Roland Rydell

Voice Evaluation before and after Laser Excision vs. Radiotherapy of T1A Glottic Carcinoma

Quality of voice after treatment for T1A glottic squamous cell carcinoma was studied in two matched groups of males treated either with CO2 laser cordectomi (n = 18, mean age 65.2 years) or with full dose radiotherapy (n = 18, mean age 65.1 years). All patients had histologically verified invasive squamous cell carcinoma. Fifteen male patients (mean age 63.9 years) without laryngeal disorders were used as controls. Voice recordings prior to treatment, and both at 3 months and at 2 years after completed treatment were analyzed. Acoustic measures of shimmer, jitter, breathiness, harmonic-to-noise ratio and fundamental frequency (F0) average were calculated with the Soundscope program. Two plain measures were also used: time required to read a running speech voice sample, and number of breaths. Perceptual voice analysis was performed blindly by two groups of listeners, Group A (4 experienced listeners) and Group B (4 naive listeners). Group A estimated quality of voice according to a modified GRBAS score, whereas Group B estimated Grade only. We found voice quality both at 3 months and at 2 years after radiotherapy to be significantly better than after laser treatment, as assessed by the acoustic variables breathiness, jitter, F0 average, running speech voice sample reading time and number of breaths. The perceptual variables Grade (Group A and B), Breathiness, Asthenia and Strain were also significantly better after radiotherapy.

Clinical multi-colour fluorescence imaging of malignant tumours - initial experience

Purpose: the detection of malignant tumours relies on a variety of diagnostic procedures including X-ray images and, for hollow organs, endoscopy. the purpose of this study was to present a new technique for non-invasive tumour detection based on tissue fluorescence imaging Material and Methods: A clinically adapted multi-colour fluorescence system was employed in the real-time imaging of malignant tumours of the skin, breast, head and neck region, and urinary bladder. Tumour detection was based on the contrast displayed in fluorescence between normal and malignant tissue, related to the selective uptake of tumour-marking agents, such as haematoporphyrin derivative (HPD) and δ-amino levulinic acid (ALA), and natural chromophore differences between various tissues. in order to demarcate basal cell carcinomas of the skin, ALA was applied topically 4–6 h before the fluorescence investigation. for urinary bladder tumour visualisation (transitional cell carcinoma of different stages including carcinoma in situ), ALA was instilled into the bladder 1–2 h prior to the study. Malignant and premalignant lesions in the head and neck region were imaged after i.v. injection of HPD (Photofrin). Finally, the extent of in situ and invasive carcinomas of the breast was investigated in surgically excised specimens from patients that received a low-dose injection of HPD 24 h prior to the study. the tumour imaging system was coupled to an endoscope. Fluorescence light emission from the tissue surface was induced with 100-nslong optical pulses at 390 nm, generated from a frequency-doubled alexandrite laser. with the use of special image-splitting optics, the tumour fluorescence, intensified in a micro-channel plate, was imaged in 3 selected wavelength bands. These 3 images were processed together to form a new optimised-contrast image of the tumour. This image, updated at a rate of about 3 frames/s, was mixed with a normal colour video image of the tissue Results: A clear demarcation from normal surrounding tissue was found during in vivo measurements of superficial bladder carcinoma, basal cell carcinoma of the skin, and leukoplakia with dysplasia of the lip, and in in vitro investigations of resected breast cancer Conclusions: the initial clinical experience of using multi-colour fluorescence imaging has shown that the technique has the potential to reveal malignant tumour tissue, including non-invasive early carcinoma and also precancerous tissue. Further investigations are needed to fully develop the method

Speaker's Comfort in Teaching Environments: Voice Problems in Swedish Teaching Staff.

OBJECTIVES The primary objective of this study was to examine how a group of Swedish teachers rate aspects of their working environment that can be presumed to have an impact on vocal behavior and voice problems. The secondary objective was to explore the prevalence of voice problems in Swedish teachers. METHOD Questionnaires were distributed to the teachers of 23 randomized schools. Teaching staff at all levels were included, except preschool teachers and teachers at specialized, vocational high schools. The response rate was 73%. RESULTS The results showed that 13% of the whole group reported voice problems occurring sometimes, often, or always. The teachers reporting voice problems were compared with those without problems. There were significant differences among the groups for several items. The teachers with voice problems rated items on room acoustics and work environment as more noticeable. This group also reported voice symptoms, such as hoarseness, throat clearing, and voice change, to a significantly higher degree, even though teachers in both groups reported some voice symptoms. Absence from work because of voice problems was also significantly more common in the group with voice problems--35% versus 9% in the group without problems. CONCLUSION We may conclude that teachers suffering from voice problems react stronger to loading factors in the teaching environment, report more frequent symptoms of voice discomfort, and are more often absent from work because of voice problems than their voice-healthy colleagues.

