Ethical and legal aspects in the care of singers and actors

Univ Fed Sao Paulo, Unifesp, EPM, Sao Paulo, SP, BrazilUniv Coimbra, Direito Med, Coimbra, PortugalEPD, Direito Med, Sao Paulo, SP, BrazilAssoc Brasileira Otorrinolaringol & Cirurgia Cerv, Dept Jurid, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Unifesp, EPM, Sao Paulo, SP, BrazilWeb of Scienc

Laryngeal electromyography in dysphonic patients with incomplete glottic closure

The lack of specificity in laryngoscopical examination requires that the diagnosis of superior laryngeal and recurrent laryngeal nerve involvement be carried out with the aid of electromyography. OBJECTIVE: This study aims to assess the electrophysiological function of the superior and inferior laryngeal nerves by measuring the electrical activity of the muscles they innervate in dysphonic patients with incomplete closure of the vocal folds during phonation. METHOD: Thirty-nine patients with incomplete glottic closure were enrolled in a prospective study and had their cricothyroid, thyroarytenoid, and lateral cricoarytenoid muscles examined bilaterally through electromyography. Insertion activity, electrical activity at rest (fibrillation, positive wave and fasciculation) and during muscle voluntary contraction (recruitment, amplitude, potential length and latency between electrical activity and phonation) were measured. RESULTS: No altered test results were observed for parameters insertion activity and electrical activity at rest. None of the patients had recruitment dysfunction. The mean electrical potential amplitude values were within normal range for the tested muscles, as were potential durations and latency times between the onset of electrical activity and phonation. CONCLUSION: No signs of denervation were seen in the thyroarytenoid, cricothyroid, and lateral cricoarytenoid muscles of the studied patients.O diagnóstico de comprometimento do nervo laríngeo superior e de ramos do laríngeo recorrente demanda eletromiografia, pois as alterações à laringoscopia são inespecíficas. OBJETIVO: Avaliar eletrofisiologicamente a função dos nervos laríngeo superior e inferior por meio da atividade elétrica dos músculos por eles inervados, em pacientes com disfonia com coaptação incompleta das pregas vocais à fonação. MÉTODO: Estudo prospectivo; 39 indivíduos com disfonia e fechamento glótico incompleto foram submetidos à eletromiografia dos músculos tireoaritenóideo, cricotireóideo e cricoaritenóideo lateral bilateralmente. Foram avaliadas atividade de inserção, no repouso (fibrilação, onda positiva e fasciculação) e durante contração voluntária dos músculos (recrutamento, amplitude e duração do potencial e latência entre início da atividade elétrica e a sonorização). RESULTADOS: Não observamos alteração na atividade de inserção e no repouso. Nenhum paciente apresentou recrutamento alterado. A média da amplitude dos potenciais elétricos esteve compatível com a normalidade nos músculos testados, assim como a duração do potencial e o tempo de latência entre o início da atividade elétrica e a sonorização. CONCLUSÃO: Não observamos sinais de desnervação nos músculos tireoaritenóideo, cricotireóideo e cricoaritenóideo lateral bilateralmente nos pacientes estudados.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUniversidade Federal de São Paulo (UNIFESP) Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço Escola Paulista de MedicinaInternational Federation of ORL SocietiesUNIFESP, EPMUNIFESP, Depto. de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço Escola Paulista de MedicinaSciEL

Repeated Epley’s maneuver in the same session in benign positional paroxysmal vertigo

SummaryAimTo assess whether more than one Epley’s maneuver in the same session, compared to a single one, decreases the number of sessions necessary to suppress positional nystagmus.MethodEpley’s maneuver was done in 123 patients with BPPV due to unilateral posterior semicircular canal canalolithiasis. The number of sessions for positional nystagmus suppression was compared in two groups of patients. Group I consisted of 75 patients submitted to a single Epley’s maneuver on weekly sessions and group II consisted of 48 patients that were submitted to four Epley’s maneuvers during the first session.ResultsGroup II showed greater nystagmus latency and duration than group I (p<0.05). The number of sessions and standard deviation showed by group I was greater than in group II (p=0.008). We observed a significant association between number of sessions and group (p=0.039) studied. Group II had 21.4% more nystagmus-free patients following only one session (CI95% [7.7% - 35.1%]).ConclusionRepeated Epley’s maneuvers in less sessions rendered more positional nystagmus-free patients when compared to those submitted to more sessions of single maneuvers

