Pepsin Inhibitors Prevent Inflammation and Loss of Laryngeal Barrier Function in Mice with Gastroesophageal Reflux.

OBJECTIVE: This study aimed to evaluate the role of pepsin inhibitors in the inflammatory response and their effects on laryngeal mucosal integrity during gastroesophageal reflux (GERD) under in vivo conditions. METHODS: A surgical model of GERD was used, in which mice were treated with pepstatin (0.3 mg/kg) or darunavir (8.6 mg/kg) for 3 days. On the third day after the experimental protocol, the laryngeal samples were collected to assess the severity of inflammation (wet weight and myeloperoxidase activity) and mucosal integrity (transepithelial electrical resistance and paracellular epithelial permeability to fluorescein). RESULTS: The surgical GERD model was reproduced. It showed features of inflammation and loss of barrier function in the laryngeal mucosa. Pepstatin and darunavir administration suppressed laryngeal inflammation and preserved laryngeal mucosal integrity. CONCLUSION: Pepsin inhibition by the administration of pepstatin and darunavir improved inflammation and protected the laryngeal mucosa in a mouse experimental model of GERD. LEVEL OF EVIDENCE: NA Laryngoscope, 134:3080-3085, 2024.

Efecto inmediato de dos ejercicios con tracto vocal semiocluido en el contacto glótico de usuarios ocupacionales de la voz / Immediate effect of two semi-occluded vocal tract exercises in glottal contact of occupational voice users

Introducción. Los docentes son usuarios ocupacionales de la voz con alto riesgo de desarrollar patologías vocales a causa de su labor. Para enfrentar esta proble-mática, suelen usarse ejercicios con tracto vocal semiocluido (TVSO), estrategia de educación/rehabilitación empleada para generar un cambio en el patrón de vibración de los pliegues vocales, minimizando el riesgo de lesión vocal al reducir el estrés de colisión al que se someten los tejidos. Diversos reportes han indicado que este tratamiento tiene efectos en el cociente de cierre (CQ), medida indirecta del estrés de colisión.Objetivo. Examinar el efecto fisiológico de dos ejercicios con TVSO en la actividad laríngea de profesores con esfuerzo vocal constante pero sin patología vocal. Metodología. Se registraron muestras de 43 profesores antes, durante y después de la realización de dos ejercicios con TVSO (vibración lingual y fonación en tubos). Las muestras de electroglotografía se analizaron para obtener el CQ. Resultados y conclusión. Se observó una diferencia significativa al comparar los valores del CQ antes y durante la realización de ambos ejercicios. No se encontraron cambios en este parámetro después de ejecutar la actividad. Estos hallazgos concuer-dan con reportes previos en los cuales el CQ tiende a aumentar durante la fonación en tubos; contrariamente, la realización de la vibración lingual tiende a decrecer el valor del CQ. Es posible que este comportamiento se deba a los mecanismos biome-cánicos particulares de cada ejercicio

Introduction. Teachers are occupational voice users with high risk of developing vocal pathologies due to their work. To face this situation, it is common the use of semi-occluded vocal tract (SOVT) exercises, a strategy of voice education/rehabil-itation implemented to induce a change in the vibration pattern of the vocal folds, mitigating, therefore, the risk of vocal lesion by reducing the collision stress applied to tissues. A variety of reports have indicated that this treatment has effects in the closed quotient (CQ), an indirect measure of collision stress. Aim. The purpose of this study was to examine the physiological effect of two dif-ferent SOVT exercises in larynx activity of teachers with constant vocal effort but without vocal pathology. Methods. 43 samples of teachers were recorded before, during and after executing two SOVT exercises (tongue trill and tube phonation). Electroglottographic samples were analyzed in order to obtain CQ. Results and conclusion. Both exercises had a significant difference of CQ scores when before and during conditions were compared. Any difference was found on this parameter after executing the activity. These findings agree with previous reports where CQ tends to increase during phonation through resonance tubes; on the con-trary, execution of tongue trill tends to decrease CQ values. This behavior might be because of the particular biomechanical mechanisms of each exercise

Laryngeal Mucosa Alterations in Mice Model of Gastroesophageal Reflux: Effects of Topical Protection.

