Gustavo Polacow Korn

Proposta de um método prático de sialometria

Introducao: A xerostomia e uma queixa subjetiva que pode ou nao estar relacionada a diminuicao da salivacao. Deve, porem, ser sempre investigada, pois esta frequentemente associada a doencas sistemicas, incluindo a sindrome de Sjogren. Apesar de nao haver padrao universal que caracterize a hipossalivacao, consideramos a sialometria importante para avaliacao do tratamento, atraves da realizacao de exames seriados em um mesmo paciente. Analisando as tecnicas de sialometria ja descritas, optamos por adaptar e padronizar o metodo de Bolwig e Rafaelsen (1972) por considera-lo o mais pratico e fidedigno e visando a partir de entao a sua utilizacao em larga escala. Objetivo: Avaliar os resultados de metodo submultiplo de sialometria. Material e metodo: Foram avaliados 10 sujeitos, 5 sem sintomatologia de xerostomia que formam considerados compativeis e 5 com xerostomia. Foram submetidos ao metodo de sialometria com algodao pre e pos estimulados. Os resultados foram comprovados. Resultados: Todos os pacientes apresentaram melhora da saliva mensuravel pelo metodo pos-estimulado. Conclusoes: O metodo utilizado se mostrou de facil realizacao e fidedigno.

Reabilitação vestibular personalizada: levantamento de prontuários dos pacientes atendidos no ambulatório de otoneurologia da I.S.C.M.S.P.

The objective of this research study was to verify the efficiency of the personalized vestibular rehabilitation (PVR) in different otoneurologic clinical diseases, as well as set the best protocol option in each case. STUDY DESIGN: clinical retrospective. MATERIAL AND METHOD: A retrospective study was conducted based on the description of the vestibular rehabilitation program of 37 patients aged 21 to 87 years, twenty-six females and eleven males, with different clinical diseases seen in the Otoneurologic Ambulatory of Otolaryngology, department of Irmandade da Santa Casa de Misericordia de Sao Paulo, from 2002 to 2003. Those patients went through otoneurologic evaluation and after diagnosis they were referred to vestibular rehabilitation. Each patient followed a specific program based on diagnosis, clinical disease and symptoms. We performed an individual analysis of the evaluation of each patient and group analysis in order to verify the efficiency of the PVR. CONCLUSION: It was possible to conclude that the PVR program is an effective resource in the treatment of otoneurologic symptoms of patients, consequently improving their quality of life.

Repeated Epley’s maneuver in the same session in benign positional paroxysmal vertigo

AIM To assess whether more than one Epleys maneuver in the same session, compared to a single one, decreases the number of sessions necessary to suppress positional nystagmus. METHODS Epleys maneuver was done in 123 patients with BPPV due to unilateral posterior semicircular canal canalolithiasis. The number of sessions for positional nystagmus suppression was compared in two groups of patients. Group I consisted of 75 patients submitted to a single Epleys maneuver on weekly sessions and group II consisted of 48 patients that were submitted to four Epleys maneuvers during the first session. RESULTS Group II showed greater nystagmus latency and duration than group I (p<0.05). The number of sessions and standard deviation showed by group I was greater than in group II (p=0.008). We observed a significant association between number of sessions and group (p=0.039) studied. Group II had 21.4% more nystagmus-free patients following only one session (CI95% [7.7% - 35.1%]). CONCLUSION Repeated Epleys maneuvers in less sessions rendered more positional nystagmus-free patients when compared to those submitted to more sessions of single maneuvers.

