Alternative treatment for otitis media with effusion: eustachian tube rehabilitation

In this study, we evaluated the effectiveness of eustachian tube rehabilitation (ETR) as treatment for otitis media with effusion (OME). Thirty-five children with persistent OME were enrolled. Patients were divided into three groups: group I (isolated OME); group II (OME and atypical swallowing); group II (OME, habitual mouth breathing and atypical swallowing). All children underwent ETR. Otomicroscopy and tympanograms were performed before treatment, and at one and three months following ETR. Considering the overall patient population after ETR (one and three months later), the prevalence of type A tympanogram increased significantly compared to before therapy (p < 0.005), while the prevalence of type B tympanogram decreased significantly (p < 0.005). We found significant differences between pre- and both post-therapy control in groups I and II. However, children in group II experienced significant improvement of middle ear conditions only three months after the end of therapy (p < 0.005). On the basis of the physiopathologic knowledge of OME and the underlying principles of ETR, we conclude that ETR can be considered a useful therapy in management of OME

The prevalence of signs and symptoms of laryngopharyngeal reflux and laryngeal precancerous lesions in urban taxi drivers

Purpose: Taxi drivers represent a large group of workers employed in the service sector of transport. Many studies found an increased risk of a range of health disorders in relation to their irregular work shifts, inappropriate diet, drinking and smoking habits and their high exposure to gasoline- and diesel-engine exhaust fumes. The aim of the present study was to assess the sample of a larynx from taxi drivers, considering symptoms and endoscopic signs of laryngopharyngeal reflux (LPR) and precancerous lesions. Methods: Taxi drivers enrolled (n = 74) were questioned about their nicotine dependence using the Fagerstrom scale. The Reflux Symptom Index (RSI) was administered to screen LPR symptoms. Each subject underwent videolaryngoscopy with Reflux Finding Score (RFS) calculation. Data were compared with those obtained from the control group (n = 102). Results: Taxi drivers’ group did not show a significantly greater dependence on cigarette smoking (p &lt; 0.05) based on the Fagerstrom scale. RSI resulted greater or equal to 13 (cut-off for reflux disease) for 28/74 (37.3%) taxi drivers and 14/102 (13.7%) controls, with a statistically significant difference between the two groups (p = 0.0015; OR = 3.14). RFS was greater or equal to 7 (95% certainty of having LPR) in 40/74 (53%) cases and 30/102 (29.4%) controls (p = 0.0010, OR = 2.82). Three taxi drivers (4%) had leucoplastic lesions of the vocal cords worthy of biopsy, which turned out to be infiltrating squamous cell carcinoma on histological examination. Conclusions: Taxi drivers resulted at risk of LPR and presented high-prevalence laryngeal precancerous lesions and carcinoma

Pre-operative speech-language pathology counselling in patients undergoing total laryngectomy: A pilot randomized clinical trial

Total Laryngectomy seriously affects on patients Quality of Life and on their psychological well-being. The aim of this study was to verify the effects of pre-operative Speech-Language Pathology counselling on laryngectomized patients. Pilot randomized controlled trial. Twenty-seven patients undergoing total laryngectomy and primary tracheoesophageal puncture were randomized as follows: 14/27 subjects were collocated in the Experimental group who received preoperative Speech-Language Pathology counselling and 13/27 in the Control group group that did not receive it. Two interviews and four questionnaires (Psychological Distress Inventory, Impact of Event Scale-Revised, Hospital Anxiety and Depression Scale, Italian-Self-Evaluation of Communication Experiences after Laryngeal Cancer) were administered immediately after surgery (T0), 1- (T1) and 3-months (T2) after hospital discharge in order to asses levels of distress, post-traumatic stress and anxious-depressive symptoms, acquisition and acceptance of the new voice. Student’s t test and chi square test showed that the two groups of patients were equivalent. Experimental group was more satisfied with the information and obtained statistically better (p &lt; 0.05) scores in terms of levels of distress, post-traumatic stress, anxious-depressive symptoms and acceptance of the new voice than the Control group. The Speech-Language Pathology counselling may reduce the anguish, sadness and anticipatory anxiety deriving from the uncertainty of the post-operative course and it might facilitate the process of emotional adaptation, making patients more capable and prepared to face their new condition

Speech perception in noise in children with dyslexia: Does speech sound disorder matter?

The aim of this observational cohort study with a control group is to compare consonant perception skills in quiet and in noise in children with typical language and learning development and in children with dyslexia, with and without Speech Sound Disorder (SSD). Three groups were included: A control group of twenty children with normal reading abilities and typical language development, twelve children with dyslexia and typical language development and thirteen children with dyslexia and SSD. All subjects received a consonant recognition test in three different listening conditions (quiet, + 10 and 0 Signal-to-Noise Ratio). In all test conditions, children with dyslexia and SSD had significantly lower consonant recognition scores than the control group and the children with dyslexia and typical language development (p&nbsp;&lt;.0001). The poorer performances observed in children with dyslexia and SSD may be explained by impaired phonological processing underlying both conditions

Valutazione dell'attività muscolare faringea attraverso elettromiografia di superficie nasofaringea in pazienti disfagici affetti da ictus ischemico acuto

