Objectives/Hypothesis
Laryngopharyngeal reflux (LPR) has been proposed both as a trigger for recurrent respiratory papillomatosis (RRP) onset and as a factor favoring an aggressive clinical course.
...Study Design
In this prospective study, 106 participants were recruited within a period of 24 months at the Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana.
Methods
This study compared a group of RRP patients (N = 36) with a group of LPR patients (N = 28) and a group of healthy participants (N = 42) based on Reflux Symptom Index (RSI), Reflux Finding Scores (RFS), and saliva analyses (pH, pepsin concentration, bile acid concentration, and pepsin enzymatic activity).
Results
The RRP group compared to the LPR group showed a statistically significant difference only in RSI and RFS scores, while the RRP group compared to healthy controls showed significantly higher values in all tested parameters (RSI score, RFS, saliva pH, pepsin concentration, bile acids concentration, pepsin enzymatic activity).
Conclusions
LPR is common in RRP patients and significantly more prevalent compared to healthy controls. Our results show that saliva analyses are a better office‐based tool than RSI questionnaires and RFS scores for diagnosing LPR in RRP patients.
Level of Evidence
3 Laryngoscope, 132:619–625, 2022
The purpose was to determine the incidence of voice disorders in a group of professional actors and singers, to compare the two groups, and to investigate the potential causes of their voice ...problems.
65 actors and 63 singers from professional theatres and choirs were included. The data concerning voice problems, their possible causes, and factors adversely affecting voice quality were obtained through a questionnaire. The results were compared between the groups of professional singers and actors, and between the subgroups of singers and actors both with and without frequent voice problems.
The incidence of frequent voice problems over the entire career in singers and actors was lower than reported in the literature. Professional actors displayed more inappropriate life and vocal habits than the singers. Significant risk factors for voice disorders in singers turned out to be loud speech (p=0.029) and the presence of allergies or asthma (p=0.048). No such significant risk factors were found in actors.
The study confirmed the importance of preventive examination of the vocal tract function before enrolling in studies for an elite voice user. Professional singers and especially actors demonstrated insufficient knowledge of proper voice care. The results suggest that elite voice users require additional information on voice hygiene and occasional professional help from college to the end of career. Speech and language therapists can play a crucial role in such voice care in order to effectively prevent voice problems in elite voice users.
Purpose
According to the classification of glottic lesions by narrow-band imaging (NBI) proposed by the European Laryngological Society (ELS), lesions without perpendicular patterns are benign, while ...wide- and narrow-angled perpendicular lesions include both papilloma and carcinoma/high-grade lesions, respectively. The purpose of the study was to investigate the effectiveness of the ELS classification.
Methods
One hundred and forty four patients with glottic lesions underwent microlaryngoscopy with NBI. The affected vocal cords (arm A) were histologically analysed. The unaffected vocal cords (arm B) were not histologically analysed and were considered to be true negatives if no suspicious changes appeared during the follow-up. The vocal cords from arm A were categorised into three groups—those with a benign disease (papilloma excluded), those with a carcinoma/high-grade lesion and those with papilloma. The ratio of vascular patterns was determined and the groups were statistically compared using the Chi-square test.
Results
Perpendicular patterns were identified only in 9.3% (9/97) of those in the benign group (without papilloma). Wide-angled patterns were mainly identified in cases of papilloma (80%, 12/15), while the narrow-angled ones were mostly identified in cases of carcinoma and high-grade lesions (96.2%, 76/79) (
P
< 0.001). The sensitivity, specificity, positive and negative predictive values and accuracy were 98%, 95%, 88%, 99% and 95%, respectively.
Conclusion
The ELS classification of vocal cord lesions by NBI is effective in differentiating between carcinoma/high-grade lesions and papilloma and the remaining benign lesions of the vocal cords.
The voice represents a basic working tool for carrying out certain occupations. Hoarseness, as a consequence of vocal fold lesions, presents an important cause of work-related absences for voice ...professionals.
Our study was designed as a retrospective cohort one. Data on gender, workplace, vocal load and exposure to risk factors for voice disorders of the patients who had surgery in the 2014-2015 period at the tertiary centre due to benign vocal fold lesions were collected from their clinical records. We compared professional voice users (PVU) to subjects with no vocal load at work (NPVU). The SPSS programme, version 22.0, was used for statistical analysis.
From 2014 to 2015, 103 PVU and 132 NPVU were surgically treated for benign vocal fold lesions. In comparison to the second group, loud speech use was reported significantly more often by PVU (40.8% vs. 14.4%), as was a fast speaking rate (22.3% vs. 9.8%) and additional vocal load outside of the workplace (23.3% vs. 12.9%). The time that had passed between the occurrence of the hoarseness and the surgical treatment did not differ between the groups. The majority of patients were satisfied with the outcome of the operation.
