Introduction. Modern diagnostics of laryngeal diseases is based on the use of video endoscopic technologies. The authors of the article, having almost thirty years of experience with various methods of video endoscopy, proposed a classification of video endoscopic methods of laryngeal examination. Objective. To develop an algorithm for the application of various video endoscopic methods of laryngeal examination in voice professionals with functional and organic dysphonia. Materials and methods. From 2020 to 2022, 2308 patients aged 18 to 80 years (43.2 ± 11.5) were examined in the phoniatric department of the St. Petersburg Research Institute of ENT. There were 1424 women (61,7 %), 884 men (38,3 %) people. Functional dysphonia was detected in 705 (30,5 %) people, acute and chronic laryngitis in 668 (28,9 %), tumor-like formations in 436 (18,9 %), the remaining nosological forms were diagnosed in 499 (21,7). All the patients turned out to be representatives of voice-speaking professions and complained of dysphonia.For videolaryngoscopy, videolaryngostroboscopy, autofluorescence endoscopy, NBI–endoscopy, equipment from various manufacturers was used. Results. An algorithm for the application of video endoscopic research methods in persons of voice-speech professions with dysphonia has been developed. Overview videolaryngoscopy and videostroboscopy were mandatory research methods for all patients with complaints of voice function. The use of these two methods proved to be sufficient for the diagnosis of functional dysphonia, paresis and paralysis, congenital malformations of the larynx, scar stenosis. In-depth diagnostics and differential diagnostics of tumor-like formations, various forms of chronic laryngitis, benign and malignant formations, in addition to videolaryngoscopy and videostroboscopy, included autofluorescence endoscopy or NBI endoscopy, which revealed the earliest stages of the pathological process. Conclusions. Only the complex application of various methods of video endoscopy of the larynx provided timely diagnosis and early treatment of dysphonia, maximum restoration of voice function, and, consequently, the preservation of professional longevity by persons of voice-speech professions.
Among the symptoms of COVID-19, scientists pay the most attention to damage to the lower respiratory tract, neurological and cardiovascular systems, gastrointestinal tract, psychoemotional disorders and anosmia. Less common are articles about the state of auditory and vestibular as well as voice disorders. Inflammatory changes of the larynx, trauma due to intubation and severe coughing, neuropathy of the recurrent laryngeal nerve, consequences of the pathology of the bronchopulmonary system, psychogenic factors are indicated as the cause of dysphonia. The purpose of our study is to determine the structure of laryngeal morbidity in voice professionals during the COVID-19 pandemic. The analysis of case histories of 2,438 patients of voice professions who applied to the phoniatric department of the Saint Petersburg Institute of Ear, Throat, Nose, and Speech was performed. The diagnosis, a history of COVID-19, dysphonia directly during COVID-19 were considered. The number of patients compared to the period before the COVID-19 decreased by 39,8% due to anti-epidemic measures. The leading causes were functional dysphonia (29,3%), acute and chronic laryngitis (27,8%). Tumor-like disease are in third place (19,1%). Paresis of the larynx (8,5%) was diagnosed less frequently compared to the period before the pandemic, which is associated with a reduction in the number of elective operations on the organs of the head and neck. The frequency of laryngeal neoplasms (4,1%) has remained at the same level, almost half of them are malignant. Congenital malformations of the larynx were found in 2,9% of patients. Vascular pathology of the vocal folds was detected in 1.1%, scar stenosis, in 0,5%, rare diseases of the larynx, in 0,6% of patients. Appeals on the other occasions accounted for 6,1% of cases. 43,7% of patient have had COVID-19. The direct connection of dysphonia with COVID-19 was revealed in 18,0% of them. The most common cause of impaired vocal function against the background of coronavirus infection were functional dysphonia (39,1%) and inflammatory diseases of the larynx (34,9%). Tumor-like disease became the next most common (17,2%). Vascular pathology of the vocal folds was found less frequently (5,2%). Unilateral vocal fold paresis was detected in 3,1% of patients. One patient suffered from chondroperichondritis with granuloma formation in the area of the arytenoid cartilage of the larynx (0,5%). In relation to the total number of examined patients, COVID-19 as the cause of dysphonia was 7,9% of cases.
Phoniatry is a branch of otorhinolaryngology and deals with issues related to the diagnosis, treatment and prevention of voice disorders. Violations of voice function, especially in persons of voice-speaking professions, worsen the quality of life, affect interpersonal relationships, create difficulties in communication, and in some cases lead to professional unfitness. It is known that about 6% of the population suffers from voice disorders, and laryngeal diseases are 56 times more common among specialists of voice-speaking professions. The invention of the laryngeal mirror became a landmark event in the emergence of laryngology, and subsequently phoniatry. The process of voice formation is provided by the voice apparatus, which consists of four departments and forms a single functional system. The vibrations of the vocal folds are a complex physiological process as a result of which sound appears. But this sound is not like the voice we hear. He acquires his unique timbre in the resonator department. It is possible to assess the state of voice function with the help of video endostroboscopy of the larynx and acoustic research methods. These diagnostic methods complement each other and create the most objective representation of the voice and its disorders.
Introduction. Today the high prevalence of benign vocal fold lesions is shown (up to 55-70%). The possibilities of surgical management of this pathology are very extensive. Laser technologies are becoming more and more popular among high-tech treatment methods. However the comprehensive postoperative management of these patients is equally important.The aim of the study was to assess the features of the postoperative period in patients undergoing the endolaryngeal surgery using a semiconductor laser with a wavelength of 445 nm.Material and methods. On the basis of Saint-Petersburg Research Institute of Ear, Throat, Nose and Speech from February to June 2021 20 patients with benign vocal fold lesions 6 women and 14 men from 24 to 67 years old were examined and treated. All the patients underwent endolaryngeal surgery with direct microlaryngoscopy using a new semiconductor 445 nm laser in an inert gas atmosphere (intraoperative helium supply). After surgical treatment, the patients observed vocal rest, received antiinflammatory, antibacterial therapy, inhalations, as well as the drug Homeovox® according to the standard scheme.Conclusion. Endolaryngeal surgery with the removing of benign vocal fold lesions using a semiconductor laser with a wavelength of 445 nm has been proven to be safe and effective. According to the results of video laryngostroboscopy, acoustic analysis of the voice (the questionnaire “Voice handicap index-30”) it was noted that the laryngeal functions were restored in a short time. The inclusion of Homeovox® in the complex postoperative treatment had a favorable effect on the restoration of the phonatory function.
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