Assessment of voice and speech symptoms in early Parkinson's disease by the Robertson dysarthria profile.

Changes in voice and speech are thought to involve 75-90% of people with PD, but the impact of PD progression on voice/speech parameters is not well defined. In this study, we assessed voice/speech symptoms in 48 parkinsonian patients staging <3 on the modified Hoehn and Yahr scale and 37 healthy subjects using the Robertson dysarthria profile (a clinical-perceptual method exploring all components potentially involved in speech difficulties), the Voice handicap index (a validated measure of the impact of voice symptoms on quality of life) and the speech evaluation parameter contained in the Unified Parkinson's Disease Rating Scale part III (UPDRS-III). Accuracy and metric properties of the Robertson dysarthria profile were also measured. On Robertson dysarthria profile, all parkinsonian patients yielded lower scores than healthy control subjects. Differently, the Voice Handicap Index and the speech evaluation parameter contained in the UPDRS-III could detect speech/voice disturbances in 10 and 75% of PD patients, respectively. Validation procedure in Parkinson's disease patients showed that the Robertson dysarthria profile has acceptable reliability, satisfactory internal consistency and scaling assumptions, lack of floor and ceiling effects, and partial correlations with UPDRS-III and Voice Handicap Index. We concluded that speech/voice disturbances are widely identified by the Robertson dysarthria profile in early parkinsonian patients, even when the disturbances do not carry a significant level of disability. Robertson dysarthria profile may be a valuable tool to detect speech/voice disturbances in Parkinson's disease.

Voice Differences When Wearing and Not Wearing a Surgical Mask.

OBJECTIVE: The purpose of our study was to investigate the impact of surgical mask on some vocal parameters such as F0, vocal intensity, jitter, shimmer and harmonics-to-noise ratio in order to understand how surgical mask can affect voice and verbal communication in adults. METHODS: The study was carried out on a selected group of 60 healthy subjects. All subjects were trained to voice a vocal sample of a sustained /a/, at a conversational voice intensity for the Maximum Phonation Time (MPT), wearing the surgical mask and then without wearing the surgical mask. Voice samples were recorded directly in Praat. RESULTS: There were no statistically significant differences in any acoustic parameter between the masked and unmasked condition. There was a non-significant decrease in vocal intensity in 65% of the subjects while wearing a surgical mask. CONCLUSIONS: The statistical comparison carried out between all the acoustic voice parameters observed, extracted wearing and not wearing a surgical mask did not reveal any significant statistical difference. Most of the subjects, after wearing the surgical mask, presented a decrease in vocal intensity measured. Our conclusion was that wearing a mask is likely to induce the unconscious need to increase the vocal effort, resulting over time in a greater risk of developing functional dysphonia. The reduction of intensity can affect also social interaction and speech audibility, especially for individuals with hearing loss.

Clinical Considerations for Immigrant, Refugee, and Asylee Youth Populations.

This article will explore the psychological sequelae of forced family separation in immigration policy, the effects of the COVID-19 pandemic on the youth migrant population, how youth migrants form an identity in their new country, and finally how politics affect the mental health of youth migrants.

The association between dysphagia and OSA.

OBJECTIVE: The aim of our study was to investigate the presence of dysphagia in patients with Obstructive Sleep Apnoea (OSA) and to correlate swallowing impairment with hypnologic and anatomic parameters. METHODS: The study population includes 36 patients suffering from OSA. Patients were divided into two groups using the presence of dysphagia as a distinctive parameter. Group 1 included 27 OSA patients without signs of dysphagia and Group 2 included 9 OSA patients with signs of dysphagia. RESULTS: The age of patients in Group 2 was higher compared with the age of patients in Group 1. Analysis of Continuous Positive Airway Pressure (CPAP), obtained in the titration phase, showed that OSA patients with signs of dysphagia required a higher level of CPAP pressure than those who were not affected by swallowing abnormalities (12.6 ± 1 vs 10.5 ± 1.9 p = 0.003). No other differences in anthropometric, hypnologic, or arterial blood gas values were found between the two groups. CONCLUSIONS: In clinical practice, all OSA patients should undergo a complete ENT exam, including assessment of swallowing, before CPAP therapy is started. This may predict the need for higher CPAP pressure settings to resolve apnoea episodes in the presence of dysphagia as well as guide the choice of CPAP interfaces (orofacial vs. nasal) in these patients.