Nearly a half of the operated patients had a considerable vocal load at work. An ENT assessment prior to starting a job as well as priority phoniatric treatment of voice disorders for PVU would significantly reduce the costs of work absences and contribute to a speedier recovery and return to the workplace.
The aim of this paper is to compare the prevalence of voice disorders and the risk factors for them in different occupations with a vocal load in Slovenia.
A meta-analysis of six different Slovenian ...studies involving teachers, physicians, salespeople, catholic priests, nurses and speech-and-language therapists (SLTs) was performed. In all six studies, similar questions about the prevalence of voice disorders and the causes for them were included.
The comparison of the six studies showed that more than 82% of the 2347 included subjects had voice problems at some time during their career. The teachers were the most affected by voice problems. The prevalent cause of voice problems was the vocal load in teachers and salespeople and respiratory-tract infections in all the other occupational groups. When the occupational groups were compared, it was stated that the teachers had more voice problems and showed less care for their voices than the priests. The physicians had more voice problems and showed better consideration of vocal hygiene rules than the SLTs. The majority of all the included subjects did not receive instructions about voice care during education.
In order to decrease the prevalence of voice disorders in vocal professionals, a screening program is recommended before the beginning of their studies. Regular courses on voice care and proper vocal technique should be obligatory for all professional voice users during their career. The inclusion of dysphonia in the list of occupational diseases should be considered in Slovenia as it is in some European countries.
In the case of an aggressive course of recurrent respiratory papillomatosis (RRP), adjuvant therapy can be used besides surgery. The aim of the study was to investigate the influence of vaccination ...with a quadrivalent vaccine against human papilloma viruses (HPV) types 6, 11, 16 and 18 on the course of RRP. Eleven subjects aged 13–46 years with a rapid growth of laryngeal papillomas were included in the study. They were vaccinated with three doses of the quadrivalent prophylactic HPV vaccine (Silgard
®
, MSD) and followed up for 12–52 months. The intervals between the successive surgical procedures, the extension of the disease (Derkay score) at each surgery, and the number of surgical procedures per year before vaccination and after its completion were compared. The mean interval between the surgical procedures was 271.2 days before the vaccination and 537.4 days after it (
p
= 0.034). The mean number of surgeries per year was 2.16 before the vaccination and 0.93 after it (
p
= 0.022). The Derkay score did not change significantly after vaccination. Complete remission of the disease was observed in one patient, partial response to the vaccination was observed in seven patients and no response was observed in three patients. In conclusion, vaccination with the quadrivalent HPV vaccine can favorably influence the course of RRP in patients with the rapid growth of the papillomas. It significantly prolongs the intervals between the surgical procedures and reduces the number of procedures needed in the majority of patients. The present investigation can serve as a pilot study for further research. For a final conclusion a longer follow-up and studies on more patients are necessary.
Background. Gastroesophageal reflux is suspected to be an etiological factor in laryngeal and pharyngeal cancer. The aim of this study was to establish, using a non-invasive method, whether ...laryngopharyngeal reflux (LPR) appears more often in patients with early laryngeal cancer than in a control group.
Patients and methods. We compared the pH, the level of bile acids, the total pepsin and the pepsin enzymatic activity in saliva in a group of 30 patients with T1 laryngeal carcinoma and a group of 34 healthy volunteers.
Results. The groups differed significantly in terms of levels of total pepsin and bile acids in the saliva sample. Higher levels of total pepsin and bile acids were detected in the group of cancer patients. No significant impact of other known factors influencing laryngeal mucosa (e.g. smoking, alcohol consumption, and the presence of irritating substances in the workplace) on the results of saliva analysis was found.
Conclusions. A higher level of typical components of LPR in the saliva of patients with early laryngeal cancer than in the controls suggests the possibility that LPR, especially biliary reflux, has a role in the development of laryngeal carcinoma.
Exercise-inducible laryngeal obstruction (EILO) has been recognized as a not rare respiratory problem in youth practicing sports. The aim of the study was to test the mechanosensitivity of the ...larynx, and to identify the factors affecting it in a group of youth with proven EILO. Laryngeal sensory testing was performed in 54 adolescents and young adults with EILO. Laryngeal mucosal alterations were assessed according to the Reflux Finding Score (RFS). The data concerning diseases possibly affecting the upper airway, findings of previously performed flexible videolaryngoscopy during exercise, and RFS score were compared between the participants with laryngeal hyposensitivity and those with normal sensitivity. The participants with isolated vocal folds' adduction during an EILO attack were compared with those who demonstrated supraglottis collapse. Testing revealed an increased threshold for mechanical stimuli in 81.5% of participants. Among participants with hyposensitivity, there were significantly more participants with dysphagia during EILO attacks than among the participants with normal laryngeal sensitivity. The hyposensitivity group had a significantly higher RFS score compared with the other group. Isolated vocal folds' approximation was only observed in 11.9% of participants. These participants were younger and had asthma more frequently compared with the others. Only 16.9% of participants with EILO did not state symptoms related to gastroesophageal reflux. The decreased mechanosensitivity was detected in the majority of participants, suggesting that laryngopharyngeal reflux can be an important etiological factor. The problem of breathing difficulties during sport activities in youth can also be associated with the disproportionate growth of the respiratory tract.
