Hoarseness Research Articles

Paulina Rivoli – Moniuszko’s Heroines and a Falcon soprano?

Paulina Rivoli was the first Warsaw Halka and then the first Countess in Moniuszko’s operas. In this article, I will relate how the singer, who at first frowned on Moniuszko’s proposals, launched the performance tradition of two great Moniuszko operas in which she created the title roles. Her immediate successors had to deal with the inevitable comparisons. Unfortunately, Rivoli suffered from serious vocal complaints. This was nothing unusual: phoniatric disorders plagued singers throughout Europe at that time, when massive changes were occurring in the aesthetics of solo singing. Rivoli was excellent in bel canto repertoire – a style of singing favourable to a maturing voice, which allowed her to develop fully. What was Halka’s original singing style? That was probably a mature period for Rivoli’s voice, which did not necessarily correspond to the notion of a modern, very ‘light’, even Donizettian approach to singing this role. Some of the circumstances surrounding the twilight of Rivoli’s career allow us to draw a comparison between her and another great singer whose career ended prematurely. Cornélie Falcon famously sang the role of Rachel in Halévy’s La Juive, which contributed to her legendary demise, and she had lost her voice irrevocably five years after her debut. Rivoli and Falcon sang similar repertoire, including Alice in Meyerbeer’s Robert le diable (Falcon’s debut and an early role for Rivoli), Donna Anna in Mozart’s Don Giovanni and Valentine in Les Huguenots, but Rivoli’s downfall was spread over a longer period, as her career lasted more than 20 years. Nor was her loss of voice as drastic as that of Falcon, who was literally left voiceless during a performance of Niedermeyer’s Stradella. Rivoli’s problems grew gradually, peaking after the premiere of The Countess [Hrabina]. It was probably this last burst of energy that ultimately depleted her powers altogether.

Lipoid Proteinosis, Its Symptoms, and Oral Manifestations: A Case Report and Review of Literature

Introduction: Lipoid proteinosis (LP), also known as Urbach-Wiethe disease, is an autosomal recessive disorder characterized by the deposition of glycoproteins in mucous membranes, skin, and organs. Symptoms typically begin in childhood, persist throughout life, and encompass hoarseness, skin inflammation, scarring, and ulcers, resulting in a waxy appearance. Oral manifestations present as white plaques and ulcers, significantly impacting the oral cavity. To date, approximately 400 cases have been reported worldwide. Case Presentation: Herein, we present the case of a 36-year-old female diagnosed with LP who sought a dental implant evaluation. Her medical history revealed tooth decay, which necessitated extractions, and she had previously undergone maxillary implant placement and mandibular bone grafting. Upon general examination, the patient exhibited voice hoarseness, hyperkeratosis on the elbows and hands, and papules on the fingers. Oral examination revealed firm and fibrotic mucosa, papillomatosis, and limited mouth opening. Hyposalivation and the absence of the left parotid duct orifice were noted. No significant abnormalities were observed on the eyelids or face. Salivary gland assessment indicated a reduced flow rate (1 ml in 5 minutes). This case highlights the importance of conducting a comprehensive evaluation and tailoring management strategies to the individual needs of patients with LP. Conclusions: Lipoid proteinosis is a rare mucocutaneous disorder characterized by a slow and benign course, with varying prevalence in different regions. Early recognition of oral symptoms is crucial, as they often precede skin and neurological manifestations. Although typical oral signs usually include tongue firmness and an inability to protrude, these were not observed in the present case. Xerostomia and dental agenesis, though uncommon, have been reported in previous cases, consistent with the findings of the present case, although different areas of the oral cavity might be involved in some instances.

Understanding Lipoid Proteinosis: A Brief Overview

Lipoid proteinosis is a rare autosomal recessive deposition disorder resulting from a loss-of-function mutation of ECM1 on chromosome 1q21. It is characterized by the deposition of hyaline-like material within multiple organs, including the skin, oral mucosa, larynx, and brain. Clinically, the first sign is often a weak cry or hoarseness of voice due to the infiltration of the laryngeal mucosa; hoarseness remains throughout life. Cutaneous lesions occur in two stages, which may be overlapping; the first stage consists of vesicles and hemorrhagic crust on the skin of the face and extremities, which resolves with pock-like scarring. In the second stage, the skin becomes diffusely thickened and waxy yellow. The classical clinical feature is beaded papules linearly arranged over the eyelid margin, known as Moniliform blepharosis. Involvement of the tongue, oropharynx, recurrent parotitis, dental anomalies, and neurological manifestations are other findings. A pathognomonic radiographic finding is bilateral intracranial sickle-shaped calcification in the amygdala. Pink hyaline deposits are found in the dermis in skin biopsy. Lipoid proteinosis is a chronic cutaneous disease with a benign course.

