喉全切除后安装Blon—Singer发音管发声重建手术

文中对２７例喉全切除后安装Ｂｌｏｍ－Ｓｉｎｇｅｒ发音管的临床资料进行了分析讨论，除３例先访外，随访到２４例中２２例获得满意的语言效果，成功率为９１．６６％（２２／２４）无一例发生误咽等不良反应，表明本法简单，安全，有效，并介绍了术中及术后的注意事项。     

碳颗粒鼻粘膜下充填术治疗萎缩性鼻炎

本文采用碳颗粒对２２例重度萎缩性鼻炎患者行鼻粘膜下充填术。术后随访６～２４个月，结果：痊愈１８例，显效２例，有效２例。未出现排斥反应及脱落现象，是较理想的人工材料。     

全喉切除－期瓣膜式气管食管分路发音重建术的探讨──附24例报告

报告２４例全喉切除一期瓣膜式所管食管分路发音重建术，采用该术式，帮助患者恢复发音功能，收到满意效果，２２例发音重建成功，占９ｌ．７％。本文介绍了该术式的适应证，手术操作以及发音功能恢复情况，作者认为，无喉瓣膜式气管食管分路发音，吐字清晰，语言连贯性好，保持了患者原来语言特点，而已有效地防止了术后唾液漏，值得在临床中推广。     

人工骨下鼻甲粘膜下充填术治疗萎缩性鼻炎

我科于１９８９年采用羟基磷灰石微粒（简称人工骨）作填充物治疗萎缩性鼻炎３１例，部分患者作了术前、术后组织病理切片观察鼻粘膜变化情况，现将资料完整的２６例报告如下。一、资料与方法患者男４例，女２２例，年龄１８～５８岁，２４岁以下１６例，４１岁以上１０例...     

全喉切除—期瓣膜式气管食管分路发音重建术的探讨——附24例报告

报告２４例全喉切除一期瓣膜式气管食管分路发音重建术，采用该术式，帮助患者恢复发音功能，收到满意效果，２２例发音重建成功，占９１．７％，本文介绍了该术式的适应证，手术操作以及发音功能恢复情况，作者认为，无喉瓣膜式气管食管分路发音，吐字清晰，语言连贯性好，保持了患者原来语言特点，而且有效地防止了术后唾液漏，值得的临床推广。     

乙状窦后进路面神经干梳理术治疗半面痉挛

２２例半面痉挛患者行乙状窦后进路面神经干梳理术治疗，均取得良好近期疗效。其中１６例术后观察１～４年，痊愈１１例，显效３例。术中观察面神经有动脉袢压迫者１２例。该手术安全可靠，适应证宽，术后不遗有面瘫，无死亡。对术后听力减退、复发及其他问题进行了讨论。     

乙状窦后进路面神经干梳理术治疗半面痉挛

２２例半面痉挛患者乙状窦后进路面神经干梳理术治疗，均取得良好近期疗效。其中１６例术后观察１￣４年，痊愈１１例，显效３例。术中观察面神经有动脉袢压迫者１２例。该手术安全可靠，适应证宽，术后不遗有面瘫，无死亡。对术后听力减退、复发及其他问题进行了讨论。     

颈廓清术后复发癌的再手术治疗

报告３５例颈廓清术后复发癌的再手术结果。术中无１例死亡。术中发生颈动脉破裂２例，结扎血管后无严重后果；术后发生颈动脉破裂２例，其中１例死亡。发生咽瘩５例、乳糜瘘１例。术后１、３和５年生存率分别为５４％．３５．７％和２２．７％。尽管手术风险大，并发症严重，但手术达到了减轻患者痛苦、挽救或延长患者生命的目的。颈廓清术后的患者应定期接受检查，一旦发现肿瘤复发，应尽早再手术治疗。     

颈部带蒂肌皮瓣在喉部分切除术缺损修复的应用

为了提高喉部分切除术的治疗效果，用颈部带蒂肌皮瓣一期复喉部分切除术后组织缺损２２例，其结果术后喉功能全部恢复，术后随访３年生存率为８６．４％（１９／２２），５年生存率为８１．８％（１８／２２）。本文还介绍其手术方法，并对术后修复的适应症、禁忌症等进行讨论。我们的实践证明，以颈部带蒂肌皮瓣作为修复材料较为理想。     