Acoustic voice analysis in the COVID-19 era.

OBJECTIVE: Among the different procedures used by the ENT, acoustic analysis of voice has become widely used for correct diagnosis of dysphonia. The instrumental measurements of acoustic parameters were limited during the COVID-19 pandemic by the common belief that a face mask affects the results of the analysis. The purpose of our study was to investigate the impact of surgical masks on F0, jitter, shimmer and harmonics-to-noise ratio (HNR) in adults. METHODS: The study was carried out on a selected group of 50 healthy subjects. Voice samples were recorded directly in Praat. All subjects were trained to voice a vocal sample of a sustained /a/, at a conversational voice intensity, with no intensity or frequency variation, for the Maximum Phonation Time (MPT), wearing the surgical mask and then without wearing the surgical mask. RESULTS: None of the variations in acoustic voice analysis detected wearing a surgical mask and not wearing a surgical mask were statistically significant. CONCLUSIONS: Our study demonstrates that the acoustic voice analysis procedure can continue to be performed with the use of a surgical mask for the patient, even during the COVID-19 pandemic.

Incidental metastases of well-differentiated thyroid carcinoma in lymph nodes of patients with squamous cell head and neck cancer: eight cases with a review of the literature.

The examination of a large series of cervical lymph nodes in patients with head and neck cancer revealed the presence of incidental metastases of occult thyroid carcinoma in eight patients, of which six cases were squamous cell carcinoma of glottic and supraglottic sites of the larynx and two cases were pyriform sinus and tongue carcinomas. Three patients had two lymph nodes and the remaining patients had one lymph node each involved. The nodal chains affected were the jugular (n=5; level IV), Kuttner (level II), supraomohyoid (level III) and supraclavicular (level VI). In four cases, a subtotal thyroidectomy or unilateral lobectomy was performed during laryngectomy (for surgical reasons) or after histologic nodal examination; a minimal focus of thyroid papillary carcinoma was detected in one patient. Three of eight patients died from recurrence of the squamous cell carcinoma; no case presented clinical evidence of thyroid malignancy. The differential diagnosis from benign thyroid heterotopia was based on the presence of minimal nuclear atypia. The choice of treatment of patients with a coexisting neoplasm characterized by poor prognosis is difficult, and contrasting opinions exist regarding the use of radical thyroidectomy and the subsequent management. As reported in the literature (66 cases), the more aggressive squamous cell carcinoma will determine the prognosis of these patients; in fact, only one of the referred cases died of cerebellar metastases of the thyroid cancer. Our results emphasize the importance of an accurate re-evaluation and follow-up of patients with incidental occult metastases for detection of a primary thyroid tumor. In the general population, this incidental nodal involvement may be related to a minimal occult thyroid carcinoma.

Carta a um jovem terapeuta: “pessoas iniciam terapia para não mudar” / Letter to a young therapist: "people come into therapy in order not to change”

Este artigo é a primeira de sete cartas de um livro a um jovem terapeuta (Di Nicola, 2011) que ganhou o prestigiado Prêmio Camille-Laurin da Associação dos Médicos psiquiatras de Québec. Nestas sete cartas, o autor compartilha sabedoria com um jovem terapeuta após 25 anos de experiência trabalhando com terapia relacional. O livro de Di Nicola complementa seu modelo de trabalho com famílias de todas as culturas, apresentadas em Um Estranho na Família: Cultura, e Terapia (Di Nicola, 1997/1998). Esta primeira carta aborda questões sobre a leitura de Freud e quando a terapia é iniciada. Pessoas iniciam a terapia para não mudar, o que significa seu desejo de manter a coerência. Como resultado, temos de encontrar formas sutis de abordá-los, e desta forma, eu descrevo minha primeira ferramenta para a terapia familiar: espirais. Discute-se o fato de que as pessoas nem sempre optam em iniciar a terapia, assim como a questão da técnica. A explicação do autor sobre o que a narrativa faz para a nossa compreensão removendo "cortinas" que obscurecem nosso entendimento da fenomenologia humana, destaca o que fazemos em terapia. Isso é contrastado com a nossa era da tecnópole, que deseja reduzir tudo a técnica, o que pode ser medido em uma guerra contra a subjetividade e julgamento humano...

