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1.
Artigo em Chinês | MEDLINE | ID: mdl-35866281

RESUMO

Objective: To evaluate the clinical value of high-definition intelligent endoscopy (iSCAN) combined with stroboscopy in identifying vocal cord leukoplakia. Methods: Seventy-nine patients with vocal cord leukoplakia who underwent CO2 laser laryngeal microsurgery and diagnosed by histopathology were recruited between October 2020 to August 2021. The morphological features, microvascular morphology and mucosal waves were observed by stroboscope; SPSS 20.0 software was used for statistical analysis. Results: There were 79 patients with a total of 119 lesions (56 on left and 63 on right).Pathological examination showed that 51 sides of the vocal cords were malignant lesions (severe dysplasia, carcinoma in situ and invasive carcinoma), and 68 sides were benign lesions.Under stroboscopy, 69 sides of mucosal wave were normal or slightly decreased, and 50 sides were severely decreased or disappeared.The decrease degree of mucosal wave was positively correlated with malignant lesions (ρ=0.687, P<0.001).Under iSCAN endoscopy, there was a positive correlation between the morphological changes of microvessels at the lesion site (vertical) and the malignant lesion (ρ=0.687, P<0.001).Univariate analysis showed that lesion size, thickness, uneven color, granular elevation, peripheral erythema and asymmetry were positively correlated with malignant lesions (ρ=0.530, 0.401, 0.538, 0.315, 0.497, 0.281, P<0.05).Logistic regression analysis showed that the risk of pathological malignancy with large lesions was 5.437 times higher than those of small lesions, the vertical vascular changes under iSCAN were 8.711 times higher than that of normal vascular morphology, and the severe reduction or disappearance of mucosal waves was 9.12 times higher than that of normal or mild reduction of mucosal waves. Conclusion: ISCAN can be combined with staphyloscopy to comprehensively observe and evaluate the changes of vocal cord morphology, submucosal microvessels and mucosal wave of vocal cord in patients with vocal cord leukoplosis, thus improving the ability to distinguish benign and malignant lesions.


Assuntos
Doenças da Laringe , Prega Vocal , Endoscopia , Humanos , Doenças da Laringe/diagnóstico , Doenças da Laringe/patologia , Leucoplasia/diagnóstico , Leucoplasia/patologia , Estroboscopia , Prega Vocal/patologia
4.
Laryngoscope ; 132(11): 2206-2208, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-35716355

RESUMO

Tone enhancement electro fiberscope combined with strobe light source is benefit for dynamic observation of vocal fold vibration, mucosal waves and voice, it also may be effective for early detection of cases of glottal cancer rather than ordinate stroboscopic examination or simple NBI observation. Laryngoscope, 132:2206-2208, 2022.


Assuntos
Neoplasias Laríngeas , Laringoscópios , Humanos , Estroboscopia , Vibração , Prega Vocal/diagnóstico por imagem
5.
J Voice ; 36(2): 212-218, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32456836

RESUMO

PURPOSE: Participation in sorority recruitment often results in acute vocal impairment. The purpose of this investigation was to characterize the extent to which voice function and laryngeal appearance may be altered by participation in this social phenomenon. METHODS: Using a within-participant repeated measures design, nine women participating as sorority recruiters completed the study protocol. The following data were collected at two time points, immediately before and after the completion of two weeks of sorority recruitment: stroboscopic laryngeal imaging, vocal acoustic measures, and perceptual measures of vocal effort and voice quality. RESULTS: Perceived phonatory effort and overall severity of voice quality were significantly impaired following sorority recruitment. All participants had evidence of mucosal changes in the form of one or more the following: observed edema, erythema, increased vascularity, glottic margin changes. No significant differences in acoustic measures were identified. CONCLUSIONS: Increased perceived vocal effort, increased overall severity ratings of voice quality, and deleterious vocal fold tissue changes observed support the hypothesis that the acute vocal loading that is characteristic of the sorority recruitment process contributes to a decline in voice function in the short term. Acoustic measures taken either lacked the sensitivity for the perceived decline in voice function or the participants, who were otherwise healthy, managed to adapt the acoustic signal to the tissue changes observed. The extent to which these acute changes may be mitigated with vocal hygiene and voice training is an area for future study.


Assuntos
Distúrbios da Voz , Feminino , Humanos , Fonação , Estroboscopia , Distúrbios da Voz/diagnóstico , Distúrbios da Voz/etiologia , Qualidade da Voz , Treinamento da Voz
6.
J Voice ; 36(3): 423-433, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-32690345

