Laryngeal Alterations Research Articles

Characterization of a chronic cough in cerebellar ataxia, neuropathy, vestibular areflexia syndrome.

Cerebellar ataxia with neuropathy and vestibular areflexia syndrome (CANVAS) is a common cause of late-onset ataxia that often presents with chronic cough. This study is the first to characterize the CANVAS cough both objectively and subjectively. A cross-sectional study of 13 patients was conducted. Medical records and available esophagram, modified barium swallow study, esophageal manometry, and video laryngostroboscopy data were reviewed. Leicester cough questionnaire (LCQ) and Eating Assessment Tool-10 were administered to evaluate quality of life (QoL) impairments and dysphagia symptoms, respectively. CANVAS history questionnaire was developed to characterize the clinical course. 92% of patients endorsed chronic cough that preceded gait instability by a median of 16 years. Cough was dry (67%), disturbed sleep (75%), triggered by various factors, including talking, eating, and dry/spicy foods, did not respond to standard reflux therapy, and inconsistently responded to neuromodulators and superior laryngeal nerve injections. Despite perceived cough severity worsening or remaining constant in most patients, no correlation was found between cough duration and total LCQ scores. Patients reported significantly more negative social QoL impacts compared to physical QoL impacts. Ataxia duration and years of cough before ataxia symptoms were directly and inversely correlated with total LCQ scores, respectively. Imaging data revealed esophageal dysmotility (71%), vestibular penetration (57%), vestibular aspiration (14%), supraglottic compression (63%), vocal fold lesions/atrophy (50%), and arytenoid erythema (38%). Chronic cough is a hallmark presenting symptom in CANVAS with predominantly psychosocial QoL effects and unrecognized laryngeal alterations. In cases of idiopathic, refractory chronic cough, genetic testing for CANVAS should be considered, especially in association with sensory, cerebellar, and/or vestibular involvement. VI.

Videokymographic index of glottic function: an analysis of diagnostic accuracy.

To develop the Videokymographic Index of Glottic Function (VIGF), a composite indicator from digital videokymography parameters, captured by high-speed videolaryngoscopy exams of women with and without laryngeal alterations of behavioral etiology. The sample consisted of 92 women aged between 18 and 45 years. Fifty-five (55) women with behavioral dysphonia, presenting with laryngeal and voice alterations, and thirty-seven (37) women without any laryngeal and voice alterations. Voice evaluation was performed by consensus via an auditory-perceptual analysis of the sustained vowel /a/ at a habitual pitch and loudness. Voice classification was obtained by means of a general degree of dysphonia, where G0 indicated neutral voice quality and G1 to G3 indicated altered voice quality. Laryngeal images were captured via digital videokymography analysis of a sustained vowel /i/ at a habitual pitch and loudness. The VIGF was based on the midpoint of the glottal region for analysis. Logistic regression was performed using the MINITAB 19 program. Logistic regression was composed of two stages: Stage 1 consisted of the analysis of all variables, where the maximum opening and closed quotient variables showed statistical significance (p-value <0.05) and the model was well adjusted according to the Hosmer-Lemeshow test (p-value=0.794). Stage 2 consisted of the re-analysis of the selected variables, also showing a well-adjusted model (p-value=0.198). The VIGF was defined as follows: VIGF=e^(8.1318-0.2941AbMax-0.0703FechGlo)/1+e^(8.1318-0.2941AbMax-0.0703FechGlo). The VIGF demonstrated a cut-off value equal to 0.71. The probability of success was 81.5%, sensitivity 76.4%, and specificity 89.2%.

