RESUMEN
The aim of this study was to determine the long term histopathologic changes in tracheal mucosa after a total laryngectomy , and to find out the relationship between the progression of histopathologic changes in tracheal mucosa and the duration of breathing through the tracheostomy. Tracheal mucosal biopsies were taken from a total of 35 patients, of both sexes, who underwent a total laryngectomy for laryngeal carcinoma at least one year prior. Histologic specimens of tracheal mucosa were stained with hematoxylin and eosin and examined under light microscopy. Almost all of the patients demonstrated histopathologic changes or abnormalities. Based on the results, histological findings were grouped into seven categories: normal respiratory epithelium, mild, moderate and advanced basal cell hyperplasia, squamous metaplasia, and slight and moderate and dysplasia. The time elapsed since surgery was calculated for each histopathological change separately. In laryngeal carcinoma patients, after a total laryngectomy histopathologic changes occur in tracheal mucosa. The mildest histopathological changes are found in the patients who had a longer period between the operation and the examination.
Asunto(s)
Laringectomía/efectos adversos , Mucosa Respiratoria/patología , Tráquea/patología , Adulto , Anciano , Biopsia , Femenino , Humanos , Hiperplasia/etiología , Hiperplasia/patología , Neoplasias Laríngeas/cirugía , Masculino , Metaplasia/etiología , Metaplasia/patología , Persona de Mediana EdadRESUMEN
The aim of the study was to determine the influence of swimming on postlaryngectomy olfactory rehabilitation. This prospective open interventional trial at a tertiary academic hospital included 100 laryngectomised patients; 17 were swimmers and 83 were nonswimmers. Participants practiced the polite yawning technique (PYT) for postlaryngectomy olfactory rehabilitation. Rhinomanometry was used to measure air quantity in the right and left nostrils, respectively; to test sense of smell, we applied the smell diskettes olfaction test (SDOT). Swimmers used swimming aids and swam only in a pool accompanied by another person trained in the rescue and resuscitation of a laryngectomee. Measures were made at three time points. Following PYT initiation, the number of accurately guessed odours was higher among swimmers (SDOT1 = 5.29, SDOT2 = 6.40, SDOT3 = 6.76) than nonswimmers (SDOT1 = 3.73, SDOT2 = 5.48, SDOT3 = 5.60) as were airflows through the left (swimmers: FL1 = 40.82, FL2 = 137.71, FL3 = 172.80; nonswimmers: FL1 = 13.05, FL2 = 104.63, FL3 = 113.00) and right nostrils (swimmers: FR1 = 46.82, FR2 = 115.41, FR3 = 145.40; nonswimmers: FR1 = 13.70, FR2 = 92.77, FR3 = 106.43). The number of odours identified by laryngectomised patients increased with the volume of nasal airflow, but this number and the efficiency of olfactory rehabilitation were higher in swimmers compared to nonswimmers. Swimming with a swimming aid improved the quality of life after surgery and may facilitate resocialisation of laryngectomised patients.
Asunto(s)
Laringectomía/rehabilitación , Olfato , Natación , Humanos , Estudios ProspectivosRESUMEN
Total laryngectomy, as a consequence of carcinoma of the larynx, results in loss of speech function. Cerebrovascular stroke is the leading cause of reduced speech production ability, and thereby communication difficulties. The case is presented of a 60-year-old male patient who suffered stroke five years after a total laryngectomy. Speech rehabilitation was hampered due to the depressive state of the patient. Although contraindicated, the secondary voice prosthesis was implanted. Only at that moment the patient showed willingness and motivation for speech rehabilitation. The aim of this presentation is to demonstrate that not all neurological disorders are contraindicated for implantation of voice prostheses.
