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Purpose: There are many specific instruments for assessing the quality of life (QoL) in patients with chronic rhinosinusitis. Of all these tests, the Sino-Nasal Outcome Test-22 (SNOT-22) is the most widely used internationally. The purpose of the study was linguistic adaptation and validation of the SNOT-22 scale in the Polish language., Methods: The SNOT-22 was adapted into Polish and was administered to 148 subjects (108 patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and 40 asymptomatic controls. Seventy-one patients completed the SNOT-22 a second time to evaluate test-retest reliability. The Polish SNOT-22 was assessed for internal consistency, test-retest reliability, discriminant validity, criterion validity, and sensitivity and specificity., Results: The Polish SNOT-22 exhibited satisfactory psychometric properties. A high Cronbach's alpha coefficient (α = 0.89) was obtained. Significantly higher scores (p < 0.01) were revealed in the Study Group with a median score of 32 (range 15-53) points in comparison with controls: 5 (range 0-20). A moderate correlation was found between SNOT-22 and the Lund-Kennedy test score (r = 0.334; p < 0.001) and a strong correlation between SNOT-22 and the Lund-Macay test score (r = 0.469; p < 0.001). The best cut-off point was set at a 16 score with a sensitivity of 0.981 and a specificity of 0.995. The determined Area Under Curve (AUC = 0.997; p < 0.001) confirms the diagnostic accuracy of the Polish SNOT-22., Conclusions: The Polish version of the SNOT-22 is a valid and reliable tool for measuring health-related quality of life in patients with CRSwNP in the Polish-speaking population., (© 2024. The Author(s).)

Background: The domination of the Contemporary Commercial Music (CCM) industry in music markets has led to a significant increase in the number of CCM performers. Performing in a wide variety of singing styles involves exposing CCM singers to specific risk factors potentially leading to voice problems. This, in turn, necessitates the consideration of this particular group of voice users in the Occupational Health framework. The aim of the present research was threefold. First, it sought to profile the group of Polish CCM singers. Second, it was designed to explore the prevalence of self-reported voice problems and voice quality in this population, in both speech and singing. Third, it aimed to explore the relationships between voice problems and lifetime singing involvement, occupational voice use, smoking, alcohol consumption, vocal training, and microphone use, as potential voice risk factors., Materials and Methods: The study was conducted in Poland from January 2020 to April 2023. An online survey included socio-demographic information, singing involvement characteristics, and singers' voice self-assessment. The prevalence of voice problems was assessed by the Polish versions of the Vocal Tract Discomfort Scale (VTDS) and the Singing Voice Handicap Index (SVHI). Also, a self-reported dysphonia symptoms protocol was applied. The perceived overall voice quality was assessed by a Visual Analogue Scale (VAS) of 100 mm., Results: 412 singers, 310 women and 102 men, completed the survey. Nearly half of the studied population declared lifetime singing experience over 10 years with an average daily singing time of 1 or 2 h. 283 participants received vocal training. For 11.4% of respondents, singing was the primary income source, and 42% defined their career goals as voice-related. The median scores of the VTDS were 11.00 (0-44) and 12.00 (0-40) for the Frequency and Severity subscales, respectively. The median SVHI score of 33 (0-139) was significantly higher than the normative values determined in a systematic review and meta-analysis (2018). Strong positive correlations were observed between SVHI and both VTD subscales: Frequency ( r = 0.632, p  < 0.001) and Severity ( r  = 0.611, p < 0.001). The relationships between most of the other variables studied were weak or negligible., Conclusion: The examined CCM singers exhibited substantial diversity with regard to musical genre preferences, aspirations pertaining to singing endeavors, career affiliations, and source of income. Singing voice assessment revealed a greater degree of voice problems in the examined cohort than so far reported in the literature, based on the SVH and VTDS., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Morawska, Pietruszewska, Politański and Niebudek-Bogusz.)

Background: To date, there are no studies that have analyzed the possible influence of exposure to prenatal sex hormones on the risk of laryngeal cancer (LC) and premalignant laryngeal lesion-vocal fold leukoplakia (VFL). Digit ratio (2D:4D) is suggested to be a proxy of prenatal sex hormone exposure., Objective: To examine 2D:4D in patients with LC and clarify if it could add to the verified risk factors in estimating the overall risk of LC., Methods: 511 subjects participated in the study. The study group included 269 patients: with LC (N = 114, 64 men) and VFL (N = 155, 116 men). Controls included 242 healthy individuals (66.40 ± 4.50 years (106 men))., Results: Predictive models estimating the risk of VFL and LC in women, based solely on predictors like smoking and alcohol consumption had a lower area under the ROC curve (AUC) than the model with left 2D:4D. AUC for the model estimating the likelihood of VFL increased from 0.83 to 0.85, and for LC from 0.76 to 0.79., Conclusions: Low left 2D:4D may be associated with an increased risk of developing leukoplakia and laryngeal cancer in women. In the case of laryngeal cancer, left 2D:4D may serve as additional variable (to other known risk factors, such as smoking and/or alcohol consumption), which can improve cancer risk prediction., (© 2023. The Author(s).)

