Microbiological evaluation of different reprocessing methods for cuffed and un-cuffed tracheostomy tubes in home-care and hospital setting

Background: Manufacturers’ recommendations on cleaning of tracheostomy tubes focus on general warning information and non-specific manual cleaning procedures. The aim of this experimental study was to evaluate different reprocessing methods and to determine the mechanical integrity and functionality of tracheostomy tubes following reprocessing. Methods: Sixteen cuffed or un-cuffed tracheostomy tubes obtained from hospital in-patients were reprocessed using one of the following reprocessing methods: a) manual brushing and rinsing with tap water, b) manual brushing followed by disinfection with a glutaraldehyde solution, c) manual brushing followed machine-based cleaning in a dishwasher, and d) manual brushing followed by ultrasound cleaning in a commercially available ultrasound device. Microbial burden of the tubes before and after reprocessing was assessed by measurement of microbial colony-forming units per mL (CFU/mL) of rinsing fluid. After cleaning, tracheostomy tubes were investigated for loss of functionality. Findings: Manual brushing and rinsing with tap water reduced microbial colonization in average by 102 CFU/mL, but with poor reproducibility and reliability. Complete microbial reduction was achieved only with additional chemical or machine-based thermal disinfection. Ultrasound sonification yielded no further microbial reduction after manual brushing. Conclusion: Manual brushing alone will not result in complete eradication of microorganism colonising cuffed or un-cuffed tracheostomy tubes. However, manual cleaning followed by chemical or thermal disinfection may be regarded as safe and reproducible reprocessing method. If a machine-based reprocessing method is used for cuffed tubes, the cuffs’ ventilation hose must be secured in a safe position prior to thermal disinfection

Tracking of Multiple Fundamental Frequencies in Diplophonic Voices

Diplophonia is a type of pathological voice in which two fundamental frequencies fo are present simultaneously. Specialized audio analyzers that can handle up to two fos in diplophonic voices are in their infancy. We propose the tracking of up to two fo s in diplophonic voices by audio waveform modeling AWM, which involves obtaining candidates by repetitive execution of the Viterbi algorithm, followed by waveform Fourier synthesis, and heuristic candidate selection with majority voting. Our approach is evaluated with reference fo-tracks obtained from laryngeal high-speed videos of 29 sustained phonations and compared to state-of-the-art tracking algorithms for multiple fos. An accurate and a fast variant of our algorithm are tested. The median error rate of the accurate variant is 6.52, whereas the most accurate benchmark achieves 11.11. The fast variant is more than twice as fast as the fastest relevant benchmark, and the median error rate is 9.52. Furthermore, illustrative results of connected speech analysis are reported. Our approach may help to improve detection and analysis of diplophonia in clinical research and practice, as well as to advance synthesis of disordered voices.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Acoustic waveform model based detection of diplophonia for clinical application

info:eu-repo/semantics/publishe

Fundamental frequency tracking in diplophonic voices

Background and objectives Fundamental frequency (fo) extraction in disordered voices is a prerequisite for many types of clinical analyses. Special attention must be paid if multiple oscillators with different fos are active simultaneously. Two independent approaches to fo tracking in diplophonic voices are proposed and compared with a benchmark from the literature. Material and methods Six samples of sustained phonations were analyzed. High-speed videos were obtained in addition to audio recordings. Video-based fo tracks were obtained from cycle marks that report maximal vocal fold deflection in digital kymograms. Audio waveform modeling based extraction involved candidate tracking, oscillator waveform synthesis and track selection. Audio subband auto-correlation based extraction served as a benchmark. Results and discussion Promising qualitative and quantitative agreement of audio waveform modeling based estimates with kymogram-based tracks was observed. With reference to the kymogram-based tracks, audio waveform modeling based extraction had a median total error rate of 1.9%, which is an improvement over the benchmark method (17.7%). Conclusion The results illustrate that fos of diplophonic voices may be validly obtained from kymogram cycle marks, as well as via audio waveform modeling. The acquisition of two simultaneous fo tracks in diplophonic voices may increase the validity of clinical voice analysis procedures in the future.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Differentiating Diplophonia from other Types of Severe Dysphonia by Acoustic Analysis

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Oral health status of patients after cancer treatment for squamous cell carcinoma in the upper aero-digestive tract

