Manfred Nusseck

The use of narrow band imaging for the detection of benign lesions of the larynx

In the cases of uncertainty, even if the patient has no complaints about his voice quality, sometimes, benign vocal fold mass lesions are removed to exclude malignancy with the risk of resultant dysphonia. Narrow Band Imaging (NBI) enables a specific visualization of vessel structures in the superficial tissue. Benign lesions of the larynx are frequently characterized by abnormal vessel configuration or an absence of vessels in the area of the lesion. It was hypothesized that, in the primary diagnosis of patients with these benign lesions, the combination of white light and NBI endoscopy enables a better detection compared with white light endoscopy alone. Twenty-nine patients (eight patients with a cyst on a vocal fold, eight with a polyp, seven with a Reinke´s edema, two with a leukoplakia, one with a carcinoma, one with a granuloma, and two without any pathologic finding) were examined with normal white light and NBI endoscopy. 87 video sequences (29 white, 29 NBI, and 29 white/NBI) were generated and randomized and presented to 20 otolaryngologists who rated the videos in terms of the suspected diagnosis. Results were compared with the histopathologic findings of microlaryngoscopy. The probability of detecting benign lesions of the vocal folds was higher using NBI in combination with white light endoscopy compared with white light endoscopy alone. For vocal fold cysts, this difference was statistically significant. NBI endoscopy in combination with normal white light endoscopy improves the detection rate of benign lesions of the larynx, especially of vocal fold cysts.

The effectiveness of a multimodal concept of audition training for music students in coping with music performance anxiety

Music performance anxiety (MPA) occurs regularly before and during a musical stage performance. Coping with MPA optimizes the performance outcome and plays an important role for musicians, especially when auditioning for work in an orchestra. In this study the effectiveness of a seminar to train students to cope with MPA was evaluated. Thirteen music students participated in the intervention program of 14 weekly sessions. Eight students were in the control group. The intervention contained video feedback, exercises in methods of body awareness, and insights into cognitive strategies. All students were required to perform two simulated auditions, at the beginning and at the end of the semester. They filled in self-assessment questionnaires related to MPA at both auditions. Additionally, two judges rated the performances in both auditions. Audio recordings of the performances were also sent to 12 orchestral musicians for appraisal as well. The results revealed significant improvements in coping with MPA, shown in the participants’ self-assessment ratings as well as in the ratings of the judges during the auditions in the trained group compared with the control group. Additionally, the orchestral musicians rated the audio presentations of the intervention group in the second audition significantly better than the control group.

Music performance anxiety in young musicians: comparison of playing classical or popular music.

OBJECTIVES Music performance anxiety (MPA) is an issue frequently experienced by musicians. It occurs not only in experienced musicians but also in children and adolescents. Furthermore, most research on MPA has been done with musicians who specialized in classical music. This study investigated the development of MPA across the ages in young musicians focusing on the classical and popular genres. METHODS In a cross-sectional survey, 239 students at German music schools, aged between 7 and 20 yrs, were asked about their perceived MPA and musical background. The data were analyzed according to musical genre and age. Multiple regression analyses were performed to investigate the influences of musical experiences on MPA. RESULTS The analyses yielded high levels of MPA for classical musicians between 7 and 16 yrs, which was reduced in older students; for popular musicians, low MPA was seen in the younger (7-11 yrs) and high MPA in the older (16+ yrs) musicians. MPA was influenced by gender and the number of performances in the classical music group and only by gender and age in the popular music group. CONCLUSION The results showed clear different trends for the development of MPA between musical genres that should be taken into account for educational aspects in musical training.

Narrow Band Imaging A Tool for Endoscopic Examination of Patients With Laryngeal Papillomatosis

Objectives: Narrow band imaging (NBI) is supposed to be a technique for a better visualization of vessel structures in superficial tissue as it selects the wavelengths of hemoglobin. It was hypothesized that, in the regular follow-up examination of patients with recurrent laryngeal papillomatosis, NBI enables a better detection of laryngeal papillomatosis in contrast to normal white light endoscopy. Methods: Eleven patients, 10 with a known recurrent papillomatosis (8 with a relapse, 2 without) and 1 with a primary diagnosis of papillomatosis, were examined with normal white light and NBI endoscopy. Twenty-six video sequences (11 white, 11 NBI, 4 doubled for validity) were generated and randomly presented to 20 otolaryngologists who rated the videos in terms of lesions seen and number of lesions identified. Results were compared with the histopathologic findings of microlaryngoscopy. Results: Detection of papillomatosis and the correct number of lesions identified were more accurate with NBI than with normal white light endoscopy. There was a significantly higher probability of detecting laryngeal papillomata with NBI. Conclusions: NBI endoscopy enables a more accurate detection of laryngeal papillomatosis than white light endoscopy.

Long-term analysis of health status and preventive behavior in music students across an entire university program.

OBJECTIVES The aim of this investigation was to analyze longitudinal data concerning physical and psychological health, playing-related problems, and preventive behavior among music students across their complete 4- to 5-year study period. METHODS In a longitudinal, observational study, we followed students during their university training and measured their psychological and physical health status and preventive behavior using standardized questionnaires at four different times. RESULTS The data were in accordance with previous findings. They demonstrated three groups of health characteristics observed in beginners of music study: healthy students (cluster 1), students with preclinical symptoms (cluster 2), and students who are clinically symptomatic (cluster 3). In total, 64% of all students remained in the same cluster group during their whole university training. About 10% of the students showed considerable health problems and belonged to the third cluster group. CONCLUSION The three clusters of health characteristics found in this longitudinal study with music students necessitate that prevention programs for musicians must be adapted to the target audience.

Health status and preventive health behavior of music students during university education: Merging prior results with new insights from a German multicenter study:

Musicians are at high risk of developing playing-related health problems. A considerable number of musicians suffer from severe health issues even during their university education. In previous studies using similar music student populations, health status and preventive health behavior could be classified into three groups. The first group of students did not report playing-related health problems and did not engage in preventive activities. The second group of students experienced rather low-level playing-related health problems and practiced preventive activities. The third group reported a rather high frequency of playing-related health problems and all of them were taking medication. These results were obtained from studies done at one German university of music. In order to compare these results with a nationwide sample of music students, a multicenter study at five German universities of music was performed. A total of 288 music students participated in the first survey at the beginning of their university education, 142 in the second survey at the start of their third semester and 75 in the third survey at the start of the last year of their university education. The data was analyzed using the same methods as the prior studies. The results confirmed the group classifications identified in previous studies. While approximately half the students indicated that they participated in preventive health behavior in the first survey, in the following two surveys more than three-quarters of the students reported practicing such activities during the course of their university education. Nevertheless, in all three surveys a large number (about a third) of music students reported playing-related health problems.

Zur Beurteilung der Therapieerfolge bei dysphonen Patienten

Einleitung: Die multidimensionale Stimmdiagnostik gilt als Goldstandard in der Stimmmedizin. Zur standardisierten Evaluation wurde diesbezuglich ein Protokoll der Europaisch Laryngologischen Gesellschaft (ELS-Protokoll) vorgeschlagen. Hinsichtlich der Beurteilung von Therapieverlaufen liegen nach wie vor wenige Daten vor. Material und Methoden: 276 Patienten (136 mit phonochirurgischer Operation, 81 mit Stimmtherapie und 59 als stimmgesunde Kontrollgruppe) wurden hinsichtlich der Stimmfunktion vor und nach Stimmtherapie bzw. phonochirurgischer Intervention anhand dieses Protokolls evaluiert. Ergebnisse: In den Kennwerten des ELS-Protokolls liesen sich hinsichtlich DSI, VHI und RBH-System deutliche Verbesserungen durch die Therapie darstellen. Somit konnte die Eignung dieser statistisch signifikanten Messwerte zur Verlaufseinschatzung von dysphonen Patienten sowohl bei organischen als auch funktionellen Stimmstorungen bestatigt werden. Allerdings zeigten sich in der Detailanalyse aller erhobenen Parameter zum Teil schwache bis keine Korrelationen bei Werten, die eigentlich ahnliche Informationen geben sollten wie z. B. Perturbationswerten oder Werten, die sich aus dem Schallspektrum ableiten. Diskussion: Die multidimensionale Stimmmessung, wie sie im ELS-Protokoll vorgeschlagen wird, ist unabhangig vom gewahlten Therapieverfahren in der Lage, Therapieerfolge gut zu dokumentieren. Die zum Teil ungenugenden Korrelationen von Werten, die eigentlich etwas vergleichbares Ausdrucken sollten, zeigen, dass eine Optimierung bzw. Vereinheitlichung von Messgeratschaft, Computer Hard- und Software dringend erforderlich ist.INTRODUCTION Multidimensional voice evaluation is considered as gold standard in voice medicine. In this respect, the European Laryngological Society recommended a protocol for standardized evaluation (ELS-Protocol). However, there are only rare data analyzing changes during therapeutical follow-up. MATERIAL AND METHODS Using this protocol, 276 patients (136 after phonosurgery, 81 after voice therapy and as a control group 59 patients without voice impairment) were evaluated with regard to their vocal capacity before and after voice therapy or phonosurgery, respectively. RESULTS The parameters of the ELS-protocol showed significant improvement under therapy with respect to DSI, VHI, and RBH-scale. It has been confirmed, that these measurements are suitable for the assessment of dysphonic patients with organic as well as functional voice disorders. However, detailed analysis of all the obtained parameters showed only weak or no correlation between all regarding parameters, which should be expected to provide comparable information, such as perturbation parameters or such parameters, that are derived from the acoustical spectrum. DISCUSSION Multidimensional evaluation of the voice as recommended by the ELS protocol is independent from the therapeutical approach able to document therapeutical success. The lack of sufficient correlations of values which should provide comparable information shows that an optimization or standardization of measuring instruments, computer hardware and software is necessary.