手术预案汇报制度在耳鼻咽喉头颈外科住院医师规范化培训中的应用

目的 探讨手术预案汇报制度在耳鼻咽喉头颈外科住院医师规范化培训中的应用效果。方法 以2016—2020年在首都医科大学宣武医院耳鼻咽喉头颈外科进行住院医师规范化培训的15名住院医师为研究对象,分为实验组(8名)和对照组(7名)。对照组按照住院医师规范化培训大纲进行培训,实验组要求住院医师在完成培训大纲的基础上,制作并汇报手术预案,通过比较两组的出科考核成绩和年度考核成绩,分析手术预案汇报在教学中的效果。结果 实验组住院医师出科考核成绩为(92.44±2.41)分,而对照组为(88.79±2.67)分,差异具有统计学意义(t=-2.78,dF=13,P<0.05)。实验组住院医师年度考核成绩为(85.87±3.64)分,对照组为(80.29±2.98)分,差异具有统计学意义(t=-3.22,dF=13,P<0.05)。实验组8名住院医师共汇报预案397例,平均(49.62±17.20)例。结论 在耳鼻咽喉头颈外科住院医师规范化培训中,住院医师通过制作和汇报手术预案,巩固了基础理论知识、提高了临床思维能力,指导教师对预案中暴露出的问题进行针对性指导,提高了教学效果。     

可吸收胶原膜在累及前联合的声门型喉癌手术中的应用

目的探讨可吸收胶原膜一期置入在累及前联合的声门型喉癌内镜手术中的应用价值及治疗效果。方法累及前联合的声门型喉癌患者19例，全麻支撑喉镜下行喉肿瘤切除术，同期放置修剪合适大小可吸收胶原膜并经环甲膜固定，1~2周后根据胶原膜贴敷情况去除喉外固定缝线。所有患者术后随访6个月至5年，随访内容包括：声带创面恢复情况；前联合形态；嗓音障碍指数量表(VHI)、最长发音时间(MPT)及嗓音障碍严重指数(DSI)。结果① 术后随访时，除1例患者术后1个月复查时发现肿瘤残余复发，3例患者声带前三分之一粘连，其余15例患者均未出现呼吸困难且声带前联合获得良好三角形形态, 对比既往5例未放置可吸收胶原膜同分期患者，均获得满意的声门形态；②术后疼痛评分中17例(89.5%)轻度疼痛，2例(10.5%)中度疼痛，均无重度疼痛；③术后半年黏膜功能稳定后行嗓音功能评估，VHI手术前后(60.63±12.93 vs 19.37±5.73)，差异具有统计学意义(P < 0.001)；客观声学参数MPT手术前后(10.07±1.47 vs 14.40±1.48)，差异具有统计学意义(P < 0.001)；DSI手术前后(-1.52±4.20 vs 0.97±2.12)，差异均具有统计学意义(P < 0.001)。结论一期置入可吸收胶原膜可预防累及前联合声门型喉癌切除术后双侧声带粘连，且患者术后疼痛感轻微，可促进患者术后喉功能的恢复，无不良反应发生。     

