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ABSTRACT: INTRODUCTION: Despite the relatively high prevalence of the polycystic ovary syndrome (PCOS) affecting up to 15% of all women of reproductive age, only little is known about vocal changes related to this endocrinologic disorder that is characterized by biochemical or clinical hyperandrogenism, impaired cycles, and/or polycystic ovaries. The aim of our study was to describe objective and subjective vocal changes in women with a diagnosed PCOS compared with a control group. MATERIALS AND METHODS: Our study group comprised 34 women-24 cases with confirmed PCOS and 10 controls in whom PCOS was excluded. A complete endocrinologic laboratory status was obtained by all participants; study procedures included a videolaryngostroboscopy, voice recording, and completion of the German version of the Voice Handicap Index. RESULTS: A trend toward lower mean fundamental frequency was detectable, but this failed statistical significance. No differences were found in the objective and subjective voice parameters. CONCLUSION: Elevated serum levels of androgens, as found in women with PCOS, were shown not to have an impact on the subjective and objective voice parameters.
Journal of voice: official journal of the Voice Foundation 11/2012; · 0.95 Impact Factor
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ABSTRACT: Tissue engineering is a multidimensional process combining cells, scaffold matrices, and chemical signals to produce a structure similar to a target tissue. These techniques have opened a completely new field in diagnosis and therapy in numerous fields, including that of laryngology. Laryngeal tissue engineering has emerged in the last decade, although clinical applications are rare. The reasons therefore are numerous including ethical reasons, as well as the extremely complex anatomical structure of the vocal fold. The search for new treatment options has also enlarged our knowledge about the microphysiology and micropathophysiology of the vocal fold. To date, only specific growth factors are in clinical use for treatment of vocal fold atrophy. Big advances have been made in creating state-of-the-art scaffolds with various techniques including biomaterials as well as fully synthetic polymers. These scaffolds are supposed to provide an optimal environment for residual or implanted cells. Several in vitro settings showed practicability of these scaffolds, also in studying effects of growth factors. Cell therapy is a powerful tool in regenerative medicine but bears the uncertainty of possible malignant transformation. The aim of this review was to give a comprehensive overview about current knowledge in the field of laryngeal tissue engineering and regenerative medicine, including restoration of both vocal folds and laryngeal cartilage, and furthermore to elucidate further trends in this fascinating field.
Journal of voice: official journal of the Voice Foundation 07/2012; 26(5):670.e7-670.e13. · 0.95 Impact Factor
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ABSTRACT: Low 25-hydroxycholecalciferol [25(OH) vitamin D] status is known to play an important role in many diseases with focus on bone health.
Based on recently reported genetic determinants of vitamin D insufficiency, we aimed to analyze genetic variants of group-specific component (GC), 7-dehydrocholesterol reductase (DHCR7), and cytochrome P450IIR-1 (CYP2R1) for association with vitamin D levels, bone mineral density (BMD), and bone fractures.
We conducted a cross-sectional BMD and fracture study and a prospective cohort study.
The cross-sectional study comprised participants of a BMD screening study, and the prospective cohort study comprised nursing home subjects.
The cross-sectional study included 342 subjects (mean age, 55.3 ± 12.0 yr), and the prospective study included 1093 subjects (mean age, 84.0 ± 6.0 yr).
Patients were stratified by GC, DHCR7, and CYP2R1 genotypes. For each gene, the allele associated with lower 25(OH) vitamin D levels was designated as "risk allele." The potential role of these risk alleles in fracture risk was analyzed by logistic regression analysis including age and sex as confounders.
We measured BMD and fractures.
GC genotypes were significantly associated with lower mean 25(OH) vitamin D levels in both cohorts (P = 0.001 and P = 0.048, respectively). There was no significant association of BMD with any of the genotypes. None of the alleles was associated with past fractures, whereas the DHCR7 G-allele was significantly associated with prospective fractures (odds ratio, 0.68; 95% confidence interval, 0.51-0.92; P = 0.011).
The DHCR7 gene polymorphism may be a predictor for fracture risk.
