Yavuz Yildiz

Airway and Respiration Parameters Improve Following Vocal Fold Medialization: A Prospective Study.

Objectives/Hypothesis: Laryngeal medialization procedures such as injection laryngoplasty (IL) and thyroplasty type 1 (TT1) are standard techniques for the treatment of glottic insufficiency related to unilateral vocal fold paralysis (UVFP). These procedures reliably improve the voice and may also improve swallowing function. Despite the association of laryngeal paralysis with airway regulation, there is little published on the effect of UVFP and its surgical treatment on respiration. The aim of this prospective study was to evaluate the aerodynamic outcomes of UVFP patients before and after vocal fold medialization, either by IL or TT1. Methods: Consecutive patients with dysphonia due to UVFP were included in this prospective study between 2012 and 2014. Nineteen patients were investigated (5 females, 14 males) with a mean age of 37.05 ± 17.8 years. Eight patients were treated by IL while 11 patients received TT1. The patients were subjected to Modified Medical Research Council (MMRC) and Borg dyspnea scales, maximum phonation time (MPT) measurement, spirometry, and cycle ergometry, pre- and postoperatively at 2 months. Results: There was a statistically significant increase in MPT from 5.5 ± 3 seconds to 11.2 ± 4.9 seconds postoperatively (P < .001). The MMRC and Borg dyspnea scales also showed significant improvement postoperatively (P < .001, P = .006, respectively). The change in spirometric parameters (peak expiratory flow, forced expiratory volume in 1 second, forced vital capacity, and peak inspiratory flow) were nonsignificant, while there was a significant improvement in cycle ergometry test postoperatively (P = .018). Conclusion: Laryngeal medialization procedures such as IL and TT1 improve UVFP patients’ respiration-related quality of life and aerodynamic performance with no significant changes in spirometry.

Impact of unilateral carbon dioxide laser posterior transverse cordotomy on vocal and aerodynamic parameters in bilateral vocal fold paralysis

OBJECTIVES Carbon dioxide laser posterior transverse cordotomy is a common option for bilateral vocal fold paralysis. This study prospectively evaluated aerodynamic and acoustic effects of unilateral carbon dioxide laser posterior transverse cordotomy in bilateral vocal fold paralysis patients. METHODS The study comprised 11 bilateral vocal fold paralysis patients (9 females, 2 males), with a mean age of 46.6 ± 14.1 years. All patients were treated by laser posterior transverse cordotomy. Pre-operative and two-month post-operative assessments were conducted, including: dyspnoea scales, maximum phonation time measurement, spirometry and bicycle ergometry. RESULTS All subjective and objective aerodynamic parameters showed statistically significant improvements between the pre- and post-operative period. Objective spirometric and ergometric parameters showed a significant increase post-operatively. The changes in objective voice parameters (fundamental frequency (f0), jitter, shimmer, soft phonation index and noise-to-harmonic ratio) were statistically non-significant; however, there was a significant improvement in subjective voice parameters post-operatively, as assessed by the voice handicap index and grade-roughness-breathiness-asthenia-strain scale (p = 0.026 and p = 0.018 respectively). CONCLUSION Unilateral carbon dioxide laser posterior transverse cordotomy is an effective procedure that results in improved dyspnoea and aerodynamic performance with some worsening of voice parameters.

Can We Predict Success of Orienteering Athletes

ABS TRACT Objective: Orienteering is an extreme sport which require different physical and cognitive properties from other sports. We aimed to predict whether the athletes will be successful or not in the competitions by pre-season performance tests. Material and Methods: Total 45 athletes who are in the same orienteering club were included in the study. Demographic data, balance, coordination and strength parameters were assessed before season. Tanita Body Composition Analyzer, Holtain skinfold, vernier caliper, Vmax Encore Viasys Program, Balance System SD TM and Biodex System 4 Pro were used. According to the individual ranking list created as the result of the same year’s competitions, athletes were divided into two groups: Successful and Unsuccessful. Groups were compared as to measurement results. Kolmogorov Smirnov, Mann-Whitney U, Pearsons chi-square, Wilcoxon Signed-Rank tests and ROC curve analysis (area under the curve) were used for statistical analyses. Results: Left OSI (overall stability index), right OSI, left API (anterior posterior index) and right API were statistically significant differences (p=0.032, p=0.013, p=0.045, p=0.009, respectively). ROC curve analysis of measurements: The first value is right API 0.749 (95% confidence interval in 0.582-0.915), the second right OSI 0.737 (95% confidence interval in 0.5730.901), the third left OSI 0.712 (95% confidence interval in 0.535-0.888) and the fourth left API 0.694 (95% confidence interval in 0.517-0.871) in total statistics. Left OSI 0.908 (95% confidence interval in 0.729-1.000) in males and 0.540 (95% confidence interval in 0.275-0.805) in females. Conclusions: For determining the competition success of an orienteering athlete; balance tests may be the best choice.

P-72 What changes with core strengthening exercises in orienteering athletes?

