Virtual Reality Helps Describe the Progression of Thyroid Cartilage Calcification

OBJECTIVES

Thyroid cartilage (TC) calcifications may impact surgical planning and clinical management. However, few studies to date have implemented virtual reality (VR) to evaluate these calcifications. This study assessed the feasibility of evaluating TC calcifications in various regions and measuring their volumes through VR models generated from computed tomography scans. We also investigated age and gender-related differences in calcification patterns.

METHODS

Ninety-two participants were categorized into younger, middle-aged, and older age groups. Calcification patterns (degree in Hounsfield units and volume of calcification in cm3) in different TC regions were identified by VR analysis, which enabled comparisons between age groups and genders.

RESULTS

Significant differences in calcification patterns were observed between males and females, particularly in the middle right, middle left, bottom left, and vertex regions. Age-related differences in the vertex region showed increased calcification in the older age group.

CONCLUSION

This study points to the contribution of VR in the evaluation of complex anatomical structures. The findings revealed significant gender and age patterns in TC calcification. These insights can inform surgical planning and highlight the potential of using VR to gain a better understanding of TC calcification clinically.

Deep learning in voice analysis for diagnosing vocal cord pathologies: a systematic review

OBJECTIVES

With smartphones and wearable devices becoming ubiquitous, they offer an opportunity for large-scale voice sampling. This systematic review explores the application of deep learning models for the automated analysis of voice samples to detect vocal cord pathologies.

METHODS

We conducted a systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. We searched MEDLINE and Embase databases for original publications on deep learning applications for diagnosing vocal cord pathologies between 2002 and 2022. Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2).

RESULTS

Out of the 14 studies that met the inclusion criteria, data from a total of 3037 patients were analyzed. All studies were retrospective. Deep learning applications targeted Reinke's edema, nodules, polyps, cysts, unilateral cord paralysis, and vocal fold cancer detection. Most pathologies had detection accuracy above 90%. Thirteen studies (93%) exhibited a high risk of bias and concerns about applicability.

CONCLUSIONS

Technology holds promise for enhancing the screening and diagnosis of vocal cord pathologies. While current research is limited, the presented studies offer proof of concept for developing larger-scale solutions.

Voice Disorders and Personality: New Steps on an Old Path

OBJECTIVES

This study examined the association between voice disorders and personality by comparing a heterogenic group of dysphonic patients to non-dysphonic speakers using the NEO-FFI big-five personality inventory.

METHODS

A group of 100 dysphonic patients diagnosed with 24 different pathologies was compared to 149 non-dysphonic speakers. Inter-group differences on the five NEO-FFI scales were evaluated using three analysis approaches, a general comparison between the dysphonic and non-dysphonic groups and arranging pathologies using a categorical and a continuous approach.

RESULTS

Of the five NEO-FFI scales, Openness emerged as the single personality trait that yielded a statistically significant difference between the dysphonic group and the non-dysphonic group (P < 0.001). Moreover, when the 24 pathologies were arranged categorically, people with structural pathologies were lower on the Openness scale than non-dysphonic speakers (P < 0.001). Similarly, when pathologies were arranged continuously, people with pathologies characterized by high organicity were low on the Openness scale compared to the non-dysphonic group (P < 0.001).

CONCLUSIONS

This study represents a new approach to examining the association between voice disorders and personality. Openness emerged as the single personality trait that repeatedly and consistently differentiated between dysphonic and non-dysphonic people and among specific pathologies, using all analysis approaches. Our findings suggest that examining a spectrum of pathologies, rather than focusing on a particular pathology, provides a new perspective and sheds light on the complex association between voice disorders and personality.

Development and Validation of the Children's Voice Questionnaire (CVQ)

OBJECTIVES

This study developed and validated the children's voice questionnaire (CVQ), a new self-administered instrument for children, and evaluated its internal consistency and reliability.

STUDY DESIGN

Observational, prospective, cross-sectional study.

METHODS

The initial preparation of the CVQ was conducted in four steps. First, individual interviews were conducted with dysphonic and non-dysphonic children and their parents, teachers, and speech pathologists. Second, the responses collected from the interviews were arranged into a comprehensive list of 175 items. Third, this list was reduced to a preliminary 21-item version of the questionnaire, which was tested as a pilot with 254 children. Fourth, a further reduction to 18 items was performed to construct the final version of the CVQ. The questionnaire was then administered to 342 children (73 dysphonic, 269 non-dysphonic) aged 6-18. Simultaneously, the parents of these children completed the pediatric voice handicap index (pVHI). Finally, after 2 weeks, 30 randomly selected children (nine dysphonic, 21 non-dysphonic) completed the CVQ again to evaluate test-retest reliability.