The Journal of clinical endocrinology and metabolism 04/2012; 97(7):E1234-40. · 6.50 Impact Factor
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ABSTRACT: Despite big advances in understanding the mechanisms of wound healing in vocal fold injury, it still remains unclear which are the decisive factors that lead to a complete restoration or to scarring. Among several other factors, stem cells are believed to play an important role in vocal fold restoration. Side population (SP) cells are considered to contain high numbers of stem cells and have gained great interest in the tissue engineering community. The aim of the following study was to investigate the recruitment pattern of SP cells in a rat vocal fold injury model.
Experimental animal study.
Unilateral vocal fold scarring was performed in Sprague Dawley rats. Larynges were harvested 1, 3, 5, 7, 14, 21, and 35 days after initial injury and were examined immunohistochemically for the presence of SP cells. This was done in coronal sections of the posterior and anterior macula flava as well as in the midportion of the vocal fold investigating the lamina propria.
The number of SP cells peaked significantly after 7 days in the midportion of injured vocal folds, with a return to pre-injury levels after 14 days. No increase was detected throughout the observed time in the contralateral side. The number of SP cells increased slightly but not significantly in both anterior and posterior macula flava.
Our findings suggest that SP cells may play an important role in early vocal fold wound healing and may serve as a possible therapeutic target.
The Laryngoscope 08/2011; 121(8):1662-7. · 1.75 Impact Factor
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ABSTRACT: Laryngeal framework surgery requires a good understanding of the biomechanics of the cricoarytenoid (CA) joint, the precise function of which is still only poorly understood. The aim of the study was (1) to show that, by superimposing two or more three-dimensional (3D) images, we can visualize the exact position of the arytenoid cartilages within the larynx at different phases of their movement; and (2) to demonstrate that it is possible to analyze the arytenoid cartilage movements mathematically with the help of vector analysis.
In vitro cadaver study.
Twenty fresh and intact cadaver larynges were scanned by high-resolution computerized tomography with the arytenoid cartilages in "respiratory" position and in "phonatory" position. The two positions were superimposed and rendered in 3D with MIMICS (Materialise Interactive Medical Image Control System, Leuven, Belgium). The spatial trajectory of the arytenoid cartilage movements was calculated with vector analysis.
The movement from the "respiratory" to the "phonatory" position has three components: (1) an inward rocking action around the longitudinal CA joint; (2) a forward sliding movement along the longitudinal axis of the CA joint; and (3) an inward rotation around a virtual axis that runs perpendicular to the CA joint axis.
Superimposing 3D images of the larynx with the help of the software package MIMICS allows us to visualize and to analyze mathematically the trajectory of the arytenoid cartilage. The arytenoid cartilages rock inward, slide forward, and rotate inward when they move from the "respiratory" to the "phonatory" position.
Journal of voice: official journal of the Voice Foundation 07/2011; 25(4):406-10. · 0.95 Impact Factor
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ABSTRACT: Genetic aberrations of DNA repair enzymes are known to be common events and to be associated with different cancer entities. Aim of the following study was to analyze the genetic association of single nucleotide polymorphisms (SNP) of the DNA repair genes with the risk of squamous cell carcinoma of the head and neck (HNSCC).
Genetic variants ERCC2 Lys751Gln (rs13181), ERCC2 Asp312Asn (rs1799793), XRCC1 Arg194Trp (rs1799782); XRCC1 Gln399Arg (rs25487), XRCC1 Arg280His (rs25489) and XRCC3 Thr241Met (rs861539) were analyzed in a primary study group comprising 169 patients with histologically confirmed HNSCC and 463 healthy control subjects. Polymorphisms associated with HNSCC were furthermore analyzed in an independent replication study including 125 HNSCC.
Only the ERCC2 751 Gln/Gln genotype was associated with HNSCC in the primary study (p=0.033) and in the replication study (p=0.023), resulting in an overall odds ratio of 0.54 (95% confidence interval 0.35-0.92; p=0.006).
Carriers of the homozygous ERCC2 751 Gln/Gln genotype may be at lower risk for HNSCC.
