RESUMEN

OBJECTIVE: Many employees, especially in voice-intensive professions, are under psychological stress at work, which is very difficult to objectify. The aim of the study was to analyze correlations between heart rate variability (HRV) parameters and objective voice function using weighted voice parameters (Dysphonia Severity Index [DSI]) in order to determine whether subjects with impaired vocal function show a predominance of sympathetic control during a vocal stress test. STUDY DESIGN: Prospective. METHODS: Fifty-three people of working age were examined. After asking for sociodemographic, occupational, and voice-related data, the objective voice function was determined using the DiVAS voice diagnostics system, and a 20-minute vocal stress test was performed. The electrocardiogram was recorded using medilog AR12plus during the vocal stress test and in a 5-minute rest phase before and a 5-minute recovery phase after the test. HRV was analyzed using the Kubios HRV Premium software. RESULTS: HRV was reduced during the vocal stress test compared to the resting and recovery phase. A Spearman correlation analysis showed significant correlations, particularly between the frequency-related HRV parameters and the DSI. The DSI correlated positively with the high frequency (HF) band (the relative power and the normalized unit). The DSI correlated negatively with the quotient between low frequency and HF and the low frequency normalized unit. CONCLUSION: During a vocal stress test, adults in working age show a correlation between parameters of objective vocal function and parameters of HRV. The more impaired the objective vocal function, the higher the predominance of sympathetic activation under vocal stress. The voice can therefore be seen as a "warning signal" for the processes in the autonomic nervous system. The use of preventive strategies for stress management and for voice health appears to be particularly beneficial in vocally stressful occupations in order to achieve a positive effect on parasympathetic activity.

RESUMEN

INTRODUCTION: Kindergarten teachers are exposed to numerous kinds of strains, such as noise, which can negatively affect their voices. This cross-sectional study investigates whether and to what extent the profession-specific high vocal demand is associated with the educators' mental health. METHODS: One hundred and ninety-two kindergarten teachers from Magdeburg, Germany and its surrounding areas aged 43.4 ± 12.8 years, voluntarily participated in a survey. Vocal demand and vocal demand response, general strain factors, and mental health were assessed by using questionnaires (self-check on voice demands, Rudow checklist, General Health Questionnaire, and Maslach Burnout Inventory). The statistical analyses were carried out using SPSS. RESULTS: The interviewed educators felt stressed by the excessive number of work tasks and children in each class, noisy work environment, and loud conversations. In addition, educators complained of headaches and neck pain (66%), while 28% of them experienced hoarseness and a burning throat. The mental health of 39 of the educators was impaired, and nine were at an increased risk of burnout. Self-reported voice effort correlated low with mental health (r = 0.287; p < 0.001) and burnout risk (r = 0.306; p < 0.001). CONCLUSION: The vocal demands on educators in day care settings are very high, which is a major associated factor for the development of burnout syndrome and is also associated with headaches and neck pain. Measures for the prevention of occupational voice disorders and voice training should be a mandatory part of the educators' training and must be offered as in-service training.

Asunto(s)

RESUMEN

Transoral endoscopic laryngeal surgery (TEC) is typically used as a cervical tissue-sparing and function-preserving surgical procedure. Transoral robotic surgery (TORS) in particular has been pushing the boundaries towards transoral resection in recent years. Nevertheless, there are still limitations to this approach. Transcervical surgery is then the therapy of choice. It is used in case of insufficient visibility of the entire larynx and especially the tumor-bearing region, cartilage infiltration, a lack of mobility of both arytenoid cartilages or a lack of patient compliance. Even with the transcervical approach, from an oncological point of view, the procedure must be as radical as necessary on the one hand and as function-preserving as possible on the other. In case of a transcervical appraoch, however, additional requirements, side effects and consequences must be considered during planning, implementation and follow-up treatment. In addition to our previous publications, this article is intended to provide an overview of transcervical surgery for malignancies of the larynx.

Asunto(s)

RESUMEN

This article is intended to give an overview of the surgery for laryngeal malignancies and the current state of transoral endoscopic laryngeal surgery. The current therapy concepts in transoral endoscopic laryngeal surgery are presented in combination with the various possibilities of reconstruction. The adequate oncological treatment under functional aspects described plays the decisive role here: treatment goals beyond the cure of the tumor disease are the functional maintenance of the larynx with simultaneous preservation of the voice. In general, the diagnosis and treatment of (pre-) cancerous lesions of the laryngeal mucosa is demanding and requires a great deal of experience of the attending laryngologist. Updated classification systems support level-based categorization. In transoral endoscopic laryngeal surgery, resection using cold instruments and the CO2 laser are currently among the traditional methods, although newer methods such as the angiolytic laser can be used to ablate these lesions. Transoral endoscopic laryngeal surgery is a highly endoscopic-microscopic procedure in (pre-) cancerous lesions, which may presumably continue to evolve from the microlaryngoscopic approach over the next few years due to the introduction of new instruments and high-resolution imaging techniques. Robot-assisted surgery has also found its way into the transoral endoscopic treatment of laryngeal carcinoma. Only in the next few years, however, will it become clear to what extent this technique can supplement, replace or clarify surgical methods, since the individualized surgical strategy currently has a priority position for every single patient.

