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   2012| January-June  | Volume 2 | Issue 1  
    Online since April 9, 2012

 
 
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ORIGINAL ARTICLES
Voice therapy outcome in puberphonia
Vrushali Desai, Prasun Mishra
January-June 2012, 2(1):26-29
DOI:10.4103/2230-9748.94730  
Background: Puberphonia is inappropriate use of high-pitched voice beyond pubertal age in males. It is usually seen in the immediate post-pubescent period when the male vocal mechanism has undergone significant changes in size and function caused by hormonal changes. Voice therapy is one of the modality of management for puberphonia. Aim: To evaluate the efficacy of voice therapy provided to a group of 30 Puberphonia cases as the sole treatment approach to lower the pitch range. Setting: The study was carried out in a tertiary voice care and laryngology center. Materials and Methods: This is a prospective study of 30 cases diagnosed with Puberphonia managed with various techniques of voice therapy. The subjective assessment was done with GRBAS scale and objective assessment was done by acoustic analysis using Multi Dimensional Voice Profile. Results: All 30 patients achieved appropriate pitch range following Voice Therapy. Conclusion: This study encourages speech and language professionals to advice and use voice therapy as the foremost treatment modality for Puberphonia.
  36,631 873 3
REVIEW ARTICLES
Unilateral pediatric vocal cord paralysis: Evolving trends
Nancy Grover, Abir Bhattacharyya
January-June 2012, 2(1):5-9
DOI:10.4103/2230-9748.94727  
Unilateral vocal cord paralysis (UVCP) in children is a rare and challenging disorder for the pediatric otolaryngologist. The overall etiology differs from that in adults, iatrogenic causes are the commonest, followed by traumatic - birth or intubation trauma and neurologic causes. Prolonged spontaneous recovery occurs in up to 50% of cases. Management strategies used for adults have evolved and been utilized in children, with increasing reports of surgical intervention over the last decade. However, number of children treated remains small with no long-term follow-up. We used the terms "vocal cord palsy," "vocal cord paresis," "vocal fold immobility" each limited by "paediatric," "children," to search Medline, Embase, PubMed, Cochrane, and CINHAL. Reference lists were crosschecked to include relevant studies. Only English language literature was searched. Studies specifically relating to unilateral vocal cord or containing relevant data were identified and analyzed. We present our review of literature on pediatric UVCP with emphasis on various interventions for management, especially the growing experience with laryngeal re-innervation.
  14,973 609 3
Olfaction following total laryngectomy
Elizabeth Ward, Anna Rumbach, Corina J van As-Brooks
January-June 2012, 2(1):10-20
DOI:10.4103/2230-9748.94728  
Total laryngectomy (TL) results in the complete disconnection of the upper and lower respiratory tract, ceasing orthonasal airflow. Hence, olfaction and olfactory acuity are negatively impacted. Prior to the late 1990s, impaired olfaction was simply accepted as a negative consequence of TL surgery. However, a growing body of research conducted within this past decade has demonstrated that rehabilitation is possible with a simple and effective behavioral technique. The current review outlines the literature supporting the negative impact of altered olfaction on quality of life, details of known best practice methods for olfactory assessment both for research and clinical use, and outlines the evidence for interventions known to improve olfactory performance in the TL population. Intervention for olfactory impairment should be part of a holistic, evidence-based rehabilitation process for patients post-laryngectomy.
  8,776 436 3
ORIGINAL ARTICLES
Voice characteristics of elderly college teachers: A pilot study
Prakash Boominathan, Shenbagavalli Mahalingam, John Samuel, Mumudi V Dinesh Babu, Aishwarya Nallamuthu
January-June 2012, 2(1):21-25
DOI:10.4103/2230-9748.94729  
Background: Rise in the age of retirement for teachers has created opportunities to continue in the profession even after 60 years of age. Elderly teachers will be more prone to developing voice problems due to their continuing teaching assignments, and age-related changes in larynx. Aim: To profile the voice characteristics of elderly teachers through comprehensive voice assessment. Design: Cross-sectional study. Materials and Methods: Stroboscopic, perceptual, acoustic, aerodynamic, and self percept features of voice in 20 elderly teachers were assessed using the Sri Ramachandra voice assessment protocol. Statistical Analysis: Differences between genders were calculated using independent t-test. Inter-judge reliability for perceptual analysis was calculated using intra-class correlation coefficient. Results: Stroboscopy revealed sarcopenic changes of vocal muscles, such as discoloration of vocal folds, incomplete closure, and reduced mucosal waves. On GRBAS scale, the subjects were rated as predominantly breathy, asthenic, and strained. Subjects showed reduced Maximum Phonation Time (11-13 seconds) and increased s/z ratio (1.21 in males and 1.19 in females). Mean F0 was 121 Hz (males) and 172 Hz (females). Mean I 0 range [28.4 dB (A) in males and 24.2 dB (A) in females] was reduced and shimmer (5.80% in males and 4.84% in females) values were increased. Dysphonia Severity Index revealed mild to moderate deviation (0.07 in males and 0.16 in females). However, on self evaluation of voice through Voice Disorder Outcome Profile, scores revealed certain physical changes with less or no obvious functional limitation. Conclusion: This study documents the trends in voice-related changes in elderly teachers. This information may be crucial for voice professionals to advice elderly teachers and management to advocate "good vocal health."