Sulfated glycosaminoglycans in human vocal fold lamina propria

Introduction: The distribution, concentration and function of glycosaminoglycans in the various vocal fold tissues are still unclear. Objective: To evaluate the distribution and concentration of sulfated glycosaminoglycans in different layers of the human vocal fold according to gender and age. Methods: We used 11 vocal folds obtained from cadavers (7 men and 4 women) with no laryngeal lesion, less than 12 h after death, and aged between 35 and 98 years. The folds underwent glycosaminoglycans extraction from the cover and ligament, and post-electrophoresis analysis. Data were compared according to the layer, age and gender. Results: The concentration of dermatan sulfate was significantly higher in all layers. No differences were observed in the total concentrations of glycosaminoglycans in layers studied according to gender. It is significantly lower in the cover of individuals aged below 60 years. Conclusion: Dermatan sulfate, chondroitin sulfate, and heparan sulfate were observed in the human vocal folds cover and ligament of both genders, with the concentration of dermatan sulfate being significantly higher in all layers. Glycosaminoglycans concentration on the cover is significantly lower in individuals below 60 years compared with elderly. (C) 2016 Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial. Published by Elsevier Editora Ltda.Univ Fed Sao Paulo UNIFESP, EPM, Dept Otorrinolaringol & Cirurgia Cabeca & Pescoco, Setor Laringe & Voz, Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP, EPM, Dept Bioquim, Div Biol Mol, Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP, EPM, Dept Med, Div Endocrinol & Metab, Sao Paulo, SP, BrazilPUC SP, Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP, EPM, Dept Otorrinolaringol & Cirurgia Cabeca & Pescoco, Setor Laringe & Voz, Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP, EPM, Dept Bioquim, Div Biol Mol, Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP, EPM, Dept Med, Div Endocrinol & Metab, Sao Paulo, SP, BrazilWeb of Scienc

Repeated Epley maneuver in the same session in benign positional paroxysmal vertigo

Objetivo: Avaliar se a repetição de manobras de Epley em uma mesma sessão resulta em um menor número de sessões para abolir o nistagmo de posicionamento do que uma única manobra de Epley por sessão. Método: A manobra de Epley foi realizada em 123 pacientes com VPPB por ductolitíase de canal do semicircular posterior unilateral. O número de sessões necessárias para eliminar o nistagmo de posicionamento foi comparado em dois grupos de pacientes. O grupo I foi composto por 75 pacientes submetidos a uma única manobra de Epley por sessão semanal e o grupo II foi constituído por 48 pacientes que foram submetidos a quatro manobras de Epley na primeira sessão. Resultados: O grupo II apresentou latência e duração do nistagmo maiores do que o grupo I (pBV UNIFESP: Teses e dissertaçõe

Visual-perceptive assessment of glottic characteristics of vocal nodules by means of high-speed videoendoscopy

Objective: Visual-perceptive assessment of glottic characteristics of vocal nodules by means of high-speed videoendoscopy. Methods: Descriptive observational research with convenience sampling of five laryngeal videos of women with an average age of 25 years. The diagnosis of vocal nodules was defined by two otolaryngologists, with 100% intra-rater agreement and 53.40% inter-rater agreement and five otolaryngologists as judge assessed the laryngeal videos based on an adapted protocol. The statistical analysis calculated measures of central tendency and dispersion, as well as percentage. The AC1 coefficient was used for agreement analysis. Results: In high-speed videoendoscopy imaging, vocal nodules are characterized by amplitude of the mucosal wave and muco-undulatory movement with magnitude between 50% and 60%. Non-vibrating segments of vocal folds are scarce, and the glottal cycle does not show a predominant phase, it is symmetric and periodic. Glottal closure is characterized by the presence of a mid-posterior triangular chink (double chink or isolated mid-posterior triangular chink), without movement of supraglottic laryngeal structures, with irregular contour of the free edge of vocal folds, which are vertically on-plane. Conclusion: Vocal nodules present mid-posterior triangular chink and irregular free edge contour. Amplitude and mucosal wave were partially reduced. Level of evidence: Level 4 (Case-series)