Unlocking tracheoesophageal speech from pharyngoesophageal spasm: preliminary results of a videofluoroscopic-guided botulinum toxin A injection technique.

PURPOSE: The tracheoesophageal puncture for the voice prosthesis (VP) placement is the recognized gold standard in post-laryngectomy voice rehabilitation. Despite the development of specific intraoperative techniques, a subset of patients will suffer from poor functional outcomes due to pharyngoesophageal spasms (PES). This paper evaluates the functional outcomes after transcutaneous botulinum toxin type A (BTX-A) infiltration for PES with a videofluoroscopy-guided technique. METHODS: Since 2022, eight consecutive patients with VP and affected by PES were treated with BTX-A injection by a standard videofluoroscopic guided technique at the European Institute of Oncology, IRCCS (IEO) in Milan. A lidocaine test was performed pre-operatively to evaluate the potential effect of chemical neurectomy. All patients with positive lidocaine tests were injected with 50 IU of BTX-A (Allergan, Irvine, CA) according to the sites marked during the videofluoroscopy. Reported symptoms (VHI, SECEL), perceptual (INFVo), aerodynamic (MPT) and manometric parameters were collected before and after treatment. RESULTS: In all cases, BTX-A was performed as an outpatient procedure without complications. For seven patients, only one BTX-A injection was needed, while one patient required a re-injection. Subjective and perceptive improvement after BTX-A was significant for VHI, SECEL and INFVo. MPT showed significant improvement after a chemical neurectomy. After a mean follow-up of 6 months, all patients maintained a good TES quality. CONCLUSION: The videofluoroscopic guided BTX-A injection of the pharyngoesophageal tract showed to be a feasible and reproducible technique in all cases. The pharyngoesophageal videofluoroscopy allows defining of patients' anatomical landmarks that help the surgeon to perform a homogeneous injection, empowered by post-injection massage.

The impact of the end of COVID confinement on pandemic dreams, as assessed by a weekly sleep diary: a longitudinal investigation in Italy.

The Coronavirus 2019 pandemic strongly affected our sleep and dream activity. Many cross-sectional studies highlighted increased dream recall frequency, and revealed a great presence of pandemic-related oneiric contents. Here, we present the first prospective study carried out on an Italian sample. One-hundred subjects were requested to fill out a web-survey including socio-demographic information, and questionnaires collecting sleep and clinical measures during lockdown. A final sample of 90 subjects participated in the longitudinal protocol lasting 2 weeks: (a) the first week (April 28-May 4) of full lockdown; and (b) the second week (May 5-May 11) of easing of restrictions. Subjects were asked to record at home their dream experiences, and complete a sleep-dream diary each morning. Statistical comparisons showed that participants had higher numbers of awakenings, lower ease of falling asleep, higher dream recall and lucid dream frequency during lockdown than post-lockdown. Further, subjects reported more dreams, including "being in crowded places" during post-lockdown than lockdown. The poorer sleep quality during lockdown is quite consistent with previous findings. The relationship between traumatic events and dream recall frequency confirmed the idea of pandemic as "collective trauma". Also, we hypothesized that the greater presence of lucid dreams during confinement could reflect the attempt to cope with the waking pandemic-experiences. Finally, the presence of crowded places into dream scenarios during the second week of our protocol appears consistent with the continuity-hypothesis, as the possibility to access places frequented by other people could represent a relevant experience after a long period of confinement.

Semioccluded Vocal Tract Exercises Improve Self-Perceived Voice Quality in Healthy Actors.

PURPOSE: Semi-occluded vocal tract exercises (SOVTE) have shown to lead to more effective and efficient vocal production for individuals with voice disorders and for singers. The aim of the present study is to investigate the effects of a 10-minute SOVTE warm-up protocol on the actors' voice. METHODS: Twenty-seven professional theater actors (16 females) without voice complaints were audio-recorded while reading aloud, with their acting voice, a short dramatic passage at four time points. Recordings were made: the day before the show, just before and soon after the warm-up protocol which was performed prior to the show and soon after the show. The voice quality was acoustically and auditory-perceptually evaluated and quantified at each time point by blinded raters. Self-assessment parameters anonymously collected pre and post exercising were also analyzed. RESULTS: No statistically significant differences on perceptual ratings and acoustic parameters were found between pre/post exercise sessions and males/females. A statistically significant improvement was detected in the self-assessment parameters concerning comfort of production, sonorousness, vocal clarity and power. CONCLUSIONS: Vocal warm-up with the described SOVTE protocol was effective in determining a self-perceived improvement in comfort of production, voice quality and power, although objective evidence was missing. This straightforward protocol could thus be beneficial if routinely utilized by professional actors to facilitate the voice performance.