Objective: The purpose of the present study was the cross-cultural and linguistic adaptation and validation of the Vocal Fatigue Index (VFI) in the Polish language., Methods: The Vocal Fatigue Index was adapted into Polish and was administered to 323 subjects (216 with voice disorders, and 107 without voice disorders). One hundred and four participants with voice disorders completed the VFI a second time to evaluate test-retest reliability. VFI was assessed for internal consistency, test-retest reliability, discriminant validity, criterion validity, and sensitivity and specificity., Results: The Polish VFI exhibited satisfactory psychometric properties. A high Cronbach's alpha coefficient for the three factors (α=0.971 for Factor 1, α=0.929 for Factor 2, α=0.930 for Factor 3) was obtained. Significantly higher scores were revealed in subjects with voice disorders (48.88±11.73 [mean±SD]) in comparison with vocally healthy subjects (12.25±6.75 [mean±SD]) in the total VFI score as well as in the three factors (all P-values < 0.01). The best cut-off for VFI Total Score was set at a 32.5 score with sensitivity of 0.931 and specificity of 0.991., Conclusions: The translated version of the VFI is a valid and reliable tool for identifying vocal fatigue symptoms in the Polish-speaking population., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Vocal fold leukoplakia (VFL), despite our knowledge of its etiopathogenetic factors, and the development of laryngeal visualization, remains a diagnostic and therapeutic challenge. Objective: This research aimed to explore the efficacy of clinical and morphological feature identification in videolaryngoendoscopy (VLE) using a three-tier classification, and videolaryngostroboscopy (VLS) in predicting the risk of VFL malignant transformation. Material and Methods: We examined 98 patients with VFL by flexible endoscopy under VLE and VLS. Morphological characteristics of 123 lesions including the surface, margin, and texture were assessed; then, VFL was subdivided into three types: I—flat and smooth, II—elevated and smooth, and III—rough. Based on the histopathological findings, 76 (61.79%) lesions were classified as low- and 47 (38.21%) lesions as high-grade dysplasia. Results: The inter-rater agreement between two raters evaluating the VFL in VLE was almost perfect (Cohen’s kappa = 0.826; p < 0.00; 95%CI 0.748−0.904). In ROC curve analysis, the AUC difference between Rater I and Rater II was 0.024 (0.726 vs. 0.702). In multivariate analysis, high-risk VFL was positively related to unilateral plaque localization (p = 0.003), the type III VLE classification (p = 0.013), absence of a mucosal wave (p = 0.034), and a positive history of alcohol consumption (p = 0.047). In ROC analysis, VLE had an AUC of 0.726, with a high sensitivity of 95.7% and low specificity of 40.8%. The NPV was high, at 93.9%; however, the PPV was low, at 50%. The proposed logistic regression model including features significant in multivariate analysis showed lower sensitivity (80.9% vs. 95.7%) and lower NPV (86.2% vs. 93.9%); however, the specificity and PPV were improved (73.7% vs. 40.8% and 65.5% vs. 50.0%, respectively). Conclusions: The combination of clinical history with endoscopic (plaque morphology) and stroboscopic examination (mucosal wave assessment) can fairly estimate the degree of dysplasia in VFL and thus is recommended for use in clinical settings. The findings of this study can be used to guide the decision regarding immediate biopsy or watchful waiting.

This is the first study assessing the clinical management of severe, isolated dysphonia during post-COVID-19 syndrome. One hundred and fifty-eight subjects met the inclusion criteria for the post-COVID-19 condition as specified by the WHO. Six patients were diagnosed with isolated severe dysphonia, constituting 3.8% of the initial group. The pre- and post-examination protocol consisted of subjective voice self-assessment and routine laryngological examination, followed by an instrumental examination by means of Laryngovideostroboscopy (LVS) and High-Speed Videolaryngoscopy (HSV). The treatment included short-term systemic steroids in decreasing doses, moisturizing inhalations with hyaluronic acid, and protective agents against Laryngopharyngeal Reflux. The kinematic imaging of the glottis performed by means of HSV before treatment showed deviations in the regularity and symmetry of vocal fold vibrations, absence of mucosal wave, and incomplete glottal closure. Improvement of the structural and functional state of the larynx was observed post-treatment. Kymographic sections and Glottal Width Waveform (GWW) graphs obtained from post-treatment HSV recordings showed improvement in vocal fold vibrations. The decrease in mean Jitter and Shimmer was observed, with the following mean values of 3.16 pre-treatment and 2.97 post-treatment for Jitter and 7.16 pre-treatment and 2.77 post-treatment for Shimmer. The post-treatment self-evaluation of voice showed considerable improvement in vocal function and voice quality in all the examined patients. Severe dysphonia in patients with post-COVID-19 syndrome requires urgent ENT diagnosis using instrumental assessment with the evaluation of laryngeal phonatory function and intensive comprehensive treatment.

Singers, classified as "vocal performers" are at an increased risk of developing voice disorders. The area of contemporary commercial singing has not been studied as extensively as classical singing. Non-classical singing is generally considered detrimental to vocal health and thus the information on challenges contemporary commercial singers (CCS) pose to otolaryngologists and other healthcare professionals is scarce. The authors present an overview of contemporary commercial singing styles in comparison to classical singing, discuss the notion of non-classical style being harmful to vocal health, present major risk factors associated with developing voice disorders in contemporary commercial singers, and outline the diagnostic process of vocal health assessment in this group of occupational voice users. Given that contemporary commercial singers constitute a unique and vast group of elite vocal performers, the authors stress the importance of raising awareness among healthcare professionals of the fact that these patients require special considerations for voice evaluation and treatment in the occupational health and safety framework. Med Pr. 2022;73(1):33-41., (This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.)

