Adi Primov-Fever

Evaluating the validity of the Voice Handicap Index-10 (VHI-10) among Hebrew speakers.

OBJECTIVE: To evaluate the validity of a translated version of the Voice Handicap Index-10 (VHI-10). STUDY DESIGN AND SETTING: In a parallel group design, 221 patients with different laryngeal pathologies and 172 people with no laryngeal pathology completed a Hebrew version of the VHI-10. Validity and reliability were assessed as well as group differences. RESULTS: Statistical analyses demonstrated high reliability values (Cronbachs Alpha r = 0.949). Responses were not affected by age (P = 0.373) or gender (P = 0.360). The control group received significantly lower scores than all pathological groups (P < 0.05). Within the pathological groups, the “neurogenic” and “mucosa irregularity’ groups were rated higher than all other pathological groups (P < 0.05). CONCLUSION: The VHI-10 questionnaire maintains its validity and reliability across translation to Hebrew. Moreover, although the VHI-10 is essentially a unidimensional tool, it provides partial information on the 3 subjective dimensions of the full VHI.

Granular myringitis: Incidence and clinical characteristics.

Objective: To examine the incidence and the clinical features of granular myringitis (GM). Study Design: A 2-year prospective cohort study. Setting: A primary otolaryngology clinic affiliated with a tertiary academic referral center. Patients: All-aged patients diagnosed with GM who had no apparent middle ear disease or did not undergo ear surgery. Intervention: Otoscopy and bacteriologic and histopathologic studies. Main Outcome Measures: Granular myringitis was noted in 0.41% of patients population presenting different forms. Results: Granular myringitis was detected in 26 patients. Recurrent infection occurred in seven (26.9%) and bilateral GM in five patients (19.2%). Perforation of the tympanic membrane (TM) was noted in eight patients (30.7%), six of which closed spontaneously. Otoscopic findings could be classified into three grades: focal de-epithelization (in 10), focal polypoid granulations (in 13), and diffuse polypoid formation over the entire TM (in 3). Histopathologic examination disclosed tiny fragments of granulation tissue infiltrated by nonspecific chronic and acute inflammatory reaction. Conclusion: Granular myringitis is encountered not infrequently in primary otolaryngology practice and presented different forms, recurrent episodes, and bilateral involvement. Topical application of antibiotics or caustic agents was successful in all cases. Perforation of the TM may develop and resolve spontaneously during the course of the disease.

Granular myringitis in children.

BACKGROUND Granular myringitis (GM), described mainly in adults, is considered a rare infection of the tympanic membrane (TM) with possible involvement of the external ear canal. The study was aimed to evaluate the clinical characteristics of the disease in children. MATERIAL A 2-year prospective study on all children with GM in a primary otolaryngology practice affiliated to a tertiary academic medical center. GM was defined by de-epithelization of the TM, granulation-tissue formation and discharge. Children with otitis media were excluded. Treatment included topical application of ear drops, caustic solution in unresponsive cases and mechanical removal of polypoidal granulations. RESULTS Nine children, five boys and four girls, aged 3--16 (mean=11.5 years) were diagnosed as GM. Mainly plugged ear (6) and aural discharge (5) presented GM. Only a circumscribed area of the pars tensa was involved. GM was expressed either by a tiny shallow lesion (6) or by raised polypoidal masses (3). All children recovered within 2--11 weeks (mean 3.6). Recurrent infection was noted twice in one child. Small dry perforation of the TM was noted in two children. Histopathological studies revealed non specific acute and chronic inflammatory reaction. CONCLUSIONS Granular myringitis must be recognized in children. GM has a benign course responding to topical treatment. It may be misidentified as persistent chronic suppurative otitis media with polyps protruding through the TM. Although perforation of the TM may develop in the course of the disease, the middle ear remained intact.

Outcome of tracheostomy in patients over 85 years old (oldest-old patients):

Objective: To investigate morbidity, complication rate, and mortality in oldest-old patients who undergo tracheostomy. Study Design: Historical cohort study. Subject and Methods: The medical records for 64 patients (>85 years) who underwent standard or percutaneous tracheostomy between 2001 and 2005 in a tertiary care hospital were reviewed for in-hospital and out-of-hospital mortality, complications, and decannulation rate. Results: Twenty-eight (43.8%) patients were discharged from the hospital and all remained tracheotomized at that time. Postoperative mortality had not been related to the procedure itself and the mortality rate reached 75 percent within the first three postoperative months and 93.8 percent within the first year post-tracheostomy. The post-tracheostomy course was complicated in three (4.7%) patients. There was no significant correlation between the length of hospital stay or survival and demographic parameters, pneumonia as the reason for mechanical ventilation, or performance of surgery before tracheostomy. Conclusion: Tracheostomy is a safe surgical procedure in the oldest-old patients. The high rate of the postoperative mortality is not related to the procedure itself. The possibility of permanent stoma should be considered and discussed with the patients and their families during the preoperative counseling.

