Decannulation factors in patients after serious brain injuries

Background. Patients with a long term tracheotomy (longer than 4 weeks) are quite frequent patients in the Neurorehabilitation Wards. These are especially patients after serious traumatic brain injuries, ischemic or hemorrhagic strokes, ischemic brain injuries and others. A correct multidisciplinary treatment requires a very close cooperation of: physiotherapists, neurologists, laryngologists and speech therapists. The aim of our study was to analyze factors that may influence positive decanulation in patients with tracheotomy performed because of the traumatic brain injury, stroke or cardiac arrest. Methods. Our material includes 127 patients hospitalized in our Department of Rehabilitation between 2002 and 2005. All of them had tracheotomy performed after the brain injury. We analyzed factors like: age, sex, cause of tracheotomy, GCS scale, duration of tracheotomy, concomitant diseases, microbiology examination of the bronchial secretion and the influence of these factors on decanulation. Results. We confirmed that young age (less than 40), traumatic brain injury and short time of tracheotomy are the positive decannulation factors.Background. Patients with a long term tracheotomy (longer than 4 weeks) are quite frequent patients in the Neurorehabilitation Wards. These are especially patients after serious traumatic brain injuries, ischemic or hemorrhagic strokes, ischemic brain injuries and others. A correct multidisciplinary treatment requires a very close cooperation of: physiotherapists, neurologists, laryngologists and speech therapists. The aim of our study was to analyze factors that may influence positive decanulation in patients with tracheotomy performed because of the traumatic brain injury, stroke or cardiac arrest. Methods. Our material includes 127 patients hospitalized in our Department of Rehabilitation between 2002 and 2005. All of them had tracheotomy performed after the brain injury. We analyzed factors like: age, sex, cause of tracheotomy, GCS scale, duration of tracheotomy, concomitant diseases, microbiology examination of the bronchial secretion and the influence of these factors on decanulation. Results. We confirmed that young age (less than 40), traumatic brain injury and short time of tracheotomy are the positive decannulation factors

Post-Mutational Voice Instability – a Case Report

Pomutacyjna niestabilność głosu (PNG) – puberfonia, jest schorzeniem występującym rzadko. W pracy przedstawiono przypadek rehabilitacji logopedycznej pacjenta ze zdiagnozowaną pomutacyjną niestabilnością głosu. Pacjent został objęty opieką przez lekarza foniatrę, logopedę oraz psychologa. Wdrożono indywidualnie dostosowaną terapię logopedyczną. Przed rozpoczęciem rehabilitacji oraz po jej zakończeniu pacjent dokonywał samooceny głosu przy użyciu kwestionariusza Voice Handicap Index (VHI), skali dyskomfortu traktu głosowego Vocal Tract Discomfort (VTD) oraz kwestionariusza Oceny Jakości Życia zależnej od głosu Voice-Related Quality of Life (V-RQOL). Rehabilitację głosu prowadzono przez 6 miesięcy. W jej wyniku uzyskano niski, stabilny głos. Pozytywny efekt terapeutyczny u pacjenta był wynikiem ścisłej współpracy interdyscyplinarnego zespołu.Post-mutational voice instability (PNG) – puberphonia is a rare disease. The paper presents a case of logopedic rehabilitation of a patient with diagnosed PNG. The patient was cared for by a phoniatric specialist, speech therapist, and psychologist. Customized logopedic therapy has been implemented. Before and after rehabilitation, the patient performed voice self-assessment using the Voice Handicap Index (VHI) questionnaire, the Vocal Track Discomfort (VTD) scale and evaluating questionnaire on the Voice-Related Quality of Life (V-RQOL). Rehabilitation was conducted for 6 months. It resulted in a low, stable voice. The positive therapeutic effect was the result of the cooperation of an interdisciplinary team

Bleeding into the Abdominal and Ilio-Lumbar Muscles—A Rare Complication in the Course of COVID-19: Analysis of Four Cases and a Literature Review