OBJECTIVES/HYPOTHESIS: The objectives of this study were to evaluate laryngeal inflammation and mucosal integrity in a murine model of reflux disease and to assess the protective effects of topical agents including alginate, hyaluronic acid, and cashew gum. STUDY DESIGN: Animal study. METHODS: A surgical murine model of reflux disease was evaluated at 3 or 7 days postsurgery, and laryngeal samples were collected to measure inflammation (wet weight and myeloperoxidase [MPO]) and mucosal integrity (transepithelial resistance [TER] and mucosal permeability to fluorescein). Additional groups of animals were administered one of several topical agents (alginate, hyaluronic acid, or cashew gum) daily, and laryngeal inflammation and mucosal integrity were evaluated at 3 days postsurgery. RESULTS: At 3 days, and not 7 days postsurgery, we observed increased laryngeal wet weight and MPO, decreased laryngeal TER, and increased laryngeal mucosa permeability. Alginate partially decreased laryngeal inflammation (wet weight and not MPO) and dramatically improved laryngeal mucosal integrity. Conversely, hyaluronic acid eliminated the inflammation; however, it had no effect on laryngeal mucosal integrity impairment. Cashew gum eliminated laryngeal inflammation as well as the impairment in laryngeal mucosal integrity. CONCLUSIONS: This study shows that a surgical model of reflux disease induced laryngeal inflammation and impairment in laryngeal barrier function. These observed alterations were partially attenuated by alginate and hyaluronic acid and completely reversed by cashew gum. LEVEL OF EVIDENCE: NA Laryngoscope, 2020.

Impact of laryngeal sequelae on voice- and swallowing-related outcomes in paracoccidioidomycosis

The present study was carried out aiming to evaluate the impact of laryngeal sequelae on the quality of life of treated paracoccidioidomycosis (PCM) patients. Methods: This cross-sectional study was conducted at the Otorhinolaryngology Outpatient Clinic of the University Hospital, Federal University of Mato Grosso do Sul, Brazil. Thirty-two PCM patients considered clinically and immunologically cured were included: 16 with laryngeal involvement during the active phase of the disease (laryngeal PCM group) and 16 without laryngeal involvement (control group). They were submitted to structured interview, otorhinolaryngology examination, videolaryngoscopy, videoendoscopic swallowing study, completed two questionnaires for voice self-assessment - Voice-related Quality of Life (V-RQOL) and Voice Handicap Index (VHI) - and were asked to score their voices on a scale from zero to 10 (self-assessment of vocal quality). Results: Dysphonia was present in 50% of the cases. Patients with laryngeal PCM presented worse voice-related quality of life scores on the V-RQOL and poorer vocal quality self-assessment than the control group. No significant differences in the VHI were found between the groups. None of the participants developed dysphagic sequelae, although some minor changes were observed on videoendoscopic examination. Conclusion: There were no dysphagia complaints and only a few mild changes were found on the fiberoptic endoscopic evaluation of swallowing, suggesting that this evaluation should be performed only in specific cases. Patients with laryngeal involvement presented worse V-RQOL and self-assessment voice quality. This study contributes to the current knowledge of the functional assessment of the larynx affected by PCM and the impact of dysphonia on quality of life.(AU)

Topical protection of mice laryngeal mucosa using the natural product cashew gum.

OBJECTIVES/HYPOTHESIS: Evaluate the effect of in vitro exposure of mice laryngeal mucosa to solutions that simulated human gastric juice and to assess the topical protective effect of cashew gum on mice laryngeal mucosal integrity in vitro. STUDY DESIGN: Animal study. METHODS: Murine (Swiss) laryngeal samples were mounted in Ussing chambers. The luminal side of biopsies was exposed to solutions of different acidity with or without pepsin and/or taurodeoxycholic acid (TDC). Transepithelial electrical resistance (TER) was continuously recorded. The topical protective effect of cashew gum solution was evaluated by precoating the biopsies before the exposure with a solution at pH 5 containing 5 mM TDC. Changes in TER and mucosal permeability to fluorescein were measured. RESULTS: Exposure of laryngeal mucosa to acidic solutions containing pepsin and TDC provoked a pH-dependent drop in TER with the maximal effect at pH 1, but still present at pH 5 (weakly acidic). The exposure of the laryngeal mucosa to a solution of pH 5 with TDC, but not with pepsin, produced a dose-dependent decrease in TER. Precoating the mucosa with cashew gum prevented the reduction of TER and increased transepithelial permeability by exposure to a solution at pH5 containing TDC. CONCLUSIONS: Weakly acidic solutions containing bile acids can produce impairment of laryngeal epithelial barrier, which may be protected by topical treatment with cashew gum. LEVEL OF EVIDENCE: NA. Laryngoscope, 128:1157-1162, 2018.