This article is the first letter of a book of seven letters to a young therapist (Di Nicola, 2011) which won the prestigious Prix Camille-Laurin of the Association des médecins psychiatres du Québec. In these seven letters, the author offers wisdom to a young therapist from 25 years of experience conducting relational therapy. Di Nicola’s book complements his model of working with families across cultures presented in Um Estranho na Família: Cultura e Terapia (Di Nicola, 1997/1998). This first letter addresses questions about reading Freud and when therapy begins. People come into therapy in order not to change, meaning they want to maintain coherence. As a result, we must find gentle ways of approaching them, so I describe my first tool for family therapy: spirals. The fact that people do not always choose to enter therapy is discussed as well as the question of technique. A novelist’s explanation of what narrative does to our understanding by removing "curtains” that obscure our understanding of human phenomenology highlights what we do in therapy. This is contrasted to our age of technopoly which wants to reduce everything to technique, to what can be measured, in a war against subjectivity and human judgment...(AU)

Localización del ganglio centinela “natural“ en el carcinoma de laringe e hipofaringe / Localization of "natural" sentinel node in laryngeal and hypopharyngeal cancer

La técnica del ganglio linfático centinela localiza el ganglio que drena primariamente el territorio neoplásico anatómico. Más tarde, este procedimiento ha sido aplicado a pacientes con carcinoma epidermoide (CE) de cabeza y cuello. Nuestra experiencia de veinte años con las disecciones cervicales funcionales en el cáncer de laringe e hipofaringe nos permite asegurar que existe un ganglio linfático centinela natural en estos órganos. En nuestro estudio, examinamos una serie de 170 pacientes con disecciones funcionales del cuello con metástasis mediante el uso de un procedimiento quirúrgico de acuerdo con la anatomía topográfica clásica. En los casos con metástasis ganglionares únicas, resultaban afectados en alto porcentaje los ganglios de Küttner, supraomohioideo y prelaríngeo (46%, 38% y 6%, respectivamente), lo que representa una prueba in vivo de ganglio linfático centinela. En los casos con más de tres metástasis ganglionares, los ganglios de Küttner y supraomohioideo siempre estaban afectados primariamente. En cambio, en las metástasis detectadas en otros ganglios, podría suponerse la aparición de un drenaje linfático inconstante del pedúnculo laríngeo superior o un cambio patológico del flujo linfático. Por lo tanto, el examen histopatológico intraoperatorio simple de estos ganglios permitiría a los cirujanos controlar la difusión locorregional de la neoplasia y reducir la disección cervical total. Esta acción no es predecible cuando se emplea la división de los ganglios cervicales por niveles que se utiliza actualmente.

Sentinel lymph node technique locates that node whichprimarily drains anatomic neoplastic territory. Lately, thisprocedure has been applied to patients with head andneck squamous cell carcinoma. Our twenty-yearexperience in functional neck dissections for larynx andhypo pharynx cancer let us to assert that there exists anatural sentinel lymph node in these organs. In our study,we examined a series of 170 patients with metastasized functional neck dissections using a surgical procedure according to classic topographic anatomy. In the cases with single nodal metastasis, Küttner, Supraomohyoid, Pre-laryngeal nodes were involved with a high percentage(46%, 38%, 6% respectively) representing an “in vivo”evidence of sentinel lymph node. In cases with more thanthree nodal metastases, Küttner and supraomohyoid werealways primarily interested. Instead, for the metastasesdetected in other nodes, it might be supposed theoccurrence of an unsteady lymphatic drainage of thesuperior laryngeal peduncle or a pathological change ofthe lymphatic flow. Therefore, the simple intraoperative histopathological examination of these nodes would allow surgeons to control locoregional diffusion of neoplasia and to reduce total neck dissection. This acting is not predictable using the division of cervical nodes bylevels currently used.