Summary
AIM: To identify the role of allergy in the occurrence of Reinke's edema on vocal folds. METHODS: This was a prospective study in patients with Reinke's edema on vocal folds (
n
= 80) and a ...control group of patients without Reinke's edema (
n
= 80). All the patients were examined by the same ENT specialist at an ENT outpatient center in the period 2001–2003. The control group comprised 80 successive patients from the same clinic who were willing to cooperate in the study and were not already being treated for allergic disease by any specialist other than an ENT specialist. Patients from both groups were examined by rigid laryngoscope, skin prick allergic testing (type I allergy) and laboratory determination of serum thyroid-stimulating hormone level. RESULTS: The prevalence of allergy was not significantly different between the two groups: 20.0% in the patients with Reinke's edema and 23.8% in the control group (
P
= 0.576). No significant difference was detected in the prevalence of allergy when comparing patients with recurrent Reinke's edema after previous surgical treatment (
n
= 10) with patients with a first occurrence (
n
= 70) (
P
= 1.000). However, we found significantly more type I allergy in the patients with Reinke's edema and chronic hyperplastic rhinitis than in the patients with Reinke's edema without chronic hyperplastic rhinitis. All other risk factors (reflux of gastric content to the larynx, vocal abuse or misuse, unfavorable microclimate conditions at work, thyroid diseases) appeared significantly more often in the group with Reinke's edema on vocal folds than in the control group. CONCLUSIONS: Type I allergy is not a crucial factor in the pathogenesis of Reinke's edema on vocal folds or in recurrence of the disease after surgical treatment.
Background Radiotherapy (RT) is a successful mode of treatment for early glottic cancer. The aim of the study was to assess voice quality both before and 3 months after successful RT using multimodal ...methods while also identifying the factors affecting it. Patients and methods In 50 patients with T1 glottic carcinoma, the subjective (patients' assessment of voice quality VAS, Voice Handicap Index VHI questionnaire, phoniatricians' assessment using the grade/roughness/ breathiness GRB scale), and objective assessments (fundamental laryngeal frequency F0, jitter, shimmer, maximum phonation time MPT) of voice quality were performed before RT and 3 months post-RT. The data on gender, age, extent of the tumors, biopsy types, smoking, local findings, and RT were obtained from the medical documentation. Results Three months after the treatment, VAS, VHI, G and R scores, F0, and MPT significantly improved in comparison with their assessment prior to treatment. Before the treatment, the involvement of the anterior commissure significantly deteriorated jitter (p = 0.044) and the involvement of both vocal folds deteriorated jitter (p = 0.003) and shimmer (p = 0.007). After the RT, F0 was significantly higher in the patients with repeated biopsy than in the others (p = 0.047). In patients with post-RT changes, the B score was significantly higher than in those without post-RT changes (p = 0.029). Conclusions Voice quality already significantly improved three months after the treatment of glottic cancer. The main reason for the decreased voice quality prior to treatment is the tumor's extent. Post-RT laryngeal changes and repeated biopsies caused more scarring on vocal folds adversely influencing voice quality after the treatment.
Motnje glasu, govora in požiranja niso redke, najbolj pa prizadenejo profesionalne uporabnike glasu, otroke in odrasle s prirojenimi anomalijami ali nevrološkimi motnjami ter bolnike po zdravljenju ...raka glave in vratu. Foniater je otorinolaringolog, ki obravnava te motnje. Osnovne preiskave foniatra so endoskopske preiskave grla ter fleksibilna endoskopska analiza požiranja. Kirurški posegi se izvajajo v grlu v splošni ali lokalni anesteziji. V času pandemije covida-19 se je zaradi teh visoko tveganih posegov z nastajanjem aerosola delo foniatra prilagodilo situaciji. Iz preglednih člankov in po stališčih Združenja evropskih foniatrov (angl. Union of the European Phoniatricians, UEP) so povzeta priporočila o načinu in potrebnosti izvajanja diagnostičnih in terapevtskih postopkov. Bistvenega pomena je dosledna uporaba osebne zaščitne opreme, upoštevanje čiščenja in zračenja prostorov ter s tem povezana razpoložljivost zadostnega časa za obravnavo posameznega bolnika. Za vsakega bolnika je potrebna individualna odločitev, ali se preiskava izpelje, ali pa jo je možno vsaj delno nadomestiti z drugo preiskavo, ki ne predstavlja take nevarnosti za prisotne zdravstvene delavce.
Background: Orofacial clefts are the most common congenital craniofacial malformations. Children with orofacial clefts do not only have problems with speech, but also with feeding and swallowing. ...Alternative methods of feeding need to be introduced in severe cases. Until now there has not been conducted a single study regarding feeding and swallowing problems in children with orofacial clefts in Slovenia. Methods: The aim of the study was to determine the prevalence and the type of feeding and swallowing problems in children with orofacial clefts, aged between five months and six years. An anonymous questionnaire for parents was created, containing questions about the type of the child’s orofacial cleft, child’s possible feeding, swallowing and speech problems, and special feeding gadgets. The questionnaire was initially tested in a pilot study during routine medical follow-up visits. Afterwards, it was sent to 93 parents of children with clefs, born in a period of three consecutive years. A descriptive statistics was used to present the prevalence of feeding and swallowing problems in children with orofacial clefts. The factors correlated with feeding problems were analysed. Results: Almost three-quarters of children had problems with feeding immediately after birth; problems with feeding later decreased, but they were still present in one quarter of all cases until the completed surgical treatment. Most difficulties occurred due to nasal regurgitation, excessive air intake while bottle feeding, and prolonged feeding time. Children with cleft palate with or without cleft lip had significantly more feeding problems in comparison to children with cleft lip only. Most parents used special feeding bottles and were generally satisfied with their use. More than a half of the parents believed that they had received too little information about feeding before and immediately after the child’s birth. Conclusion: Despite the well-organized multidisciplinary care of children with orofacial clefts in Slovenia, parents still miss the professional counselling about feeding their children. Therefore, an additional education of nurses working in maternity hospitals will be necessary in the future. Considering the high prices of special feeding gadgets for children with orofacial clefts, covering of their costs by the health insurance would be welcome.