Índice videoquimográfico da função glótica: análise da precisão diagnóstica

ABSTRACT Purpose To develop the Videokymographic Index of Glottic Function (VIGF), a composite indicator from digital videokymography parameters, captured by high-speed videolaryngoscopy exams of women with and without laryngeal alterations of behavioral etiology. Methods The sample consisted of 92 women aged between 18 and 45 years. Fifty-five (55) women with behavioral dysphonia, presenting with laryngeal and voice alterations, and thirty-seven (37) women without any laryngeal and voice alterations. Voice evaluation was performed by consensus via an auditory-perceptual analysis of the sustained vowel /a/ at a habitual pitch and loudness. Voice classification was obtained by means of a general degree of dysphonia, where G0 indicated neutral voice quality and G1 to G3 indicated altered voice quality. Laryngeal images were captured via digital videokymography analysis of a sustained vowel /i/ at a habitual pitch and loudness. The VIGF was based on the midpoint of the glottal region for analysis. Logistic regression was performed using the MINITAB 19 program. Results Logistic regression was composed of two stages: Stage 1 consisted of the analysis of all variables, where the maximum opening and closed quotient variables showed statistical significance (p-value &lt;0.05) and the model was well adjusted according to the Hosmer-Lemeshow test (p-value=0.794). Stage 2 consisted of the re-analysis of the selected variables, also showing a well-adjusted model (p-value=0.198). The VIGF was defined as follows: VIGF=e^(8.1318-0.2941AbMax-0.0703FechGlo)/1+e^(8.1318-0.2941AbMax-0.0703FechGlo). Conclusion The VIGF demonstrated a cut-off value equal to 0.71. The probability of success was 81.5%, sensitivity 76.4%, and specificity 89.2%.

Reinke Edema: Factors that Interfere with Vocal Recovery after Surgery.

Introduction Dysphonia and lower pitch after surgery of Reinke edema are common. They are caused especially due to chronic smoking but, probably, other factors should be associated. Objectives To evaluate the results of laryngeal microsurgery in patients with Reinke edema, following a standardized postoperative guidance protocol in our service. Methods Retrospective study. Thirty patients (3 males; 27 females) were included, 70% between 41 and 60 years old. The parameters analyzed in the pre- and postoperative (between 4 and 6 months) of patients undergoing laryngeal microsurgery for Reinke edema were: smoking, vocal symptoms, videolaryngostroboscopy, voice therapy, perceptual and acoustic vocal evaluation, histopathological report. Results Smoking was reported by 100% of the patients and maintained in the postoperative period by 80%. Complete improvement of symptoms in the postoperative period was reported by 43% of them, partial improvement by 40%, and maintenance by 17%. There was low adherence to voice therapy in the pre- and postsurgery. Postoperative videolaryngoscopy indicated congestion (19), atrophy and bowed vocal fold (1), subepithelial edema (2), and normal findings (8). The histological findings were subepithelial edema, enlargement of vessels, inflammation, epithelial hyperplasia, and thickening of the basement membrane. The perceptual and acoustic vocal analyzes indicated improvement of the analyzed parameters. Conclusions The maintenance of some vocal symptoms and laryngeal alterations in videolaryngoscopy after microsurgery of Reinke edema is frequent, even in patients who follow the recommendations of vocal rest and control of gastroesophageal reflux. Vocal symptoms are attributed to changes in the laryngeal mucosa caused by chronic smoking, aggravated by the maintenance of addiction in the postoperative period.

ANALYSIS OF LARYNGEAL ALTERATIONS IN PATIENTS AFTER SARS-COV-2 INFECTION

Introduction: The new coronavirus pandemic has given rise to several systemic pathologies correlated to the viral infection, which has flu-like symptoms in the upper airways. There are reports in the literature, however, that mention signs of dysphonia, odynophagia and pharyngeal globus sensation after infection. The larynx, an organ that is part of the airway, is possibly the affected location to set off those symptoms. Objective: To examine the laryngeal alterations in patients after SARS-CoV-2 infection. Methods: This was an observational and analytical cross-sectional study in which the medical records of patients with the aforementioned complaints, and who underwent videolaryngoscopy, were reviewed. The statistical level of significance was set at p&lt;0.05. Results: 34,143 medical records were reviewed, and a final result of 57 patients with the aforementioned complaints and videolaryngoscopy examination was found. The age, analyzed on the socioeconomic profile, was significant in the performed review. Out of the laryngeal alterations, hypotonia, fusiform glottal gap (p&lt;0.001) and triangular glottal gap were significant. Laryngeal alterations were also significant in patients hospitalized for COVID-19. Discussion: These findings must be the main reason for post-COVID-19 hypokinetic dysphonia, due to probable damage to the recurrent laryngeal nerve.

