Juan Pablo Díaz-Molina

El espectrograma de banda estrecha como ayuda para el aprendizaje del método GRABS de análisis perceptual de la disfonía

INTRODUCTION Perceptual evaluation of voice quality remains a key standard for judgment of vocal impairment. The GRABS method has become a commonly-used scale for rating severity of dysphonia, but it has no published, standardised protocol to follow. Training is important for reaching good interrater agreement for its parameters; however, the references most often cited for the GRABS provide no guidelines for clinical administration, speech material or rating calibration. This study investigated the effect of anchors (standard reference voices) and visible speech (narrow band spectrogram) in training non-expert professionals in the GRABS method. MATERIAL & METHODS Four inexperienced listeners evaluated 107 recorded pathological voices using the GRABS scale in 2 separate sessions; at first, without a visible spectrogram and then, 6 months later, with anchors and a narrow band spectrogram as additional information. RESULTS The results show that anchors and visible speech helped to improve the reliability of G, B, A and S parameters. Interrater agreement according to k statistics was significantly stronger with the addition of spectrographic information for rating breathiness and strain. DISCUSSION This study found that non-expert listeners showed significant improvement after training with external anchors (standard reference voices) and a narrow band spectrogram.

Oncological Results After Surgical Treatment of Squamous Cell Cancer of the Lateral Wall of the Oropharynx

The gold standard of treatment of cancer of the lateral wall of the oropharynx continues to be unclear, especially in advanced stages. In this study, we report our experience with surgical treatment of these cancers and describe the functional and oncological results of the procedures.

Tratamiento quirúrgico de los condrosarcomas de cabeza y cuello

INTRODUCTION Head and neck chondrosarcomas may adopt different locations and biological behaviour. MATERIAL AND METHOD We present a retrospective clinical series of 17 chondrosarcomas surgically treated in our Department from 1977 until 2006. RESULTS Chondrosarcomas were located in the nasosinusal area (n=6), larynx (n=5), petrous bone (n=3), atlas (n=1), parapharyngeal space (n=1) and trachea (n=1). All patients except for one underwent surgery with radical intention. The mean follow-up period was 84 months (median, 71 months). Six patients developed recurrent disease with a mean latency of 10 months. Two patients died due to the disease and two remained alive with evidence of tumour. Patients with grade I chondrosarcomas presented less recurrent disease than those with grade II or III chondrosarcomas (17% versus 80%, P=0.029). The estimated 5-year survival was 88% with the better survival of patients with grade I chondrosarcomas reaching statistical significance (P=0.023). In 2 patients with cricoid chondrosarcomas, the reconstruction was carried out using the Rethi-Ward technique, and they were without evidence of disease at 71 months (with no cannula) and 145 months (with cannula). Chondrosarcomas of the jugular foramen were treated using a modified infratemporal type A approach. CONCLUSION Low grade head and neck chondrosarcomas have a good prognosis while high grade chondrosarcomas tend to recur, despite radical surgical treatment.

Baroreceptor failure after bilateral resection of carotid artery paragangliomas

Abstract Multiple head and neck paragangliomas are unusual pathologies. We report a case of a 24-year-old patient operated on at our centre for bilateral carotid artery paragangliomas who developed baroreceptor failure after their resection. Although this is an infrequent complication, it is important to be aware of it in order to ensure speedy diagnosis and treatment so as to avoid major post-surgical complications.

Resultados oncológicos y funcionales del tratamiento no quirúrgico comparado con el quirúrgico en los carcinomas epidermoides de orofaringe

INTRODUCTION AND OBJECTIVES Squamous cell carcinomas of the oropharynx are aggressive tumours usually diagnosed at advanced stage. Their optimal treatment has not been established. The aim of this study was to compare the oncological and functional outcomes in patients with carcinomas of the oropharynx treated by radiotherapy (with chemotherapy in advanced stages) vs surgery (with radiotherapy in advanced stages). METHODS A retrospective study on 50 patients with squamous cell cancer of the oropharynx treated by radiotherapy (with or without chemotherapy) at our institution between 1998 and 2008 was carried out. The oncological and functional results were compared with patients with same cancer location and stage treated by surgery (with or without radiotherapy). In both groups, the patients were classified as follows: 10% Stage I, 12% Stage II, 16% Stage III, 48% Stage IVa and 14% Stage IVb. RESULTS The 5-year disease-specific survival was 33% in the radiotherapy group and 52% in the surgical group (P=.17). Five-year disease-specific survival for Stage I and II patients was 82% in the radiotherapy group and 70% in the surgical group. In Stage III and IV disease, 5-year disease-specific survival was higher in the surgical group (47% vs 17%). The functional results were similar; anatomical and functional preservation of the larynx was higher in the radiotherapy group but the successful return to oral food intake was higher in the surgical group. CONCLUSIONS The prognosis of squamous cell carcinoma of the oropharynx is poor. Oncological results in Stages I and II were similar for radiotherapy and surgical treatments. In advanced stages, the prognosis was better in patients treated by surgery with or without radiotherapy. Functional results were similar in both treatment modalities.

Oncologic and functional results after transhyoid surgical approach for cancer of the base of tongue

The optimal treatment for base of tongue cancer remains unclear, especially in advanced stages.

Fallo barorreceptor tras la resección bilateral de paragangliomas carotídeos

Multiple head and neck parangliomas are unusual pathologies. We report a case of a 24-year-old patient operated on at our centre for bilateral carotid artery parangliomas who developed baroreceptor failure after their resection. Albeit an infrequent complication, it is important to be aware of it in order to ensure is speedy diagnosis and treatment so as to avoid major post-surgical complications.

Voice outcomes after laser cordectomy

Early glottic carcinoma can be treated using endoscopic surgery, radiotherapy, or partial open surgery. Lesions limited to the vocal fold are normally treated with endoscopic surgery or partial open surgery, with local control results between 80% and 90%. The choice of one treatment over another should contemplate the cure rate, larynx preservation rate, post-treatment voice quality, morbidity, and treatment cost. Although both external beam radiotherapy and endoscopic carbon dioxide laser excision of early glottic cancer will affect voice quality, it is difficult to compare them. A complete voice assessment including perceptual, objective, and subjective evaluation is mandatory whenever a meaningful analysis of the pathological voice is to be accomplished. Meta-analyses of the results of voice treatments are generally limited and may even be impossible owing to the major diversity in the ways functional outcomes are assessed. The postsurgical voice outcome depends upon having a straight postoperative vocal fold for glottic closure and intact vibration from the contralateral vocal fold. Subepithelial and subligamental cordectomies are oncologically safe resections and have a quality of voice comparable to that of controls. By contrast, with wider resections (types III-V cordectomies), a concave neocord may form resulting in an aerodynamic glottic incompetence. In order to select the most appropriate treatment modality according to the patients age, gender, compliance, and professional activity, a detailed preoperative counseling concerning vocal outcome is recommended. After phonosurgical resection, patients who have lost paraglottic musculature may benefit from medialization and augmentation procedures to re-establish glottic competence.