Objective Treatment for head & neck cancer is associated with severe oral complications, such as reduced salivary flow rate, mucositis, or development or exacerbation of oral diseases (caries and periodontitis). Especially periodontitis represents a chronic inflammatory process, which is regarded as a risk factor for cancer development as well as after cancer treatment as a risk factor for development of osteoradionecrosis of the jaw. The aim of the present study was to determine the oral health status of patients at least 6 months after cancer treatment for squamous cell carcinoma in the upper aero-digestive tract. It was evaluated, whether the patients consulted a dentist prior to cancer treatment and, whether dental treatment was sustained after cancer treatment. Methods Thirty-eight patients (27 male / 11 female, age range 21 to 79 years) of the Department of Otorhinolaryngology (Medical University of Vienna) gave their written consent to participate in the present cross-sectional study. All of the participants were asked on dental treatment before and after cancer treatment, daily oral hygiene, habits, such as smoking and alcohol consumption, education, income, and family status. The decayed, missing and filled teeth (DMF-T) index, clinical (plaque control record (according to O’Leary, PCR), community periodontal index of treatment needs (CPITN), disease severity according to CDC/AAP criteria) and radiological (alveolar bone loss) periodontal parameters were determined. Results Twenty-two of 38 patients consulted a dentist for a check-up before cancer treatment and of those 17 received a treatment, of which tooth extraction was most often performed (in 59% of the cases). Although 71% of the patients consulted a dentist within the last year, 90% of the examined patients presented the necessity of dental treatment at time-point of evaluation; 75 % had at least one decayed tooth, with an average of 4 decayed teeth. The average DMF-T-index was 25.5. Seventy-two percent showed a CPITN of 3 or 4 and 31 % of the patients presented moderate and 47 % severe periodontitis. Mean alveolar bone loss was 4.3mm. A professional dental cleaning session was never performed in 40% of the patients and the mean PCR was 65%. The consultation of a dentist before cancer treatment presented no significant effect on the oral health status after cancer treatment. Conclusion The oral health status of patients at least 6 months after cancer treatment for squamous cell carcinoma in the upper aero-digestive tract presented to an extremely high degree the necessity of treatment for oral diseases, such as caries and periodontitis. Regarding the risks associated with these oral diseases after cancer treatment, such as the development of osteoradionecrosis of the jaw, the multidisciplinary teams in cancer care should include dental professionals, who are well schooled in the treatment of cancer patients. This might improve the dental treatment before as well as the sustainment of oral health after cancer treatment

Oral health status of patients after cancer treatment for squamous cell carcinoma in the upper aero-digestive tract (San Francisco)

Objective Treatment for head & neck cancer is associated with severe oral complications, such as reduced salivary flow rate, mucositis, or development or exacerbation of oral diseases (caries and periodontitis). Especially periodontitis represents a chronic inflammatory process, which is regarded as a risk factor for cancer development as well as after cancer treatment as a risk factor for development of osteoradionecrosis of the jaw. The aim of the present study was to determine the oral health status of patients at least 6 months after cancer treatment for squamous cell carcinoma in the upper aero-digestive tract. It was evaluated, whether the patients consulted a dentist prior to cancer treatment and, whether dental treatment was sustained after cancer treatment. Methods Thirty-eight patients (27 male / 11 female, age range 21 to 79 years) of the Department of Otorhinolaryngology (Medical University of Vienna) gave their written consent to participate in the present cross-sectional study. All of the participants were asked on dental treatment before and after cancer treatment, daily oral hygiene, habits, such as smoking and alcohol consumption, education, income, and family status. The decayed, missing and filled teeth (DMF-T) index, clinical (plaque control record (according to O’Leary, PCR), community periodontal index of treatment needs (CPITN), disease severity according to CDC/AAP criteria) and radiological (alveolar bone loss) periodontal parameters were determined. Results Twenty-two of 38 patients consulted a dentist for a check-up before cancer treatment and of those 17 received a treatment, of which tooth extraction was most often performed (in 59% of the cases). Although 71% of the patients consulted a dentist within the last year, 90% of the examined patients presented the necessity of dental treatment at time-point of evaluation; 75 % had at least one decayed tooth, with an average of 4 decayed teeth. The average DMF-T-index was 25.5. Seventy-two percent showed a CPITN of 3 or 4 and 31 % of the patients presented moderate and 47 % severe periodontitis. Mean alveolar bone loss was 4.3mm. A professional dental cleaning session was never performed in 40% of the patients and the mean PCR was 65%. The consultation of a dentist before cancer treatment presented no significant effect on the oral health status after cancer treatment. Conclusion The oral health status of patients at least 6 months after cancer treatment for squamous cell carcinoma in the upper aero-digestive tract presented to an extremely high degree the necessity of treatment for oral diseases, such as caries and periodontitis. Regarding the risks associated with these oral diseases after cancer treatment, such as the development of osteoradionecrosis of the jaw, the multidisciplinary teams in cancer care should include dental professionals, who are well schooled in the treatment of cancer patients. This might improve the dental treatment before as well as the sustainment of oral health after cancer treatment

Assessment and Psychacoustic Modelling of Auditory Streams in Diplophonic Voice

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Diplophonia disturbs jitter and shimmer measurement

Objectives: The aims of this study are to investigate the effects of diplophonia on jitter and shimmer and to identify measurement limitations with regard to material selection and clinical interpretation. Materials and Methods: Four hundred and ninety-eight audio samples of sustained phonations were analyzed. The audio samples were assessed for the grade of hoarseness and the presence of diplophonia. Jitter and shimmer were reported with regard to perceptual ratings. We investigated cycle marker positions exemplarily and qualitatively to understand their implications for perturbation measurements. Results: Medians of jitter and shimmer were higher for diplophonic voices than for nondiplophonic voices with equal grades of hoarseness. The variance of jitter for moderately dysphonic voices was larger than the variance observed in a corpus from which diplophonic samples had been discarded. The positions of cycle markers in diplophonic voices did not match the positions of the pulses, indicating that the validity of jitter and shimmer values for these voices were questionable. Conclusion: Diplophonia biases the reporting of dysphonia severity via perturbation measures, and their validity is questionable for these voices. In addition, diplophonia is an influential source of variance in jitter measurements. Thus, diplophonic fragments of voice samples should be excluded prior to perturbation analysis.SCOPUS: ar.jinfo:eu-repo/semantics/publishe