Lesão de mucosa laringotraqueal e fatores associados após extubação endotraqueal: estudo piloto / Laryngotracheal mucosa injury and associated factors after endotracheal extubation: a pilot study

Resumo Objetivo Descrever os sinais clínicos de lesão de mucosa laringotraqueal e seus fatores associados. Métodos Estudo observacional, longitudinal, em pacientes intubados por ocasião da anestesia geral. Foram realizadas avaliações no pré-operatório, transoperatório, e nas 24, 48 e 72 horas após extubação. Para análise, utilizaram-se estatísticas descritiva e exploratória, e também foi verificada a razão de chances. Resultados Dentre os pacientes, 53,3% apresentaram pelo menos um sinal clínico de lesão de mucosa laringotraqueal, sendo predominantes: rouquidão (43,3%), disfagia (40%) e odinofagia (33,3%). Estiveram associados aos seguintes fatores: pressão intra-cuff acima de 25cmH2O, intubação por mais de 120 minutos e uso de tubos maiores que 7,5mm. Conclusão Os sinais clínicos de lesão de mucosa laringotraqueal mais frequentes na população deste estudo foram rouquidão, disfagia e odinofagia, associados à pressão do cuff acima de 25 cmH2O, seguido do tempo de intubação e tamanho inadequado de tubos endotraqueais.

Abstract Objective To describe the clinical signs of laryngotracheal mucosal injuries and associated factors. Methods This was an observational longitudinal study conducted with patients intubated due to general anesthesia. Assessment was carried out in the preoperative period, intraoperative period and at 24, 48, and 72 hours after extubation. Descriptive and exploratory statistics were used for analysis, in addition to odds ratio. Results 53.3% of the sample presented at least one clinical sign of laryngotracheal mucosal injury, mainly: hoarseness (43.3%), dysphagia (40%), and odynophagia (33.3%). The following factors were associated: intracuff pressure above 25 cmH2O, intubation longer than 120 minutes, and the use of tubes larger than 7.5mm. Conclusion The most common clinical signs of laryngotracheal mucosal injury among the studied population were hoarseness, dysphagia, and odynophagia, associated with cuff pressure above 25 cmH2O, followed by duration of intubation and inadequate endotracheal tube size.

Comparative study of the behavior of p53 immunoexpression in smoking associated lesions: Reinke's edema and laryngeal carcinoma.

OBJECTIVE: To assess the behavior of the immunoexpression of protein p53 in Reinke's edema and laryngeal squamous cell carcinoma. STUDY DESIGN: retrospective. METHODS: we recovered the histological paraffin blocks of patients who were subjected to Reinke's edema and laryngeal squamous cell carcinoma surgery in 2000-2011. The paraffin blocks were cut into 3-µm sections; the specimens were prepared in silanized slides (one slide for each paraffin block) and subjected to immunohistochemical reaction according to the Avidin Biotin Peroxidase method. Monoclonal primary anti-p53 antibodies were used at 1:50 dilution. Slides were examined under a light microscope at different magnitudes and results were interpreted based on the degree of brown staining in the nuclei of epithelial cells and in the extent of the fragment by using a semi-quantitative score from 0 to 3. RESULTS: 67 slides of Reinke's edema and 60 slides of laryngeal squamous cell carcinoma were included. Scores 2 and 3 for staining of the nuclei of epithelial cells were recorded for 46 slides of Reinke's edema (68.65%) and for 57 slides of laryngeal squamous cell carcinoma (95%). As to the extent of the fragment, scores 2 and 3 were recorded for 74% slides of Reinke's edema and for 95% slides of carcinomas. CONCLUSION: the positive immunoexpression for protein p53, positive in 95% carcinomas and 74% Reinke's edemas, makes us aware of the possible preneoplastic condition of the latter lesion. Further studies are needed to identify and reveal the genetic changes that lead to these results.