Novel Anatomic Characteristics of the Laryngeal Framework A Computed Tomography Evaluation

Objective The thyroid cartilage (TC) in men has a more prominent thyroid notch and a narrower interlaminae angle (ILA) as compared with women. Anatomy textbooks classically stipulate that the ILA is 90° in men and 120° in women. Our observation, based on thyroid chondroplasty operations, of a much narrower angle led to the current investigation. Study Design Cohort imaging study. Setting Tertiary academic referral center. Subjects and Methods Computed tomography angiography neck images of adult patients were studied. The ILA was measured on 2 axial planes: at the level of the vocal processes (and the upper portion of thyroarytenoid muscles) and 5 mm superior and parallel to the former. The anterior projection of the TC and the vertical dimensions of the midline cricothyroid membrane (CTM) were also measured. Results A total of 126 patients were included in the study. The average ILAs were 63.5°±20.6° and 93.3°±16.6° for men and women, respectively (P < 10−14), and were significantly narrower at the upper level in comparison with the vocal process level (P < 10−7 for men, P = .004 for women). The anterior projection of the TC in men was more prominent as compared with women (P = .0003) and significantly correlated with the ILA (P = .0159). The length of the midline CTM was 11.1±2.3 mm in men and 10.3±1.7 mm in women (P = .0355). Conclusions The ILA is narrower than that reported in the classic anatomy textbooks. In male patients, the upper part of the TC becomes narrower and projects anteriorly like a “jug’s spout.” The mean vertical dimension of the midline CTM was 10 to 11 mm.

Evaluating Voice Characteristics of First-Year Acting Students in Israel: Factor Analysis

HYPOTHESIS Acting students require diverse, high-quality, and high-intensity vocal performance from early stages of their training. Demanding vocal activities, before developing the appropriate vocal skills, put them in high risk for developing vocal problems. STUDY DESIGN A retrospective analysis of voice characteristics of first-year acting students using several voice evaluation tools. METHODS A total of 79 first-year acting students (55 women and 24 men) were assigned into two study groups: laryngeal findings (LFs) and no laryngeal findings, based on stroboscopic findings. Their voice characteristics were evaluated using acoustic analysis, aerodynamic examination, perceptual scales, and self-report questionnaires. Results obtained from each set of measures were examined using a factor analysis approach. RESULTS Significant differences between the two groups were found for a single fundamental frequency (F(0))-Regularity factor; a single Grade, Roughness, Breathiness, Asthenia, Strain perceptual factor; and the three self-evaluation factors. Gender differences were found for two acoustic analysis factors, which were based on F(0) and its derivatives, namely an aerodynamic factor that represents expiratory volume measurements and a single self-evaluation factor that represents the tendency to seek therapy. CONCLUSIONS Approximately 50% of the first-year acting students had LFs. These students differed from their peers in the control group in a single acoustic analysis factor, as well as perceptual and self-report factors. No group differences, however, were found for the aerodynamic factors. Early laryngeal examination and voice evaluation of future professional voice users could provide a valuable individual baseline, to which later examinations could be compared, and assist in providing personally tailored treatment.

The anatomical evolution of the thyroid cartilage from childhood to adulthood: A computed tomography evaluation

To enhance knowledge and understanding of the laryngeal framework maturation in different age groups and genders.

Acute Invasive Fungal Rhinosinusitis in Children With Hematologic Malignancies: Outcome of Surgical Treatment

The incidence of acute invasive fungal rhinosinusitis (AIFR) is rising due to more aggressive chemotherapy and longer survival of immunosuppressed patients. Early diagnosis and appropriate but nonmutilating surgical treatment are particularly problematic in the pediatric population. This study aimed to evaluate the outcome of surgery for pediatric AIFR. Medical records of children surgically treated for AIFR between 1998 and 2014 were reviewed. Diagnosis was based on both histopathological and microbiological confirmation. Surgery was performed with curative intent and repeated for any resectable extension. The children underwent endoscopy and magnetic resonance imaging every 2 and 6 months, respectively, during the first postoperative year. Thirteen patients (2–18 years old) met the EORTC/MSG criteria for proven invasive fungal sinusitis; fungal invasion was diagnosed by preoperative biopsy and confirmed in the surgical specimen. All patients underwent an average of two endoscopic procedures (range 1–3), and four of them also underwent an open surgery. The local control rate was at least 79%. There was no facial disfiguration during follow-up (average 41 months). Although AIFR is still associated with high mortality, aggressive medical and surgical treatment provides local control in most cases. Fair outcome should encourage a maximal joint effort of pediatric hemato-oncologists and otorhinolaryngologists in the management of AIFR.

Noninvasive detection of aneuploid cells in laryngeal epithelial precursor lesions

Most cases of laryngeal cancer are preceded by precursor lesions which, if left untreated, can progress toward an invasive cancer. The objective of this study was to investigate the presence of chromosomal numerical aberrations in cells that were collected by noninvasive brush sampling from laryngeal lesions.

Computerized Analysis of Vocal Folds Vibration From Laryngeal Videostroboscopy

OBJECTIVES To develop an objective analysis of laryngeal videostroboscopy (VSS) movies in the space-time domain for quantitative determination of the true vocal folds (TVFs) vibratory pattern to allow for detection of local pathologies at early stages of development. METHODS Contours of the TVF and false vocal folds (FVFs) were tracked on each frame of a VSS movie. A registration algorithm was used with respect to the centerline of the FVF to eliminate movements not related to TVF vibration. The registered contours of the TVF were analyzed in time and frequency domains. RESULTS The TVF vibration demonstrated a sinusoidal pattern with the same fundamental frequency at every section along the folds of healthy subjects, as well as detection of an abnormal area with a different fundamental frequency in TVF with local pathologies. Analysis of the TVF vibration time delay of healthy subject revealed a posterior-to-anterior longitudinal wave that was not detected by visual observation. CONCLUSIONS An objective analysis of laryngeal VSS movies was developed for quantitative determination of the TVF vibration. This analysis was able to detect and quantify TVF characteristics in normal subjects as well as in patients with pathologies beyond the ability of examinees naked eyes.