Brachycephalic Syndrome in Dogs - Endoscopic Findings in the Airways

Background: Brachycephalic dogs have several abnormalities in the airways, which generate clinical manifestations that impair the quality of life of these animals. Primary alterations promote airflow obstruction and increase intraluminal negative pressure, causing secondary alterations due to a cycle of inflammation with consequent obstruction. With the onset of inflammation and other alterations in the airways, clinical manifestations can be observed, such as snoring, reverse sneezing, coughing, dyspnea, cyanosis, syncope, and vomiting. Endoscopic examination of the airways allows visualization and diagnosis of morphological changes in these animals. This study aimed to evaluate the endoscopic findings of the airways and determine the quantitative and qualitative assessment of the severity of clinical manifestations in 14 dogs with brachycephalic syndrome (BS). Materials, Methods &amp; Results: Historical and anamnesis data and clinical, respiratory, and digestive manifestations were collected from the owners’ reports. The clinical manifestations were classified as mild, moderate, or severe. All animals were subjected to endoscopy of the airways, and image findings were grouped according to the anatomical site where they were observed, then the abnormalities were correlated with the severity of the clinical manifestations. When comparing the frequency of endoscopic abnormalities with the severity of clinical manifestations, it is interesting to observe that animals with severe disease more frequently presented the following alterations: prolongation and thickening of the soft palate, laryngeal changes, presence of hyperemia, lymphoid hyperplasia and polyps in the nasopharynx, hypoplasia and presence of tracheal secretion and thickening of the dorsal tracheal muscle; bronchial collapse, hypoplasia of the main bronchi and bronchial hyperemia and the presence of aberrant nasal turbinates. Comparison between the means of nonparametric variables was performed using the Mann-Whitney test, with a 5% significance level. Discussion: A higher frequency of French Bulldog dogs included in the study was observed, probably due to their greater popularity, although any brachycephalic dog may be affected by BS. Considering that nostril stenosis is a congenital alteration, which is usually diagnosed early, and since the animals included in the study were dogs referred for the rhinoplasty procedure the higher frequency of young dogs in the study was not surprising. The results revealed a significant difference in the endoscopic findings with the severity of the clinical manifestations in different variables, such as prolongation and thickening of the soft palate, eversion of the laryngeal saccules, presence of laryngeal inflammation and collapse, presence of polyps or lymphoid hyperplasia in the nasopharynx, thickening of the dorsal muscle of the trachea, polyps in the trachea and hypoplasia in addition to bronchial hyperemia. The larynx was the most affected anatomical site, with alterations present in 92.8% of the evaluated dogs. Based on these findings, it can be concluded that airway obstruction caused by primary alterations can cause secondary alterations, with consequent clinical manifestations in brachycephalic dogs it is possible to suggest that dogs with this syndrome may present severe manifestations of the disease, regardless of age. Furthermore, it can be concluded that in this study, dogs with BS had frequent laryngeal alterations and that alterations in the main bronchi were present in all animals with severe manifestations of the disease. Keywords: airway obstruction, bronchial collapse, endoscopy, larynx.