透明质酸在鼓室成形术中的应用

报告对２３例病人行鼓室成形术中应用透明质酸，以加速术后创口愈合，２２例取得了良好的疗效，移植鼓膜成活率高，创面修复快，愈合后鼓膜萎缩率低，且可减轻术后听骨粘连，使病人听力稳定提高，表明ＨＡ值得在耳科领域推广应用。     

Voice following radiotherapy

This study was undertaken to provide information on the voice of patients following radiotherapy for glottic cancer. Part I presents findings from questionnaires returned by 227 of 235 patients successfully irradiated for glottic cancer from 1960 through 1971. Part II presents preliminary findings on the speaking fundamental frequencies of 22 irradiated patients. Normal to near-normal voice was reported by 83 percent of the 227 patients; however, 80 percent did indicate persisting vocal difficulties such as fatiguing of voice with much usage, inability to sing, reduced loudness, hoarse voice quality and inability to shout. Amount of talking during treatments appeared to affect length of time for voice to recover following treatments in those cases where it took from nine to 26 weeks; also, with increasing years since treatment, patients rated their voices more favorably. Smoking habits following treatments improved significantly with only 27 percent smoking heavily as compared with 65 percent prior to radiation therapy. No correlation was found between smoking (during or after treatments) and vocal ratings or between smoking and length of time for voice to recover. There was no relationship found between reported vocal ratings and stage of the disease. Data on mean speaking fundamental frequency seem to indicate a trend toward lower frequencies in irradiated patients as compared with normals. A trend was also noted in both irradiated and control groups for lower speaking fundamental frequencies in heavy smokers compared with non-smokers or previous smokers. These trends would indicate some vocal cord thickening or edema in irradiated patients and in heavy smokers. It is suggested that the study of irradiated patients' voices before, during and following treatments by means of audio, aerodynamic and acoustic instrumentation would yield additional information of diagnostic value on recovery of laryngeal function. It is also suggested that the voice pathologist could assist in evaluating and guiding patients in vocal usages during and following treatments.     

Voice changes in acromegaly

The fundamental frequency of 14 patients undergoing hypophysectomy was studied. Eight patients had acromegaly, 3 had a prolactinoma, and 3 had nonfunctioning adenomas. The fundamental frequency of 22 normal, healthy volunteers was measured for comparison. In addition, the external size of the larynx of all patients and volunteers was measured and a relationship between external laryngeal size and the mean fundamental frequency was identified in the volunteers. The mean fundamental frequency in patients with acromegaly was significantly lower than the other 6 patients undergoing hypophysectomy and, in addition, was also lower than the 22 normal volunteers. Postoperatively the fundamental frequency of the acromegalic patients increased rapidly to within the expected normal range. Patients with acromegaly have a lowered fundamental frequency which is most likely due to altered vocal cord mass and elasticity, which is a reversible change. Patients with acromegaly can expect a rapid and complete return of normal fundamental frequency within 2 weeks of surgery to remove the pituitary adenoma.     

Timing of removal of neck drains following head and neck surgery

Studies of the volume of drainage over a 24-hour period that is sufficient to allow for the removal of a neck drain after head and neck surgery have not been reported, and thus the timing of drain removal varies among surgeons and institutions. We conducted a prospective study of 47 patients who had undergone major head and neck surgery to determine the safety and cost-effectiveness of removing a neck drain when the amount of drainage over a 24-hour period fell to 50 ml or less. When the volume reached that point in any given patient, the drain was clamped, and if no fluid collection was observed the following day, the drain was removed. We found that drain removal according to this protocol was successful in 91% of cases, as only 4 patients (9%) developed a seroma following removal. No other complications were observed. In a separate analysis, we retrospectively reviewed the cases of 22 other patients who had undergone surgery at a different institution. Their drains were not removed until the drainage volume fell to 25 ml over 24 hours. It took a median of 1.3 days (range: 1 to 3) for drainage to fall from 50 ml to less than 25 ml over 24 hours. We conclude that drains can be removed safely when the volume falls to 50 ml or less over a 24-hour period. This would result in less morbidity, shorter hospital stays, and significant cost savings.     

