Otolaryngology http://oto.sagepub.

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Vocal Cord Lesions in Professional Voice Users

Julia Azevedo, Camilla Cruz, Isabelle Mury, Marcio Osorio, Ricardo E. Steffen, Everson Quinto and Gustavo Rangel Otolaryngology -- Head and Neck Surgery 2011 145: P84 DOI: 10.1177/0194599811416318a138 The online version of this article can be found at: http://oto.sagepub.com/content/145/2_suppl/P84.2

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P84 Method: Laser cordectomy of Tis (21), T1a (179), T1b (57), and T2-3 (32) tumors and supraglottic laser resection of 40 epiglottis (36 T1, 4 T1N1), 4 vestibular fold (T1), 13 vallecula (10 T2, 3 T2N1), and 6 aryepiglottic fold (3 T2, 3 T2N1) tumors with 10 ND was evaluated. Results: There was no recurrence after a single laser cordectomy in 87.5% of the patients (253/289 patients). Laser-specific survival is 92.7% (268/289). Five-year survival is 92.2% (214/232). Local recurrence was found in 36 of 289 patients (12.5%). In the supraglottic group, 47 patients are free of tumor after primary laser excision so far. Sixteen patients with local recurrence underwent salvage treatments. Late neck metastasis required 5 radical neck dissections (RND). Tumorfree survival is 75%. Survival after salvage therapy is 98%. The voice improved during the healing. Conclusion: Transoral CO2 laser surgery of the early vocal cord and supraglottic cancer proved to be a primary treatment option with success: good oncological and acceptable functional results.

OtolaryngologyHead and Neck Surgery 145(2S)

Laryngology/Broncho-Esophagology Vocal Cord Lesions in Professional Voice Users Julia Azevedo (presenter); Camilla Cruz; Isabelle Mury; Marcio Osorio; Ricardo E. Steffen; Everson Quinto, MD; Gustavo Rangel
Objective: The aim of this study was to survey professional voice users referred to an otorhinolaryngology center in a tertiary hospital in Rio de Janeiro, Brazil, and evaluate the incidence of vocal cord diseases in these patients. Method: Professional voice users records were analyzed using database from a videolaryngoscopic service in a tertiary hospital, from January 2000 to 2010. Patients diagnoses were divided into the following categories: nodules, polyps, minor structural changes, Reinke edema, papilloma, neoplasm, vocal fold palsy, functional dysphonia, vocal cord paralyis, and laryngitis. Age, gender, and smoking habit were also annotated. Results: A total of 409 professional voice users were referred to the otorhinolaryngology service. The majority of patients were female (69.3%). Dysphonia was the most common complaint, found in 76.3% of patients. The most common vocal cord lesions were polyps, found in 13.7% of patients. Laryngitis due to laryngopharyngeal reflux was found in 11.3% of patients, followed by vocal cord cysts, found in 8.1% of patients. Reinke edema was found in 5.6% of patients. The examination was normal in 45.2% of patients. Smoking was found in 19.7% of patients with any abnormal finding and only 9.7% of patient with no visible alterations (OR = 2.3, CI = 1.3-4.1). Conclusion: Professional voice users are at increased risk of vocal cord lesions. In this study, the most common lesions identified were polyps. Followed by laryngitis due to laryngopharyngeal reflux disease. Smoking was higher in the group with abnormal findings. Smoking cessation is an important aspect of the treatment of professional voice users.

ORAL PRESENTATIONS

Laryngology/Broncho-Esophagology Validation of a Theater-Based Immersive Microlaryngoscopy Simulator Jason Fleming, MRCS (presenter); Nick Sevdalis; Meredydd Harries, FRCS; Karan Kapoor, MBBS, MRCS, DOHNS
Objective: Assess the face and construct validity of 2 assessment tools: a Checklist Assessment for Microlaryngeal Surgery (CAMS) and a Global Rating Assessment for Microlaryngeal Surgery (GRAMS) on a new theater-based immersive microlaryngscopy simulator. Method: Fifteen candidates were divided into the novice or experienced group depending on their previous microlaryngoscopy experience. Each candidate undertook a 10-minute simulation of a microlaryngoscopy and excision biopsy, and 2 blinded experts rated their performance live. Candidates subsequently completed a questionnaire on their opinion of the simulator. Results: The model demonstrated good face validity across all levels of experience. The GRAMS demonstrated excellent interrater reliability (0.9) compared with the CAMS (0.7). The CAMS assessment was able to differentiate experienced and novice candidates and, therefore, demonstrated construct validity. The GRAMS tool, however, was unable to differentiate candidates. There was a significant correlation between the 2 assessment tools (correlation coefficient = 0.624). Conclusion: This study is the first reported trial of a high fidelity microlaryngoscopy simulator with task-specific rating tools. Use of these tools is recommended within otolaryngology training programs, with GRAMS for use as a frequently used feedback tool and CAMS as a confirmatory evaluation of competency at transitions of professional training.