Introduction: Discerning the preoperative nature of vocal fold leukoplakia (VFL) with a substantial degree of certainty is fundamental, seeing that the histological diagnosis of VFL includes a wide spectrum of pathology and there is no consensus on an appropriate treatment strategy or frequency of surveillance. The goal of our study was to establish a clear schedule of the diagnostics and decision-making in which the timing and necessity of surgical intervention are crucial to not miss this cancer hidden underneath the white plaque., Material and Methods: We define a schedule as a combination of procedures (white light and Narrow Band Imaging diagnostic tools), methods of evaluating the results (a combination of multiple image classifications in white light and Narrow Band Imaging), and taking into account patient-related risk factors, precise lesion location, and morphology. A total number of 259 patients with 296 vocal folds affected by leukoplakia were enrolled in the study. All patients were assessed for three classifications, in detail according to Ni 2019 and ELS 2015 for Narrow Band Imaging and according to Chen 2019 for white light. In 41 of the 296 folds (13.9%), the VFL specimens in the final histology revealed invasive cancer. We compared the results from the classifications to the final histology results., Results: The results showed that the classifications and evaluations of the involvement of anterior commissure improve the clinical utility of these classifications and showed improved diagnostic performance. The AUC of this model was the highest (0.973) with the highest sensitivity, specificity, PPV, and NPV (90.2%, 89%, 56.9%, and 98.3%, respectively)., Conclusion: The schedule that combines white light and Narrow Band Imaging, with a combination of the two classifications, improves the specificity and predictive value, especially of anterior commissure involvement., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Klimza, Pietruszewska, Rosiak, Morawska, Nogal and Wierzbicka.)

High-Speed Videoendoscopy (HSV) is becoming a robust tool for the assessment of vocal fold vibration in laboratory investigation and clinical practice. We describe the first successful application of flexible High Speed Videoendoscopy with innovative laser light source conducted in clinical settings. The acquired image and simultaneously recorded audio data are compared to the results obtained by means of a rigid endoscope. We demonstrated that the HSV recordings with fiber-optic laryngoscope have enabled obtaining consistently bright, color images suitable for parametrization of vocal fold oscillation similarly as in the case of the HSV data obtained from a rigid laryngoscope. The comparison of period and amplitude perturbation parameters calculated on the basis of image and audio data acquired from flexible and rigid HSV recording objectively confirm that flexible High-Speed Videoendoscopy is a more suitable method for examination of natural phonation. The HSV-based measures generated from this kymographic analysis are arguably a superior representation of the vocal fold vibrations than the acoustic analysis because their quantification is independent of the vocal tract influences. This experimental study has several implications for further research in the field of HSV application in clinical assessment of glottal pathologies nature and its effect on vocal folds vibrations., (© 2021. The Author(s).)

&lt;br&gt;&lt;b&gt;Introduction:&lt;/b&gt; Advances in computer image analysis have enabled the use of new functional imaging methods in the diagnosis of laryngeal diseases. Particularly interesting techniques of dynamic laryngeal imaging involve High Speed Videoendoscopy (HSV). This still-developed technique allows to overcome the limitations of laryngovideostroboscopy (LVS) and a more detailed analysis of the glottal function based on the image of the actual vibrations of the vocal folds. It also enables the determination of objective coefficients parameterizing phonatory vibrations of the vocal folds.&lt;/br&gt; &lt;br&gt;&lt;b&gt;Aim:&lt;/b&gt; The aim of this pilot study was to evaluate the use of a high-speed videoendoscopy set with laser illumination for the diagnosis of glottic pathology in ENT practice.&lt;/br&gt; &lt;br&gt;&lt;b&gt;Material and methods:&lt;/b&gt; The study included 40 patients who underwent LVS followed by HSV. The modern HSV examination kit - Advanced Larynx Imager System (ALIS), used for the first time in a clinical setting in Poland, is characterized by significantly improved, compared to the previously used high-speed cameras, operational parameters - a light head, the possibility of continuous lighting operation without excessive heating of the head tip, registration of the image in full color scale. Thanks to such modernization, the safety and course of the examination do not differ from laryngoscopy conducted with commonly used recorders. The device owes some of these improvements to a laser illuminator which was used for the first time as the main light source in a high-speed camera. In the study, two cases were selected to present the results of HSV and the analysis of the generated kymograms - a woman with no glottic pathology and a man with a polyp of the right vocal fold. In the first case, the HSV examination compared with the LVS revealed a discrete glottis functional disorder in the form of a tendency to hyperphonation. The patient with an organic lesion had a clearly visible irregularity of vocal fold vibrations, which also allowed to trace mucosal wave disturbances related to its reflection from the pathological structure of the glottis and the formation of a return wave, both on the fold affected by the lesion and, to a lesser extent, contralaterally. The glottic dysfunctions observed in the studied patients were confirmed in the generated kymograms and the graphs of the glottal width waveform (GWW), as well as in the parameters calculated on their basis, assessing the frequency and amplitude of phonatory vibrations.&lt;/br&gt; &lt;br&gt;&lt;b&gt;Conclusions:&lt;/b&gt; The use of high-speed videoendoscopy allows for a much more accurate assessment of the phonatory function of the glottis than in laryngovideostroboscopy. The presented HSV system allows for obtaining high quality kinematic images of the larynx, color fidelity, and contrast. The use of this technology in laryngological practice enables precise structural and functional assessment of the glottis and detection of discrete phonation disorders that elude the techniques used so far.&lt;/br&gt.