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.
Background. A laryngectomy affects many of a patient’s functions. Besides speech and respiratory-tract problems, olfaction and gustation problems can also have an influence on the quality of life. ...The aim of this study was to find out how often various nasal problems and decreased gustation appear after a laryngectomy.
Patients and methods. One hundred and five laryngectomized patients (9 women, 96 men, aged 45-88 years), treated in two tertiary centers, were included in the study. They completed a questionnaire about various nasal problems, olfactory and gustatory capabilities, possible allergies and irritants in their environment, and the impact of the nasal and gustation problems on their quality of life.
Results. Olfaction was impaired in 51.4%, and was even not possible in 30.5%, of patients. Decreased gustation abilities were reported in 26.7%, and dysgeusia in 11.4%, of patients. Almost 21% of patients were bothered by an impaired gustatory ability and 50.5% of patients were affected by their loss of olfaction. Frequent nasal discharge was reported in 20%, frequent sneezing in 58.1%, and nasal itching in 33.3% of the laryngectomized patients. There were no correlations between the age and the olfaction and gustation abilities and between the allergy and the nasal symptoms, whereas the correlation between olfaction and gustation appeared significant (p=0.025).
Conclusions. Various nasal and gustatory problems were reported in more than 80% of laryngectomized patients. The olfaction and gustation abilities are connected and have a substantial impact on the quality of life. Like in the case of speech, the rehabilitation of olfaction is also necessary in all laryngectomized patients and must take place soon after the completion of the treatment.
Background: Vocal fold polyp is one of the most common causes for hoarseness. Many different etiological factors contribute to vocal fold polyp formation. The aim of the study was to find out whether ...the etiological factors for polyp formation have changed in the last 30 years.Methods: Eighty-one patients with unilateral vocal fold polyp were included in the study. A control group was composed of 50 volunteers without voice problems who matched the patients by age and gender. The data about etiological factors and the findings of phoniatric examination were obtained from the patients' medical documentation and from the questionnaires for the control group. The incidence of etiological factors was compared between the two groups. The program SPSS, Version 18 was used for statistical analysis.Results: The most frequent etiological factors were occupational voice load, GER, allergy and smoking. In 79% of patients 2 – 6 contemporary acting risk factors were found. Occupational voice load (p=0,018) and GER (p=0,004) were significantly more frequent in the patients than in the controls. The other factors did not significantly influence the polyp formation.Conclusions: There are several factors involved simultaneously in the formation of vocal fold polyps both nowadays and 30 years ago. Some of the most common factors remain the same (voice load, smoking), others are new (GER, allergy), which is probably due to the different lifestyle and working conditions than 30 years ago. Occupational voice load and GER were significantly more frequently present in the patients with polyp than in the control group. Regarding the given results it is important to instruct workers with professional vocal load about etiological factors for vocal fold polyp formation.
Paresis or paralysis of one or both vocal cords affects phonation, swallowing and breathing. The major cause for reduced mobility or even immobility is innervation damage, less often mechanical ...disorder.The main procedures in the diagnostics of disordered vocal fold mobility are indirect laryngoscopy and videoendostroboscopy. Different imaging techniques (especially computerized tomography) are of great value in searching for a cause of the impaired mobility.In unilateral vocal fold immobility, the treatment is focused on the improvement of voice quality and the prevention of aspiration during swallowing. In bilateral paralysis, it is crucial to find a balance between effective breathing and sufficient voice quality. The treatment of unilateral paralysis is started with voice therapy and swallowing rehabilitation. If these procedures are not enough surgical treatment for the medialization of the paralyzed vocal fold is applied. In the case of breathing difficulties in bilateral vocal fold immobility there is a possibility of surgical lateralization of one or both folds or a surgical excision of a part or the entire vocal fold. Surgical reinnervation, functional electrostimulation of certain laryngeal muscles and gene therapy are developing treatment modalities.
Paresis or paralysis of one or both vocal cords affects some significant aspects of a human life: breathing, swallowing and speech. The major causes for reduced mobility or even immobility are ...innervation damage, less often fixation of vocal cord or impaired mobility of crycoarytenoid joint. An injury of the superior or/and inferior laryngeal nerve can be a consequence of different medical procedures, tumor growth, trauma, infection, neurological disorders, radiation exposure, toxic damage, impaired circulation of the area or it is idiopathic. The symptoms are different in the case of unilateral and bilateral paresis of the vocal folds. They also depend on the cause for the impaired mobility. In the patients with unilateral vocal fold paresis, hoarseness and aspiration during swallowing are the leading symptoms. In the bilateral vocal fold paralysis, dyspnea prevails.
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