Descrição de periodicidade do sinal eletroglotográfico durante a emissão dos exercícios de vibração sonorizada de língua e lábios comparados à vogal sustentada /E/ / Comparison of tongue and lip trills with phonation of the sustained vowel /E/ regarding the periodicity of the electroglottographic waveform and the amplitude of the electroglottographic signal

INTRODUÇÃO: Os exercícios de vibração sonorizada de lábios e língua têm-se se mostrado eficientes quando utilizados tanto no tratamento de pacientes disfônicos como no aquecimento ou preparação vocal. Há grande variação do coeficiente de contato de um mesmo sinal eletroglotográfico e dificuldade na sincronização da luz estroboscópica durante a emissão dos exercícios de vibração sonorizada de língua e lábios, sendo levantada a possibilidade de aperiodicidade de vibração das pregas vocais durante a execução desses exercícios. OBJETIVO: descrever a vibração das pregas vocais durante a emissão de vibrações sonorizadas de língua e lábios comparando-as com a emissão da vogal /E/ sustentada quanto à regularidade e amplitude dos ciclos vibratórios na eletroglotografia, em cantores eruditos profissionais. METODOLOGIA: Participaram desse estudo 10 cantores eruditos profissionais, que emitiram a vogal /E/ sustentada e os exercícios de vibração sonorizados de língua e de lábios na mesma frequência e intensidade durante a execução da eletroglotografia. Foi realizada a inspeção visual da onda eletroglotográfica, quanto à periodicidade e amplitude, além do espectrograma do sinal quanto aos harmônicos presentes em cada amostra. As amostras foram randomizadas e analisadas por 3 avaliadoras. Além disso, foram extraídas as medidas de jitter e shimmer do sinal eletroglotográfico para confirmação dos resultados, além da frequência da variação de vibração dos exercícios de vibração sonorizada. RESULTADOS: Os avaliadores tiveram coeficiente alfa de Cronbach em mais de 0,9 na maior parte das amostras, indicando alto grau de concordância. Na inspeção visual do sinal eletroglotográfico foi considerada na vogal /E/ sustentada: onda periódica com amplitude regular e harmônicos múltiplos da frequência fundamental. Durante o exercício de vibração sonorizada de língua e lábios foram consideradas onda quase-periódica com amplitude oscilante (frequencia aproximada de 23Hz e 24Hz)...

INTRODUCTION: Lip and tongue trills have been effectively used as vocal warmups in the treatment of dysphonia and in the training of professional voice users. In a previous study, we found that the closed quotient varied widely during tongue and lip trills. We encountered difficulty in synchronizing the stroboscopic illumination with the vocal fold vibration during the trill exercises. We hypothesize that there is aperiodicity of vocal fold vibration during tongue and lip trills. AIM: to compare the vocal fold vibration seen during lip and tongue trills with that seen during phonation of the sustained vowel /E/, in terms of the periodicity of the EGG wave form and the amplitude of the EGG signal, in professional voice users. METHODS: We used electroglottography (EGG) to compare the vocal fold vibration seen during tongue and lip trills with that seen during phonation of the sustained vowel /E/, in terms of the EGG waveform periodicity and signal amplitude, in 10 classically trained, professional singers. The participants produced the sustained vowel /E/ and performed tongue and lip trills at the same frequency and intensity. The periodicity of the waveform and the amplitude of the signal were visually analyzed by three blinded, experienced readers. To confirm the visual analysis results, we measured the jitter and shimmer of the signal and the frequency of variation in vocal fold vibration during the trill exercises. RESULTS: Cronbach's alpha coefficient values were high (>0,9), indicating high inter-rater reliability. In sustained vowel /E/ was considered periodic wave and regular amplitude. In tongue and lip trills the waveform EGG was considered quasi-periodic and the amplitude of the EGG signal was classified as oscillating. The mean amplitude was as follows: 24.4 Hz during lip trills performed at high intensity; 24.7 Hz during tongue trills performed at high intensity; 23.3 Hz during lip trills performed at low intensity; and 24.3 Hzl...

Consequences of chronic nasal obstruction on the laryngeal mucosa and voice quality of 4- to 12-year-old children.