Sex differences in symptom presentation and their impact on diagnostic accuracy in Werner syndrome.

Whether sex differences exist in hereditary progeroid syndromes remains unclear. In this study, we investigated sex differences in patients with Werner syndrome (WS), a model of human aging, using patient data at the time of diagnosis. The presence of six cardinal signs in the diagnostic criteria was retrospectively evaluated. We found that the percentage of patients with all cardinal signs was higher in males than in females (54.2% vs. 21.2%). By the age of 40 years, 57.1% of male patients with WS presented with all the cardinal signs, whereas none of the female patients developed all of them. In particular, the frequency of having a high-pitched, hoarse voice, a characteristic of WS, was lower in female patients. The positive and negative predictive values for clinical diagnosis were 100% for males and females, indicating the helpfulness of diagnostic criteria regardless of sex. More female patients than male (86.7% vs. 64%) required genetic testing for their diagnosis because their clinical symptoms were insufficient, suggesting the importance of genetic testing for females even if they do not show typical symptoms of WS. Finally, the frequency of abnormal voice was lower in patients with WS harboring the c.3139-1G > C homozygous mutation. These results indicate, for the first time, that there are sex differences in the phenotypes of hereditary progeroid syndromes. The analysis of this mechanism in this human model of aging may lead to the elucidation of sex differences in the various symptoms of normal human aging. Geriatr Gerontol Int 2024; 24: 161-167.

Case Series of Surgical Treatment in Pediatric Thyroid Carcinoma in a Single Institution.

The prevalence of thyroid carcinoma (TC) among pediatric and adolescent populations is infrequent, yet its global occurrence is escalating. Insufficient information pertaining to TC in the pediatric populace of Indonesia presents issues in the identification and management of patients with this condition. The objective of this study is to provide a detailed account of a collection of pediatric TC cases that were recorded at a tertiary care center throughout an extended interval of eight years. The present study conducted a retrospective data analysis of ten patients who received a diagnosis of TC during the period spanning from 2014 to 2022. The present study focused on analyzing the clinical manifestation, diagnostic measures, treatment modalities, and immediate postoperative consequences of TC. All patients diagnosed with thyroid cancer exhibited the presence of neck lump. Nine patients underwent total thyroidectomy, while one patient underwent isthmolobectomy. The histopathologic evaluation confirmed the diagnosis of thyroid cancer in every individual. There were a significant number of patients, up to 50%, who encountered complications after undergoing surgery. Two patients reported the hoarseness of voice, whereas two other patients experienced the signs of hypocalcemia. Only one patient exhibited both these symptoms simultaneously. The implementation of total thyroidectomy as a surgical intervention in pediatric patients poses a notable challenge. Postoperative monitoring for potential complications following surgery for total thyroidectomy is imperative. The current study provides evidence that the utilization of total thyroidectomy in combination with lymph node dissection as indicated in patients with lymph node metastases in pediatric patients with thyroid carcinoma leads to a significant reduction in the probability of recurrence of lymph node enlargement. During the performance of surgical procedures, meticulous observation plays a key role in mitigating the risk of postoperative complications, such as hypoparathyroidism, hypocalcemia, and injury to the recurrent laryngeal nerve. Thus, it is imperative to conduct follow-up procedures for post-surgical interventions among pediatric patients diagnosed with TC.