RESULTS

High reliability was found for the CVQ (Cronbach's α = 0.94). Test-retest revealed strong and statistically significant reliability (r = 0.79, P < 0.001). A highly significant group difference was found between the CVQ scores obtained for the dysphonic and non-dysphonic groups (t[78.25] = 6.22, P < 0.001). In addition, significant medium-to-strong positive correlations were found between the children's evaluations using the CVQ and their parents' evaluations using the pVHI (0.59 < r < 0.66, P < 0.01).

CONCLUSIONS

The newly developed CVQ is a valid and reliable instrument. Findings reveal general agreement between children and their parents, but also show that children's perspective on their dysphonia is not equivalent to the parent's perspective. This demonstrates that combining both perspectives provides a more holistic and complete overview of dysphonic children's voice-related quality of life. The self-administered CVQ reliably differentiates dysphonic from non-dysphonic children and may serve as a valuable tool for the initial or ongoing evaluation of children with voice disorders in clinical and research settings.

A Very Rare Complication of Vocal Fold Augmentation With Calcium Hydroxylapatite: Neck Abscess

INTRODUCTION

Vocal fold injection augmentation is performed routinely for the treatment of glottic insufficiency especially due to unilateral vocal fold paralysis. There are numerous materials that are used for injection laryngoplasty, calcium hydroxylapatite being one of them.

CASE REPORT

We present an interesting case of a 64-year-old male patient with metastatic acinic cell carcinoma of the right parotid gland, who underwent right vocal cord injection laryngoplasty with calcium hydroxylapatite for right vocal cord paralysis with glottal insufficiency and developed a neck abscess.

DISCUSSION

This is the first report in the literature of neck abscess following vocal fold injection laryngoplasty using calcium hydroxylapatite. It seems that over injection of the vocal fold gave rise to extravasation of the injected material outside the laryngeal framework which later became a nidus for infection.

CONCLUSIONS

We present the first case in the literature of neck abscess following vocal fold injection laryngoplasty using calcium hydroxylapatite. Clinicians should be aware of this rare but dangerous complication.

Two-dimensional Scheme for Arranging Voice Disorders

Importance

Prevalent schemes that have been used for arranging voice pathologies have shaped theoretical and clinical views and the conceptualization of the pathologies and of the field as a whole. However, these available schemes contain inconsistencies and categorical overlaps.

Objective

To develop and evaluate a new approach for arranging voice pathologies, using 2 continuous scales, organicity and tonicity, which were used to construct a 2-dimensional plane.

Design, Setting, and Participants

This survey study was conducted among experts in the fields of laryngology and/or voice disorders from 10 countries. The survey was conducted using an online platform from March to May 2021. The data were analyzed in June 2021. Of the 45 experts who were initially approached, 39 (86.7%) completed the survey.

Main Outcomes and Measures

The primary outcome measures were group ratings on 2 rating scales: organicity and tonicity. On the organicity scale, 0 represented nonorganic and 10 organic. On the tonicity scale, 0 represented hypotonic and 10 hypertonic.

Results

Participants included 16 laryngologists and 23 speech-language pathologists, of whom 27 (69.2%) were women and 12 (30.8%) men with a mean age of 55 years. The Cronbach α was high for organicity and tonicity (0.98 and 0.97, respectively). Interrater agreement (rwg) was moderate to very strong (rwg≥0.50) for most pathologies. The correlation between the 2 scales was moderate and negative (r = -0.38; P = .03). The pathologies were scattered across the full range of both scales and the 4 quadrants of the 2-dimensional plane, suggesting the continuity and bidimensionality of the new arrangement scheme. In addition, a latent profile analysis suggested that the 4-cluster solution is valid and roughly corresponded to the 4 quadrants of the constructed plane.