INTRODUCTION: Dysphonia affects 6% to 23% of children, and chronic nasal obstruction may participate in its pathophysiology. OBJECTIVES: To study the effects of chronic nasal obstruction on children's vocal quality. SUBJECTS AND METHODS: Two study groups were formed: nasal obstruction group (NOG), consisting of 60 children aged 4-12 years with important symptoms of chronic nasal obstruction; and a control group (CG), similar in gender and age range, consisting of healthy students without nasal, vocal, or auditory symptoms. The parents answered a questionnaire containing questions concerning their children's vocal qualities. All the children were submitted to perceptual auditory analysis, acoustic vocal analysis, auditory acuity assessment (transient otoacoustic emissions and/or threshold tone audiometry), and videoendoscopic assessment (flexible laryngoscopy and rigid laryngoscopy). RESULTS: The groups were similar in age and gender. Parents reported a dysphonia rate of 76.6% in NOG and a vocal abuse rate of 68.3%. Eight children from NOG (13.34%) showed mild conductive hypoacusia. Laryngeal lesions were detected in 35 children from NOG (58%): inflammatory processes (n=19), mucosal thickening (n=10), nodules (n=5), and cyst (n=1). In children from the NOG were observed higher scores for the Grade, Roughness, Breathiness, Aesthenia, Strain, Instability (GRBAS) perceptual scale (P<0.05), lower maximum phonation time values, and higher values to the s/z ratio, insufficient nasal resonance. CONCLUSIONS: Relevant changes in perceptual auditory and acoustic vocal analyses and in the videolaryngoscopy were detected in children with nasal obstruction. These results showed the importance of the assessment of nasal obstruction in dysphonic children.

Ingestión de 208 cuerpos extraños en niños: enero 2004 - abril 2009 / Ingestion of 208 foreign bodies in children: January 2004 - April 2009

Introducción: La ingesta de cuerpo extraño representa la segunda causa de urgencia endoscópica en niños. Objetivo: Evaluar nuestra experiencia en niños con ingesta de cuerpo extraño: sexo, edad, tipo, conducta y complicaciones. Pacientes y métodos: Se realizó un estudio retrospectivo longitudinal a 208 niños hospitalizados por esta etiología desde Enero de 2004 hasta Abril de 2009 en Hospital Universitario Dr. "Luis Razetti", Barcelona. A todos se les realizó Radiografías de cervical, tórax y abdomen. Resultados: Predominaron: masculinos (55,77%), y preescolares (70,67%). Los objetos más frecuentes fueron: moneda (164/208), zarcillo (6/208), pinza de cabello, pila de reloj, semilla 4/208 en cada uno. Con respecto a los procedimientos: 1. Endoscopia: (177/208), de estos 166 se encontraron en esófago (93,37% en 1/3 superior), 130 se extrajo el objeto con pinza, 40 se le desplazó a estómago y 5 no se encontraron. Se evidenció lesión de mucosa a 43 y a 3/177 estenosis esofágica; dos ameritaron cirugía. 2. Laringoscopia: (4/208) y 3. Broncoscopia (2/208): un imperdible en bronquio derecho y una semilla en bronquio izquierdo. 4. Expulsión natural por heces (25/208). Conclusión: La ingesta de cuerpo extraño está entre las primeras causas de los accidentes en los niños, amerita un diagnóstico e intervención precoz.

Introduction: Intake of foreign bodies represents the second cause endoscopic emergency in children. Objectives: Evaluate our experience with children in foreign body intake: sex, age, type, conduct and complications. Patients and methods: A retrospective longitudinal study in 208 children hospitalized for this etiology since January 2004 until April 2009 at Dr. "Luis Razetti", Barcelona University Hospital. All underwent cervical, thoracic and abdominal radiographs. Results: prevailed: male (55.77%), and pre-school (70.67%). Objects frequently found were: currency (164/208), earring (6/208), hairclip, clock battery, seed 4/208 in each. With concerning the procedures: 1. Endoscopy: (177/208), of these 166 were found in the esophagus (93.37% in 1/3 superior), 130 extracted the object with clamp, 40 were displaced to the stomach and 5 were not found. Mucosal injury was found to 43 and in 3/177 esophageal stenosis, two requierd surgery. 2. Laringoscopy: (4/208) and 3. Bronchroscopy (2/208): a safety pin in the right bronchus and a seed in left bronchus. 4. Natural expulsion by feces (25/208). Conclusion: foreign body intake is among the primary causes of accidents in children, deserves a diagnosis and precocious intervention.

Sulcus mucosal slicing technique.