La disfagia orofaringea è spesso presente durante la fase acuta di un ictus. Lo scopo di questo lavoro è stato quello di valutare se la registrazione elettromiografica di superficie tramite un elettrodo nasofaringeo può essere impiegata per testare l'attività muscolare del faringe nei pazienti con ictus acuto e se queste misurazioni elettrofisiologiche possono essere correlate con la valutazione clinica della deglutizione. Dal punto di vista clinico la severità del quadro è stata valutata mediante l'utilizzo della scala del National Institute of Health Stroke (NIHSS); la disfagia è stata valutata mediante il test di screening Gugging Swallowing Scale (GUSS); l'estensione della lesione ischemica alla TAC è stata misurata attraverso l'Alberta Stroke Programme Early CT Score (ASPECTS). Abbiamo valutato 70 pazienti di cui 50 disfagici (Dys+), e 20 non disfagici (Dys). Ciascun partecipante è stato sottoposto a un'elettromiografia di superficie registrata mediante un elettrodo NP costituito da un catetere di Teflon isolato in acciaio (lungo 16 cm e con un diametro in punta di 1,5 mm). L'elettrodo è stato inserito attraverso la cavità nasale, ruotato e posizionato approssimativamente 3 mm antero-inferiormente rispetto alla volta salpingo-palatina. Per ogni partecipante sono state registrate ed analizzate le risposte elettromiografiche di almeno quattro deglutizioni volontarie ripetute. La deglutizione induce sempre all'elettromiografia burst ripetitivi e polifasici di durata compresa fra 0,25 e 1 secondo, con un'ampiezza intorno ai 100-600mV. I disfagici hanno mostrano una maggiore durata del burst rilevato all'elettromiografia rispetto ai non disfagici, con una differenza statisticamente significativa (p < 0,001), ma non hanno mostrano differenze in termini di ampiezza del burst stesso (p = 0,775); quest'ultima invece era inversamente correlata con lo NIHSS score [r(48) = 0,31; p < 0,05)] e con lo ASPECTS score [r(48) = 0,27; p < 0,05]. Questi risultati suggeriscono che le registrazioni nasofaringee possono rappresentare un indice semi-quantitativo delle difficoltà deglutitorie secondarie a disfunzione faringea ed in particolare, i risultati dell'elettromiografia sarebbero indicativi di una ridotta motilità faringea durante la fase acuta di un ictus

Patients With Voice Prosthesis Rehabilitation During the COVID-19 Pandemic: Analyzing the Effectiveness of Remote Triage and Management

Objective: To describe a remote approach used with patients with voice prosthesis after laryngectomy during the COVID-19 pandemic and the resulting clinical outcomes in terms of voice prosthesis complications management, oncological monitoring, and psychophysical well-being. Study Design: Prospective cohort study. Setting: Otolaryngology Clinic of the University Polyclinic A. Gemelli, IRCCS Foundation. Subjects and Methods: All patients with voice prosthesis who underwent laryngectomy followed by our institute were offered enrollment. Patients who agreed to participate were interviewed to inquire about the nature of the need and to plan a video call with the appropriate clinician. Before and 1 week after the clinician’s call, patients were tested with the Hospital Anxiety and Depression Scale. Degrees of satisfaction were investigated with a visual analog scale. A comparison between those who accepted and refused telematic support was carried out to identify factors that influence patient interest in teleservice. Results: Video call service allowed us to reach 37 (50.68%) of 73 patients. In 23 (62.16%) of 37 cases, the video call was sufficient to manage the problem. In the remaining 14 cases (37.83%), an outpatient visit was necessary. Participants who refused telematic support had a significantly shorter time interval from the last ear, nose, and throat visit than patients who accepted (57.95 vs 96.14 days, P =.03). Video-called patients showed significantly decreased levels of anxiety and depression (mean Hospital Anxiety and Depression Scale total score pre– vs post–video call: 13.97 vs. 10.23, P &lt;.0001) and reported high levels of satisfaction about the service. Conclusion: Remote approach may be a viable support in the management of patients with voice prosthesis rehabilitation

Risultati funzionali dopo cordectomia in laringofissura e in microlaringoscopia con Laser CO2

Videolaryngostroboscopy, psychoacoustic and spectrographic analyses were performed to evaluate vocal function in two groups of male patients who had undergone CO2Laser (n = 23) and laryngofissure cordectomy (n = 21) for the treatment of T1a glottic carcinoma. None of the patients used their voices professionally. This study revealed a good correlation between the anatomical features and voice quality. Psychoacoustic and spectrographic analysis showed that the functional results were significantly worse in the patients treated by laryngofissure (p < 0.003). In this group videolaryngostroboscopy showed a higher rate of compensation in both ventricular folds than shown in the laser-treated group (p < 0.02). The authors conclude that the functional results obtained after cordectomy depend on the various combinations of scarring patterns and compensatory hyperkinesia of the ventricular or vocal folds. The better anatomical and functional results achieved following laser cordectomy may be explained by the fact that such procedures result in better, more rapid healing processes

Medical-legal evaluation of laryngeal dysfunction to determine disability

The "New Table indicating the percentage of disability resulting from injury and disabling diseases" approved by the Italian Ministerial Decree dated February 5, 1992 gives a superficial, highly disorganized handling of laryngeal pathologies. This Table only considers phonatory function disorders which are included in a special section; it totally neglects dyspnea and dysphagia of laryngeal origin. This omission cannot even be overcome on the basis of similarities since there are no analogous items listed for reference. In fact, the parameters applied to evaluate dyspnea (CV, VEMS, O2 consumption) apply to ventilation disorders of a pulmonary nature and cannot, therefore, be used in cases of laryngeal dyspnea. Moreover, the Table does not deal with dysphagia at all. In addition, the basis for the Table--the concept of permanent functional damage--is not always adhered to in giving indications for evaluation of phonatory tract damage. The purpose of the present work is not, however, to propose a different way to determine the percentages for the individual items in the tables; rather, the aim is to suggest a different, highly standardized procedure for evaluating laryngeal dysfunctions which is easy to apply