Effect of Nebulization on Laryngeal Parameters: Analysis Using High-Speed Digital Videolaryngoscopy

Superficial laryngeal hydration, obtained through nebulization, is related to the moisture level on the epithelial surfaces of the vocal folds, modifying their biomechanical and aerodynamic properties. Through high-speed videolaryngoscopy it is possible to obtain objective data for laryngeal analysis after nebulization and a better understanding of this phenomenon OBJECTIVE: To verify the effects of nebulization with saline solution on laryngeal parameters of digital videokymography obtained by high-speed videolaryngoscopy examination in women and men with and without laryngeal alterations METHOD: This is a clinical, comparative intra-subject study. Fifty-nine adults were selected, with and without laryngeal alterations, 30 females and 29 males. Digital videokymographs in the anterior, middle and posterior thirds of the vocal folds of the participants were analyzed before and after nebulization with 0.9% saline solution. Women without laryngeal alterations showed more parameters changes after nebulization, in which there was a decrease in maximum and medium opening, amplitude of opening of the left and right vocal fold in the anterior glottal third, and an increase of the percentage of closure of the vocal folds. These results indicate a minor extent of lateral excursion of the vocal folds during phonation. In women with laryngeal alterations, the parameters that changed after nebulization were the increased frequency of opening of the left and right vocal folds in the topography of the posterior third. In men, nebulization did not change the variables studied, except for the amplitude of the right vocal fold in men with laryngeal alterations, in the analysis of the posterior glottic third. The results suggest that surface hydration modifies laryngeal dynamics differently between genders. After nebulization with saline solution, women without laryngeal alterations showed a decrease in the lateralization of the vocal folds during phonation, suggesting a better phonatory efficiency.

Histopathological changes of parotid and larynx in hypothyroid rats: experimental study.

In this study, we aimed to investigate the laryngeal and parotid histopathological alterations in rats with experimentally induced postnatal hypothyroidism. 200-300g weighed Wistar albino rats were included in this study. The rats were randomly divided into four groups: group 1 is control and the other groups are experimental groups. Food and water were supplied ad libitum in group 1, no medication was administered. Propylthiouracil (PTU) was administered intraperitoneally for 15days in group 2; for 30days in group 3, for 45days in group 4. The larynx and parotid glands of the rats were removed and intracardiac blood samples were collected for thyroid-stimulating hormone (TSH) analysis under anesthesia (ketamine hydrochloride, 100mg/kg) 24h after the last PTU injection. The same procedures were done for the control group at day 46. Histopathological evaluation was done for all the specimens. While submucosal vascular dilatation was significantly higher in the experiment groups (p < 0.05), there was not a significant difference in lamina propria edema, inflammation, goblet cell loss, cilia loss between the groups in larynx specimens. In parotid gland specimens, serous asinus atrophy, stromal connective tissue increase were significantly higher in experiment groups (p < 0.05). In addition, there was a significant difference in nuclear morphology between control and experimental groups (p < 0.05). The results of the study showed that hypothyroidism may have effect on inflammatory procedure by causing vascular dilation in larynx and serous asinus atrophy nucleus changes, connective tissue increase in stroma in parotid gland.

Lidocaine Infusion Improves the Functionality of Intraoperative Nerve Monitoring During Thyroid Surgery: A Prospective, Randomized, Double-Blinded Study.