Conclusions and Relevance

The findings of this survey study suggest the potential use of a 2-dimensional plane that was based on 2 continuous scales as a new arrangement scheme for voice disorders. The results suggest that this approach provides a valid representation of the field based on 2 basic measures beyond the specific etiology of each laryngeal pathology or condition. This simple and comprehensive organization scheme has the potential to facilitate new insights on the nature of voice pathologies, considering the interpathology similarities and differences.

Endoscopic Management of Benign Laryngo-Tracheal Stenosis: Balloon vs. Rigid Dilatation

BACKGROUND

Management of acquired laryngotracheal stenosis (LTS) is challenging and often requires recurrent procedures.

OBJECTIVES

To compare the efficacy and safety of balloon dilatation (BD) versus rigid dilatation (RD) in the treatment of LTS.

METHODS

A retrospective study of patients undergoing endoscopic intervention for LTS was performed.

RESULTS

The study included 69 balloon (BD) and 48 rigid dilations (RD). Most cases were grade 3 Cotton-Meyer stenosis. Mean time interval to recurrence after BD and RD were 27.9 and 19.6 weeks, respectively. Remission of over 8 weeks was achieved in 71% of BD compared to 31.2% of RD (P < 0.05). In the BD group, dilatation of subglottic stenosis showed higher rates of remission of over 8 weeks compared to upper and mid-tracheal stenosis (92% vs. 62% and 20%, respectively, P < 0.05). Complications were encountered in 4.2% of RD and 2.9% of BD.

CONCLUSIONS

BD and RD are effective and safe procedures. Overall, BD achieved slightly better long-term results compared to RD.

Songbirds Must Sing: How Artistic Voice Users Perceive Their Voice in Times of COVID-19

OBJECTIVE

The COVID-19 pandemic has led to a critical disruption in the music and performing arts industry, and affected singers and other artists. This study was designed to examine the effect of this unique time on artistic voice users, the way they perceive their voice and their voice-related behaviors.

METHODS

A total of 110 participants volunteered for the study: 57 professional artistic voice users (34 singers and 19 actors) and a control group of 53 nonprofessional voice users. All participants completed three questionnaires related to their self-assessment of their voice, their voice difficulties, vocal training, and current stress in the time of the COVID-19 pandemic.

RESULTS

Compared to the controls, artistic voice users were more concerned about their voice (P < 0.001), practiced their voice more often (P < 0.001), and experienced more anxiety and stress (P < 0.05). In addition, within the professional group, singers reported practicing their voice in the time of the COVID-19 significantly more than actors (P < 0.01).

CONCLUSIONS

Professional artistic voice users experience the COVID-19 pandemic as a stressful time, with negative effects on their well-being and specifically on their voice. This should be considered in the treatment and maintenance of their voice and professional career at current and future stressful times.

Translation, Cross-Cultural Adaptation, and Preliminary Validation of the Transsexual Voice Questionnaire for Male-to-Female Transsexuals (I-TVQMtF) Into Italian

OBJECTIVE

To perform a cross-cultural adaptation into Italian and to analyse reliability and validity of the Transsexual Voice Questionnaire for male-to-female transsexuals (I-TVQ^MtF).

STUDY DESIGN

Cross-sectional nonrandomized survey study.

METHODS

For item-generation, a cross-cultural adaptation and translation process was performed following standard guidelines. Transgender women were consecutively recruited and asked to fill out the I-TVQ^MtF and a form on social, demographic and transition-related variables. Firstly, data collected from participants were used to perform confirmatory factor analysis, and to evaluate internal consistency and test-retest reliability Subsequently, convergent validity was evaluated comparing I-TVQ^MtF total scores with the two extra items addressing self-perception (SPVF) and aspiration (AVF) of voice femininity. To evaluate convergent validity, scores of the Italian version of the Voice Handicap Index were considered for comparisons. A correlation analysis was performed to verify potential association between I-TVQ^MtF scores and social, demographic and transition-related variables.

RESULTS

Confirmatory factor analysis demonstrated that a two-factor model fits data better than the unidimensional one. Both internal consistency and test retest reliability of the I-TVQ^MtF were satisfactory. Negative correlations were highlighted between I-TVQ^MtF scores on one side and self-perception vocal functioning and aspiration vocal functioning on the other. Positive correlations between I-TVQ^MtF and Italian version of the Voice Handicap Index scores were also found. Finally, negative correlations were demonstrated between I-TVQ^MtF scores and time spent living in the female role.