The risk of venous thromboembolic (VTE) complications, mainly in the form of pulmonary embolism (PE) and deep vein thrombosis (DVT), in COVID-19 is well known, necessitating the administration of thrombotic prophylaxis in most patients. With a high risk of VTE complications or their presence, full anticoagulation may be associated with hemorrhagic complications. COVID-19 bleeding is rarely reported. Here, we present four cases of patients with muscle bleeding: two in the iliopsoas muscle, which resulted in death despite the embolization of the bleeding vessel, and two in the oblique and straight abdominal muscles, which were treated conservatively. In the reported cases, the severity of the bleeding coincided with the severity of the course of COVID-19. When observing a sudden drop in hemoglobin (Hb) in a patient with COVID-19, one must always remember the possible complications in the form of muscle bleeding, which can be fatal

Teachers’ voice rehabilitation in sanatorium conditions

Schorzenia narządu głosu zajmują 3 miejsce wśród rozpoznawanych chorób zawodowych w Polsce. Nadal istnieje potrzeba wdrażania skutecznych i ekonomicznych metod prewencji pierwotnej i wtórnej zaburzeń głosu u nauczycieli. Celem pracy była ocena skuteczności kompleksowej rehabilitacji głosu u nauczycieli prowadzonej w warunkach szpitala uzdrowiskowego.Materiał i metody Przedstawiono wyniki kompleksowej rehabilitacji głosu przeprowadzonej podczas 24-dniowego turnusu sanatoryjnego u 100 nauczycielek ze stażem pracy 10–30 lat (M = 17 lat). W pierwszym i ostatnim dniu turnusu wykonano badania laryngologiczne i foniatryczne [czas fonacji (maximum phonation time – MPT), ocenę percepcyjną głosu w skali GRBAS, badanie laryngowideostroboskopowe, analizę akustyczną głosu], wypełnienie Kwestionariusza samooceny głosu (Voice Handicap Index – VHI), ocenę logopedyczną i audiometrię tonalną. W zakres programu terapeutycznego wchodziły: zajęcia edukacyjne dotyczące higieny głosu, terapia głosu, fizjoterapia i psychoterapia. Efekty rehabilitacji sanatoryjnej pacjenci oceniali również w badaniu ankietowym.WynikiStwierdzono poprawę obiektywnych parametrów akustycznych, oceny percepcyjnej głosu, samoceny głosu VHI i MPT. Zmiany w sposobie fonacji potwierdzono w badaniu laryngowideostroboskopowym, w którym obserwowane zwarcie fonacyjne poprawiło się znamiennie u 30% badanych. W ankiecie oceniającej korzyści z sanatoryjnej rehabilitacji głosu 97% uczestników potwierdziło skuteczność i celowość okresowego powtarzania takiej rehabilitacji.WnioskiWyniki przedstawionych badań i pozytywne oceny uczestników rehabilitacji sanatoryjnej potwierdzają skuteczność sanatoryjnej terapii zawodowych zaburzeń głosu. Leczenie i rehabilitacja w formie stacjonarnej powinny zmierzać do poprawy głosu oraz kontynuacji pracy zawodowej. Tak ukierunkowane postępowanie może przyczynić się do zmniejszenia nakładów finansowych związanych z leczeniem, urlopami dla poratowania zdrowia i rentami zawodowymi. Med. Pr. 2021;72(4):399–405Voice diseases occupy the third place among all of the diagnosed occupational disorders in Poland. There still exists the necessity to implement effective and economical methods of the primary and secondary prevention of voice disorders in teachers. The aim of this study was to assess the effectiveness of comprehensive voice rehabilitation in teachers, conducted within a health resort hospital.Material and MethodsThe results of comprehensive voice rehabilitation in 100 teachers with job seniority of 10–30 years (M = 17 years), conducted during 24-day-long staying in a sanatorium, are presented in this research. Phoniatrical and laryngological examinations (maximum phonation time [MPT], perceptual assessment of voice in GRBAS scale, laryngovideostroboscopy, and acoustic analysis of voice), self-assessment of voice (the Voice Handicap Index – VHI), logopedical estimation and audiometry were conducted during the first and the last day of the sanatorium stay. The therapeutic program included educational workshops on vocal hygiene, voice therapy, physiotherapy and psychotherapy. The inpatient therapy effects were also described by the teachers using a questionnaire.ResultsImprovements of objective acoustic parameters, a perceptual assessment of voice, and a self-assessment of VHI and MPT were observed. Phonation style changes were confirmed in the laryngovideostroboscopic examination. Phonation closure improved significantly in 30% of the examined teachers. Moreover, 97% of the participants confirmed in the questionnaire the effectiveness and purposefulness of periodic recurrence of such rehabilitation courses.ConclusionsThe results of this research as well as the positive feedback from the participants of inpatient rehabilitation confirmed the effectiveness of occupational voice disorder rehabilitation in sanatorium (inpatient) conditions. Treatment and rehabilitation in a stationary form should aim to achieve voice improvement and job continuation. Such a procedure may contribute to reducing the financial outlays related to treatment, health leaves and occupational pensions. Med Pr. 2021;72(4):399–40

