Novel esophageal speech therapy method in total laryngectomized patients: biofeedback by intraesophageal impedance

The loss of the best communication port after total laryngectomy surgery makes speech rehabilitation an important goal. Our aim was to improve the quality of esophageal speech (ES) using online esophageal multichannel intra-luminal impedance (MII) as a new biofeedback method. Twenty-six total laryngectomized patients were included. Before ES therapy, an esophageal motility test was carried out. MII catheters were placed in all subjects who were then randomized into two groups. Group 1 included 13 cases, who were retrained according to the classical method. Group 2 included 13 cases, who were retrained according to the simplified animation of air movements within the esophagus and upper stomach resulting from the modifications of intra-esophageal air kinetics gained by MII. The level of speech proficiency was evaluated relative to pretraining levels using perceptual scales in the third and sixth months. Acoustic voice was analyzed. The number of syllables read per minute and the intelligibility of monosyllabic and dissyllabic words were calculated. In this study, MII was used for the first time in alaryngeal speech rehabilitation as a biofeedback method; an overall sufficient speech level was achieved by 68.4% at the end of therapy, whereas attendance was 90%. A statistically significant improvement was found in both groups in terms of ES level compared with the pretraining period although there was no significant difference between groups. Although we did not observe the expected difference between groups suggested by our hypothesis, MII may be used as an objective tool to show patients how to swallow and regurgitate air during training, and may thus expedite ES therapy both for the speech therapist and the patient in the future.

Is vestibular rehabilitation as effective in bilateral vestibular dysfunction as in unilateral vestibular dysfunction?

BACKGROUND

Bilateral vestibular dysfunction causes serious disabilities and handicaps. Patients with bilateral dysfunction often restrict their activities and tend to be unsocial.

AIM

To compare the effects of vestibular rehabilitation on disability, balance, and postural stability in patients with unilateral and bilateral vestibular dysfunction.

DESIGN

Retrospective study.

SETTING

Outpatient rehabilitation center.

POPULATION

Patients with unilateral (group 1, N.=42) and bilateral vestibular dysfunction (group 2, N.=19).

METHODS

All patients were evaluated before and after eight weeks of customized vestibular rehabilitation for disability (Dizziness Handicap Inventory [DHI], Activities-specific Balance Confidence Scale [ABC]), dynamic balance (Timed Up and Go Test [TUG], Dynamic Gait Index [DGI]), and postural stability (static posturography).

RESULTS

The differences between DHI, TUG, DGI, and falling index (as assessed by static posturography) scores before and after the exercise program were statistically significant in both groups (P<0.05). There were no significant intergroup differences in any of the parameters evaluated (P>0.05).

CONCLUSION

In this study, vestibular rehabilitation was found to be equally effective in unilateral and bilateral vestibular dysfunction patients for improving disability, dynamic balance, and postural stability.

CLINICAL REHABILITATION IMPACT

Patients with bilateral dysfunction, causing more disability and greater handicap may indeed regain their functions as in patients with unilateral vestibular dysfunction by receiving appropriate and adequate vestibular rehabilitation.

Predictive value of esophageal motility test in the proficiency of esophageal speech

One method of speech rehabilitation following total laryngectomy surgery is esophageal speech therapy (EST). In this method, which has witnessed relatively low success rates at the end of therapy, identification of patients who can benefit from EST beforehand will be important for determining the appropriate method for alaryngeal speech rehabilitation and might be cost-effective, saving time and labor. To this end, this study conducted research on the feasibility of manometric data measured prior to therapy using an esophageal motility test (EMT) in order to determine the candidates most suitable for esophageal speech (ES) beforehand. A total of 51 total laryngectomy male patients who had never been subject to any kind of speech rehabilitation and had always been articulate were included in the study. Data were collected from 44 patients who completed EST, lasting for 6 months in total and consisting of 11 sessions. Manometric measures were obtained through EMT using a water-perfusion system with a Dent sleeve catheter on the patients prior to the therapy. Wepman's scale was used in order to evaluate ES proficiency. Following the therapy, in accordance with this scale, while patients whose scores was 1, 2, or 3 were considered as adequate, those whose scores were 4, 5, 6, or 7 were considered inadequate and were divided into two groups. Manometric correlations were analyzed between 17 patients (group I) who were able to perform ES at an adequate level and 27 patients (group II) who could not. No statistically significant difference between the groups could be observed in terms of average pressure generated within the upper and lower esophageal sphincters obtained through EMT, peak amplitude of esophageal body contraction pressure, contraction duration time, onset velocity, or peak velocity values. EMT conducted prior to application of EST to total laryngectomized patients did not have any value in determining the level of ES that a patient could reach. Our results also suggest that sphincter pressures or esophageal motility patterns do not have any predictive value and should not be performed.