CONCLUSION

The I-TVQ^MtF appears to be a reliable and valid instrument for the assessment of voice-related quality of life in transgender women.

Non-contact optical sensing of vocal fold vibrations by secondary speckle patterns

Vocal folds lesions are commonly diagnosed using an endoscopic-stroboscope. However, the stroboscopic picture of the vocal folds vibrations is subjectively and qualitatively evaluated by the clinician and, due to technical limitations, is unable to accurately distinguish between healthy and pathologic regions. In this paper, we propose two optical approaches for objectively sensing the vocal folds vibrations, using either external or internal laser illumination, based on temporal tracking of the reflected spatial distribution of secondary speckle patterns. The external configuration (the neck) is noninvasive and the internal configuration (the larynx) allows simultaneous extraction of data from multiple sites on the vocal folds. In this paper, we present measurements of healthy human subjects. Quantitative and precise measurements of vibration parameters of the vocal folds will enable a better understanding of hidden pathologies and optimize the diagnosis and treatment.

Imaging of the age-related anatomical relationship between the innominate artery and the trachea

PURPOSE

To measure the age-dependent changes of anatomical positions and relations between the trachea, cricoid cartilage (CC), and innominate artery (IA) in adults by computed tomography (CT).

METHODS

A retrospective cohort reviewing images of 127 consecutive adult patients who underwent CT angiography (CTA) of the neck. The trachea-to-IA (T-IA) distance was measured as the minimal horizontal distance between them. The vertical distance between the CC and the IA was measured between the axial section, demonstrating the CC's inferior border to the axial section at the level of the T-IA measurement.

RESULTS

Images of 125 patients (median age 53 years, range 18-89; 74 males) were reviewed. The mean T-IA distance was 2.3 ± 1.1 mm for males and 1.7 ± 0.9 mm for females (P = 0.002). The vertical C-IA distance was 44.2 ± 11.4 mm and 49.5 ± 12.5 mm for males and females, respectively (P = 0.01). Age correlated negatively with the vertical C-IA distance (P < 0.0001) and positively with the T-IA distance (P < 0.0001). The rate of IA variants was 23.2%, with no significant difference between the measurements of distances among patients with or without IA variants.

CONCLUSIONS

This is the first description of the relationships between the trachea, CC, and IA distances in adults as depicted on CTA. The T-IA distance becomes larger while the T-CC distance becomes shorter with age.

The Prevalence of Self-Reported Voice Disorders in Israel

OBJECTIVE

Data on the prevalence of voice disorders is vital in order to describe and understand the phenomenon. The aim of this study was to estimate the prevalence of voice disorders in Israel, and perform a preliminary comparison between the two major societies in the country.

METHODS

A sample of 1146 people participated in a survey on voice disorders. This sample comprised 510 Israeli Jews and 627 Israeli Arabs. Each participant completed a questionnaire concerned with voice and its disorders as well as the shortened Voice Handicap Index-10 (VHI-10).

RESULTS

The overall prevalence of voice disorders within our sample was 13.90%. In addition, 30.26% of the participants reported experiencing a voice problem over the last year, while 12.81% reported seeing a physician for that reason. No significant differences were found in the prevalence of voice disorders between participants who identified themselves as either Jews or Arabs. A higher prevalence of voice disorders was found in the older age groups, and among people who reside in the southern region of the country. In contrast, no significant differences in the prevalence of reported voice disorders were found between men and women.

CONCLUSION

The prevalence of reported voice disorders in Israel is comparable with previous prevalence reports from other regions and societies. Data show that despite cultural, religion, language, and other factors, the prevalence of voice disorder among Israeli Jews and Arabs is very similar.

Evaluating the Validity of the Voice Handicap Index-10 (VHI-10) Among Hebrew Speakers

OBJECTIVE: To evaluate the validity of a translated version of the Voice Handicap Index-10 (VHI-10).

STUDY DESIGN AND SETTING: In a parallel group design, 221 patients with different laryngeal pathologies and 172 people with no laryngeal pathology completed a Hebrew version of the VHI-10. Validity and reliability were assessed as well as group differences.

RESULTS: Statistical analyses demonstrated high reliability values (Cronbach's Alpha r = 0.949). Responses were not affected by age ( P = 0.373) or gender ( P = 0.360). The control group received significantly lower scores than all pathological groups ( P < 0.05). Within the pathological groups, the “neurogenic” and “mucosa irregularity’ groups were rated higher than all other pathological groups ( P < 0.05).

