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Intraoperative nerve monitoring (IONM) aimed at reducing the injuries of recurrent laryngeal nerve during thyroidectomy is controversial. We conducted a meta-analysis to assess the incidence of nerve injuries with or without IONM. Studies published from January 1994 to February 2012 in English language on humans were identified. Heterogeneity of studies was checked by the Higgins test. Summary estimates of predictive values of injury were made using the Mantel-Haenszel test based on the fixed-effects model. Publication bias was assessed by a funnel plot and Egger's method. Eight articles were selected accounting a total of 5257 nerves at risk. IONM revealed a significant impact in preventing transient injuries (positive predictive value = 5% [95% CI: 2-8], negative = 96% [95% CI: 91-100], relative risk = 0.73 [95% CI: 0.54-0.98], p = 0.035), whereas they failed to demonstrate effect on permanent injuries (positive predictive value = 2% [95% CI: 0.6-3.8], negative 99% [95% CI: 97-100], relative risk = 0.73 [95% CI: 0.44-1.23], p = 0.235). This meta-analysis demonstrated the merit of IONM in preventing transient injury during thyroidectomy. No advantage was found in permanent injuries.L'utilità del monitoraggio intraoperatorio dei nervi periferici (IONM), allo scopo di ridurre il danno dei nervi ricorrenti nel corso della chirurgia tiroidea, rappresenta ancora un aspetto controverso. Abbiamo, quindi, compiuto una metaanalisi, allo scopo di definire l'incidenza di danno nervoso con e senza IONM. Sono stati dapprima identificati gli studi eseguiti dal gennaio 1994 fino al febbraio 2012 in lingua inglese. L'eterogeneità degli studi presi in considerazione è stata valutata con il test di Higgins. Una valutazione complessiva del valore predittivo di danno è stata eseguita utilizzando il test di Mantel-Haenszel, basato sul modello effetti-fissi. Eventuali problemi legati alla pubblicazione sono stati valutati con un funnel plot e il metodo di Egger. Sono stati, alla fine, selezionati 8 lavori, per un numero complessivo di tronchi nervosi a rischio pari a 5.257. L'indagine ha mostrato un ruolo rilevante dello IONM nel prevenire danni nervosi transitori (valore predittivo positivo = 5% [95%CI:2-8], negativo = 96% [95%CI:91-100], rischio relativo = 0,73 [95%CI:0,54-0,98], p = 0,035), mentre non è stato possibile mettere in evidenza un effetto sul danno permanente [valore predittivo positivo = 2% (95%CI:0.6- 3.8), negativo 99% (95%CI:97-100), rischio relativo = 0,73 (95%CI:0,44-1,23), p = 0,235]. La meta analisi ha dimostrato l'importanza dello IONM nel prevenire il danno nervoso transitorio durante la tiroidectomia, mentre non è stato possibile rendere evidente un suo ruolo per quanto riguarda il danno permanente.

The field of communication disorders is primarily involved in the knowledge of the normal functioning of some human abilities and specifically of the following: voice, speech, language, non verbal and verbal communication, fluency of the above mentioned functions, swallowing, academic learning, and interpersonal relationship. The nosological catalogue could be divided into the following chapters: voice disorders, organic speech disorders, fluency disorders, aphasias, dysarthrias, retardations and dementiae, swallowing disorders, verbal disorders in the deaf and related disabilities and problems, learning disorders, socio-cultural and emotional troubles. Phoniatrics is the medical specialty involved in the management of communication and swallowing disorders; physical, developmental, functional and behavioural aspects of verbal communication and swallowing can be taken care of in phoniatrics with competence.Prevalence and incidence data are essential for health planning, and phoniatrics is no exception. Large epidemiologic studies on communication disorders in the general population barely don't exist; prevalence and incidence scores therefore are available for some diseases only, such as cleft palate or child deafness. Prevalence of the following disorders are reviewed: primary child language impairment, reading disability, mental retardation, cerebral palsy, autism spectrum, tongue thrust, stuttering, cleft lip/palate, child deafness, dysphagia, traumatic brain injury, dysarthria, aphasia, dementia, chronic dysphonia.Estimate of prevalence of voice disorders, organic speech disorders, fluency disorders, primary language impairment, aphasias, dysarthrias, mental retardation, dementia, swallowing disorders, verbal disorders in the deaf, learning disorders as well as socio-cultural and emotional troubles will be shown.

Tracheo-oesophageal voice prostheses are currently widely used following total laryngectomy. Data on maximum phonation time and spectrum have been studied by various Authors and are well known. On the contrary, intensity and fundamental frequency control have received little attention. Intensity and fundamental frequency play an important role in the prosodic aspects of speech. Fundamental frequency variations have been studied in tone language speakers, but the ability to voluntarily change intensity and fundamental frequency remain to be fully investigated. Aim of the present study was to analyse the ability of tracheo-oesophageal voice users to change intensity and fundamental frequency. A total of 12 male subjects who underwent total laryngectomy, in whom a tracheo-oesophageal prosthesis had been inserted, were considered. Maximum phonation time was calculated. Each subject was asked to utter an /a/ as loud as possible and an /a/ as soft as possible. Each subject was then asked to utter an /a/ at comfortable pitch and then at an interval of a fifth. Intensity as well as fundamental frequency variations were compared using Wilcoxon signed rank test. Correlation between maximum phonation time and variation in intensity and in fundamental frequency as well as between the two latter variables was calculated using Spearman's rank correlation coefficient. Mean maximum phonation time was 8 (+/- 3.8) sec. Mean energy was 50 (+/- 4.8) dB SPL for soft phonation and 68 (+/- 4.7) dB SPL for loud phonation. The difference observed was statistically significant (p0.02). Mean fundamental frequency values were 106 (+/- 14) Hz and 135 (+/- 34) Hz at the interval of a fifth. The difference observed was statistically significant (p0.02). Tracheo-oesophageal voice users were able to change intensity and fundamental frequency, but their control was rather poor. Variations in intensity, as well as fundamental frequency, did not show any correlation with maximum phonation time, and were not correlated with each other. In conclusion, the tracheo-oesophageal voice allows small fundamental frequency variations, but their control appears difficult. On the contrary, intensity variations appear larger and control somewhat easier.