Aim. The aim of this paper is to compare the prevalence of voice disorders and the risk factors for them in different occupations with a vocal load in Slovenia.
Methods. A meta-analysis of six ...different Slovenian studies involving teachers, physicians, salespeople, catholic priests, nurses and speech-and-language therapists (SLTs) was performed. In all six studies, similar questions about the prevalence of voice disorders and the causes for them were included.
Results. The comparison of the six studies showed that more than 82% of the 2347 included subjects had voice problems at some time during their career. The teachers were the most affected by voice problems. The prevalent cause of voice problems was the vocal load in teachers and salespeople and respiratory-tract infections in all the other occupational groups. When the occupational groups were compared, it was stated that the teachers had more voice problems and showed less care for their voices than the priests. The physicians had more voice problems and showed better consideration of vocal hygiene rules than the SLTs. The majority of all the included subjects did not receive instructions about voice care during education.
Conclusions. In order to decrease the prevalence of voice disorders in vocal professionals, a screening program is recommended before the beginning of their studies. Regular courses on voice care and proper vocal technique should be obligatory for all professional voice users during their career. The inclusion of dysphonia in the list of occupational diseases should be considered in Slovenia as it is in some European countries.
Cilj. Primerjati prevalenco glasovnih motenj in dejavnikov tveganja za njihov nastanek pri različnih poklicih v Sloveniji.
Metode. Narejena je bila meta analiza šestih različnih raziskav v Sloveniji, ki so vključevale zdravnike, učitelje, prodajalce, duhovnike, medicinske sestre in logopede. V vseh študijah so bili uporabljeni podobni vprašalniki, ki so zajemali vprašanja o pojavu glasovnih motenj in razlogih zanje.
Rezultati. Primerjava raziskav je pokazala, da je 82% od 2.347 vključenih že imelo glasovne težave v svoji karieri. Največ težav z glasom so imeli učitelji. Glavni vzrok hripavosti pri učiteljih in prodajalcih je bila glasovna obremenitev, pri preostalih poklicih pa akutne respiratorne okužbe. Primerjava poklicev je pokazala, da imajo učitelji več glasovnih težav kot duhovniki, manj tudi skrbijo za svoj glas. Primerjava zdravnikov in logopedov je pokazala, da imajo zdravniki več glasovnih motenj, čeprav bolje skrbijo za svoj glas. Večina vprašanih ni dobila navodil glede skrbi in rabe glasu med svojim študijem.
Zaključki. Za zmanjšanje pojava glasovnih motenj bi bili potrebni presejalni pregledi kandidatov za poklice z glasovno obremenitvijo še pred začetkom študija. Poklicni govorniki bi se morali tudi med opravljanjem svojega poklica dodatno izobraževati o skrbi za glas in pravilni vokalni tehniki. Glasovne motnje bi morali vključiti v seznam poklicnih bolezni, tako kot je to urejeno že ponekod v Evropi.
To quantify the relationship between the stage of histologic changes of the stapedial footplate in otosclerosis and the magnitude of preoperative hearing loss, tinnitus, vestibular disorder, and ...postoperative improvement of hearing.
Retrospective case review.
Tertiary referral center.
The study included 97 patients (ears) (69 female and 28 male patients), with conductive or mixed hearing loss who were operated on for otosclerosis. The criterion for including a patient in the study was otosclerosis established by tympanoscopy and confirmed by histologic examination of a piece of the stapedial footplate.
By the histologic features of the stapedial footplate fragments, the stage of the otosclerotic lesion was classified as spongiotic, fibrotic, or sclerotic. The patients were carefully matched for sex, age, duration of hearing impairment, presence of tinnitus, and vestibular symptoms. Preoperative and postoperative air-conduction and bone-conduction thresholds were calculated as an average of four frequencies (0.5, 1, 2, and 4 kHz). Analysis was subsequently carried out on the preoperative and postoperative air-bone gap and bone-conduction threshold improvement.
With regard to the histologic stage of otosclerotic lesions, tinnitus and vestibular disorders were present more frequently in patients with the sclerotic type of lesion. The type of otosclerotic lesion had no significant influence on the mean preoperative air-conduction threshold, bone-conduction threshold, and air-bone gap or on postoperative air-conduction threshold and bone-conduction threshold, but the postoperative air-bone gap was higher in patients with the fibrotic type of otosclerotic lesion and was highest in patients with the spongiotic type of otosclerotic lesion (p < 0.01).
Tinnitus, vestibular disorders, and better postoperative closure of the air-bone gap are present more frequently in patients with a sclerotic type of otosclerotic lesion on the stapedial footplate.
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