CONCLUSION: The VHI-10 questionnaire maintains its validity and reliability across translation to Hebrew. Moreover, although the VHI-10 is essentially a unidimensional tool, it provides partial information on the 3 subjective dimensions of the full VHI.

Acute Invasive Fungal Rhinosinusitis in Children With Hematologic Malignancies: Outcome of Surgical Treatment

The incidence of acute invasive fungal rhinosinusitis (AIFR) is rising due to more aggressive chemotherapy and longer survival of immunosuppressed patients. Early diagnosis and appropriate but nonmutilating surgical treatment are particularly problematic in the pediatric population. This study aimed to evaluate the outcome of surgery for pediatric AIFR. Medical records of children surgically treated for AIFR between 1998 and 2014 were reviewed. Diagnosis was based on both histopathological and microbiological confirmation. Surgery was performed with curative intent and repeated for any resectable extension. The children underwent endoscopy and magnetic resonance imaging every 2 and 6 months, respectively, during the first postoperative year. Thirteen patients (2-18 years old) met the EORTC/MSG criteria for proven invasive fungal sinusitis; fungal invasion was diagnosed by preoperative biopsy and confirmed in the surgical specimen. All patients underwent an average of two endoscopic procedures (range 1-3), and four of them also underwent an open surgery. The local control rate was at least 79%. There was no facial disfiguration during follow-up (average 41 months). Although AIFR is still associated with high mortality, aggressive medical and surgical treatment provides local control in most cases. Fair outcome should encourage a maximal joint effort of pediatric hemato-oncologists and otorhinolaryngologists in the management of AIFR.

Novel Anatomic Characteristics of the Laryngeal Framework

Objective

The thyroid cartilage (TC) in men has a more prominent thyroid notch and a narrower interlaminae angle (ILA) as compared with women. Anatomy textbooks classically stipulate that the ILA is 90° in men and 120° in women. Our observation, based on thyroid chondroplasty operations, of a much narrower angle led to the current investigation.

Study Design

Cohort imaging study.

Setting

Tertiary academic referral center.

Subjects and Methods

Computed tomography angiography neck images of adult patients were studied. The ILA was measured on 2 axial planes: at the level of the vocal processes (and the upper portion of thyroarytenoid muscles) and 5 mm superior and parallel to the former. The anterior projection of the TC and the vertical dimensions of the midline cricothyroid membrane (CTM) were also measured.

Results

A total of 126 patients were included in the study. The average ILAs were 63.5°±20.6° and 93.3°±16.6° for men and women, respectively ( P < 10−14), and were significantly narrower at the upper level in comparison with the vocal process level ( P < 10−7 for men, P = .004 for women). The anterior projection of the TC in men was more prominent as compared with women ( P = .0003) and significantly correlated with the ILA ( P = .0159). The length of the midline CTM was 11.1±2.3 mm in men and 10.3±1.7 mm in women ( P = .0355).

Conclusions

The ILA is narrower than that reported in the classic anatomy textbooks. In male patients, the upper part of the TC becomes narrower and projects anteriorly like a “jug’s spout.” The mean vertical dimension of the midline CTM was 10 to 11 mm.

Evaluation of nasal airway patency by analysis of breathing sounds

CONCLUSIONS

A simple non-invasive method, based on acoustic analysis of breathing signals, revealed a potential for objective evaluation of differences between the patency of nasal passageways.

OBJECTIVES

To examine whether acoustic signals of nasal breathing contain information that can differentiate between obstructed and patent nasal passageways.

METHOD

A technical study aimed to examine measurements of nasal airflow acoustic signals, taken, non-invasively, simultaneously from both external sides of the nostrils. The signals were acquired for several breathing cycles, with different respiratory efforts, before and after application of a nasal decongestant to the (narrower) side that yielded lower amplitudes. Data processing of the expiratory phase yielded the power spectrum density (PSD), which was used to compute the ratio of PSD areas between the signals from both sides of the nose. The study group was composed of 20 healthy volunteers.

RESULTS

PSD changes were noted in accordance with the rise in expiratory efforts. The ratio of PSD areas between the two sides of the nasal cavity, calculated for maximal expiratory efforts, correlated well with the side that was treated with nasal decongestant in 18 out of the 20. Changes in the opposite direction were noted in two examinees.

