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The drug effects on voice quality: Review of literature
OtolaryngologyHead and Neck Surgery Volume 121 N u m b e r 2
158
Detection and Treatment of Mediastinal Parathyroid Adenomas JAMES K FORTSON MD MBA; LANERDO THOMPSON MD; