Psychogenic dysphonia: diversity of clinical and vocal manifestations in a case series

IntroductionPsychogenic dysphonia is a functional disorder with variable clinical manifestations.ObjectiveTo assess the clinical and vocal characteristics of patients with psychogenic dysphonia in a case series.MethodsThe study included 28 adult patients with psychogenic dysphonia, evaluated at a University hospital in the last ten years. Assessed variables included gender, age, occupation, vocal symptoms, vocal characteristics, and videolaryngostroboscopic findings.Results28 patients (26 women and 2 men) were assessed. Their occupations included: housekeeper (n = 17), teacher (n = 4), salesclerk (n = 4), nurse (n = 1), retired (n = 1), and psychologist (n = 1). Sudden symptom onset was reported by 16 patients and progressive symptom onset was reported by 12; intermittent evolution was reported by 15; symptom duration longer than three months was reported by 21 patients. Videolaryngostroboscopy showed only functional disorders; no patient had structural lesions or changes in vocal fold mobility. Conversion aphonia, skeletal muscle tension, and intermittent voicing were the most frequent vocal emission manifestation forms.ConclusionsIn this case series of patients with psychogenic dysphonia, the most frequent form of clinical presentation was conversion aphonia, followed by musculoskeletal tension and intermittent voicing. The clinical and vocal aspects of 28 patients with psychogenic dysphonia, as well as the particularities of each case, are discussed.     

Pharyngeal motility in patients submitted to type I thyroplasty

IntroductionType 1 thyroplasty is performed to improve glottis closure as well as dysphagic symptoms in patients with unilateral vocal fold immobility.ObjectivesThis study aims to compare the motility of the pharynx and upper esophageal sphincter in patients with unilateral vocal fold immobility before and after thyroplasty Type I.MethodsWe prospectively studied 15 patients with unilateral vocal fold immobility who underwent thyroplasty Type I. Subjects were divided according to the topography of vagal injury and presence of dysphagia. High resolution manometry was performed before and 30 days after surgery. Time and pressure manometric parameters at the topography of the velopharynx, epiglottis and upper esophageal sphincter were recorded.ResultsDysphagia was present in 67% of patients. 63% had lower vagal injuries. Manometric parameters did not change after thyroplasty for the whole population. The group of dysphagic patients, however, had an increase in residual pressure at the upper esophageal sphincter after thyroplasty (1.2 vs. 5.2 mmHg; p = 0.05). Patients with low vagal injury developed higher peak pressure (100 vs. 108.9 mmHg p ≤ 0.001), lower rise time (347 vs. 330 ms p = 0.04), and higher up stroke (260 vs. 266.2 mmHg/ms p = 0.04) at the topography of the velopharynx after thyroplasty.ConclusionPharyngeal motility is affected by thyroplasty Type I in patients with dysphagia and low vagal injury.     

Reconocimiento auditivo musical y melódico en pacientes con implante coclear,mediante nuevo método de programación de asignación frecuencial

Introduction and objectiveMusic is a universal, cross-cultural phenomenon. Perception and enjoyment of music are still not solved with current technological objectives of cochlear implants. The objective of this article was to advance the development and validation of a method of programming of cochlear implants that implements a frequency allocation strategy. We compared standard programming vs frequency programming in every subject.MethodsWe studied a total of 40 patients with cochlear implants. Each patient was programmed with a optimal version of the standard program, using the Custom Sound Suite 3.2 cochlear platform. Speech tests in quiet were performed using syllable word lists from the protocol for the assessment of hearing in the Spanish language. Patients implanted bilaterally were tested in both ears at the same time. For assessing music listening habits we used the Munich Music Questionnaire and «MACarena»(minimum auditory capability) software.ResultsAll patients achieved better results in recognition, instrument tests and tonal scales with frequency programming (P < .005). Likewise, there were better results with frequency programming in recognising harmonics and pitch test (P < .005).ConclusionsFrequency programming achieves better perception and recognition results in patients in comparison with standard programming. Bilateral stimulation patients have better perception of musical patterns and better performance in recognition of tonal scales, harmonics and musical instruments compared with patients with unilateral stimulation. Modification and frequency allocation during programming allows decreased levels of current intensity and increase the dynamic range, which allows mapping of each audio band less obtrusively and improves the quality of representation of the signal.     

