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Laryngo- Rhino- Otologie Jul 2024
Topics: Humans; Dysphonia; Botulinum Toxins, Type A; Pain Perception; Injections, Intramuscular; Neuromuscular Agents
PubMed: 38955149
DOI: 10.1055/a-2226-0970 -
Laryngo- Rhino- Otologie Jul 2024
Topics: Humans; Dysphonia; Botulinum Toxins, Type A; Injections, Intramuscular; Pain Perception; Female; Middle Aged
PubMed: 38955148
DOI: 10.1055/a-2226-0626 -
The Laryngoscope Jul 2024Myasthenia gravis (MG) is an autoimmune disease that affects the neuromuscular junction. MG patients may present de novo with primary otolaryngology complaints,...
INTRODUCTION
Myasthenia gravis (MG) is an autoimmune disease that affects the neuromuscular junction. MG patients may present de novo with primary otolaryngology complaints, including swallowing dysfunction. This study describes a range of unique presentations and rare diagnostic serologies, which have not previously been fully described.
METHODS
A retrospective review was performed of all patients presenting with primary symptom of dysphagia and subsequently diagnosed with MG. Data collected included demographics, clinical presentation, swallow studies, serology, imaging, treatment, and response.
RESULTS
Five patients met the inclusion criteria. Four endorsed dysphagia as primary complaint and one endorsed dysphagia and dysphonia. All patients underwent in-office swallow evaluations that showed vallecular or pyriform sinus residue. Three patients completed modified barium swallow studies that showed pharyngeal weakness and epiglottic dysfunction in all, and upper esophageal sphincter dysfunction in two. One patient with additional symptom of dyspnea was admitted and found to be in myasthenic crisis. Upon serologic evaluation, three patients were positive for acetylcholine receptor (AChR) antibodies only, one for muscle-specific-kinase (MuSK) antibodies only, and one for low density lipoprotein receptor-related protein 4 (LRP4) antibodies only. All patients received neurology evaluation and were treated with steroids, pyridostigmine, plasma exchange, or rituximab. In three patients with over 1 year follow-up, symptoms were significantly improved or resolved.
CONCLUSION
MG is an important differential diagnosis in patients with unexplained pharyngeal dysphagia. While workup can include AChR antibody screening, in seronegative patients with persistent symptoms, additional testing for MuSK and LRP4 may lead to diagnosis and effective treatment.
LEVEL OF EVIDENCE
Level 4 Laryngoscope, 2024.
PubMed: 38949061
DOI: 10.1002/lary.31601 -
Tremor and Other Hyperkinetic Movements... 2024Musician's focal task-specific dystonia is a complex disorder of fine motor control, with incomplete understanding of its etiology. There have been relatively few trials... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Musician's focal task-specific dystonia is a complex disorder of fine motor control, with incomplete understanding of its etiology. There have been relatively few trials of botulinum toxin in upper limb task-specific dystonia, and prior studies have yielded variable results, leading to skepticism regarding the utility of this approach in elite performers.
METHODS
We conducted a double-blind, placebo-controlled, randomized, cross-over study of incobotulinum toxin-A in 21 professional musicians with focal upper extremity task-specific dystonia affecting performance on their instrument, using a novel paradigm of initial injections followed by booster injections at two- and four-week intervals. The primary outcome measure was the change in blinded dystonia rating of the active arm by two expert raters using a Clinical Global Impression numeric scale at week 8 compared to enrollment.
FINDINGS
19 men and 2 women with musicians' dystonia were enrolled over a six-year period. Nineteen patients completed the study. Analysis of the primary outcome measure in comparison to baseline revealed a change in dystonia severity of P = 0.04 and an improvement in overall musical performance of P = 0.027. No clinically significant weakness was observed, and neutralizing antibodies to toxin were not found.
INTERPRETATION
Despite its small sample size, our study demonstrated a statistically significant benefit of incobotulinum toxin-A injections as a treatment for musicians' task-specific dystonia. Tailoring the use of toxin with booster injections allowed refinement of dosing strategy and outcomes, with benefits that were meaningful to patients clearly visible on videotaped evaluations. In addition to its application to musicians' dystonia, this approach may have relevance to optimize application of botulinum toxin in other forms of focal dystonia such as blepharospasm, cervical dystonia, writer's cramp, and spasmodic dysphonia.