鼻内进路歪鼻-鼻中隔矫正术

目的 探讨歪鼻-鼻中隔矫正的手术治疗效果。方法60例病人中22例行鼻中隔矫正术;14例行骨部歪鼻矫正术;24例行骨部、软骨部歪鼻矫正术(其中歪鼻合并鞍鼻矫正术8例,合并驼峰鼻矫正术3例)。结果 经随访6～24个月,60例病人中,歪鼻矫正良好54例(满意率90.0％)。结论 鼻内进路歪鼻-鼻中隔矫正术,适应症广泛、操作方便、效果满意、并发症少。术中矫正鼻中隔、彻底松解畸形部位的组织及矫正后的内外固定是保证手术成功的关键。     

Voice Handicap Index

BACKGROUND: The goal of this study was to assess and compare voice handicap in patients with benign organic and functional dysphonia. PATIENTS AND METHODS: Voice handicap was assessed using a German version of the Voice Handicap Index. A total of 108 German speaking patients, 64 women and 44 men aged 45.3+/-15.1 years with benign organic ( n=69) or functional ( n=39) voice disorders completed the questionnaire immediately after clinical examination and without knowing their individual diagnosis. Fifty individuals without voice complaints and normal voice status, 28 women and 22 men aged 47.1+/-15.5 years, served as controls. RESULTS: Significant differences ( P<0.001) were found between all dysphonic patients and the control group. When comparing dysphonic patients according to their gender and diagnosis group (organic or functional) no significant differences were detected. CONCLUSION: It can no longer be assumed that patients with functional voice disorders over emphasize their disease. The data obtained in this study prove that there are no gender specific differences in the way a voice disorder is experienced. There are also no differences in the way patients with a different language background experience their voice handicap.     

Voice prostheses: long-term follow-up retrospective study (three- to sixteen-year follow-up of 22 patients)

BACKGROUND: Thirty-five patients using tracheoesophageal voice with a 3- to 16-year follow-up were investigated. We analyzed functional voice outcome, voice prosthesis (VP) lifespan, and VP-related complications. METHODS: Between 1987 and 2001, 81 patients underwent total laryngectomy (TL). The 35 currently surviving patients (31 men, 4 women) were studied for VP lifespan and VP-related complications encountered up to 16 years after surgery. For voice rehabilitation, the 35 laryngectomies of our study required 178 prostheses. Short- and long-term voice results of 22 patients were compared by objective voice examination: maximum phonation time (MPT), intensity range (Int.), fundamental frequency (F0), frequency analysis (FA), and voice handicap index (VHI). RESULTS: Long-term results are: F0=131 (range: 30-250); Int=22.5 dB (range: 17-35 dB); MPT=4 sec (range: 2-12 sec); FA=3 (range: 1-4); VHI=38/120 (range: 8-73). Short- vs long-term outcome comparison shows the following values: F0: 93 vs 135 Hz; Int: 25 vs 24 dB; FA: 1 vs 3; and MPT: 21 vs 4 sec. The mean VP lifespan is 165.5 days for Provox (range: 2 days-30 months); 143.5 days for Blom-Singer (range: 10 days-24 months); and 195 days for VoiceMaster (6-7 months). Postoperative complications involved 12 cases of periprosthetic leakage (6.74%); 31 granulomas (17.4%); 3 partial stenoses of the tracheoesophageal tract (1.6%); and 1 temporarily removed VP (0.5%). CONCLUSIONS: Complications are generally resolved during standard office-setting examination. The commercially available VPs are complementary, used according to the diverse characteristics of each VP.     

Detection of Epstein-Barr Virus in Nasopharyngeal Carcinoma by In Situ Hybridization and Polymerase Chain Reaction

The association of Epstein-Barr virus (EBV) with nasopharyngeal carcinoma (NPC) has been shown by various methods. The purpose of this study is to identify the most useful method to detect EBV in NPC. Both polymerase chain reaction (PCR) for EBV-DNA and in situ hybridization for EBV-encoded small RNAs(EBERs) were examined in formalin-fixed, paraffin-embedded NPC specimens. In situ hybridization was performed in 56 cases, and PCR for EBV-DNA was performed in 42 cases. EBV-DNA was detected in 0 of 3 keratinizing squamous cell carcinomas(KSCC), 22 of 24 nonkeratinizing carcinomas (NKC), all 13 undifferentiated carcinomas (UNPC), and 0 of 2 adenocarcinomas (AC). EBERs were detected in 0 of 5 KSCC, 30 of 32 NKC, 16 of 17 UNPC, and 0 of 2 AC. Among them, EBERs was detected in 35 of 42 cases in which PCR was also performed, 0 of 3 KSCC, 22 of 24 NKC, all 13 UNPC, and 0 of 2 AC, respectively. Both results were consistent in 40 of 42 cases. We conclude that both PCR and in situ hybridization are useful to detect EBV in NPC. In situ hybridization has a particular advantage because it can demonstrate the localization of EBV in neoplastic cells. In addition, close association of NKC and UNPC but not KSCC and AC with EBV is suggested.     

Voice prosthesis in patients after total laryngectomy

The aim of the study is to present the role of voice prostheses in the voice rehabilitation in patients who underwent total laryngectomy. 7 patients with laryngeal cancer were included in the study. All patients are males aged 41-72 years (mean age 58) treated in the Department of Otolaryngology Medical Academy of Bialystok from November 2001 to March 2002. The voice prostheses were placed during the total laryngectomy in 5 patients. In 2 patients the voice prosthesis was placed in the period of 1.5 to 2 years after laryngectomy. The voice prostheses type Provox 2 were used in all cases. In 2 cases the prosthesis was in size of 8 mm, in 5 cases--10 mm. The control group included 7 patients after total laryngectomy without placing the voice prostheses. These patients developed oesophageal speech. All patients underwent phoniatric measurements during 12 to 30 days after the surgical procedure. The data indicate that patients who developed oesophageal speech, their voice in the range of subjective measurements is understandable but it is necessary to emphasize that the voice is harsh, low without fluency of the speech result from the intervals essential to accumulate the air in the oesophagus. The patients with voice prostheses have dull voice but more fluent and louder. The clarity of the voice of the patients with voice prostheses is significantly higher. According to the objective measurements all parameters are better in the oesophageal speech.     

Voice therapy in pediatric functional dysphonia: a prospective study

OBJECTIVE: We evaluated the efficacy of voice therapy according to Borragan's method associated to S. Magnani's vocal counselling in functional dysphonia in children. PATIENTS AND METHODS: We prospectively treated 16 patients with vocal fold nodules (10 males, 6 females). Age ranged from 6 to 11 years with a mean age of 9 years. We performed a full screening phoniatric evaluation. In addition psychological tests were carried out to investigate psychological background. RESULTS: We lost three patients at follow-up; one patient received surgery, eight patients healed (43.75%), four improved (25%). There was no statistical difference in the analysis of electroacoustical parameters while MPT significatively raised after therapy. CONCLUSION: If patients have motivation voice therapy could improve functional dysphonia in children. It is also important psychological background. Further studies on bigger populations with long-term follow-up are needed.     

Voice acoustic analysis in patients with a hearing aid or cochlear implant

The subject of our study was two groups of patients with hearing disorders: 23 cases implanted with multi-channel cochlear device (Nucleus Mini System 22) and 10 patients with perceptive hypoacusis who used hearing aids. The voice acoustic analysis was performed before cochlear implantation or application of a hearing aid and after a 6-month rehabilitation period. The acoustic analysis was carried out by means of a laryngophone connected to KAY 4300 instrument. The estimation of acoustic parameters of a laryngeal tone during rehabilitation process as well as parameters of spectrographic analysis was presented with the use of MDVP and CSL. Voice acoustic analysis can be an objective evaluation of progress in voice and speech rehabilitation process of patients with hearing disorders, particularly small children.