in the other literature. Furthermore, all the three patients with no history of tobacco or alcohol existed acid or weakly acidic reflux episodes. Conclusions: Laryngopharyngeal reflux might play a role as an etiologic factor in laryngeal cancer and vocal leukoplakia.


Assuntos
Neoplasias Laríngeas/etiologia , Refluxo Laringofaríngeo/complicações , Leucoplasia/etiologia , Prega Vocal/patologia , Distribuição de Qui-Quadrado , Refluxo Gastroesofágico , Humanos , Incidência , Doenças da Laringe/epidemiologia , Doenças da Laringe/etiologia , Neoplasias Laríngeas/epidemiologia , Refluxo Laringofaríngeo/epidemiologia , Leucoplasia/epidemiologia , Prevalência , Estatísticas não Paramétricas
16.
Clin Gastroenterol Hepatol ; 16(10): 1670-1672, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29408585

RESUMO

Reflux-associated laryngeal symptoms (RALS) is the process in which chronic laryngeal symptoms are related to gastroesophagopharyngeal reflux.1 Impairment of upper esophageal sphincter (UES) reflexes may predispose to esophagopharyngeal reflux.1 The novel noninvasive nonpharmacologic UES assist device (UESAD) applies external cricoid pressure to augment intraluminal UES pressure by 20 to 30 mm Hg and reduce esophagopharyngeal reflux events.2 This study aimed to assess the therapeutic efficacy of the UESAD in a pragmatic clinical setting, and to identify factors associated with symptom response among patients with suspected RALS.


Assuntos
Equipamentos e Provisões , Esfíncter Esofágico Superior/fisiopatologia , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/terapia , Doenças da Laringe/epidemiologia , Doenças da Laringe/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
17.
J Voice ; 32(2): 239-243, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28624315

RESUMO

OBJECTIVE: The study aimed (1) to evaluate the prevalence of sulcus vocalis (SV) coexisting with vocal fold polyp (SV-VFP), and (2) to determine the effect of their coexistence on voice quality. STUDY DESIGN: This is a retrospective cohort study in a tertiary referral center. METHODS: The medical records of all patients who underwent micro direct laryngoscopy due to VFPs between January 2013 and April 2015 were reviewed. Patients with SV-VFP were identified and data of their demographics, medical history, habits, preoperative and intraoperative laryngeal findings, and pre- and postoperative GRBAS (Grade, Roughness, Breathiness, Asthenia, Strain) score, and compared with the data of patients with solitary VFPs (S-VFPs). RESULTS: Eighty-nine patients were diagnosed with VFPs, 14 (15.7%) of whom were diagnosed with SV-VFPs. Patients with SV-VFPs had significantly lower incidence of concurrent leukoplakia (P = 0.01), higher incidence of contralateral vocal fold lesions (P = 0.04), increased voice roughness score postoperatively (P = 0.01) on the GRBAS score, and had a lower rate of cigarette smoking (P = 0.02) compared with patients with S-VFPs. CONCLUSIONS: The possibility of a hidden SV should be considered when detecting VFPs, particularly in patients with contralateral vocal fold lesions and without cigarette smoking history. Because the group of patients with SV-VFP presented with unique features, we suspect that the coexistence of VFPs and SVs is not incidental and that SVs may contribute to the formation of VFPs, possibly by alternating glottic airflow.


Assuntos
Rouquidão/epidemiologia , Doenças da Laringe/epidemiologia , Pólipos/epidemiologia , Prega Vocal/fisiopatologia , Qualidade da Voz , Adulto , Feminino , Rouquidão/diagnóstico por imagem , Rouquidão/fisiopatologia , Rouquidão/cirurgia , Humanos , Incidência , Israel/epidemiologia , Doenças da Laringe/diagnóstico por imagem , Doenças da Laringe/fisiopatologia , Doenças da Laringe/cirurgia , Laringoscopia/métodos , Masculino , Microcirurgia/métodos , Pessoa de Meia-Idade , Pólipos/diagnóstico por imagem , Pólipos/fisiopatologia , Pólipos/cirurgia , Prevalência , Estudos Retrospectivos , Fatores de Risco , Fumar/efeitos adversos , Fumar/epidemiologia , Centros de Atenção Terciária , Resultado do Tratamento , Prega Vocal/diagnóstico por imagem , Prega Vocal/cirurgia
18.
Clin Otolaryngol ; 43(1): 124-130, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28556524

RESUMO

OBJECTIVE: Office-based laryngeal procedures (OBLPs) are emerging as effective alternative modalities for vocal disorders. This study systematically investigates the haemodynamic status of patients, specifically focusing on the potential effects of underlying comorbidity and medication use. DESIGN: Prospective cohort study. SETTING: Tertiary referral centre. PARTICIPANTS: We prospectively recruited 214 consecutive patients who received OBLPs during January-December 2015. All procedures were performed under local anaesthesia without sedation, in an upright (sitting) position. MAIN OUTCOME MEASURES: We measured heart rate (HR), systolic and diastolic blood pressure, and oxygen saturations at baseline (before procedure), immediately after local anaesthesia to the pharynx and larynx, immediately after completing of procedure, and 20 minutes after the procedure. RESULTS: Systolic, diastolic blood pressures and HR all significantly increased after local anaesthesia, and gradually decreased after the procedure (P<.01). Oxygen concentration remained unchanged. Patients with comorbidity and those receiving vasoactive medications showed significantly higher perioperative blood pressures than the other patients (P<.05), but the trend remained similar. Prominent hypertension (systolic ≥160 mm Hg or diastolic ≥100 mm Hg) was noted in 17 patients, more commonly in patients with older age, higher baseline blood pressures and receiving vasoactive medications. Only 2% of patients with normal baseline measurements developed prominent hypertension perioperatively. Tachycardia (HR≥100 bpm) developed in 22 patients, more frequently in patients with higher baseline HRs, and perceiving greater discomforts. CONCLUSION: This study revealed that routine haemodynamic monitoring may not be necessary for all the OBLPs, but should be considered for older patients, those with higher baseline blood pressure or HR, sensitive patients who might be more susceptible to perioperative discomfort, and those receiving vasoactive medications.