Topics: Humans; Double-Blind Method; Male; Female; Botulinum Toxins, Type A; Dystonic Disorders; Cross-Over Studies; Adult; Music; Neuromuscular Agents; Middle Aged; Treatment Outcome; Occupational Diseases
PubMed: 38948014
DOI: 10.5334/tohm.903 -
Frontiers in Pharmacology 2024Tivozanib, a vascular endothelial growth factor tyrosine kinase inhibitor, has demonstrated efficacy in a phase III clinical trials for the treatment of renal cell...
BACKGROUND
Tivozanib, a vascular endothelial growth factor tyrosine kinase inhibitor, has demonstrated efficacy in a phase III clinical trials for the treatment of renal cell carcinoma. However, comprehensive evaluation of its long-term safety profile in a large sample population remains elusive. The current study assessed Tivozanib-related adverse events of real-world through data mining of the US Food and Drug Administration Adverse Event Reporting System FDA Adverse Event Reporting System.
METHODS
Disproportionality analyses, utilizing reporting odds ratio proportional reporting ratio Bayesian confidence propagation neural network and multi-item gamma Poisson shrinker (MGPS) algorithms, were conducted to quantify signals of Tivozanib-related AEs. Weibull distribution was used to predict the varying risk incidence of AEs over time.
RESULTS
Out of 5,361,420 reports collected from the FAERS database, 1,366 reports of Tivozanib-associated AEs were identified. A total of 94 significant disproportionality preferred terms (PTs) conforming to the four algorithms simultaneously were retained. The most common AEs included fatigue, diarrhea, nausea, blood pressure increased, decreased appetite, and dysphonia, consistent with prior specifications and clinical trials. Unexpected significant AEs such as dyspnea, constipation, pain in extremity, stomatitis, and palmar-plantar erythrodysaesthesia syndrome was observed. The median onset time of Tivozanib-related AEs was 37 days (interquartile range [IQR] 11.75-91 days), with a majority (n = 127, 46.35%) occurring within the initial month following Tivozanib initiation.
CONCLUSION
Our observations align with clinical assertions regarding Tivozanib's safety profile. Additionally, we unveil potential novel and unexpected AE signatures associated with Tivozanib administration, highlighting the imperative for prospective clinical studies to validate these findings and elucidate their causal relationships. These results furnish valuable evidence to steer future clinical inquiries aimed at elucidating the safety profile of Tivozanib.
PubMed: 38939844
DOI: 10.3389/fphar.2024.1408135 -
Parkinsonism & Related Disorders May 2024Botulinum toxin (BoNT) is first-line treatment for cervical dystonia (CD). Treatment of CD with BoNT usually requires injections every 3-4 months for as long as symptoms... (Review)
Review
INTRODUCTION
Botulinum toxin (BoNT) is first-line treatment for cervical dystonia (CD). Treatment of CD with BoNT usually requires injections every 3-4 months for as long as symptoms persist, which can be for the lifetime of the individual. Duration of BoNT effect can impact quality of life since it is important that efficacy is maintained throughout an injection cycle to avoid fluctuations of effect after each injection. There is currently no consensus on how to assess duration of BoNT effect in patients with CD.
METHODS
A scoping review was conducted to summarize the available evidence from phase 3 clinical trials of BoNT in CD and on the interpretation of the reported duration of effect. The available evidence was analyzed in the context of clinical experience and real-world treatment practices of CD.
RESULTS
Methods for estimating duration of effect varied across publications; most were based on artificial constructs developed for clinical trials (time until a pre-specified efficacy endpoint was reached) and are not appropriate to apply in clinical practice. Clinical trial outcomes in CD were not objectively evaluated, and did not prioritize patients' needs or focus on factors that impact patients' daily living activities and quality of life.
CONCLUSION
Better evidence and consistency of reporting for duration of effect for BoNT in CD is needed to help guide clinicians on when reinjection is likely to be required. The goal should be to keep patients as symptom-free as possible with flexible reinjection intervals tailored to individual needs.
PubMed: 38909588
DOI: 10.1016/j.parkreldis.2024.107011 -
Journal of Cardiothoracic Surgery Jun 2024This manuscript aims to describe the symptoms, demographics, surgical approaches and techniques, the volume of surgical interventions, histological results, intra- and...
BACKGROUND
This manuscript aims to describe the symptoms, demographics, surgical approaches and techniques, the volume of surgical interventions, histological results, intra- and postoperative complications, and postoperative results in patients with anterior mediastinal tumors of thyroid origin (AMTTO).