  7,749 495 1
IMAGES IN PATHOLOGY
Aspergillosis of larynx with involvement of epiglottis in immunocompetent patient, a rare observation
Dnyaneshwari P Ghadage, Archana B Wankhade, Rupali J Mali, Arvind V Bhore
January-June 2012, 2(1):35-37
DOI:10.4103/2230-9748.94732  
A rare case of aspergillosis of larynx with involvement of epiglottis and subglottic region in immunocompetent patient is described in this study. A 65-year old male was presented with complain of upper airway obstruction, difficulty in swallowing, and hoarseness of voice. Presentation was similar to malignancy. Microbiological diagnosis was made by isolation and identification of Aspergillus fumigatus from the specimen. This diagnosis changed the treatment to antifungal drugs in day-by-day deteriorating patient. Patient responded dramatically to the antifungal therapy. Despite various radiological, histopathological investigations, microbiological reports supported clinicians in early and correct management of the case to prevent the development of serious complications.
  6,036 180 -
CASE REPORT
Subcutaneous emphysema: An unusual presentation of an unsuspected foreign body bronchus in an adult patient
Sushil K Aggarwal, Amit Keshri
January-June 2012, 2(1):38-41
DOI:10.4103/2230-9748.94733  
Foreign body in airway is common in children but extremely rare in adults. Here, we are presenting a case report of an adult patient with an unsuspected foreign body in the airway who presented unusually as widespread subcutaneous emphysema in neck. We did an extensive review of literature on this topic but could find only few cases with similar clinical presentation of asymptomatic inhaled foreign body in adults. This case underlines the fact that airway foreign bodies can have extremely unusual presentations and only a high degree of clinical suspicion can clinch the diagnosis. This case is being reported for its unusual presentation and its rarity.
  5,697 223 1
ORIGINAL ARTICLES
Remission in juvenile-onset recurrent respiratory papillomatosis
Sachin Gandhi, Reba Jacob
January-June 2012, 2(1):30-34
DOI:10.4103/2230-9748.94731  
Background: Juvenile-onset recurrent respiratory papillomatosis (JORRP) is a distressing disease due to relentless recurrence and progression. In JORRP, recurrence is a rule, but remission can be considered if the disease-free period after a particular treatment modality is more than one year. Objective : The present study was undertaken with the aim to address this dilemma of remission in JORRP. Materials and Methods: A total of 30 patients of JORRP presenting over 2 years were included. Detailed history, aggressiveness of disease, number of surgical interventions, and surgical modality used were elicited. Videolaryngostroboscopy was performed in all patients using Kays RLS 9100B stroboscope. Papilloma excision was done using CO 2 laser and all patients were followed up three monthly for 1 year, then were kept on yearly follow-up. Results: It was observed that majority of the patients (83%) underwent recurrent excision of papillomas for 1 to 5 times. Of the 30 patients, 15 (50%) showed remission. Eleven of the 30 patients (36.67%) had minimal papillomas and symptomatic recurrence of papilloma was seen in four of the 30 patients (13.33%) and required further surgeries. Nine of the 30 patients who showed remission were diagnosed and managed within 1- to 15-year age group. Six of the 30 patients who presented with recurrence and minimal papillomas were in the age group 31 to 45 years. These patients had transition of JORRP to adult papilloma. Conclusion: The present study shows that the chance of remission is higher in children who had an early onset of JORRP. Remission was more when surgical excision was done only with CO2 laser.
  5,500 214 1
LETTER TO THE EDITOR
Recurrent neck abscess - A clue to laryngopyocele
Nitish Baisakhiya, Ginni Dutta, Dalbir Singh, Sanaha Mahajan
January-June 2012, 2(1):42-43
DOI:10.4103/2230-9748.94734  
  4,578 224 -
EDITORIALS
Bending the rules-The flexible CO2 laser in head and neck surgery
Paul O'Flynn
January-June 2012, 2(1):1-2
DOI:10.4103/2230-9748.94725  
  4,365 207 -
On the TENSION in segmental tracheal resection
Paul F Castellanos
January-June 2012, 2(1):3-4
DOI:10.4103/2230-9748.94726  
  4,272 260 -
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