The efficiency of the DoctorVox voice therapy technique in conversion dysphonia and aphonia

OBJECTIVE

The main purpose of this study was to retrospectively evaluate the efficiency of DoctorVox voice therapy in psychogenic dysphonia or aphonia patients, and to share the mid- to long-term results of the method.

METHODS

The study was carried out on patients who underwent DoctorVox voice therapy for psychogenic dysphonia or aphonia between January 2015 and September 2019. The evaluation methods used were: the Voice Handicap Index-10; the grade, roughness, breathiness, asthenia and strain ('GRBAS') scale; and videolaryngostroboscopy recordings.

RESULTS

The mean Voice Handicap Index-10 values of the patients were 30.91 ± 2.97 before treatment, 8.14 ± 3.82 after treatment, and 3.36 ± 1.78 in the final follow-up examination. The grade, roughness, breathiness, asthenia and strain scale scores were: 9 ± 0.67 pre-treatment, 0.78 ± 0.80 post-treatment, and 0.57 ± 0.64 at the final follow up.

CONCLUSION

DoctorVox voice therapy seems to be an efficient treatment method for psychogenic dysphonia or aphonia; it helps develop phonatory muscle functions, using multidimensional biofeedback mechanisms, and increases the patients' therapy adherence.

Effects of Obesity on the Auditory Function of Children and Adolescents

Introduction Childhood and adolescent obesity is associated with insulin resistance, abnormal glucose metabolism, hypertension, dyslipidemia, inflammation, liver disease, and compromised vascular function.

Objective We aimed to evaluate the effects of obesity on the auditory function and speech audiometry of children and adolescents.

Methods Subjects with a body mass index (BMI) higher than +2 standard deviation (SD) were classified as obese, and subjects with normal BMI SD were classified as the control group. Blood samples were taken for glucose, insulin, and lipid profiles following an 8-hour fasting period, and a hepatobiliary ultrasound was performed. The homeostatic model assessment for insulin resistance (HOMA-IR) was calculated. The audiological evaluation included pure-tone audiometry (PTA), speech reception threshold (SRT), and speech discrimination score (SDS).

Results The study included 100 children (50 girls) with obesity, with a mean age of 11.4 ± 2.9 years and 30 children with normal body weight, with a mean age of 11.9 ± 3.3 years. Of the children with obesity, 55% (n = 55) were found to have hyperlipidemia, 68% (n = 68) insulin resistance, and 21% (n = 21) hepatosteatosis. There were no statistically significant differences between children with obesity and the control group in terms of SDS or PTA, while SRT was found to be higher in children with obesity. There was no difference between obese children with or without hyperlipidemia, between obese children with or without insulin resistance, and between obese children with or without hepatosteatosis, according to hearing tests.

Conclusion The result of the present study indicates that children with obesity are more prone to having auditory problems than the normal population. We recommend more frequent audiological evaluations, including speech audiometry, in children and adolescents with obesity problems

Mucosal Bridge Reconstruction: A Novel Approach for the Vocal Fold Mucosal Bridge

INTRODUCTION

Mucosal Bridges (MBs) are defined as benign connective tissue abnormalities of unclear etiology that extend over the free surface of the vocal fold, are attached to the front and back of the vocal fold but are not attached to its free surface, and are histologically covered by stratified squamous epithelium. In order to overcome these drawbacks, we aimed to retrospectively evaluate and present the preoperative and postoperative results of patients with MB, who were applied the method we call "Mucosal Bridge Reconstruction" (MBR), which we apply as suturing rather than resection of the MB.

METHODS

Between January 2016 and February 2020, 5 patients who applied to the voice clinic due to dysphonia and were diagnosed with MB via laryngostroboscopic examination and direct laryngoscopy under general anesthesia were included in the study. Dr Speech software was used for acoustic analysis; mean fundamental frequency (fo), jitter %, shimmer %, and noise to harmonic ratio (NHR) were objectively measured and recorded. Voice Handicap Index-10 (VHI-10) was used for positive self-reporting of the severity of vocal symptoms. GRBAS scale (G: Grade, R: Roughness, B: Breathiness, A: Asthenia, and S: Strain) was also used (by the same clinician) for clinic subjective evaluation.