METHODS
Twenty patients with AMTTO were operated between 2017 and 2021. Fifteen were women and 5 were men. The mean age was 66.8 years.
RESULTS
The most common histology was nodular micro- and macrofollicular goiter (15/20, 75%). Kocher cervicotomy (65%) was the preferred approach. Total thyroidectomy was performed in 95% of patients. Intraoperative complications were identified in 25% (5/20), and in 2 patients a tracheostomy was required. Early postoperative complications were established in 65% and the most common was unilateral transient recurrent nerve paresis or paralysis and dysphonia (25%).
CONCLUSIONS
Commonly resection of AMTTO is a challenge due to its complexities associated with high-risk cases, emphasizing the need for experienced centers in managing such cases.
Topics: Humans; Male; Female; Aged; Mediastinal Neoplasms; Thyroidectomy; Middle Aged; Thyroid Neoplasms; Retrospective Studies; Postoperative Complications; Treatment Outcome; Adult; Intraoperative Complications; Thyroid Gland; Aged, 80 and over
PubMed: 38907269
DOI: 10.1186/s13019-024-02831-7 -
Journal of Voice : Official Journal of... Jun 2024The Dysphonia Severity Index (DSI) and Acoustic Voice Quality Index (AVQI) are the two widely used multiparameter acoustic instrumented indices that estimate dysphonia...
Comparison of Two Multiparameter Acoustic Voice Outcome Indices in the Treatment of Hyperfunctional Voice Disorders: Dysphonia Severity Index and Acoustic Voice Quality Index.
INTRODUCTION
The Dysphonia Severity Index (DSI) and Acoustic Voice Quality Index (AVQI) are the two widely used multiparameter acoustic instrumented indices that estimate dysphonia severity and track treatment outcomes. This study compared the performance of these two indices in identifying voice quality changes with eclectic voice therapy in individuals with hyperfunctional voice disorders (HFVD).
METHOD
Twenty individuals with HFVD including eight males and 13 females in the age range of 20-55 years received an eclectic voice therapy program named the Comprehensive Voice Habilitation Program. All the participants attended 15 sessions of voice therapy. DSI and AVQI measures were obtained at the baseline, immediate post therapy, 15 days post therapy (follow-up 1), and 60 days post therapy (follow-up 2). Repeated measures analysis of variance was performed to verify whether there were any differences between the time points for dependent variables DSI and AVQI. The effect sizes obtained for the DSI and AVQI measures were also noted.
RESULTS
A significant difference was obtained between the baseline and post therapy, follow-up 1 and follow-up 2 for AVQI measure with a very large effect size, ηp2 = 0.451. In contrast, DSI showed a significant difference only between the baseline and follow-up 1 with effect size, ηp2 = 0.187.
CONCLUSIONS
The results of this study confirmed that both DSI and AVQI were effective in tracking the changes in the severity of dysphonia. However, when compared, AVQI appeared to be more sensitive than DSI in potentially reflecting the effect of eclectic voice therapy in HFVD.
PubMed: 38906742
DOI: 10.1016/j.jvoice.2024.06.002 -
Brazilian Journal of Medical and... 2024Unilateral vocal cord paralysis is frequently observed in patients who undergo thyroid surgery. This study explored the correlation between acoustic voice analysis...
Unilateral vocal cord paralysis is frequently observed in patients who undergo thyroid surgery. This study explored the correlation between acoustic voice analysis (objective measure) and Voice Handicap Index (VHI, a self-assessment tool). One hundred and forty patients who had thyroid surgery with or without postoperative unilateral vocal cord paralysis (PVCP and NPVCP) were included. The patients were evaluated by the VHI and Dysphonia Severity Index (DSI) tools. VHI scores were significantly higher in PVCP patients than in NPVCP patients. Jitter (%) and shimmer (%) were significantly increased, whereas DSI was significantly decreased in PVCP patients. Receiver operating characteristics curve revealed that VHI scores were associated with the diagnosis of PVCP, of which VHI total score yielded an area under the curve (AUC) of 0.81. Among acoustic parameters, DSI was highly associated to PVCP (AUC=0.82, 95%CI=0.75 to 0.89). Moreover, we found a correlation between VHI scores and voice acoustic parameters. Among them, DSI had a moderate correlation with functional and VHI scores, as suggested by an R value of 0.41 and 0.49, respectively. VHI scores and acoustic parameters were associated with the diagnosis of PVCP.
