Lucia D'Alatri

Long-term outcome of functional post-thyroidectomy voice and swallowing symptoms.

BACKGROUND Voice and swallowing symptoms are frequently reported early after thyroidectomy even in the absence of laryngeal nerves injury. We evaluated the short-term and long-term outcomes of these functional alterations. METHODS Consenting patients undergoing total thyroidectomy (TT) were enrolled. Videolaryngostroboscopy (VSL), acoustic voice analysis (AVA), and maximum phonation time (MPT) were performed pre-operatively, 3 months postoperatively, and >1 year postoperatively. Subjective evaluation of voice (Voice Impairment Score=VIS) and swallowing (Swallowing Impairment Score=SIS) were obtained pre-operatively, as well as 1 week, 1 month, 3 months, and >1 year postoperatively. RESULTS The long-term evaluation was completed in 110 patients. The percentage of patients with symptoms 1 week after operation was significantly higher than preoperatively, whereas it was significantly lower at long-term evaluation. VIS was significantly worse than pre-operatively, 1 week, 1 month, and 3 months after surgery, but it was similar to pre-operative >1 year after TT. SIS was significantly worse 1 week after thyroidectomy but not 1 month and 3 months after thyroidectomy, and it was significantly lower than the pre-operative >1 year after TT. CONCLUSION Vocal and swallowing symptoms are frequent after TT. In the absence of laryngeal nerve injury, after an initial impairment, late after operation, patients experienced subjective amelioration of their voice and swallowing performances, which may be related to the resolution of compressive symptoms.

Multidisciplinary Approach in the Treatment of T1 Glottic Cancer The Role of Patient Preference in a Homogenous Patient Population

AbstractBackground and Purpose:To compare oncological outcome and voice quality among a uniform and well-defined subset of patients with T1 glottic carcinoma.Patients and Methods:Patients, affected by laryngeal glottic carcinoma, treated by laser CO2 surgery or radiotherapy, have been analyzed. Overall survival and disease-free survival were calculated. In order to verify differences in functional outcomes and voice quality, all patients were interviewed during their last follow-up visit during 2009 using the VHI (Voice Handicap Index) questionnaire. The data were analyzed using the MedCalc software.Results:A total of 143 patients were analyzed: 73 underwent surgery and 70 underwent radiotherapy. No statistically significant differences were found between the two groups in terms of overall survival and disease-free survival; dividing patients into stages T1a and T1b also made no difference. In order to evaluate the differences in outcomes for surgery and radiotherapy, patients were interviewed using the VHI questionnaire. Better scores for each category in the VHI were found for patients receiving radiotherapy compared to surgery (physical: p = 0.0023; functional: p < 0.0001; environmental: p < 0.001). The median VHI score for radiotherapy patients was 4, while for surgical patients it was 18 (p < 0.0001).Conclusion:This study confirms the well-known knowledge that results from radiotherapy and surgery in early glottic cancer treatment are equivalent. Furthermore, the role of patient preference in the treatment modality choice and the value of a multidisciplinary approach for a detailed and multi-oriented discussion with the patient are outlined.ZusammenfassungHintergrund und Zielsetzung:Es sollen das onkologische Ergebnis und die Sprachqualität in einer homogenen und gut definierten Gruppe von Patienten mit T1-Stimmbandkarzinomen verglichen werden.Patienten und Methoden:Patienten mit einem Glottiskarzinom, die sich einer CO2-Laser-Operation oder einer Radiotherapie unterzogen hatten, wurden analysiert. Das Gesamtüberleben und die krankheitsfreie Zeit wurden errechnet. Um Unterschiede im funktionellen Ergebnis und bezüglich der Sprachqualität zu quantifizieren, wurden alle Patienten während der letzten Nachsorge im Jahre 2009 dazu angehalten den VHI-(Voice Handicap Index-)Fragebogen auszufüllen. Diese Daten wurden mittels der MedCalc-Software bearbeitet.Ergebnisse:Insgesamt wurden 143 Patienten untersucht: 73 wurden operiert und 70 erhielten eine Strahelentherapie. Es konnte kein statistisch signifikanter Unterschied zwischen den zwei Gruppen bezüglich der Gesamtüberlebenszeit und der krankheitsfreien Zeit festgestellt werden; dies gelang auch nicht, wenn die Gruppen in Stadium T1a und T1b getrennt betrachtet wurden. Um die Unteschiede zwischen Operation und Radiotherapie zu evaluieren, wurde der VHI-Fragebogen verwendet. Es ließ sich zeigen, dass in jeder Kategorie des VHI-Fragebogens die Patienten, die strahlentherapiert wurden, bessere Ergebnisse erzielten als jene, die operiert wurden („physikalisch“: p = 0,0023; „funktionell“: p < 0,0001). Der durchschnittliche VHI-Score für strahlentherapierte Patienten ist 4, im Gegensatz zu 18 für operierte Patienten (p < 0,0001).Zusammenfassung:Diese Studie bestätigt die Erkenntnis, dass Radiotherapie und Operation beim Stimmbandkarzinom im frühen Stadium zu äquivalenten Ergebnissen führen. Weiterhin wird die Bedeutung des Patientenwunsches im Hinblick auf die Therapieoptionen und die Bedeutung eines multidiszplinären Therapieansatzes belegt.