RESUMO

OBJECTIVES: Evaluation of trends and utilization of speech-language-pathology (SLP) services, including stroboscopy, before and after medialization laryngoplasty (ML) over 11 years. METHODS: Retrospective national US database study conducted using OptumLabs Data Warehouse. Study cohort included patients (age ≥18 years) who underwent ML between January 2007 and December 2016. Primary outcomes were rates of SLP visits in the 12 months before and 12 months after ML. Linear regression analysis was performed assessing for trends utilization across years. Secondary outcomes were predictors of utilization After-ML using multivariable logistic regression. RESULTS: 1114 patients met criteria. Services, including stroboscopy, were utilized by 774 (69%) Before-ML and 697 (63%) After-ML. SLP services, excluding stroboscopy, were utilized by 512 (46%) Before-ML and 478 (43%) After-ML. Vocal cord paralysis was the most common diagnosis, 945 (84.8%) patients. Other service billed were stroboscopy, [Before-ML 676 (60.7%); After-ML 567 (50.9%)], voice evaluation [Before-ML 431(38.7%); After-ML 366 (32.9%)], voice therapy [Before-ML 309 (27.7%); After-ML 339 (30.4%)], laryngeal function studies, [Before-ML 175 (15.7%); After-ML 164 (14.7%)], swallow evaluations [Before-ML 150 (13.5%); After-ML 90 (8.1%)], and swallow therapy [Before-ML 53 (4.8%); After-ML 47 (4.2%)]. SLP utilization Before-ML predicted SLP utilization After-ML [Odds Ratio (95% Confidence Interval): 9.31 (6.78, 12.77)]. Nearly half (49%) of visits occurred in the 6 months around ML. Of those who had voice therapy, the majority (73.7%) had a total of 1 to 5 sessions. CONCLUSION: Based on this retrospective US national database study, SLP services and stroboscopy are a complementary component of assessment and treatment of patients who undergo ML with the majority of services occurring in the 3 months before and after ML. Future work would benefit from outcome data.


Assuntos
Laringoplastia , Patologia da Fala e Linguagem , Adolescente , Adulto , Humanos , Laringoplastia/efeitos adversos , Estudos Retrospectivos , Estroboscopia , Resultado do Tratamento , Qualidade da Voz
7.
Ann Otol Rhinol Laryngol ; 131(5): 471-477, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-34148426

RESUMO

OBJECTIVE: The efficiency of laryngovideostroboscopy (LVS) in detecting premalignancies of the vocal fold and early glottic cancer was determined in a prospective monocentric study. In addition, the recovery rate of the mucosal membrane on the vocal fold after surgical intervention was determined by LVS. METHODS: We included 159 patients with a leukoplakia of the vocal folds and 50 healthy controls. Clinicopathological data and LVS characteristics (amplitude, mucosal wave, nonvibratory segment, glottic closure, phase symmetry, periodicity) at the lesion site were obtained and compared with the histopathological results. LVS parameters were recorded before cordectomy and in a 12-month follow-up interval. Patients who had prior laryngosurgery, radiotherapy, or laryngeal scarring were excluded. RESULTS: Absent or greatly reduced mucosal waves were found in all patients with an invasive carcinoma, in 94% with a severe intraepithelial neoplasia (SIN III), in 38% with a moderate squamous intraepithelial neoplasia (SIN II), in 32% with a mild squamous intraepithelial neoplasia (SIN I), and in 23% with a hyperkeratosis without dysplasia. The sensitivity and specificity of LVS in predicting an invasive carcinoma based on the absence or reduction of mucosal waves was 0.96 and 0.90, respectively. Following surgical intervention, the recovery rate of the mucosal wave and amplitude was 12% in the invasive carcinoma group, 36% in the SIN III group and up to 80% for both these parameters in the SIN I, SIN II, and hyperkeratosis groups. CONCLUSION: LVS is a valid tool to identify early glottic carcinoma and its high risk premalignancy carcinoma in situ (CIS). Even when there is no definitive differentiation between SIN I and II, the invasive character of a CIS and an invasive glottic carcinoma can be identified. Especially strobosopic signs of abnormal amplitude and/or mucosal waves, particularly phoniatric halt, are an early indication for a CIS or an invasive carcinoma.


Assuntos
Carcinoma de Células Escamosas , Neoplasias Laríngeas , Lesões Pré-Cancerosas , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Glote/cirurgia , Humanos , Hiperplasia/patologia , Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/patologia , Neoplasias Laríngeas/cirurgia , Lesões Pré-Cancerosas/patologia , Estudos Prospectivos , Estroboscopia/métodos , Prega Vocal/patologia , Prega Vocal/cirurgia
8.
Laryngoscope ; 132(4): 822-830, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-34057225

RESUMO

OBJECTIVES/HYPOTHESIS: Vocal fold sulcus and scars are benign vocal fold lesions that present as a challenge to the laryngologist. A number of different surgical techniques have been proposed, aiming at restoring the lamina propria (LP), closing the glottal gap, or both. This study aimed to provide a systematic review of surgical treatment for sulcus and scar and to propose a new classification for these techniques. STUDY DESIGN: A literature search using MEDLINE and Google Scholar through August 2020. METHODS: Data on study design were retrieved and outcomes were classified as acoustic, aerodynamic, self-reported, perceptual, and stroboscopic. Methodological quality was assessed using the MINORs criteria. Each technique was classified as direct, indirect, or combined. RESULTS: Our search included 31 studies with a total of 617 patients. Direct techniques included dissection, graft interposition, or LP regeneration/scar degradation while indirect techniques aimed for glottal gap closure. Only one article performed a comparison between different types of techniques and only eight studied the five types of outcomes. No superiority of any technique was noted in our analysis. Self-reported outcomes were the most frequently improved. CONCLUSIONS: There seems to not exist a one-fits-all treatment for this clinical picture and no clear decision-making pattern. A recent trend toward sequential approaches, starting with less invasive procedures, can be observed. Laryngoscope, 132:822-830, 2022.


