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The article presents the results of a study of the acoustic characteristics of the voice in voice professionals and non-voice professionals. We examined 80 people aged 23 to 45 years with functional dysphonia of the hypotonic type, who applied to the phoniatric office of the St. Petersburg Research Institute of ENT. Of these, 23 were professional vocalists, 12 were representatives of speech professions, and 45 were non-professional voices. First, the phoniatrist examined the larynx and assessed its condition with video endostroboscopy (K. Storz) or video pharyngolaryngoscopy (VIVIDEO, KayPentax). Objective acoustic analysis was performed using the Multi-Speech software and hardware complex and the MDVP software (KayPentax). The numerical and graphical expressions of the following parameters were evaluated: noise-to-harmonic ratio (NHR), voice turbulence index (VTI), and soft phonation index (SPI). The results of the study showed that the SPI index is the most informative in assessing hoarseness in patients with hypotonic functional dysphonia. The lower values of this indicator in vocalists can be explained by the presence of a sufficiently developed resonator system of the vocal apparatus, which is reflected in the amplification of the high-frequency components of the voice spectrum.

The aim of the study was to improve the efficiency of diagnosis of various forms of chronic hyperplastic laryngitis, which is referred to as precancerous conditions of the larynx, video laryngostroboscopy was performed in 249 patients. All patients have occupational hazards: increased voice load, smoking, working capacity in a hospital state during acute respiratory viral infections, laryngitis, bronchitis. In case of detection of areas of dyskeratosis of mucous membrane of vocal folds (leukoplacia, hyperkeratosis) biopsy followed by histological examination was carried out. The results of a histological study of leukoplakia showed the presence of metaplasia of stratified squamous epithelium in 100% of the examined. Among patients with vocal fold hyperkeratosis, metaplasia of stratified squamous epithelium was detected in 20,8%, grade II and III dysplasia – 15,1% of observations. 64,1% of patients were diagnosed with laryngeal cancer. The video laryngostroboscopic picture of the larynx in various forms of chronic hyperplastic laryngitis was studied. According to the results of the study, pathological changes in the mucosa of the vocal folds with possible malignation include hyperkeratosis. During video laryngostroboscopy, asymmetric, irregular, mucous waves oscillate in the hyperkeratosis area in 60,4% of patients, and in 39,6% of patients the absence of vibrations of the vocal fold in the area of hyperkeratosis is diagnosed.

Diagnosis and treatment of larynx diseases in voice professionals are an important task of otorhinolaryngology. 244 voice professionals have visited Phoniatric Department of Saint Petersburg Research Institute of Ear, Throat, Nose and Speech. The condition of larynx was assessed by videoendolaryngoscopic and videoendolaryngostroboscopy methods. Larynx pathology was found in 212 patients, 32 persons were healthy. The main causes of dysphonias were the continuous vocal stress, work in sick condition, the diseases of endocrine, gastroduodenal, respiratory, neural system. 77 patients with voice disorders were diagnosed with functional dysphonia, 61 patients – with acute or chronic laryngitis. The cause of hoarseness in 46 persons were the vocal fold nodules, and in 28 patients – the vocal fold polyps. The article describes the clinical manifestations of pathological changes of the larynx. Based on the studied voice disorder etiological factors and clinical picture of the larynx, the authors developed a clinical and diagnostic algorithm of otorhinolaryngologist’s work with voice professionals.

Diagnosis and treatment of diseases of the larynx in patients with dysphonia are an urgent task of modern otorhinolaryngology. The reason for this is the constant growth of professions with high requirements for voice quality. The modern methods of diagnosis in diseases of the larynx are based on endoscopic diagnostic techniques. The article provides detailed description of the clinical and endoscopic signs of functional and organic diseases of the larynx that are significantly more prevalent in voice professionals: hypotonic and hypo-hypertonic functional dysphonia, soft and hard vocal fold nodules, acute and chronic occupational laryngitis, and vascular pathology of vocal cords. The article presents the main approaches to the treatment of diseases of the larynx, including using the drug Homeovox. The article will be useful to the otorhinolaryngologists of the outpatient network to establish the diagnosis and assign а therapy to the voice and speech professionals.

