Barbara Crippa

Effects of Tonsillectomy on Speech and Voice

The aim of this study was to evaluate changes in acoustic features of speech after tonsillectomy and to establish concepts of patient management and rational therapeutic approach. Before and 1 month after surgery, phonetically balanced sentences and sustained vowels a, e, i were carried out and digitalized with Multi-Dimensional Voice Program (Kay Elemetrics, Lincoln Park, NJ) in all the patients, as an evaluation of nasal resonance, speech articulation, and voice handicap index (VHI). These parameters were estimated: average of fundamental frequency, Jitter percent, Shimmer, noise-to-harmonics ratio, voice turbulence index, soft phonation index, degree of voiceless, degree of voice breaks, and peak amplitude variation. Our data showed that 1 month after tonsillectomy, improvements in all the acoustic parameters, a subjective decrease of hypernasality, and an improvement of speech articulation and VHI were achieved. These data suggest the reduction of the nasal resonance and highlight the role of tonsillectomy in the improvement of voice and speech quality. Furthermore, tonsillectomy should be performed before consideration of pharyngeal flap surgery. Our results highlight that objective evaluation of speech and voice helps the specialist to improve patient management and avoid unnecessary and dangerous surgical procedures.

Sulphurous water inhalations in the prophylaxis of recurrent upper respiratory tract infections

OBJECTIVE The aim of this study was to evaluate the efficacy and the effect of sulphurous thermal water inhalations in the treatment of the recurrent upper respiratory tract (RURT) infections in children. METHODS A total of 100 children with RURT infections were included. All children underwent a 12-day course warm vapour inhalations. For the inhalations, we used sulphurous thermal water in the group A, while physiological solution in the group B. At the beginning, at the end and 3 months after start, all children underwent medical history, ENT examination, plasma levels of immunoglobulins class E, G, A, M (IgE, IgG, IgA, IgM), subjective assessment of symptoms (VAS), nasal mucociliar transport time (NMTT) determination, and evaluation of frequency, duration, severity and social impact of RURT episodes. RESULTS Compared with group B, after the treatment and at the end of the study, in children treated with sulphurous thermal water, the serum concentration of IgE was significantly (p<0.05) lower (75.13+/-27.1mg/dl vs 96.87+/-41.3mg/dl; 74.23+/-26.2mg/dl vs 98.24+/-42.7 mg/dl), IgA titers were higher (238.14+/-122.1mg/dl vs 218.62+/-115.8 mg/dl; 239.72+/-119.7 mg/dl vs 210.46+/-107.3mg/dl), serum concentrations of IgG and IgM unchanged, VAS scores presented a significant (p<0.05) improvement (1.8+/-0.19 vs 6.8+/-0.54; 1.9+/-0.21 vs 6.9+/-0.61), NMTT was normal (11.15+/-1.59 min vs 17.63+/-2.17; 11.25+/-2.10 min vs 17.77+/-2.19 min) and frequency, duration, severity and social impact of RURT episodes were significantly (p<0.05) lower. CONCLUSIONS Our findings indicate that, in addition to their known effects, the sulphurous water also have an immunomodulant activity that contributes to their therapeutic effects.

The impact of tonsillectomy with or without adenoidectomy on speech and voice

OBJECTIVES The aim of this study was to evaluate changes in acoustic features of speech and voice after tonsillectomy with or without adenoidectomy. METHODS Before and 1 month after surgery the following parameters were estimated: average of fundamental frequency (Fo), Jitter percent (Jitt), Shimmer, noise-to-harmonics ratio (NHR), voice turbulence index (VTI), soft phonation index (SPI), degree of voiceless (DUV), degree of voice breaks (DVB) and peak amplitude variation (vAm); as an evaluation of nasal resonance, speech articulation and voice handicap index (VHI). RESULTS The results were statistically evaluated using the unpaired t-test. Probability values below 0.05 were regarded as significant. One month after surgery, our data showed significant (P<0.05) improvements of the acoustic and other parameters in the children submitted to adenotonsillectomy: Fo (176Hz vs. 206Hz, after sustained vowels: 206Hz vs. 192Hz; 148Hz vs. 168Hz; 171Hz vs. 161Hz after balanced sentences), Jitt (0.85% vs. 1.81% to 0.82% vs. 1.81%), Shimmer (3.41% vs. 5.81% to 4.89% vs. 5.73%), NHR (0.16 vs. 0.42 to 0.29 vs. 0.39), VTI (0.05 vs. 0.38 to 0.28 vs. 0.37), SPI (14.78 vs. 21.14-19.89 vs. 21.89), DUV (0% vs. 0.44% to 0% vs. 0.48%), DVB (0% vs. 0.42% to 0% vs. 0.42%) and vAm (8.93% vs. 23.89% to 8.89% vs. 24.25%). CONCLUSIONS The results suggest the role of adenotonsillectomy in the improvement of voice and speech quality and of objective evaluation of speech and voice in the correct management of these children.