Assuntos
Cicatriz , Prega Vocal , Acústica , Cicatriz/etiologia , Cicatriz/patologia , Cicatriz/cirurgia , Humanos , Músculos Laríngeos/patologia , Estroboscopia , Prega Vocal/patologia , Prega Vocal/cirurgia
9.
Otolaryngol Head Neck Surg ; 166(1): 133-138, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-33874792

RESUMO

OBJECTIVE: To describe laryngeal findings and voice quality in patients with suspected lung cancer, relative to voice quality and possible laryngeal pathology. STUDY DESIGN: Prospective cohort study. SETTING: Tertiary care center. METHODS: Patients with known or suspected lung cancer were approached before planned thoracic surgery, and they completed acoustic analysis, the Voice-Related Quality of Life (V-RQOL) questionnaire, and stroboscopy. The prevalence of dysphonia, V-RQOL and Cepstral Spectral Index of Dysphonia (CSID) scores, and laryngeal findings were examined and compared between patients ultimately found to have lung cancer and those without cancer. RESULTS: Sixty-one patients (45 cancer, 16 noncancer) were analyzed. Patients with cancer were older than those without (mean ± SD, 72.3 ± 9.94 vs 62.6 ± 9.30 years; P = .001). Otherwise, the distribution of stroboscopy findings, acoustic measures, and self-reported voice handicap were similar between the cancer and noncancer cohorts. Prior to surgery, no patients had vocal cord paralysis or obvious neoplasm, though 4 (6.56%) had leukoplakia and 28 (45.9%) had vocal fold movement asymmetry on stroboscopy. Overall, 21 patients (35.0%) had average CSID scores >19, and 13 (21.7%) had CSID scores >24; however, only 4 self-described their voice as not working as it should, and only 2 had a V-RQOL score <85. CONCLUSION: Patients with suspected lung cancer have moderate dysphonia on acoustic measures, though self-reported impact on quality of life is low. While leukoplakia was seen in 4 patients, obvious neoplasm and occult paralysis were not seen in this cohort. Together, these findings suggest that patients with suspected lung cancer should be assessed for subjective voice dysfunction, but routine laryngeal screening may otherwise be unnecessary.


Assuntos
Disfonia/epidemiologia , Neoplasias Laríngeas/epidemiologia , Neoplasias Pulmonares/complicações , Qualidade da Voz , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Disfonia/diagnóstico , Feminino , Humanos , Neoplasias Laríngeas/diagnóstico , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Qualidade de Vida , Autoimagem , Índice de Gravidade de Doença , Estroboscopia , Inquéritos e Questionários
10.
Laryngoscope ; 132(10): 1993-2016, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-34582043

RESUMO

OBJECTIVES/HYPOTHESIS: This scoping review aims to provide a broad overview of the applications of artificial intelligence (AI) to office laryngoscopy to identify gaps in knowledge and guide future research. STUDY DESIGN: Scoping Review. METHODS: Searches for studies on AI and office laryngoscopy were conducted in five databases. Title and abstract and then full-text screening were performed. Primary research studies published in English of any date were included. Studies were summarized by: AI applications, targeted conditions, imaging modalities, author affiliations, and dataset characteristics. RESULTS: Studies focused on vocal fold vibration analysis (43%), lesion recognition (24%), and vocal fold movement determination (19%). The most frequently automated tasks were recognition of vocal fold nodules (19%), polyp (14%), paralysis (11%), paresis (8%), and cyst (7%). Imaging modalities included high-speed laryngeal videos (45%), stroboscopy (29%), and narrow band imaging endoscopy (7%). The body of literature was primarily authored by science, technology, engineering, and math (STEM) specialists (76%) with only 30 studies (31%) involving co-authorship by STEM specialists and otolaryngologists. Datasets were mostly from single institution (84%) and most commonly originated from Germany (23%), USA (16%), Spain (9%), Italy (8%), and China (8%). Demographic information was only reported in 39 studies (40%), with age and sex being the most commonly reported, whereas race/ethnicity and gender were not reported in any studies. CONCLUSION: More interdisciplinary collaboration between STEM and otolaryngology research teams improved demographic reporting especially of race and ethnicity to ensure broad representation, and larger and more geographically diverse datasets will be crucial to future research on AI in office laryngoscopy. LEVEL OF EVIDENCE: NA Laryngoscope, 132:1993-2016, 2022.


