Luciano Rodrigues Neves

Questionário de auto-avaliação vocal: instrumento epidemiológico de controle da síndrome disfônica ocupacional em professores

INTRODUCTION: The dysphonic syndrome is an occupational disease of high prevalence in the professor population. OBJECTIVE: In order to broach preventively the vocal aggression, it was tried to standardize a self assessment questionnaire to professors of all educational level, including beyond the clinical symptoms also the factors of the work organization. METHOD: It was performed a study of transversal cut in 328 professors of 4 educational institutions of the northern of Sao Paulo, which it was applied a self assessment questionnaire elaborated by TRipartite Commission of Standardization for Professional Voice. RESULTS: It was determined the prevalence of clinical symptoms that compound the dysphonic syndrome, as well as it was delineate the work organization and the quality of life of this population. CONCLUSION: The questionnaire applied was showed itself satisfactory en the description and elaboration of parameters with the aim of to implement preventive programs to populations exposed to professional overload of the voice use. Case study.

Imunohistoquímica como método de estudo das fibras elásticas em prega vocal humana

AIM: Verify the use of immunohistochemistry as a method to measure all forms of elastic fibers at human vocal folds. STUDY DESIGN: transversal cohort. MATERIAL AND METHOD: We collected vocal folds following these criterion: age between 25 and 40, Caucasian men, dead by gun shot, within 12 hours of death, without instrumentation of the larynx or suspicion of neck injury and without mucosal lesions noted by microscopy. Ten vocal folds were collected and one, of a man aged 28 years, was selected to study. The vocal fold was transversely cut in 9 regions and in each segment three slides were made. These slides were stained by Verhoeff and Weigherts resorcin-fuchsin and used for immunohistochemistry. The elastic compound was measured by colorimetric software analysis. RESULTS: In Verhoeff and Weigherts resorcin-fuchsin, the intermediate and deep layer showed values higher than those of the superficial layer. The amount of tropoelastin identified by the antibody at the superficial layer was close to those of intermediate and deep layer. CONCLUSION: Immunohistochemistry is a method that can identify and measure all forms of elastic fibers at human vocal fold.

Detecção de receptor de ácido hialurônico em prega vocal humana por método imunohistoquímico

Hyaluronic acid receptor is a glycoprotein of the plasmatic membrane, and the CD44 is its representative, expressed in many cell types where it has the task of cell adhesion. AIM: the goal of the present experimental study is to investigate the possibility of using immunohistochemistry to identify the distribution of hyaluronic acid along the vocal fold. MATERIALS AND METHODS: We resected the normal vocal folds from a normal 23 year-old male black individual. The slides were analyzed by means of a histomorphometric study, comparing the color intensity in the superficial, middle and deep layers of the lamina propria. In the silanized slides we used immunohistochemistry, and evaluated the slides under light microscopy with 40x magnification, and the color changed to brown when there was a reaction with the receptor for hyaluronic acid. RESULTS: Immunohistochemical findings showed the presence of hyaluronic acid receptors in the epithelium covering the vocal fold, being more concentrated in the central region of the vocal fold. CONCLUSION: immunohistochemistry, used to assess the distribution of hyaluronic acid receptors in the central portion of the vocal fold, proved it to be present in the vocal fold epithelium and it prevailed in its middle third.

Influence of aging on hyaluronic acid concentration in the vocal folds of female rats

UNLABELLED The vibration of the vocal fold lamina propria is an important factor involved in vocal production and aging may change the amount of hyaluronic acid in the vocal fold leading to dysphonia. AIMS This study compares the concentration of hyaluronic acid in vocal folds of aged and young female rats. STUDY DESIGN experimental. MATERIALS AND METHODS We used the vocal cords of 13 female rats divided into two groups: five aged rats and eight young ones. The tissue concentration of hyaluronic acid was determined using the fluorimetric method with the hyaluronic acid binding-protein coated on plates of enzyme-linked immunosorbent assay (ELISA), conjugated with biotin. Europium-labeled streptavidin was added and, after europium release with the use of enhancement solution, the final fluorescence was measured in a fluorometer. RESULTS We found the following concentrations of hyaluronic acid in vocal fold according to the group: 581.7 ng/mg in old female rats and 1275.6 ng/mg in young female rats. Statistical analysis showed differences between groups. CONCLUSIONS The vocal folds of old female rats have a lower concentration of hyaluronic acid when compared to such concentration on the vocal folds of young female rats.

Detection of Hyaluronic Acid Receptor in Human Vocal Folds by immunohistochemistry

UNLABELLED Hyaluronic acid receptor is a glycoprotein of the plasmatic membrane, and the CD44 is its representative, expressed in many cell types where it has the task of cell adhesion. AIM the goal of the present experimental study is to investigate the possibility of using immunohistochemistry to identify the distribution of hyaluronic acid along the vocal fold. MATERIALS AND METHODS We resected the normal vocal folds from a normal 23 year-old male black individual. The slides were analyzed by means of a histomorphometric study, comparing the color intensity in the superficial, middle and deep layers of the lamina propria. In the silanized slides we used immunohistochemistry, and evaluated the slides under light microscopy with 40x magnification, and the color changed to brown when there was a reaction with the receptor for hyaluronic acid. RESULTS Immunohistochemical findings showed the presence of hyaluronic acid receptors in the epithelium covering the vocal fold, being more concentrated in the central region of the vocal fold. CONCLUSION immunohistochemistry, used to assess the distribution of hyaluronic acid receptors in the central portion of the vocal fold, proved it to be present in the vocal fold epithelium and it prevailed in its middle third.