日间手术模式下内镜辅助低温等离子腺样体消融术的临床探讨

目的 探讨日间手术模式下内镜辅助低温等离子腺样体消融术的可行性和安全性。方法 回顾分析2018年1—12月佛山市第一人民医院耳鼻咽喉头颈外科收治的108例腺样体肥大患者的临床资料，根据住院流程分为日间组65例和住院组43例。日间组于门诊完成各项检查，24 h内完成入院、手术、出院。比较两组患者手术情况（手术时间、出血量）、围手术期并发症（术后疼痛、发热、出血）和住院相关指标（术前等待时间、住院时间、住院总费用、西药费）。结果 日间组65例患者均顺利完成手术，日间组和住院组的手术时间分别为（6.9±2.3） min和（7.5±2.8） min，出血量分别为（5.2±3.6） mL和（5.5±2.4） mL，组间比较差异无统计学意义（P>0.05）。日间组3例出现术后发热、无术后出血、平均疼痛指数评分为（1.6±0.5）分；住院组6例出现术后发热、无术后出血、平均疼痛指数评分为（2.1±1.1）分，组间比较差异无统计学意义（P>0.05）。日间组和住院组临床疗效分别是96.9%（63/65）和95.3%（41/43），两组差异无统计学意义（P=0.935）。日间组术前等待时间和住院时间分别为（1.2±0.6） h和（10.5±2.8） h，较住院组术前等待时间（21.5±5.8） h和住院时间（76.2±12.5） h均明显缩短（P<0.001）。日间组住院总费用和西药费分别是（9 629.1±206.8）元和（650.4±54.3）元，亦较住院组住院总费用（11 672.7±1 016.2）元和西药费（779.5±103.9）元明显减少，差异具有统计学意义（P<0.05）。结论 日间手术模式下开展内镜辅助低温等离子腺样体消融术是安全、有效的，与住院手术相比可大大缩短术前等待时间和住院时间，降低住院费用，有助于减少医疗资源的消耗，加快病房运行效率。     

舌骨位置与多导睡眠监测指标及腭咽成形术后疗效的相关性分析

目的研究阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者舌骨位置与多导睡眠监测(PSG)参数指标以及腭咽成形手术疗效相关性,探讨舌骨位置对OSAHS患者疾病程度及腭咽成形手术预后的影响。方法收集2020年6月—2021年10月47例不同程度OSAHS行改良悬雍垂腭咽成形术(H-UPPP)患者术前上气道CT影像及术前、术后3个月PSG数据资料,回顾性分析颏下点至舌骨下缘的垂直距离(MH-v)、下颌骨颏棘至舌骨水平距离(MH-h)以及Friedman舌位(FTP)与阻塞性睡眠呼吸暂停低通气指数(AHI)、平均血氧饱和度(AvSpO₂)、最低血氧饱和度(LSpO₂)及血氧饱和度低于90%累积时间占总睡眠时间比(CT90)相关性,并进一步分析FTP、MH-v与H-UPPP手术疗效的相关性。结果MH-v与AHI、LSpO₂和AvSpO₂均呈中等程度相关(r=0.540, P=0.000;r=-0.523, P=0.000;r=-0.514, P=0.000),MH-v与CT90呈弱相关(r=0.495,P=0.000);MH-h与上述PSG指标均无相关性(P＞0.05);FTP与AHI、LSpO₂、AvSpO₂及CT90均呈弱相关(ρ=0.329, P=0.024;ρ=-0.309, P=0.034;ρ=-0.370, P=0.01;ρ=0.325, P=0.026)。在H-UPPP手术有效组与无效组的MH-h比较差异无统计学意义(t=-0.448,P=0.656),MH-v差异具有统计学意义(t=-5.908, P=0.000),而两组之间FTP比较差异无统计学意义(χ²=1.540,P=0.215),MH-v受试者工作特征ROC曲线下面积为0.884,在预测H-UPPP手术有效性方面具有中等诊断价值。结论作为影响OSAHS患者病情的解剖学因素,CT影像中的舌骨位置MH-v相比FTP与PSG诸多指标具有更好的相关性,对预测H-UPPP手术有效性具有一定的价值。     

先天性耳廓畸形耳模矫正的疗效分析

目的 分析先天性耳廓畸形耳模矫正治疗的临床疗效。方法 回顾2019年1月—2021年12月在湖南省妇幼保健院耳鼻咽喉科门诊进行耳模矫正的201例（318耳）先天性耳廓畸形患儿，按患儿开始治疗的日龄将其分为3组：109例（181耳）<14 d的患儿为1组，75例（117耳）14～42 d的患儿为2组，17例（20耳）43～89 d的患儿为3组；分析3组患儿的治疗效果、治疗时长、并发症发生率等。结果 201例（318耳）先天性耳廓畸形患儿治疗的显效及治愈率为93.4%，佩戴时长平均（32.4±10.8） d，并发症发生率45.9%。3组的治疗显效及治愈率分别为96.7％、90.6％、80.0％，组间差异具有统计学意义（χ²=10.479，P=0.005）；3组的矫正时长分别为（30.2±10.4）、（35.2±10.8）、（35.5±9.7） d，组间差异具有统计学意义（F=8.940，P=0.000）；3组的并发症发生率分别为37.0％、59.8％和45.0％，差异具有统计学意义（χ²=14.900，P=0.001）。结论 先天性耳廓畸形患儿通过耳模矫正可获得良好的治疗效果，14 d内开始治疗有助于提高治疗效率，缩短治疗时长，降低并发症发生率。     