Experimental and Molecular Pathology 03/2011; 91(1):331-4. · 2.42 Impact Factor
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ABSTRACT: Laryngeal electromyography (LEMG) is an important tool for the assessment of laryngeal nerve and muscle functioning. The purpose of the study was to determine electrode insertion angle and insertion depth for the various laryngeal muscles.
Twenty-three cadaver larynges were examined with magnetic resonance tomography (MRT) and Materialize Interactive Medical Image Control System (Leuven, Belgium) 3-dimensional (3D) imaging software. Geometrical analysis was used to calculate the electrode insertion angles.
All laryngeal muscles could be identified and 3D visualized on MRT scans. Although the insertion angles were the same in male and female larynges, the insertion depth was significantly larger in male than in female larynges (P<0.05). Of particular clinical importance is the fact that the electrode has to be directed lateral and upward for the thyroarytenoid muscle but lateral and downward for the lateral cricoarytenoid muscle (insertion point=midline lower border of the thyroid).
This is the first study that analyzes electrode insertion angles and insertion depths for each laryngeal muscle using 3D imaging. We hope that the information gained from this study will help clinicians performing LEMG to localize the individual laryngeal muscles.
Journal of voice: official journal of the Voice Foundation 01/2011; 26(1):110-6. · 0.95 Impact Factor
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ABSTRACT: Considerable clinical and experimental data suggest that vitamin D plays a role in pathogenesis and progression of cancer; nevertheless clinical data for head and neck squamous cell carcinoma (HNSCC) are not available. The aim of our study was to associate tumor and clinical characteristics with status of vitamin D [25-hydroxyvitamin D (25(OH)D)]. 88 patients with newly diagnosed squamous cell carcinoma of the head and neck were included in the study. A blood draw was taken at the time of diagnosis. The observation period lasted from 2006 until 2010. Results: When compared to a cohort from an epidemiological study, serum levels of 25(OH)D were significantly reduced in patients with HNSCC. We furthermore found disease-free survival, as well as overall survival times to be significantly associated with 25(OH)D levels. In conclusion, results from our study suggest an influence of vitamin D status on cancer incidence, as well as on mortality of HNSCC.
Archives of Oto-Rhino-Laryngology 01/2011; 268(8):1201-4. · 1.29 Impact Factor
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ABSTRACT: Cricothyroid approximation (CTA) surgery aims at raising the voice pitch in male-to-female transsexuals. However, 30% of the patients are not satisfied with the result. The purpose of our study was to examine the cricothyroid joint (CTJ) biomechanics and to analyze if (and how) the CTJ anatomy influences the movement of the cricoid and, consequently, the elongation of the vocal fold and the voice pitch after CTA.
Twenty-four cadaver larynges were examined with high-resolution computerized tomography and MIMICS three-dimensional imaging software (Materialise Interactive Medical Image Control System, Leuven, Belgium). After superimposing the two scans taken in "neutral" and in "CTA" positions, vector geometrical analysis was used to determine the effective rotation axis of the CTJ and to calculate the elongation of the vocal folds after CTA.
Our results showed that the cricoid rotates around an axis, the position of which depends on the anatomical structure of the CTJ. Based on the location of this effective rotation axis, we could distinguish three groups. In group I (N=13), the rotation axis was located in the lower third; in group II (N=5), it was located in the middle third; and in group III (N=6), it was located in the upper third of the cricoid. The elongations of the vocal fold were 12%, 8%, and 3%, in groups I, II, and III, respectively.
The anatomical structure of the CTJ influences directly (1) the position of the effective rotation axis and (2) the elongation of the vocal folds.
Journal of voice: official journal of the Voice Foundation 10/2010; 25(5):632-7. · 0.95 Impact Factor
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ABSTRACT: Dysphonia is considered a major symptom of unilateral vocal fold paralysis (UVFP). Besides this, many patients complain of further symptoms such as dysphagia and dyspnea, which might not be expected to such an extent. The aim of this survey was to elucidate these symptoms in a cohort of patients with UVFP.
Sixty-three patients (22 men, 41 women) suffering from UVFP were interviewed. Therefore we developed a questionnaire dealing with each of the three symptom categories: voice production, swallowing and breathing.