Olfaction disorders: retrospective study

Introduction: The smell, subjective phenomenon of great importance, is poorly understood and studied in humans. Physicians with more knowledge about smell disorders tend to consider the phenomenon important and to better manage the diagnosis and its treatment. Aims: First to describe a sample of patients presenting with main complaint of disturbances of smell. And second, to show our experience on management and treatment of this disease. Design: Retrospective cross-sectional cohort study. Materials and methods: Sample description and assessment of treatment response in patients with main complaint of hyposmia or anosmia from January 2005 to October 2011. Results: From 38 patients presented with main complaint of an olfactory disorder, 68.4% of the patients were presented with hyposmia and 31,5% with anosmia, with a mean duration of 30.8 months. The main etiologic diagnoses were idiopathic (31.5%), rhinitis (28.9%) and CRS with polyps (10.5%). Responses to treatment with topical steroids and alpha-lipoic acid were variable, as well as in the literature. Conclusion: Greater importance should be given to disorders of smell in practice of otolaryngologists, since its large differential diagnosis and the fact that could increase morbidity to patients, impacting on their quality of life.INTRODUCTION The smell, subjective phenomenon of great importance, is poorly understood and studied in humans. Physicians with more knowledge about smell disorders tend to consider the phenomenon important and to better manage the diagnosis and its treatment. AIMS First to describe a sample of patients presenting with main complaint of disturbances of smell. And second, to show our experience on management and treatment of this disease. DESIGN Retrospective cross-sectional cohort study. MATERIALS AND METHODS Sample description and assessment of treatment response in patients with main complaint of hyposmia or anosmia from January 2005 to October 2011. RESULTS From 38 patients presented with main complaint of an olfactory disorder, 68.4% of the patients were presented with hyposmia and 31,5% with anosmia, with a mean duration of 30.8 months. The main etiologic diagnoses were idiopathic (31.5%), rhinitis (28.9%) and CRS with polyps (10.5%). Responses to treatment with topical steroids and alpha-lipoic acid were variable, as well as in the literature. CONCLUSION Greater importance should be given to disorders of smell in practice of otolaryngologists, since its large differential diagnosis and the fact that could increase morbidity to patients, impacting on their quality of life.

Sarcoidose laríngea: revisão de literatura

INTRODUCTION: Laryngeal sarcoidosis is a granulomatous disease representing a challenge as regards diagnosis and treatment. METHOD: In this review, all aspects of the disease are involved, including etiology, clinical manifestations in adults and children, diagnosis, and treatment, by searching through Medline, Lilacs and Scielo databases, as well as English and Portuguese articles published from 1973 to 2008. FINAL COMMENTS: Despite the breakthroughs in its diagnosis and treatment, sarcoidosis is a disease that remains without a clear etiology and physiopathology, becoming an exclusion diagnosis due to both the lack of precise exams and its likely multifactor background. Laryngeal impairment, however infrequent, is a suspicion mainly when there is a precedent history of systemic sarcoidosis, and the research for differentiated diagnosis must be wide-ranging so as to prevent severe diseases like malign neoplasia from being unnoticed.

Immunohistochemistry as a method to study elastic fibers of human vocal fold

AIM Verify the use of immunohistochemistry as a method to measure all forms of elastic fibers at human vocal folds. STUDY DESIGN Transversal cohort. MATERIAL AND METHOD We collected vocal folds following these criterion: age between 25 and 40, Caucasian men, dead by gun shot, within 12 hours of death, without instrumentation of the larynx or suspicion of neck injury and without mucosal lesions noted by microscopy. Ten vocal folds were collected and one, of a man aged 28 years, was selected to study. The vocal fold was transversely cut in 9 regions and in each segment three slides were made. These slides were stained by Verhoeff and Weigherts resorcin-fuchsin and used for immunohistochemistry. The elastic compound was measured by colorimetric software analysis. RESULTS In Verhoeff and Weigherts resorcin-fuchsin, the intermediate and deep layer showed values higher than those of the superficial layer. The amount of tropoelastin identified by the antibody at the superficial layer was close to those of intermediate and deep layer. CONCLUSION Immunohistochemistry is a method that can identify and measure all forms of elastic fibers at human vocal fold.

Impact of adenotonsillectomy on vocal emission in children

INTRODUCTION Adenotonsillectomy is the most common surgery performed by otolaryngologists in pediatric age, and one of the most frequently asked questions about the postoperative period is whether there is a potential for change in vocal pattern of these children. OBJECTIVE To evaluate the impact of adenotonsillectomy in the voice emission pattern of children with hypertrophy of palatine and pharyngeal tonsils. METHODS This is a prospective study in which we carried out perceptual auditory assessments and acoustic analysis of 26 children with adenotonsillar hypertrophy at three time points: before surgery, one month and three months after surgery. The following acoustic parameters were estimated using the Praat software: fundamental frequency, jitter, shimmer, and harmonic-noise ratio. RESULTS A statistically significant change was found between shimmer and harmonic-noise ratio during vowel /u/ production between the preoperative and 1st month postoperative time points. No significant differences were detected for acoustic parameters between preoperative analysis and that of the 3rd month post-operation. CONCLUSION Transient changes in acoustic parameters occur in children with adenotonsillar hypertrophy submitted to adenotonsillectomy, progressing to normalization in the 3rd postoperative month.

The judicialization of the medical act

Escola Paulista de Medicina, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP, Brasil