Assessment of the light intensity of otoscopes utilized in teaching hospitals

IntroductionTo attain an accurate otoscopic diagnosis, a functioning device with adequate capacity must be used.ObjectiveEvaluate the light intensity of otoscopes, comparing it utilizing the batteries present at the moment of calibration and after new batteries were supplied.MethodsCross-sectional study of a historical cohort, which assessed 38 otoscopes, measuring the light intensity with the batteries present at the moment of assessment compared to the intensity with new batteries, as well as charge of the test batteries and the new batteries.ResultsThe mean of the sum of new batteries’ charge was 3.19 V, and of the test batteries was 2.70 V, representing a decrease of 18.02% in charge. The mean luminosity with the new batteries was 366.89 lumens, whereas in the test batteries it was 188.32 lumens, representing a decrease of 83.75% in the light intensity. Student's t-test was applied for data comparison, showing a statistical difference between the light intensity with the original batteries and the new batteries (p = 0.0001; CI = 0.95).ConclusionThere was a statistically significant difference between the proportions of light intensity in the otoscopes. A small variation in battery charge results in a great variation in light.     

Reproducibility (test–retest) of vestibular evoked myogenic potential

IntroductionThere is still no consensus in the literature as to the best acoustic stimulus for capturing vestibular evoked myogenic potential (VEMP). Low-frequency tone bursts are generally more effective than high-frequency, but recent studies still use clicks. Reproducibility is an important analytical parameter to observe the reliability of responses.ObjectiveTo determine the reproducibility of p13 and n23 latency and amplitude of the VEMP for stimuli with different tone-burst frequencies, and to define the best test frequency.MethodsCross-sectional cohort study. VEMP was captured in 156 ears, on the sternocleidomastoid muscle, using 100 tone-burst stimuli at frequencies of 250, 500, 1000, and 2000 Hz, and sound intensity of 95 dB nHL. Responses were replicated, that is, recorded three times on each side.ResultsNo significant difference was observed for p13 and n23 latencies of the VEMP, captured at three moments with tone-burst stimuli at 250, 500, and 1000 Hz. Only the frequency of 2000 Hz showed a difference between captures of this potential (p < 0.001). p13 and n23 amplitude analysis was also similar in the test–retest for all frequencies analyzed.Conclusionp13 and n23 latencies and amplitudes of VEMP for tone-burst stimuli at frequencies of 250, 500, and 1000 Hz are reproducible.     

Radiofrequency of the soft palate for sleep-disordered breathing: A 6-year follow-up study

ObjectiveTo determine the long-term (> 3 years) outcome of patients suffering from simple snoring or non-severe obstructive sleep apnea syndrome (OSAS) treated by radiofrequency ablation of the soft palate.Study designObservational retrospective study.SettingTertiary care university hospital.Subjects and methodsSeventy-seven subjects were included between 1999 and 2006. Twenty-seven suffered from mild or moderate OSAS. All patients were treated by radiofrequency-assisted stiffening of the soft palate, with or without uvulectomy. Snoring (assessed on a 10 cm visual analog scale (VAS)), marital status, presence of cardiovascular risk factors or pathologies and follow-up time were evaluated by postal questionnaire.ResultsMean follow-up time was 6.3 ± 2.3 years. Mean snoring intensity decreased significantly in the immediate postoperative period (8.1 ± 2.9 to 3.5 ± 2.2 cm on VAS). Over the longer term, however, we observed a significant increase in snoring intensity (5.7 ± 2.9 cm), which nevertheless remained below the preoperative values (P < 0.001). Bed-partners noticed a relapse of snoring in 92.7% of cases. Nine percent of couples separated. Hypertension and diabetes were diagnosed during follow-up in 12.1% and 6.6% of the subjects, respectively. A majority of patients failed to undergo repeat polysomnography or further treatment.ConclusionRelapse of snoring was observed in nearly all patients in the long run, although intensity appears to remain lower than preoperatively. Most patients did not comply with the follow-up instructions and did not seek other forms of treatment when recurrence occurred.     