All of the surveyed patients reported voice impairment, almost 60% complained of swallowing problems after the onset of paralysis. Seventy-five percent reported a subjectively impaired breathing sensation, not just phonatory dyspnea but during everyday physical activity as well.
Our study revealed a certain discrepancy between objectively assessed laryngoscopic findings and subjective symptoms. A majority of patients suffered from an impairment in each of the three laryngeal functions (dysphonia, dysphagia and dyspnea). The latter two differ from the classic approach to this condition but must be considered as well in clinical diagnostics and therapy.
Folia Phoniatrica et Logopaedica 10/2010; 63(3):142-6. · 1.12 Impact Factor
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ABSTRACT: To investigate the hypothesis that eosinophil major basic protein is released in high concentrations in the nasal mucus of patients with polypoid chronic rhinosinusitis.
Single center, open, prospective trial.
Medical University of Graz, Austria.
Patients with polypoid chronic rhinosinusitis (n = 23) were compared to three different control groups: patients with chronic rhinosinusitis-like symptoms but without general mucosal thickening, patients who underwent functional endoscopic sinus surgery for reasons other than chronic rhinosinusitis, and patients without sinus disease (total n = 21). Mucus was harvested from each patient using a standardized technique and analyzed for eosinophil major basic protein with an enzyme-linked immunosorbent assay.
In the patient group with polypoid chronic rhinosinusitis, 20 of 23 (87%) were positive for eosinophil major basic protein. In contrast, only one control patient was positive, whereas the remainder had no detectable amount of eosinophil major basic protein in the mucus (P < 0.001 vs chronic rhinosinusitis).
Toxic eosinophil major basic protein levels are elevated in polypoid chronic rhinosinusitis patients compared to control groups that have similar clinical presentations but upon closer examination turn out not to have chronic rhinosinusitis. In the future, the detection of eosinophil major basic protein in nasal mucus may become a sensitive and specific marker for chronic rhinosinusitis and a helpful diagnostic tool.
Otolaryngology Head and Neck Surgery 09/2010; 143(3):386-91. · 1.72 Impact Factor
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ABSTRACT: Topical antifungal treatment is a subject of discussion in the treatment of chronic rhinosinusitis. The aim of this research was to study the effects of antifungal drugs on ciliary beat frequency (CBF) of human nasal mucosa under in vitro conditions.
Case series of in vitro experiments and in vitro study of cultured ciliated cells of human nasal mucosa.
Human nasal mucosa was acquired during routine endoscopic sinus surgery. Cells were cultivated on object slides and exposed to different antifungal drugs in a newly developed test system. This system allowed continuous and reproducible exposure to different drugs at constant temperature, pH value, and osmolarity. The drugs were amphotericin B in two different concentrations and itraconazole.
Rinsing with higher concentrations of amphotericin B led to an immediate decrease of CBF, with a total stop after 15 minutes. A different result was seen in the group with lower concentrations; CBF decreased again quickly after rinsing with the test drug, but all of them recovered after rinsing with neutral solution. When using itraconazole a decline in CBF was observed again; one half of the samples returned to activity.
Our in vitro results demonstrate a dose-dependent effect of the antifungal drugs amphotericin B and itraconazole on ciliary beat frequency of human nose epithelium.
The Laryngoscope 07/2010; 120(7):1444-8. · 1.75 Impact Factor
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ABSTRACT: Discussions relating to the biomechanics of the larynx are still generally controversial. The purpose of this study is to develop a 3D model of the larynx based on high-resolution computer tomography (HRCT) data identifying and visualizing anatomical landmarks and structures of the larynx. We examined four fresh cadaver larynges with HRCT. The DICOM (Digital Imaging and Communication in Medicine) data were post-processed with the software package MIMICS for three-dimensional visualization. All relevant structures of the laryngeal cartilages could be identified on HRCT and visualized in a 3D model. We conclude that 1) HRCT provides excellent data for three-dimensional visualization of the laryngeal anatomy, and 2) the combined technology of HRCT and MIMICS is useful to study the biomechanics on 3D images and for preoperative planning of laryngeal framework surgery.