PURPOSE OF REVIEW: To present the accurate surgical indication for the slicing mucosal technique, the case selection, surgical aspects, rehabilitation concerns, and the characteristics of immediate and long-term outcomes. RECENT FINDINGS: The literature is still scarce; few cases are submitted to the slicing mucosa technique due to its specific indication; an alternative procedure was designed for cases where mucosal movement is strongly reduced, the inner section of the vocal ligament or submucosal scar tissue, which can eventually be associated with fat inclusion. Some selected cases may require thyroplasty type III to optimize functional results. SUMMARY: Slicing technique is an aggressive powerful resource for the surgical treatment of severe cases of sulcus striae major, in which mucosal wave is absent and glottic chink is moderate to severe; voice is intensely deviated immediately postoperation; vocal rehabilitation is mandatory and an intensive regimen is usually required for the first 2 months; final results can mostly be achieved up to 6 months.

Elastic fibers in Reinke's edema.

OBJECTIVES: We describe the distribution of elastic system fibers in the superficial layer of the lamina propria of Reinke's edema, as compared with normal vocal folds. METHODS: Weigert's resorcin-fuchsin stain after oxidation with 10% oxone was used to study the arrangement of elastic fibers. The findings were categorized and afterward compared with the severity of Reinke's edema. RESULTS: Analysis of 20 specimens of vocal folds with Reinke's edema showed that the network of thin elastic fibers in Reinke's space lost their undulated appearance and had a tangled aspect. In addition, these fibers were no longer parallel to the epithelial basement membrane, but had a random distribution scattered throughout Reinke's space. The elastic fiber network immediately below the epithelial basement membrane also appeared more fragmented in Reinke's edema because of some alteration in organization combined with the 5-microm-thick histologic sectioning plane. No significant difference in the degree of elastic system fiber disarrangement was observed between severity grades II and III (p = 0.382). Large areas of disarrangement were predominant (80% of cases). CONCLUSIONS: The disarrangement of elastic fibers in Reinke's edema may cause insufficient tissue resistance and resilience, contributing to the hypermobility observed in Reinke's edema.

Estudio comparativo entre las características citológicas de los epitelios nasal, faríngeo y vaginal en mujeres adultas jóvenes / Comparative study of cytological characteristics of the nasal, pharygeal and vaginal epithelium in young adult women

Determinar y comparar las características citológicas de los epitelios nasal, faríngeo y vaginal en mujeres adultas jóvenes. Estudio prospectivo y transversal de 35 mujeres no embarazadas, entre 18 y 35 años de edad, durante el período comprendido entre el 01 de enero al 01 de julio de 2004; que ingirieron o no anticonceptivos orales y a quienes se les estudiaron las citologías de los epitelios vaginal, faríngeo y nasal, según el porcentaje de índice de maduración de células exfoliadas y la cuantificación sérica de estrógeno y progesterona. En el Departamento de Obstetricia y Ginecología Hospital Chiquinquirá de Maracaibo, Estado Zulia. Se determinó que no existe diferencia significativa entre la celularidad de los epitelios estudiados. Se estableció que existe buena correlación entre las células superficiales e intermedias de los frotis de vagina, faringe y nariz durante las fases del ciclo menstrual, en todas las mujeres, aun en las que recibieron píldoras anticonceptivas. Los niveles de estrógenos y progesterona tuvieron concordancia con las fases del ciclo, con el porcentaje y tipo de células exfoliadas. Los resultados obtenidos demuestran que los epitelios nasales y faríngeos responden al influjo de hormonas ováricas similarmente como ocurre en la vagina y que estos métodos pueden ser aplicados en condiciones de difícil acceso a laboratorios hormonales o en pacientes vírgenes o con atresia/agenesia vaginal y niñas

To determine and compare the cytological characteristics of nasal, pharyngeal and vaginal epitheliums in young adult women. A prospective and transversal study of 35 non pregnant women of 18 to 35 years old during the period January 1, 2004 - November 2004; some on contraceptives pills, were studied by analysis of smear of nasal, pharyngeal and vaginal trough maturation index of exfoliated cells and serum level of estrogen and progesterone. Department of Obstetrics and Gynecology, Hospital Chiquinquira, Maracaibo, Estado Zulia. Venezuela. It was established that exists a good correlation between the superficial and intermediate cells in the different phases of the menstrual cycle and those who received oral contraceptives and the group that did not. Is established that there are correlation between the cells when compared vaginal-pharynx and vaginal-nose, in both groups. The serum levels of estrogen and progesterone were accorded to the cycle phases and with the percentage of cells in both, medicated and non medicated patients. Ours results demonstrate that the nasal and pharyngeal epitheliums respond to ovarian hormones, similar to what occurs in the vagina. It is recommended to use this method in those patients where it is need to investigate the endocrine status and where it is difficult to reach the vagina: nubile girls, vaginal agenesis, imperforate hymen; or where there is not a endocrine laboratory near

Angiogenesis, fibrinogenesis and presence of synechiae after exeresis of a swine vocal fold mucosal microflap and use of topical mitomycin-C.

