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Predicting definitive outcomes of post-thyroidectomy vocal fold paralysis (VFP) is challenging. We aimed to identify reliable predictors based on intraoperative neuromonitoring (IONM) and flexible fiberoptic laryngostroboscopy (FFL) findings.Among 1172 thyroid operations performed from April to December 2021, all patients who exhibited vocal fold paralysis (VFP) at post-operative laryngoscopy were included. IONM data, including type of loss of signal (LOS), were collected. Patients underwent FFL, with arytenoid motility assessment, at 15, 45 and 120 days post-operatively. Patients were divided into two groups: those who recovered vocal fold motility (VFM) by the 120th post-operative day (recovery group) and those who did not (non-recovery group).Fifty-nine VFP cases (5.0% of total patients) met the inclusion criteria. Eight patients were lost at follow-up and were excluded. Overall, 9 patients were included in the non-recovery group (0.8% of total patients) and 42 in the recovery group. Among various predictive factors, only arytenoid fixation (AF) at the 15th post-operative day and Type I LOS were significant predictors for no VFM recovery (p = 0.007, RR = 9.739, CI:1.3-72.3 and p = 0.001, RR = 9.25, CI:2.2-39.3 for AF and Type I injury, respectively). The combination of type of LOS and arytenoid motility at the 15th post-op day yielded satisfactory predictive values for the progression of transient VFP to permanent.Arytenoid motility at the 15th post-op day and type II LOS are associated with recovery of VFM. Type of LOS and FFL could be included in the follow-up protocols of patients with VFP to reliably predict clinical outcomes.

A high percentage of patients suffered symptoms also after recovery from the Coronavirus Disease—2019 (COVID-19) infection. It is not well clear what are the specific long-term sequelae (complications and symptoms). During the acute phase the patients may develop a multi-organ system pathology including aerodigestive tract. As the pathophysiology of COVID-19 emerges, the aim of our study was to describe the prevalence of oropharyngeal dysphagia after COVID-19 disease. From March to July 2020 we enrolled patients recovered from SARS-CoV-2 infection who had been previously hospitalized for the disease. They were screened for dysphagia by mean of the Eating Assessment Tool-10 (EAT-10). The cases with EAT-10 score > 3 were graded for the aspiration risk by applying the Gugging Swallowing Screen (GUSS) and were submitted to the Swal-QoL questionnaire. The cases with a GUSS score > 19 were subjected to FEES. 8/117 (7%) patients had positive screening result. 4/8 (50%) revealed an abnormal health related quality of life in oropharyngeal dysphagia with a mean Swal-QoL score of 69.73. The most affected domain was the “time of meals” (mean score 65) following by the “sleep” (mean score 66) and “eating desire” (mean score 72). 1/8 cases showed increased risk for aspiration and did not showed endoscopic signs of oropharyngeal dysphagia. Our results showed that the prevalence of upper dysphagia after hospitalization for SARS-CoV-2 is not anecdotal and that probably this long-lasting sequela has a psychogenic etiology.

Total Laryngectomy seriously affects on patients Quality of Life and on their psychological well-being. The aim of this study was to verify the effects of pre-operative Speech-Language Pathology counselling on laryngectomized patients. Pilot randomized controlled trial. Twenty-seven patients undergoing total laryngectomy and primary tracheoesophageal puncture were randomized as follows: 14/27 subjects were collocated in the Experimental group who received preoperative Speech-Language Pathology counselling and 13/27 in the Control group group that did not receive it. Two interviews and four questionnaires (Psychological Distress Inventory, Impact of Event Scale-Revised, Hospital Anxiety and Depression Scale, Italian-Self-Evaluation of Communication Experiences after Laryngeal Cancer) were administered immediately after surgery (T0), 1- (T1) and 3-months (T2) after hospital discharge in order to asses levels of distress, post-traumatic stress and anxious-depressive symptoms, acquisition and acceptance of the new voice. Student’s t test and chi square test showed that the two groups of patients were equivalent. Experimental group was more satisfied with the information and obtained statistically better (p

Purpose The surgical thyroid disease includes upper aerodigestive complaints with not homogenous prevalence and specific features. The purpose was to analyze before and after total thyroidectomy (TT) the prevalence and severity of voice, swallowing, respiratory, and reflux airway symptoms in relation with thyroid weight. Methods A total of 98 consenting patients undergoing TT were enrolled. Preoperatively, 1 and 3 months after TT, patients underwent videolaryngoscopy, subjective evaluation of voice (VIS), swallowing (SIS and EAT-10), respiratory (mMRC), and reflux symptoms (RSI, Gerd-Q). The scores were analyzed based on thyroid weight (75 gr) and post-operative score gain was calculated from the score before TT and the follow-up examination. Results In total, 40/98 selected cases of uncomplicated TT completed the postoperative evaluation. Endoscopic signs suggestive of reflux disease were observed in 1/40 (2.5%) and 0/19 cases before and after TT respectively. The prevalence of cases with abnormal reflux symptom index decreased significantly after surgery (8/40 vs 1/40) (p p p p Conclusions The surgical thyroid disease is associated to mild aerodigestive preoperative compressive symptoms, that include respiratory abnormalities and reflux like symptoms, regardless of the gland weight. In absence of endoscopic signs of airway reflux the presence of reflux symptoms suggests an overlapping with thyroid neck complaints. The patients undergoing uncomplicated TT had improvement in compressive symptoms and the greatest improvement is seen in larger goiters.

To evaluate results of telerehabilitation (TR) during the coronavirus disease 2019 pandemic for the treatment of dysphonia caused by permanent post-thyroidectomy unilateral vocal fold paralysis (UVFP).Forty subjects with post-thyroidectomy UVFP (onset1 month) underwent TR. Videostrobolaryngoscopy, acoustic and perceptual voice analysis and patient self-assessment were carried out in person before, at the end of TR and 6 months later.Twenty-five subjects spontaneously recovered full vocal fold motility at some time during follow-up, whereas 15 had a permanent UVFP at the end of the follow-up period. These subjects constituted our study group. At the early posttherapy control 10/15 subjects (66.6%) showed a complete glottal closure, while in 5/15 (33.3%) a glottal gap remained (P = 0.03). These results did not change 6 months after TR. At the late posttherapy control the maximum phonation time improved significantly (P = 0.02). Both post-therapy Voice Handicap Index scores were significantly lower than the pre-therapy ones (P = 0.04). Grade, Breathiness, and Asthenia parameters of the Grade-Roughness-Breathiness-Asthenia-Strain scale improved 6 months after TR (P0.05). The number of voice signals suitable for acoustic analysis increased significantly after therapy. Finally, 87% of patients were satisfied with TR.With careful patient selection, TR may be considered as a promising method for voice therapy in postthyroidectomy UVFP.