初次甲状腺癌术后声带麻痹模型预测分析

目的 构建初次行甲状腺癌手术患者术后声带麻痹情况的预测模型,预测声带麻痹发生几率。方法 回顾性分析2012年1月—2022年2月收集的394例甲状腺癌患者的临床资料,根据术后有无声带麻痹分为声带麻痹组与无声带麻痹组。根据时间顺序,将2012年1月—2021年5月收集的358例患者作为建模组,2021年6月—2022年2月收集的36例患者作为验证组,运用单因素及多因素,分析两组临床患者基本资料,选择最合适的自变量构建Logistic回归模型,分析甲状腺癌术后声带麻痹的影响因素。内部通过十折交叉验证,外部验证通过比较建模组及验证组的区分度、校准度及临床有效性,绘制受试者工作特征(ROC)曲线、校准曲线及临床决策曲线,评估Logistic回归模型预测价值,计算约登指数、灵敏度、特异度、预测概率P值,根据P=1/1+e^-y,计算出Y值,最后绘制Nomogram图。结果 394例患者均一次完成甲状腺癌手术切除,术后41例患者发生声带麻痹,声带麻痹发生率为10.4%。Logistic回归模型可知喉返神经入喉处是否粘连(OR=11.804,95%CI为3.078~45.273)、术前Tg(OR=0.021,95%CI为0.002~0.202)、是否贴近喉返神经(OR=20.984,95%CI为2.058~214.007)、手术时间(OR=2.768,95%CI为1.122~6.829)是甲状腺癌术后声带麻痹的独立预测因素。十折交叉验证显示ROC曲线下面积为0.7284,建模组ROC曲线下面积为0.794 3(95%CI为0.716~0.872),验证组ROC曲线下面积为0.772 2(95%CI为0.526~1);Hosmer-Lemeshow拟合优度检测显示模型拟合较好,建模组Chi-Square=1.1,P=0.981 6,验证组Chi-Square=3.87,P=0.567 7;约登指数最大为0.188,此时灵敏度为0.57,特异度为0.62,ROC曲线下面积为0.59,P=0.216,为最佳临界值,根据P=1/1+e^-y,此时Y=-1.25。结论 本回归模型预测准确度较好,对甲状腺癌术后预防声带麻痹的发生具有一定的参考意义。     

二氧化碳激光与常规冷器械切除声带良性病变的疗效比较

目的 比较二氧化碳激光与常规冷器械切除声带良性病变的手术效果。方法 选取2017年12月—2020年12月于四川省会理市人民医院和四川省肿瘤医院接受治疗的200例良性声带病变患者,依据双盲法随机分为A组(100例)与B组(100例)。A组行常规冷器械法治疗,B组二氧化碳激光切除术治疗,术后对各组视频频闪、声学分析和语音障碍指数(VHI)进行评价。结果 两组结节、息肉、囊肿、黏膜白斑分布例数对比无明显差异(P>0.05)。两组术后3个月的闪烁噪声、嗓音抖动、基频均小于术前,术后3个月的最大发声时间大于术前。但两组术前和术后3个月的闪烁噪声、嗓音抖动、基频、最大发声时间对比差异无统计学意义(P>0.05)。两组患者术后3个月的VHI的躯体、功能、情感、总计得分均小于术前,但经比较差异无统计学意义(P>0.05)。结论 两种手术方法在处理良性声带病变方面都有良好的疗效,但各有其优缺点。     

