Role of Laryngopharyngeal Reflux in Eustachian Tube Dysfunction in Adults

We have here studied the relationship between Eustachian tube dysfunction and laryngopharyngeal reflux, evaluating also the results of medical therapy in patients with such problems. Based on clinical, endoscopic and cytological investigations, we found that acid laryngopharyngeal reflux was the basis of audiological symptoms and chronic dysfunction of the Eustachian tube

Audio-Vestibular Alterations During the Phases of the Menstrual Cycle in Patients with Cochlear Implant

Background: The female hormones fluctuations in woman’s life play a dominant role in homeostasis of the body and can influence the psycho-neurological processes in different body systems. In particular, in the auditory system seems that hormonal alterations during the menstrual cycle can compromise the homeostasis of the labyrinthine fluids altering balance and/or hearing. Aims/Objectives: Our study aims to verify if hormonal changes during different menstrual phases may have an influence, in females with cochlear implants, on the trend of auditory and vestibular performances. Materials and methods: Tonal, speech audiometry, vestibular examination and a measure of cochlear implants electrodes impedances were realized in the follicular and luteal phases on a group of eight women who are at a fertile age, affected by profound sensorineural form of hearing loss and carrying a monolateral cochlear implant. Results: Audio-vestibular alterations, as well as, an increase of impedance electrodes are reported in the luteal phase. Conclusions: Our work suggests that audio-vestibular alterations are related to the different phases of the menstrual cycle with consequent variation also of the performances of the implant. It is very important to keep in mind this aspect to avoid negative results during rehabilitation

Effects of hormonal changes on the quality of voice, vestibular and listening skills: an experimental study on young hearing-impaired women with cochlear implant.

The female hormones fluctuations in woman’s life play a dominant role in homeostasis of the body and can influence the psycho-neurological processes in different body systems. In particular, in the auditory system seems that hormonal alterations during the menstrual cycle can compromise the homeostasis of the labyrinthine fluids altering balance and/or hearing. Our study aims to verify if hormonal changes during different menstrual phases may have an influence, in females with cochlear implants, on the trend of auditory, vestibular and phoniatric performances. An audiological, vestibular and phoniatric evaluation, according to standard protocols, was performed in the follicular and luteal phases, on a group of eight women who are at a fertile age, affected by profound sensorineural form of hearing loss and carrying a mono-lateral cochlear implant. Audio-vestibular and phoniatric alterations, as well as, an increase of impedance electrodes are reported in the luteal phase only. Our work suggests that audio-vestibular and phoniatric alterations are related to the different phases of the menstrual cycle with consequent variation also of the performances of the implant. It is very important to keep in mind this aspect to avoid negative results during rehabilitation

QUALITATIVE AND QUANTITATIVE MEASUREMENT OF SINGING VOICE

Objective: The aim of the study was to clarify the mecha- nisms underlying the singing voice. Patients and Methods: Forty-eight professional opera singers underwent flexible and rigid endoscopy, spectrographic analysis and percep- tual evaluation. Results: The data provided by voice analysis were not as clear and relevant to the aim of our study as those commonly obtained for speech evaluation. Laryngos- copy with rigid and flexible fiber optics and the singing pow- er ratio (SPR) measurement provided more applicable data. Indeed, the former allowed us to assess laryngeal position, the glottic pattern and vocal tract modifications during the actual singing performance. The latter, already recommend- ed by other authors as a reliable vocal emission index, also yielded more relevant information in comparison with the assessment of voice quality. Specifically, SPR provided data directly correlated to both the years of singing activity and the vocal category of each singer (the higher the singing pitch, the wider the vocal extension). More importantly, the data fully reflected the subjective assessment of each pho- niatrician. Conclusions: We suggest that the SPR indices can be used as the electroacoustic equivalent of the subjective judgment of vocal focus

Spasmodic dysphonia follow-up with videolaryngoscopy and voice spectrography during treatment with botulinum toxin

Spasmodic dysphonia (SD) is a focal dystonia of laryngeal muscles seriously impairing quality of voice. Adductor SD (ADSD) is the most common presentation of this disorder that can be identified by specialized phoniatricians and neurologists firstly on a clinical evaluation and then confirmed by videolaryngoscopy (VL). Botulinum toxin (BTX) injection with electromyographic guidance in muscles around vocal cords is the most effective treatment. Voice Handicap Index (VHI) questionnaire is the main tool to assess dysphonia and response to treatment. Objective of this study is to perform VL and voice spectrography (VS) to confirm the efficacy of BTX injections over time. 13 patients with ADSD were studied with VHI, VL and VS before and after 4 consecutive treatment with onobotulinumtoxin-A. For each treatment vocal improvement was proved by a significant reduction of VHI score and increase of maximum time phonation and harmonic-to-noise ratio while VL showed the absence of spasm in most of patients. No change of the response to BTX was found between injections. This study supports the efficacy of the treatment of SD with BTX with objective measurements and suggests that the efficacy of recurring treatments is stable over time

Dysphonia in pharyngolaryngeal reflux: evaluation of acid lesions with video endoscopy

BACKGROUND: In this study, the authors assessed the injury of acid reflux on the mucosa of laryngopharyngeal district, and the associated symptoms, dysphonia especially. METHODS: Data from 270 patients, collected in 18 months, have been evaluated by video laryngoscopy. Sixty-two presented dysphonia, associated with symptoms of reflux disease. Later the patients have been investigated for the presence of reflux esophagitis by endoscopic examination and assessed the 24 hours pH value, by ph-metry. RESULTS: The results showed that only 26 patients presented signs of reflux esophagitis. CONCLUSIONS: In conclusion we can assert that some important endoscopic signs recorded, such as edema and hyperemia of arytenoids, thickening the region interarytenoid, granulomas of the posterior portion of the true vocal cords, can be considered as valuable indicators of reflux disease. In many cases a simple dysphonia may represent a precise signal of disease of gastro-esophageal reflux, even in the absence of endoscopic marks of esophagitis

Enlarging the spectrum of cluster headache: Extracranial autonomic involvement revealed by voice analysis

People with cluster headache (CH) are frequently burdened by misdiag-nosis or diagnostic delay. The peculiar somatic and behavioral changes characterizing patients with CH are not useful to improve diagnostic accuracy. In our clinical experi-ence, we noticed a typical voice quality with low and croaking tone in patients with CH.In this cross-sectional study, we evaluated, by digital voice analysis, whether it is pos-sible to identify typical voice quality characterizing patients with CH compared with healthy controls (HCs). Furthermore, to investigate whether putative differences in voice characteristics could be underpinned by constitutional aspects or pathological processes of vocal cords, subjects underwent a videolaryngostroboscopy. Smoking habits and alcohol consumption were specifically investigated. Conclusion: Creaky phonation is a “physiological mode of laryngeal operation” usually underpinned by shortened and thickened vocal folds. Creaky voice phonation can be due to a vocal fold's reduced capability to become slack or flaccid secondary to vocal cord edema underpinned by laryngopharyngeal reflux affecting the phonatory mecha-nisms in patients with CH. The laryngopharyngeal reflux may represent a dysautonomic sign related to the increased parasympathetic tone during in- bout period, reinforcing the hypothesis of an extracranial autonomic dysfunction as part of CH clinical picture