Hoarseness as A Window into the Complexity of Supraglottic Carcinoma: A Case Report and Literature Review

ABSTRACT Laryngeal carcinoma ranks among the most prevalent malignancies affecting the head and neck, with supraglottic carcinoma emerging as the predominant subtype, particularly in certain developing regions characterized by prevalent risk factors such as alcohol consumption and smoking. Hoarseness, characterized by a change in the voice, constitutes approximately 1% of all primary care consultations. The predominant etiologies include acute and chronic laryngitis, responsible for 42.1% and 9.7% of cases, respectively, followed by functional dysphonia, benign and malignant tumors, neurogenic factors, and the natural aging process. A 65-year-old male, with a history of active smoking, was referred from a primary healthcare center due to complaints of throat pain and worsening hoarseness that had persisted for one year. The significant airway obstruction observed in this patient underscores the importance of discussing available management options in such cases. It is crucial for primary care physicians to recognize the clinical signs presented by the patient promptly in order to initiate the appropriate management without delay. Regrettably, tend to seek medical attention at an advanced stage of the disease, resulting in a notably unfavorable overall survival rate. Keyword: Laryngeal Carcinoma, Supraglottic Carcinoma, Hoarseness, Survival Rate

The impact of a speaker's voice quality on auditory perception and cognition: a behavioral and subjective approach.

Our voice is key for conveying information and knowledge to others during verbal communication. However, those who heavily depend on their voice, such as teachers and university professors, often develop voice problems, signaled by hoarseness. The aim of this study was to investigate the effect of hoarseness on listeners' memory for auditory-verbal information, listening effort, and listening impression. Forty-eight normally hearing adults performed two memory tasks that were auditorily presented in varied voice quality (typical vs. hoarse). The tasks were Heard Text Recall, as part of a dual-task paradigm, and auditory Verbal Serial Recall (aVSR). Participants also completed a listening impression questionnaire for both voice qualities. Behavioral measures of memory for auditory-verbal information and listening effort were performance and response time. Subjective measures of listening effort and other aspects of listening impression were questionnaire rating scores. Results showed that, except for the aVSR, behavioral outcomes did not vary with the speaker's voice quality. Regarding the aVSR, we found a significant interaction between voice quality and trial, indicating that participants' recall performance dropped in the beginning of the task in the hoarse-voice condition but not in the typical-voice condition, and then increased again toward the end. Results from the listening impression questionnaire showed that listening to the hoarse voice resulted in significantly increased perceived listening effort, greater annoyance and poorer self-reported performance. These findings suggest that hoarseness can, at least subjectively, compromise effective listening. Vocal health may be particularly important in the educational context, where listening and learning are closely linked.

Spontaneous Laryngeal Hematoma: A Rare Presentation of Supratherapeutic INR

Introduction: Warfarin is one of the most routinely used drugs for anticoagulation. However, it poses a significant bleeding risk. Incidence of major bleeding events ranges from 0.4-7.2% per year, and that of minor bleeding events can be as high as 15.4% per year. Here we present a rare case of laryngeal hematoma due to supratherapeutic INR. Case description: A 48-year-old male with past medical history of hypertension, Insulin dependent diabetes mellitus, and multiple episodes of deep venous thromboses on chronic anticoagulation with warfarin presented to the emergency department complaining of left sided neck pain and hoarseness of voice that started and progressively worsened since the past 24 hours. He denies any fever, chills, cough, shortness of breath, or dental pain. He was found to be hemodynamically stable with no oxygen requirement. He spoke with a hoarse voice, but no stridor was noted. Tenderness of the left anterior triangle of the neck below the jawline and mild trismus was noted. Laboratory work-up showed stable hemoglobin of 12.2 and a supratherapeutic INR of 9.9. CT of soft tissue neck showed retropharyngeal fluid collection extending from skull base to C7 with mild to moderate supraglottic airway narrowing. Flexible nasopharyngeal endoscopy showed significant collection of secretions with omega shaped epiglottis and retropharyngeal swelling, raising concerns for a hematoma. INR reversal with 2 units of fresh frozen plasma was initiated and patient was transferred to medical intensive care unit. He underwent daily endoscopies for three days; on day 3 significant improvement of the hematoma size was noted. Daily oral Vitamin K for 3 days ensured INR reversal from 9.9 to 1.7. After transferring to floors, the patient was gradually re-started on his anticoagulation and discharged home safely. Discussion: This case exemplified one of the rare but life-threatening complications of supratherapeutic INR. Bleeding into the larynx is a very rare life-threatening complication of chronic anticoagulation with warfarin. Similar case was reported by Cody A. Koch et al in 2010. In 2017 another case was reported which resulted in death from asphyxia before patient was taken to the hospital. A patient with similar presentation and demographics with the index case was reported also in 2019. As per literature, this case will be one of the very few reported cases of Spontaneous laryngeal hematoma due to supratherapeutic INR. Several factors could potentially affect the INR level of patients on chronic warfarin therapy and can cause acute elevation of INR which can lead to several complications including epiglottal hematoma as seen in this case. The index patient has significant history of chronic diarrhea along with OTC Tylenol ingestion for chronic patient both of which can cause INR increase. Thus, high index of suspicion is important especially for patients with comorbidities due to the fragile interaction of warfarin with several common medications and clinical conditions. Epiglottal hematoma can expand and potentially compromise the airway if immediate reversal of supratherapeutic INR is not commenced. Regardless of presentation, every patient who exhibits warfarin-associated upper airway hemorrhage should receive treatment that includes stopping anticoagulation, correcting the coagulopathy quickly, closely monitoring the patient's airway in an intensive setting, and having a low threshold for tracheostomy. Given the predicted difficulty with direct and fiberoptic laryngoscopy, the delayed time course for hematoma clearance, and the potential trauma resulting in further bleeding in an anticoagulated patient, securing the airway via intubation is frequently not desirable. Such cases of non-traumatic hemorrhage may be managed medically or surgically. Spontaneous hemorrhage is usually managed conservatively. Regarding the ideal course of treatment, there is, however, no agreement. Conclusion: There is need for a high index of suspicion for atypical presentations of supratherapeutic INR (including bleeding into the airway) in patients on prolonged anticoagulation with warfarin. The need for immediate reversal and routine INR monitoring in these patients is also emphasized in this clinical vignette.