Assuntos
Anti-Hipertensivos/uso terapêutico , Hemodinâmica/fisiologia , Hipertensão/epidemiologia , Doenças da Laringe/epidemiologia , Laringoscopia , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade/tendências , Feminino , Seguimentos , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/fisiopatologia , Doenças da Laringe/terapia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Taiwan/epidemiologia , Adulto Jovem
19.
Otolaryngol Head Neck Surg ; 157(4): 670-675, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28895450

RESUMO

Objective To identify occupational groups' use of specialty voice clinic evaluation. Study Design Retrospective cohort study. Setting Tertiary subspecialty clinic. Subjects and Methods We analyzed data collected on patients presenting to the Massachusetts Eye and Ear Infirmary Voice and Speech Laboratory over a 20-year period (1993-2013). The relative risk (RR) and 99% confidence interval (CI) of presentation were calculated for each occupational category in the greater Boston population using year-matched data from the Bureau of Labor Statistics (BLS). Results The records of 12,120 new patients were reviewed. Using year- and occupation-matched BLS data from 2005 to 2013, 2726 patients were included in the cohort analysis. Several occupations had significantly higher risk of presentation. These included arts and entertainment (RR 4.98, CI 4.18-5.95), law (RR 3.24, CI 2.48-4.23), education (RR 3.08, CI 2.70-3.52), and social services (RR 2.07, CI 1.57-2.73). In contrast, many occupations had significantly reduced risk of presentation for laryngological disorders, for example, maintenance (RR 0.25, CI 0.15-0.42), food preparation (RR 0.35, CI 0.26-0.48), and administrative support (RR 0.49, CI 0.41-0.57). Conclusion Certain occupations are associated with higher use of laryngological services presumably because of their vocational voice needs. In addition to confirming findings from other studies, we identified several new occupation groups with increased or decreased risk for laryngologic disorders. Understanding what factors predispose to requiring specialty voice evaluation may help in targeting preventative efforts.


Assuntos
Doenças da Laringe/epidemiologia , Doenças Profissionais/epidemiologia , Saúde do Trabalhador , Ocupações , Medição de Risco/métodos , Qualidade da Voz , Adulto , Idoso , Feminino , Seguimentos , Humanos , Doenças da Laringe/diagnóstico , Doenças da Laringe/fisiopatologia , Masculino , Massachusetts/epidemiologia , Pessoa de Meia-Idade , Doenças Profissionais/diagnóstico , Doenças Profissionais/fisiopatologia , Ocupações/classificação , Prevalência , Estudos Retrospectivos , Fatores de Risco
20.
Curr Opin Otolaryngol Head Neck Surg ; 25(6): 469-474, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28759458

RESUMO

PURPOSE OF REVIEW: The current review summarizes previous reports on laryngopharyngeal symptoms associated with thyroid disease. This review also includes pharyngolaryngeal symptoms caused by thyroidectomy. However, we focus on pharyngolaryngeal symptoms following uncomplicated thyroidectomy, as this is an important issue in the fields of otolaryngology. RECENT FINDINGS: An enlarged thyroid gland, as in thyroiditis, multinodular goiter, or large nodules, can cause compressive symptoms. Malignant nodules invading the recurrent laryngeal nerve and benign nodules compressing the nerve can cause vocal cord paralysis and hoarseness. Pharyngolaryngeal symptoms are known to develop after a thyroidectomy, generally as a result of injury to the superior or recurrent laryngeal nerve. However, recent studies have shown that various pharyngolaryngeal symptoms, such as globus symptoms and voice changes, occur after thyroidectomy in the absence of laryngeal nerve injury. These symptoms are known collectively as postthyroidectomy syndrome. Several possible explanations have been proposed and evaluated for postthyroidectomy syndrome. SUMMARY: Several thyroid disorders can cause compressive symptoms and hoarseness. Superior and/or recurrent laryngeal nerve injury during thyroidectomy is the main cause of various pharyngolaryngeal symptoms. However, other pharyngolaryngeal symptoms that arise following thyroidectomy in the absence of nerve injury, a condition known as postthyroidectomy syndrome, are becoming more common.


Assuntos
Doenças da Laringe/diagnóstico , Doenças Faríngeas/diagnóstico , Doenças da Glândula Tireoide/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Doenças da Laringe/epidemiologia , Traumatismos do Nervo Laríngeo/diagnóstico , Traumatismos do Nervo Laríngeo/epidemiologia , Masculino , Doenças Faríngeas/epidemiologia , Medição de Risco , Índice de Gravidade de Doença , Doenças da Glândula Tireoide/epidemiologia , Paralisia das Pregas Vocais/diagnóstico , Paralisia das Pregas Vocais/epidemiologia
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