Logopedics, phoniatrics, vocology 04/2010; 35(1):19-23.
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ABSTRACT: We present two cases of tumorlike lipomatous lesions in the thyroid cartilage. Both presented as circumscribed tumors by ultrasonography and were identified accidentally.
Two tumorlike lesions were identified in two different patients. Additionally, computed tomography and magnetic resonance imaging scans of the laryngeal skeleton were performed. Surgery was performed in one patient, and the lesion was excised. Histopathology revealed fatty tissue with several foci of hematopoietic cells.
This is the first report of intralaminar tumorlike lipomatous lesions in the thyroid cartilage. These should be included in the differential diagnoses of primary cartilaginous lesions of the laryngeal skeleton.
Journal of voice: official journal of the Voice Foundation 02/2010; 25(4):487-9. · 0.95 Impact Factor
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ABSTRACT: Modern laryngeal framework surgery (LFS) requires an exact understanding of the laryngeal biomechanics and precise pre-operative planning, for which bi-planar imaging is not sufficient. The aim of the study was to test whether MIMICS, a commercially available software package for three-dimensional (3D) rendering of high-resolution computerised tomography (HRCT), is suitable for 3D imaging of the larynx, analysis of laryngeal biomechanics and pre-operative planning. We examined four cadaver larynx and one patient larynx. In the five larynges, all relevant structures and landmarks could be 3D visualised. Superimposing of two HRCT scans shows that when the arytenoids move from 'respiration' to 'phonation', they perform a rotating, translating and tilting motion. Moreover, we could demonstrate that the vocal fold elongates by 7% with cricothyroid approximation. We conclude that MIMCS is well suited for 3D imaging of the larynx, analysis of laryngeal biomechanics and pre-operative planning of LFS procedures.
Archives of Oto-Rhino-Laryngology 10/2009; 267(4):557-63. · 1.29 Impact Factor
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ABSTRACT: Ventricular fold phonation (VFP) is a phenomenon characterized by phonation using the false vocal folds. Besides a substitution voice due to loss of the true vocal folds-so called compensatory type-the noncompensatory types have a psychogenic, functional, or habitual background. Therapeutic options for these cases so far comprise voice therapy, pharmacological therapy (injection of anesthetics or botulinum toxin), and, in case of failure, surgical resection of the ventricular folds. Indication for aggressive surgical interventions is usually difficult, as there is always a risk of producing an irreversible state with an even worse situation. We present two cases of functional (psychogenic) VFP treatment refractory to conservative treatment. Lateralization of the ventricular folds by an endo-extralaryngeal temporary suture, similar to that used in bilateral vocal fold paralysis, was performed. Immediately after the procedure, a constant phonation at glottic level could be achieved in both cases. Sutures were removed 4 days after surgery, and phonation remained at the glottic level. Vocal fold phonation could be stabilized in the long run, and both patients recovered completely under additional voice therapy.
Journal of voice: official journal of the Voice Foundation 10/2009; 24(5):606-9. · 0.95 Impact Factor
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ABSTRACT: We present the first case of an endolaryngeal manifestation of a myxofibrosarcoma. These tumors represent a distinct clinicopathologic entity and are fibroblast-derived soft-tissue neoplasms usually arising in late adulthood. The tumor presented as an edematous swelling of the right vocal fold, appearing as a common Reinke edema. Surgery is the most common form of therapy, only a limited number of papers dealing with radio/chemotherapy exist due to the small number of cases. Unilateral cordectomy was performed, tumor was resected with negative surgical margins. This is the first report of an endolaryngeal myxofibrosarcoma. The tumor presented clinically as a unilateral swelling of the right vocal fold.