Urbach-Wiethe disease: a rare pediatric case report

Urbach-Wiethe disease also known as lipoid proteinosis (LP) is a rare autosomal recessive Geno dermatosis.1 It is characterized by the deposition of an amorphous hyaline material in the skin, mucosa and viscera and is also known as cutaneous-mucosal hyalinosis.2,3 Parental consanguinities is identified in approximately 20% of Urbach-Wiethe disease cases. The classic manifestation due to laryngeal infiltration is a hoarse cry with its onset in infancy. Skin and mucous membrane changes become clinically apparent important consequences.4 Rarely, the central nervous system and respiratory tract may be involved resulting in seizures and airway obstruction, respectively. The lifespan is generally normal. We report a case of Urbach-Wiethe disease in a 6-year-old boy with hoarseness of voice who was started on oral acitretin therapy following his diagnosis. Oral acitretin can prove useful in cases of lipoid proteinosis who present with hoarseness of voice or vocal cord palsy. The mutations in the gene encoding extracellular matrix protein 1 (ECM1) have been linked to lipoid proteinosis. Even though no effective treatment is known, acitretin has proved to reverse hoarseness of voice in few reported cases and was started in our case as it was his chief presenting complaint.

Ehlers-Danlos syndrome in the practice of an otorhinolaryngologist: Clinical observation and literature review

The presented own clinical observation showed that functional dysphonia can be one of the clinical manifestations of EhlersDanlo syndrome: it is the deep layer of the own plate of the vocal fold, containing a large amount of collagen, that is most susceptible to changes in this pathology. The patient of the vocal voice for many years: a picture of hypotonic dysphonia was revealed during video pharyngostroboscopy – gaping of the laryngeal ventricles, non-closure of the vocal folds throughout by 1.5–2 mm. Acoustic analysis of the voice showed a decrease and instability in the amplitude of the pitch frequency, a narrowing of the dynamic range, a decrease in the intensity of the voice in the area of individual tones of the transient register, an increase in the level of noise components in the spectrum. The patient underwent a course of neuromuscular electrophonopedic stimulation No. 12 in combination with taking B vitamins for three weeks; after that, an increase in voice endurance was subjectively noted, however, according to the results of phonetography, spectrography and videolaryngostroboscopy, no visible positive dynamics was noted. The rheumatologist revealed hyperextension and increased traumatism of the skin, increased folding of the palms and flat feet. DNA sequencing revealed mutations in the genes and confirmed the diagnosis of Ehlers-Danlo syndrome.