RESULTS

Patient age ranged from 33 to 55 years and mean patient age was 42 years. Mean duration of symptoms was 22 months (range 16-30). Mean postoperative follow-up time was 14 months (range 6-24). Unilateral MB was observed in all patients (2 left, 3 right). There was a significant improvement in objective and subjective assessment methods in all our patients after surgery.

CONCLUSIONS

According to the results of our few patients, MBR offers a physiological and anatomical approach to the treatment of patients with MB. The outcomes of delicate microlaryngeal surgery are promising.

Investigation of Effect on Activities of Daily Living and Symptoms in Hemodilaysis Patients

Background

Hemodialysis patients develop many physical and psychosocial symptoms associated with chronic kidney disease and its treatment. The presence of these symptoms also adversely affects an individual's activities of daily living.

Aim

The aim of this study was to evaluate the symptoms seen in hemodilaysis patients and to examine the effect on daily living activities.

Materials and Methods

This was a cross-sectional descriptive study carried out on 126 patients in two dialysis centers in Turkey. Patient Information Form, Dialysis Symptom Index (DSI) and Katz Activities of Daily Living Scale (KADL) were used as data collection tools.

Results

The most frequent symptoms described by the patients undergoing hemodialysis were tiredness, sadness, and muscle-joint pain. The mean of the DSI was 30.03 (SD: 14.7). There was a statistically significant relationship between dialysis symptom index and disease duration and hemodialysis vintage (P < 0.05). In addition, the mean score of the Patients' KADL was 14.48 (SD: 2.55). Eighty-two (65.1%) patients maintain their daily living activities independently. On the other hand, 26.2% of the dialysis patients maintained their daily living activities as semi-dependent, while 8.7% were totally dependent on others. A statistically significant relationship was found between KADL, marital status, year of dialysis and presence of another chronic disease (P < 0.05). There was statistically significant relationship between DSI and KADL. In hemodilaysis patients, as the DSI score increased, the dependence on daily living activities increased.

Conclusion

The symptoms seen in patients have a negative effect on maintaining their daily living activities. Health workers should perform symptom evaluation in patients undergoing dialysis. Thus, each patient-specific individualized care plan should be designed for effective management of these symptoms in patients. Effective symptom management will be effective in maintaining patients' daily living activities.

Effect of Omalizumab on Nasal Symptoms in Asthma and Perennial Allergic Rhinitis

OBJECTIVE

To determine the efficacy of omalizumab on nasal symptoms in patients having allergic asthma with rhinitis symptoms.

STUDY DESIGN

Cohort study.

PLACE AND DURATION OF STUDY

University of Health Sciences, Izmir Tepecik Training and Research Hospital, İzmir, Turkey, between October and November 2019.

METHODOLOGY

This study included patients with perennial allergic rhinitis without nasal polyposis who were followed up in the adult allergy outpatient clinic, had findings consistent with allergic rhinitis upon nasal endoscopic examination. They were given 2-4 weekly subcutaneous omalizumab for more than six months changes in nasal symptoms were noted using nasal symptoms score. Each symptom was individually evaluated.

RESULTS

There were 42 patients, consisting of 36 women (85.7%) and six men (14.3%), who received omalizumab treatment. Patient age ranged between 30 and 77 years, mean = 54.21±10.85 years. Median change in nasal symptom score of all cases after treatment was a 3.5 (2-6.25) decrease, which was statistically significant (p <0.001). When we examine the decrease in nasal symptoms after omalizumab compared to pre-omalizumab in all cases, the most prominent change was observed in the symptom of nasal congestion.