个性化设计3D打印鼻前庭支撑器用于鼻前庭区狭窄治疗的临床研究

目的 分析个性化设计3D打印鼻前庭器支撑扩张与常规支撑扩张对鼻前庭区狭窄治疗后鼻腔通气功能和前鼻孔形态上恢复疗效的评价。方法 73例单侧外伤性鼻前庭区狭窄的患者,随机分为两组,35例对照组采用常规支撑扩张,38例试验组采用3D打印鼻前庭器支撑扩张,分别从主观评价指标、客观的局部形态结构参数和数值模拟鼻腔气流动力学参数等方面来评价两组患者术前和支撑扩张治疗后鼻腔局部形态和功能恢复情况。结果 两组患者支撑治疗后鼻塞主观感觉和鼻孔对称性满意度视觉模拟评分(VAS)均较术前有明显改善(P<0.05),在鼻孔对称性满意度方面试验组评分高于对照组(P＜0.05);支撑扩张治疗后两组的鼻瓣区截面积[对照组(0.86±0.29)cm²和试验组(0.71±0.26)cm²]均较手术前明显增加(P<0.05), 其中对照组鼻瓣区截面积均值大于试验组(P<0.05),但鼻孔形态学参数显示支撑扩张治疗后试验组Δ_长轴比值和Δ_短轴比值的值均小于对照组(P<0.05),在恢复鼻孔形态上个性化设计3D打印的鼻前庭支撑器支撑扩张治疗更优;支撑扩张治疗后两组的狭窄侧鼻腔阻力均分别低于术前(P<0.05),并且试验组[(0.022±0.008)Pa.s.mL^-1]比对照组[(0.028±0.012)Pa.s.mL^-1]有更小的狭窄侧鼻腔阻力值(P<0.05),但两组的总鼻腔阻力值差别不明显(P=0.64);鼻腔气流温度与湿度调节功能参数结果显示,支撑扩张治疗后对照组(94.55±2.54)%和试验组(95.26±3.21)%患者的鼻腔气流的加温效率较手术前[对照组(95.45±2.93)%和试验组(96.14±2.63)%]均有明显减小(P<0.05),但两组之间患者总鼻腔加温效率和加湿效率无明显差异(P均＞0.05)。结论 个性化设计3D打印鼻前庭支撑器用于前鼻孔狭窄患者的术后支撑扩张治疗使前鼻孔外形、鼻腔正常的通气功能和鼻腔气流的温湿度调节作用均有较好的恢复,能够体现个性化治疗的优势并让患者获得更为满意的疗效,可作为临床上鼻前庭局部支撑扩张治疗的补充,其临床应用前景较好。     

鼻声反射和鼻阻力测量在阻塞性睡眠呼吸暂停低通气综合征患者术后鼻功能评估中的应用

目的 探讨鼻声反射和鼻阻力测量在鼻腔扩容手术治疗鼻腔结构异常致阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者鼻功能评估中的应用。方法 选择经多导睡眠监测（PSG）确诊且经视觉模拟量表（VAS）评估具有鼻塞、鼻内镜及鼻窦CT检查证实结构异常的成年OSAHS患者36例作为研究对象。根据检查结果实施个体化的鼻内镜下鼻腔扩容手术。术前及术后6个月所有患者均进行VAS评估、鼻声反射测量和鼻阻力测量,比较手术前后测量结果。结果 患者术前VAS评估计分、鼻腔吸气总阻力、鼻腔呼气总阻力、鼻腔最小横截面积、鼻腔容积、最小横截面积至前鼻孔的距离分别为（6.97±1.27）分、（2.07±1.07）kPa/L·S^-1、（2.15±1.09）kPa/L·S^-1、（0.39±0.16）cm²、（2.20±0.97）cm³及（1.97±0.47）cm;术后6个月分别为（1.33±0.92）分、（1.69±1.03）kPa/L·S^-1、（1.90±1.02）kPa/L·S^-1、（0.51±0.17）cm²、（2.73±1.05）cm³及（2.19±0.46）cm。手术前后各指标差异均具有统计学意义（P均<0.05）。结论 鼻腔扩容术可以显著改善伴有鼻腔结构异常的OSAHS患者的鼻通气功能,鼻声反射和鼻阻力测量能客观评估鼻腔扩容手术治疗前后伴有鼻腔结构异常的OSAHS患者鼻通气功能的变化。     