Clinical manifestations of autoimmune rheumatic diseases in the larynx

Introduction. Autoimmune rheumatic diseases are attributed to a systemic process that develops in many organs, including the larynx. Complaints of impaired vocal function in patients with this pathology require a thorough clinical and endoscopic analysis.The purpose of the study. To determine the clinical-endoscopic changes of the larynx in patients with impaired vocal function in autoimmune rheumatic diseases..Materials and methods. 31 (100%) patients aged 25 to 84 (41 ± 15) years with autoimmune rheumatic diseases applied to the phoniatric department of the St. Petersburg Research Institute of ENT. There were 3 men (10%), 28 women (90%). All patients complained of impaired vocal function, 5 of the examined (16%) were also concerned about breathing disorders during exercise or at rest.Patients were grouped into three groups: systemic lupus erythematosus 4 (13%) people, systemic vasculitis 10 (32%) people, rheumatoid arthritis 17 (55%) people.Videolaryngoscopy, videolaryngostroboscopy, autofluorescence endoscopy, NBI – endoscopy (according to indications) were used to make the diagnosis.Results. The distribution of laryngeal pathology by nosological forms in patients with аutoimmune rheumatic diseases was as follows. The most numerous were groups with functional dysphonia of the hypotonic type 10 (32%) and bamboo nodules of 8 (26%) patients. Chronic laryngeal stenosis was diagnosed in 5 (16%), and chronic catarrhal laryngitis and soft nodules of the vocal folds in 3 (9.5%) people in each group (respectively). The smallest number of patients suffered from ulcerative necrotic changes of the larynx and pharynx – 2 (7%).Conclusion. Thus, laryngeal changes in аutoimmune rheumatic diseases had both specific manifestations and non-specific ones. The latter include functional dysphonia of the hypotonic type, chronic catarrhal laryngitis, soft nodules of the vocal folds. Bamboo nodules of the vocal folds, ulcerative necrotic diseases, chronic laryngeal stenosis (infiltrative and scarring) were specific for patients with аutoimmune rheumatic diseases.

Validation and Development of Voice Handicap Index-Throat for Koreans

Introduction: This study aimed to develop, validate, and analyze the reliability of the Korean version of the Voice Handicap Index-Throat (VHI-Tk). Methods: This prospective study included 103 patients in the case group with voice problems (18 with functional dysphonia, 44 with mass in the larynx, 18 with neurological voice disorder, 23 with throat problems) and 27 in the control group without voice problems. All participants completed these questionnaires at their initial visit: the Korean version of the Voice Handicap Index (K-VHI), VHI-Tk, and the Korean version of the Voice Symptom Scale (K-VoiSS). Case group patients in the case group recompleted the VHI-Tk questionnaire to assess test-retest reliability. Finally, a one-way analysis of variance was implemented to assess differences in VHI-Tk scores among the four diagnosis types in the case group. Results: The VHI-Tk scores in the case group were significantly higher than in the control group. The VHI-Tk was significantly correlated with the subscales of K-VHI and K-VoiSS. The VHI-Tk has significant test-retest reliability, and its internal consistency is good to excellent (Cronbach’s alpha correlation coefficient range: 0.895–0.901). There was significant difference in the mean VHI-Tk scores according to the four diagnosis types (throat problems group > neurological voice disorder group). Conclusion: We validated the VHI-T questionnaire to measure self-perceived voice and throat problems among Koreans. A large sample size and various diagnosis types are required in future studies to fully validate the VHI-T for use in multiple cultures.

Prevalence of Benign Vocal Fold Lesions: Long-Term Results From a Single European Institution