The management of Vocal Fold Leukoplakia (VFL) remains problematic. There is no consensus on the indications or the timing for surgery. The objective was to select the most accurate classification for predicting low- and high-risk VFL in White Light Imaging (WLI) and Narrow Band Imaging (NBI) and to establish a diagnostic algorithm with a timely referral for treatment. A total of 259 VFL patients were included in the study; 186 lesions were classified as low-grade and 110 as high-grade dysplasia. The results of WLI acc. to the two-tier and the three-tier Chen 2019 classifications and NBI classifications: ELS, Ni 2011, and Ni 2019 with different cut-off points were compared with the pathological examination (HP). In WLI, the greatest agreement was obtained between type 3 of the three-tier classification and high-grade dysplasia (accuracy, specificity, and PPV: 80.4%, 92.0%, and 81.5%, respectively). Assessing VFL periphery in NBI, cut-off point 5 (Ni 2011 type V) demonstrated a higher accuracy, specificity, and PPV than 4 (83.1%, 93.6%, 85.5% and 77.4%, 74.9%, and 65.4%, respectively). In NBI, we observed higher accuracy, sensitivity, and PPV (84.1%, 93.0%, 85.2% vs. 80.7%, 81.3% and 71.3%, respectively) for cut-off point 5 (Ni 2019 type V and VI) in comparison to the cut-off point 4 group (type IV, V, and VI) (80.7%, 81.3%, 71.3%, respectively), and a higher kappa value (0.68 vs. 0.58) was obtained. We have shown that both the plaque image and the microvascular pattern on the leukoplakia periphery are critical in the diagnosis of high-risk VFL. The most accurate predictor of VFL malignant transformation in WLI is type 3 according to the Chen 2019 classification, while in NBI type V and VI according to the Ni 2019 classification.

Introduction: Speech and voice disorders are among the least well-described clinical manifestations of Multiple Sclerosis (MS) although their estimated prevalence reaches 40-50%. The aim of the present study was adaptation and validation of the Speech Pathology-Specific Questionnaire for Persons with Multiple Sclerosis (SMS) into the Polish language to be used as part of the diagnostic procedure to quantify important speech-related changes and to improve individual tailoring of therapeutic activities., Material and Methods: The study included a total number of 178 participants. The study group consisted of 107 patients diagnosed with Multiple Sclerosis, mean age 42.8±11.6 years and the Control Group were 71 healthy sex and age matched normophonic subjects, mean age 44.2±12.5 years with no neurological symptoms. Translated version of SMS was administered to all participants of the study. Voice Handicap Index (VHI) questionnaire was used for comparison purposes. Test-retest reproducibility, internal consistency, floor and ceiling effects, discriminant validity and construct validity of the Polish SMS were investigated. Preliminary assessment of diagnostic value of SMS was conducted on the basis of the results recorded in duration-related quartiles of the Study Group., Results: High value of Intraclass Correlation Coefficient (ICC= 0 .930) obtained for the test-retest indicates a good level of reproducibility of the Polish SMS. High Cronbach's alpha (α=0.94) proves the test's good internal consistency. There were no floor and ceiling effects for the SMS test score in the Study Group and they were negligible in the Control Group. A significant difference in mean SMS total scores between patients and controls (14.22 points vs. 6.06 points) shows discriminant validity of SMS. Similar differences were observed for all the subscales of the test (in t test: p<0.001). A statistically significant correlation was found for the SMS score and its all subscales, as well as between all the subscales of the test proving good construct validity of the test. Similarly, statistically significant correlations were observed for the total score of SMS and VHI (r=.817, p <0.001) as well as between the particular subscales of SMS test and the subscales of VHI. There was a statistically significant difference in the mean total score of SMS in the distinguished quartiles of the Study Group with the highest values (20 points) recorded in the group of patients suffering from MS for over 15 years., Conclusion: The psychometric properties of the Polish version of Speech Pathology-Specific Questionnaire indicate that it is a valid patient-reported outcome measure suitable for the assessment of speech-language pathology aspects on the population of Multiple Sclerosis patients and can be used as an complementary diagnostic tool in clinical practice., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Short and long-term results of microsurgical treatment with the mini-microflap technique in patients with Reinke's edema (RE) were assessed based on the phonatory and ventilatory functions of the larynx., Objectives: To assess the short and long-term results of microsurgical treatment with the mini-microflap technique in patients with RE based on the phonatory and ventilatory functions of the larynx., Material and Methods: Twenty patients diagnosed with advanced stage of RE confirmed with laryngovideostroboscopy (LVS) were enrolled in the study. Phonatory function disturbances were additionally assessed on the basis of Maximum Phonation Time (MPT) measurement, Voice Handicap Index (VHI) and Voice-Related Quality of Life (V-ROOL) questionnaires. Ventilatory function was assessed using spirometry. The aforementioned complex examinations were conducted prior to surgery and 1, 6 and 9 months following the surgery., Results: Good postsurgical results were obtained in subjective and objective evaluation, which assessed the phonatory function and ventilatory parameters. Post-surgery increase in MPT, VHI and VQROL was noticed in all patients in 3 check points (p < 0.001). The results demonstrate postsurgical improvement for some LVS parameters, including assessment of glottis closure (p < 0.003) observed 6 months after the surgery. An improvement in most of the ventilation parameters was observed also 6 months after surgery (p < 0.001). For the spirometry flow parameter PEF, significant improvement was noted in each check point (p1 < 0.004, p6 < 0.001, p9 < 0.001). The study revealed a correlation between phonatory parameter - MPT and PEF observed 1 month after the procedure (p = 0.026), confirming the interdependence of ventilatory efficiency and phonatory condition of larynx., Conclusions: Mini-microflap surgery brings satisfactory clinical effect in patients with advanced stages of RE by optimization of phonatory and ventilatory functions of the larynx.

