Vocal fold nodules in adult singers: Regional opinions about etiologic factors, career impact, and treatment. A survey of otolaryngologists, speech pathologists, and teachers of singing

This study was undertaken to better understand current regional opinions regarding vocal fold nodules in adult singers. A questionnaire was sent to 298 persons representing the 3 professional groups most involved with the care of singers with vocal nodules: otolaryngologists, speech pathologists, and teachers of singing. The questionnaire queried respondents about their level of experience with this problem, and their beliefs about causative factors, career impact, and optimum treatment. Responses within and between groups were similar, with differences between groups primarily in the magnitude of positive or negative responses, rather than in the polarity of the responses. Prevailing opinions included: recognition of causative factors in both singing and speaking voice practices, optimism about responsiveness to appropriate treatment, enthusiasm for coordinated voice therapy and voice training as first-line treatment, and acceptance of microsurgical management as appropriate treatment if behavioral management fails.     

Sociodemographic variables of a german sample of patients with contact granuloma

We report 28 German patients with contact granuloma (27 male, 1 female). Their mean age was 52 years (ranging from 35 to 70). Thirty-two percent were retired. The occupations of the others represented a wide range of different jobs. The majority of the sample had a middle educational level. Most patients lived with their family or with a partner. According to self-assessments, 68% had average daily strain on their speaking voice. All patients were nonsmokers. The patients felt themselves more disturbed by somatic troubles as the general population. Heartburn was felt by nearly half of the patients. A little more than half of the patients suffered from globus sensation. Thus, it is not possible at present to explain the laryngeal contact granuloma by sociodemographic data, vocal stress, or special somatic complaints in this sample. Therefore a multifactorial etiology should be supposed.     

柯萨奇-腺病毒受体在扩张型心肌病患者外周血白细胞表面的表达及意义

目的观察柯萨奇-腺病毒受体（CAR）在扩张型心肌病（DCM）患者外周血白细胞表面的表达及意义。方法选择DCM患者50例作为观察组,同期选择30例正常体检者作为对照组。入选后分别采用流式细胞术（FCM）检测外周血白细胞表面CAR表达水平;RT- PCR技术测定柯萨奇B组病毒-核糖核酸（CVB- RNA）表达;ELISA法检测CVB抗体效价。在客观比较病毒检测方法的同时,分析CAR在DCM患者中的表达及意义并探讨FCM在临床病原学检测中的价值。结果（1）经FCM技术检测,观察组外周血白细胞表面CAR表达水平较对照组升高（P＜0.01）,观察组CVB- RNA阳性22例（44.0%）,对照组阳性6例（20.0%）,差异有统计学意义（P＜0.05）;观察组CVB抗体阳性32例（64.0%）,对照组阳性10例（33.3%）,差异有统计学意义（P＜0.05）。（2）CVB- RNA阳性者中外周血白细胞表面CAR表达水平较阴性者明显升高（P＜0.01）;22例CVB- RNA阳性者中CVB抗体全部阳性,而28例CVB- RNA阴性患者中CVB抗体阳性者亦有16例。结论外周血白细胞表面CAR高表达的DCM患者可能存在病毒持续感染;FCM技术检测白细胞表面CAR表达水平可以作为DCM患者病毒感染的定量指标。     

不同病原体引起的儿童化脓性扁桃体炎的临床特点

目的探究不同病原体引起的儿童化脓性扁桃体炎的临床特点。方法选择2014年住院确诊且有明确病原体的化脓性扁桃体炎患儿97例,比较不同病原体引起的化脓性扁桃体炎的流行病学特点、临床症状与体征、实验室检查结果等。结果A族β溶血性链球菌（GABHS）、EB病毒、腺病毒和肺炎支原体（MP）引起的化脓性扁桃体炎患儿发病年龄分别为（6.29±2.17）、（3.41±1.81）、（3.35±2.50）、（3.88±2.95）岁,差异有统计学意义（P＜0.05）,其中GABHS感染患儿年龄最大。GABHS感染患儿发病年龄多在5岁以下,冬春季为发病高峰季节。有咽部出血点表现的多为GABHS和腺病毒感染,EB病毒感染患儿易出现肝、脾和颈部淋巴结肿大,腺病毒感染患儿易出现结膜炎。不同病原体引起的急性化脓性扁桃体炎患儿血清中性粒细胞（NC）、C-反应蛋白（CRP）、血清降钙素原（PCT）水平比较,差异均有统计学意义（均P＜0.05）;与GABHS感染患儿相比,EB病毒、MP感染患儿CRP水平均较低（均P＜0.05）,EB病毒、腺病毒和MP感染患儿PCT水平均较低（均P＜0.05）。结论在化脓性扁桃体炎患儿中,除GABHS感染外,腺病毒、EB病毒和支原体感染也占相当一部分。对于年龄＜5岁,冬末春初发病,有明显咽痛、咽后壁出血样表现,CRP明显升高,PCT＞0.5ng/ml的患儿,应考虑GABHS感染的可能,并及早、足疗程使用抗生素。     