Hoarseness and limited voice capacity are often associated with benign vocal fold (VF) lesions. Despite their high clinical prevalence, epidemiological investigations focusing on these structural alterations are rare. The aim of the study was to present current European data on five typical lesion types (VF nodules, polyp, cyst, contact granuloma, Reinke´s edema). Retrospective investigation. Video recordings of laryngoscopies from all patients with one of the above-mentioned VF pathologies were subjected to a review process. Data collected arose from a single institution over a period of 13years. They were evaluated statistically with respect to lesion type, sex, age at first diagnosis, and affected side. In a total of 535 patients, VF polyps occurred most frequently, followed by Reinke's edema and nodules. Each of the lesion types studied was significantly associated with sex and, except VF cysts, all diagnoses were also significantly related to age. Female sex was a risk factor for VF nodules, cysts, and Reinke's edema, whereas male sex was associated with polyps and contact granulomas. VF nodules occurred predominantly in young patients, VF polyps in middle-aged, Reinke's edema, and contact granulomas in later adulthood. The predominantly affected side (bilateral, right, or left VF) depended on sex. Different prevalences from previous studies resulted from inconsistencies in terms of classification framework, terminology, and definition. In addition to endoscopic findings, socio-cultural backgrounds must also be considered when studying benign VF lesions. Prophylactic voice care education for all populations and concomitant efficacy studies are required. Further research is needed to verify possible correlations between sex and the affected side. A non-binary view could broaden the spectrum of phoniatric research issues.

Incidence and Risk Factors of Post-Thyroidectomy Stridor

Background: Thyroidectomy is a common procedure performed by the general surgeons. Stridor is an airway sign caused by a variety of post-thyroidectomy complications. Objective: To determine the incidence of post-thyroidectomy stridor and the risk factors associated with its occurrence. Patients and Methods: The study included 280 adult patients who had total or partial thyroidectomy performed by various surgeons. Patients were followed up for 6 months after they were discharged from the hospital. Data collected included demographic information, type of thyroid disease, duration of illness before surgery, type of surgery, number of intubation attempts, and the presence of hoarseness and hematoma post-operatively. Results: Only eighteen patients (6.43%) who underwent thyroidectomy developed stridor during the follow-up period. They were compared to 25 other patients who were chosen from the original sample based regular visit of patients during the follow up. Higher body mass index (BMI), bilateral thyroidectomy, presence of concomitant hoarseness and hematoma, and more than one attempt at intubation were all associated with an increased risk of post-thyroidectomy stridor. Conclusion: Stridor affects only a small percentage of patients undergoing thyroidectomy. Increased BMI, bilateral thyroidectomy, presence of concomitant hoarseness and hematoma, and frequent tracheal intubation are the most common risk factors for post-thyroidectomy stridor. Keywords: Thyroidectomy, stridor, hoarseness of voice. Background: Thyroidectomy is a common procedure performed by the general surgeons. Stridor is an airway sign caused by a variety of post-thyroidectomy complications. Objective: To determine the incidence of post-thyroidectomy stridor and the risk factors associated with its occurrence. Patients and Methods: The study included 280 adult patients who had total or partial thyroidectomy performed by various surgeons. Patients were followed up for 6 months after they were discharged from the hospital. Data collected included demographic information, type of thyroid disease, duration of illness before surgery, type of surgery, number of intubation attempts, and the presence of hoarseness and hematoma post-operatively. Results: Only eighteen patients (6.43%) who underwent thyroidectomy developed stridor during the follow-up period. They were compared to 25 other patients who were chosen from the original sample based regular visit of patients during the follow up. Higher body mass index (BMI), bilateral thyroidectomy, presence of concomitant hoarseness and hematoma, and more than one attempt at intubation were all associated with an increased risk of post-thyroidectomy stridor. Conclusion: Stridor affects only a small percentage of patients undergoing thyroidectomy. Increased BMI, bilateral thyroidectomy, presence of concomitant hoarseness and hematoma, and frequent tracheal intubation are the most common risk factors for post-thyroidectomy stridor. Keywords: Thyroidectomy, stridor, hoarseness of voice.

The role of the autonomic nervous system in the development of hypotonic dysphonia

Background. Hypotonic dysphonia occupies a special place in the structure of functional dysphonia in terms of prevalence. At the same time, the autonomic nervous system has a significant impact on the course and outcome of the disease. However, data on the neurovegetative status of patients with hypotonic dysphonia in the scientific literature are extremely rare and do not fully reflect its features.Aim. To determine the neurovegetative status of laryngological patients with hypotonic dysphonia.Materials and methods. 26 patients (6 men and 20 women) with hypotonic dysphonia and hypersensitivity of the larynx (main group) and 45 patients (13 men and 32 women) with hypersensitivity of the larynx without signs of dysphonia (comparison group) were examined as a control, data on the functional state of the autonomic nervous system in 20 practically healthy people (5 men and 15 women) aged 18 to 25 years were used. The state of vegetative parameters – vegetative tone, vegetative reactivity and vegetative activity support – were evaluated using the medical diagnostic complex “Valenta”. The examination of patients included anamnestic analysis, objective examination of lororgans according to generally accepted methods and video stroboscopy of the larynx.Results. The differences between healthy and sick people regarding neurovegetative indicators are obvious, unidirectional and indicate the existence of autonomic disorders in both groups of patients. The ratios of vegetative parameters recorded during the study indicate the involvement of autonomic nervous system not only in the development of laryngeal hypersensitivity, but also in the pathogenesis of functional dysphonia of the hypotonic type.Conclusion. Thus, neurovegetative disorders – vegetative dystonia and autonomic dysfunction – are one of the factors of the pathogenesis of hypotonic dysphonia.