Background: Given the growing number of occupational voice users, easy and quick broad-scale screening is necessary to provide prophylaxis of voice disorders. The aim of the study was to assess applicability of the Voice Related Quality of Life questionnaire (V-RQOL) to screening occupational voice disorders., Material and Methods: The research comprised 284 subjects divided into 3 groups: 0 - the control group of normophonic subjects, non-professional voice users (N = 60), 1 - occupational voice users with objectively confirmed voice disorders (N = 124), 2 - the non-randomized group of occupational voice users with and without voice problems (N = 100). Self-assessment of voice was performed by means of the V-RQOL in comparison to the Voice Handicap Index (VHI). The relation between the V-RQOL and VHI was determined by means of linear regression. Receiver Operating Characteristic (ROC) curves were constructed and the cut-off point of the VRQOL was determined to discriminate between normophonic and dysphonic subjects., Results: The relationship between the VHI and V-RQOL scores indicated a satisfactory coefficient of determination: R 2 = 0.7266. High values of Cronbach's α confirmed high reliability of the V-RQOL test (0.867). Voice-Related Quality of Life questionnaire (V-RQOL) results were significantly worse in the study group than for normophonic controls (p < 0.001). The cut-off point for the test was set at 79 points. The determined area under the curve (AUC) = 0.910 (p < 0.001) showed high diagnostic accuracy of the V-RQOL. Results of the VRQOL differed for diagnose-based subgroups of dysphonic patients., Conclusions: The study gives grounds for application of the V-RQOL as a reliable tool for screening occupational voice disorders. Med Pr 2018;69(2):119-128., (This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.)

Introduction: Digital imaging techniques enable exploration of novel visualization modalities of the vocal folds during phonation and definition of parameters, facilitating more precise diagnosis of voice disorders., Aim: Application of computer vision algorithms for analysis of videolaryngostroboscopic (VLS) images aimed at qualitative and quantitative description of phonatory vibrations., Materials and Methods: VLS examinations were conducted for 45 females, including 15 subjects with vocal nodules, 15 subjects with glottal incompetence, and 15 normophonic females. The recorded VLS images were preprocessed, the glottis area was segmented out, and the glottal cycles were identified. The glottovibrograms were built, and then the glottal area waveforms (GAW) were quantitatively described by computing the following parameters: open quotient (OQ), closing quotient (CQ), speed quotient (SQ), minimal relative glottal area (MRGA), and a new parameter termed closure difference index (CDI)., Results: Profiles of the glottal widths assessed along the glottal length differentiated the study groups (P < 0.001). Moreover, it was shown that the OQ, CQ, CDI, and MRGA indices can be considered as viable parameters for quantifying kinematics of the vocal folds for normophonic subjects and patients with diagnosed vocal nodules and glottal incompetence (P < 0.001)., Conclusions: Computer image processing and analysis methods applied to videolaryngostroboscopic images allow for their quantitative assessment. Computation of the size-related and time-related parameters characterizing glottic pathologies is of interest for evidence-based voice diagnostics. Results of the performed ROC curve analysis suggest that the evaluated parameters can distinguish patients with voice disorders from normophonic subjects.

Background: The aim of this study has been to assess the larynx and soft tissue around the vocal tract in a group of people with healthy voice, and in a group of patients with occupational dysphonia using the new laryngeal manual therapy palpatory evaluation scale (LMTPE)., Material and Methods: The examinations were performed in a study (dysphonic) group of professional voice users who had developed voice disorders (N = 51) and in the control group of normophonic subjects (N = 50). All the participants underwent perceptual voice assessment and examination by means of the LMTPE scale. Additionally, phoniatric examination including VHI (Voice Handicap Index) questionnaire, GRBAS (the Grade of hoarseness, Roughness, Breathiness, Asthenic, Strained) perceptual evaluation, maximum phonation time (MPT) measurement and videostroboscopy was performed in the study group., Results: The comparison of the LMTPE total score showed that the results of the study group were significantly poorer than those of controls (p < 0.001). In the study group, correlations were found between the LMTPE results and the VHI scores (p < 0.05), perceptual evaluation by the GRBAS (p < 0.05) and the objective parameter MPT (p < 0.05)., Conclusions: The study has proven that the LMTPE scale is characterized by the high score of Cronbach's α ratio estimating the reliability of the test. The results have confirmed that the LMTPE scale seems to be a valuable tool, useful in diagnostics of occupational dysphonia, particularly of hyperfunction origin. Med Pr 2017;68(2):179-188., (This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.)

The paper presents a case study of a transsexual patient who underwent a voice pitch elevation surgery performed in Poland for the first time. The human voice is a reflection of the working of hormones and human psyche. This fact is of particular importance in transsexualism, a disorder consisting in incongruence between the individual's biological sex and their identified gender. For many transsexual people, especially of the MTF (male to female) type, who have undergone hormonal and surgical sex change, the voice still presents a major problem, causing difficulties in everyday life. Hormonal treatment does not influence feminisation of the larynx. In the described MTF case, the patient's low androphonic voice was perceived as a male voice. In order to feminise the patient's voice a phonosurgical procedure was performed: the length of the vibrating portion of the vocal folds was shortened by over 50% of their total length by means of suturing of the anterior part of the vocal fold. As a result of the surgical treatment the pitch of voice was raised considerably, with F0 of spoken voice increased from 109 Hz to 209 Hz. The voice range also changed towards female tones, from 59-146 Hz to 148-343 Hz. Pitch elevation positively influenced the patient's subjective voice assessment: total score of the Voice Handicap Index (VHI) improved from 99 to 19 points, and the score of its emotional sub-scale: 39 and 2 points, respectively. The described case of a surgical male-to-female voice change presents one of the dilemmas faced by modern medicine. (Endokrynol Pol 2016; 67 (4): 452-455).