29例外伤性大脑半球间硬膜下血肿的临床分析

目的 探讨外伤性大脑半球间硬膜下血肿(TISH)的治疗方法和预后。方法 回顾性分析华中科技大学同济医学院附属同济医院2014年8月—2019年5月收治的29例TISH患者的临床资料。患者治疗后2周由Glasgow预后量表(GOS)评估短期疗效。GOS 1~3分为疗效差,GOS 4~5分为疗效好。结果 疗效良好者20例,占69.0%,疗效差者9例,占31.0%。疗效好组治疗后2周Glasgow昏迷评分(GCS)平均为(14.6±0.7)分,疗效差组为(9.4±2.2)分,两组间比较差异具有统计学意义(P＜0.001)。单因素分析显示影响TISH疗效的因素包括合并合并脑挫裂伤(P=0.032),入院时GCS评分(P＜0.001),住院期间病变变化(P=0.049),住院期间GCS极低值(P＜0.001),治疗方式(P=0.016)和手术方式(P＜0.05)。重症TISH患者(GCS≤8分)中7例行手术治疗,3例非手术治疗。手术组预后良好者4例,预后差者3例;而非手术组3例患者短期预后均较差。结论 TISH临床少见,多数患者病情较轻经保守治疗效果较好。部分患者出现迟发性出血,颅内压增高,神经功能障碍等,需严密监护。重症TISH患者手术治疗能够改善预后。     

Comparison of the efficacy of vocal training and vocal microsurgery in patients with early vocal fold polyp

IntroductionVocal fold polyp is a benign proliferative disease in the superficial lamina propria of the vocal fold, and vocal microsurgery can improve the voice quality of patients with vocal fold polyp. In preliminary studies, we found that vocal training could improve the vocal quality of patients with early vocal fold polyp.ObjectiveThis study aimed to compare the efficacies of vocal training and vocal microsurgery in patients with early vocal fold polyp.MethodsA total of 38 patients with early vocal fold polyp underwent 3 months of vocal training (VT group); another 31 patients with early vocal fold polyp underwent vocal microsurgery (VM group). All subjects were assessed using laryngostroboscopy, voice handicap index, and dysphonia severity index, and the efficacies of vocal training and vocal microsurgery were compared.ResultsThe cure rates of vocal training and vocal microsurgery were 31.6% (12/38) and 100% (31/31), respectively. The intragroup paired-sample t-test showed that the post treatment vocal handicap index, maximum phonation time, highest frequency (F0-high), lowest intensity (I-low), and dysphonia severity index in both the VT and VM groups were better than those before treatment, except for the jitter value. The intergroup independent-sample t-test revealed that the emotional values of vocal handicap index (t = ? 2.22, p = 0.03), maximum phonation time (t = 2.54, p = 0.013), jitter (t = ? 2.11, p = 0.03), and dysphonia severity index (t = 3.24, p = 0.002) in the VT group were better than those in the VM group.ConclusionsBoth, vocal training and vocal microsurgery could improve the voice quality of patients with early vocal fold polyp, and these methods present different advantages.     

