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
Chronic rhinosinusitis (CRS) is a multifaceted disease with variable clinical courses and outcomes. We aimed to determine CRS-associated nasal-tissue transcriptome in clinically well-characterized ...and phenotyped individuals, to gain a novel insight into the biological pathways of the disease. RNA-sequencing of tissue samples of patients with CRS with polyps (CRSwNP), without polyps (CRSsNP), and controls were performed. Characterization of differently expressed genes (DEGs) and functional and pathway analysis was undertaken. We identified 782 common CRS-associated nasal-tissue DEGs, while 375 and 328 DEGs were CRSwNP- and CRSsNP-specific, respectively. Common key DEGs were found to be involved in dendritic cell maturation, the neuroinflammation pathway, and the inhibition of the matrix metalloproteinases. Distinct CRSwNP-specific DEGs were involved in NF-kβ canonical pathways, Toll-like receptor signaling, HIF1α regulation, and the Th2 pathway. CRSsNP involved the NFAT pathway and changes in the calcium pathway. Our findings offer new insights into the common and distinct molecular mechanisms underlying CRSwNP and CRSsNP, providing further understanding of the complex pathophysiology of the CRS, with future research directions for novel treatment strategies.
Our aim was to track the changes in voice quality for two years after radiotherapy (RT) for early glottic cancer. A videoendostroboscopy, subjective patient and phoniatrician voice assessments, a ...Voice Handicap Index questionnaire, and objective acoustic measurements (F0, jitter, shimmer, maximal phonation time) were performed on 50 patients with T1 glottic carcinomas at 3, 12, and 24 months post-RT. The results were compared between the subsequent assessments, and between the assessments at 3 months and 24 months post-RT. The stroboscopy showed a gradual progression of fibrosis of the vocal folds with a significant difference apparent when the assessments at 3 months and 24 months were compared (p < 0.001). Almost all of the subjective assessments of voice quality showed an improvement during the first 2 years, but significant differences were noted at 24 months. Jitter and shimmer deteriorated in the first year after RT with a significant deterioration noticed between the sixth and twelfth months (p = 0.048 and p = 0.002, respectively). Two years after RT, only 8/50 (16%) patients had normal voices. The main reasons for a decreased voice quality after RT for early glottic cancer were post-RT changes in the larynx. Despite a significant improvement in the voice after RT shown in a few of the evaluation methods, only a minority of the patients had a normal voice two years post-RT.
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.
Izhodišče: Za injiciranje različnih materialov v glasilko se odločimo v primeru sulkusa, brazgotine, pareze in atrofije glasilke. Ta stanja povzročajo nepopolno zaporo glotisa in vplivajo na normalno ...širjenje sluzničnega vala glasilke. Glavna bolnikova težava je običajno disfonija, lahko pa so prisotne tudi težave pri požiranju.Metode: Za okrepitev glasilke snov vbrizgamo globoko v tiroaritenoidno mišico, s tem povečamo njeno prostornino ter zmanjšamo glotisno insuficienco. Glede na izraženost bolnikovih težav in napoved izida uporabljamo različne začasne in dolgo obstojne materiale. Poseg se lahko opravi v splošni anesteziji z direktno mikrolaringoskopijo, v zadnjem času pa se zaradi številnih prednosti in razvijanja transkutanih pristopov vse bolj uveljavlja tudi ambulantno injiciranje v lokalni anesteziji. Velik potencial ima področje tkivnega inženirstva, ki razvija materiale za preprečevanje in zdravljenje brazgotine glasilke, kar je vzrok za nepopolni stik med glasilkama pri addukciji.Lastne izkušnje: Od leta 2006 dalje zdravimo bolnike z glotisno insuficienco z vbrizganjem lastne maščobe v eno ali obe glasilki tudi na Kliniki za ORL in CFK UKC Ljubljana. Pri večini bolnikov je vzrok za nepopoln stik med glasilkama motena gibljivost glasilke, vodilni težavi sta hripavost in manj pogosto zaletavanje pri pitju. Zdravljenje je bilo uspešno pri veliki večini, glas se je izboljšal, težave pri požiranju so se praviloma zmanjšale ali izginile. Le pri manjšem številu bolnikov je bilo čez nekaj let potrebno injiciranje ponoviti zaradi poslabšanja stika med glasilkama. Subjektivno izboljšanje potrjujejo tudi rezultati akustične analize glasu pred in po posegu.