BackgroundIntraoperative nerve monitoring (IONM) to assess the recurrent laryngeal nerve function during thyroid surgery is becoming the standard of care across many institutions. The successful deployment and data analysis from the IONM require complete laryngeal relaxation and reflex suppression. We investigated the role of intravenous lidocaine infusion (IVLI) to provide such operating conditions, under a lighter plane of anesthesia and fewer hemodynamic fluctuations.MethodsSixty-five patients were randomly assigned to lidocaine group (LG) or placebo group (PG) based on the computer-generated coding developed by the pharmacy department. The study medication (SM) was delivered by the pharmacist in a pre-filled coded syringe to the investigator 30 min prior to the surgery. All the patients were anesthetized by narcotic and inhalation based general anesthesia. The SM was administered at the rate of 1.5mg/kg/h following a loading dose of 1 mg/kg. Dragonfly® laryngeal surface electrode and Nerveana® nerve locator system were used for IONM during surgery.ResultsThe proportion of patients requiring lower strength stimulating current (StMC) at 0.5 mA was significantly higher in the LG than in the PG (X2 (1, N = 61) = 10.1615, P = 0.001434). Similarly, the proportion of patients with the drop in the aggregate impedance level (DAIL) by < 50% at the end of surgery was significantly higher in the LG than in the PG (X2 (1, N = 61) = 15.982, P = 0.000064). In addition, the proportion of patients with the hypotensive episodes requiring rescue medications more than twice during surgery was significantly lower in the LG than in the PG (X2 (1, N = 61) = 0.0183, P < 0.05).ConclusionsThe enhanced laryngeal relaxation and the reflex suppression afforded by the IVLI could have enabled a lower StMC to elicit a positive signal. The lower StMC promotes less intense laryngeal alterations as evidenced by the lower DAIL in the LG. IVLI can enhance the functionality of the IONM during prolonged operating time and the resultant increased number of IONM stimulations, while providing a stable hemodynamic environment.

Self-perception of insomnia, sleep quality, and musculoskeletal pain in dysphonic women: preliminary study

Objective To evaluate the association between musculoskeletal pain, insomnia indices, and sleep quality with voice functioning among women. Methods Thirty women aged between 18 and 50 years old participated in two groups: dysphonic group (DG) – composed of 15 women diagnosed with behavioral dysphonia; and control group (CG) – composed of 15 vocally healthy women. All participants answered the Musculoskeletal Pain Investigation Questionnaire, Pittsburgh Sleep Quality Index (PSQI), and Insomnia Severity Index (ISI) questionnaires. Statistical tests were applied to compare groups and to relate outcome variables, with a significance of 5% (p<.05). Results Dysphonic women presented a higher frequency of musculoskeletal pain in the posterior neck, lower back, masseter, submandibular, and larynx regions. There was no statistically significant difference for the other compared variables. We observed that there was a difference in the comparison between pain in some head and neck regions and the quality of sleep and evidence of insomnia, both in DG and CG. Conclusions Dysphonic women have a higher frequency of pain in the head and neck regions when compared to vocally healthy women. There is a difference between sleep quality, insomnia, and musculoskeletal pain, regardless of the presence of vocal and laryngeal alterations.

Laryngeal signs and pH-multichannel intraluminal impedance in infants and children: The missing ring: LPR and MII-pH in children

Objectiveto investigate the reliability of laryngeal reflux finding score (RFS) and symptom index (RSI) in assessing gastroesophageal reflux (GER) in children and infants. Methodspatients with laryngeal or respiratory symptoms, who underwent laryngoscopy and esophageal pH-impedance (MII-pH) were recruited. RSI and RFS were correlated to MII-pH results. A RSI>13, RFS>7, acid exposure index>7%, total reflux episodes>100/24 h in infants or>70/24 h in children, or a positive symptom index or association probability, were considered pathological. Analysis considering age (</>12 months) was performed. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) of the laryngeal scores were calculated. Results197 children (median 53 months, 61 infants) were enrolled. MII-pH was pathological in 5/10 patients with RFS>7, and in 17/31 with RSI>13. RFS>7 had 3.9% sensitivity, 93% specificity, a PPV of 50 and a NPV of 34 in predicting GER disease. RFS was inversely associated to weakly acidic and proximal GER. RSI>13 had 13% sensitivity, 83% specificity, and a PPV and NPV similar to RFS. RSI was significantly associated with the number of acid reflux episodes, and, in infants, with bolus exposure index. ConclusionsRSI and RFS aren't accurate in predicting GER in infants and children. Acid reflux relates to laryngeal symptoms, but neither acid, nor proximal and weakly acidic GER relate to laryngeal alterations.

