THE EFFECT OF HEAT AND MOISTURE EXCHANGER ON MORPHOLOGICAL AND FUNCTIONAL STATE OF LOVER AIRWAYS IN LARYNGECTOMIZED PERSONS

CILJ ISTRAŽIVANJA: proširenje dosadašnjih spoznaja o terapijskoj vrijednosti i učinkovitosti kazeta za održavanje vlažnosti i temperature zraka čija je uporaba jedini nefarmaceutski način liječenja i prevencije tegoba nastalih nakon totalne laringektomije. NACRT STUDIJE: prospektivna opservacijska studija ISPITANICI I METODE: U studiju je bilo uključeno 70 ispitanika - laringektomiranih osoba obaju spolova liječenih u KBC-u Osijek. Skupinu ispitanika činilo je 35 ispitanika koji se redovito koriste kazetama za održavanje vlažnosti i temperature zraka, a kontrolnu skupinu 35 ispitanika koji se njima ne koriste. Svim ispitanicima uzet je bioptat proksimalnog dijela traheje te su analizirane histološke promjene sluznice. Svi su podvrgnuti spirometriji, a na temelju dobivenih podataka procijenjen je i uspoređen morfološki i funkcionalni status donjih dišnih putova za obje ispitivane skupine. Ispitanici su potom ispunili posebno osmišljen upitnik na osnovi kojega je procijenjen utjecaj kazeta na neke aspekte kvalitete života laringektomiranih osoba. Statistička obrada podataka provedena je pomoću statističkog paketa SPSS (verzija 17.0.0, SPSS Inc., Chicago, IL, SAD). REZULTATI: Blago zadebljanje bazalnih stanica epitela nađeno je u 8 (11 %), srednje zadebljanje bazalnih stanica epitela u 7 (10 %), a jako zadebljanje bazalnih stanica epitela u 2 (3 %) ispitanika. Najveći broj ispitanika imao je nalaz pločaste metaplazije 35 (50 %). Blaga displazija nađena je u 5 (7 %), a umjerena u 4 (6 %) od 70 ispitanika. Postoji statistički značajna razlika u pojavnosti najtežih, prekanceroznih promjena (displazije) u bioptatu sluznice traheje u promatranim skupinama. Displazija I. i II. stupnja nalazi se u 1 (1 %) ispitanika u skupini koja se koristi kazetama, a u 8 (11 %) ispitanika kontrolne skupine. Ispitivani spirometrijski parametri za sve kategorije pokazuju bolji rezultat nalaza u kategoriji ispitanika koji nose kazetu u usporedbi s onima oni ju koji ne nose, no ni za jedan parametar nije nađena statistički značajna razlika u ispitivanim skupinama. Svi su ispitanici ocijenili ukupno 10 obilježja vezanih uz dišne putove, osjetilne funkcije i gornji dio probavnog sustava (bol u vratu, problemi vezane uz usnu šupljinu, osjet okusa i mirisa, tegobe s disanjem i nosnom sekrecijom, problemi s gutanjem, govor, kašalj i iskašljavanje). Od ukupno 10 ocijenjenih kategorija, postoji statistički značajna razliku u pojavnosti osjećaja boli u području vrata te osjeta okusa. Od ukupno osam obilježja vezanih uz psihosocijalno funkcioniranje u vlastitom okruženju, statistički značajna razlika nađena je u ocjeni kvalitete komunikacije, socijalne interakcije i koncentracije. ZAKLJUČAK: Kazete za održavanje vlažnosti i temperature zraka mogle bi imati ulogu u očuvanju staničnog integriteta respiratornog epitela. Rezultate spirometrije koji ne pokazuju statistički značajnu razliku za dvije ispitivane skupine moglo bi se pripisati malom uzorku, no ipak predstavljaju značajan temelj za buduća istraživanja. Kazete za održavanje vlažnosti i temperature zraka povoljno utječu na neke simptome koji su uobičajeni nakon totalne laringektomije te na neke aspekte kvalitete života laringektomiranih osoba.OBJECTIVES. Expansion of previous cognitions on therapeutic values and effectiveness of the heat and moisture exchanger as its use is the only non-pharmaceutical way of treatment and prevention of pulmonary complications after total laryngectomy. STUDY DESIGN. Prospective observational study. PATIENTS AND METHODS. The study included 70 respondents – laryngectomized persons of both genders who were treated at Clinical Hospital Center Osijek. There were 35 respondents who regularly used heat and moisture exchangers and 35 respondents in control group who didn't use them. Biopsy specimen of the proximal part of the trachea has been taken in all respondents, and histological changes of the tracheal epithelium have been analysed. All of them have undergone spirometry. According to the obtained data morphological and functional status of lower respiratory tract has been evaluated and compared in both groups of respondents. Subsequently, the respondents have filled in a questionnaire according to which the influence of the heat and moisture exchanger onto some aspects in life quality of patients after laryngectomy could be evaluated. Statistical analysis was performed with SPSS Statistics (Version 17.0.0, SPSS Inc.,Chicago, IL, USA). RESULTS. Mild basal cell hyperplasia has been found in 8 (11 %), moderate basal cell hyperplasia in 7 (10 %), and advanced basal cell hyperplasia in 2 (3 %) respondents. Squamous metaplasia was the most common finding (50 %). Mild dysplasia was found in 5 (7 %), and moderate dysplasia in 4 (6 %) of 70 respondents. There is a statistically significant difference in manifestation of most severe, precancerous changes (dysplasia) in tracheal biopsy specimen in both groups. Mild and moderate squamous dysplasia has been found in 1 (1 %) user, and in 8 (11 %) non-users. Although the examined spirometric parameters for all categories show a better result in experimental group, statistical comparison has not detected any significant differences between the experimental and control group. All respondents graded 10 characteristics connected to respiratory system, sensory functions and the upper part of digestive system (neck pain, dry mouth, taste and smell, breathing problems, nose secretion, swallowing problems, speech, cough and expectoration). Out of 10 categories evaluated three were statistically significant difference in neck pain and taste. Out of eight characteristics connected to psychosocial functioning in the environment, statistically significant difference was found in communication, social interaction and concentration. CONCLUSION. Heat and moisture exchanger could have an important role in protection of respiratory epithel cell integrity. Spirometry results which didn't show statistically significant difference for the two examined groups could be explained by small sample, but they represent an important basis for future research. Heat and moisture exchanger positively influences some symptoms that are frequent after total laryngectomy, as well as some aspects of the life quality in patients after total laryngectomy