In the beginning of the present century the epidemic situation on tuberculosis in the Tver region after a long period of deterioration under the influence to implemented medico-social and anti-epidemic measures received the tendency to the gradual improvement.

In the article from the standpoint of psychosomatic approach compares the mental component of the clinical picture and stuttering voices violations as variants of communicative disorders. Using batteries psychodiagnostical techniques surveyed 109 adult patients with voice disorders and 102 adults who stutter, the results of which are considered from the perspective of the concept of the inner picture of the disease. Fixing the disease more expressed in stutterers, and neuroticism indicators, Introversion and alexithymia – in patients with dysphonia. The dispersion of mental characteristics leading value have individual characteristics of patients.

The objective of the present study was to evaluate the effectiveness of the application of homeovox for the combined treatment of small vocal cord nodules and acute laryngitis in the professional voice users. A total of 40 subjects presenting with dysphonia were examined after they were divided into two study groups and two groups of comparison depending on the nosological form of the pathological condition. The subjects comprising the study groups were given traditional therapy in the combination with the intake of homeovox whereas the patients included in the two groups of comparison received the traditional treatment alone. The outcome of the treatment was evaluated on days 1, 5, and 10 after the initiation of therapy based on the analysis of the changes in the videoendostroboscopic picture of the larynx and the acoustic characteristics obtained by the computer-assisted analysis of the voice. The analysis of the results of the combined treatment has demonstrated the statistically significant differences in some acoustic parameters of the voice between the subjects with small vocal cord nodules and acute laryngitis belonging to the study groups and the groups of comparison. It is concluded that the introduction of homeovox in the combined treatment of the patients presenting with the small nodules in the vocal cords and acute catarrhal laryngitis accelerates the recovery of the acoustic characteristics of the voice within various periods after the onset of the treatment in comparison with the patients treated with the use of traditional therapy alone.Цель исследования - изучение эффективности применения препарата Гомеовокс в комплексном лечении мягких узелков голосовых складок и острого ларингита у профессионалов голоса. Были обследованы 40 пациентов с дисфониями, которых распределили по нозологическим формам на две группы исследования и две группы сравнения. В группах исследования больные получали традиционную терапию в сочетании с препаратом Гомеовокс, а в группах сравнения - только традиционную терапию. Результаты оценивали на 1, 5, 10-й дни лечения по изменению видеоэндостробоскопической картины гортани и акустических показателей компьютерного анализа голоса. Анализ результатов проведенного комплексного лечения выявил статистически значимые различия для ряда акустических показателей голоса между группами исследования и сравнения у пациентов с узелками голосовых складок и острым ларингитом. Включение препарата Гомеовокс в комплексное лечение пациентов с мягкими узелками голосовых складок и острым катаральным ларингитом приводит к более быстрому восстановлению акустических показателей голоса в различные сроки наблюдения по сравнению с пациентами, получавшими только традиционную терапию.