Asunto(s)
Afasia de Broca/rehabilitación , Neoplasias Laríngeas/rehabilitación , Neoplasias Laríngeas/cirugía , Laringectomía/rehabilitación , Laringe Artificial , Afasia de Broca/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Radiografía , LogopediaRESUMEN
OBJECTIVE: To show long-term anatomic and functional results of full thickness cartilage palisade tympanoplasty in children and adults. METHODS: In 51 patients (56 ears); 9 children (12 ears) and 42 adults (44 ears) full thickness cartilage palisade tympanoplasty and interposition with malleus head autograft was performed. On average 11 years after the tympanoplasty, an otomicroscopy and a tonal audiogram were done to assess anatomic and functional results. RESULTS: Anatomic results of 56 ears: 40 (71.43%) tympanic membranes have no anatomic irregularities; 14 (25.00%) have cartilage resorption (11 of them minor and 3 major resorptions), 2 (3.57%) have secondary perforation. In the group of children all ears tympanic membrane were with no or minor resorption and no perforations. Functional results (51 audiograms performed: in children 12 and in adults 39): pre- and post-operative average pure tone average air-bone gaps were 27.29 ± 10.26 and 10.73 ± 7.90 dB, respectively. In the group of children pre- and post-operative average pure tone average air-bone gaps were 29.44 ± 10.30 and 6.81 ± 3.47 dB, respectively. In the group of adults pre- and post-operative pure tone average air-bone gaps were 26.63 ± 10.30 and 11.93 ± 8.50 dB, respectively. The differences between the two groups preoperatively (z=0.733; p=0.463) and postoperatively are irrelevant (z=1.723; p=0.085). The hearing gain is bigger in children (F=4.788; p=0.033). CONCLUSION: The full thickness cartilage palisade tympanoplasty with malleus autograft interposition is also nowadays a successful method in solving of an advanced ear pathology also in children.
Asunto(s)
Cartílago/trasplante , Martillo/trasplante , Perforación de la Membrana Timpánica/cirugía , Timpanoplastia/métodos , Adolescente , Adulto , Niño , Femenino , Estudios de Seguimiento , Humanos , Masculino , Resultado del Tratamiento , Adulto JovenRESUMEN
The aim of this crossectional study was to investigate the relationship between pepsin concentration in saliva and the occurrence of tracheoesophageal fistula (TEF) complications and voice prosthesis (VP) complications, after total laryngectomy and VP implantation. We assessed the concentrations of pepsin in the saliva of 41 laryngectomized patients and correlated it with the incidence of TEF complications (periprostethic leakage, atrophy, esophageal mucosa hypertrophy, granulations, fistula enlargement, and VP dislocation), VP complications (transprosthetic leakage, Candida infection) and voice quality. Pepsin levels were measured by enzyme-linked immunoadsorbent assay (ELISA). Voice quality was assessed by Harrison-Robilard--Schultz (HRS) scale. In all, 17 (42%) patients had complications. All of them had TEF complications, whereas VP complication, together with TEF was found in 9 (22%) patients. We found no significant correlation between adjuvant radiotherapy and TEF complications. Most of patients, 30 (73%), had positive pepsin level in saliva. Median value of pepsin concentration in all patients was 4.8 (range 81.7). Median pepsin concentration was higher in patients free of TEF or VP complications (6.6, range 81.7 vs. 3.2, range 19.3) but that difference was not statistically significant (Mann-Whitney test, Z--1.562, p = 0.118). In addition, statistically insignificant negative correlation between pepsin levels and voice quality measured by HRS scale (Spearman's rho, p > 0.05). Although reflux was proposed as cause of TEF complications and pepsin has been proven as a most sensitive and specific marker of ekstraesophageal reflux, we did not find any statistically significant correlation between pepsin levels and occurrence of TEF or VP complications.
Asunto(s)
Laringe Artificial/efectos adversos , Pepsina A/metabolismo , Saliva/metabolismo , Fístula Traqueoesofágica/metabolismo , Anciano , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The use of speech prosthesis after total laryngectomy has become an international standard for voice restoration today. Provox II voice prosthesis is not permanently inserted, and as such, it must meet the criterion of achieving prolonged retention time within the walls of tracheo-esophageal fistula (TEF). Complications after the insertion of speech prosthesis are familiar and anticipated but efforts are being made in order to reduce them. Part of the complications is caused by inadequate choice of the length of the prosthesis. The Department of Otorhinolaryngology and Head and Neck Surgery in Rijeka conducted a study which included 91 patients in the period from 01.01.2004. to 31.12.2010. We used ultrasound and computerized neck tomography on 58 (63.7%) patients in preoperative procedure through which we determined the length of the subsequent TE fistula. At the same time we used this opportunity to specify the length of the speech prosthesis we have inserted primarily or secondary. The number of respondents who had complications, and with whom we used neck ultrasound during preoperative procedure in order to determine the length of the prosthesis, was significantly smaller than the number of respondents who had complications but with whom we did not use the above mentioned procedure (5.6% vs. 15.5%, p = 0.042). Comparing our results to other studies, we believe that we managed to reduce the number of complications caused by inadequate length of the prosthesis, by routine preoperative use of neck ultrasound. This procedure has extended the median retention time of the prosthesis within the TE fistula, thus improving the results of speech restoration using voice prosthesis on laryngectomized patients.