The Role of Esophagus in Voice Rehabilitation of Laryngectomees

The total laryngectomy is a standard procedure of laryngeal carcinoma treatment which leaves multiple persistent consequences on a laryngectomized person. After laryngectomy, all of patients cannot speak loudly, and 10–58% patients have a dysphagia. In such changed anatomical condition, the esophagus has a key function in two of three primary approaches to voice—speech rehabilitation of laryngectomized patients: esophageal and tracheoesophageal speech therapy method because one of these is the only acceptable solution of substitute alaryngeal speech. In esophageal speech, the esophagus has the role of speech air reservoirs since the respiratory and digestive pathways are permanently separated after the procedure. In the production of tracheoesophageal speech, the tracheoesophageal fistula and the esophagus allow the recommunication of these pathways and the use of air from the lungs for speech. There are several prerequisites for successful esophageal and tracheoesophageal speech. After tracheoesophageal puncture and insertion, the tracheoesophageal prosthesis may occur different complications in the early or late postoperative period in 10–60% of patients. The quality of alaryngeal voice is very different from the quality of laryngeal voice, but allows communication to laryngectomees

ULOGA KAZETA ZA ODRŽAVANJE VLAŽNOSTI I TEMPERATURE ZRAKA U KVALITETI ŽIVOTA NAKON LARINGEKTOMIJE

Aim: The aim of this study was to investigate the effect of heat and moisture exchanger use on everyday problems and quality of life aspects in laryngectomized patients. Methods: Seventy laryngectomized patients were included and divided into a control group that used no device, and a group equipped with a heat and moisture exchanger. The effect of the heat and moisture exchanger was evaluated by means of a specially designed questionnaire. Medical records were reviewed to collect demographic, health, behavior, tumor and surgical data. Assessment of the benefi ts and drawbacks of the device was made by statistical comparison of the control group and the group using the device. Results: the group using the device scored signifi cantly better on the questions about verbal communication, social interaction, paying attention and concentration. Discussion: The results of this study suggest that the use of heat and moisture exchanger can effectively reduce psychosocial and physical problems after total laryngectomy. A review of medical literature and comparison of the results of this study with the literature data available shows that the use of heat and moisture exchanger influences particular aspects of the quality of life of laryngectomized persons. Conclusion: the heat and moisture exchanger cannot fully restore physiological functions of the upper respiratory tract, but it plays an important role in the prevention of symptoms and in pulmonary and psychosocial rehabilitation after laryngectomy.Cilj: Ispitati ulogu kazeta za održavanje vlažnosti i temperature zraka u smanjenju svakodnevnih problema i u nekim aspektima kvalitete života laringektomiranih bolesnika. Metode: Sedamdeset laringektomiranih bolesnika uključenih u istraživanje podijeljeni su u kontrolnu skupinu koja ne rabi kazete za održavanje vlažnosti i temperature zraka i skupinu ispitanika koja ih rabi. Uloga kazeta za održavanje vlažnosti i temperature zraka procijenjena je pomoću posebno osmišljenog upitnika. Pregledana je medicinska dokumentacija te su dobiveni demografski i zdravstveni podatci, podatci o navikama te podatci o tumoru i liječenju. Procjena prednosti i nedostataka ovog pomagala učinjena je statističkom usporedbom kontrolne skupine i skupine ispitanika. Rezultati: Ispitivana skupina je statistički značajno bolje ocijenila verbalnu komunikaciju, društvenu interakciju, pozornost i koncentraciju. Rasprava: Rezultati ovoga istraživanja ukazuju na to da upotreba kazeta za održavanje vlažnosti i temperature zraka može učinkovito smanjiti psihosocijalne i fi zičke probleme nakon totalne laringektomije. Pretraživanje medicinske literature i usporedba rezultata ovoga istraživanja s dostupnim publiciranim podatcima pokazuje da upotreba kazeta za održavanje vlažnosti i temperature zraka utječe na određene aspekte kvalitete života laringektomiranih osoba. Zaključak: Kazeta za održavanje vlažnosti i temperature zraka ne može u potpunosti obnoviti fi ziološke funkcije gornjeg dišnog puta, ali ima važnu ulogu u prevenciji simptoma te u plućnoj i psihosocijalnoj rehabilitaciji nakon laringektomije