Objectives: We aim to analyze long-term voice outcomes and Quality of Life (QoL) in patients undergoing Open Partial Horizontal Laryngectomy Type II (OPHL Type II) and to compare them to those obtained by patients undergoing Total Laryngectomy (TL) with voice prosthesis (VP). Design: Cross-sectional cohort study Setting: patients undergoing surgery for advanced laryngeal cancer, assessed during the usual follow-up consultations at the Phoniatric Unit (February 2020-December 2020). Participants: Forty-five patients were enrolled and divided into two groups: OPHL Group and TL Group. Main outcomes measures: Maximum phonation time, INFV0 scale, I-SECEL, UWQoL-V4 and MDADI questionnaires were used to assess the long-term outcomes. Results: Voices of patients undergoing OPHL Type II were worse than those of laryngectomized patients with VP. Nevertheless, scores in voice and dysphagia-related QoL were comparable and scores in the Social domain of QoL were better in OPHL group. Conclusions. OPHL Type II allows an acceptable voice recovery and a satisfactory QoL.

To investigate the effectiveness of Lee Silvermann Voice Treatment (LSVT15 patients with Parkinson's disease were assessed before LSVTA significant increase of the mean values of Imax and rF0 was observed until 6 months post-therapy (p0.001), whereas Running Speech Standard Deviation (rSTD) (p = 0.004), Amplitude Variability (rVAm) (p = 0.02) and Frequency Variability (rvFIn addition to the subjective and perceptual beneficial effect of LSVTValutazione multidimensionale della voce dopo riabilitazione vocale sec. Lee Silverman nei pazienti affetti da malattia di Parkinson.Valutare l’efficacia del LSVT® nel migliorare gli aspetti prosodici dei pazienti con malattia di Parkinson.Sono stati valutati 15 pazienti subito dopo il LSVT® e nei follow-up a una settimana, a 3 e a 6 mesi dal termine del trattamento attraverso la somministrazione dei seguenti strumenti: Voice Handicap Index -10 (VHI-10), scala GRBAS, item 18 dell’Unified Parkinson’s Disease Rating Scale III (UPDRS III), Tempo Massimo Fonatorio (TMF/s/), Voice Range Profile (VRP) e l’Intonation Stimulability Protocol del Motor Speech Profile (MSP).Dopo la terapia i parametri acustici Imax e rF0 hanno mostrato un incremento significativo che si è mantenuto nel follow-up a 6 mesi (p0,001), mentre per le variabili rSTD (p = 0,004), rVAm (p = 0,02) e rvF0 (p = 0-01) si è evidenziato un miglioramento significativo nel follow-up a 3 mesi che tuttavia non si è mantenuto nel successivo controllo a 6 mesi. Il punteggio dell’item 18 dell’UPDRS III ha mostrato un incremento significativo soltanto a una settimana dal termine del trattamento (p = 0,03). Infine si è evidenziato un miglioramento statisticamente significativo dei parametri G (Grado) e A (Astenia) della scala GRBAS così come del valore medio del VHI-10 sia subito dopo il LSVT® che nei successivi follow-up a 3 e a 6 mesi (p0,05).I risultati hanno evidenziato, oltre ad un miglioramento soggettivo e percettivo della sintomatologia, un incremento dell’intensità e della frequenza fondamentale. Il miglioramento dei parametri acustici relativi alla prosodia è stato temporaneo e non si è mantenuto nel tempo.

Objectives: To confirm the data reported in our previous studies on the analysis of the variability of the electroglottographic signal in the pathological voice; to evaluate possible differences in variability between organic and functional pathologies; to identify any distinctive/typical EGG patterns for these pathologies. Methods: One hundred twenty-five subjects were enrolled (36 euphonic and 89 pathological: 24 functional dysphonia, 21 bilateral vocal nodules, 23 unilateral polyps and 21 unilateral cysts). All subjects were studied with videolaryngostroboscopy, spectrographic analysis of voice and electroglottography (EGG). The EGG signal variability was then investigated using amplitude-speed combined analysis, by means of a proprietary software algorithm. Amplitude and Speed variation were expressed as a new parameter, the Variability Index (VI), calculated both for the whole EGG signal recorded (VI-tot) and in each phase of the glottic cycle (VI-Q, absolute value; VI-Q%, percentage value). Results: In the comparison of VI values between pathological and normal groups, VI-tot and VI-Q2% (which corresponds to the final phase of vocal fold contact) were significantly greater in pathological subjects (P= 0.002). The comparison of VI values among subgroups of the various pathologies showed a difference for VI-tot (P< 0.0001) and VI-Q2% (P= 0.001); this difference was more marked in the cysts than in the functional dysphonia. The cut-off values of VI-tot and VI-Q2% were 0.191 and 18.17%, respectively (sensitivity and specificity 65.2% and 66.7% for VI-tot and 84.3% and 77.8% for VI-Q2%). Conclusions: The variability of the EGG signal investigated through the combined analysis of the amplitude and the speed of vibration using a proprietary algorithm software has proved useful not only to distinguish the normal voice from the pathological voice, but also to characterize which phases are more altered in the various voice pathologies studied, both functional and organic. Furthermore, the analysis of the VI parameter allowed to propose cut-off values characterized by a good sensitivity and specificity to discriminate dysphonia from the euphonic voice. Larger groups of patients will be needed to confirm these results.

Background The classic symptoms of Frey syndrome are gustatory sweating and flushing. Aims of the study were to describe prevalenceand severity of typical and atypical presentations of the disorder and to assess the effects of botulinum neurotoxin A (BoNT-A) therapy in patients with Frey syndrome after parotidectomy. Methods In this prospective, observational study on 18 patients, we assessed symptom severity before therapy, after 15 days, 1, 3 and 6 months' follow-up with the sweating-flushing-itch-paresthesia-pain (SFIPP) Frey scale specifically designed by the authors themselves for this study. Results Before BoNT-A injection, all patients (100%) complained gustatory sweating, 80% paresthesia, 77% gustatory flushing, 60% pain and 60% gustatory itch. The SFIPP-Frey overall score and the symptom-specific ones decreased significantly at each post-therapy control. Conclusions The prevalence of "unusual" manifestations is not negligible. BoNT-A improves symptoms severity. The SFIPP-Frey scale may be useful to assess symptoms and to monitor post-therapy outcomes.

Dysphagia is common in tracheostomized patients who underwent head and neck surgery for cancer treatment. The objective of this study was to evaluate, by means of oropharyngoesophageal scintigraphy (OPES), the impact of an occluded tracheal tube (TT) on swallowing in patients treated for head and neck cancer before hospital discharge, to provide further information to the benefit of out-patient care management. From October 2018 to November 2019, we enrolled 19 tracheostomized patients (6 females and 13 males; mean age 61 years) who underwent primary surgical resection of head and neck tumor and swallowing rehabilitation during hospitalization. All subjects underwent a double-standard OPES, one with occluded tracheal tube and the other without TT, with their tracheal stoma being closed directly by a plaster. For each study, we assessed and compared the following quantitative parameters: oral transit time (OTTsec), pharyngeal transit time (PTTsec), esophageal transit time (ETTsec), oral retention index (ORI%), pharyngeal retention index (PRI%), esophageal retention index (ERI%), and aspiration percentage (AP%). The mean values of OTT, PTT, ORI%, PRI%, and ERI% were abnormal during OPES both with TT and without TT and did not statistically differ between the two tests (p > 0.05). Aspiration was detected in 4 cases out of 19 (21.05%) cases during OPES with TT and in 4/19 (21.05%) cases without TT who showed a mean AP% of 11.4% and 11.5% respectively (p > 0.05). Patients with abnormal AP% (> 0%) during OPES with TT showed aspiration signs without TT. Our study showed that the mere presence of a closed tracheal tube does not impact significantly the oropharyngeal transit of bolus during swallowing. This result suggests the possibility to maintain a small-diameter occluded tracheal tube in place for the postsurgical management of head and neck cancer patients.