Assuntos
Pólipos , Paralisia das Pregas Vocais , Inteligência Artificial , Humanos , Laringoscopia/métodos , Pólipos/patologia , Estroboscopia/métodos , Paralisia das Pregas Vocais/diagnóstico , Prega Vocal/patologia
11.
Auris Nasus Larynx ; 48(5): 963-972, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33896674

RESUMO

OBJECTIVE: After thyroidectomy, many patients suffer from voice problems and vague neck discomfort. The Thyroidectomy-related Voice and Symptom Questionnaire (TVSQ) is a self-administered questionnaire used to evaluate pre- and post-operative vocal status as well as throat and neck discomfort. We investigated voice conditions in thyroidectomy patients using the TVSQ as well as correlations between TVSQ responses and objective voice parameters. Also, we examined whether any clinicopathologic or surgical factors affect phonetic change after thyroidectomy. METHODS: We retrospectively reviewed the records of 242 patients who underwent total thyroidectomy to treat papillary carcinoma between January to December of 2019. Of these, we enrolled 232 who exhibited normal vocal cord mobility after surgery. TVSQ responses and acoustic voice analysis results were examined preoperatively and at 1, 3, and 6 months postoperatively. We subclassified patients into favorable and unfavorable TVSQ groups based on the increase in TVSQ score (△TVSQ ≥20) at 1 month postoperatively. We then investigated the difference of acoustic characteristics between two groups and analyzed the correlations between acoustic parameters and various clinical and surgical factors including pathologic results and lymph node status by subgroup. RESULT: All acoustic voice parameters except for the noise-to-harmonics ratio were significantly worse at 1 month postoperatively and recovered over time, but the TVSQ score did not recover from the 1-month value until 6 months postoperatively. In the subgroups, among the many clinicopathologic factors examined, advanced N stage (p = 0.002) and high positive total and central-and-lateral-neck lymph node ratios were significantly associated with an increased risk of an unfavorable TVSQ (p = 0.049, 0.027, <0.01, respectively). Among the acoustic parameters, only the changes in TVSQ total score and voice score were correlated with deterioration in jitter and shimmer at 1 month postoperatively. However, the correlations was not statistically significant and had disappeared at 6 months postoperatively. CONCLUSION: We figured out that TVSQ was able to capture the negative effects of lymph node status and lymph node dissection on vocal outcomes after thyroidectomy. Although there was a weak correlation between worsened perturbation value and TVSQ changes, no other acoustic analysis parameters were statistically significant correlated with the TVSQ score.


Assuntos
Complicações Pós-Operatórias/fisiopatologia , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia , Distúrbios da Voz/fisiopatologia , Adulto , Feminino , Humanos , Razão entre Linfonodos , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical , Estadiamento de Neoplasias , Complicações Pós-Operatórias/epidemiologia , Estroboscopia , Inquéritos e Questionários , Câncer Papilífero da Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Distúrbios da Voz/epidemiologia
12.
Laryngoscope ; 131(11): 2523-2529, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-33835504

RESUMO

OBJECTIVES/HYPOTHESIS: To examine patterns of recurrence of benign phonotraumatic vocal fold lesions over time for insights into pathophysiology. STUDY DESIGN: Case series with mathematical modeling. METHODS: Medical records and stroboscopic exams of adults who underwent microlaryngoscopic resection of phonotraumatic vocal fold lesions over a 13-year period were reviewed for time to recurrence after surgery. Uniform and log-normal probability distributions were fitted to the time to recurrence curves for vocal fold polyps, midfold masses, and pseudocysts. Model fits were compared using the Akaike information criterion corrected, a standard measure of the goodness of fit. Stochastic simulations were used to verify that the mechanistic hypotheses were concordant with the selected probability distributions and empiric data. RESULTS: Of 567 patients who underwent microlaryngoscopic resection, 65 had a recurrence (16 polyps, 14 midfold masses, and 35 pseudocysts). Midfold mass and pseudocyst recurrences were predominantly seen in younger women. Polyps were best fit by a uniform distribution rather than log-normal, whereas midfold masses and pseudocysts were better fit by log-normal rather than uniform. Stochastic simulations suggest that polyps recur sporadically according to a paroxysmal-developmental model, whereas midfold mass and pseudocyst recurrences follow a force-multiplication, damage-accumulation process. CONCLUSIONS: Vocal fold polyps are acute lesions evenly distributed by age and gender that recur uniformly over time, suggesting they arise from sudden tissue reactions to phonotraumatic stress. Pseudocysts and midfold fibrous masses are chronic lesions predominantly found in young women that recur with log-normal distribution over time, suggesting gradual damage accumulation in larynges predisposed to enhanced phonotrauma. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:2523-2529, 2021.