ULOGA KAZETA ZA ODRŽAVANJE VLAŽNOSTI I TEMPERATURE ZRAKA U KVALITETI ŽIVOTA NAKON LARINGEKTOMIJE

Aim: The aim of this study was to investigate the effect of heat and moisture exchanger use on everyday problems and quality of life aspects in laryngectomized patients. Methods: Seventy laryngectomized patients were included and divided into a control group that used no device, and a group equipped with a heat and moisture exchanger. The effect of the heat and moisture exchanger was evaluated by means of a specially designed questionnaire. Medical records were reviewed to collect demographic, health, behavior, tumor and surgical data. Assessment of the benefi ts and drawbacks of the device was made by statistical comparison of the control group and the group using the device. Results: the group using the device scored signifi cantly better on the questions about verbal communication, social interaction, paying attention and concentration. Discussion: The results of this study suggest that the use of heat and moisture exchanger can effectively reduce psychosocial and physical problems after total laryngectomy. A review of medical literature and comparison of the results of this study with the literature data available shows that the use of heat and moisture exchanger influences particular aspects of the quality of life of laryngectomized persons. Conclusion: the heat and moisture exchanger cannot fully restore physiological functions of the upper respiratory tract, but it plays an important role in the prevention of symptoms and in pulmonary and psychosocial rehabilitation after laryngectomy.Cilj: Ispitati ulogu kazeta za održavanje vlažnosti i temperature zraka u smanjenju svakodnevnih problema i u nekim aspektima kvalitete života laringektomiranih bolesnika. Metode: Sedamdeset laringektomiranih bolesnika uključenih u istraživanje podijeljeni su u kontrolnu skupinu koja ne rabi kazete za održavanje vlažnosti i temperature zraka i skupinu ispitanika koja ih rabi. Uloga kazeta za održavanje vlažnosti i temperature zraka procijenjena je pomoću posebno osmišljenog upitnika. Pregledana je medicinska dokumentacija te su dobiveni demografski i zdravstveni podatci, podatci o navikama te podatci o tumoru i liječenju. Procjena prednosti i nedostataka ovog pomagala učinjena je statističkom usporedbom kontrolne skupine i skupine ispitanika. Rezultati: Ispitivana skupina je statistički značajno bolje ocijenila verbalnu komunikaciju, društvenu interakciju, pozornost i koncentraciju. Rasprava: Rezultati ovoga istraživanja ukazuju na to da upotreba kazeta za održavanje vlažnosti i temperature zraka može učinkovito smanjiti psihosocijalne i fi zičke probleme nakon totalne laringektomije. Pretraživanje medicinske literature i usporedba rezultata ovoga istraživanja s dostupnim publiciranim podatcima pokazuje da upotreba kazeta za održavanje vlažnosti i temperature zraka utječe na određene aspekte kvalitete života laringektomiranih osoba. Zaključak: Kazeta za održavanje vlažnosti i temperature zraka ne može u potpunosti obnoviti fi ziološke funkcije gornjeg dišnog puta, ali ima važnu ulogu u prevenciji simptoma te u plućnoj i psihosocijalnoj rehabilitaciji nakon laringektomije

Objective Assessment of Tracheoesophageal and Esophageal Speech Using Acoustic Analysis of Voice