Laryngeal dyskinesia in a horse

SummaryA 3‐year‐old Warmblood gelding was evaluated for intermittent respiratory distress and an inspiratory noise. These signs were mainly observed at exercise but sometimes occurred at rest as well. At the age of 2 months, a severe episode of respiratory distress had necessitated a temporary tracheotomy, which had then healed uneventfully. Examination of the patient and resting endoscopy revealed no structural laryngeal alterations. Exercise endoscopy revealed episodes of active bilateral laryngeal adduction during inspiration. Spirometrically, a corresponding impairment of inspiratory airflow was identified. These abnormalities were most pronounced at the trot but they occurred at magnitudes of inspiratory airflow lower than those inducing dynamic arytenoid collapse in horses with recurrent laryngeal neuropathy. Therefore, the diagnosis of a laryngeal dyskinesia characterised by an active bilateral arytenoid adduction during inspiration was made. No specific treatment was implemented. Three years later, the owner reported that the condition was markedly improved and the horse was used for pleasure riding.

Laryngeal assessment of patients with rheumatoid arthritis using laryngeal photodocumentation

Objective The aim was to assess the prevalence of dysphonia and laryngeal changes upon videolaryngoscopic examination of patients with rheumatoid arthritis (RA). Background RA effects on larynx vary from mild asymptomatic effect to life-threatening conditions. Many authors have emphasized the need of studies in different communities on its effect. In Egypt, the knowledge regarding its manifestations on the larynx, as well as its laryngeal alterations, is limited. Patients and methods A total of 79 patients diagnosed as having RA in Menoufia University Hospitals from March 2015 to March 2017 were assessed by taking history and asking about different laryngeal complaints followed by telescopic videolaryngeal examination. Results The estimated prevalence of laryngeal complaints in patients with RA was 57%. The most frequent complaints were globus pharyngeus in 53.2% of patients followed by phonasthenic symptoms in 32.9% of the patients. Dysphonia prevalence was 25.3%. Regarding videolaryngoscopic findings, the prevalence of changes was present in 86.15% of the patients. Most common finding has been posterior laryngitis, which was found in 78.5% of patients, followed by glottic gap in 34.2% and vocal folds rheumatoid nodules in 26.6% of them. Conclusion Laryngeal complaints and videolaryngoscopic morphological findings are prevalent among patients with RA, with a prevalence rate of 57 and 86.15%, respectively. The most frequent complaints were globus pharyngeus in 53.2% of patients followed by phonasthenic symptoms in 32.9% of the patients. Most common videolaryngoscopic findings have been posterior laryngitis, which was found in 78.5% of our patients, followed by glottic gaps in 34.2%.

Laryngeal complaints and videolaryngoscopic laryngeal alterations in rheumatoid arthritis patients and its association with disease activity and duration

Background: Rheumatoid arthritis (RA) is an autoimmune systemic disease with a wide clinical presentation. The laryngeal manifestations are often masked by the articular disability often experienced in the early and late stages of the disease. Objective: Association between different laryngeal complaints and videolaryngoscopic laryngeal alterations in patients with RA, and disease activity and duration. Patients and methods: A retrospective study was conducted on 79 patients with RA. All subjects were recruited from the out-patient clinic of physical medicine, rehabilitation, and rheumatology in Al-Menoufia University Hospitals during the period from March 2015 to March 2017. All patients were subjected to both phoniatric and rheumatological assessment. Results: Patients with phonasthenic symptoms and globus pharynges had significantly (p=0.01, 0.008 respectively) higher disease duration than patients without. No significant association found between rheumatoid arthritis duration and different videolaryngoscopic laryngeal alterations, patient’s self-assessment of the impact of laryngeal complaints on their lives, and auditory perceptual assessment (APA) of patient’s voice characters. As regards rheumatoid disease's activity no significant correlation has been established (p&gt;0.05) with different laryngeal complaints except for patients in remission who had higher prevalence of intermittent dysphonia than patients with low activities. Rheumatoid disease's activity had no significant association with different laryngeal findings except those with moderate activity; they had significantly higher prevalence of vocal folds nodules than patients with high activity and patients in remission. Conclusion: A significant association between the disease's duration and presence of laryngeal complaints, dysphonia, and its persistence has been established. Also, patients with phonasthenic symptoms and globus pharynges had significantly higher disease duration than patients without. Rheumatoid diseases activity had significant association with different laryngeal complaints in patients with remission that had higher prevalence of intermittent dysphonia than patients with low activities. No significant association between the disease activity and different laryngeal findings that has been found except for patients with DAS-28&gt;3.2, they had significantly higher prevalence of rheumatoid nodules.