Background: An objective determination of the range of vocal efficiency is rather difficult. The aim of the study was to assess the possibility of application of short-term acoustic efficiency analysis in diagnosing occupational voice disorders., Material and Methods: The study covered 98 people (87 women and 11 men) diagnosed with occupational dysphonia throuigh videostroboscopic examination. The control group comprised 100 people (81 women and 19 men) with normal voices. The short-term acoustic analysis was carried out by means of DiagnoScope software, including classical parameters (Jitter group, Shimmer group and the assessment of noise degree NHR), as well as new short-term efficiency parameters determined in a short time period during sustained phonation of the vowel "a." The results were then compared. Results: The values of all the examined classical parameters were considerably higher in the study group of pathological voices than in the control group of normal voices (p = 0.00). The aerodynamic parameter, maximum phonation time, was significantly shorter by over 0.5 s in the study group than in the control group. The majority of the acoustic efficiency parameters were also considerably worse in the study group of subjects with occupational dysphonia than in the control group (p = 0.00). Moreover, the correlation between the efficiency parameters and most of the classical acoustic parameters in the study group implies that for the voices with occupational pathology the decreased efficiency of the vocal apparatus is reflected in the acoustic voice structure., Conclusions: Effliciency parameters determined during short-term acoustic analysis can be an objective indicator of the decreased phonatory function of the larnx, useful in diagnosing occupational vocal pathology.

Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by destructive cartilages, bones and other structures formed joints. RA belongs to connective tissue diseases represented by systemic nature, internal illness, extra-articular features and rapidly progress of atherosceirosis. The extra-articular complications cause the reduction of patient longevity. The frequency of symptoms in patient with RA and respiratory disorders occur in 10-20% of cases. Pulmonary complications are the second most common cause of premature of patient deaths. Respiratory disorders associated with RA are devided into 3 groups: infection, lung disease caused by drugs and pulmonary manifestation connected by RA. These last affect interstitial tissue, bronchioli, pulmonary vessels, pleura, also are presented by pulmonary rheumatoid nodules and pulmonary hypertension.

In this article we describe problems of genetic counseling with features of morphological phenotype, biochemical and molecular changes observed in osteodystrophy Albright syndrome, inherited autosomal dominant condition.

In this article we describe localization and structure of genes from GNAS1 cluster, which mutations are responsible for characteristic group of features described mainly as Albright's syndrome. We present the capabilities of expressions of different phenotypes depending on types of molecular changes and possibilities of genetic prognosis with problems need to be solved in interdisciplinary support.

Objective: Because omega-3 polyunsaturated fatty acids (PUFAs) may have anti-inflammatory properties, we tested the hypothesis that intradialytic, intravenous omega-3 PUFA treatment, combined with dietary supplementation, can modify the inflammatory response to dialysis, and influence the nutritional status of hemodialysis (HD) patients., Methods: Twenty HD patients with serum albumin at <39g/L received 100mL of 10% omega-3 PUFA emulsion during 11 consecutive HD sessions. Body mass index (BMI), serum albumin, transferrin, and lipids were measured before and after treatment. Serum interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hsCRP) levels were determined before and after the HD session at baseline and after 4 weeks of treatment., Results: No adverse events were evident during the study. There were no significant changes in BMI, serum albumin, transferin, total and low-density lipoprotein cholesterol, and triglycerides. Predialysis hsCRP and IL-6 did not change. There was a significant increase in hsCRP (P=.01) and a tendency of IL-6 concentration to increase during the HD session before treatment (P=.067). In contrast, neither hsCRP (P=.21) nor IL-6 (P=.26) changed during the final HD session. Neither urea reduction ratio nor Kt/V changed significantly during the study, but the normalized protein catabolic ratio increased after treatment (P=.003)., Conclusions: Short-term parenteral administration of omega-3 PUFA is safe and well-tolerated by HD patients. The intervention does not significantly influence markers of inflammation or change the nutritional status of chronic HD patients, but it may attenuate the inflammatory response to HD sessions.

We described guidelines for personel working in poison information service in case of acute paracetamol overdose. The guidelines were created with respect to EBM (Evidence Based Medicine) by the American Association of Control Centers.

In this article we presented actual legislation concerning biocide products in Poland. Rules of reporting and archiving of biocide products exposure were discussed. We presented the first results of monitoring of biocide poisoning cases in Poland from July 2007 to June 2008.

Unlabelled: Among the numerous complications associated with chronic renal disease both bone and hormonal disturbances have long been recognized. The aim of this study was to assess the relations between bone mineral density, gonadal status and specific markers of bone turnover in haemodialysis (HD) population., Material and Methods: We performed a cross-sectional study involving 40 HD patients: 27 men (mean age 54 +/- 14, 2 years) and 13 women (mean age 58.9 +/- 9.8 years), mean HD time 68 +/- 43 months. Serum levels of testosterone, estradiol, LH, FSH, osteocalcin (OC), beta-CrossLaps, iPTH and alkaline phosphatase (ALP) were measured. Bone mineral density (BMD) was estimated in the lumbar spine and in the femoral neck using dual energy absorptiometry (DXA)., Results: 67.5% of HD patients showed a low BMD. Diagnostic criteria of osteoporosis were fulfilled by 32.5% of subjects, they were found more frequently in women (38.5%) than in men (29.6%). Osteopenia was observed in 35% of patients, more frequent in women (46.2%) than in men (29.6%). Mean serum levels of FSH and LH were above the normal range and they were higher in women that in men. The serum levels of estradiol in women were below normal range in 11 from 13 subjects (84.6%). The mean serum testosterone concentrations in HD men were in normal range. We also observed a positive correlation between serum beta-CrossLaps concentrations and PTH (in men p < 0.001, r = 0.66; in women p < 0.006, r = 0.71) and between serum OC levels and PTH (in men p < 0.02, r = 0.44; in women p < 0.01, r = 0.65), respectively. CONCLUSIONS; The frequency of low bone mineral density in haemodialysis patients is high, more common in women. Hypergonadotropic hypogonadism that occurs in dialysis patients may be one of the main risk factors of bone disturbances in these patients. The levels of bone turnover markers are mainly determined by the severity of hyperparathyroidism.