The effect of laparoscopic Nissen fundoplication on laryngeal findings and voice quality

BACKGROUND

This study aimed to report the need for an ear, nose, and throat (ENT) specialist to evaluate the laryngeal findings and the voice quality of patients with gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux (LPR) symptoms before and after surgery.

METHODS

For this study, 38 GERD patients who had a Reflux Symptom Index (RSI) score higher than 14 underwent complete assessment in the ENT department. Standard 24-h pH monitoring, esophageal motility assessment, a detailed ENT examination including the RSI, the Reflux Finding Score (RFS), and objective voice analysis were performed for all the patients before reflux surgery, then 6 to 8 months afterward.

RESULTS

The subject's mean RSI scores were 25.45 +/- 7.5 before and 16.52 +/- 5.06 after surgery (p < 0.05), and the mean RFS scores were, respectively, 10.37 +/- 2.7 and 5.5 +/- 1.45 (p < 0.05). The pre- and postoperative differences in the RSI and RFS scores and the voice parameters were statistically significant.

CONCLUSIONS

Objective voice analysis, RSI, and RFS can be used to evaluate the postoperative results for GERD patients with LPR symptoms. Examination of these patients by an ENT specialist is necessary before and after the operation.

Pre-emptive effects of ibuprofen syrup and lidocaine infiltration on post-operative analgesia in children undergoing adenotonsillectomy

We aimed to compare the effects of lidocaine and adrenaline with ibuprofen syrup (administered before adenotonsillectomy) on post-operative analgesia and initiation of oral feeding. One group of 20 children received 100 g/5 ml ibuprofen suspension (10 mg/kg) 1 h before anaesthesia; bleeding control was provided by pre-incisional administration of 1:200,000 adrenaline solution (10 ml). The same amount of 0.5% lidocaine solution plus 1:200,000 adrenaline was applied pre-incisionally in a similar manner in a second group of 20 children. No significant differences were observed between the two groups in terms of the duration of operation and anaesthesia, post-operative pain scores, paracetamol requirements, times to initiation of liquid and solid food intake, or adverse side-effects. We conclude that ibuprofen syrup applied pre-incisionally and local infiltration with lidocaine are equally effective for post-operative analgesia.

An important procedure in ossiculoplasty: autoclaving the ossicles

Autoclaving of the ossicles prior to ossiculoplasty is a very important procedure in surgery of cholesteatomatous chronic otitis media. Autoclaving allows the reuse of the ossicles removed from patients with cholesteatomatous chronic otitis media as an autograft. It also allows utilization of the malleus, incus and stapes taken from cadavers or of the uneroded malleus and incus removed from patients undergoing non-functional middle ear surgery chosen carefully with detailed history and laboratory analysis. The powerful disinfecting effect of the sterilising procedures of the homografts inactivates prion proteins which cause degenerative encephalopathies. In various studies, it has been concluded that autoclaving does not alter the matrix of the bone which is responsiable for its biophysical properties, whereas it removes all viable cells within the bone and dentures the soft tissue attached to the surface of the ossicle. We have also found confirming histological results in our two previous studies published in 1999 and 2001. It is usually recommended that soft tissue on the surface of the ossicles is removed before autoclaving. It is also sufficient to autoclave the ossicles at 134 degrees C, and at 2.5 atmosphere pressure for 5 minutes in a flash autoclave. The autoclaving time of the homograft ossicles must be longer, for 20 minutes. Following the autoclaving, these homograft ossicles should be kept at pH 5.6 for 3 days, then use a solution of 0.5% formaldehyde at pH 7 and 4 degrees C for 21 days and it should be washed with physiologic saline solution three times for 7 minutes before use. Depending on the results obtained from our planned comparative experimental study, there will be no need for additional formaldehyde fixation procedure after autoclaving and the autoclaved ossicles will be used immediately without preservation in formaldehyde solution for 24 days.

