Antonio Schindler

Genetic and acquired prothrombotic risk factors and sudden hearing loss.

Objectives: Idiopathic sudden sensorineural hearing loss (ISSNHL) is a frequently encountered condition, and various pathogenetic mechanisms have been hypothesized, such as viral infections, autoimmune processes, and ischemic events; however, whatever the cause, impaired cochlear perfusion appears to be the most important event. A number of inherited prothrombotic risk factors and their related genetic alterations have recently been correlated with vascular disorders.

Validation of the Voice Handicap Index by Assessing Equivalence of European Translations

Objective: We aimed to assess the equivalence of translations of the Voice Handicap Index (VHI). Patients and Methods: Confirmatory factor analysis was used to assess equivalence of the US version and several translations including (1) Dutch, (2) Flemish Dutch (Belgium), (3) UK English, (4) French, (5) German, (6) Italian, (7) Portuguese and (8) Swedish. VHI questionnaires were gathered from 1,281 subjects. Patients were classified into 11 voice lesion categories. Patients with incomplete response (4%) and patients within voice lesion categories with small numbers were excluded from further analyses, leaving a cohort of 1,052 patients from 8 countries. Results: The internal consistency of the VHI proved to be good. Confirmatory factor analysis across countries revealed that a 3-factor fixed measurement model best fitted the data; the 3 subscales appeared to highly intercorrelated, especially in the US data. The underlying structure of the VHI was also equivalent regarding various voice lesions, but distinct groups were recognized with respect to the height of the VHI scores, indicating that various voice lesions lead to a diversity of voice problems in daily life. Conclusion: The US VHI and the translations appeared to be equivalent, which means that the results from studies from the various included countries can be compared.

Cross-cultural Adaptation and Validation of the Voice Handicap Index Into Italian

OBJECTIVES To evaluate the internal consistency, reliability, and clinical validity of the Italian version of the Voice Handicap Index (VHI). STUDY DESIGN Cross-sectional survey study was carried out. METHODS One hundred and seventy-five patients with voice disorders, divided in four groups according to the etiology of the disease (neurogenic, structural, functional, and inflammatory), and 84 asymptomatic subjects were included in the study. Internal consistency was analyzed through Cronbach α coefficient. For the VHI test-retest reliability analysis, the Italian VHI was filled twice by 56 patients and 56 control subjects. The test-retest reliability was assessed through the Pearson correlation test. For the clinical validity assessment, the scores obtained in the pathological group were compared with those found in asymptomatic individuals through the Kruskal-Wallis test. Also, the correlation between VHI and the grade of voice disorder was assessed. Finally, the effect of age and gender on overall VHI and its three subscales was analyzed. RESULTS Optimal internal consistency was found (α=0.93); the test-retest reliability in both groups was high (r>0.86). Nonparametric Kruskal-Wallis analysis of variance for the overall VHI score and its three domains revealed a significant main effect for group (P=0.000). The control group scored significantly lower than the four groups of voice-disordered patients. The overall VHI score positively correlated with the grade of voice disorder (r=0.43). In the voice-disorder group, age and gender were not correlated to the overall VHI score and to their three domains. CONCLUSION The Italian VHI is highly reproducible, and exhibits excellent clinical validity.

Extracorporeal lithotripsy for salivary calculi: A long-term clinical experience

Objectives/Hypothesis: The objective was to assess in a large series of patients with a long‐term clinical follow‐up the validity of extracorporeal electromagnetic shock wave lithotripsy as a minimally invasive therapy for sialolithiasis.

Correlation between the Voice Handicap Index and voice measurements in four groups of patients with dysphonia

OBJECTIVES: To evaluate the correlation between the Voice Handicap Index (VHI) and objective voice measurements in patients with dysphonia of different origin. STUDY DESIGN: Cross-sectional survey. SETTING: Otolaryngology department in a university hospital. SUBJECTS AND METHODS: One hundred fifteen patients consulting for voice disorders were enrolled in the study: 32 presented with functional dysphonia (Group 1), 24 with unilateral vocal fold paralysis (Group 2), 30 with structural dysphonia (Group 3), and 29 with nodules (Group 4). From each patient, the maximum phonation time (MPT) and a voice spectrogram were obtained: patients with type 1 signal underwent perturbation analysis. Each patient completed the VHI. RESULTS: No significant difference across the four groups, in the VHI scores and voice measurements, was found. The correlation between the different voice measurements was good, while those between the VHI domains were very good. Considering the patients with type 1 signal (n = 80) all together, the correlations between VHI and voice laboratory measurements ranged between poor and good. Analyzing each patient group separately, good correlations were found between MPT and functional and physical VHI domain in Group 1 (r = 0.58 and 0.68), jitter and functional VHI domain in Group 2 (r = 0.61), MPT and functional VHI domain in Group 3 (r = 0.52), and physical VHI domain and jitter, shimmer, and noise-to-harmonic ratio in Group 4 (r = 0.58, 0.77, 0.76). CONCLUSION: The VHI and the voice laboratory measurements give independent information. However, the correlation between VHI and some laboratory measurements increases in populations with voice disorder of the same origin.