儿童过敏性紫癜的临床特点及血淋巴细胞亚群的变化

目的探讨过敏性紫癜（HSP）患儿的临床特点及发病机制。方法对76例HSP患儿急性期的临床表现进行分析总结；并采用流式细胞仪分析技术及免疫比浊法对外周血淋巴细胞亚群（CD3、CD4、CD8、CD19、NK细胞）及血清补体C3进行检测，与30例健康儿童进行对照比较。结果76例患儿中发病同时或发病前2周内有呼吸道感染62例（81.6%）。76例患儿均先后出现紫癜，以双下肢皮肤紫癜最多见，合并消化道症状56例（73.7%），其中以消化道症状为首发症状21例（27.6%）；合并肾损害36例（47.3%），其以微量蛋白尿型、血尿和蛋白尿型为多见，肾病综合征型少见。HSP组急性期外周血CD4及NK细胞数量降低、CD19显著升高，与对照组比较，差异均有统计学意义（均P＜0.01）；血清补体C3增高，与对照组比较，差异有统计学意义（P＜0.05）；血CD8增高，但与对照组比较，差异无统计学意义（P＞0.05）。结论 HSP患儿发病与呼吸道感染有密切关系，胃肠道症状为首发症状的比例较高，合并肾损害也较多，但以微量蛋白尿型、血尿和蛋白尿型为多见，预后良好。儿童HSP的发病与T、B淋巴细胞及NK细胞的功能紊乱有关，且补体系统也参与HSP的发病。     

Etiology and treatment of psychogenic voice disorder:Results of a follow-up study of thirty patients

It is generally accepted that psychogenic voice disorder (PVD) is aresult of psychosocial stress; however, systematic studies of etiological factors in this condition are few. Furthermore, although immediate effects of therapy are estimated to be good, relapses are frequent, and the long-term effects of therapy are not known. The present prospective and longitudinal study on 30 patients was thus focused on possible etiological factors, the course of therapy, and the long-term results of therapy for PVD. The results indicate that interpersonal conflicts related to family and work are of basic importance in precipitating this condition. PVD is interpreted as a specific disorder of verbal emotional expression. Our therapy model in which vocal exercises are performed, together with training of communicative skills, seems rewarding. Relapses were not reported in 88% of the patients during the followup period of 1.9-8.4 years after therapy.     

Pattern recognition in muscle misuse voice disorders:How I do it

The diagnosis of the patient with a muscle misuse voice disorder can be a complex process. The dysphonia is usually caused by problems stemming from a number of interacting factors that may include habitual vocal technique and postural use, vocal behavior, emotion, manifestations of gastroesophageal refux, neuromuscular abnormalities, and associated organic mucosal disease. Sorting out the relative importance of the various factors is the first step towards planning an effective treatment program. This article addresses the difficulties caused by trying to classify dysphonia too rigidly, and presents a strategy for collecting the necessary information in a manner that facilitates the development of effective tools for clinical decision making. For each dysphonic patient, a pattern of causation will emerge in a way that helps the clinician to disentangle the interrelated factors.     

The Evolving Etiology of Bilateral Vocal Fold Immobility

In the past, bilateral vocal fold immobility (BVFI) occurred most commonly after thyroidectomy. However, no large series documenting the etiology of adult BVFI has been published within the past fifteen years. This study reviews the etiologic patterns of BVFI at our institutions. We compare BVFI from before and after 1980. We also review combined studies of unilateral vocal fold immobility (UVFI) to compare and unilateral versus bilateral etiologic trends. In comparison with previously published series, fewer cases of BVFI present today as a complication of thyroid surgery and more as the result of malignancies and nonsurgical trauma. Unfortunately, BVFI caused by malignancy is not usually an initial sign of local disease, but an ominous sign of recurrence or metastases. In comparing UVFI and BVFI we found that thyroidectomy causes a higher percentage of BVFI than of UVFI. Over one-third of UVFI cases were caused by neoplasm which further underscores the potential seriousness of immobile vocal folds and the need for careful investigation.