PURPOSE: To evaluate swine vocal fold healing in a period of 30 days after topical mitomycin-C application. METHODS: Twelve swine underwent exeresis of mucosal flaps from the free edge of the anterior third of both vocal folds with a cold instrument (laryngeal scissors). The animals were divided into two groups: EG (Experimental Group), consisting of 6 animals undergoing topical MMC application (4 mg/dL) on the operated area for 4 minutes; CG (Control Group), 6 animals undergoing topical saline solution application on the operated area for 4 minutes. After 30 days, the animals were sacrificed and the larynges were collected and examined for the presence of synechiae as well as a histological immunohistochemical assessment of immature and mature collagen deposition, number of blood vessels and myofibroblasts. RESULTS: Mature collagen deposition in the EG was 452.12 microm(2) and 1332.31 microm(2) in the CG; immature collagen deposition was 1511.73 microm(2) in the EG and 1020.61 microm(2) in the CG. The number of myofibroblasts was 1.556 in the EG and 3.583 in the CG. The number of blood vessels was 2.565 in EG and 6.917 in the CG. There were no synechiae in the two studied groups. CONCLUSIONS: There was an increase in immature collagen deposition in the experimental group when compared with the control group. There was a decrease in mature collagen deposition in the experimental group when compared with the control group. There was a decrease in the number of myofibroblasts in the experimental group when compared with the control group. A decrease in blood vessels was observed in the experimental group when compared with the control group. There was no synechia formation in either studied group.

Angiogenesis, fibrinogenesis and presence of synechiae after exeresis of a swine vocal fold mucosal microflap and use of topical mitomycin-C / Estudo da angiogênese, fibrogênese e presença de sinéquias após exérese de fragmento de mucosa de pregas vocais de suínos utilizando instrumental frio e mitomicina-C tópica

PURPOSE: To evaluate swine vocal fold healing in a period of 30 days after topical mitomycin-C application. METHODS: Twelve swine underwent exeresis of mucosal flaps from the free edge of the anterior third of both vocal folds with a cold instrument (laryngeal scissors). The animals were divided into two groups: EG (Experimental Group), consisting of 6 animals undergoing topical MMC application (4 mg/dL) on the operated area for 4 minutes; CG (Control Group), 6 animals undergoing topical saline solution application on the operated area for 4 minutes. After 30 days, the animals were sacrificed and the larynges were collected and examined for the presence of synechiae as well as a histological immunohistochemical assessment of immature and mature collagen deposition, number of blood vessels and myofibroblasts. RESULTS: Mature collagen deposition in the EG was 452.12 μm² and 1332.31μm² in the CG; immature collagen deposition was 1511.73μm² in the EG and 1020.61μm² in the CG. The number of myofibroblasts was 1.556 in the EG and 3.583 in the CG. The number of blood vessels was 2.565 in EG and 6.917 in the CG. There were no synechiae in the two studied groups. CONCLUSIONS: There was an increase in immature collagen deposition in the experimental group when compared with the control group. There was a decrease in mature collagen deposition in the experimental group when compared with the control group. There was a decrease in the number of myofibroblasts in the experimental group when compared with the control group. A decrease in blood vessels was observed in the experimental group when compared with the control group. There was no synechia formation in either studied group.

