Sami Tanbouzi Husseini

Salvage surgery of vestibular schwannoma after failed radiotherapy: The Gruppo Otologico experience and review of the literature

OBJECTIVES The use of radiation therapy has largely widespread and becomes in many centers the preference modality of treatment for symptomatic patients who are old, medically unfit for surgical therapy, those who refuse surgery and in some recurrent or residual growing tumors. The risk of radiotherapy failure in the treatment of vestibular schwannoma might be underestimated in the literature. The purpose of this study is to show the Gruppo Otologico experience with salvage surgery to better understand the surgical outcomes and difficulties in treating vestibular schwannoma after failed radiotherapy. STUDY DESIGN Retrospective chart review of patients who required salvage surgery of vestibular schwannoma after failed radiotherapy. SETTINGS Quaternary referral otology and skull base center. RESULTS Between 1987 and 2010, 2500 cases of VS underwent surgical treatment at the Gruppo Otologico. Nineteen patients had received stereotactic radiation therapy before the surgical treatment. The interval time between radiotherapy and surgical salvage ranged from 1 to 10 years. In all the cases decision of surgery was taken following an increase in tumor size with or without new onset of symptoms. Complete tumor removal was achieved in 86.6% of the cases through a transotic, transcochlear or enlarged translabyrinthine approach with trans-apical extension. Difficult dissection of the tumor was encountered in 93.3% the cases. The facial nerve was anatomically preserved in 93.3% but its function was worsened in 73.3% of patients after at least 6 months of follow up. Malignant transformation of the vestibular schwannoma was encountered in one patient. CONCLUSION Complete surgical resection of VS is more difficult after radiotherapy with relatively poor facial nerve outcomes and nearly impossible hearing preservation. Patients who receive radiation therapy for the treatment of vestibular schwannoma should be made aware of its potential complications and risk of failure, especially in young patients and NF2 cases.

Cricothyroid joint abnormalities in patients with rheumatoid arthritis.

The objective of this study was to assess structural and functional abnormalities of the cricothyroid joint (CTJ) in patients with advanced rheumatoid arthritis (RA). A total of 19 subjects--11 patients with advanced RA and eight normal controls--were considered. All subjects underwent laryngeal endoscopy, acoustic analysis, and high-resolution computerized tomography (HRCT). Vocal symptoms, such as hoarseness, loss of range, vocal fatigue, and dyspnea were inquired and acoustic parameters, mainly pitch range, fundamental frequency, habitual pitch, perturbation parameters, and noise-to-harmonic ratio (NHR) and voice turbulence index were measured. Frequencies and means were calculated for categorical and continuous variables. Cases and controls were compared with respect to acoustic analysis, HRCT findings and laryngeal symptoms using nonparametric tests, Mann-Whitney U test for continuous variables and Fishers exact test for categorical variables. Almost half of the patients with RA had loss range and two-thirds had vocal fatigue. Thirty-six percent experienced hoarseness compared with 25% in the control group. 9.1% had decrease in vocal fold mobility and 27% had moderate/severe edema of the vocal folds/arytenoids compared with none in the control group. HRCT showed narrowing in the CTJ in 81.8% and ankylosis in 9.1% compared with none in the control group. 45.5% had an increase in the CTJ density compared with 12.5% in the control group. Acoustic analysis revealed significant decrease in pitch range and maximum phonation time (MPT) and significant increase in perturbation parameters. CTJ is commonly affected in patients with RA. Functional disabilities are crucial especially in professional voice users. Proper awareness is important for early detection and intervention.

Vocal Technique in a Group of Middle Eastern Singers

Objective: We aimed to report on the vocal technique in a group of Middle Eastern singers. Subjects and Method: A total of 78 Middle Eastern singers were assessed. Demographic data included age, gender, training status and number of years of singing. All singers had laryngeal videoendostroboscopy. Description and grading of posture, tension, type of breathing, type of phonation, resonance and tone quality are reported. Proportions and means (± SD) were used to describe the sample for categorical and continuous variables respectively. Associations between endostroboscopy and voice technique were determined by χ2 or Fisher’s exact test. Results:There were 43 males and 35 females with an age ranging between 16 and 32 years and a mean of 23 ± 4 years. Of these, 88.5% were nontrained singers and 50% had more than 3 years of singing experience. Around 80% of Middle Eastern singers rely on either thoracic or clavicular breathing. Posture was average in 68% and moderate tension was present in 63% of the cases. Two thirds had a bright voice, 61% were hypernasal and almost 46% had a strained phonation. There was a significant correlation between posture and tension. Conclusion: Middle Eastern singing relies more on thoracic breathing and is characterized by tension.

Arytenoid asymmetry in relation to posture, neck tension and glottal attack in singers.

Objectives: To look at the incidence of arytenoid asymmetry in a group of healthy singers and to investigate whether the asymmetry correlates with posture, neck tension and glottal attack. Materials and Method: The medical records and video recordings of 42 singers were reviewed retrospectively. Posture, neck tension and glottal attack were evaluated in relation to arytenoid asymmetry during adduction. Results: The number of singers was 42, with a male-to-female ratio of 2:1. The age range was 16–38 years, with a mean of 24 ± 4.13 years. The total prevalence of arytenoid asymmetry was 50%, with a predominance in males and on the right side. The most common asymmetry was that of the cuneiform cartilages, accounting for 40.5% of the total sample and 81% of the total asymmetries. There was no correlation between arytenoid asymmetry and either posture, neck tension or glottal attack (p = 0.343, 0.489 and 0.945, respectively). Conclusion: One out of 2 singers is likely to have arytenoid asymmetry during adduction. The presence of asymmetry does not correlate with posture, neck tension or glottal attack.