Specific features of vocal fold paralysis in functional computed tomography

Background: Vocal fold paralysis is usually recognized in laryngological examination, and detailed vocal fold function may be established based on laryngovideostroboscopy. Additional imaging should exclude any morphological causes of the paresis, which should be treated pharmacologically or surgically. The aim of this paper was to analyze the computed tomography (CT) images of the larynx in patients with unilateral vocal fold paralysis. Material/Methods: CT examinations of the larynx were performed in 10 patients with clinically defined unilateral vocal fold paralysis. The examinations consisted of unenhanced acquisition and enhanced 3-phased acquisition: during free breathing, Valsalva maneuver, and phonation. The analysis included the following morphologic features of the paresis: the deepened epiglottic vallecula, the deepened piriform recess, the thickened and medially positioned aryepiglottic fold, the widened laryngeal pouch, the anteriorly positioned arytenoid cartilage, the thickened vocal fold, and the filled infraglottic space in frontal CT reconstruction. CT images were compared to laryngovideostroboscopy. Results: The most common symptoms of vocal cord paralysis in CT were the deepened epiglottic vallecula and piriform recess, the widened laryngeal pouch with the filled infraglottic space, and the thickened aryepiglottic fold. Regarding the efficiency of the paralysis determination, the three functional techniques of CT larynx imaging used did not differ significantly, and laryngovideostroboscopy demonstrated its advantage over CT. Conclusions: CT of the larynx is a supplementary examination in the diagnosis of vocal fold paralysis, which may enable topographic analysis of the fold dysfunction. The knowledge of morphological CT features of the paralysis may help to prevent false-positive diagnosis of laryngeal cancer

Evaluation of laryngeal cartilage calcification in computed tomography

Background: Computed tomography (CT) is one of the basic methods used for laryngeal carcinoma diagnostics. Osteosclerotic and osteolytic changes of the cartilages are considered as a common radiologic symptom of laryngeal neoplasms. The aim of this paper was to evaluate the prevalence of both osteosclerotic changes and focal calcification defects, which may be suggestive of osteolysis. Calcification was assessed in the thyroid, the cricoid and the arytenoids cartilages on CT images of the neck. Material/Methods: We have retrospectively analyzed neck CT examinations of 50 patients without any laryngeal pathology in anamnesis. The grade and symmetry of calcifications was assessed in the thyroid, the cricoid and the arytenoids cartilages. Results: Calcification of the laryngeal cartilages was present in 83% of the patients. Osteosclerotic lesions of the thyroid cartilage were seen in 70% of the patients (asymmetric in 60% of them), of the cricoid catrilage in 50% (asymmetric in 60%), and of the arytenoid cartilages in 24% (asymmetric in 67%). Focal calcification defects were present in the thyroid cartilage in 56% of the patients (asymmetric in 67% of them), in the cricoid catrilage in 8% (asymmetric in all cases), and in the arytenoid cartilages in 20% (asymmetric in 90%). Conclusions: Osteosclerotic changes and focal calcification defects, which may suggest osteolysis, were found in most of the patients. Therefore, they cannot be used as crucial radiological criteria of neoplastic invasion of laryngeal cartilages