La disfagia orale e faringea in pazienti affetti da sclerosi sistemica: prevalenza e caratteristiche.Scopo dello studio è stato quello di valutare, per mezzo di un campionamento trasversale, la prevalenza e le caratteristiche dei disturbi di deglutizione in pazienti affetti da sclerosi sistemica (SS). Abbiamo analizzato i dati ottenuti da 19 pazienti sottoposti a tests soggettivi, clinici e strumentali. Per la valutazione soggettiva è stato utilizzato il questionario di autovalutazione “M.D. Anderson Dysphagia Inventory”. Per l’esame clinico ai pazienti veniva chiesto di eseguire specifici movimenti e prassie delle labbra, della lingua e della mandibola (score da 0 a 3), performances vocali, respiratorie e di diadococinesi in accordo con il sistema Robertson’s (“insufficiente”, “quasi sufficiente”, “sufficiente” e “normale”). Infine ciascun paziente veniva sottoposto ad esame fibroendosopico della deglutizione con test della sensibilità. Risultati dell’MDADI: il 74% dei pazienti mostrava un’alterazione “lieve” della deglutizione, il 21% ed il 5% rispettivamente un grado “moderato” e “severo” di disfagia. Le performances più compromesse erano l’apertura della mandibola e delle labbra (52,6% and 47,4%) e lo schiocco della lingua (52.7%). La voce, la respirazione e la diadococinesi erano alterate in più del 70% dei casi. La FEES ha dimostrato un’alterazione della fase faringea e la presenza di deficit della sensibilità faringolaringea in più della metà dei pazienti (58% e 53%). Lo studio mette in evidenza l’elevata prevalenza della disfagia alta nei pazienti affetti da sclerosi sistemica e dimostra l’importanza di una valutazione multidimensionale che coinvolga entrambi il logopedista ed il foniatra in grado di eseguire un esame clinico specifico e strumentale mirato, indispensabili per contribuire a riconoscere la sede della disfagia e con essa caratteristiche non altrimenti rilevabili.Herein, we describe the prevalence and features of dysphagia in patients affected by systemic sclerosis (SS). We analysed the data of 19 patients obtained by administering the M.D. Anderson Dysphagia Inventory (MDADI) scale that measures dysphagia symptoms and by physical assessment consisting of judging specific lip, mandible and tongue performances (scale 0-3) and diadochokinesis, respiratory and phonatory functions (scale “poor”, “fair”, “good”, “normal”) according to Robertson’s method. Subjects also underwent flexible endoscopic examination of swallowing. MDADI showed that 74% of answers were included in “

The use of a mandibular advancement device (MAD) increases the activity of the temporo-mandibular (TM) complex and masseter (MM) muscles with the risk of reducing treatment compliance. Predictors of treatment outcome are of importance in selecting patients who might benefit from MAD without side effects. The role of mandibular advancement (MA) during drug-induced sleep endoscopy (DISE) is controversial. In three cases (BMI30) affected by non-severe OSAS (AHI30 e/h), we recorded the surface EMG signal of MM activity during DISE. At follow-up all cases improved the AHI, two cases that showed transient increase of MM activity did not suffer from changes of overjet and did not complain of discomfort with the use of MAD. The case that showed a continuing increase of MM activity reported TM discomfort without changes of dental occlusion. EMG of MM during DISE may contribute to ameliorate the selection of cases amenable to treatment with MAD.È noto che l’applicazione dell’apparecchio per l’avanzamento mandibolare (MAD) aumenta l’attività del complesso muscolare temporomandibolare (TM) e del muscolo massetere (MM) con il rischio di ridurre l’aderenza al trattamento. Alcuni parametri clinici riconosciuti predittivi dell’efficacia del MAD sono già utilizzati per la selezione dei casi e tra questi l’avanzamento mandibolare (MA) simulato durante la “sleep endoscopy” è quello principale. Presentiamo qui i risultati della registrazione EMG del muscolo massetere in tre casi di pazienti normopeso affetti da OSAS non-severa (AHI30) sottoposti alla MA durante la “sleep endoscopy” e poi trattati con MAD. La poligrafia dinamica di controllo a distanza, documentava una significativa riduzione dell’AHI. I due casi che avevano mostrato un incremento transitorio dell’attività del MM durante la MA non riferivano effetti collaterali, l’altro, che aveva dimostrato un incremento persistente del segnale, riferiva al follow-up un “discomfort” in regione TM senza alterazioni dell’occlusione. L’EMG del massetere potrebbe contribuire a migliorare la selezione dei casi suscettibili di trattamento con MAD.