Acute Mastoiditis: Influence of Antibiotic Treatment on the Bacterial Spectrum

The work was undertaken to investigate the spectrum of bacteria responsible for acute mastoiditis and to find out whether it is affected by intake of antibiotics prior to surgical treatment. The records were reviewed of 22 children with acute mastoiditis in whom mastoidectomy had been performed and bacterial cultures obtained. Eleven of the patients had had antibiotic treatment prior to admission (9 penicillin V and 2 erythromycin). Streptococcus pneumoniae was found in 8 of the purulent discharges: Haemophilus influenzae, Streptococcus beta-hemolyticus and Staphylococcus aureus in 2 each; Proteus mirabilis, Pseudomonas pyocyaneus and a Bacteroides strain in 1 each, while five discharges-all from patients pretreated with antibiotics-yielded no growth. None of the 9 patients pretreated with penicillin V provided pure cultures of pneumococci or beta-hemolytic streptococci, while one or the other of these species was found in 8 of the 11 untreated patients. Gram-negative bacteria were found both among those with and those without antibiotic pretreatment. The data indicate that pneumococci and beta-hemolytic streptococci are more likely to cause mastoiditis than are the other pathogens found in acute otitis media, and that, when drained at operation, purulent discharges are often found to have been sterilized by the pre-operative antibiotic treatment.

How Do Teachers With Self-Reported Voice Problems Differ From Their Peers With Self-Reported Voice Health?

OBJECTIVES This randomized case-control study compares teachers with self-reported voice problems to age-, gender-, and school-matched colleagues with self-reported voice health. The self-assessed voice function is related to factors known to influence the voice: laryngeal findings, voice quality, personality, psychosocial and coping aspects, searching for causative factors of voice problems in teachers. METHODS Subjects and controls, recruited from a teacher group in an earlier questionnaire study, underwent examinations of the larynx by high-speed imaging and kymograms; voice recordings; voice range profile; audiometry; self-assessment of voice handicap and voice function; teaching and environmental aspects; personality; coping; burnout, and work-related issues. The laryngeal and voice recordings were assessed by experienced phoniatricians and speech pathologists. RESULTS The subjects with self-assessed voice problems differed from their peers with self-assessed voice health by significantly longer recovery time from voice problems and scored higher on all subscales of the Voice Handicap Index-Throat. CONCLUSIONS The results show that the cause of voice dysfunction in this group of teachers with self-reported voice problems is not found in the vocal apparatus or within the individual. The individuals perception of a voice problem seems to be based on a combination of the number of symptoms and of how often the symptoms occur, along with the recovery time. The results also underline the importance of using self-assessed reports of voice dysfunction.

Fluorescence investigations to classify malignant laryngeal lesions in vivo.

The extent of surgical resection for malignant laryngeal lesions influences voice quality. An instrument to estimate histopathologic grading of dysplasia in vivo may spare normal tissue without increasing the risk of local failure.

Advanced laryngeal cancer T3-T4 in Sweden: a retrospective study 1986-1990. Survival and locoregional control related to treatment.

Different treatment modalities for advanced laryngeal cancer are much discussed in the literature. One-hundred-and-sixty patients with T3-4, N0-3, M0-1 laryngeal cancer diagnosed in Sweden between 1986 and 1990 were retrospectively analysed. One hundred (65 T3: 35 T4) received radical radiotherapy with salvage surgery (RRSS) in case of residual or recurrent disease. Thirty-eight (11T3: 27 T4) patients received surgery with or without radiotherapy (S +/- RT). Twenty-two patients received no treatment. After a median follow up of 4.4 years, the estimated 5-year actuarial corrected survival and 3-year locoregional control were 59% and 44% for T3 RRSS and 47% and 54% for T3 S +/- RT. No significant difference between the different treatment modalities was found. The 5-year corrected survival rate and the locoregional control at 3 years between T4-RRSS (32%; 26%) and T4-S + RT (58%; 68%) groups were significantly different (p < 0.05 and p < 0.01). This might suggest that surgery with or without radiotherapy still has its place as a treatment modality for patients with advanced T4 laryngeal carcinoma.

Fluorescence Diagnostics of Head and Neck Cancer Utilizing Oral Administration of Delta-amino Levulinic Acid

Tissue fluorescence measurements utilizing a point monitoring fluorosensor and a multi-color fluorescence imaging system were performed in patients with various malignant tumors in the head and neck region. Also precancerous lesions were investigated and characterized by means of laser-induced fluorescence. Oral administration of low-dose (delta) -amino levulinic acid was used for the induction of protoporphyrin IX, which exhibits a strong fluorescence in the red wavelength region. The blue-green fluorescence emitted from the tissue natural chromophores was also utilized for tumor demarcation. By incorporating both Protoporphyrin IX and natural fluorescence in a tumor demarcation criterion a tumor demarcation with a tumor-to-normal-surrounding-tissue of about 5 - 10:1 contrast was achieved. Hypertrophic tissue did not exhibit tumor specific signals.

Viral load and mRNA expression of HPV type 6 among cases with recurrent respiratory papillomatosis.

To determine viral load of human papillomavirus type 6 (HPV6), physical state of HPV6‐DNA, and transcription level of HPV6 E7‐mRNA in laryngeal papilloma and in adjacent healthy mucosa.

Laryngeal activity during wind instrument playing: Video endoscopic documentation

The starting point of this study was that two of the authors independently experienced vocal fatigue when singing after they had played their wind instruments. We studied six subjects who played flute, trumpet or saxophone (two subjects on each instrument), with the help of videofibrelaryngoscopy. They performed different tasks and the laryngeal and pharyngeal activity was investigated. We found that all six subjects manifested activation of the laryngeal muscles while playing, though the type of activation differed: the flautists manifested vocal fold activation during the production of vibrato, whereas the trumpet and saxophone players primarily used the larynx for regulation of pressure.