Petrosal presigmoid approach to the petro-clival and anterior cerebellopontine region (extended retrolabyrinthine, transtentorial approach)

Intradural tumours affecting the clivus may be divided into three categories depending the area primarily involved by tumour. The second area extends from the spheno-occipital synchondrosis to the level of the jugular foramina. This area is best approached through the petrosal approach and suited for patients with serviceable hearing on the side of the lesion. 35 cases having skull base lesions were operated by the Skull Base Surgery Group of Ege University Medical Faculty between October 1993 and December 1997. 8 out of 35 cases having the intradural tumours affecting the petroclival and anterior cerebellopontine region, the petrosal presigmoid approach was performed in 4 patients. As hearing was absent in another 4 patients, the translabyrinthine route was coupled a the petrosal craniotomy (transtemporal approach). The aim of this article is to highlight the definitions, indications, hints and pitfalls of the approach from the otoneurological point of view.

Doppler echocardiography in adenotonsillar hypertrophy

OBJECTIVE

Adenotonsillar hypertrophy causing upper airway obstruction may lead to the pulmonary hypertension and cor pulmonale. This study aimed to clarify the diagnostic methods of this complication, besides polysomnography, to find another objective criterion for surgical intervention and to demonstrate the curative effect of adenotonsillectomy on this complication using this objective criterion.

METHODS

We studied the outcomes of 17 children with pulmonary hypertension secondary to the adenotonsillar hypertrophy. Pulmonary arterial pressure measurement was performed noninvasively by Doppler echocardiography.

RESULTS

Mean preoperative pulmonary arterial pressure was 29.12+/-4.41 mmHg and decreased dramatically after relief of upper airway obstruction by adenoidectomy and/or tonsillectomy to the normal level of 12.06+/-3.09 mmHg. These results were analyzed by equal variances t-test and found very significant (P<0.01). Regarding the symptoms of upper respiratory obstruction, symptom scores of these children decreased very significantly and were analyzed by equal variances t-test (P<0. 01) in the postoperative period. For all the symptoms individually (snoring, mouth-breathing during sleep and daytime, hyponasal voice, restless sleeping, daytime somnolence, enuresis nocturna), comparing percentages of preoperative and postoperative symptoms by unequal variances t-test, we obtained very significant decrease (P<0.01).

CONCLUSIONS

This study illustrates that Doppler echocardiography is a safe, practical and noninvasive-method in diagnosing cardiovascular disturbances--one of the complications of adenotonsillar hypertrophy and especially for measuring the pulmonary arterial pressure. All the symptoms and disorders due to the adenotonsillar hypertrophy may be reversible by performing early adeno- and/or tonsillectomy.

Wavelet transform in the time-frequency analysis of patients with articulation disorders

Spectral analysis of the human voice is a frequently used digital analysis method in the diagnosis, the planning and follow-up of the treatment of speech disorders. In the classical spectral analysis method, the principals of Joseph Fourier are used. This is called "Fourier Transform" and it accepts that all signals are formed of the synthesis of many sinusoïdal formed signals. In recent years a new transform method called "wavelet transform" accepts the complex signals formed of small signal particles called "wavelets" and it is considered that this transform will solve the documented problems of the "Fourier Transform". By using the appropriate wavelet, this transform can be used as an alternative to the Fourier transform. In this study, the patients with an articulation disorder of the "s" sound were evaluated before and after the phoniatric reeducation by using both the transform methods, and the results obtained are discussed.

The evaluation of the changes of voice registers in trainee singers by using the two-channel signal processing method

This study was done at the ENT Department of the Ege University Medical Faculty on twenty trainee singers. Using the two-channel signal processing method, the electroglottographic (EGG) signals and the voice signals were digitized with an analog-digital converting card during an ascending and descending glissando exercised by the trainee singer. These signals were recorded on the computer's hard disk and the obtained data was analysed. It has been determined that the EGG signals were more irregular the singing formant of the voice signal was very weak or absent and the change of register was more significant in less trained singers. This method can be used to evaluate objectively the change of voice registers in the training of the singers and be easily performed by adding an analog-digital converting card to a PC computer, without the need of expensive modern devices.