Auditory attention in individuals with tinnitus

IntroductionTinnitus is characterized by the presence of a sound in the absence of external sound stimulus. In individuals with normal audiometry, it may be associated with auditory attention difficulty, especially in those who report high tinnitus annoyance.ObjectiveTo investigate auditory attention ability in individuals with tinnitus complaint.MethodsCross-sectional analytical observational study. We evaluated 30 volunteers with normal hearing (up to 25 dBHL): 15 with tinnitus (test group) and 15 with no complaints (control group), aged between 18-40 years. The volunteers answered the tinnitus handicap inventory questionnaire and a visual analogue scale. Subsequently, a basic audiological evaluation (meatoscopy, tonal and vocal audiometry, and imittanciometry) and psychoacoustic measures of tinnitus (loudness and pitch) were performed. To evaluate auditory attention, the following tests were performed: auditory cognitive evoked potential (P300), central auditory processing tests (dichotic digits test and speech-in-noise test) and sustained auditory attention ability test.ResultsIn the tinnitus handicap inventory, individuals with tinnitus had a mean score of 37.78 (±27.05), characterized as moderate degree. In the dichotic digits test (binaural separation), a difference was observed between the groups in both ears. Moreover, there was a difference in the speech-in-noise test in both ears (RE: p = 0.044; LE: p = 0.019), in P300 (p = 0.049) and in total sustained auditory attention ability test (p = 0.032). Also, there is a negative correlation between sustained auditory attention ability test, decrease in attentiveness and binaural integration (RE: p = 0.044; LE: p = 0.048).ConclusionsIndividuals with tinnitus had a poorer performance compared to the control group regarding auditory attention ability. Therefore, it is inferred that tinnitus is associated with poor performance in selective and sustained auditory attention in the assessed volunteers. These aspects should be considered for the management of patients with tinnitus.     

Retropharyngeal lipostructure in the treatment of velopharyngeal insufficiency: A prospective study and update

IntroductionRetropharyngeal lipostructure is a recent procedure in velopharyngeal insufficiency (VPI), offering an effective alternative to heavier surgery.ObjectivesTo update and assess retropharyngeal lipostructure as a treatment for VPI in the University Hospital Center of Rouen (France).Type of studySingle-center prospective study, from May 2012 to May 2014.Patients and methodsSix patients (4 girls, 2 boys) presenting with VPI were treated by retropharyngeal lipostructure. Age at surgery ranged between 6 and 12 years. Four of the patients bore a 22q11 microdeletion. Treatment was indicated in case of Borel-Maisonny type 2b (n = 2) or 2 m (n = 4) despite well-conducted speech therapy and of ≥ 50% velopharyngeal sphincter closure on nasal endoscopy. Patients were assessed preoperatively and at 3 months, by a multidisciplinary team. Borel-Maisonny type was assessed by a speech therapist. Nasality was measured on assisted vocal evaluation (EVA^®). Sphincter closure was assessed on dynamic MRI.ResultsBetween 6 and 8 cm³autologous fat was injected. At 3 months, 4 children showed 1-grade improvement in Borel-Maisonny type. Nasality decreased systematically, from a mean 14.5% preoperatively to 10.5% postoperatively. MRI showed improvement in all cases, with complete closure in occlusive vowels in 3 children.ConclusionEVA^® and MRI provide precise objective assessment of VPI. Retropharyngeal lipostructure is a simple, relatively non-invasive, reproducible technique, providing good results in VPI.     

Immediate effects of a rhino-pharyngeal clearance protocol in nasal obstruction and middle ear condition of children under 3 years of age with upper respiratory infections: A randomized controlled trial

Introduction and objectivesChildren up to 2 years old are at high risk of respiratory infections and nasal irrigation is often prescribed. Yet, to date there is no sufficient knowledge about its immediate effects on the nasopharynx and middle ear. Therefore, this study aimed to analyze the effect of a rhino-pharyngeal clearance intervention protocol on nasal obstruction and middle ear condition in children under 3 years of age with URTI.Materials and methodsRandomized controlled trial in a day-care centre of Porto, including 44 children randomized to Intervention Group (IG) and Control Group (CG). Nasal auscultation and tympanometry were performed at baseline (M0) as well as after the intervention (M1), which consisted of nasal irrigation (NaCl .9%) followed by a forced nasal inspiration in the IG, and after 30 min of normal activities, in the CG.ResultsIn M1 there was a lower frequency of children classified as having an obstructed nasal sound in the IG when compared to the CG (IG = 33.3%; CG = 68.4%; p = 0.042). We also observed an improvement of mean peak pressure (PP) in the IG (Left ear: M0 = −124daPa; M1 = −92daPa; p = 0.022. Right ear: M0 = −102daPa; M1 = −77daPa; p = 0.021), which was not observed in the CG (Left ear: M0 = −105daPa; M1 = −115daPa; p = 0.485. Right ear: M0 = −105daPa; M1 = −131daPa; p = 0.105). There were no significant results concerning the compliance of the tympanic membrane.ConclusionsThe rhino-pharyngeal clearance improved the nasal obstruction and PP of the middle ear of children under 3 years of age with URTI.     

Speech audiometry in noise: Development of the French-language VRB (vocale rapide dans le bruit) test

IntroductionUnderstanding speech in noise is a major challenge for most hearing-impaired subjects, with or without hearing aids. To overcome the weaknesses of French-language speech-in-noise tests, we developed a new instrument, with a balanced mix of difficulty of the speech material.Material and methodsThe speech material comprised 127 sentences taken from the “Marginal Benefit from Acoustic Amplification” (MBAA) corpus, each including 3 keywords. The noise was created using the “onde vocale globale” (global vocal wave: OVG), described by Dodelé. The 127 speech/noise pairs were recorded individually after root-mean-square equalization. The first experiment, on 10 normal-hearing adults, determined the signal-to-noise ratio (SNR) associated with 50% correct keyword identification in each sentence (SNR-50), using an ascending method with noise level set at 73 dB SPL. Relative levels between sentences and noise were then adjusted sentence by sentence to achieve an SNR-50 of 0 dB. The second experiment, with 12 normal-hearing adults, validated the equalization of sentence difficulty.ResultsMean SNR-50 was −6.64 dB (σ = 1.47). Mean adjusted SNR-50 was 0.08 dB (σ = 0.55). Mean psychometric curve slope was 19.3%/dB, with low standard deviations, testifying to the sensitivity of the speech material.ConclusionThe VRB (vocale rapide dans le bruit: rapid speech in noise) test is based on sentences from the MBAA corpus with background noise based on the OVG at different signal-to-noise ratios. The test is feasible and able to detect slight variations in speech-in-noise performance between subjects.     

Gender differences in binaural speech-evoked auditory brainstem response: are they clinically significant?

IntroductionBinaurally evoked auditory evoked potentials have good diagnostic values when testing subjects with central auditory deficits. The literature on speech-evoked auditory brainstem response evoked by binaural stimulation is in fact limited. Gender disparities in speech-evoked auditory brainstem response results have been consistently noted but the magnitude of gender difference has not been reported.ObjectiveThe present study aimed to compare the magnitude of gender difference in speech-evoked auditory brainstem response results between monaural and binaural stimulations.MethodsA total of 34 healthy Asian adults aged 19–30 years participated in this comparative study. Eighteen of them were females (mean age = 23.6 ± 2.3 years) and the remaining sixteen were males (mean age = 22.0 ± 2.3 years). For each subject, speech-evoked auditory brainstem response was recorded with the synthesized syllable /da/ presented monaurally and binaurally.ResultsWhile latencies were not affected (p > 0.05), the binaural stimulation produced statistically higher speech-evoked auditory brainstem response amplitudes than the monaural stimulation (p < 0.05). As revealed by large effect sizes (d > 0.80), substantive gender differences were noted in most of speech-evoked auditory brainstem response peaks for both stimulation modes.ConclusionThe magnitude of gender difference between the two stimulation modes revealed some distinct patterns. Based on these clinically significant results, gender-specific normative data are highly recommended when using speech-evoked auditory brainstem response for clinical and future applications. The preliminary normative data provided in the present study can serve as the reference for future studies on this test among Asian adults.     

Stromal and epithelial syndecan-1 expression in benign and malignant salivary gland tumors: which is more reflective of behavior?

IntroductionSalivary gland tumors are a diverse group of lesions, with various origins and extremely different behaviors, leading to a variety of outcomes for patients. Therefore, the need to discover novel markers with the ability to predict the behavior of benign and malignant salivary gland neoplasms is crucial. Syndecan-1 is a cell-surface protein with significant roles in various aspects of tumor function. Its expression in salivary gland neoplasms, especially their stromal component, has not been investigated.ObjectivesWe aimed to assess the immunopositivity of syndecan-1 in epithelial and stromal components of salivary gland neoplasms and to compare it between benign and malignant subtypes in addition to evaluating its correlation with clinicopathologic parameters.Methods133 salivary gland tumors were immunohistochemically stained with syndecan-1 and the intensity and percentage of this protein was determined, compared between the tumors and correlated with clinicopathologic factors.ResultsStatistical analysis of lesions with a sufficient sample size showed significant differences in percentage and intensity between both epithelial and stromal components of all tumors (p < 0.05). Pairwise-comparisons demonstrated significantly higher staining-percentage of epithelial cells (p = 0.02) in Warthin’s tumor compared to pleomorphic adenoma and adenoid cystic carcinoma. Similarly, significantly higher staining intensities and/or percentages was observed in mucoepidermoid carcinoma and adenoid cystic carcinoma compared to pleomorphic adenoma and Warthin’s tumor (p < 0.05). Of the clinicopathologic factors, there was only a significant negative correlation between stromal percentage of mucoepidermoid carcinoma and age and a significant difference between stromal intensity+percentage of adenoid cystic carcinoma and gender (p < 0.05).ConclusionsAccording to our findings we postulate that stromal syndecan-1 correlates with the behavior of salivary gland tumors, with malignant neoplasms demonstrating a higher expression, indicating a role for syndecan-1 in invasion and metastasis.     

Improving outcomes in a high-output pediatric otolaryngology practice

ObjectivesTo identify factors associated with efficient operating room work flow on high volume pediatric otolaryngology days and the effects on provider and perceived parent satisfaction.MethodsRetrospective review was performed of a sample of 20 days with greater than 10 cases per day performed by a pediatric otolaryngologist operating in 2 rooms. Turnover time and complications were the main outcome measures. Providers from otolaryngology and anesthesia that participated in these days were surveyed regarding efficiency, safety, and satisfaction.Results223 cases were performed over 20 operative days. The average turnover time was significantly longer in “major” surgeries (p = 0.03), cases with multispecialty involvement (p = 0.01), cases requiring intubation (p < 0.001), and in cases where a fellowship trained pediatric anesthesiologist (p = 0.01) or CRNA was present (p < 0.001). When comparing “fast” (<25 min average turnover) operative days vs. “slow” (>25 min average turnover) days, presence of a non-fellowship trained anesthesiologist (p < 0.001), and the presence of an anesthesiology resident (p = 0.03) were significantly associated with “fast” days, while the presence of a CRNA was associated with “slow” days (p < 0.001). A significantly greater proportion of patients required intubation on “slow” turnover days vs. “fast” days (p = 0.13). Only one complication was observed (0.4%). 48 providers were surveyed with a 63% response rate. Reported satisfaction amongst providers was significantly greater on days with at least 10 cases (p = 0.047) and on days with turnover times of 25 min or less (p < 0.001). Pre-operative nursing evaluation/preparation of the patient, inter-provider communication and delays in room cleaning/setup were identified most often as causative factors responsible for delays in turnover.ConclusionsHigh-operative volume operating days are common in pediatric otolaryngology and can be safely performed in an efficient manner. Appropriate scheduling and high-level communication between providers is needed to ensure success on these days. Identified areas of potential inefficiency can be a starting point for work flow optimization practices.     

Positive and negative post stapedotomy effects on cervical VEMP recordings; a STROBE analysis

AimsThe primary goal of the present study was to compare the pre- and post-stapedotomy elicitation and waveform characteristics of both air- and bone-conduction (AC-, BC-) cervical vestibular evoked myogenic potentials (cVEMPs) through an individualized approach. A possible association between audiological characteristics, such as AC- and BC- pure tone audiometry thresholds and air-bone gap and the production of cVEMPs before and after stapedotomy was also investigated.Material and methodsTwenty-five ears were subjected to full audiological evaluation as well as AC- and BC-cVEMPs pre- and post-stapedotomy. Four subgroups were studied; consistently present/absent, post-operatively disappeared and restored cVEMPs.ResultsPost-stapedotomy changes in cVEMP elicitability did not reach significance for either AC-cVEMP (OR = 5.41, 95% CI 0.88–33.36, P = 0.06) or BC-cVEMP (OR = 2.40, 95% CI 0.42–13.60, P = 0.3). Normal or abnormal AC-cVEMPs were equally subject to post-operative changes (OR = 1.95, 95% CI 0.32–12.01, P = 0.5), as were BC-cVEMPs (OR = 3.75, 95% CI 0.66–21.25, P = 0.1). Neither the audiological characteristics nor the surgical outcome, in terms of ABG results, were relevant to the presence or absence of AC- and BC-cVEMPs before or after stapedotomy.ConclusionsThe presumed changes brought to the sacculus by stapedotomy are minor and beyond the diagnostic abilities of either AC-cVEMPs or BC-cVEMPs, both in terms of cVEMPs elicitability and waveform characteristics. In individual cases, however, which may deserve further investigation, cVEMPs may reappear or disappear after stapedotomy probably following minor changes toward a lower or higher vestibular system resistance for pressure and sound transmission.     

Short-term hearing outcome of malleus removal for surgery: An observational cohort study

ObjectivesThe main goal of the present study was to assess hearing outcome for malleus removal in cholesteatoma surgery compared to a group with malleus conservation. The secondary aim was to compare the auditory involvement of the stapes between the two groups.Material and methodsA single-center observational study included adult patients operated on by ossiculoplasty for acquired cholesteatoma between 2015 and 2019. Endpoints comprised improvement in pure-tone average air-bone gap (PTA-ABG) and air-bone gap (ABG) at conversational frequencies and, independently, per frequency. 136 patients were included: 95 with conserved malleus (M+) and 41 with malleus removal (M(). Mean time to audiometric follow-up was 9 months in both groups.ResultsThe PTA-ABG improvement was 4.4 ± 12.6 dB for the M+ group and 3.8 ± 13.4 dB for the M? group, with no significant significance (P = 0.8). Better results (not exceeding 7.5 dB) were found for the M+ group at 2 and 8 kHz (P = 0.3 and P = 0.052 respectively). Presence or absence of the stapes did not affect the results in either group.ConclusionThose results suggest a negligible role of the malleus in early hearing outcome of tympanoplasty for cholesteatoma. A slight improvement was observed in the M+ group at 2 and 8 kHz, but its interpretation remains uncertain.     

Characterization of middle-ear condition of Oporto daycare children up-to 3 years-old: A cross sectional study

ObjectiveThe aim of this study was to determine tympanometric values of children who attend Oporto daycare centers and further analyze any relations with host and environmental factors.MethodsCross sectional study in a randomly selected sample of 117 daycare children up-to 3-years old from Oporto. Tympanometric measures were collected.ResultsChildren presented in left ear (LE) a mean peak pressure (PP) of −156.53 daPa and a mean compliance of 0.16 cm³. Right ear (RE) revealed a PP of −145.61 daPa and a compliance of 0.19 cm³. Normal tympanograms (type A) had a lower frequency than abnormal tympanograms (type B and type C). There was a positive association between age and compliance (LE: p = 0.016; RE: p = 0.013) and between the presence of rhinorrhea and PP (LE: p = 0.002; RE: p < 0.05). Abnormal tympanograms were more frequent in Spring (RE: p = 0.009), in younger children (LE: p = 0.03) and in children that had rhinorrhea (LE: p = 0.002; RE: p = 0.044).Healthy children had a mean PP of −125.19 daPa and a mean compliance of 0.21 cm³ in LE and a mean PP of −144.27 daPa and a mean compliance of 0.22 cm³ in RE.ConclusionTympanometric measures presented in this paper may be applicable to Oporto daycare children up-to 3 years-old. Most of daycare children revealed abnormal tympanograms. Age, rhinorrhea and season influenced children's middle-ear condition.     