Confronto dell’indice di variabilità EGG nella voce eufonica e patologica.In un recente lavoro abbiamo presentato un nuovo approccio allo studio del tracciato elettroglottografico; il metodo di studio si basava sulla valutazione della variazione del segnale EGG e della sua derivata prima, mediante un nuovo software ideato dalla scuola foniatrica pisana. Tale software permette di ottenere indici quantitativi relativi alle fasi di contatto e decontatto delle corde vocali durante la fonazione, mediante lo studio della variabilità combinata dell’ampiezza e della velocità di vibrazione (derivata prima del segnale EGG). La voce patologica presenta un segnale EGG più variabile rispetto alla voce normale: la vibrazione cordale è resa irregolare dalla presenza di patologia del piano glottico. Al fine di dimostrare differenze tra voce normale e patologica relative alla variabilità combinata tra ampiezza e velocità di vibrazione, abbiamo introdotto un nuovo parametro quantitativo denominato “variability index, VI”. Abbiamo studiato 95 soggetti (35 normali e 60 con voce patologica); tra i patologici, 15 mostravano disfonia disfunzionale e 45 disfonia organica. I soggetti affetti da disfonia organica presentavano: 15 noduli vocali bilaterali, 15 polipi unilaterali e 15 cisti unilaterali. Tutti i soggetti venivano studiati con videolaringostroboscopia, i parametri elettroacustici della voce venivano analizzati attraverso il sistema KayPENTAX CSL (Model 4500). L’esame EGG veniva effettuato attraverso il KAY Model 6103 collegato al sistema CSL. Il nuovo software di analisi del segnale EGG permette non solo di ottenere un VI totale (VI-total) relativo alla variabilità durante tutta la registrazione, ma anche VI parziali relativi alle varie fasi del ciclo glottico. Applicando la variazione di ampiezza e della derivata prima su un grafico di Lissajous, è possibile dividere l’intero ciclo glottico in 4 fasi (rappresentate da 4 quadranti nel grafico): la fase iniziale di contatto delle corde vocali (VI-Q1), la fase finale di contatto delle corde vocali (VI-Q2), la fase iniziale di de-contatto delle corde vocali (VI-Q3) e la fase finale, fino al completo de-contatto delle corde vocali (VI-Q4). Per ciascun quadrante, inoltre, è possibile calcolare l’indice di variabilità percentuale. Comparando gli indici di variabilità nei gruppi normali e patologici, abbiamo ottenuto i seguenti risultati: il VI totale era significativamente maggiore nel gruppo di soggetti patologici (0,25 vs 0,18; p = 0,01); il valore assoluto di VI in 3 quadranti era maggiore nei patologici anche se non in maniera statisticamente significativa (VI-Q2, 0,041 vs 0,029; VI-Q3, 0,065 vs 0,058; VI-Q4, 0,054 vs 0,052). La variabilità percentuale del quadrante Q2 (VI-Q2%), era significativamente più elevata nei soggetti patologici rispetto ai normali (0,22 vs 0,16) (p = 0,01). I risultati di questo studio hanno confermato che il nostro nuovo software di analisi del tracciato EGG permette di distinguere la voce normale da quella patologica sulla base di un nuovo parametro quantitativo, il VI. Lo studio mette in evidenza come la fase che più caratterizza la differenza tra voce normale e patologica è quella relativa alla fase finale di contatto delle corde vocali, che presenta una maggiore variabilità di ampiezza e velocità di vibrazione. Ulteriori studi, con un numero maggiore di soggetti, saranno necessari per confermare questi risultati e per dimostrare eventuali differenze di variabilità del segnale EGG nelle diverse patologie delle corde vocali.In a recent study we introduced a new approach for analysis of the electroglottographic (ECG) signal. This method is based on the evaluation of variation of the EGG signal and its first derivative, through new software developed by the Pisan phoniatric school. This software is designed to extract quantitative indices related to the contacting and decontacting phases of the vocal folds during phonation. The software allows us to study the combined variability of vibration amplitude and velocity (i.e. the first derivative of the EGG signal). Pathological voices show a much more variable EGG signal compared to normal voices, since cordal vibration is made irregular due to the presence of glottis plane pathologies. With the aim of demonstrating the differences between normal and pathological voices relevant to combined vibration amplitude and velocity variability, we have introduced a new quantitative parameter named “variability index, VI”. We studied 95 subjects (35 normal and 60 with pathological voice); among pathologic subjects, 15 showed functional dysphonia and 45 showed organic dysphonia. Subjects affected by organic dysphonia presented: 15 bilateral vocal nodules, 15 unilateral polyps and 15 unilateral cysts. All subjects were studied with videolaryngostroboscopy; electro-acoustic parameters of the voice were analysed with the KayPENTAX CSL (Model 4500) system. The EGG signal was recorded using KAY Model 6103 connected to the CSL system. The new software for the analysis of the EGG signal allows us to obtain not only a VI total value relevant to variability during all the recording, but also partial VI values relevant to the different glottis cycle phases. In fact, plotting the amplitude variation and its first derivative on a Lissajous graph, it is possible to divide the whole glottis cycle into four phases (each represented by four quadrants on the graph): the initial vocal folds contacting activity (VI-Q1), the last phase of vocal folds contacting (VI-Q2), the first phase of vocal folds decontacting (VI-Q3) and the last phase, up to the complete decontacting of vocal folds (VI-Q4). For each quadrant, it is also possible to work out the percent variability index. By comparing the variability indices in the normal and pathological groups, we obtained the following results: the total VI was significantly higher in the pathological subjects (0.25 vs 0.18; p = 0.01); the absolute value of VI was higher in pathological subjects, although the difference was not significant (VI-Q2, 0.041 vs 0.029; VI-Q3, 0.065 vs 0.058; VI-Q4, 0.054 vs 0.052). The percent variability in the Q2 quadrant (VI-Q2%) was significantly higher in pathological subjects compared to normal subjects (0.22 vs 0.16) (p = 0.01). The results of this study confirm that our new software for analysis of EGG signal can distinguish normal voice from pathological voice based on the new quantitative parameter VI. Moreover, this study emphasises that the final contact phase of vocal folds is the most representative of the difference between the normal and pathological voice and shows a wider variability in terms of amplitude and vibration velocity. Further studies on larger groups of subjects will be required to confirm these results and assess differences in the EGG signal among the various vocal fold pathologies.

This cross-sectional investigation examined the prevalence and severity of dysphonia, globus pharyngeus, and dysphagia in patients affected by immunomediated (IM) diseases. Seventy subjects were administered the Voice Handicap Index (VHI) (scale 0–4), Glasgow-Edinburgh Throat Scale (GETS) (scale from 0 to 7) for globus pharyngeus assessment, and modified Swallowing Outcomes After Revised Laryngectomy (SOAL) (scale 0, 1, 2) to test swallowing symptoms. VHI: the mean percentage of answers with a score greater than 1 (corresponding to a frequency of situation’s occurrence “sometimes,” “almost always,” or “always”) was 25.7, 26.7, and 44.1% for functional, emotional, and physical groups of sub-items respectively. GETS: the mean percentage of answers with a score ≥ 3 was 60.85%, significantly higher if compared with that of answers with a score

Il trattamento con dispositivi di avanzamento mandibolare (MAD) rappresenta un’efficace alternativa terapeutica per i pazienti affetti da roncopatia semplice, OSAS di grado lieve/moderato e in casi selezionati di OSAS grave con scarsa tollerabilità alla terapia ventilatoria con C-PAP. Pertanto è importante identificare dei criteri oggettivi per selezionare i pazienti che possono beneficiare del trattamento con i sistemi di avanzamento mandibolare (MAD). In letteratura sono stati descritti vari fattori predittivi sia antropometrici che polisonnografici, mentre esistono ancora controversie circa il ruolo della Sleep Endoscopy e della manovra di avanzamento mandibolare bimanuale durante lo stesso esame come fattori predittivi del successo terapeutico con MAD. In questo studio descriviamo la nostra esperienza nel management di pazienti affetti da OSAS lieve/moderata trattati con MAD e selezionati mediante “sleep endoscopy”. Abbiamo eseguito una valutazione prospettica longitudinale di una serie consecutiva di pazienti giunti alla nostra osservazione con diagnosi di OSAS lieve/moderata e sottoposti a sleependoscopy. Durante il sonno indotto farmacologicamente è stata eseguita una delicata manovra di avanzamento mandibolare con escursione inferiore ai 5 mm e abbiamo riscontrato che in 30 dei 65 pazienti (46,2%) lo spazio respiratorio non migliorava in modo significativo a livello dei siti di ostruzione osservati, mentre in 35 dei 65 pazienti (53,8%) si osservava un miglioramento significativo tale da poter indicare terapia con MAD. In 7 dei 35 pazienti venivano riscontrate condizioni che ostacolavano l’applicazione del MAD per cui 28 dei 35 pazienti sono stati sottoposti a terapia con MAD. Dopo 3 mesi di trattamento abbiamo documentato un miglioramento significativo dell’indice di Epworth medio [(7,35 ± 2,8 vs 4,1 ± 2,2 (p < 0.05)], dell’AHI medio [(21.4 ± 6 eventi per ora verso 8,85 ± 6,9 (p < 0.05) ] e dell’ODI medio [(18.6 ± 8 eventi per ora versus 7 ± 5.8 (p < 0.05)]. Abbiamo inoltre osservato che l’AHI migliorava di almeno il 50% rispetto al basale nel 71.4% dei pazienti selezionati mediante sleep endoscopy. In questo studio, la terapia con i dispositivi di avanzamento mandibolare è stata prescritta con successo sulla base non soltanto dell’indice di apnea/ipopnea, ma anche dei reperti della sleep endoscopy e della manovra di avanzamento mandibolare, ottenendo una visione diretta degli effetti della protrusione mandibolare sullo spazio respiratorio in corrispondenza dei siti di ostruzione, e ottenendo una buona ottimizzazione della selezione dei pazienti per il trattamento con MAD.