Computerized Analysis of Vocal Folds Vibration From Laryngeal Videostroboscopy

OBJECTIVES

To develop an objective analysis of laryngeal videostroboscopy (VSS) movies in the space-time domain for quantitative determination of the true vocal folds (TVFs) vibratory pattern to allow for detection of local pathologies at early stages of development.

METHODS

Contours of the TVF and false vocal folds (FVFs) were tracked on each frame of a VSS movie. A registration algorithm was used with respect to the centerline of the FVF to eliminate movements not related to TVF vibration. The registered contours of the TVF were analyzed in time and frequency domains.

RESULTS

The TVF vibration demonstrated a sinusoidal pattern with the same fundamental frequency at every section along the folds of healthy subjects, as well as detection of an abnormal area with a different fundamental frequency in TVF with local pathologies. Analysis of the TVF vibration time delay of healthy subject revealed a posterior-to-anterior longitudinal wave that was not detected by visual observation.

CONCLUSIONS

An objective analysis of laryngeal VSS movies was developed for quantitative determination of the TVF vibration. This analysis was able to detect and quantify TVF characteristics in normal subjects as well as in patients with pathologies beyond the ability of examinee's naked eyes.

Posterior glottic stenosis in adults

BACKGROUND

Posterior glottic stenosis is a complication of prolonged intubation, manifesting as airway stenosis that may mimic bilateral vocal cord paralysis. It presents a variety of features that mandate specific surgical interventions.

OBJECTIVES

To summarize our experience with PSG and its working diagnosis.

METHODS

We conducted a retrospective review of a cohort of adult patients with PGS operated at the Sheba Medical Center between 1994 and 2006.

RESULTS

Ten patients were diagnosed with PGS, 6 of whom also had stenosis at other sites of the larynx and trachea. Since 2000, all patients underwent laryngeal electromyographic studies and direct laryngoscopy prior to surgery. Surgical interventions included endoscopic laser procedures (in 2 patients), laryngofissure and scar incision (in 1), laryngofissure with buccal mucosa grafting (in 3) or with costal cartilage grafting (in 1) and laryngofissure with posterior cricoid split and stenting (in 1); one patient was not suitable for surgery. Postoperative follow-up included periodic fiberoptic endoscopies. Voice analysis was evaluated by the GRBAS grading. Seven patients were successfully decannulated within one to three procedures. Voice quality was defined as good in 7 patients, serviceable in 2 and aphonic in 1.

CONCLUSIONS

Posterior glottic stenosis may be isolated or part of complex laryngotracheal pathologies. Electromyographic studies and direct laryngoscopy must be included in the diagnostic workup. Costal cartilage or buccal mucosa grafts are reliable, safe and successful with respect to graft incorporation and subglottic remodeling.

Granular Myringitis

OBJECTIVE

To examine the incidence and the clinical features of granular myringitis (GM).

STUDY DESIGN

A 2-year prospective cohort study.

SETTING

A primary otolaryngology clinic affiliated with a tertiary academic referral center.

PATIENTS

All-aged patients diagnosed with GM who had no apparent middle ear disease or did not undergo ear surgery.

INTERVENTION

Otoscopy and bacteriologic and histopathologic studies.

MAIN OUTCOME MEASURES

Granular myringitis was noted in 0.41% of patient's population presenting different forms.

RESULTS

Granular myringitis was detected in 26 patients. Recurrent infection occurred in seven (26.9%) and bilateral GM in five patients (19.2%). Perforation of the tympanic membrane (TM) was noted in eight patients (30.7%), six of which closed spontaneously. Otoscopic findings could be classified into three grades: focal de-epithelization (in 10), focal polypoid granulations (in 13), and diffuse polypoid formation over the entire TM (in 3). Histopathologic examination disclosed tiny fragments of granulation tissue infiltrated by nonspecific chronic and acute inflammatory reaction.

CONCLUSION

Granular myringitis is encountered not infrequently in primary otolaryngology practice and presented different forms, recurrent episodes, and bilateral involvement. Topical application of antibiotics or caustic agents was successful in all cases. Perforation of the TM may develop and resolve spontaneously during the course of the disease.