Acoustic and Auditory Perception Effects of the Voice Therapy Technique Finger Kazoo in Adult Women

This study aimed to verify and to correlate acoustic and auditory-perceptual measures of glottic source after the performance of finger kazoo (FK) technique. This is an experimental, cross-sectional, and qualitative study. We made an analysis of the vowel [a:] in 46 adult women with neither vocal complaints nor laryngeal alterations, through the Multi-Dimensional Voice Program Advanced and RASATI scale, before and immediately after performing three series of FK and 5 minutes after a period of silence. Kappa, Friedman, Wilcoxon, and Spearman tests were used. We found significant increase in fundamental frequency, reduction of amplitude variation, and degree of sub-harmonics immediately after performing FK. Positive correlations were measures of frequency and its perturbation, measures of amplitude, of soft phonation index, of degree and number of unvoiced segments with aspects of RASATI. Negative correlations were voice turbulence index, measures of frequency and its perturbation, and measures of soft phonation index with aspects of RASATI. There was fundamental frequency increase, within normal limits, and reduction of acoustic measures related to presence of noise and instability. In general, acoustic measures, suggestive of noise and instability, were reduced according to the decrease of perceptive-auditory aspects of vocal alteration. It shows that both instruments are complementary and that the acoustic vocal effect was positive.

Evaluation of laryngotracheal alterations associated with intubation

Background: Laryngeal injuries following intubation have a reported incidence from 63 to 94% and permanent sequelae are reported to be about 10 to 22% in the world literature. While several studies assessing the laryngeal complications are available in Western populations, minimal data is available in the literature regarding Indian population. Aim: The aim of this study is to evaluate laryngeal lesions in patients after prolonged intubation (>24 h), to correlate these lesions with the variables involved in the process of intubation and to determine the risk factors. Materials and Methods: The study was undertaken at the ICU of a Tertiary Care Hospital. AU patients extubated at the intensive care unit of our hospital after at least 24 h of intubation were included in the study. Fibreoptic Bronchoscopy was done on day of extubation, and weekly for 03 weeks. Result: 100 patients were included in the study. Laryngeal abnormalities were seen in 88 patients on the day of extubation. At the end of third week after extubation, only 09 patients had abnormal laryngeal findings. A multivariate stepwise regression model showed that bigger tube size and longer duration of intubation was associated with higher incidence of laryngeal complications on the day of extubation. At the end of third week laryngeal findings were influenced only by the duration of intubation and size of Endotracheal tube. Conclusion: Laryngeal alterations after extubation are directly associated with duration of intubation and size of Endotracheal tube.

Finger Kazoo: modificações vocais acústicas espectrográficas e autoavaliação vocal

Objetivo correlacionar modificações vocais acústicas espectrográficas e autoavaliação após o finger kazoo. Métodos análise de /a:/ de 46 mulheres sem queixas vocais ou afecções laríngeas pelo Real Time Spectrogram® e autoavaliação antes (Momento 1 – M1), após o finger kazoo (Momento 2 – M2) e após cinco minutos de silêncio (Momento 3 – M3). Teste Kappa, Qui-quadrado, Spearman. Resultados melhora da intensidade do escurecimento do traçado dos formantes (F) e das altas frequências, regularidade do traçado e definição dos harmônicos. Melhora na autoavaliação vocal, conforme aumento da intensidade do escurecimento do traçado de F3, da definição do traçado, do número de harmônicos e redução da substituição de harmônicos por ruídos nas médias frequências. Conclusões após o finger kazoo, aumentou a intensidade da cor do traçado, a regularidade e definição nas espectrografias e houve melhora na autoavaliação vocal.

