Charbel Rameh

Immediate post-operative vocal changes in patients using laryngeal mask airway versus endotracheal tube

OBJECTIVE AND HYPOTHESIS (1) To examine the vocal symptoms and acoustic changes perceived in the short period immediately after laryngeal mask airway, and (2) to compare these findings in patients using laryngeal mask airway and endotracheal tube. MATERIALS AND METHODS A total of 27 patients were enrolled. They were evaluated pre-operatively and then at 2 and 24 hours post-operatively. Patients were divided into two subgroups, laryngeal mask airway and endotracheal tube. Patients were asked about the presence or absence of the following: hoarseness, vocal fatigue, loss of voice, throat-clearing sensation, globus pharyngeus and throat pain. Patients then underwent acoustic analysis of their voice, measuring the average fundamental frequency, relative average perturbation, shimmer, noise to harmony ratio, voice turbulence index, habitual pitch and maximum phonation time. RESULTS In the laryngeal mask airway group, there was an increase in the incidence of all vocal symptoms two hours post-operatively, except for globus pharyngeus. The increase was statistically significant for vocal fatigue, loss of voice and throat pain. All the symptoms had reverted back to a normal baseline level by 24 hours. There was a decrease in the maximum phonation time and habitual pitch, with an increase in all the perturbation parameters, two hours post-operatively. At 24 hours, an increase was still present for shimmer, noise to harmony ratio and voice turbulence index. The maximum phonation time and habitual pitch reverted back to normal values. In the endotracheal tube group, there was a significant increase two hours post-operatively in the incidence of hoarseness, loss of voice and throat pain. At 24 hours, all the symptoms reverted to baseline, except for vocal fatigue and throat pain. Two hours post-operatively, there was a significant decrease in maximum phonation time and an increase in all other parameters (however, the latter was significant only for relative average perturbation and noise to harmony ratio). At 24 hours, there was a significant increase in the maximum phonation time and a persistent (but statistically insignificant) increase in the average fundamental frequency, habitual pitch, noise to harmony ratio and voice turbulence index. At two hours, there was more loss of voice and vocal fatigue in the laryngeal mask airway group, compared with the endotracheal tube group. At 24 hours, these symptoms were comparable in both groups. Comparing changes in acoustic parameters to baseline values in both groups, there were no statistically significant changes. CONCLUSION Shortly after reversal of anaesthesia, laryngeal symptoms following laryngeal mask airway are no less significant than those experienced following endotracheal tube anaesthesia. Both methods can be regarded as nontraumatic, in view of the lack of significant vocal symptoms and acoustic changes 24 hours after anaesthesia.

Recurrent facial nerve paralysis: an unusual presentation of fibrous dysplasia of the temporal bone

Facial nerve paralysis (FNP) is a rare occurrence in fibrous dysplasia (FD) of the temporal bone (FDTB). Eight such cases have been described in the literature. In none of these cases was the FNP the presenting symptom, and in all, a direct etiology for the paralysis was identified. We present the first case of recurrent, unilateral FNP as the sole otological manifestation of FDTB. We discuss possible etiological factors for the paralysis favoring a compressive, transient ischemia of the facial nerve. The authors suggest adding FDTB to the differential diagnosis of recurrent FNP.

Formant frequencies in Middle Eastern singers

PURPOSE This work was conducted to describe the formant frequencies in a group of Middle Eastern singers and to look for the presence of the singers formant described in operatic singers. MATERIAL A total of 13 Middle Eastern singers were enrolled in this study. There were 5 men and 8 women. METHOD Descriptive analysis was performed to report the various formants (F1, F2, F3, and F4) in both speaking and singing. The Wilcoxon test was used to compare the means of the formants under both conditions. RESULTS For both sexes combined, for the /a/ vowel, F1 singing was significantly lower than F1 speaking (P = .05) and F3 singing was significantly higher than F3 speaking (P = .046). For the /u/ vowel, only F2 singing was significantly higher than F2 speaking (P = .012). For the /i/ vowel, both F2 and F3 singing were significantly lower than F2 and F3 speaking, respectively (P = .006 and .012, respectively). There was no clustering of the formants in any of the Middle Eastern sung vowels. CONCLUSION Formant frequencies for the vowels /a/, /i/, and /u/ differ between Middle Eastern singing vs speaking. There is absence of the singers formant.

Brucella melitensis infection of a branchial cyst.

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Status of the remaining parotid duct and gland following superficial parotidectomy.

The changes in Stensen’s duct and remaining parotid tissue following superficial parotidectomy have not been studied previously. The aim of this clinical case control study is to describe these changes using sialography and CT-sialography techniques. Fourteen superficial parotidectomy cases underwent parotid sialography bilaterally. CT sialography was also done. Stensen’s duct was patent in 11 cases (79%), and non-patent in three cases (21%). Its angle in relation to our reference line was 20° in operated cases versus 37° for the non-operated cases. Following superficial parotidectomy, the remaining parotid tissues usually remain functional and retain drainage through Stensen’s duct. Furthermore, superficial parotidectomy changes the direction of this duct. Parotid sialography and CT sialography can still be used to study the status of remaining parotid tissue following superficial parotidectomy. The post-surgical changes should be reviewed with care before interpreting these studies.

Alterations In Immunity After Total vs Partial Tonsillectomy

Problem Palatine tonsils are secondary lymphoid organs active in sampling antigens entering the upper respiratory tract and in producing immunoglobulin (Ig) both locally and distally through migrating tonsillar B cells. Their size has been found to be directly proportional to the number of B and T cells. The aim of this study is to compare the change in serum and saliva Ig levels after total and partial tonsillectomy. Methods Children with obstructive tonsils and/or adenoid undergoing total or partial tonsillectomy were recruited in a pilot study. Patients with history of recurrent infections or immunodeficiency were excluded. Blood and saliva samples were obtained immediately preoperatively and at the 1st follow-up visit. Serum Igs (G,M&A) concentrations were determined using radial immunodiffusion. Saliva secretory IgA was measured using an Enzyme Immuoassay (EIA). Results Twenty five patients (13 partial and 12 total) were included. There were no statistically significant changes in serum Igs levels after total or partial tonsillectomy, except for IgM which increased (1.317 to 1.632 g/L) after partial tonsillectomy, more significantly in males, in those aged 5 years and older, and when the postoperative samples were taken within a 2 month-period. Moreover, there was statistically non-significant decrease in secretory IgA level after both total and partial tonsillectomy. Conclusion The effect of partial or total tonsillectomy on immunoglobulin level seems reassuring. The increase in IgM and the non-significant decrease in SIgA may represent a kind of immunological readjustment after tonsillar surgery. Significance This is the first study (to our knowledge) that compares the changes in immunoglobulin levels (in serum & saliva) after partial vs. total tonsillectomy. The obtained results are preliminary and are reassuring to the parents and physicians who have concerns regarding the immunological sequalae of tonsillectomy in children. A longer follow up will be done in a larger future study. Support This study was supported by Medtronic.