OBJETIVO: Avaliar a cicatrização de pregas vocais de suínos utilizando mitomicina-C tópica, em 30 dias. MÉTODOS: Doze suínos foram submetidos à exérese de mucosa do bordo livre do terço anterior de ambas as pregas vocais com instrumental frio (tesoura curva) e divididos em dois grupos: Grupo E (GE), composto por seis animais com utilização tópica de mitomicina-C(4 mg/dL) na área cruenta por quatro minutos e Grupo Controle (GC), composto por seis animais com utilização tópica de soro fisiológico na área cruenta por quatro minutos. Após 30 dias os animais foram sacrificados e coletadas amostras das pregas vocais para avaliação de sinéquias e análise histológica com quantificação da deposição de colágeno maduro e imaturo, quantificação do número de vasos sanguíneos e miofibroblastos, por método imunoistoquímico. RESULTADOS: A deposição do colágeno maduro no GE foi de 452,12 μm² e 1332,31μm² no GC. A do colágeno imaturo foi de 1511,73μm² no GE e de 1020,61μm² no GC. O número de miofibroblastos foi de 1,556 no GE e de 3,583 no GC. O número de vasos sanguíneos foi de 2,565 no GE e de 6,917 no GC. Não houve formação de sinéquias nos grupo s estudados. CONCLUSÕES: No grupo experimento, quando comparado ao controle, houve significativamente aumento da deposição do colágeno imaturo e diminuição da deposição do colágeno maduro, do número de miofibroblastos e de vasos sanguíneos. Não houve formação de sinéquias em ambos os grupos.

Measurement of the viscoelastic properties of the vocal folds.

OBJECTIVES: Studies of the viscoelastic properties of the vocal folds are normally performed with rheometers that use parallel plates whose interplate space is usually arbitrarily assigned a fixed value. In tissues subject to variation of thickness between samples, fixed gaps could result in different compressions, compromising the comparison among them. We performed an experimental study to determine whether different compressions can lead to different results in measurements of dynamic viscosity (DV) of vocal fold samples. METHODS: We measured the DV of vocal fold samples of 10 larynges of cadavers under 3 different compression levels, corresponding to 0.2, 0.5, and 10 N on an 8-mm-diameter parallel-plate rheometer. RESULTS: The DV directly varied with compression. We observed statistically significant differences between the results of 0.2 and 10 N (p = 0.0396) and 0.5 and 10 N (p = 0.0442). CONCLUSIONS: The study demonstrated that the level of compression influences the DV measure and suggests that a defined compression level should be used in rheometric studies of biological tissues.

T-shaped microsuture: a new suture technique for laryngeal microsurgery.

UNLABELLED: To describe a new suture technique for laryngeal microsurgery and to test its applicability in human cadaver larynges. The new technique was experimentally tested in freshly excised human larynges fixed to a larynx holder appropriate for the simulation of laryngeal microsurgery. A mucosal flap was created in the vocal fold for the fabrication of a pocket for subepithelial fat implantation, and the wound edges were then brought together and sutured using the proposed technique. The time necessary for suture was measured with a stopwatch for five successive sutures performed by one of the surgeons. The presence or absence of mucosal rupture was determined for five sutures performed by two surgeons, for a total of 10 sutures. The sutures were performed without the help of an assistant, with no laceration of the mucosa being observed in any of the attempts, and within a relatively short period of time even without previous training. The sutures performed permitted the implanted fat to remain stable under the mucosal flap. CONCLUSIONS: the new suture technique is an easy procedure, which can be performed by a single surgeon under microscopic vision, with a low risk of tissue rupture. The technique does not markedly prolong the duration of surgery and a single suture thread can be used for the fabrication of more than one stitch.

Is Reinke's edema a precancerous lesion? Histological and electron microscopic aspects.

The objectives of this study were to evaluate morphologic alterations and precancerous lesions in Reinke's edema. Patients included were 54 smokers with bilateral Reinke's edema submitted to surgery in the Otolaryngology Department, Botucatu Medical School, São Paulo State University, Brazil, between 2002 and 2006. All specimens were evaluated by light microscopy and five contralateral lesions were also evaluated by scanning electron microscopy (SEM) and transmission electron microscopy (TEM). The main histological alterations were edema (100%), inflammation (81.48%), basal membrane (bm) thickening (77.77%), and vessel proliferation (75.92%). Epithelium alterations were classified as grade 0 (11.11%), grade 1 (70.37%), grade 2 (14.81%), and grade 3 (3.70%). In the case included in grade 3 classification, microinvasive carcinoma was detected. SEM showed epithelial surface with some cellular desquamation, few microridges, and a polished and impermeable surface aspect. TEM showed epithelial hyperplasia, basal cells with different sizes, widening of the intercellular spaces, abnormal desmosome architecture, thickening of the bm, some electron-dense vesicles, and points of interruption. The morphological alterations presented in this study are not specific to Reinke's edema but this lesion can be the site of different grades of dysplasia and carcinoma, justifying the importance of periodic laryngeal endoscopic exams and meticulous histological analysis.