教师患嗓音疾病的危险因素与就诊态度的调查分析

目的 调查分析成都市教师患嗓音疾病的危险因素，了解教师患嗓音疾病后的就诊态度，为该地区教师嗓音疾病的防治提供理论依据。方法 共纳入360例教师患者，分为嗓音疾病组（177例）和无嗓音疾病组（183例），两组均完成调查表填写。结果 本组教师的嗓音疾病患病占比为49.2%，慢性喉炎（44.1%）和声带息肉（32.8%）是最常见的嗓音疾病，声嘶（81.9%）是最常见的嗓音症状。性别、学校类别、班级规模和语速是导致教师患嗓音疾病的危险因素（P<0.05）。61.6%教师患嗓音疾病后未寻求治疗。结论 教师易患嗓音疾病，性别、学校类别、班级规模、语速快是患嗓音疾病的危险因素。大多数教师患病后就诊态度不积极。因此，制定教师嗓音疾病防治方案十分必要。     

Vascular lesions of the vocal fold

The aim of the study was to present symptoms, laryngological findings, clinical course, management modalities, and consequences of vascular lesions of vocal fold. This study examined 162 patients, the majority professional voice users, with vascular lesions regarding their presenting symptoms, laryngological findings, clinical courses and treatment results. The most common complaint was sudden hoarseness with hemorrhagic polyp. Microlaryngoscopic surgery was performed in 108 cases and the main indication of surgery was the presence of vocal fold mass or development of vocal polyp during clinical course. Cold microsurgery was utilized for removal of vocal fold masses and feeding vessels cauterized using low power, pulsed CO₂ laser. Acoustic analysis of patients revealed a significant improvement of jitter, shimmer and harmonics/noise ratio values after treatment. Depending on our clinical findings, we propose treatment algorithm where voice rest and behavioral therapy is the integral part and indications of surgery are individualized for each patient. Part of the study results was presented as oral presentation at 5th Pan European Voice Congress (PEVoC), Graz, Austria, 28–31 August 2003.     

嗓音训练在单侧声带息肉术后嗓音恢复中的应用

目的 探讨单侧大、小声带息肉术后发声功能恢复规律和嗓音训练最佳时机.方法 选取68例武汉市第三医院耳鼻咽喉科行单侧声带息肉手术患者,根据与声带平行的息肉最大直径占同侧声带膜部1/3以下称为小声带息肉,1/3及以上为大声带息肉,分成大声带息肉组30例,小声带息肉组38例,每组随机分成嗓音训练组和禁声组;分别于术前1d,术...     

CO2 laser subtotal arytenoidectomy and posterior true and false cordotomy in the treatment of post-thyroidectomy bilateral laryngeal fixation in adduction

A total of 39 patients with bilateral post-thyroidectomy vocal cord paralysis in adduction underwent CO₂ laser subtotal arytenoidectomies with removal of the posterior third of the false and true vocal cords. Total airway resistance (R _tot) evaluated before and 4–10 months after surgery showed marked preoperative impairment before and significant improvement after surgery (P < 0.05). In five patients revision surgery was performed due to a progressive impairment of respiratory function. A variable degree of voice breathiness was observed after surgery; the maximum phonation time mean values were lower than normal and peak sound pressure levels 63 ± 5 dB. In three cases aspiration was present in the first postoperative days, but swallowing dysfunctions disappeared within 1 week. Subtotal arytenoidectomy with removal of the posterior third of the true and false vocal folds was found to be a satisfactory surgical treatment for bilateral vocal cord paralysis in adduction. However, further research is still needed to define the surgical procedure able to balance respiratory, phonatory and sphincteric functions optimally. Received: 26 September 1998 / Accepted: 25 February 1999     

Effects on voice by endolaryngeal microsurgery

Endolaryngeal microsurgery (EM) is functionally oriented. Therefore, assessment of vocal function is important to evaluate the effect of the surgery on voice. In all, 58 patients, including 26 patients with vocal cord nodules and 32 patients with vocal cord polyps, underwent EM. The patients’ voices were recorded and analyzed before EM and 2 weeks after. Analysis of voice quality included perceptual assessment and each patient’s own subjective evaluation of social acceptability of voice according to the 10.0 cm visual analogue scale (VAS) scale. Acoustic voice signal data were measured for fundamental frequency (F ₀), jitter, shimmer and normalized noise energy (NNE) using Tiger Electronics Dr. Speech software. Statistically significant (P < 0.001) improvement was achieved in both perceptual and acoustic analysis and in both patient groups. According to the VAS scale, a high degree of satisfaction with the surgery was achieved. The grade of hoarseness (G) as well as roughness (R) and breathiness (B) decreased significantly after the operation. EM resulted in a statistically significant decrease in the mean jitter, shimmer and NNE postoperatively. There were no significant changes in the F ₀ after EM. These results confirm a high degree of effectiveness of EM on vocal rehabilitation and meet the expectations regarding the assessment and documentation of postsurgical voice changes. Received: 26 September 1998 / Accepted: 23 February 1999     