Laryngology/Broncho-Esophagology Voice Quality of Life after Type II Thyroplasty for Spasmodic Dysphonia Tetsuji Sanuki, MD, PhD (presenter); Narihiro Kodama; Eiji Yumoto, MD, PhD
Objective: 1) Determine the effectiveness of type II thyroplasty for adductor spasmodic dysphonia (AdSD), through perceptual and accoustic analysis. 2) Assess the pre- and postoperative quality of life of AdSD patients using the Voice Handicap Index-10 (VHI-10). Method: Retrospective study. Twelve patients with AdSD underwent type II thyroplasty between March 2007 and

Oral Presentations December 2010. Measured outcomes included perceptual assessment, acoustic analyses (DVB, SDF0, jitter, shimmer, and HNR), and VHI-10 and were performed prior to and six months or more after surgery. VHI-10 and acoustic evaluation scores were compared. Results: Average follow-up interval was 12.6 months. In perceptual analysis (GRBAS), overall grade and strain significantly improved after surgery (P = .0017, P = .0002). There were no significant difference in roughness, breathiness, and asthenia. In acoustic analysis, DVB, SDF0, jitter, shimmer, and HNR (P = .039, P = .0003, P = .0016, P = .0011, P = .0003) improved significantly after surgery. Mean VHI-10 scores significantly improved from a mean of 26.5 to 3.75. Conclusion: Treatment of AdSD with type II thyroplasty significantly improved voice-related quality of life and acoustic findings. The study revealed a significant relationship between the acoustic parameters and the VHI-10. The results confirmed that VHI-10 can be a valuable tool for assessing type II thyroplasty for AdSD.

P85

Otology/Neurotology Association between Hepatitis B and Hearing Status Mohammad Shayaninasab, MD (presenter); Azam Alizamir; Mohammad Reza Fatoloomi
Objective: Viral diseases are one of the common causes of hearing loss. Inner ear may be involved directly or by secondary reaction (eg, poly arthritis nodosa). This goal was to investigate the relation between positive HBS-Ag (hepatitis B disease) and hearing loss. Method: This case-study research was done on 95 hepatitis B patients as case group and 97 normal cases as control group. They were selected sequentially, and audiologic tests were performed on them. The hearing thresholds of the 2 groups were compared using t test. Results: According to our audiometry results, pure tone average (mean thresholds of 500, 1000, and 2000 Hz) were 22.1 dB for left ear and 23.95 dB for right ear in the hepatitis B group, and 8.4 dB for left ear and 8.95 dB for right ear in the control group (HBSAg negative). Difference between 2 groups was statistically significant, with P < .05. Conclusion: The results show that hepatitis B patients are more prone to hearing loss. In other words, hepatitis B disease can cause hearing loss. This study suggests that hepatitis B prophylaxis is important in decreasing hepatitis B involvement and, therefore, hearing loss.

Otology/Neurotology A Study of Antibacterial and Antifungal Properties of Human Cerumen Rohit Singh, MS, DNB (presenter); Indira Bairey; Sumit Gupta
Objective: This study investigates the effect of human cerumen on the growth of Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, and Candida albicans and describes the order of inhibition of the bacteria and fungi. Method: Prospective study on 100 cerumen samples using Nutrient agar and SDA as culture medium was performed. Serial 10-fold dilutions using 3.5% cerumen suspension was incubated at 37C for 12 hours. Ten microliters of each dilution were inoculated on blood agar and incubated for 24 hours. Results: Of 100 samples, only sterile samples were taken. At dilutions of 103 there was no growth of Escherichia coli and Pseudomonas aeruginosa in all samples, no growth of Staphylococcus aureus in 81.25% samples, and Candida albicans in 87.50% samples. After analysis, the order of inhibition was noted as Escherichia coli greater than Pseudomonas aeruginosa greater than Staphylococcus aureus greater than Candida albicans. Conclusion: Human cerumen has antibacterial and antifungal properties in descending order as shown: Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, Candida albicans. Hence, wax acts as a protective coating over the external auditory canal. Thus, routine wax removal is not mandatory unless impacted wax is leading to earache or conductive hearing loss.

Otology/Neurotology Audiometric Protocols for MRI Screening of Acoustic Tumors Teddy C. Cheng (presenter); Michael Wareing, FRCS
Objective: 1) Evaluate audiometric protocols and recommend the protocol with best sensitivity and specificity for MRI Screening of acoustic neuroma and meningioma tumors. 2) Determine the clinical risks of missing tumors and financial wastes in screening nonacoustic tumors and nonpathological cases. 3) Identify decision-making parameters in best-performing protocols. Method: Retrospective review of 3-year cohort (September 2006 to October 2009) of 1,751 ENT patients who underwent puretone audiometry and acoustic-tumor MRI-screening in a tertiary center. Audiometric protocols were ranked sensitivity to acoustic tumors; specificity (A and B rates) to nonacoustic tumors and nonpathologies. False negatives indicated clinical risks; false positives determined financial wastes. Results: No audiometric protocols achieved 100% sensitivity or specificity rates. Only 2 protocols achieved >90% sensitivity ratesthe AMCLASS-A-Urben protocol (93.16%)

ORAL PRESENTATIONS