Concentration of Hyaluronic Acid in Human Vocal Folds in Young and Old Subjects

Objective. To compare and evaluate concentrations of hyaluronic acid (HA) in normal vocal folds of both young and elderly people of both sexes. Study Design. Experimental study. Setting. The research was carried out at the ENT, Head and Neck Surgery Department and the Pharmacology Institute of São Paulo Federal University. Subjects and Methods. Enzyme-linked immunosorbent assay plates coated with biotin-conjugated binding protein and streptavidin-europium conjugate were sequentially incubated with samples from the middle portion of the cover, vocal ligament, and vocal muscle of 19 young and 20 elderly subjects of both sexes. After the release of europium in an enhancement solution, final fluorescence was measured using a fluorometer. Results. Statistically significant comparisons: (1) all subject groups combined exhibited a higher HA concentration in the cover and ligament compared with the muscle samples; (2) women subjects had a significantly lower HA concentration in muscle compared with the ligament, and male subjects showed significantly lower HA in muscle compared with the cover; and (3) both genders of young subjects showed a higher HA concentration in ligament samples compared with the muscle. Conclusion. HA concentrations are higher in the cover and ligament compared with the muscle in both genders and age groups, and there is a higher HA concentration in ligament compared with the muscle of young subjects of both genders. HA levels in the cover samples of younger women showed great variability that may relate to ovarian hormone levels, reflecting different phases of the menstrual cycle.

Dysphonia Severity Degree and Phonation Onset Latency in Laryngeal Adductor Dystonia

Although the latency between the initiation of thyroarytenoid electrical activity and the onset of phonation generally is increased in patients with adductor laryngeal dystonia, there is disagreement about whether there is overlap of latency values in these patients and normal subjects. The goal of this article was to compare the severity of dysphonia with the latency between electrophysiological activation of the thyroarytenoid muscle (TA) and the onset of phonation in patients with adductor laryngeal dystonia and compare the values with normal controls. Twenty-one patients with adductor dystonia and 15 control patients underwent laryngeal electromyographic (EMG) examination of the left TA. We measured the latency from initiation spike of the electric activity of the TA muscle to the onset of phonation. Three speech-pathologists/voice specialists arrived at a consensus to rate the perceptual evaluation of voice quality for the study group. The average latency measured for patients with mild dysphonia was 332 milliseconds, for moderate dysphonia was 426 milliseconds, and for the severe dysphonia was 792 milliseconds. We used the Spearmans correlation test to compare the latency time values and the dysphonias degree of severity (P<0.05). Latency was significantly and directly related to the degree of severity of dysphonia.

Posttraumatic facial nerve regeneration in rabbits

UNLABELLED Posttraumatic facial paralysis is a frequent disease. This work studies posttraumatic regeneration of the facial nerve in rabbits. Functional and histological analysis compared injured and normal nerves on opposite sides. The left facial nerve trunk of twenty rabbits were subjected to compression lesion, and sacrificed after two (subgroup AL), four (BL) and six (CL) weeks. Comparison between groups was made by analysing total and partial densities of myelinated axons. STATISTICAL ANALYSIS Tukey Method (p<0.05). RESULTS There was partial functional recovery after two weeks, and complete recovery after five weeks. Qualitative analysis demonstrated a degenerative pattern in the AL group, with an increased tissue inflammatory process. Evident regeneration signs were observed in the BL group, and almost complete regeneration was seen in the CL group. Normal nerves (N) had an average TD of 15705.59 and average PD of 21800.75. The BL group had an average TD of 10818.55 and an average PD of 15340.56. The CL group had an average TD of 13920.36 and an average PD of 16589.15. The BL group had an average TD of N equal to 68.88%, and the CL group had an average TD of N equal to 88,63% (statistically significant). N showed a significant higher PD than injured nerves. However, this was not statistically different between BL and CL subgroups. Nerve DT was a more reliable method than PD in this study.

Personalized vestibular rehabilitation: medical chart survey with patients seen at the ambulatory of otoneurology of I.S.C.M.S.P.

UNLABELLED The objective of this research study was to verify the efficiency of the personalized vestibular rehabilitation (PVR) in different otoneurologic clinical diseases, as well as set the best protocol option in each case. STUDY DESIGN Clinical retrospective. MATERIAL AND METHOD A retrospective study was conducted based on the description of the vestibular rehabilitation program of 37 patients aged 21 to 87 years, twenty-six females and eleven males, with different clinical diseases seen in the Otoneurologic Ambulatory of Otolaryngology, department of Irmandade da Santa Casa de Misericórdia de Sao Paulo, from 2002 to 2003. Those patients went through otoneurologic evaluation and after diagnosis they were referred to vestibular rehabilitation. Each patient followed a specific program based on diagnosis, clinical disease and symptoms. We performed an individual analysis of the evaluation of each patient and group analysis in order to verify the efficiency of the PVR. CONCLUSION It was possible to conclude that the PVR program is an effective resource in the treatment of otoneurologic symptoms of patients, consequently improving their quality of life.