The Act on Nature Conservation of 16.04.2004 (Official Journal, 2004, No 92, item 880) imposes on private individuals the duty to register some animals. The data collected by Kraków municipal authorities and delivered to the Poison Information Centre (Colleglum Medicum, Jagiellonian University) indicate that there are following species in private hands in the city and its surroundings: 11 individuals of Naja naja, 2--Hydrodynates gigas and 55-- Dendrobates spp. According to these information the employees of the PIC elaborated the advice on the treatment of specific animals' poisoning. In the period May 2003 - May 2004 (before the above Act came into force) there were 143 individuals from Brachypelma genus and 3 scorpions (Pandinus imperator) registered in Krakow. These species produce venoms which take local effect. According to art. 64 (1) of the above Act it is compulsory to register amphibians, reptiles, birds and mammals. However, it would be desirable to introduce the duty to register also dangerous species of invertebrates and fishes. It would provide the complete list of poisonous animals kept in private hands. Thus, it would be possible to estimate any possible threats and to elaborate adequate treatment in case of specific animals' poisoning.

Social survey is a very important source of information concerned with planing the preventive strategy and protecting against problems relevant to the use of psychoactive substances. The survey covered a group of 211 first-year students from five colleges in Kraków. The students showed weak awareness of law. The respondents are of the opinion that the rules dealing with the addiction issue have been too liberal thus far. The emphasis should be put on enforcing the anti-drug law. Otherwise it will not became a powerful weapon to counteract the drug addiction. According to the opinion of respondents the trade and delivery of drugs are highly disapproving and they require inflicting stringent punishments. The results of our analysis are the integral part of Kraków model to help addicted to psychoactive substances and of prevention activities referred to the students of colleges.

Poison information centres (PIC) provide telephone advice on the treatment of poisonings to the lay public and medical professionals. The number of inquiries increases every year. Poison Information Centre of Collegium Medicum of Jagiellonian University in Krakow provided 1611 items of advice in 1999 and 2263--five years later--in 2004. Each incoming call is recorded and documented by standardized protocol. Another aspect of PIC activity of is prevention and education. Inquiries protocols' analysis shows the most frequent reasons and circumstances of poisonings. Thus, it is possible to conduct appropriate prophylactic campaigns. The above aspects of activity of PIC do not bring direct financial benefit. There is one index which shows that PIC saves the money. There were 335 cases in 2004 (above 50% consulted lay public) when unnecessary hospital admissions were prevent. It should be noted that the others were refer to proper specialist. This aspect of PIC's activity significantly decreases the costs which should be paid in any medical intervention.

World trends for a home breeding of exotic freshwater and marine fishes did not miss Poland. There are almost all species of aquarium fishes available in Polish pet shops, but there is not enough information about threat given to customers. In some fish, there are masses of one-cell glands, mainly serous, in the proximity of the spines. In others, those one-cell glands may be grouped in larger aggregates of cells called venom glands, that may form organs resembling multicellular glands of terrestrial animals. They are usually located around the spines or hard rays of the fins. Even if covered with a connective tissue sheath, the aggregates of the venom cells do not have any common outlet; they are not, therefore, proper multicellular glands. The venom glands of the catfish are covered with a thin sheath and they release their contents when the fin ray is pressed. Spines are derived from fin rays. When the spine penetrates the body of its prey, it presses its base against the cells, squashes them and squeezes the venomous contents into the wound. Catfish, lionfish and stonefish have the venom glands producing secretion which could be dangerous. The eels and morays blood is also dangerous, as well as slime of reduced squamae. Poison information centers noted several cases of fishes' stings in Poland.

509 toxicological telephone inquiries concerning children under 15 years have been provided by Kraków Poison Information Centre (PIC) in the year 2004. Medication drugs were involved in almost one half (n=208) the cases noted. 63.7% of calls concerned children under 4 years with a two-year-old group predominance. The main reason for poisoning in children under 4 were pharmaceuticals (42.6%), followed by pesticides (9.8%), corrosives (8.8%), hydrocarbons (8.1%), plants (5.5%) and detergents (3.7%); all exposure were accidental. Suicide attempts reached 32.3% in the 12-14 age group. In that group also a cases of psychoactive substances overdosing were noted. Most exposures in children reported to poison centre were accidental (87.2%). Thus, it is absolutely necessary to intensify prevention and education activity both for parents and primary school children to avoid the poisoning.

Social survey by questioning people is a significant source of information, valuable for planning and developing of prophylactic strategies. An illicit drugs use among a first-year students of Kraków's universities and factors determining the usage were analysed. The research by completing the questionnaire designed by National Bureau for Drug Prevention, Poland was performed in 725 a first-year students of six Kraków's universities. The students were asked to complete the questionnaire confidentially, while the lecture on psychoactive substances. 83.6% of those polled know some students who use a drugs, 38.3% already initiated into drugs, 61.9% reported that they needed at least one day to get drugs. The male students reach for drugs more often then females, and those first-year students being already 20 years old compared to the younger. The greater risk was also noted among students who rent apartments or when a parents earned together more than 3500 PLN. The medical students reached for drugs more rarely than the others. Our survey is one of the first source of information about trends in the drugs usage by Kraków's students. The results will help to develop a preventive standards and creation of effective anti-drugs campaign to be accomplished by college authorities and the Kraków Environmental Diseases Out-patient Clinic for students and academic teachers. The clinic was organised in 2004.