Izhodišče: Orofacialni razcep je najpogostejša prirojena obrazna nepravilnost. Otroci z razcepi v orofacialnem področju imajo poleg težav z govorom tudi težave na področju hranjenja in požiranja. ...Raziskave kažejo, da so simptomi težav s hranjenjem precej raznoliki. V skrajnih primerih je potrebno uvesti nadomestne načine hranjenja. V Sloveniji še ni bila narejena raziskava o pojavljanju težav s hranjenjem pri otrocih z razcepi v orofacialnem področju.Metode: Ugotoviti smo želeli pogostost in vrsto težav s hranjenjem otrok z razcepi v orofacialnem področju, starih od pet mesecev do šest let. V ta namen smo izoblikovali anonimni vprašalnik za starše o vrsti orofacialnega razcepa, možnih otrokovih težavah pri hranjenju, požiranju in govoru ter pripomočkih za hranjenje. Vprašalnik je bil najprej pilotsko preizkušen pri starših otrok z orofacialnimi razcepi med kontrolnimi ambulantnimi pregledi, nato pa poslan 93 staršem otrok z orofacialnimi razcepi, rojenih v obdobju treh zaporednih let. Z opisno statistiko smo predstavili pogostnost pojavljanja težav ter analizirali dejavnike, ki so se pogosteje pojavljali pri otrocih s težavami pri hranjenju.Rezultati: Starši 58 otrok z orofacialnimi razcepi so izpolnili vprašalnik. Ugotovili smo, da je imelo skoraj tri četrtine otrok težave z vzpostavitvijo hranjenja takoj po rojstvu, kasneje so se težave s hranjenjem zmanjšale, vendar so bile v četrtini primerov še vedno prisotne do zaključenega kirurškega zdravljenja. Največ težav se je pojavljalo zaradi uhajanja hrane in pijače skozi nos, požiranja zraka pri hranjenju po steklenički in podaljšanega časa hranjenja. Otroci z razcepom neba z razcepom ustnice ali brez so imeli bistveno več težav s hranjenjem kot otroci samo z razcepom ustnice. Večina staršev je za hranjenje uporabljala prilagojeno stekleničko in je bila z uporabo zadovoljna. Več kot polovica staršev je izjavila, da so prejeli premalo informacij v zvezi s hranjenjem pred in takoj po rojstvu otroka.Zaključek: Kljub dobro organizirani multidisciplinarni skrbi za otroke z orofacialnimi razcepi v Sloveniji starši še vedno pogrešajo konkretna navodila o hranjenju otroka z orofacialnim razcepom, zaradi česar bo potrebno dodatno izobraziti predvsem medicinske sestre, ki delajo v porodnišnicah. Glede na visoke cene pripomočkov za hranjenje otrok z orofacialnimi razcepi bi bilo dobrodošlo, da bi kril stroške ZZZS.
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.
Seventy initial and 125 follow-up tissue specimens of laryngeal papillomas, obtained from 70 patients who had had recurrent respiratory papillomatosis for from 1—22 years, were investigated for the ...presence of human papillomavirus (HPV) DNA and HPV E5a, LCR and/or full-length genomic variants. HPV-6 was found in 130/195, HPV-11 in 63/195, and HPV-6/HPV-11 in 2/195 samples. Within 67/70 (95.7%) patients, all follow-up HPV isolates genetically matched completely initial HPV isolate over the highly variable parts of the genome or over the entire genome. Frequent recurrence of laryngeal papillomas is a consequence of long-term persistence of the identical initial HPV genomic variant.
Skeletal anterior open bite (AOB) or apertognathism is characterized by the absence of contact of the anterior teeth and affects articulation parameters, chewing, biting and voice quality. The ...treatment of AOB consists of orthognatic surgical procedures. The aim of this study was to evaluate the effects of treatment on voice quality, articulation and nasality in speech with respect to skeletal changes. The study was prospective; 15 patients with AOB were evaluated before and after surgery. Lateral cephalometric x-ray parameters (facial angle, interincisal distance, Wits appraisal) were measured to determine skeletal changes. Before surgery, nine patients still had articulation disorders despite speech therapy during childhood. The voice quality parameters were determined by acoustic analysis of the vowel sound /a/ (fundamental frequency-F0, jitter, shimmer). Spectral analysis of vowels /a/, /e/, /i/, /o/, /u/ was carried out by determining the mean frequency of the first (F1) and second (F2) formants. Nasality in speech was expressed as the ratio between the nasal and the oral sound energies during speech samples. After surgery, normalizations of facial skeletal parameters were observed in all patients, but no statistically significant changes in articulation and voice quality parameters occurred despite subjective observations of easier articulation. Any deterioration in velopharyngeal insufficiency was absent in all of the patients. In conclusion, the surgical treatment of skeletal AOB does not lead to deterioration in voice, resonance and articulation qualities. Despite surgical correction of the unfavourable skeletal situation of the speech apparatus, the pre-existing articulation disorder cannot improve without professional intervention.
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