Diseases diagnosis of the larynx in children and adults remains a difficult and urgent task of otorhinolaryngology. Modern diseases diagnostics of the larynx is based on endoscopic examination methods, which are the most informative and allow assessing the status of the larynx at a very advanced level. In 397 patients (329 adults and 68 children) with dysphonia, video rhinopharyngolaryngoscopy was performed using the PENTAX Medical VIVIDEO system. In addition, in 36 adults and 8 children, the status of the larynx was assessed by video laryngoscopy and video laryngostroboscopy using a rigid endoscope. Comparative analysis of video rhinopharyngolaryngoscopy and video endolaryngoscopy usage showed that the quality and size of the video image of the larynx in adults and children when using a video rhinopharyngolaryngoscope are comparable to the picture obtained using a rigid endoscope. The use of a video rhinopharyngolaryngoscope increases the efficiency of the examination, since the small diameter of the inserted working part allows carrying out the procedure as fast and comfortably as possible for the patient.Диагностика заболеваний гортани у детей и взрослых остается сложной и актуальной задачей оториноларингологии. Современная диагностика заболеваний гортани основана на эндоскопических методах исследования, которые являются наиболее информативными и позволяют на качественно новом уровне оценить состояние гортани. У 397 пациентов (329 взрослых и 68 детей) с дисфониями провели видеоринофаринголарингоскопию с использованием системы PENTAX Medical VIVIDEO. Кроме этого, у 36 взрослых и 8 детей состояние гортани оценили методом видеоларингоскопии и видеоларингостробоскопии, используя жесткий эндоскоп. Сравнительный анализ применения видеоринофаринголарингоскопии и видеоэндоларингоскопии показал, что качество и размеры видеоизображения гортани у взрослых и детей при использовании видеоринофаринголарингоскопа сопоставимы с картиной, полученной при использовании жесткого эндоскопа. Применение видеоринофаринголарингоскопа повышает эффективность проводимого исследования, так как малый диаметр вводимой рабочей части позволяет провести процедуру максимально быстро и комфортно для пациента.

Laryngeal cancer still occupies the leading position among malignant neoplasms of the upper respiratory tract. The detection of laryngeal cancer in situ occurs only in 2.3–6% of cases. It is explained by the complexity of differential diagnosis between dyskeratosis and cancer in situ of the vocal folds. The objective of the study was to identify pathognomonic differential-diagnostic signs of videoendostroboscopic and auto-fluorescent larynx picture in the patients with premalignant diseases and early stages of the vocal folds cancer. The study included 110 patients with premalignant diseases and suspected for early stage of laryngeal cancer. All the patients underwent biopsy of mucosa areas that caused oncological alertness. As a result, squamous cell carcinomas in situ and T1 have been detected in 58 (52.7%) patients, chronic hyperplastic laryngitis with stage 2-3 mucosa dysplasia – in 32 (29.1%), chronic hyperplastic laryngitis with metaplasia sections – 12 (10.9%) patients, benign neoplasms– 4 (3.6%), tumor-like diseases – 4 (3.6%) patients. According to videoendostroboscopy results, most of 58 patients with cancer, 46 (79.3%) people, had no vocal fold vibrations and mucotic waves. Less frequently they were preserved, but had reduced amplitude and were irregular. During auto-fluorescent endoscopy the decrease in fluorescence intensity was observed in almost all cases – in 57 (98.3%) patients. In 32 patients with stage 2–3 dysplasia videoendostroboscopy showed lower amplitude of the vocal folds vibration, they were irregular in 30 (93.7%) observations, mucosal wave stopped at the lesion site in 27 (84.4%) observations. Vocal folds vibrations were absent in 2 (6.3) patients. In auto-fluorescent endoscopy, the increase in fluorescence intensity was observed in most cases – in 25 (78.1%) patients. Timely performed videoendostroboscopy in combination with auto-fluorescent larynx endoscopy provides the increase of efficacy of diagnostics of premalignant changes and early vocal folds cancer.