Journal of voice: official journal of the Voice Foundation 09/2009; 24(3):374-6. · 0.95 Impact Factor
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ABSTRACT: Microlaryngoscopy is the standard procedure for endolaryngeal surgery. The advantages are a steady operating field, bimanual handling and stereoscopic view in high-resolution magnification. The major drawback is that the oropharyngeal structures have to be brought into an unnatural position by the straight rigid laryngoscope with considerable forces occurring. These forces can lead to tissue injuries or even make a microlaryngoscopic operation impossible. To overcome these disadvantages, a few case studies using curved rigid laryngoscopes are published. However, there is still a lack of information to what extent curved rigid laryngoscopes could actually improve the endolaryngeal exposure with less forces occurring. It was the aim of this study to gain basic data on the forces that are needed for endolaryngeal exposure with a prototype of a curved rigid laryngoscope and to compare the occurring forces with straight laryngoscopes. In 30 consecutive patients scheduled for routine microlaryngoscopic procedures the curved laryngoscope was inserted and occurring forces were measured by a tension spring balance in four different head positions. A standard straight laryngoscope was inserted afterwards and measurements were taken again. Our results showed that the occurring forces could be reduced significantly in each head position when compared with a standard straight laryngoscope. Similarly, the anterior commissure could be exposed in a significantly higher percentage with the curved laryngoscope. In conclusion, we could show that even with a moderate-curved rigid laryngoscope a significant reduction of the forces to the oro-pharyngeal tissues can be obtained and that endolaryngeal exposure is possible in virtually all patients. Bimanual precise operations should be possible in the common way like in standard microlaryngoscopy with the only difference of not using a microscope, but operating via a monitor. We do not think that traditional microlaryngoscopy with straight instruments can or should be replaced by curved laryngoscopes, but these techniques could bridge the gap to indirect techniques in particular in specialised institutions dealing frequently with difficult patients and situations.
Archives of Oto-Rhino-Laryngology 05/2009; 266(10):1583-8. · 1.29 Impact Factor
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ABSTRACT: The objective was to describe influences of sex hormones on the male voice in an elderly cohort. Sixty-three elderly males were recruited to undergo assessment of voice parameters, stroboscopy, voice-related questionnaires, a blood draw, and an ultrasound examination of the laryngeal skeleton. The group was divided into men with normal hormonal status and men with lowered levels of sex hormones, called hypogonades. Depending on the level of androgens, voice parameters did not differ. In subjects with decreased levels of estrogens, a significant increase in mean fundamental frequency, as well as changes of highest and lowest frequency plus a shift of the frequency range could be detected. We could detect significant changes of voice parameters depending on status of estrogens in elderly males. Androgens appear to have no impact on the elderly male voice. To our knowledge, this is the first prospective study that correlates sex hormones with voice parameters in elderly men.
Journal of voice: official journal of the Voice Foundation 02/2009; 24(3):369-73. · 0.95 Impact Factor
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ABSTRACT: Considerable forces are exerted on oropharyngeal tissues during microlaryngoscopic procedures. Although it is generally accepted that positioning of the patient's head influences the quantity of these forces and the easiness of the exposure of the anterior glottis, there is a lack of systematic studies on this topic. The aim of our study was to measure the forces occurring during microlaryngoscopy in different positions. This should result in a recommendation for a "low-pressure" position which minimises the risk of postoperative complications due to tissue trauma. Thirty consecutive patients planned for microlaryngoscopy underwent study procedures. During general anaesthesia, measurements were taken using a tension spring balance in neutral position, during extension of the cervical spine, as well as under moderate and maximum flexion. Elevation of the patient's head thus flexing the cervical spine reduced the occurring forces significantly. Maximum elevation allowed a full exposure of the anterior commissure in all cases, whereas exposure of the anterior commissure was not possible even with maximum external counterpressure in almost 40% of cases with maximum extended cervical spine. The largest differences were observed between extension, neutral and flexion position, whereas the differences between moderate and maximum flexion were not significant. Elevation of the patient's head with consecutive flexion of the cervical spine allows for better exposure in microlaryngoscopy and reduces significantly the pressure exerted on the oropharyngeal tissues thus minimising the risk of tissue injury. A slight modification of standard instruments can be necessary when using this "low-pressure" position.
Archives of Oto-Rhino-Laryngology 02/2009; 266(7):999-1003. · 1.29 Impact Factor