Cricotracheal resection for airway reconstruction: The Sheba Medical Center experience

BACKGROUND

Intubation and tracheostomy are the most common causes of benign acquired airway stenosis. Management varies according to different conceptions and techniques.

OBJECTIVES

To review our experience with cricotracheal resection and to assess related pitfalls and complications.

METHODS

We examined the records of all patients who underwent CTR in a tertiary referral medical center during the period January 1995 to April 2005.

RESULTS

The study included 61 patients (16 women and 45 men) aged 15-81 years. In 17 patients previous interventions had failed, mostly dilatation and T-tube insertion. Complete obstruction was noted in 19 patients and stenosis > 70% in 26. Concomitant lesions included impaired vocal cord mobility (n=8) and tracheo-esophageal fistula (n=5). Cricotracheal anastomosis was performed in 42 patients, thyrotracheal in 12 and tracheotracheal in 7. A staged procedure was planned for quadriplegic patients and for three others with bilateral impaired vocal cord mobility. Restenosis occurred in six patients who were immediately revised with T-tube stenting. Decanulation was eventually achieved in 57 patients (93.4%). Complications occurred in 25 patients, the most common being subcutaneous emphysema (n=5). One patient died of acute myocardial infarction on the 14th postoperative day.

CONCLUSIONS

CTR is a relatively safe procedure with a high success rate in primary and revised procedures. A staged procedure should be planned in specific situations, namely, quadriplegics and patients with bilateral impaired vocal cord mobility.

The feasibility of rigid stroboscopy in children

OBJECTIVE

Voice disorders in children are common but ways of their analysis are limited. We conducted a prospective feasibility study of rigid stroboscopy in children.

METHODS

All children referred for voice analysis during the years 2002-2003 were evaluated including subjective perception of voice, voice recording, flexible or rigid laryngoscopy and stroboscopy. Children were prepared by an explanation and visual demonstration. Local anesthesia was introduced through inhalation of Lidocaine (2%) solution prior to examination. Stroboscopy was performed either by a 70 degrees rigid laryngoscope or by a 3.0 mm fiberoptic-flexible endoscope.

RESULTS

Forty-two children were analyzed. Rigid stroboscopy was feasible in 31 children of whom 7 were under 10 years of age. Short phonation time (7), gag reflex (6), impaired view due to high and posteriorly inclined epiglottis (4) were the main reasons of failure.

CONCLUSIONS

Standard telescopic stroboscopy can be safely and effectively implemented in the majority of children over 10 years of age.

[Upper respiratory tract manifestations in yellow nail syndrome]

Yellow Nail Syndrome (YNS) is characterized by a triad of ankle edema, pleural effusion and yellow nails. A close association was also found between YNS and rhinitis and sinusitis ranging from 25% to 83%. Although usually other symptoms precede rhinosinusitis, we describe three cases in which the onset of the upper respiratory tract manifestations predated nail changes and other characteristics of YNS. Our aim is to emphasize the importance of upper respiratory tract diseases in this uncommon syndrome.

Granular myringitis in children

BACKGROUND

Granular myringitis (GM), described mainly in adults, is considered a rare infection of the tympanic membrane (TM) with possible involvement of the external ear canal. The study was aimed to evaluate the clinical characteristics of the disease in children.

MATERIAL

A 2-year prospective study on all children with GM in a primary otolaryngology practice affiliated to a tertiary academic medical center. GM was defined by de-epithelization of the TM, granulation-tissue formation and discharge. Children with otitis media were excluded. Treatment included topical application of ear drops, caustic solution in unresponsive cases and mechanical removal of polypoidal granulations.

RESULTS

Nine children, five boys and four girls, aged 3--16 (mean=11.5 years) were diagnosed as GM. Mainly plugged ear (6) and aural discharge (5) presented GM. Only a circumscribed area of the pars tensa was involved. GM was expressed either by a tiny shallow lesion (6) or by raised polypoidal masses (3). All children recovered within 2--11 weeks (mean 3.6). Recurrent infection was noted twice in one child. Small dry perforation of the TM was noted in two children. Histopathological studies revealed non specific acute and chronic inflammatory reaction.

CONCLUSIONS

Granular myringitis must be recognized in children. GM has a benign course responding to topical treatment. It may be misidentified as persistent chronic suppurative otitis media with polyps protruding through the TM. Although perforation of the TM may develop in the course of the disease, the middle ear remained intact.