Postoperative dysphagia versus neurogenic dysphagia: scintigraphic assessment.

In order to differentiate the features of dysphagia that occur after supraglottic horizontal laryngectomy from those that occur during neurologic diseases, we divided 38 subjects into 3 groups and submitted them to oropharyngoesophageal scintigraphy. Group 1 (control group) included 15 healthy volunteeers; group 2 comprised 8 patients who had residual dysphagia at least 1 year after supraglottic laryngectomy; and group 3 included 15 patients with various neurologic and neuromuscular disorders. In group 1, the mean values (±2 SD) of selected semiquantitative parameters were consistent with those reported in the literature for normal subjects. In group 2, oral, pharyngeal, and esophageal transit times were not significantly altered, and moderate tracheobronchial postdeglutitive aspiration was present (maximum value, 6.7%; mean value, 2.04%). The pharyngeal retention index was significantly increased (p = .0003) as compared to normal subjects in all cases (maximum value, 40%; mean value, 23%) and was associated in all cases with slight but consistent postdeglutitive aspiration. In group 3, the oral and esophageal phases were significantly prolonged and the retention indices were significantly increased. Statistical analysis documented a significant increase in oral transit time (p = .003), esophageal transit time (p = .01), oral retention index (p = .006), pharyngeal retention index (p = .0007), and esophageal retention index (p = .009) as compared to normal subjects. The swallowing pattern was also altered by 1) an early loss of the bolus from the oral cavity; 2) bolus fragmentation due to double or triple deglutition, reduced lingual propulsion, or the return of a small part of the bolus into the oral cavity during deglutition; and/or 3) double pharyngeal peaks in the activity-time curves. Tracheobronchial aspiration (maximum value, 90%; mean value, 9.70%) was present in some cases, mainly in patients affected by post-stroke dysphagia. On the basis of the obtained results and considering the low doses of radiation delivered to the patient (0.043 Gy), the limited invasiveness, and the excellent patient tolerance, scintigraphy appears to be clinically valid in the functional study of swallowing and in identifying different deglutition disorders.

Auditory brainstem responses in the aged.

The auditory brainstem responses (ABR) in a group of 74 aged subjects (60-80 years), affected by presbycusis were evaluated for presence of a retrocochlear involvement. The comparison of results from subjects with presbycusis with those from normally-hearing elderly subjects, and young subjects, affected by a cochlear sloping hearing loss, revealed that the latency increase of ABR observed in presbycusis is mainly correlated to the audiometric shape of the hearing loss and not to age per se.

The External Ear and the Tympanic Membrane A Three-dimensional Study

The study of the anatomical variations of the external ear is important for the ear surgeon who assesses the middle ear in this way. Furthermore, the design of insert earmoulds for use with either hearing aids or portable radios requires a better knowledge of the shape of the external ear. We studied the external ear structures and the drumhead in 140 cadavers with no previous history of ear pathology. A silicone resin was used, employing a dental impression technique. These permanent impressions were analysed by means of an operating microscope. Different parameters were studied, to determine the average dimensions of the structures. The clinical significance of these results is discussed.

Scintigraphic monitoring of swallowing rehabilitation after horizontal supraglottic laryngectomy.

INTRODUCTION The resection of the top two sphincters of the upper airways represented by the epiglottis, the aryepiglottic folds, and the false vocal cords — better known as horizontal supraglottic laryngectomy (HSL) — is a well-established conservative surgical procedure in cases of supraglottic laryngeal cancer. Along with the oncological aspects, its functional success depends on the patients ability to resume physiologic respiration, phonation, and deglutition. However, normal respiratory and swallowing functions sometimes are hardly recovered after surgery, delaying decannulation and normal oral feeding.