Effects of Piezosurgery on the cochlear outer hair cells.

Conclusions. The absence of audiologic side effects highlights the reduced trauma of the piezoelectric cut, demonstrates the superiority of the Piezosurgery® device in terms of safety and protection of anatomical structures and confirms its applicability in all the otologic techniques tested. Objectives. The aim of the present study was to estimate the effect of Piezosurgery® on the cochlea and in particular on the cochlear outer hair cells. Patients and methods. We selected 60 patients with a history of otologic surgery with Piezosurgery®. Before and 6 months after surgery, all the patients underwent the following instrumental examinations: pure-tone audiometry, tympanometry, transient evoked otoacoustic emissions (TEOAEs), distortion product otoacoustic emissions (DPOAEs) and auditory brainstem response (ABR). Results. Piezosurgery® showed its safety on the inner ear and in particular on the cochlear outer hair cells: for each instrumental examination (pure-tone audiometry, tympanometry, TEOAE, DPOAEs and ABR), no patients presented postoperative worsening.

A new method for osteotomies in oncologic nasal surgery: Piezosurgery.

OBJECTIVE Piezosurgery is a recently developed system for cutting bone without necrosis and nonmineralized tissues damage. The aim of this work has been to test Piezosurgery as a new bony scalpel in nasal surgery. METHODS In this nonrandomized study, we have performed Piezosurgery in the excision of malignant nasal tumors through a paralateronasal approach. We have used Piezosurgery on 10 patients affected by nasal adenocarcinoma. The piezoelectric device uses low-frequency ultrasonic waves (24.7-29.5 kHz); the applied power can be modulated between 2.8 and 16 W and is programmed in accordance to the density of the bone. The equipment consists of 2 hand pieces, 2 inserts, and 2 peristaltic pumps; the microvibrations that are created in the piezoelectric hand piece cause the inserts to vibrate linearly between 60 and 210 mum. RESULTS In all the patients, Piezosurgery provided excellent control without bleeding and harming effects on the adjacent structures. No patients experienced adverse effects. CONCLUSION Piezosurgery is a new and revolutionary osteotomy technique using the microvibrations of scalpels at ultrasonic frequency, so that soft tissue will not be damaged even upon accidental contact with the cutting tip. The safety of Piezosurgery as regards soft tissues was confirmed. No adverse effects were detected during unintentional contact with the tumor, nerve, vessel, and mucoperiosteum; this renders the piezoelectric device ideal for this application.

Piezosurgery in the cochleostomy through multiple middle ear approaches.

OBJECTIVE Piezosurgery is a new instrument which is able to cut the bone without necrosis and non-mineralized tissues damage. The aim of this work has been to test Piezosurgery as a new and alternative method in cochleostomy. METHODS We have performed Piezosurgery on nine temporal bone specimens from voluntary bone donors. Piezosurgery was used in the mastoidectomy with posterior tympanotomy approach (three specimens), suprameatal approach (three specimens) and combined approach (three specimens). The piezoelectric device uses low frequency ultrasonic waves (24.7-29.5 kHz), the applied power can be modulated between 2.8 and 16 W, and is programmed in accordance to the density of the bone. The equipment consists of two handpieces, two inserts and two peristaltic pumps: the microvibrations that are created in the piezoelectric handpiece cause the inserts to vibrate linearly between 60 and 210 microm. RESULTS In all the specimens, Piezosurgery provided excellent control without side effects on the adjacent structures of the middle and inner ear. CONCLUSIONS Piezosurgery is a new and revolutionary osteotomy technique utilizing the microvibrations of scalpels at ultrasonic frequency, so that soft tissue will not be damaged even upon accidental contact with the cutting tip. The vibration frequency of Piezosurgery is optimal for mineralized tissue and does not cut the adjacent soft tissue, minimizing the risk of harming the adjacent tissues: this renders the piezoelectric device ideal for cochlear implantation in children with ossified, partial ossified cochlea and/or malformation of ear.

Restoration of immune-mediated sensorineural hearing loss with sodium enoxaparin: a case report.

The aim of the study was to assess the efficacy of sodium enoxaparin in the treatment of autoimmune sensorineural hearing loss. A small number of patients with unilateral sensorineural hearing loss were selected and divided randomly into two numerically equal groups (groups A and B) if they fulfilled the inclusion criteria, i.e. being between 20 and 65 years of age, had been affected by systemic lupus erythematosus, had presented with a hearing loss of at least 30 dB of audibility threshold involving the medium frequencies (2000-4000 Hz), and had provided informed consent. Group A received sodium enoxaparin while group B (control) received placebo. In group A, all patients except one showed an improvement in hearing after sodium enoxaparin treatment. In group B, no patients showed an improvement in auditory function. In conclusion, our results underline the important role of sodium enoxaparin in the therapeutic management of this disease. The low number of patients suggests that further studies are required to confirm this initial data but this study suggests that sodium enoxaparin provides encouraging results in the treatment of autoimmune sensorineural hearing loss.

