nesrine hamouda 1

1 faculty of medicine, alexandria university, otorhinolaryngology, alexandria

Aboras,Y.A.^*, Abd-Elfattah,H.^*, Emam,M.H.^**, Hamouda, N.H.^*

Faculty of Medicine, Alexandria University, Egypt

^* Department of Otorhinolaryngology.

^** Department of Physical Medicine

Objectives: To determine the diagnostic and prognostic role of laryngeal electromyography in vocal fold immobility and the relation between the different electromyographic patterns and both acoustic and aerodynamic measures.

Subjects & methods: Twenty patients with vocal fold immobility diagnosed by indirect rigid laryngoscopy were studied and followed up for six months for return of vocal fold motion. Each patient was subjected to laryngeal electromyography of the thyroarytenoid and cricothyroid muscles, acoustic and aerodynamic measurements at the time of presentation as well as after six months. A control group of 10 healthy subjects was included for comparative study.

Results: The specificity of laryngeal EMG was 100 %, whereas the sensitivity was 80% in diagnosing vocal fold immobility. The specificity of laryngeal EMG was 75%, while the sensitivity was 93.7% in predicting recovery in patients with vocal fold immobility. The Patients with reduced recruitment showed statistically significant higher mean flow rate, mean pressure and lower mean resistance.

Conclusion: Laryngeal electromyography is a useful adjunct to the diagnosis of vocal fold immobility. Laryngeal electromyography reflects vocal fold muscle tone as observed in acoustic and aerodynamic studies.

Jan Wouter Brunings 1 , Janneke J.B.F.G. Schepens 1 , Freek Bot 2 , Carine J. Peutz 2 , Bernd Kremer 1

1 Maastricht University Medical Centre, Otorhinolaryngology, Maastricht

2 Maastricht University Medical Centre, Pathology, Maastricht

Background: The quality of the female voice is altered under influence of the menstrual cycle and alters in hormonally different situations such as pregnancy and menopause. The underlying pathophysiology is unknown. The aim of this study is to prove the existence of estrogen receptors in the human vocal fold.

Methods: 34 vocal fold specimen obtained during surgery in 2006, were immunohistochemically investigated for ER and PR expression by two independent pathologists. In a second study 25 vocal fold specimen of laryngeal edema and laryngocele obtained during surgery from 2003-2006 were investigated.

Results: Specific immunohistochemical staining for ER was observed in the specimen of laryngeal edema and laryngoceles. No staining was seen in normal tissue. Unspecific staining patterns could be observed in cases with reactive changes such as cysts and polyps.

Conclusion: Our study demonstrates the expression of estrogen receptors in certain benign lesions of the female human vocal fold. Further research towards the function of estrogen receptors in laryngeal edema is advised.

Josef Schlömicher-Thier 1 , Matthias Weikert 1

1 Austrian Voice Institute, , Neumarkt

Professional singers are expected to meet very special demands. As freelance artists, they may have a full diary of engagements in opera houses and at music festivals all over the world, and only air travel enables them to attend rehearsals in one place and concerts in another.

If such a singer falls ill, a variety of individual factors arise. The decision to recast is made more difficult by responsibility towards the other members of the cast, anxiety on the part of the management, exertion of influence by the conductor and the director; recording contracts are tempting, and – last but not least – the audience wishes to see a radiant hero or heroine. In such cases, the physician in attendance assumes a high degree of responsibility. It is his duty to protect singers affected by indisposition from further damage which might have a fatal effect on their further career. He must also devise an effective concept of treatment which will enable patients to make full use of their voice again within the shortest possible time.

 

The voice specialist's primary concern is to protect his patients and to retain their trust. He must also act as a mediator between the singers and the intendant of the opera house or festival, and do his best to gain the confidence of both sides. Thus he has to make a precise estimate of the patient's condition and the voice rest time necessary before the next performance. Over-protective "safety advice" at every incipient infection ("Better stay at home for a week, and then we'll see how you're doing") only causes both sides to lose out: the singer loses his fee and the festival has to pay for a replacement. Only if both sides – the doctor and the management – collaborate in the best interests of the indisposed singer, is it possible to reorganise rehearsal schedules. One possibility is a "standby" replacement to sing in the orchestra pit while the indisposed singer acts out the complicated movements on stage. It is also important for the doctor to inform the artist director as soon as possible – even if it's midnight – that a standby may be required. This way, the singer is relieved of the burden of responsibility and the management gains time. The authors will familiar the auditorium with the special circumstances of the Salzburg Festival by casepresentation and videodocumentation and will present a study of 74 high professional femal and male singers at the Salzburg Festival over 5 festival seasons (2001-2005)

 

 

The motto here is:

Save the singer's fee, but avoid health risks.

Müller Rainer 1 , Albrecht Niemz 1

1 University-Hospital, ENT, Dresden