Asunto(s)

RESUMEN

PURPOSE: Flexible transnasal endoscopy is a common examination technique for the evaluation of laryngeal lesions, while the use of narrow band imaging (NBI) has been reported to enhance the diagnostic value of white light endoscopy (WLE). The purpose of this study is to assess observer variability and diagnostic value of both modalities and investigate the possible influence of previous laryngeal surgery on the detection rates of laryngeal malignancy. METHODS: The study was based on the retrospective evaluation of 170 WLE and NBI images of laryngeal lesions by three observers in a random order. The histopathological diagnoses serve as the gold standard. RESULTS: In identifying laryngeal malignancy, the sensitivity of NBI proved to be higher than that of WLE (93.3% vs. 77.0%). NBI was also superior to WLE in terms of accuracy (96.3% vs. 92%) and diagnostic odds ratio (501.83 vs. 120.65). Both modalities had a specificity of 97.3%. The inter-observer agreement was substantial (kappa = 0.661) for WLE and almost perfect (kappa = 0.849) for NBI. Both WLE and NBI showed a high level of intra-observer agreement. The sensitivity was significantly lower in images with history of previous laryngeal surgery compared to those without. CONCLUSIONS: Flexible transnasal endoscopy has been proved to be a valuable tool in the diagnosis of laryngeal malignancy. The use of NBI can increase the sensitivity and observer reliability in that context and can also provide a diagnostic gain in cases with previous laryngeal surgery.

Asunto(s)

RESUMEN

Modern endoscopic imaging techniques make it possible to detect tumor diseases of the upper respiratory and digestive tract and treat them minimally invasive - with a good oncologic outcome and maintaining the functionality of the tissue.Horizontal techniques permit the inspection of big mucous membrane surfaces, searching vor areas suspicious of dysplasia or tumor. They can be used as screening techniques. Vertical techniques serve for precise examination of in-depth expansion, infiltration chraracteristics and dignity of known lesions. Cellular techniques deal with the detection of cellular changes in vivo. As the techniques have different advantages and disandvantages, it is recommended to combine several techniques for best diagnostic gains.

Asunto(s)

RESUMEN

Objective Postoperative pain after tonsillectomy (TE) can usually be treated sufficiently by non-steroidal anti-inflammatory drugs (NSAIDs). In some patients, however, postoperative pain is more prominent on one side of the neck. Our clinical experience has demonstrated that these patients often show a segmental hypomobility of the upper cervical joints that can be successfully treated by manual medicine (MM). The analgetic effectiveness of this treatment was investigated in a prospective, randomized, placebocontrolled, single-blind study. Material and Methods 52 adults with exceptionally strong (visual analog scale VAS > 4) and/or unilateral pain after TE (between day 1 and 4) were included in this study. Postoperatively (TE) pain scores were immediately evaluated by VAS before (t0) and after (t1) the treatment (MM) as well as 4 hours (t2) and 1 day later (t3). Results Results show a significantly higher reduction in pain in the verum group compared to the placebo group (t1: p = 0.012, t3: p = 0.012, both Bonferroni-adjusted). The difference to t2 was not significant (p = 0.54 Conclusion This study has demonstrated effective pain reduction by manual medicine in adults with exceptionally strong and/or unilateral pain after TE and cervical hypomobolity.

Asunto(s)

Asunto(s)

RESUMEN

No clinical standard procedure has yet been defined to quantify the vascular pattern of vocal folds. Subjective classification trials have shown a lot of promise. Narrow band imaging (NBI) as an endoscopic imaging tool is useful, because it shows the vascular structure clearer than white light endoscopy (WL) alone. Endoscopic images of 74 human vocal folds (NBI and WL) were semi-automatically evaluated after image processing with respect to pixels of vessels and mucosa by the software MeVisLab. The ratios of vessel/mucosa pixels were compared. Using NBI, more vocal fold vessels are visible compared with WL alone (p = 0.000). There may be a difference between the right and left vocal folds due to the handedness of the examiner (p = 0.033) without any interaction between the method (NBI/WL) and the side (right/left) (p = 0.467). MeVisLab is a suitable tool for the objective quantification of the vessel/mucosa ratio for NBI and WL endoscopic images. NBI is an appropriate endoscopic tool for examination of diseases of vocal folds with changes in the vascular pattern. There is evidence that the handedness of the examiner may have an influence on the quality of the examination between the right and left vocal folds.

Asunto(s)

RESUMEN

In the last decades new endoscopic tools have been developed to improve the diagnostic work-up of vocal fold lesions in addition to normal laryngoscopy, i.e., contact endoscopy, autofluorescence, narrow band imaging and others. Better contrasted and high definition images offer more details of the epithelial and superficial vascular structure of the vocal folds. Following these developments, particular vascular patterns come into focus during laryngoscopy. The present work aims at a systematic pathogenic description of superficial vascular changes of the vocal folds. Additionally, new nomenclature on vascular lesions of the vocal folds will be presented to harmonize the different terms in the literature. Superficial vascular changes can be divided into longitudinal and perpendicular. Unlike longitudinal vascular lesions, e.g., ectasia, meander and change of direction, perpendicular vascular lesions are characterized by different types of vascular loops. They are primarily observed in recurrent respiratory papillomatosis, and in pre-cancerous and cancerous lesions of the vocal folds. These vascular characteristics play a significant role in the differential diagnosis. Among different parameters, e.g., epithelial changes, increase of volume, stiffness of the vocal fold, vascular lesions play an increasing role in the diagnosis of pre- and cancerous lesions.

Asunto(s)

Asunto(s)

Asunto(s)