Relationships between middle latency auditory responses (MLR) and speech discrimination tests in the elderly

74 subjects aged between 60 and 80 years underwent tonal audiometry, speech discrimination tests (phonetically balanced words, normal sentences and compressed sentences) and middle latency responses (MLRs) in order to evaluate possible correlations between behavioural and electrophysiological tests. The results showed that in elderly patients normal sentences are better understood than phonetically balanced words, that performances decrease dramatically when listening conditions became difficult, that auditory threshold seems to influence speech discrimination scores more than does age per se. MLRs seem to be unaffected both by age and by auditory threshold and Pa occurrence is a more reliable parameter than its latency. No correlation between speech discrimination tests and MLRs could be observed; on the contrary in the presence of abnormal speech discrimination tests the MLRs were almost normal and vice versa.

Tensor veli palatini electromyography for monitoring Eustachian tube rehabilitation in otitis media

BACKGROUND The pathogenesis of otitis media is related to Eustachian tube dysfunction. The tensor veli palatini muscle actively opens the Eustachian tube and promotes middle-ear ventilation. This study describes a technique for paratubal electromyography that uses a surface, non-invasive electrode able to record tensor veli palatini muscle activity during swallowing. METHODS Twenty otitis media patients and 10 healthy patients underwent tensor veli palatini electromyography. Activity of this muscle before and after Eustachian tube rehabilitation was also assessed. RESULTS In 78.5 per cent of patients, the electromyography duration phase and/or amplitude were reduced in the affected side. The muscle action potential was impaired in all patients who underwent Eustachian tube rehabilitation. CONCLUSION This study confirmed that Eustachian tube muscle dysfunction has a role in otitis media pathogenesis and showed that muscle activity increases after Eustachian tube rehabilitation therapy.

ENT function in a 14-days guinness scuba dive

Scuba diving is known to affect the rhino-pharyngo-tubaric district (RPT unit). The aim of the study was to document function modifications of the RPT unit in 6 Italian divers (3 men and 3 women) who lived for 14 days consecutively at a depth of 8-10 m, breathing air (21% oxygen) at a pressure ranging between 1.8 and 2 ATA. RPT and inner ear assessment were carried out before the dive (TIME 0) and 24 h (TIME 1) after resurfacing, in order to investigate diving-related RPT and inner ear alterations. Physical examination after resurfacing revealed: fungal external otitis, otoscopic findings consistent with middle ear barotraumas and rhinosinusitis. Rhino-manometry showed a remarkable increase in inspiratory nasal flow and a substantial decrease in nasal resistance. No epithelial cell disruption was retrieved comparing pre and post resurfacing samples. Post-diving tubaric dysfunction was found. Pure tone audiometry revealed a bilateral 40 dB HL hearing loss at 4 kHz in 1 diver. Relevant PTA functions did not seem to be affected by the experiment, no remarkable changes were found at the Sensory Organisation Test and at the Motor Control Test. The 14-day underwater period had a positive effect on nasal flows and resistances.

Music identification skills of children with specific language impairment

BACKGROUND To date very few studies have investigated the musical skills of children with specific language impairment (SLI). There is growing evidence that SLI affects areas other than language, and it is therefore reasonable to hypothesize that children with this disorder may have difficulties in perceiving musical stimuli appropriately. AIMS To compare melody and song identification skills in a group of children with SLI and in a control group of children with typical language development (TD); and to study possible correlations between music identification skills and language abilities in the SLI group. METHODS & PROCEDURES This is a prospective case control study. Two groups of children were enrolled: one meeting DSM-IV-TR(®) diagnostic criteria for SLI and the other comprising an age-matched group of children with TD. All children received a melody and a song identification test, together with a test battery assessing receptive and productive language abilities. OUTCOMES & RESULTS 30 children with SLI (mean age = 56 ± 9 months) and 23 with TD (mean age = 60 ± 10 months) were included. Melody and song identification scores among SLI children were significantly lower than those of TD children, and in both groups song identification scores were significantly higher than melody identification scores. Song identification skills bore a significant correlation to chronological age in both groups (TD: r = 0.529, p = 0.009; SLI: r = 0.506, p = 0.004). Whereas no other variables were found explaining the variability of melody or song identification scores in either group, the correlation between language comprehension and song identification in the SLI group approached significance (r = 0.166, p = 0.076). CONCLUSIONS & IMPLICATIONS The poorer music perception skills of SLI children as compared with TD ones suggests that SLI may also affect music perception. Therefore, training programmes that simultaneously stimulate via language and music may prove useful in the rehabilitation of children affected by SLI.