Assuntos
Doenças da Laringe/etiologia , Modelos Biológicos , Fonação , Pólipos/etiologia , Prega Vocal/lesões , Adulto , Feminino , Humanos , Doenças da Laringe/diagnóstico , Doenças da Laringe/cirurgia , Laringoscopia/estatística & dados numéricos , Masculino , Registros Médicos/estatística & dados numéricos , Microcirurgia/estatística & dados numéricos , Pessoa de Meia-Idade , Pólipos/diagnóstico , Pólipos/cirurgia , Recidiva , Estroboscopia/estatística & dados numéricos , Prega Vocal/diagnóstico por imagem , Prega Vocal/cirurgia , Qualidade da Voz , Adulto Jovem
13.
Auris Nasus Larynx ; 48(5): 949-955, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33640199

RESUMO

OBJECTIVE: Fibrotic changes in the vocal fold mucosa have been observed in patients with vocal fold scarring, aged vocal fold, and sulcus vocalis, which often lead to severe voice disorders. Previous research suggests that the basic fibroblast growth factor (b FGF) improves variations in vocal fold properties [1,2]. Although clinical studies on b FGF treatments have been conducted [3,4,5], these studies only demonstrated the efficacy of this drug over a short period. The present study is the first to investigate the long-term efficacy of b FGF treatment. METHODS: b FGF injections were performed in six patients from January of 2016 to December of 2017 at our institution. Patient follow-up continued for at least two years after the last injection. Three patients had vocal fold scarring, two had aged vocal fold atrophy, and one patient had sulcus vocalis. Each vocal fold was injected with 10 µg of b FGF four times. Voice and stroboscopic examinations were performed after surgery (at one month, three months, six months, one year, two years). Fundamental frequency, maximum phonation time (MPT), mean flow rate (MFR), amplitude perturbation quotient (APQ), pitch perturbation quotient (PPQ), and noise-to-harmonic ratio (NHR), and voice handicap index-10 (VHI-10) were examined and compared statistically between the pretreatment time and at each posttreatment time point. RESULTS: The speaking F0 had an obvious decreasing tendency, with significant differences suggesting the increase in volume in the vocal folds. Aerodynamic parameters also showed small improvements. The most remarkable improvement was observed in the acoustic parameters, indicating that the treatment could improve the vocal fold to make vibrations symmetrically and regularly for a long period. Achievement of symmetry and regularity on vocal fold vibrations suggested the property changes had happened in the vocal folds. Consequently, the score of VHI-10 had improved, indicating high patient satisfaction with this treatment. CONCLUSION: b FGF injections could be a reliable treatment option for diseases that deteriorate the property of vocal fold.


Assuntos
Fator 2 de Crescimento de Fibroblastos/uso terapêutico , Disfunção da Prega Vocal/tratamento farmacológico , Prega Vocal/patologia , Distúrbios da Voz/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Atrofia , Cicatriz/tratamento farmacológico , Feminino , Fibrose/tratamento farmacológico , Humanos , Injeções Intralesionais , Masculino , Pessoa de Meia-Idade , Estroboscopia , Prega Vocal/fisiopatologia , Adulto Jovem
14.
Laryngoscope ; 131(10): 2298-2304, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-33605442

RESUMO

OBJECTIVES/HYPOTHESIS: Performing while on steroids is widely considered to increase risk of vocal injury. This study aims to determine incidence and type of injury, and changes in performers' voices after treatment of vocal fold edema (VFE) with glucocorticoids. STUDY DESIGN: Prospective Cohort. METHODS: Fifty-five performers (34 female; 21 male) treated for acute VFE with short-course oral glucocorticoids were prospectively evaluated pre- and post-treatment. Subjects underwent videostroboscopy, acoustic/aerodynamic assessment, and functional assessment with the Singing Voice Handicap Index-10 (SVHI-10) and Evaluation of the Ability to Sing Easily (EASE). Blinded reviewers rated videostroboscopic examinations and performed audio-perceptual assessment. Chi-square tests and Wilcoxon signed rank tests were applied for analyses of treatment changes. RESULTS: Following glucocorticoid treatment, two instances of vocal fold hemorrhage (3.6%) and three instances of glottic thrush (5.5%) were observed. These resolved without consequence. Mucosal wave dynamics and edema improved. Nearly all subjects completed scheduled performances, and significant improvement was noted on the EASE, reflecting improved function after treatment. These were further supported by statistically significant improvements in CAPE-V and some acoustic and aerodynamic outcomes (semitone pitch range for females, airflow measures for males). CONCLUSIONS: Oral glucocorticoids appear to be generally safe for performers presenting with acute VFE. The incidence of adverse effects, specifically hemorrhage and thrush, was low and the effects transient. Vocal fold examination should be considered obligatory before prescribing glucorticoids to working performers. A treatment strategy for acute VF edema incorporating glucocorticoids when appropriate appears to result in significant improvements in measures of glottal function including videostroboscopic appearance, subject perception, and auditory perception. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:2298-2304, 2021.