Laryngitis is one of the commonest causes of dysphonia in the subjects engaged in the voice and speech professions. This condition can be either associated with the professional activities or related to voice fatigue. It is a common practice to distinguish between acute and chronic forms of occupational laryngitis. The main factors responsible for development of both conditions include the non-observance of directions concerning the protection and hygiene of the speaking and singing voice. The present study included 478 (100%) subjects engaged in the voice and speech professions presenting with the diagnosis of acute or chronic occupational laryngitis who applied for medical assistance to our Phoniatric Care Department. The clinical state of their larynx was evaluated with the use of the videoendostroboscopic technique. Acute laryngitis was diagnosed in 103 (21.5%) of the examined subjects while the remaining 375 (78.5%) ones presented with chronic laryngitis. A characteristic feature of acute occupational laryngitis documented in 38 (36.9%) examined professional voice users with this condition (practically healthy in all other respects) was the development of this disorder as a result of overloading the speech organs. On the contrary, viral and/or bacterial laryngitis revealed in 65 (63.1%) of the patients was preceded by acute respiratory symptoms. A total of 62 (16.5%) patients suffered from chronic occupational laryngitis attributable to overloading of the organs of speech during protracted periods. The remaining 313 examined professional voice users were found to present with various forms of chronic laryngitis including catarrhal laryngitis in 175 (46.7%) of them, edematous-polypoid and atrophic forms in 32 (8.5%) and 19 (5.1%) subjects respectively. The main etiological factors underlying the development of all the tree forms of chronic laryngitis were smoking, chronic tonsillitis, gastroesophageal reflux disease, bronchial asthma, and diabetes mellitus.Одной из частых причин дисфоний у лиц голосо-речевых профессий являются ларингиты, которые могут быть обусловлены профессиональной деятельностью или не быть связаны с голосовой нагрузкой. Выделяют острую и хроническую формы профессиональных ларингитов. Основной причиной их развития является несоблюдение правил охраны и гигиены певческого и речевого голоса. Было обследовано 478 (100%) профессионалов голоса с диагнозом 'острый или хронический ларингит', обратившихся в фониатрическое отделение. Клиническое состояние гортани оценивали с использованием метода видеоэндостробоскопии. Острый ларингит диагностировали у 103 (21,5%) пациентов, хронический - у 375 (78,5%) больных. Характерным для острого профессионального ларингита, выявленного у 38 (36,9%) человек, являлось его развитие после большой голосовой нагрузки на фоне полного здоровья. Напротив, вирусному или вирусно-бактериальному ларингиту у 65 (63,1%) пациентов предшествовали острые респираторные явления. Хроническим профессиональным ларингитом страдали 62 (16,5%) пациента, которые испытывали длительные голосовые перегрузки. У остальных 313 больных выявлены различные формы хронического ларингита: катаральная в 175 (46,7%) случаев, гиперпластическая - в 87 (23,2%), отечно-полипозная - в 32 (8,5%), атрофическая - в 19 (5,1%). Основными этиологическими факторами развития этих форм были курение, хронический тонзиллит, гастроэзофагеальная рефлюксная болезнь, бронхиальная астма, сахарный диабет.

The article is devoted to a rare ENT disease. The introduction deals with pathogenesis, classification, and clinical course of AL­amyloidosis, which is in most cases diagnosed in the larynx diseases. The article presents three authors’ own clinical cases of vestibular, vocal and sub-vocal larynx amyloidosis.

We have undertaken the electron microscopic investigation into peculiarities of six tumour-like structures on the vocal cords. The study has demonstrated changes in the number and distribution patterns of intercellular junctions, keratin and tonofilament contents in epithelial cells, basal membrane structure, and composition of the basic substance in lamina propria. All the examined tumour-like structures contained bacteria an two of them had viral particles in vacuoles of fibroblasts. Moreover, the bacteria were found on the surface of epithelium, between epithelial cells and in the basic substance in lamina propria. Cytoplasm of epithelial cells and fibroblasts not infrequently contained bacteria in the phase of division.С целью выявления ультраструктурных особенностей проведено электронно-микроскопическое исследование шести опухолеподобных образований голосовых складок. Обнаружены изменения в количестве и характере распределения межклеточных контактов, изменения кератина и тонофиламентов в эпителиальных клетках, изменения базальной мембраны и состава основного вещества собственной пластинки. Во всех образованиях обнаружено присутствие бактерий, а в двух образованиях - наличие вирусных частиц в вакуолях фибробластов. Бактерии выявлены на поверхности эпителия, между эпителиальными клетками и в основном веществе собственной пластинки, в цитоплазме эпителиальных клеток и фибробластов; нередко встречались бактерии в стадии деления.