Orienteering is a running-related endurance sport comprised of physical and cognitive components. Orienteering athletes compete on a timed run through unknown cross-country terrain, checking in at predetermined control sites while navigating with only a map and compass. Because of the nature of orienteering sport, which involves speedy traversing on uneven terrain, uphill running ability is a determining factor of performance. In orienteering competition, athlete’s navigating the fastest route based on the his/her own running ability will influence overall performance. Core muscle strength is an important prerequisite for several sport (e.g., track and field, climbing, soccer), and everyday activities (e.g., sitting, standing, walking in an upright position). Functionally, the core can be thought of as the kinetic link that facilitates the transfer of torques and angular momentum between the lower and upper extremities that is of vital importance for sport-specific. Core strengthening programs have not been well researched for clinical outcomes. Our literature scan showed us that studies about effect of core strengthening exercises in athletes are few and there is no study in orienteering athletes. We aimed to determine the contribution of core strengthening exercises in addition to general training on physical and physiological parameters in elite orienteering athletes. A total of 30 female elite athletes in the same orienteering club with age of 20 to 21 years were included in the study. Athletes were randomly divided into two groups (Group 1 core strengthening exercises and group 2 as control). Both groups were done same orienteering training program and training programs lasted 12 weeks (5 days/week). Group 1 was also performed core strengthening exercise program, each program lasted 40 minutes (3 days/week) with body weight and gravitational loading (3 sets of 8 core strengthening exercises including the curl-up, side bridge, and quadruped position). Age, height, weight, body mass index, fat percentage, pulmonary function test, Wingate anaerobic power test, Cooper test, Isokinetic test, balance and coordination measurements were assessed at baseline and at the end of 12 weeks. Groups were compared to measurement results. Demographic data, balance, coordination, strength and endurance parameters, aerobic and anaerobic performance of groups were compared. Percentage differences of groups before and after training values of right MLI, peak torque in 60°/sec extension right, peak torque in 240°/sec extension right and left knee, FVC (Forced vital capacity), FEV1 (Forced expiratory volume in 1 second), Cooper tests were statistically significant differences (p = 0.002, p = 0.002, p = 0.002, p = 0.012, p = 0.015, p = 0.012, p = 0.008, respectively). Both groups had a significant improvement because of training. Balance, coordination, muscle strength, pulmonary function and aerobic performance parameters increased more in core strengthening training group. Interestingly, endurance parameters increased in control group but decreased in core strengthening training group. Our study has demonstrated that core strengthening exercises are important for the performance of orienteering athletes but maybe it is a fault for marathon runners. Consequently, if the goal is to enhance endurance, core strengthening training has disadvantage over performance. Further studies are needed in the future. References Roos L, Taube W, Zuest P, Clénin G, Wyss T. Musculoskeletal Injuries and Training PatternsinJunior Elite Orienteering Athletes. Biomed Res Int 2015;2015:259531. Granacher U, Schellbach J, Klein K, Prieske O1, Baeyens JP3, Muehlbauer T1. Effects of core strength training using stable versus unstable surfaces on physical fitness in adolescents a randomised controlled trial. BMC Sports Sci Med Rehabil 2014 Dec 15;6(1):40.

O-36 Stress injury detection with TC-99m MDP bone scan in recreational athletes with calf pain; contribution of SPECT/CT

Objectives Lower extremity stress fractures and stress reactions result in moderate to severe functional limitations that often preclude participation in sports and recreational activities, that involve vigorous repetitive lower limb activities and training. However these athletes may have other systemic or locoregional pathologies that may symptomatically mimic tibial stress injury. Our aim in this study was to evaluate stress injury type with bone scan, relation of exercise duration per week and contribution of SPECT/CT in recreational athletes with calf pain. Methods One hundred and forty nine patients (25 bilateral symptoms) with age of 18–53 with tibial pain who had undergone a three phase dynamic Tc-99 m MDP bone scan between January 2014 and May 2016 were included to the study. Stress injury types were determined as simple stress injury, shin split or stress fracture up to their uptake features in three phase dynamic images and uptake intensity. In case of subtle, inappropriate uptake or other sites of uptake in whole body images SPECT/CT was performed. 149 patient of 174 legs were divided into four groups (Group 1 stres injury, group 2 stress fracture, group 3 shin splint and group 4 healthy legs as control). Duration of weekly exercise were statistically analysed. Results There was no statistically significant difference between the groups in terms of age and symptoms durations (p > 0.05). There was a statically difference in exercise duration per week between the groups (p = 0.012) (Table 1). 10.5% of subjects who dealt with sports 5 hours or less was evaluated as “pathological” whereas 53% of 10 hours or more dealers were in the same category. Abstract O-36 Table 1 Percentage of exercise duration in groups Duration of exercise per week Group 1 Group 2 Group 3 Group 4 Total P Value n % n % n % n % (%)* 1-5 hours 1 5,3 1 5,3 0 0 17 89,5 10,9 0,012 5-10 hours 2 5,0 4 10,0 6 15,0 28 70,0 23,0 Over than 10 hours 10 8,7 21 18,3 30 26,1 54 47,0 66,1 Total (n)** 13 26 36 99 174 *The percentage of the column, **The percentage of the line 87/149 bone scan revealed one or more foci compatible with stress injury. Among 149 patients 41 had also undergone a SPECT/CT scan. 20/70 patients who have stress injury in bone scans had positive findings bilaterally. There was a statically difference in a SPECT/CT scan between groups (%38, 5, %50, 0, %13, 9, %18, 2, p = 0.002 respectively). SPECT/CT images revealed stress fractures of metatarsal region in nine patients and also demonstrated five other causes of Tc-99m MDP uptake which were a fibroxantoma, a giant cell bone tumour, a polyosthotic bone disease, a an osteoid osteoma and a unilateral sacroileitis. Conclusions Dynamic -three phase bone scan is a conventional method in assesment of stress injuries. SPECT/CT imaging has a leading and distinctive role for also other musculoskeletal disorders and may offer a different opportunity for treatment and follow ups. Duration of exercise is also an important factor for discrimination of stress injury patients. Reference Shaffer SW, Uhl TL. Preventing and Treating Lower Extremity Stress Reactions and Fractures in Adults. J Athl Train 2006 Oct–Dec; 41(4):466–9.