Asunto(s)
Laringe Artificial , Diseño de Prótesis , Ultrasonografía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
The aim of this study was to compare the self-assessed vocal handicap of laryngectomees treated with three different communication methods: tracheoesophageal speech, esophageal speech and electrolarynx. Forty-eight patients, 40 males and 8 females, who had undergone total laryngectomy for laryngeal carcinoma were enrolled in the study. Depending on the voice restoration method, all patients were divided into three groups: 20 patients were tracheoesophageal speakers (group 1), 13 patients were esophageal speakers (group 2) and 15 patients were electrolaryngeal speakers (group 3). They autonomously completed the Croatian version of Voice Hendicap Index, a questionnaire that was developed to quantify the patient's perception of deficiency due to vocal dysfunction. Statistical analyses were performed using the Statistical Package for Social Sciences (SPSS 13.0), and the data obtained with each group and scale were formally compared. 31.25% of patients rated their voice disorder as a minimum handicap, 54.16% of patients rated their voice disorder as a medium handicap, and 14.58% of them rated their voice disorder as a significant handicap. There are differences between each group, but differences were not statistically significant. No single method is considered to be the best for every patient. Selection of a method should be based on the input from the patient, surgeon and speech pathologist.
Asunto(s)
Percepción Auditiva , Laringe/fisiopatología , Femenino , Humanos , Laringectomía , Masculino , Persona de Mediana Edad , Calidad de Vida , Encuestas y CuestionariosRESUMEN
The aim of this study was to compare the respective value of videofluoroscopy and ultrasound for assessment of the tonicity of the neoglottis and determination of the exact neolaryngeal segment of hypertonicity. We examined twelve patients who had developed inadequate tracheoesophageal voice following total laryngectomy and installation of tracheoesophageal prosthesis. We assumed that the cause of the unsatisfactory voice quality in our patients was neolaryngeal muscle spasm. After determining the exact hypertonic segment, we administered lidocaine intramuscularly and tried to act on the hypertonic segment. By means of videofluoroscopy as gold standard for comparison with ultrasound examination, we followed the passage of contrast through the neo-larynx and watched for dilatation of the segment during swallowing, phonation and at rest to determine whether there were any tonus disturbances or differences before and after lidocaine injection. In conclusion, a combination of the two methods could yield better results in voice restoration. Videofluoroscopy is the method of choice for initial assessment and determination of the hypertonic segment, while ultrasound is the method to apply to facilitate administering the drug more precisely.
Asunto(s)
Esófago/fisiopatología , Fluoroscopía/métodos , Laringectomía , Tono Muscular , Músculo Liso/fisiopatología , Faringe/fisiopatología , Esófago/diagnóstico por imagen , Humanos , Músculo Liso/diagnóstico por imagen , Faringe/diagnóstico por imagen , UltrasonografíaRESUMEN
OBJECTIVE: To investigate if the clinical status of the eardrum could be an inclusion criterion for the therapy of chronic secretory otitis media (CSOM). To compare the results of treating CSOM by adenoidectomy and by adenoidectomy in combination with tympanostomy tubes in two groups of patients chosen according to that criterion. METHODS: 161 ears in 87 children were treated for CSOM. An otomicroscopic examination showed there were no pathological changes on the tympanic membrane (signs of adhesive process, malleus rotation, and dangerous attic retractions). The patients were randomly divided into two groups: the first group of 59 ears was treated by myringotomy and tympanostomy tubes and adenoidectomy, while the other group of 102 ears was treated only by adenoidectomy. At least 6 months after the treatment, otomicroscopy and audiological assessments were performed in order to show the resolution of the middle ear effusion (MEE), audiological results and incidence of clinical sequelae of the eardrum. RESULTS: The resolution of MEE by adenoidectomy alone was not significantly different from the results of treatment by adenoidectomy and tympanostomy tubes (z=1.565; p=0.0587). There were no differences in pure tone audiometry between the two methods of treatment. Only at the frequency of 2000 Hz (t=2.173; p=0.031) in treatment with adenoidectomy and tympanostomy tubes the values of air-bone gap (ABG) were lower. Sequelae: scars of the eardrum (chi-square=28.107; ss=1; p<0.001) and attic retractions (chi-square=4.592; ss=1; p=0.032) were more often in treatment with tubes. The incidence of clinical sequelae on the eardrum after treatment by tubes was commented on. CONCLUSION: A criterion that could influence the approach to the therapy of CSOM in children.