CONCLUSION

Two-four weekly subcutaneous omalizumab for six months or more was effective in treating all rhinitis symptoms and had the greatest effect on nasal congestion compared to all other symptoms. Key Words: Allergic rhinitis, Anti-IgE, Omalizumab, Total nasal symptom score (TNSS), Asthma.

A Novel Surgical Technique for Bilateral Vocal Fold Paralysis: Microlaryngeal Posterior Glottoplasty

OBJECTIVES/HYPOTHESIS

Bilateral vocal fold paralysis (BVFP) is a clinical condition that may require emergency intervention that is characterized by airway obstruction. The main aspect to be taken under consideration in treatment is to preserve the vocal functions as much as possible while also ensuring an open airway. This study aims to present the preliminary results of a novel surgical method that we refer to as "posterior glottoplasty," which has been performed on BVFP patients to minimize phonation disorder and achieve a better respiratory function.

METHODS

Five female patients who developed BVFP-related respiratory distress following total thyroidectomy surgery and underwent "posterior glottoplasty" between 2017 and 2019 were included in our study. Preoperative and postoperative aspiration-swallowing, respiration, and phonation functions were separately evaluated in all patients.

RESULTS

Five subjects were included in the study. All patients were female and between 31 and 67 years of age (mean 47). The mean duration of dyspnea was 58.4 months (range: 6-120). Mean postoperative follow-up time was 11.6 months (range: 6-18). All patients experienced respiratory relief in the postoperative period. Acoustic voice analysis showed minimal to no phonation loss. Minimal aspiration was observed in the early postoperative period which was supposed to be related to the Botulinum effect and it resolved in 2-4 weeks.

CONCLUSIONS

The posterior glottoplasty technique aims to increase the posterior (respiratory) glottic space for a better inhalation while keeping the membranous (phonatory) glottic gap to preserve phonation by redirecting the residual or synkinetic muscular vectors. It does not carry major morbidity risks in terms of phonation and aspiration and validates potential spontaneous recovery of the vocal fold paralysis since it preserves the integrity of the cricoarytenoid joints.

The effect of anatomic variations and maxillary sinus volume in antrochoanal polyp formation

PURPOSE

The antrochoanal polyp (ACP), otherwise known as the Killain polyp, is a benign lesion that originates from maxillary sinus mucosa, extending from the accessory ostium towards the middle meatus, and later tends to protrude posteriorly towards the choana and nasopharynx. Many studies have emphasized that its etiopathogenesis is unclear. Research suggests that chronic sinusitis and allergic rhinitis are factors that play an important role in the formation of ACP, as well as anatomical variations. In this study, we aimed to evaluate the effect of anatomical variations and maxillary sinus volume in patients diagnosed with anthrochoanal polyp.

METHODS

Paranasal sinus computed tomography (PNS CT) images of patients with unilateral ACP patients were examined. The non-ACP sides of the patients comprised the control group. Nasal septal deviation, agger nasi cells, concha bullosa, paradoxical middle turbinate, hyperpneumotized ethmoid bulla, uncinate pathology (medialized or pneumatized uncinate), haller cell, accessory ostium, maxillary sinus retention cyst and maxillary sinus volumes were evaluated.

RESULTS

The study included a total of 54 patients (33 females, 21 males). Mean patient age was 22.92 ± 13.95 (range 6-56) years. Mean maxillary sinus volume was 17.88 ± 5.16 mm³ for the ACP sides and 16.37 ± 4.55 mm³ for the non-ACP sides. Maxillary sinus volume was significantly larger in the ACP side (p = 0.000). Concha bullosa was observed on the ACP side in 23 patients (42.6%) and in the non-ACP side in 21 patients (38.9%). Agger nasi cells were observed in the ACP side in 47 patients (87.0%) and in the non-ACP side in 42 patients (77.7%). Hyperpneumatized ethmoid bulla was observed in the ACP side in 14 patients (25.9%) and in the non-ACP side in 12 patients (22.2%). Haller cells were observed in the ACP side in seven patients (12.96%) and in the non-ACP side in ten patients (18.51%).