Item Reduction of the Voice Handicap Index Based on the Original Version and on European Translations

Objective: Constructing an internationally applicable short-scale of the Voice Handicap Index (VHI). Methods: Subjects were 1,052 patients with 5 different types of voice disorder groups from Belgium, France, Sweden, Germany, Italy, The Netherlands, Portugal, and the USA. Different 9- and 12-item subsets were selected from the 30 VHI items using (1) the first factor of an unrotated factor analysis (narrow range subsets) and (2) the first three factors after promax rotation (broad range subsets). Country-specific subsets were selected to test deviations from the international subsets. For all subsets, reliability was investigated using Cronbach’s alphas and correlations with the total VHI. Validity was investigated using regression on voice disorder groups. All analyses were performed for the total and for all country-specific subject samples. Results: Reliability was high for all item subsets. It was lower for the international compared to the country-specific subsets and for the broad range compared to the narrow range subsets. Validity was best for the broad range subsets. Validity was better for the international than for the country-specific subsets. For all statistics the 12-item subsets were not essentially better than the 9-item subsets. Conclusion: The international broad range 9-item subset forms a scale which approximates well the total VHI.

Alzheimer's disease-associated disability: An ICF approach

Purpose. The aim of the study is to provide a description of dementia-associated disability in Alzheimers disease (AD) patients through the International Classification of Functioning, Disability and Health (ICF). Method. Twenty-six AD patients at different stages of disease participated in the study. Mini Mental State Examination (MMSE) and Global Deterioration Scale (GDS) were used to stage the degree of cognitive impairment and the stage of disease, respectively. All subjects were classified using the ICF categories in the more detailed four-level version. Correlation between compromised ICF items and both MMSE and GDS scores were calculated through Spearman Rho test. Results. Mental functions were impaired in all the subjects examined. Data on activity and participation showed that not only domestic life, self care, and mobility but also communication and interaction and social relationships are compromised in AD patients. Three main areas appeared as the most relevant facilitators: products and technology, support and relationship and services, systems and policies. ICF codes were generally correlated with both MMSE and GDS: subjects who appeared more compromised on MMSE and GDS showed higher impairment of functions, activity limitation, and participation restriction. Conclusion. ICF is a useful tool to describe health status in AD patients in that it underlines important aspects of daily living generally not considered by activity of daily living scales such as communication, social relationships, and recreation and leisure.

Dysphagia in head and neck cancer patients treated with radiotherapy and systemic therapies: Literature review and consensus.

BACKGROUND Head and neck cancer (HNC) and its therapy are associated with acute and late swallowing dysfunction. Consensus guidelines regarding evaluation and management are lacking. To address this gap, a multidisciplinary team of experts (oncologists, practitioners, deglutologists, etc.) met in Milan 17-18 February 2013 with the aim of reaching a consensus on the management of swallowing difficulties in HNC patients treated with radiotherapy with or without systemic therapies (such as chemotherapy and targeted agents). The consensus was focused particularly on those statements with limited evidence. The results of the literature review and the statements that obtained a consensus are reported and discussed in this paper. MATERIALS AND METHODS The Delphi Appropriateness Method was used for this consensus. External expert reviewers then evaluated the conclusions carefully according to their area of expertise. RESULTS This paper contains 6 clusters of statements about the management of swallowing problems in radio-treated HNC patients and a review of the recent literature on these topics. CONCLUSIONS Dysphagia assessment and its management are difficult and require a multi-team cooperation (ENT specialists, radiation and medical oncologists, deglutologists, etc.).

New Therapy for Orolaryngeal Manifestations of Crohn's Disease

Crohns disease is a chronic inflammation that may involve the entire gastrointestinal tract, from the mouth to the anus. The most widely accepted etiologic theory involves an immunologic aberration leading to local tissue destruction. Cell-mediated immunity with increased tumor necrosis factor (TNF) production may play a role in mucosal damage. Oral and laryngeal involvement are rare manifestations of Crohns disease that are usually treated successfully by steroids. We here report a rare case of extra-intestinal Crohns disease resistant to steroid therapy, which was successfully treated with infliximab, a chimeric antibody directed against TNF-α that is the only registered agent for the treatment of Crohns disease. The relative safety, efficacy, and efficiency of infliximab make it an alternative treatment of which otolaryngologists should be aware.

Supracricoid laryngectomy: Age influence on long-term functional results

Supracricoid laryngectomies (SCL) are conservative surgical techniques for the treatment of selected laryngeal carcinomas, currently adopted also in old patients. Long‐term functional results have not been reported in elderly patients. The aim of this study is to compare voice and swallowing in elderly and younger patients following SCL.