Assuntos
Edema/tratamento farmacológico , Glucocorticoides/efeitos adversos , Canto/fisiologia , Prega Vocal/lesões , Distúrbios da Voz/epidemiologia , Administração Oral , Adulto , Edema/fisiopatologia , Feminino , Glucocorticoides/administração & dosagem , Humanos , Incidência , Laringoscopia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estroboscopia , Prega Vocal/diagnóstico por imagem , Prega Vocal/efeitos dos fármacos , Prega Vocal/fisiopatologia , Distúrbios da Voz/induzido quimicamente , Distúrbios da Voz/diagnóstico , Distúrbios da Voz/fisiopatologia , Qualidade da Voz/efeitos dos fármacos , Adulto Jovem
15.
Laryngoscope ; 131(10): 2305-2311, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-33577090

RESUMO

OBJECTIVES/HYPOTHESIS: Glottic stenosis is a discrete cause of airway compromise. We aimed to determine the surgical outcomes of transverse cordotomy with anteromedial arytenoidectomy (TCAMA), performed in the setting of isolated glottic stenosis resulting from two discrete etiologies: bilateral vocal fold paralysis (BVFP) and posterior glottic stenosis (PGS). STUDY DESIGN: Retrospective, analytic cohort study. METHODS: Twenty-six patients with isolated glottic stenosis were treated with TCAMA between 2006 and 2019. A retrospective analysis determined decannulation rates and intervals, voice outcomes, swallowing outcomes, and reoperation rates postoperatively. Outcomes between the two etiologic cohorts were compared. RESULTS: Of the 26 patients, 16/26 patients were diagnosed with PGS and 10/26 with BVFP. Eighteen patients required tracheotomies during their clinical course (11/16 PGS, and 7/10 BVFP), and 100% were ultimately decannulated. The PGS cohort required two-sided interventions more frequently than the BVFP cohort (45.5% vs. 0%, P = .066). Trach-dependent PGS patients required a longer time to achieve decannulation than BVFP patients by a factor of 2.38, although the difference was not statistically significant (102.3 days vs. 42.9 days, respectively, P = .113). Patients demonstrated a significant change in maximum phonation time but no statistically significant differences with preoperative versus postoperative voice outcomes like voice-related quality of life. All patients ultimately returned to their baseline swallow function postoperatively. CONCLUSION: TCAMA is an effective treatment for surgical rehabilitation of glottic stenosis caused by both BVFP and PGS. Patient-reported outcomes of postoperative vocal function remain consistent following surgical intervention. Additional, prospective studies with greater power are warranted to validate the contrasting outcomes observed when applying this discrete surgical technique across two distinct diagnostic cohorts in this retrospective study. LEVEL OF EVIDENCE: 4. Laryngoscope, 131:2305-2311, 2021.


Assuntos
Cartilagem Aritenoide/cirurgia , Constrição Patológica/cirurgia , Glote/cirurgia , Laringectomia/métodos , Paralisia das Pregas Vocais/cirurgia , Adulto , Idoso , Cartilagem Aritenoide/diagnóstico por imagem , Terapia Combinada/métodos , Constrição Patológica/diagnóstico , Constrição Patológica/etiologia , Constrição Patológica/fisiopatologia , Deglutição/fisiologia , Feminino , Glote/diagnóstico por imagem , Humanos , Laringoscopia/métodos , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Estroboscopia/métodos , Resultado do Tratamento , Paralisia das Pregas Vocais/diagnóstico , Paralisia das Pregas Vocais/fisiopatologia , Qualidade da Voz/fisiologia
16.
Am J Otolaryngol ; 42(3): 102940, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33545449

RESUMO

BACKGROUND: Spasmodic dysphonia (SD) is a neurological condition of the larynx characterised by task specific, involuntary spasms of the intrinsic laryngeal muscles causing frequent voice breaks during speech. The current treatment modality involves Botulinum Toxin injections into the affected group of muscles. This has yielded satisfactory results in Adductor SD (ADSD) and mixed SD but not in Abductor SD (ABSD). Sulcus vocalis is a morphological condition of the vocal folds with invagination of the superficial epithelium into the lamina propria or deeper layers. It is characterised by breathiness in voice and hypophonia. In our voice clinic, patients diagnosed with SD were occasionally found to have a sulcus on flexible stroboscopy. Studies have revealed an asymmetric stimulation of both the adductor and abductor group of muscles in ABSD and a predominant possibly symmetric stimulation of the adductor group of muscles in ADSD. Our objective was to study any significant association between vocal fold sulcus and two groups within SD; group one being ADSD and group two being both ABSD and Mixed SD. A literature review did not reveal any studies suggesting an association between SD and vocal fold sulcus to date. METHODS: A retrospective review of the stroboscopic video recordings as well as file records of all patients diagnosed with SD between January 2016 and September 2019 was conducted at our voice clinic. The first author was the laryngologist who had diagnosed SD and its type on the basis of hearing the voice and making the patient perform various vocal tasks with and without flexible videostroboscopy. The SD patients were divided into two groups with the first group consisting of ADSD patients and the second group consisting of ABSD as well as Mixed SD patients. The presence or absence of vocal fold sulcus was noted in all the SD patients. Odds ratio was used to establish statistical significance of the presence of vocal fold sulcus in the two SD groups. RESULTS: Among the 106 patients of SD, 62 patients were males and 44 were females. A total of 84 patients were diagnosed as ADSD, 10 as ABSD and 12 as Mixed SD patients. Vocal fold sulcus was noted in 5 out of 84 patients of ADSD, 4 out of 10 patients of ABSD, and in 3 out of 12 patients of mixed SD. Odds Ratio of 7.37 (C.I. = 2.063-26.35) was obtained for the second group of patients i.e. ABSD and Mixed SD. CONCLUSION: Our study revealed a significant association between patients of SD having an abductor component (ABSD and mixed SD) and vocal fold sulcus. The two hypothesis proposed for this are the possibility of asymmetrical adductor and abductor muscle stimulation in SD being responsible for the development of a vocal fold sulcus or the primary presence of a vocal fold sulcus contributing to altered sensory feedback resulting in SD. Further study to evaluate this, as well as a study of the vocal response to medialisation procedures for patients of ABSD with sulcus is recommended.