The aim of this study was to analyze the voice quality of alaryngeal tracheoesophageal and esophageal speech, and to determine which of them is more similar to laryngeal voice production, and thus more acceptable as a rehabilitation method of laryngectomized persons. Objective voice evaluation was performed on a sample of 20 totally laryngectomized subjects of both sexes, average age 61.3 years. Subjects were divided into two groups: 10 (50%) respondents with built tracheoesophageal prosthesis and 10 (50%) who acquired esophageal speech. Testing included 6 variables: 5 parameters of acoustic analysis of voice and one parameter of aerodynamic measurements. The obtained data was statistically analyzed by analysis of variance. Analysis of the data showed a statistically significant difference between the two groups in the terms of intensity, fundamental frequency and maximum phonation time of vowel at a significance level of 5% and confidence interval of 95%. A statistically significant difference was not found between the values of jitter, shimmer, and harmonic-to-noise ratio between tracheoesophageal and esophageal voice. There is no ideal method of rehabilitation and every one of them requires an individual approach to the patient, but the results shows the advantages of rehabilitation by means of installing voice prosthesis

Bilateral Laryngoceles in Association with Squamos Cell Carcinoma: A Case Report and Literature Review

Coexistence of laryngoceles and laryngeal carcinoma is still being debated, and there are several suggested theories about the pathophysiological relationship between these two entities. We present the case of a 66-year-old male patient with bilateral laryngomucoceles and laryngeal squamos cell carcinoma. A systematic hystological examination of whole organ sections showed that the submucosal spreading of cancer around the saccular necks on both sides caused stenosis which probably created a one-way valve mechanism allowing air to enter the saccule but not to exit. Progression of the tumor completely obstructed the laryngeal opening, leading to glandular secretion stagnation and formation of laryngomucoceles

Bilateral Laryngoceles in Association with Squamos Cell Carcinoma: A Case Report and Literature Review

Coexistence of laryngoceles and laryngeal carcinoma is still being debated, and there are several suggested theories about the pathophysiological relationship between these two entities. We present the case of a 66-year-old male patient with bilateral laryngomucoceles and laryngeal squamos cell carcinoma. A systematic hystological examination of whole organ sections showed that the submucosal spreading of cancer around the saccular necks on both sides caused stenosis which probably created a one-way valve mechanism allowing air to enter the saccule but not to exit. Progression of the tumor completely obstructed the laryngeal opening, leading to glandular secretion stagnation and formation of laryngomucoceles

Importance of Correct Therapeutic Procedure Selection in Voice Recovery

Psychological and physical patient state as well as the influence of other social factor is of great influence voice rehabilitation. A team of experts in the field of voice and its function are involved in voice therapy. Our research was focused on the succefulness of voice recovery depending on the patient vocal disorder approach. We made a comparison of two methods: RVT and Accent method. We attempted to evaluate clinically relevant voice disorders in relation to certain vocal methods, we propose that a lot can be learned about voice trough therapeutic procedures, which can also be used to enhance the practical application of vocal methods and raise the level of success in dealing with people that suffer from voice pathology

The Incidence of Skin Squamous Cell Carcinoma in Osijek-Baranja County – An Epidemiological Study

The aim of this study is to show the incidence of squamous cell carcinoma of the skin in Osijek Baranja County, Eastern Croatia, in period from 2004 to 2009. This is the first report of epidemiological features of squamous cell skin carcinoma in this region. In this period we registred 469 patients with SCC of the skin, from which 237 females (50.5%) and 232 males (49.5%). World age-standardised rates (ASRW per 100,000) incidence in this period was 11.8/100,000 (16.8/ 100,000 for men and 9.0/100,000 for women). SCC of the skin occur in elderly commonly after 70 years. Most common localization is on the photoexposed areas, for example head, neck and backs of the hands. These localization varied in males and females (in females 2.5 times more in the nose area than males while 6 times more on the ear). The relation between photoexposed and photo non-exposed areas is 5:1. These results will serve as reference for studying the patterns of descriptive epidemiology of squamous cell carcinoma of the skin in the Osijek-Baranja County and the surrounding region

The Incidence of Skin Squamous Cell Carcinoma in Osijek-Baranja County – An Epidemiological Study

The aim of this study is to show the incidence of squamous cell carcinoma of the skin in Osijek Baranja County, Eastern Croatia, in period from 2004 to 2009. This is the first report of epidemiological features of squamous cell skin carcinoma in this region. In this period we registred 469 patients with SCC of the skin, from which 237 females (50.5%) and 232 males (49.5%). World age-standardised rates (ASRW per 100,000) incidence in this period was 11.8/100,000 (16.8/ 100,000 for men and 9.0/100,000 for women). SCC of the skin occur in elderly commonly after 70 years. Most common localization is on the photoexposed areas, for example head, neck and backs of the hands. These localization varied in males and females (in females 2.5 times more in the nose area than males while 6 times more on the ear). The relation between photoexposed and photo non-exposed areas is 5:1. These results will serve as reference for studying the patterns of descriptive epidemiology of squamous cell carcinoma of the skin in the Osijek-Baranja County and the surrounding region