Asunto(s)
Adenoidectomía/métodos , Ventilación del Oído Medio/métodos , Miringoplastia/métodos , Otitis Media con Derrame/diagnóstico , Otitis Media con Derrame/cirugía , Membrana Timpánica/patología , Factores de Edad , Análisis de Varianza , Audiometría de Tonos Puros , Distribución de Chi-Cuadrado , Niño , Preescolar , Enfermedad Crónica , Terapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Masculino , Ventilación del Oído Medio/efectos adversos , Miringoplastia/efectos adversos , Otoscopía/métodos , Complicaciones Posoperatorias/fisiopatología , Complicaciones Posoperatorias/cirugía , Estudios Prospectivos , Recurrencia , Reoperación/métodos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales , Factores de Tiempo , Resultado del Tratamiento , Membrana Timpánica/cirugíaRESUMEN
Voice is one of the most important means of communication and as such should be taken care of. The etiology of voice disorders is diverse. Due to the development of the society we live in, way of life, environmental factors, and exposure to pharmacological agents as well as demands we make towards our voice, there is a substantial growth in the number of people with voice disorders. We tasked ourselves to find out if it is possible to enlighten people on the importance of voice, to motivate them to take care of it, to notice the changes in its quality and eventually ask for help. We assessed in which measure do we understand the importance of a healthy voice, and do we know which is the most important factor that adds to its decline. For a long number of years voice therapists and other experts in the voice disorder field have been discussing the optimal voice impostation as well as vocal exercises and methods behind voice recovery. They have all come to the same conclusion that phonation is dependant on the sort of the voice disorder and the patient motivation. We wanted to go one step further and investigate, dependence of voice quality and the damage etiology (organic - functional), which are the predominant causes, what are the factors that account for the damage and how the disorder motivates the patient and therefore influences the rehabilitation success rate.
Asunto(s)
Logopedia , Trastornos de la Voz , Entrenamiento de la Voz , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Resultado del Tratamiento , Trastornos de la Voz/etiología , Trastornos de la Voz/prevención & control , Trastornos de la Voz/rehabilitaciónRESUMEN
The purpose of this study was to determine the presence of individual microorganisms and the most frequent microbial combinations in the biofilm of the indwelling Provox2 voice prosthesis in situ. Furthermore, we wanted to evaluate the possible influence of biofilm composition on the mean and median lifetime of these voice prostheses. Over a 5-year period, implantation of a Provox2 voice prosthesis was performed in 85 patients, or 90% of the overall number of patients who underwent total laryngectomy. In total 100 implanted voice prostheses, at least one of every patient, were microbiologically processed immediately after being replaced. Out of the total of 292 isolates, 67% were bacteria and the remaining 33% were yeasts. The most frequently found yeast species on voice prostheses biofilms was C. albicans, followed by C. krusei and C. tropicalis. The most frequently isolated bacteria included Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, Proteus mirabilis, and Streptococcus agalactiae. Simultaneous presence of bacteria and fungi was established in 83% of the processed voice prostheses; in 16% of samples the biofilm contained only one or more bacterial species. The mean time of implantation was 238 days and the median lifetime of the device was 180 days. Dividing the prostheses in four groups according to the composition of biofilm revealed that the device lifetimes varied significantly between groups. The longest lifetime of voice prostheses was associated with the presence of single fungal isolate in combination with bacteria. There is a significant correlation between biofilm composition and the device life time.
Asunto(s)
Biopelículas , Laringectomía , Laringe Artificial/microbiología , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma/microbiología , Carcinoma/radioterapia , Carcinoma/cirugía , Croacia , Esófago , Femenino , Humanos , Neoplasias Laríngeas/microbiología , Neoplasias Laríngeas/radioterapia , Neoplasias Laríngeas/cirugía , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Falla de Prótesis/efectos de la radiación , TráqueaRESUMEN
Carotid artery stenosis (CAS) is one of the major complications of external irradiation (radiotherapy, RT) for laryngeal carcinoma. Considering amaurosis fugax is often one of the first signs of significant CAS our focus was to determine weather patients with post-irradiation CAS also develop ocular microangiopathy as a result of insufficient ophthalmic circulation. In our study Carotid Duplex ultrasound scans revealed that 33.33% of patients had significant radiation-induced CAS. The majority (over 85.71%) of radiation-induced CAS had more than one atherosclerotic plaque including any degree of stenosis in the RT group, and had significantly more than that of the control group. Microangiopathic changes were documented only with the patients that have had an increased cerebrovascular risk (diabetes mellitus and arterial hypertension).