Assuntos
Disfonia/diagnóstico , Disfonia/patologia , Músculos Laríngeos , Laringismo/complicações , Medida da Produção da Fala/métodos , Prega Vocal/patologia , Adolescente , Adulto , Idoso , Disfonia/etiologia , Disfonia/fisiopatologia , Feminino , Humanos , Músculos Laríngeos/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estroboscopia/métodos , Gravação em Vídeo , Prega Vocal/diagnóstico por imagem , Voz , Adulto Jovem
17.
Laryngoscope ; 131(7): 1594-1598, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-32902880

RESUMO

OBJECTIVE/HYPOTHESIS: The objective of this study was to investigate the glottic gap area as a significant marker for the severity of presbyphonia as it relates to patient-reported outcome measures (Voice Handicap Index-10 [VHI-10]) and stroboscopic findings. STUDY DESIGN: Retrospective case-control study conducted in an academic tertiary voice center. METHODS: Patients seen at a tertiary voice clinic who were diagnosed with presbyphonia without other organic laryngeal pathology from January 2014 to December 2017 were included. Clinical data and laryngeal videostroboscopy videos were collected. Still images at the point of vocal process approximation during adduction were captured, and the glottic gap area was measured using ImageJ. These were compared to a control cohort. Correlations were made using Wilcoxon rank sum test, Mann-Whitney U test, and Pearson correlation coefficients. RESULTS: Thirty-three patients were included. Inter-rater reliability of glottic area measurement was strong (intraclass correlation coefficient = 0.73, P < .001). Compared to controls, presbyphonia patients had a larger glottic gap area (P < .001) and greater open-phase quotient on laryngeal videostroboscopy (P < .001). Larger glottic gap area did not correlate with patient-reported vocal function as measured by VHI-10 (P = .79) and did not correlate with presence of secondary muscle tension dysphonia (P = .99). In the presbyphonia cohort, the glottic gap area did not correlate with age (P = .29). CONCLUSIONS: Glottic gap area at the point of vocal process approximation during phonation can be reliably measured. Patients with presbyphonia have a larger glottic gap area and greater open-phase quotient on stroboscopy, but these do not correlate with patient-reported voice impairment or the presence of secondary muscle tension dysphonia (MTD). These data suggest that dysphonia severity in presbyphonia is not fully explained by a glottic gap or secondary MTD alone. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:1594-1598, 2021.


Assuntos
Envelhecimento/fisiologia , Disfonia/diagnóstico , Glote/patologia , Laringoscopia/métodos , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Disfonia/patologia , Disfonia/fisiopatologia , Glote/diagnóstico por imagem , Humanos , Laringoscópios , Laringoscopia/instrumentação , Masculino , Pessoa de Meia-Idade , Fonação/fisiologia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Índice de Gravidade de Doença , Estroboscopia/instrumentação , Estroboscopia/métodos , Gravação em Vídeo/métodos , Qualidade da Voz/fisiologia
18.
Laryngoscope ; 131(5): 1071-1077, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-32750170

RESUMO

OBJECTIVE: Understanding transgender voice is in nascent stages. This study describes voice characteristics in treatment-seeking trans women by comparing two validated questionnaires-Voice Handicap Index-10 (VHI-10) and Transsexual Voice Questionnaire (TVQMtF )-and reports incidence of abnormal stroboscopy findings and acoustic characteristics. METHODS: Retrospective review of transgender patients presenting to tertiary-care laryngology center between February 2018-February 2019. Mean VHI-10, TVQ, and Singing VHI-10 (SVHI-10) scores; audio-perceptual grade; acoustic measures; and stroboscopy findings were analyzed. VHI-10 and SVHI-10 vs TVQMtF were compared. RESULTS: Sixty-one trans female patients (mean age: 32 ± 11 years) were analyzed. Mean duration since start of transition was 41.5 ± 61 months. Sixty-nine percent presented full-time female in all contexts. Pathologic stroboscopy findings were found in 5%. Mean questionnaire scores were 16 ± 10 (VHI-10), 19 ± 13 (SVHI-10), and 81 ± 22 (TVQMtF ). Correlation between VHI-10 and SVHI-10 versus TVQMtF was weak, R = 0.47 (P = .053) and R = 0.35 (P = .17), respectively. Mean audio-perceptual grade was 0.27 ± 0.15. Mean Cepstral Spectral Index of Dysphonia (CSID, sustained vowel) was 8.5 ± 21.9. Mean Cepstral Peak Prominence (CPP) Fo and CPP Fo SD in rainbow passage were 157.3 ± 16 and 59.4 ± 15.9, respectively. CONCLUSION: Trans women report perceived voice handicap in speaking and singing, which appears separate from gender-related voice/communication concerns. This study is the first to report stroboscopy findings in transgender individuals, with 5% being abnormal. Stroboscopy is encouraged before initiating voice intervention in transgender patients. Preliminary evaluation suggests weak correlation between VHI-10 or SVHI-10 and TVQMtF but requires further investigation. TVQMtF may provide information which more specifically reflects voice concerns of trans women as compared to VHI-10 and SVHI-10. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:1071-1077, 2021.