To evaluate the presence of symptoms of inattention and hyperactivity/impulsivity in a population of school age children affected by vocal fold nodules.Parents and teachers of 18 children with vocal fold nodules (10 males, eight females; aged between 6 and 12 years) and 20 matched controls without dysphonia and/or vocal fold diseases (11 males, nine females; aged between 6 and 12 years) completed Attention-Deficit/Hyperactivity Disorder (ADHD) rating scale for parents (SDAG [Scala per i Disturbi di Attenzione/Iperattività per Genitori]) and teachers (SDAI [Scala per i Disturbi di Attenzione/Iperattività per Insegnanti) rating scales containing in two subscales items that specifically evaluate the symptoms of ADHD according to the DSM-IV. All children were subjected to videolaryngoscopy.The group with vocal fold nodules scored significantly higher than the controls; the difference between the two groups was statistically significant for both the subscales of both questionnaires (SDAG and SDAI) (P 0.05). Four children in the group with vocal fold nodules who scored higher than 14 in at least one subscale were referred for psychiatric evaluation. For two of the children, both male, a diagnosis of combined ADHD was formulated.ADHD is a possible risk factor for the development of vocal fold nodules in childhood. SDAG and SDAI rating scales may supplement the diagnostic assessment of children with vocal fold nodules.

To report the results of functional outcome, dose trend and relationship between onabotulinumtoxinA (onabotA) dosage and the severity of disease or time between therapy sessions in patients affected by adductor spasmodic dysphonia (ADSD).Thirty-two patients underwent 193 EMG-guided intracordal injections of a starting dose of 2 MU of onabotA. At enrollment, each subject was administered the VHI. The response was evaluated using a subjective rating scale (0-100% of normal phonation).The quality of voice improved significantly after 1 month and stabilized by 3 months. The percentage of normal voice improved 33.34 ± 11.5% (min 26 - max 68). The functional gain was significantly worse in patients presenting with ADSD associated with dystonias in other body regions (31% vs 45% - p 0.05). The mean dose employed was 3.64 MU (min 1 - max 6) with a trend of increasing dosages up to the 5th treatment after which the doses stabilized over time. The pre-treatment VHI showed a weakly positive correlation with the cumulative dose at the 5th and 10th injections. Benefit duration and the mean between treatment interval were 103 and 136 days respectively. The correlation between dose and inter-injection time is weakly negative (r = -0.22, p 0.05), however, this is influenced predominantly by the first-to-second injection. After this initial treatment effect, the correlation becomes weakly positive (r = 0.12).Our data confirm the efficacy of onabotA to improve the quality of voice in cases of ADSD. The trial period for optimal dosage lasted up to a mean of five injections. The dosage of onabotA impacted the length of response and was influenced by the severity of ADSD. Finally the efficacy of onabotA did not change significantly after repeated administrations.

Nowadays, drug-induced sleep endoscopy (DISE) is performed widely and its validity and reliability has been demonstrated by several studies; in fact, it provides clinical information not available by routine clinical inspection alone. Its safety and utility are promising, but still needs to be improved to reach the level of excellence expected of gold standard tests used in clinical practice. Our study compares the results of clinical and diagnostic evaluation with those of sleep endoscopy, evaluating the correlation between clinical indexes of routine clinical diagnosis and sites of obstruction in terms of number of sites involved, entity of obstruction and pattern of closure. This study consists in a longitudinal prospective evaluation of 138 patients who successfully underwent sleep endoscopy at our institution. Patients were induced to sleep with a low dose of midazolam followed by titration with propofol. Sedation level was monitored using bispectral index monitoring. Our results suggest that the multilevel complete collapse was statistically significantly associated with higher apnoea hypopnea index values. By including partial sites of obstruction greater than 50%, our results also suggest that multilevel collapse remains statistically and significantly associated with higher apnoea hypopnoea index values. Analyzing BMI distribution based on number of sites with complete and partial obstruction there was no significant difference. Finally, analyzing Epworth Sleepiness Score distribution based on number of sites with complete obstruction, there was a statistically significant difference between patients with 3-4 sites of obstruction compared to those with two sites or uni-level obstruction. In conclusion, our data suggest that DISE is safe, easy to perform, valid and reliable, as previously reported. Furthermore, we found a good correlation between DISE findings and clinical characteristics such as AHI and EPS. Consequently, adequate assessment by DISE of all sites of obstruction is very important, not only in patients with low-moderate AHI and EPS, but also in patients with a high AHI or/and high EPS, in particular to plan multilevel surgery that in these latter situations is more demanding since success may be harder to achieve.Attualmente, la sleep endoscopy indotta per via farmacologica (DISE) è ampiamente eseguita e la validità ed affidabilità di tale metodica sono state dimostrate in numerosi studi. La sua sicurezza e utilità sono promettenti, tuttavia, tale esame necessita di essere migliorato per raggiungere il livello di eccellenza tipico di un test gold standard utilizzato nella pratica clinica. Obiettivo del nostro studio è stato paragonare i risultati della valutazione clinica e diagnostica tradizionale con quelli della sleep endoscopy, mettendo a confronto i parametri clinici con i siti di ostruzione, ed in particolare prendendo in considerazione il numero di siti implicati, il livello di ostruzione e il pattern di chiusura. In questo studio abbiamo effettuato una valutazione prospettica longitudinale di 138 pazienti che sono stati sottoposti a sleep endoscopy con induzione farmacologica del sonno presso la nostra clinica. Ai pazienti è stato indotto il sonno mediante un basso dosaggio di propofol seguito da una somministrazione di boli progressivi. La profondità della sedazione è stata monitorata mediante il monitoraggio BIS. Sulla base dei risultati ottenuti è stato possibile stabilire che l'ostruzione completa multilivello si associa in modo statisticamente significativo ad un indice più elevato di apnea/ipopnea (AHI). Includendo nell'analisi anche i siti di ostruzione parziale con chiusuradel 50% abbiamo potuto dimostrare che l'associazione fra il collasso multilivello ed un valore di indice apnea/ipopnea più elevato rimane statisticamente significativa. Per quanto riguarda il BMI invece non sono state riscontrate correlazioni significative con il numero di siti di ostruzione completi o parziali. Infine, analizzando la scala della sonnolenza di Epworth e correlandola con il numero di siti con ostruzione completa abbiamo trovato una differenza statisticamente significativa tra i paziente con 3-4 siti di ostruzione rispetto ai pazienti con 2 o 1 livello di ostruzione. In conclusione, i nostri dati suggeriscono che la sleep endoscopy indotta per via farmacologica (DISE) costituisce una procedura sicura, di facile esecuzione, valida ed affidabile, come già descritto in altri studi. Inoltre abbiamo dimostrato una buona correlazione e coerenza tra i risultati della sleep endoscopy e gli indici di AHI e di Epworth. Concludendo riteniamo che un'adeguata valutazione dei siti di ostruzione mediante sleep endoscopy sia molto importante non solo nei pazienti con AHI ed indice di Epworth lieve/moderato, ma anche in quelli con AHI e/o indice di Epworth elevati, soprattutto nella pianificazione di una chirurgia multilivello che in questi casi è più impegnativa con un indice di successo più difficile da raggiungere.