Impact of upper airway abnormalities on the success and adherence to mandibular advancement device treatment in patients with Obstructive Sleep Apnea Syndrome

IntroductionThe mandibular advancement device (MAD) is a option to treat patients with Obstructive Sleep Apnea Syndrome (OSAS).ObjectiveTo assess the influence of upper airway abnormalities on the success of and adherence to MAD in patients with OSAS.MethodsProspective study with 30 patients with mild to moderate OSAS and indications for MAD. The protocol included questionnaires addressing sleep and nasal complaints, polysomnography, and upper airway assessment. The analyzed parameters of patients who showed therapeutic success and failure and those who exhibited good and poor treatment adherence were compared.Results28 patients completed the protocol; 64.3% responded successfully to treatment with MAD, and 60.7% exhibited good adherence to treatment. Factors associated with greater success rates were younger age (p = 0.02), smaller cervical circumference (p = 0.05), and lower AHI at baseline (p = 0.05). There was a predominance of patients without nasal abnormalities among patients treated successfully compared to those with treatment failure (p = 0.04), which was not observed in relation to adherence. Neither pharyngeal nor facial skeletal abnormalities were significantly associated with either therapeutic success or adherence.ConclusionMAD treatment success was significantly lower among patients with nasal abnormalities; however, treatment adherence was not influenced by the presence of upper airway or facial skeletal abnormalities.     

First assessment of sophrology for the treatment of subjective tinnitus

ObjectivesTo assess (without comparison versus controls) the efficacy of a sophrology protocol adapted to disabling subjective tinnitus, in diminishing the handicap induced by perception of tinnitus.Materials and methodsOne hundred and forty consecutive patients, aged 18–83 years, underwent a protocol comprising 6–8 sessions of sophrology over a 2–4 month period. Impact was assessed on pre- to post-treatment progression on the Tinnitus Handicap Inventory (THI), a validated questionnaire measuring handicap induced by tinnitus.ResultsMean THI scores improved, by > 20 points in 59.2% of cases (i.e., clinically significant decrease). Improvement was independent of tinnitus duration (> versus < 6 months) and origin (acoustic trauma versus emotional shock), and concerned all 3 THI subscales (functional, catastrophic and emotional).ConclusionThe present sophrology protocol, dedicated to subjective tinnitus, reduced intrusiveness. Further studies with a control group are needed to confirm efficacy as compared to waiting list or other validated treatments such as cognitive behavioral therapies.     

Influence of speech-language therapy on P300 outcome in patients with language disorders: a meta-analysis

IntroductionThe patient's evolution in the audiology and speech-language clinic acts as a motivator of the therapeutic process, contributing to patient adherence to the treatment and allowing the therapist to review and/or maintain their clinical therapeutic conducts. Electrophysiological measures, such as the P300 evoked potential, help in the evaluation, understanding and monitoring of human communication disorders, thus facilitating the prognosis definition in each case.ObjectiveTo determine whether the audiology and speech-language therapy influences the variation of P300 latency and amplitude in patients with speech disorders undergoing speech therapy.MethodsThis is a systematic review with meta-analysis, in which the following databases were searched: Pubmed, ScienceDirect, SCOPUS, Web of Science, SciELO and LILACS, in addition to the gray literature bases: OpenGrey.eu and DissOnline. The inclusion criteria were randomized or non-randomized clinical trials, without language or date restriction, which evaluated children with language disorders undergoing speech therapy, monitored by P300, compared to children without intervention.ResultsThe mean difference between the latencies in the group submitted to therapy and the control group was −20.12 ms with a 95% confidence interval of −43.98 to 3.74 ms (p = 0.08, I² = 25% and p value = 0.26). The mean difference between the amplitudes of the group submitted to therapy and the control group was 0.73 uV with a 95% confidence interval of −1.77 to 3.23 uV (p = 0.57, I² = 0% and p value = 0.47).ConclusionThe present meta-analysis demonstrates that speech therapy does not influence the latency and amplitude results of the P300 evoked potential in children undergoing speech therapy intervention.