Læknablaðið : fylgirit - 01.06.2005, Blaðsíða 29

ABSTRACTS / XXIX CONGRESS OF THE NORDIC ASSOCIATION OF OTOLARYNGOLOGY
tant feature in development of cholesteatoma. We have previ-
ously shown that inflammation may cause a loss of stiffness in the
tympanic membrane, which in a long-term, negative middle ear
pressure situation may cause retractions.
Aim: To map the load bearing fibers in the normal situation and to
monitor how they may change during inflammation. The patterns
of the four most common collagen fiber types are assessed with
immunohistochemistry.
Preliminary results from normal rat ear: staining was more
intense for collagen types II and IV than for types I and III in the
pars tensa and in the fibrous annulus. Staining was more intense
for types I and II than for types III and IV in the suspending bony
ear canal. Staining for types III was the most intense in the attach-
ment of the fibrous annulus.
Discussion: This is the first study in a series of investigations aim-
ing to shed light upon the mechanisms behind the patophysiology
of cholesteatoma - perhaps the most important enigma of middle
ear pathology. The first preliminary results of the mapping of the
important stiffness bearing fiber structures of the tympanic mem-
brane are presented.
S-XI THE SOUNDS OF LARYNX
Abstract no.: 065
Metacholine-test in evaluation of possible non-specific
hyper reactivity in vocal tract
Lucyna Schalén, Viveka Lyberg Áhlander, Lars Malm, Roland Rydell,
Department of Logopedics, Phoniatrics and Audiology, Clinical Sciences,
Lund University, Lund, Sweden
The aim of the present study was to detect possible allergic dispo-
sition in patients complaining over hoarseness due to presence of
irritant factors in their working- or living environment.
Subjects and methods: eleven adult patients and eleven age- and
gender matched controls were tested. Standard allergy tests were
negative. Metacholine solution in increasing doses (3,6,12 mg)
or NaCl ( three times) were sniffed on two separate occasions,
with patient not knowing which substance was given. Subjective
complaints, results of exam of nose and throat, nasal secretion,
perceptual analysis of voice recordings and videolaryngostrobos-
copy were analysed before and after each sniffing.
Results: 9/11 patients reported sore throat, nasal- or breathing
obstruction, 6/11 reported hoarseness as well after Metacholine
as NaCl, and 2/11 became aphonic already after NaCl. All con-
trols reported slightly increased secretion in upper airway after
Metacholine and 9/11 also after NaCl, none among controls
reported hoarseness. Grade of hoarseness, as perceived by a
listener group, was somewhat higher in patients than in controls
already before testing. Voice pressure increased significantly with
increasing dose of Metacholine; however the similair change
occurred also after repeated sniffing of NaCI. There were no
detectable differences between patients and controls on videolar-
yngoscopy recordings after Metacholine and NaCl sniffing.
Conclusion: Sniffing of either NaCl or Metacholine may normally
cause slight increase in nasal secretion. In some persons repeated
sniffing of both substances may cause also additional respiratory
and vocal symptoms, perceived objectively as increased voice
pressure. It remains to investigate whether those symptoms
express a real mucosal hyper reactivity or if they rather signify a
protective reaction to fluid penetrating the upper airway.
Abstract no.: 066
Is lateralization thyroplasty an alternative for Botox treat-
ment in adductor spasmodic dysphonia?
Hans Mahieu, Amsterdam, The Netherlands
Although botulinum toxin is still considered the golden standard
for the treatment of adductor spasmodic dysphonia (ADSD),
increasing numbers of patients are requesting an alternative to
the life-long repeated botulinum toxin injections. Some are young
patients who are appalled by the prospect of the life-long repeat-
ed injections, others experience a decreased response to the injec-
tions and most find it difficult to accept the periodic voice changes
accompanying the initial paresis and the inevitable recurrence of
spasmodicity after some months.
Lateralization thyroplasty, consisting of a lateralization of
both thyroid ala following a vertical midline cartilage incision
and consequently an anterior lateralization of both vocal folds,
permanently prevents the occurrence of spasmodically ‘pressed’
phonation and sudden ‘voice stops’. As all laryngeal framework
surgeries these procedures are performed in local anaesthesia, in
order to enable voice monitoring and to determine the optimal
degree of lateralization. The aim of the procedure is to enable
phonation with less effort, not to obtain a normal voice. The
resulting voice will have a certain degree of breathiness as a result
of the intentionally created anterior incomplete glottis closure.
Patients have to realise that the voice will never be as good as
during the optimal period in the botulinum toxine cycle, but the
result will be permanent and it will certainly obtain the goal of
reducing the effort to speak.
Experience world wide is rapidly increasing and the results
in my personal series of 10 cases, the first case with a follow-up
of more than 4 years, is very promising, although careful patient
selection and counselling is essential, because of the breathy voice
quality.
In those patients suffering ADSD, who experience psychological
or voice problems, or ineffectiveness of botulinum toxin,
lateralization thyroplasty can present a very good alternative.
Abstract no.: 067
Digital High Speed recordings in the clinic
Roland Rydell, Phoniatrics/ENT, Lund, Sweden
A complete phoniatric or laryngologic evaluation of a voice
patient involves not only laryngoscopy but also control of the
vibratory function. This has earlier only been possible by use of
the stroboscope. High speed filming, due to cost and complexity,
has been a research tool only. With the development of digital
high speed systems based on ordinary PC’s, the stroboscope has
been challenged as the gold standard for judgement of vocal fold
vibration.
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Læknablaðið/Fylgirit 51 2005/91 29