Summary Objective To investigate the relationships between objective measures and the results of subjective assessment of voice quality and speech intelligibility in patients submitted to total laryngectomy and tracheoesophageal (TE) puncture. Study Design Retrospective. Materials Twenty patients implanted with voice prosthesis were studied. After surgery, the entire sample performed speech rehabilitation. The assessment protocol included maximum phonation time (MPT), number of syllables per deep breath, acoustic analysis of the sustained vowel / a / and of a bisyllabic word, perceptual evaluation (pleasantness and intelligibility%), and self-assessment. Results The correlation between pleasantness and intelligibility% was statistically significant. Both the latter were significantly correlated with the acoustic signal type, the number of formant peaks, and the F 2 −F 1 difference. The intelligibility% and number of formant peaks were significantly correlated with the MPT and number of syllables per deep breath. Moreover, significant correlations were found between the number of formant peaks and both intelligibility% and pleasantness. The higher the number of syllables per deep breath and the longer the MPT, significantly higher was the number of formant peaks and the intelligibility%. The study failed to show significant correlation between patient's self-assessment of voice quality and both pleasantness and communication effectiveness. Conclusion The multidimensional assessment seems to be a reliable tool to evaluate the TE functional outcome. Particularly, the results showed that both pleasantness and intelligibility of TE speech are correlated to the availability of expired air and the function of the vocal tract.

Objective: To analyze and compare the preoperative factors that potentially influence the outcome of stapedotomy in our study group. Materials and Methods: 161 cases were enrolled. Clinical variables considered to influence functional results – air conduction (AC) and bone conduction (BC) pure-tone average (PTA), air-bone gaps (ABG), sensorineural hearing loss (SNHL), ABG gain and ΔSNHL – were gender, age, case type (unilateral vs. bilateral), ear side (right vs. left), pregnancy, vascular disease and family history of otosclerosis. The audiometric variables were preoperative AC- and BC-PTA, SNHL and ABG. Results: Univariate logistic regression analysis showed that the probability of obtaining a ≥10 dB gain is significantly affected by the following factors: age 0.05). Nevertheless, multivariate logistic regression analysis maintained a statistically significant correlation only between gain ≥10 dB and both preoperative ABG ≥30 dB and age Conclusions: The accurate knowledge of predictive factors is a valuable tool that permits the surgeon to plan surgery with a better case selection as well as assisting in counseling the patient with regard to the likelihood of success of the procedure.

Voice and swallowing symptoms are frequently reported after thyroidectomy even in absence of objective voice alterations. We evaluated the influence of the video-assisted approach on voice and swallowing outcome of thyroidectomy. Sixty-five patients undergoing total thyroidectomy (TT) were recruited. Eligibility criteria were: nodule size ≤30 mm, thyroid volume ≤30 ml, no previous neck surgery. Exclusion criteria were: younger than aged 18 years and older than aged 75 years, vocal fold paralysis, history of voice, laryngeal or pulmonary diseases, malignancy other than papillary thyroid carcinoma. Patients were randomized for video-assisted (VAT) or conventional (CT) thyroidectomy. Videostrobolaryngoscopy (VSL), acoustic voice analysis (AVA), and maximum phonation time (MPT) evaluation were performed preoperatively and 3 months after TT. Subjective evaluation of voice (voice impairment score = VIS) and swallowing (swallowing impairment score = SIS) were obtained preoperatively, 1 week, 1 month, and 3 months after TT. Fifty-three patients completed the postoperative evaluation: 29 in the VAT group, and 24 in the CT group. No laryngeal nerves injury was shown at postoperative VSL. Mean postoperative MPT, F 0, F low, F high, and the number of semitones were significantly reduced in the CT group but not in the VAT group. Mean VIS 3 months after surgery was significantly higher than preoperatively in CT group but not in the VAT group. Mean SIS was significantly decreased 1 and 3 months after VAT but not after CT. The incidence and the severity of early voice and swallowing postthyroidectomy symptoms are significantly reduced in patients who undergo VAT compared with conventional surgery.

The aim of our study was to evaluate the functional results of stapes surgery and to compare the effectiveness of small fenestra stapedotomy with that of total stapedectomy in improving hearing in patients affected by otosclerosis.Three hundred and fifty-seven consecutive ears, in 265 patients affected by otosclerosis, underwent surgery. All cases underwent either primary small fenestra stapedotomy (group A, 196/357, 54.91 per cent) or stapedectomy (group B, 161/357, 45.09 per cent). After surgery, 256/357 (71.71 per cent) cases showed a 0–20 dB gap. There were no significant differences in hearing results between the two groups at either early or late post-operative assessment. The mean post-operative pure tone average and air–bone gap results were slightly greater for group B than for group A, at both early and late post-operative assessments, but these differences were not statistically significant. Therefore, in group A, the mean pure tone average at 4 kHz significantly improved, from 56.60 to 47.66 dB at early post-operative assessment and to 52.98 dB at late post-operative assessment.Our study suggests that the technique of microtomy of the oval window is able to improve hearing results especially at high frequencies.