Spindle cell carcinoma of the larynx: a rare entity

Squamous cell carcinoma (SCC) is the commonest malignancy encountered in the larynx in the Indian population. Spindle cell carcinoma is an extremely rare malignant tumor and is a variant of SCC with a mesenchymal like malignant cell component. This is a case report of a 58 years old patient who presented with hoarseness of voice of 7 months duration. He was diagnosed to have a right vocal cord polypoidal growth with mobile vocal cords. He underwent direct laryngoscopy and biopsy of the lesion which was reported as spindle cell neoplasm/inflammatory myofibroblastic tumor (IMT). Immunohistochemistry (IHC) was carried out and confirmed the diagnosis of inflammatory myofibroblastic tumor. He was doing well and the follow up videolaryngoscopic examinations and PET CT were normal. At subsequent follow-up 19 months later, he was found to have a recurrent right vocal cord lesion. Direct laryngoscopy and biopsy was repeated along with laserization of the right vocal cord. Histopathology was reported as spindle cell malignant neoplasm. Immunohistochemistry was reported as spindle cell carcinoma. He was then sent for radiation therapy. The patient responded well to radiation and is tumor free at last follow-up. He has been advised regular follow-ups. Spindle cell carcinoma is an extremely rare laryngeal malignancy. It typically originates in the glottis. The treatment for spindle cell carcinoma includes surgery, radiation or a combination of these modalities. Its prognosis is worse than squamous cell carcinoma and patients require close follow-ups.

Effect of fluticasone-impregnated throat packs on postoperative sore throat (POST) and hoarseness of voice: A randomized clinical trial.

Post-operative sore throat (POST) is one of the most common complaints post-endotracheal intubation and can be decreased through various interventions. This study aimed to determine the effect of fluticasone-impregnated versus saline throat packs on the occurrence and severity of POST and voice hoarseness. This prospective, randomized, double-blinded trial was conducted on patients undergoing nasosinus surgeries at Kasturba Medical College and Hospital. Patients were randomized to groups based on a computer-generated table of random numbers post-intubation after placing a definite length of oropharyngeal packs into group F (fluticasone) who received four puffs of fluticasone furoate-soaked throat packs and group C (control) wherein normal saline-soaked throat packs were used. Determining the incidence of POST and voice hoarseness was the primary outcome; severity of POST and voice hoarseness, patient satisfaction scores at 24 hours post-surgery and adverse events were secondary outcomes. Overall, 86 patients were randomized and 43 patients were included in each group. Incidence of POST (%) and voice hoarseness (%) were 55.8, 55.6, 55.8, 53.4 and 30.2, 28, 28, 28 in group C. Incidence of POST (%) and voice hoarseness (%) were 37.2, 37.2, 37.2, 34.8 and 14, 14, 14,14 in group F at 1, 2, 6 and 24 hours, respectively, however, the p values were not found to be significant at any time interval. There was no significant difference in terms of severity of POST and voice hoarseness, patient satisfaction scores between the groups and there were no reported adverse events. In patients undergoing nasosinus surgery under general anesthesia with endotracheal intubation, fluticasone furoate-impregnated throat packs failed to show any significant reduction in the incidence and severity of POST as well as hoarseness of voice, and even though it was not statistically significant, the fluticasone impregnated group had higher patient satisfaction scores. CTRI ( CTRI/2020/09/027946; 22/09/2020).