CONCLUSION

Disrupted airflow of the well-developed maxillary sinus cavity due to anatomical variations seems to be an effective factor in the formation of ACP.

Outcomes of external septorhinoplasty in a Turkish male population

Introduction

The first and one of the most important steps in facial plastic surgery is accurate preoperative facial analysis and recording of data that may help the surgeon to check the outcomes of his/her techniques, promoting a surgeon's professional development.

Objective

To evaluate the esthetic outcomes of external septorhinoplasty relevant to ethnic facial harmony and to investigate the relationship of the columellar incision scar with the type of skin and columellar incision type in a Turkish population.

Methods

In total, 28 consecutive adult male patients with a mean age of 32.14 ± 10.66 years (range: 18–61 years) were included the study. Primary outcomes were preoperative and postoperative photogrammetric facial analyses of the patients including measurement of nasofrontal angle, nasolabial angle and nasal projection ratios (Gode) assessed according to the data derived from the Rhinobase program. Results were compared to facial proportions of the Turkish population. Columellar incision scar scores related to the Fitzpatrick skin type classification of the patients and columellar incision types used for the external approach were secondary outcomes of the study.

Results

Mean preoperative and postoperative nasofrontal angles were 148.04° ± 8.18° and 144.50° ± 7.15°, respectively, while mean preoperative and postoperative nasolabial angles were 87.59° ± 14.01° and 98.50° ± 9.71°, respectively. Mean preoperative and postoperative nasal tip projection ratios were 0.56 ± 0.05 and 0.60 ± 0.06, respectively. The differences between pre- and postoperative measurements were all significantly different and were in accordance with Turkish nasal harmony. Columellar inverted “V” incisions were performed in 15 (53.6%) patients while “V” incisions were used in 13 (46.4%) patients. Fitzpatrick skin Type 4 was seen in 46.42% of the patients, Fitzpatrick Type 3 in 46.42% and Fitzpatrick Type 2 in 7.14% of the patients. No significant difference was seen between columellar scar scores according to skin type and columellar incision type used for external septorhinoplasty.

Conclusions

This study demonstrated that outcomes for nasofrontal angle, nasolabial angle and nasal tip projection ratios analyzed using the Rhinobase program in patients who underwent external septorhinoplasty were similar to reference values for the Turkish population.

Auditory neuropathy in late preterm infants treated with phototherapy for hyperbilirubinemia

OBJECTIVE

To evaluate the prevalence of auditory neuropathy (AN) in late preterms treated with phototherapy for hyperbilirubinemia.

DESIGN

Prospective observational study comprising late preterms treated with phototherapy for hyperbilirubinemia. Newborns were screened with combined transient-evoked otoacoustic emissions (TEOAEs) / automated auditory brainstem responses (AABR). Infants who failed screening underwent diagnostic (ABR). Infants were all re-evaluated with AABR at one year.

STUDY SAMPLE

Eighty-five infants with a mean serum total bilirubin concentration of 22.3 ± 1.76 mg/dl; severe-hyperbilirubinemia (SH), and 102 infants with a mean serum total bilirubin concentration of 18.6 ± 1.26 mg/dl; non-severe hyperbilirubinemia (NSH) were included.

RESULTS

From 85 late preterms with SH, six (7.1%) failed screening and underwent diagnostic ABR for six weeks. AN was diagnosed in two (2%) infants with SH. Four (3.9%) of the 102 controls with NSH demonstrated failure at TEOAE/AABR. No AN was diagnosed in the control group at the diagnostic ABR. No statistically significant difference was found between infants treated with phototherapy for SH and NSH with regard to AN/AD either in the postnatal period or at one year. No correlation was found between serum bilirubin levels and ABR latencies or thresholds.

CONCLUSIONS

AN (2%) in late preterms treated with phototherapy for severe-hyperbilirubinemia was not higher than in those with non-severe hyperbilirubinemia.