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   2014| July-December  | Volume 4 | Issue 2  
    Online since May 21, 2015

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Oral and pharyngeal transit time as a factor of age, gender, and consistency of liquid bolus
J Nikhil, Rahul K Naidu, Gayathri Krishnan, R Manjula
July-December 2014, 4(2):45-52
Introduction: The oral transit time (OTT) and pharyngeal transit time (PTT) are measures that indicate the time taken for bolus transit in oral and pharyngeal cavities, respectively. These measures vary with respect to bolus type and quantity and reflect on the efficiency of the swallow. Objectives: The study aimed to compare OTT and PTT measures for thin (water) and thick (honey) liquid bolus consistencies in 88 typical participants (44 typical adults and 44 typical geriatric persons including males and females) and 10 persons with swallowing disorders. Materials and Methods: OTT and PTT measures for liquid bolus were derived using the equipment Digital Swallowing Workstation-Swallowing Signal Laboratory (DSW-SSL) (Kay/Pentax, Lincoln, New Jersey) Model 7120. In the absence of cited standard procedures to measure OTT and PTT, the measures of OTT and PTT were specifically defined in this study based on the measures obtained from three modules/tests of the DSW-SSL: (a) Tongue array (used to measure the tongue pressure during swallow), cervical auscultation (used to measure the swallow sound), nasal cannula (used to measure the respiratory-swallow coordination). Results and Discussion: The mean group scores of OTT and PTT measures were compared across gender, age, and consistency of bolus and treated with the appropriate statistical procedure. Results revealed that: (i) PTT for honey was longer than water in typical adults and geriatric persons. (ii) There was no significant difference in OTT for honey across age groups. (iii) Atypical patterns in the morphology of tongue pressure, swallow sound and respiratory-swallow coordination during swallow were noted across age and consistency of bolus in typical and atypical population. Conclusion: The OTT and PTT measures can serve as sensitive indices to understand swallow physiology in oral and pharyngeal phase. Increase in PTT is observed for thicker liquid like honey. There are more instances of nonhomogenous patterns across typical and atypical swallows for tongue pressure, swallow sound, and respiratory-swallow coordination.
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Etiological profile of unilateral vocal cord paralysis: A single institutional experience over 10 years
Sachin Gandhi, Sheetal Rai, Nilanjan Bhowmick
July-December 2014, 4(2):58-62
Objective: Unilateral vocal cord palsy is a major cause of dysphonia. With umpteen number of causes being attributed to it and changing trends in etiology from place-to-place and over time, it is of utmost importance to arrive at a correct diagnosis to plan further management and to determine the prognosis. The aim was to evaluate the etiological profile of unilateral vocal cord palsy in our institute that is a tertiary referral center over the past 10 years. Materials and Methods: Case records of all patients diagnosed with unilateral vocal cord palsy who presented to Deenanath Mangeshkar Hospital, Pune, Maharashtra, India between 2003 and 2013 were retrospectively reviewed. The exclusion criteria included patients with laryngeal/hypopharyngeal malignancies, intubation trauma, congenital vocal cord palsy and cricoarytenoid joint ankylosis. The age, gender, laterality and etiology were the factors taken into consideration. Results: A total of 277 cases spanning over the age range of 2 months to 98 years met our inclusion criteria, out of which 179 were males, and 98 were females with a male to female ratio being 1.82:1. In terms of laterality, 182 patients had left sided, and 95 had right sided vocal cord palsy. Majority of the cases were found to be in the fourth and fifth decades. The most common etiology was idiopathic 136 (49.1%). The incidence of various other etiologies were surgical trauma 60 (21.6%), nonsurgical trauma 10 (3.7%), nonlaryngeal malignancy 36 (12.9%), central/neurological 17 (6.1%), postradiation 1 (0.3%), and other benign lesions 17 (6.1%). Among the surgical causes, the incidence of nonthyroidectomy surgeries (58.3%) was more than that of thyroidectomy (41.6%). Thyroidectomy was the single most common surgical cause for unilateral vocal cord palsy, followed by other nonthyroid neck surgeries (20%) and anterior cervical decompression (18.3%). Conclusion: The most common cause for unilateral vocal cord palsy is idiopathic. Nevertheless it is still an important sign of various underlying diseases. A thorough evaluation which must necessarily include a computerized tomographic scan from base of the skull to upper mediastinum is essential before labeling a case as idiopathic; hence, also the need for extended follow-up of the cases to avoid misdiagnosis of any underlying subclinical malignancy.
  4 11,036 74
Leukoplakia of larynx: A review update
Ishwar Singh, Divya Gupta, S. P. S. Yadav
July-December 2014, 4(2):39-44
Leukoplakia of larynx has remained a debatable topic in laryngeal pathology for decades as per classification, histology and treatment is concerned. Smoking and alcohol are the major causes and there is sufficient evidence implicating gastroesophageal reflux and human papilloma virus in its pathogenesis. A wide range of therapeutic strategies are available for different grades of dysplasia. Despite this, a significant proportion of patients progress to carcinoma for which the patients with dysplasia need to be kept in regular follow-up.
  4 19,818 81
Pediatric laryngeal schwannoma: Case report and literature review
Abdelrahman E. M. Ezzat
July-December 2014, 4(2):63-65
Neurogenic tumors of the larynx, especially the schwannomas are rare. Hence, we report a case of a schwannoma in a 15-year-old male child, which was excised endoscopically. The goal of this report is to advert to this rare disease and to review and discuss diagnostic methods and treatment options. The definite diagnosis is histopathological examination. Endoscopic resection for smaller lesions and external approaches for larger lesions are recommended treatment options, and adjuvant treatment is not required.
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Masticator space abscess with bilateral retropharyngeal kissing carotid arteries
Binit Sureka, Arif Mirza, Rajesh Gothi, RK Mathur
July-December 2014, 4(2):66-67
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Voice acoustic changes after uvulopalatopharyngo-plasty surger
Ramez S Faheem, Ramez R Botros, Sameer A Shoker, Safinaz Nagib Azab
July-December 2014, 4(2):53-57
Background: All surgical procedures for treatment of snoring and obstructive sleep apnea modify the anatomical structure of the upper airways and the resonance characteristics of the vocal tract; this can lead to a modification in voice. Aim of the Work: The purpose of this study was to evaluate the possible modifications of the fundamental frequency (F0) and of the frequency and amplitude of the first (F1) and second (F2) formants of the 6 Arabic vowels after the surgical operation uvulopalatopharyngoplasty for snoring, to verify if and how this operation can influence changes of voice. Materials and Methods: A total of 40 patients suffering from habitual snoring with or without mild to moderate obstructive sleep apnea syndrome due to upper airway obstruction at the palatal level, not affected by laryngeal, pulmonary or neurologic disorders likely to alter voice production, were selected for the study. All were submitted to acoustic voice analysis prior to surgery and again 1-month after discharge. Results: F0 was unchanged. The frequency of F1 of the vowel/a/vowel/æ/and F2 of the vowel/e/were significantly higher, whereas F1 of/i/and F2 of/o/and/u/were significantly lower compared with preoperative values. Conclusions and Recommendations: The modifications in the anatomical structure and volume of the vocal tract, induced by the surgical procedure used for the treatment of snoring, can modify the values of the formants and as a consequence, change of the voice. This change can be detected not only by means of the acoustic analysis but also by the patient itself. For this reason, singers, and all professional voice users about to undergo surgical treatment for snoring should be informed of this potential modification of the voice not only for clinical reasons but also for legal purposes.
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