Summary Objective This study was designed to compare clinical features, surgical findings and treatment results from children and adults affected by aural acquired cholesteatoma. Methods a retrospective review of 60 children (Group I: mean age 8.8 years, range 3–16 years) and 308 adults (Group II: mean age 45.4 years, range 18–81 years) with aural acquired cholesteatoma who underwent surgery from January 1992 to December 2002, was performed with a follow-up of 5 years. All patients were submitted to single-staged canal wall down tympanoplasty. Variables analysed were otoscopic features, extent of cholesteatoma, surgical findings and the rate of recidivism. Results The pathologic changes in the tympanic membrane were no different in the two groups. According to Stangerup et al. 40 cases (66.6%) of children were classified as stage III or more, with a significant higher incidence compared to adults (152 cases; 49.3%). Analysis of the ossicular chain state showed, in group I, a significant higher incidence of eroded or absent incus (76.6% versus 61.68%) and malleus (76.6% versus 56.48%), if compared to adults. Children, therefore, had a significantly higher risk of recurrence with a rate of 26.6% in Group I and 6.81% in group II. After surgery the mean gain measured in children group, was 11 dB and 13 dB in adults. Conclusion In our study we found that the behaviour of cholesteatoma in children appears more aggressive than in adults. In fact, we found a greater extension of the cholesteatoma, a worse state of the ossicular chain and a higher incidence of recurrence. Therefore, we obtained acceptable hearing results both in children and in adults.

Voice and swallowing symptoms following thyroidectomy in the absence of any demonstration of laryngeal nerves injury are usually considered a functional outcome of uncomplicated operations, mainly related to scar formation and emotional reaction. They could be related to unapparent laryngeal nerve or cricothyroid (CT) muscle injuries detectable only by laryngeal electromyography (LEMG). We correlated such symptoms with LEMG patterns. A total of 33 consenting patients undergoing total thyroidectomy (TT) were enrolled. Video-strobolaryngoscopy (VSL), acoustic voice analysis (AVA), and maximum phonation time (MPT) were performed preoperatively and 3 months postoperatively. Subjective evaluation of voice (Voice Impairment Score, or VIS) and swallowing (Swallowing Impairment Score, or SIS) were obtained preoperatively and 1 and 3 months postoperatively. At 1 month postoperatively LEMG was performed examining thyroarytenoid (TA) and CT muscles to evaluate the inferior laryngeal nerve (ILN) and the external branch of the superior laryngeal nerve (EBSLN), respectively. One patient experienced transient vocal cord palsy and was excluded. The remaining 32 patients completed the postoperative evaluation. No significant difference was found between preoperative and postoperative AVA and MPT parameters. Mean VIS was significantly worse than preoperatively 1 and 3 months after TT. No significant difference was found between preoperative and postoperative SIS. LEMG evaluation of TA muscle showed decreased voluntary activity and spontaneous fibrillation potentials in one patient. LEMG of the CT muscle did not reveal any sign of EBSLN injury. Patients frequently complain of subjective symptoms early after TT. LEMG demonstrated the absence of subclinical laryngeal nerve injury in all but one patient, confirming their functional nature.

To assess and compare the functional results obtained by means of multiple-shot Erbium: yttrium-aluminum-garnet (Er:YAG) laser to those obtained using "one-shot" CO(2) laser stapedotomy in patients affected by otosclerosis. A retrospective case review was performed. Of the total number of 123 patients (114 ears) who underwent primary small-fenestra stapedotomy from January 2006 to September 2008, seven patients who received multiple-shot laser CO(2) stapedotomy were excluded from the study. The remaining 116 patients (104 ears) were sorted, and "one-shot" CO(2) laser stapedotomy (group A) was performed in 35/104 and Er:YAG laser stapedotomy (group B) in 69/104. After surgery, air conduction-pure tone average (AC-PTA) and air-bone gap (ABG) improved significantly in both groups, whereas sensorineural hearing loss (SNHL) and bone conduction (BC)-PTA did not change in both the groups. In group A, the postoperative ABG was significantly better (12.63 vs. 14.86 dB). Moreover, after "one-shot" stapedotomy, the AC-PTA significantly improved in all tested frequencies. On the contrary, in group B the AC-PTA improved significantly only in two frequencies (0.5 and 1 kHz). Consistent with previous reports, our findings confirm that laser stapedotomy is a safe and effective surgery, regardless of the technique. Based on our functional results, the "one-shot" CO(2) laser technique seems to be associated with a significantly better postoperative ABG if compared to Er:YAG laser stapedotomy.

Meningeal carcinomatosis (MC) is an uncommon form of metastasis of solid tumors. In the absence of clinical meningeal or parenchymal involvements, the sensorineural hearing loss (SNHL) as the starting symptom of MC is very infrequent. We report the history of two patients affected by MC who presented first with progressive SNHL. In both cases the early magnetic resonance imaging (MRI) finding mimicked bilateral masses in the cerebellopontine angle (CPA). Only the histopathologic result and surgical biopsy in cases 1 and 2, respectively, identified masses secondary to occult malignancy. However the available investigations could not discover the primary site of metastatic carcinoma. Despite the poor prognosis, because of the rarity and severity of MC we consider important to make known our experience in order to consider metastatic tumors in the differential diagnosis for sudden SNHL.

Background Voice and swallowing symptoms are frequently reported early after thyroidectomy even in the absence of laryngeal nerves injury. We evaluated the short-term and long-term outcomes of these functional alterations. Methods Consenting patients undergoing total thyroidectomy (TT) were enrolled. Videolaryngostroboscopy (VSL), acoustic voice analysis (AVA), and maximum phonation time (MPT) were performed pre-operatively, 3 months postoperatively, and >1 year postoperatively. Subjective evaluation of voice (Voice Impairment Score = VIS) and swallowing (Swallowing Impairment Score = SIS) were obtained pre-operatively, as well as 1 week, 1 month, 3 months, and >1 year postoperatively. Results The long-term evaluation was completed in 110 patients. The percentage of patients with symptoms 1 week after operation was significantly higher than preoperatively, whereas it was significantly lower at long-term evaluation. VIS was significantly worse than pre-operatively, 1 week, 1 month, and 3 months after surgery, but it was similar to pre-operative >1 year after TT. SIS was significantly worse 1 week after thyroidectomy but not 1 month and 3 months after thyroidectomy, and it was significantly lower than the pre-operative >1 year after TT. Conclusion Vocal and swallowing symptoms are frequent after TT. In the absence of laryngeal nerve injury, after an initial impairment, late after operation, patients experienced subjective amelioration of their voice and swallowing performances, which may be related to the resolution of compressive symptoms.

Pharyngocutaneous fistula is the most common non-fatal complication following total laryngectomy. To start oral feeding and exclude the presence of a pharyngocutaneous fistula, a subjective test and instrumental assessments using videofluoroscopy, have been described. The aim of this study was to evaluate the effectiveness of oral-pharyngo-oesophageal scintigraphy as an objective and non-invasive tool to establish presence, site and dimensions of the fistula. Observations were performed on 3 male patients, mean age 65 years, who underwent total laryngectomy and mono or bilateral neck dissection after failure of radiotherapy in 2 cases and of conservative laryngeal surgery in the third case, complicated by post-operative pharyngocutaneous fistula. Oral-pharyngo-oesophageal scintigraphy dynamic study with sequential images were obtained during the swallowing phases. In case 1, the test showed a wide pharyngocutaneous fistula the internal orifice of which was at the level of the base of the tongue: on the scintigraphic images, the radiomarked water bolus, from the fistulous orifice, descended along the stoma walls and only a small part reached the oesophagus. In the other two patients, the pharyngocutaneous fistula was small and the internal fistulous orifice was detected in the lower part of T-suture line. In conclusion, scintigraphy offered the possibility to precisely identify presence of pharyngocutaneous fistula and location of its internal orifice and to monitor its spontaneous closure. Therefore, important information could be obtained regarding the suture line status and the possibility of deciding whether to remove the nasogastric tube or to leave it in place. Finally, these data showed that oral-pharyngo-oesophageal scintigraphy could be performed in the early post-operative period to optimize starting safe oral feeding.