Topics: Humans; Vocal Cord Paralysis; Male; Female; Middle Aged; Voice Quality; Adult; Severity of Illness Index; Thyroidectomy; Postoperative Complications; Speech Acoustics; Aged; ROC Curve; Disability Evaluation; Dysphonia
PubMed: 38896645
DOI: 10.1590/1414-431X2024e13528 -
International Journal of Language &... Jun 2024Sustained vowels are important vocal tasks that have been investigated in discriminating voice disorders using acoustic analysis. To date, no study has combined vowel...
BACKGROUND
Sustained vowels are important vocal tasks that have been investigated in discriminating voice disorders using acoustic analysis. To date, no study has combined vowel acoustic measures only that evaluate major aspects of the pathological voice signals in voice disorder discrimination.
AIMS
To investigate the value of vowel acoustic measures that quantify glottal noise, signal stability, signal periodicity, spectral slope and overall voice quality in discriminating female speakers with and without voice disorders.
METHODS & PROCEDURES
Sustained vowel /ɑ/ samples were extracted from 133 voice-disordered female patients and 97 non-voice disordered female speakers and were signal typed prior to analysis. Praat software was used to measure harmonics-to-noise ratio (HNR), glottal-to-noise excitation ratio (GNE), the standard deviation of fundamental frequency (F0SD) and cepstral peak prominence (CPPp); and the Analysis of Dysphonia in Speech and Voice (ADSV) program was used to measure CPPadsv, low/high spectral ratio (LH) and the cepstral/spectral index of dysphonia (CSID). Outcome measures included sensitivity, specificity, and discrimination accuracy.
OUTCOMES & RESULTS
As individual acoustic measures, only spectral-based measures showed good (CPPadsv) and acceptable (CSID) discrimination results. The HNR, GNE and CPPp measures had acceptable sensitivity but poor or non-acceptable specificity and discrimination accuracy. Logistic regression models with all Praat measures (F0SD, HNR, GNE, CPPp) plus ADSV measures (CPPadsv, LH or CSID) provided excellent sensitivity, good-to-excellent specificity and excellent discrimination accuracy. ROC analysis for all individual measures showed that CPPadsv, CSID, CPPp, GNE and F0SD had the highest area under the curve (AUC) values.
CONCLUSIONS & IMPLICATIONS
A combination of acoustic measures that evaluate the major aspects of vocal dysfunction resulted in good to excellent voice discrimination outcomes. Individual acoustic measures had lower discrimination ability than combined measures. The findings implied that acoustic measures extracted from a prolonged vowel were useful in voice disorder discrimination.
WHAT THIS PAPER ADDS
What is already known on this subject Acoustic measures hold great value in discriminating voice disorders from normal voices. However, no study has evaluated discrimination values of a combination of sustained vowel acoustic measures that quantify additive noise, signal stability, signal periodicity, spectral slope and overall voice quality in single-gender cohorts. Previous studies have not used signal typing (the classification of the acoustic signals) for time-based measures, impacting the reliability of discrimination. What this study adds to the existing knowledge This study was the first to implement signal typing to include sustained vowel samples of Types 1 and 2 signals for discrimination statistics. We showed that a combination of vocal acoustic measures using time- and spectral-based extraction from the sustained /ɑ/ vowel evaluating additive noise, signal stability, signal periodicity, spectral slope and overall voice quality resulted in good to excellent sensitivity, specificity and discrimination accuracy. As individual measures, traditional time-based measures such as HNR had rather limited discrimination values whilst spectral-based measures provided higher discrimination values. Measures that are sensitive to signal types have low discrimination ability. What are the potential or actual clinical implications of this work? The sustained vowel /ɑ/ is a relevant, universal vocal task for clinical application using acoustic measures to discriminate female speakers with and without voice disorders if signal typing is implemented. Clinical voice assessment using vowels may not be effective if relying solely on time-based measurements. Spectral-based measures perform better in voice disorder discrimination given their insensitivity to signal types. The most effective voice disorder discrimination could only be obtained using a combination of acoustic measures that quantify major phenomena in the signals of disordered voices. Using measures extracted from both programs, Praat and ADSV, is useful given that specific settings in a program may impact on discrimination accuracy.
PubMed: 38884559
DOI: 10.1111/1460-6984.13081