Unraveling the complexities of pathological voice through saliency analysis

The human voice is an essential communication tool, but various disorders and habits can disrupt it. Diagnosis of pathological and abnormal voices is very important. Conventional diagnosis of these voice pathologies can be invasive and costly. Voice pathology disorders can be effectively detected using Artificial Intelligence and computer-aided voice pathology classification tools. Previous studies focused primarily on binary classification, leaving limited attention to multi-class classification. This study proposes three different neural network architectures to investigate the feature characteristics of three voice pathologies-Hyperkinetic Dysphonia, Hypokinetic Dysphonia, Reflux Laryngitis, and healthy voices using multi-class classification and the Voice ICar fEDerico II (VOICED) dataset. The study proposes UNet++ autoencoder-based denoiser techniques for accurate feature extraction to overcome noisy data. The architectures include a Multi-Layer Perceptron (MLP) trained on structured feature sets, a Short-Time Fourier Transform (STFT) model, and a Mel-Frequency Cepstral Coefficients (MFCC) model. The MLP model on 143 features achieved 97.1% accuracy, while the STFT model showed similar performance with increased sensitivity of 99.8%. The MFCC model maintained 97.1% accuracy but with a smaller model size and improved accuracy on the Reflux Laryngitis class. The study identifies crucial features through saliency analysis and reveals that detecting voice abnormalities requires the identification of regions of inaudible high-pitch sounds. Additionally, the study highlights the challenges posed by limited and disjointed pathological voice databases and proposes solutions for enhancing the performance of voice abnormality classification. Overall, the study’s findings have potential applications in clinical applications and specialized audio-capturing tools.

Functional and organic dysphonia in voice professionals (lecture)

An urgent task of otorhinolaryngology (phoniatry) is the diagnosis and treatment of disorders of voice function in voice professionals or persons of voice-speech professions. An undiagnosed laryngeal disease worsens the quality of life of patients, creates difficulties in communication and can even lead to professional unfitness, because the patient does not withstand the necessary vocal load. The leading role in the modern diagnosis of laryngeal diseases belongs to endoscopic research methods video endoscopy and video endostroboscopy. All disorders of voice function are classified as functional and organic. Recent studies have shown that from 30.5 to 40% of voice professionals who have applied for phoniatric care suffer from functional disorders. Functional changes are understood to mean changes in which laryngoscopic examination does not always reveal any visible pathology. But with the help of special research methods, such as stroboscopy (videostroboscopy), spectral analysis of the voice, pathognomonic changes can be determined, and the patient presents characteristic complaints. More often than others, hypotonic and hypo-hypertonic dysphonia are diagnosed. Organic laryngeal diseases are characteristic of 69.5% of patients with dysphonia. They are represented by various nosological forms. Certain difficulties arise in the diagnosis of professional laryngitis and vascular pathology of the larynx. The lecture presents pathognomonic clinical changes of the larynx in voice professionals, knowledge of which is necessary for practical doctors to make a diagnosis.

Efficacy of Tonsenorm Compound in the management of Tundikeri with special reference to Chronic Tonsillitis in Children

Introduction: Tonsillitis is one of the most common infectious conditions in the paediatric age group. Symptoms such as pain or tenderness in the throat, fever, tonsillar swelling with a white or yellow coating, painful blisters or ulcers on the throat, headache, loss of appetite, ear pain, trouble swallowing, bad breath, a scratchy or muffled voice, and a stiff neck mentioned in this disease. Ayurveda addresses the problem of Tundikeri, similar to chronic tonsillitis with internal medicines and external therapies. Tonsenorm compound is such a herbomineral formulation formulated with extract a set of nine drugs. Aim of the proposed study is to evaluate the efficacy of the Tonsenorm compound in Tundikeri. Material and Methods: The present study is planned to be conducted under the strict protocol of an open-label clinical trial, in 40 patients. Tonsenorm compound will be given for 60 days at 250 mg thrice a day. Assessment of the patients will be done on the basis of subjective parameters with a grading/scoring system on every 15th day during the study, with a post-intervention follow-up after 1 month. Results: The result will show the effectiveness of the trial drugs, which will be economical and safe for long-term use in the patients of Tundikeri. Discussion & Conclusion: The outcome of this herbomineral drug change in scoring/ grading of symptoms of Tundikeri /chronic tonsillitis (will be assess after the completion of the trial work).