Prevalence of Laryngeal Alterations in Patients with Erosive Esophagitis

Introduction: The association between gastroesophageal reflux disease (GERD) and laryngeal disorders has been much debated in recent years. Recent studies suggest an association between laryngeal symptoms and pharyngeal symptoms extra-esophageal reflux, as atypical presentation of Gastroesophageal Reflux Disease. Objectives: To correlate the presence of laryngeal to the grades of erosive esophagitis. Methods: A prospective study. Patients with findings of esophagitis on endoscopy were categorized according to LosAngeles and submitted a questionnaire followed by laryngoscopy. The chi-square test was used for statistical analysis (p Results: Patients with typical symptoms of gastroesophageal reflux disease accounted for 96.6%. Eighteen had changes consistent with class A (60%), class B with seven (7%) and 5 with classes C + D (16.6%). The presence of laryngeal changes were more prevalent in more severe esophagitis (grades C and D Los Angeles) when compared to milder forms (classes A and B), a statistically significant difference (p Conclusion: The laryngeal disorders are frequent findings in patients with esophagitis, more frequent the greater the degree of esophageal injury.

Laryngeal involvement in rheumatoid arthritis

AbstractThe prevalence of laryngeal involvement in Rheumatoid Arthritis (RA) ranges from 13 to 75%. The specific RA manifestations include the cricoarytenoid arthritis and the presence of rheumatoid nodules in the vocal folds. ObjectiveThe objective of this study is to evaluate the prevalence of dysphonia and laryngeal alterations on videolaryngoscopy in RA patients and their association with disease activity. MethodThis is a clinical cross-sectional study that evaluated patients with rheumatoid arthritis as to their disease activity score in 28 joints (DAS-28), laryngeal symptoms, application of a Portuguese version of the Voice Handicap Index and videolaryngoscopy findings, comparing them with a control group. ResultsWe evaluated 47 (54%) patients with rheumatoid arthritis and 40 (46%) controls. The prevalence of dysphonia and videolaryngoscopy changes was respectively 12.8% and 72.4% in patients with RA. The mean of DAS-28 was 3.3 ± 1.2; 26 (74.3%) of 35 patients presenting active disease had laryngeal changes (p = 0.713). Posterior laryngitis was the most common diagnosis (44.7%). ConclusionThe prevalence of laryngeal disorders in RA patients was 72.4% and the prevalence of dysphonia was 12.8%. There was no significant relationship between laryngeal disorders and disease activity.

Incidence of post-intubation subglottic stenosis in children: prospective study

To evaluate the incidence of subglottic stenosis in children undergoing endotracheal intubation. Children in the paediatric intensive care unit of a tertiary care hospital were considered eligible for inclusion if they received endotracheal intubation for more than 24 hours. After extubation, children underwent flexible fibre-optic nasolaryngoscopy. Based on this first evaluation, they were divided into two groups: 'acute normal', with mild laryngeal alterations or normal findings; and 'acute alterations', with moderate to severe laryngeal alterations. Further laryngoscopic follow up (7-10 days later) was undertaken for those children in the acute normal group who developed symptoms during follow up (after discharge from the intensive care unit), and for all children in the acute alterations group. Children were then classified into two final groups: 'normal final examination', with no chronic changes; and 'subglottic stenosis'. We included 123 children. The incidence of subglottic stenosis was 11.38 per cent (95 per cent confidence interval, 6.63-17.94 per cent). All the children who developed subglottic stenosis had had moderate to severe alterations immediately after extubation. This incidence of subglottic stenosis is quite high and needs further investigation to identify risk factors.