Regeneração pós-traumática do nervo facial em coelhos

Posttraumatic facial paralysis is a frequent disease. This work studies posttraumatic regeneration of the facial nerve in rabbits. Functional and histological analysis compared injured and normal nerves on opposite sides. The left facial nerve trunk of twenty rabbits were subjectedto compression lesion, and sacrificed after two (subgroup AL), four (BL) and six (CL) weeks. Comparison between groups was made by analysing total and partial densities of myelinated axons. STATISTICAL ANALYSIS: Tukey Method (p<0.05). RESULTS:There was partial functional recovery after two weeks, and complete recovery after five weeks. Qualitative analysis demonstrated a degenerative pattern in the AL group, with an increased tissue inflammatory process. Evident regeneration signs were observed in the BL group, and almost complete regeneration was seen in the CL group. Normal nerves (N) had an average TD of 15705.59 and average PD of 21800.75. The BL group had an average TD of 10818.55 and an average PD of 15340.56. The CL group had an average TD of 13920.36 and an average PD of 16589.15. The BL group had an average TD of N equal to 68.88%, and the CL group had an average TD of N equal to 88,63% (statistically significant). N showed a significant higher PD than injured nerves. However, this was not statistically different between BL and CL subgroups. Nerve DT was a more reliable method than PD in this study.

Correlaçäo entre o grau de xerostomia e o resultado da sialometria em pacientes com Síndrome de Sjögren

Introduction: Xerostomia, a subjective dry mouth feeling, may be associated to several diseases and systemic disorders incluiding Sjogren syndrome. Study design: Clinical prospective. Material and method: We conducted an eight Sjogren syndrome patients study with xerostomia complains. They were asked to answer a group of questions related to commonly xerostomia signs and symptoms and had, in addition, a sialometry performed in order to assess wether any correlation could be found between both kinds of observations. Results: In spite of variable degrees of oral symptoms present in all eight patients, saliva flow decrease could only be documented in three. Conclusion: Therefore, in our observation, no correlation could be found between oral symptoms magnitude and amount of saliva secreted in Sjogren patients.

Perceptual-auditory and Acoustic Analysis of Air Traffic Controllers' Voices Pre- and Postshift

OBJECTIVE To characterize the vocal quality and acoustic parameters of voices of air traffic controllers (ATCs) without any vocal complaints before and after a shift. METHOD The voices of a group of 45 ATCs were recorded before and after a 2-hour shift, regardless of their operational position or number of previously worked shifts; both genders were included, participants had a mean age of 25 years, and they had a mean length of occupational experience of 4 years and 2 months. Each of these professionals was recorded phonating a sustained /a/ vowel and counting from 1 to 20, and the recordings were acoustically analyzed using the Praat software. A perceptual-auditory analysis of the recordings was then performed by three speech therapists specializing in voice, who evaluated the characteristics of each emission using a visual analog scale (VAS). The acoustic analysis was performed on the sustained /a/ vowel. The measures of intensity; frequency; maximum phonation time (MPT); and the first, second, third, and fourth formants were considered in this analysis. RESULTS There were no significant differences between the random pre- and postshift samples, either in the acoustic or in the perceptual-auditory analysis. The perceptual-auditory analysis revealed that 44% (n = 20) of ATCs showed alterations in vocal quality during the sustained /a/ vowel emission, and this dysphonia was also observed in connected speech in 25% (n = 5) of this group. CONCLUSION Perceptual-auditory analysis of the /a/ vowel revealed that a high percentage of ATCs had vocal alterations (44%), even among a group of subjects without vocal complaints.