Assuntos
Acústica , Disfonia/diagnóstico , Disforia de Gênero/terapia , Estroboscopia/estatística & dados numéricos , Pessoas Transgênero/estatística & dados numéricos , Adulto , Avaliação da Deficiência , Disfonia/psicologia , Disfonia/terapia , Feminino , Disforia de Gênero/psicologia , Identidade de Gênero , Humanos , Masculino , Psicometria/estatística & dados numéricos , Qualidade de Vida , Estudos Retrospectivos , Autoimagem , Fatores Sexuais , Procedimentos de Readequação Sexual , Canto/fisiologia , Acústica da Fala , Inquéritos e Questionários/estatística & dados numéricos , Pessoas Transgênero/psicologia , Qualidade da Voz/fisiologia , Adulto Jovem
19.
Sci Med Footb ; 5(4): 317-322, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-35077302

RESUMO

Purpose: This study aimed to investigate how restricted visual feedback affects performance in a football-specific skills assessment that incorporates the coupling of football a-specific perceptual information with football-specific motor actions. Methods: The Footbonaut is a 14x14m cage equipped with 8 ball dispensers and 64 targets measuring passing accuracy and time to complete each pass. Eighty-four amateur male participants (19.5 ± 5.4 years old; 13.1 ± 6.0 years experience) completed two sessions under two different visual conditions: stroboscopic and normal vision. Results: A linear regression revealed that performance under normal conditions was significantly associated (p < 0.001) with the performance decrement under stroboscopic vision conditions. Players were then subdivided into skilled (S; top 25%) and less-skilled (LS; bottom 25%) groups. Restricting visual feedback impacted the average time required to complete the passes in both S and LS groups equally (S: +0.18 s; LS: + 0.12 s; p = 0.385), yet S athletes' accuracy (-11.1%) was more heavily reduced under restricted visual conditions compared to their Normal condition; whereas the LS athletes' accuracy remained relatively unchanged (-1.9%). Conclusion: Therefore, stroboscopic vision may be used to induce performance errors during practice to stimulate larger training effects, particularly in more skilled players.


Assuntos
Futebol Americano , Futebol , Adolescente , Adulto , Atletas , Humanos , Masculino , Estroboscopia , Visão Ocular , Adulto Jovem
20.
Laryngoscope ; 131(5): E1598-E1604, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33232528

RESUMO

OBJECTIVE: Previous theoretical analysis predicted that phonation threshold flow (PTF) could be a more sensitive aerodynamic measure than phonation threshold pressure (PTP) for reflecting glottal incompetence. This study investigated the feasibility of whether PTP and PTF may differentiate subjects with unilateral adductor vocal fold paralysis and paresis (UAVFP) from those without, and whether PTP and PTF could reflect the extent of incomplete glottal closure associated with UAVFP. METHODS: PTP and PTF were quantified for 13 subjects with UAVFP and 21 control subjects with normal voice, and the normalized glottal gap area (NGGA) based on videostroboscopic image analysis was quantified for subjects with UAVFP. RESULTS: Significant differences in both PTP and PTF were found between subjects with UAVFP and control subjects. Receiver operating characteristic analysis indicated a higher discriminatory ability of PTP for differentiating subjects with UAVFP from those without (area under the curve of 0.905 for PTP, 0.678 for PTF), yet a significant positive correlation was found between PTF and NGGA (Spearman's ρ = 0.571) but not between PTP and NGGA (ρ = -0.364). CONCLUSION: Results supported the feasibility of using PTP and PTF as potential diagnostic indicators for reflecting glottal closure in UAVFP, with PTP potentially more sensitive for differentiating subjects with and without incomplete glottal closure. These preliminary findings were limited by the small sample size, with further studies needed to verify whether PTF could be more sensitive for reflecting the extent of incomplete glottal closure, as predicted theoretically. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:E1598-E1604, 2021.


Assuntos
Glote/diagnóstico por imagem , Estroboscopia/métodos , Gravação em Vídeo/métodos , Paralisia das Pregas Vocais/diagnóstico , Adulto , Idoso , Estudos de Casos e Controles , Diagnóstico Diferencial , Estudos de Viabilidade , Feminino , Glote/fisiopatologia , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Fonação/fisiologia , Pressão , Curva ROC , Valores de Referência , Paralisia das Pregas Vocais/fisiopatologia
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