In statistics from Poison Information Center in Kraków plant poisonings comprise 2% of the total registered poisonings. In toxicology cardiac glycosides poisonings existing in common foxglove plant, lilies of the valley, oleander are essential. Species of cardiotoxic plants which may cause a danger in Poland are presented in the research. The toxic mechanisms of cardiac glycosides are specified.

Background: Almost 99% of the body magnesium is inside cells. The concentration of intracellular ionized magnesium (iMg) is physiologically relevant. iMg in erythrocytes is a new parameter that can help to establish reliable information on the functional magnesium status., Methods: iMg concentration in erythrocytes and serum was measured by ion-selective electrode, in clinical analyzer Microlyte (KONE). Total magnesium (tMg) concentration was measured by atomic absorption spectrometry (AAS). Albumin and total protein concentration were measured colorimetrically., Results: In critically ill postoperative patients, the mean of albumin, protein and hematocrit concentration was significantly lower compared to healthy individuals. Hypomagnesemia was found in 15.9% patients as tMgs, at 22.2% as iMgs and 36.5% as iMge. Significant correlations are between iMgs and tMgs or iMge and iMgs/tMgs. In dialyzed patients, the mean of hematocrit was significantly lower, iMge was significantly higher compared with healthy individuals. Significant negative correlations are between iMgs and tMge or iMge/tMge and tMge., Conclusions: iMge is the best magnesium parameter to observe hypo- or hypermagnesemia for both groups of patients. The function of magnesium is mainly intracellular and intracellular magnesium concentrations can be the method to evaluate the magnesium status.

Animal models are a valuable tool in the investigation of the nervous system. Many similarities between animal and human dependency behaviours have been observed. Animal model based on the self-administration response has contributed to understanding of the neurobiological basis of particular stages of the dependence process. Animals are used also to study the mechanism of alcohol dependence. Working out an animals model of addiction should include references to the clinically important phenomena related to psychological dependence which has not been displayed. This situation get us to consider the latest findings and theories about evolution of the wise human.

A rules of telephone poison information service for general public and telephone toxicological consultation for medical staff, mainly physicians, are presented in the study. Guidelines for call management: necessity of caller assessment while dealing with information given to the general public and factors that influence successful telephone encounters are presented. The types of questions that are appropriate to ask about patient, considering both the patient state and the toxin(s) involved while dealing with a telephone toxicological consultation are also presented.

The latest legislation against drug addiction has changed the approach of Pursuing Organs in Poland to the problem of taking and distribution of drugs. Many tests have been carried out in order to evaluate the extent of legal regulations as the appropriate instrument in the struggle against drug addiction. The survey and interview were introduced during the research. The results make it possible to form the following conclusions. Law, only as a supplementary means supporting other methods may help prevent and counteract the addictions. Legal regulation on drug addiction which are based on compulsion and punishment should be widely taken into account.

Substances of abuse have been known since antiquity till now. Current trends in neurobiological and genetical study related to drug dependency were presented in the study. The trial of preparation a cocaine vaccine and the new hope for dependent people coming from investigation of Zebrafish were also described.

The growing trend toward the collection of exotic snakes by private collectors increases the danger to health and life. The analysis of the cases which have occurred in USA, England, Germany and Poland shows that only quick and united effort of experts from the different fields and antivenoms can save the life.

Vertebrate species (fish, amphibians and reptiles) with cardiotoxic venoms properties are described in the paper. A regulatory problems related to breeding of venomous animals are also included.

The pattern of poisonings in patients hospitalised in the Department of Clinical Toxicology Jagiellonian University Medical College in 1997-2001 was presented in the study. The analysis includes 17,931 patients: 6,016 (33.5%) women and 11,915 (66.4%) men. The rate of patients between 20-39 years old was highest in all the analysed year, however downward trend was noticed. The upward tendency was noted in older group of poisoned patients. A suicidal poisonings were mostly common in 1998 and 1999 in the youngest and oldest groups: 37.1%, 37% in 1998, and 25.5%, 22.2% in 1999 respectively. The medication drugs were the most common cause of acute poisoning only in the group of adolescent patients. Ethyl alcohol was the common cause of poisoning in adult groups. The highest rate of ethanol intoxication was noted in patients between 40 to 59 years old. A 89 lethal intoxication were noted in analysed period. The average mortality rate was low (0.5). A medication drugs (30.4%) followed by ethanol (17.4%), carbon monoxide (13%) and solvents (13%) were involved in lethal poisonings in the oldest group of patients.

The present paper introduces regulation of law obligatory in the modern world, with a view of preventing and fighting against drug addiction. It allowed to chart approximately the entire spectrum of possible and obeyed rules in the world. Amongst it the activity of international organisations was considered. A special attention was given to Polish legislation. Also the Law about prevention from Drug Addiction (31st January 1985) and law about Counteract against Drug Addiction (24th April 1997) were particularly regarded. A lot of effort was made to bringing the problem of drug addiction and delinquency forward, based upon Polish legislation.

This paper presents some aspects of Polish legislation against chemical dependency. The legal regulations and rules related to enforcement and prevention of drug addiction are listed. Also included is the special insight of the Rule for Prevention of Drug Addiction of January 31, 1985.

In this article new informations about systemic vasculitis were reviewed. Evaluation of ANCA and their antigen specificity is of a great help in classification of systemic vasculitis. Among idiopathic systemic vasculitis anti-serine proteinase antibodies are found in Wegener granuloma, anti-MPO antibodies in Churg-Strauss syndrome and in polyarteritis nodosa. Antibodies against other components of PMNL granules still remain unknown. The main purpose of this review was to underline incidence of systemic vasculitis and the meaning of ANCA in the diagnosis and classification of these diseases.