Analysis of voice changes after thyroidectomy using the thyroidectomy-related voice and symptom questionnaire

ObjectiveAfter thyroidectomy, many patients suffer from voice problems and vague neck discomfort. The Thyroidectomy-related Voice and Symptom Questionnaire (TVSQ) is a self-administered questionnaire used to evaluate pre- and post-operative vocal status as well as throat and neck discomfort. We investigated voice conditions in thyroidectomy patients using the TVSQ as well as correlations between TVSQ responses and objective voice parameters. Also, we examined whether any clinicopathologic or surgical factors affect phonetic change after thyroidectomy.MethodsWe retrospectively reviewed the records of 242 patients who underwent total thyroidectomy to treat papillary carcinoma between January to December of 2019. Of these, we enrolled 232 who exhibited normal vocal cord mobility after surgery. TVSQ responses and acoustic voice analysis results were examined preoperatively and at 1, 3, and 6 months postoperatively. We subclassified patients into favorable and unfavorable TVSQ groups based on the increase in TVSQ score (△TVSQ ≥20) at 1 month postoperatively. We then investigated the difference of acoustic characteristics between two groups and analyzed the correlations between acoustic parameters and various clinical and surgical factors including pathologic results and lymph node status by subgroup.ResultAll acoustic voice parameters except for the noise-to-harmonics ratio were significantly worse at 1 month postoperatively and recovered over time, but the TVSQ score did not recover from the 1-month value until 6 months postoperatively. In the subgroups, among the many clinicopathologic factors examined, advanced N stage (p = 0.002) and high positive total and central-and-lateral-neck lymph node ratios were significantly associated with an increased risk of an unfavorable TVSQ (p = 0.049, 0.027, <0.01, respectively).Among the acoustic parameters, only the changes in TVSQ total score and voice score were correlated with deterioration in jitter and shimmer at 1 month postoperatively. However, the correlations was not statistically significant and had disappeared at 6 months postoperatively.ConclusionWe figured out that TVSQ was able to capture the negative effects of lymph node status and lymph node dissection on vocal outcomes after thyroidectomy. Although there was a weak correlation between worsened perturbation value and TVSQ changes, no other acoustic analysis parameters were statistically significant correlated with the TVSQ score.     

Efficacy of total intravenous anesthesia without intubation for laryngeal framework surgery

Conclusion. Total intravenous anesthesia (TIVA) without intubation has the advantages of both conventional general anesthesia and local anesthesia. It is useful in laryngeal framework surgery because intraoperative voice monitoring while the patient remains awake is required. Objective. In laryngeal framework surgery, it is desirable to monitor the voice during surgery. However, surgery is conducted under general anesthesia, although such a procedure renders the patient unable to phonate during surgery. We conducted TIVA without intubation, allowing patients to breathe spontaneously while undergoing operation, and succeeded in intraoperative voice monitoring with satisfactory postoperative voice production. Subjects and methods. The subjects were 21 patients who underwent surgery. For TIVA, propofol and pentazocine were used as a sedative and analgesic, respectively. A bispectral index (BIS) monitor was used to measure the depth of the anesthesia. Before the vocal folds were to be rotated, propofol administration was interrupted to arouse and instruct the patient to phonate. Guided by the phonation, the vocal folds were correctly positioned. Then propofol administration was resumed, and the wound was closed. Results. The BIS value during continued administration of propofol was around 60, but exceeded 90 in all patients within 233.6±64.5 s after cessation. They clearly remembered the conversation they had with us during surgery.