Electronystagmography in migraine equivalent syndrome

Objectives: The aim of the study was to determine the efficacy of electronystagmography testing in the diagnosis of vertigo in children with migraine equivalent syndrome. Study Design: The investigation included 20 children with “migraine equivalent syndrome” (group A), characterized by benign paroxysmal vertigo of childhood. As a control group, 50 healthy children were identified. Subjects and Methods: All the subjects underwent rotatory vestibular stimulation by stop test, optokinetic stimulation, and simultaneous postrotatory vestibular and optokinetic stimulations (VVOR). Results: For the analysis of the results, we considered nystagmus mean gain and direction of visual-vestibular-ocular-reflex (VVOR) nystagmus. In group A, all the children presented a VVOR nystagmus homodirectional to vestibular-ocular reflex (VOR). In the control group, all the subjects presented a VVOR nystagmus homodirectional to optokinetic nystagmus (OKN). Conclusion: In the healthy patients, VVOR nystagmus is always homodirectional to OKN and indicates the optokinetic system prevalence on VOR. The presence of a VVOR nystagmus homodirectional to VOR indicates the absence of the optokinetic system prevalence due to a central nervous system (CNS) modification and highlights a CNS disease. Our data highlight a possible correlation between CNS disorders and migraine equivalent syndrome.

Acoustic features of voice in patients with severe hearing loss

OBJECTIVE The aim of this study was to evaluate changes in the acoustic features of voice in patients with sensorineural hearing loss. DESIGN Thirty male patients, between 35 and 53 years of age with postlingual bilateral symmetric severe sensorineural hearing loss, were included (group A). As a control group (group B), 30 normal-hearing male adults, aged 38 to 51 years, were identified. SETTING ENT Department, University of Genoa (Italy). METHODS Phonetically balanced sentences and sustained vowels a, e, and i were digitally recorded with the Multidimensional Voice Program (Kay Elemetrics) in all subjects. MAIN OUTCOME MEASURES The parameters estimated were the average of fundamental frequency (F0), jitter percent (jitter), shimmer, noise to harmonics ratio (NHR), voice turbulence index (VTI), soft phonation index (SPI), degree of voicelessness (DUV), degree of voice breaks (DVB), and peak amplitude variation (vAm). RESULTS Compared to the control group, in group A, the following acoustic parameters presented a statistically significantly higher value (p < .05) of F0 (137.2 Hz vs 120.0 Hz), jitter (1.93% vs 0.67%), shimmer (6.67% vs 3.81%), NHR (0.19 vs 0.10), SPI (12.9 vs 8.76), DVB (2.12% vs 0.01%), DUV (9.53% vs 0.51%), and vAm (23.12 % vs 12.06%). In group A, F0 was also significantly higher in the balanced sentences (126 Hz vs 111 Hz). CONCLUSIONS This study demonstrates that hearing loss affects voice production by changing its parameters, especially in subjects with marked hearing loss.

Computerized voice therapy in hypofunctional dysphonia

OBJECTIVE The aim of this study was to analyze the efficiency and applicability of the Kay CSL 4500 system with the Sona-Speech II software model 3650 (Kay Pentax, Lincoln Park, NJ) in the voice therapy of patients affected by hypofunctional dysphonia. DESIGN The study evaluated the effect of visual biofeedback, obtained with the Sona-Speech II software, on dysphonia associated with hypofunction dysphonia. SETTING The study was conducted with 40 male adults affected by hypofunctional dysphonia in the Otolaryngology Department of the University of Genoa (Italy) between April 2008 and April 2009. METHODS Before, at the end of, and 3 months after voice therapy, all subjects underwent an otolaryngology visit, videostroboscopy, and voice analysis through the Multi-Dimensional Voice Program (Kay Elemetrics, Lincoln Park, NJ) as an evaluation of nasal resonance and the Voice Handicap Index (VHI). Each cycle of rehabilitation was characterized by 30 daily consecutive sessions, each for 25 minutes. During each session, the patient was asked to perform specific computer exercises. MAIN OUTCOME MEASURES The following acoustic parameters were estimated: average of fundamental frequency, percentage of jitter, shimmer, noise to harmonics ratio, voice turbulence index, soft phonation index, degree of voicelessness, degree of voice breaks, and peak amplitude variation. RESULTS Our data showed significant (p < .05) improvements in acoustic and other parameters in the patients submitted to voice therapy. CONCLUSIONS Our preliminary results suggest the applicability and efficiency of the Kay CSL 4500 system in association with the Sona-Speech II software model 3650 in a voice therapy program.