Objective:To evaluate the functional results obtained after voice therapy in patients with unilateral vocal fold paralysis caused by different aetiologies.Design:Prospective analysis of the outcome of unilateral vocal fold paralysis cases treated at our speech and language rehabilitation service from November 2003 to January 2006. Thirty cases underwent behavioural treatment, between two and six weeks after unilateral vocal fold paralysis onset. A multi-dimensional assessment was carried out before, immediately after and six months after treatment.Results:After behavioural therapy, the prevalence of complete glottal closure increased significantly (p p vs 0.04). At both post-treatment assessments, voice range profile analysis showed a significant decrease of lowest voice frequency and a significant increase of the number of semitones (p p Conclusions:Early voice therapy may enable significant improvement in vocal function, allowing the patient to avoid surgery.

Giant cell reparative granuloma accounts for 1%-7% of all benign lesions of the jaw. Giant cell reparative granuloma often arises in the mandible and in the maxilla and affects children and young adults. It is usually a slow-growing lesion, fast-growing lesions having rarely been reported. The latter, despite the innocent histological appearance, has an aggressive behaviour mimicking a malignant lesion. In the present report the clinical features of an aggressive variety of giant cell reparative granuloma in a 21-year-old female are described focusing on the dental findings at computed tomography and surgical treatment.

The aim of this study was to evaluate the hearing results of ossiculoplasty in canal wall downtympanoplasty in one stage middle-ear cholesteatoma surgery.We carried out a retrospective review of a consecutive series of 142 cases which had undergone type twoor three canal wall down tympanoplasty with ossicular reconstruction, between January 1995 andDecember 2002, due to chronic otitis media with cholesteatoma.Pre-operative audiometric testing revealed a mean air conduction pure tone average (PTA) of 50.97 dBand a mean bone conduction PTA of 22.14 dB. The mean post-operative result for air conduction PTAwas37.62 and for bone conduction PTA was 23.37 dB. The mean pre- and post-operative air–bone gaps(ABGs) were 28.83 and 13.94 dB, respectively, with a gain of 14.89 dB. Almost 62.67 per cent ofpatients closed their ABGs to within 20 dB.Our functional results are comparable with those of other authors. In the present study, we show thathearing improvement is possible following cholesteatoma surgery with canal wall down tympanoplastyand ossicular chain reconstruction.Key words: Mastoid; Tympanoplasty; Otologic Surgical Procedures; Cholesteatoma; Hearing

Background. We performed a prospective analysis on voice and swallowing alterations following total thyroidectomy (TT), in the absence of recurrent nerve injury. Methods. Patients aged 21 to 65 years undergoing TT, in the absence of laryngeal/pulmonary disease, previous neck surgery, or malignant diseases, were subjected to videostrobolaryngoscopy (VSL), acoustic voice analysis (AVA), and maximum phonation time (MPT) tests preoperatively and 3 months postoperatively. Voice impairment scores (VIS) and swallowing impairment scores (SIS) were obtained preoperatively, and at 1 week, 1 month, and 3 months postoperatively. Results. Among the 127 selected patients, 39 completed the postoperative evaluation. No recurrent nerve injury was observed during the postoperative VSL in any of the patients. Preoperative and postoperative AVA and MPT scores did not differ significantly. The mean postoperative VIS was significantly higher than the preoperative VIS at 1 week and 1 month after TT (13.7 and 9.6 vs 4.4, respectively; P .05) but not 3 months after TT (6.7). The mean SIS was higher than the preoperative SIS at 1 week, 1 month, and 3 months after TT (10.3, 6.0, and 2.8 vs 0.5, respectively; P .05). Conclusions. Physicians should inform patients that transient voice and swallowing symptoms may occur following total thyroidectomy, and our data suggest mild symptoms may occur in the majority of operated patients. (Surgery 2006;140:1026-34.)

Objective To assess clinical safety and efficacy of the erbium: yttrium-aluminum-garnet (Er:YAG) laser in the stapes surgery; to define and optimize parameters that render the procedure safe for the inner ear. Study design Retrospective study. Material and methods A microscope-integrated Er:YAG laser stapedotomy was performed on 29 patients and a conventional stapedotomy on 41 patients. An early (within 1 to 3 days after stapes surgery) and late (at least 6 weeks) pure-tone bone-conduction threshold audiogram was obtained. Results No statistically significant differences were found by Student’s t test over all measured frequencies between pre- and postoperative bone-conduction thresholds in each group. There was no statistically significant difference for all frequencies between early (3 days) and late postoperative mean bone-conduction thresholds. Conclusions The results of our preliminary clinical study showed that erbium laser poses no risk to inner ear function. However, the lack of standardization obliges further investigation to establish safe clinical parameters of the Er:YAG laser. EBM rating B-3

Poor pitch resolution has been shown to have negative implications for speech and music perception in implanted patients. Surprisingly, works on the subject have not focused much on the impact that the non-correspondence between frequencies allocated to electrodes and perceived frequencies could have on speech and music perception. The aim of the present study is to investigate the correlation between pitch mismatch and speech performance with the implant, and to ascertain the effects of mismatch correction through a mapping function making a personalized frequency reallocation possible. We studied ten postlingually deaf adult patients with detectable bilateral residual hearing, implanted in our Clinic with Cochlear® Nucleus devices. In each test session, we asked the patients to find the best match between the pitch elicited by the residual ipsilateral and contralateral pure tones and the pitch elicited by stimulation of electrodes. We also assessed patients’ vowel and consonant recognition performance. Finally, in the only implanted patient in our clinic who had bilateral residual hearing and used a Digisonic DX10/C® device, which makes manual electrode-by-electrode frequency reallocation possible, we modified electrode-assigned frequency ranges on the basis of the pitch matching test results. We found that in none of the studied patients, the electric-to-acoustic pitch matching corresponds to the theoretical assignment pattern. A very strong correlation was detected between the electric-to-acoustic pitch mismatch and patient’s speech performance. In the Digisonic® patient, a remarkable improvement in all phoneme recognition scores was obtained 1 month after frequency reallocation. In the light of our results, we propose to assess, whenever possible, any frequency-to-electrode mismatch in all implanted patients, and correct it through mapping programs allowing manual frequency reallocation for the pitch-matched electrodes, and automated allocation of the non-tested electrodes. Cochlear implantation should therefore be proposed when residuals for all frequencies are still present, at least in one ear, so as to allow optimal alignment between allocated and subjectively perceived frequencies.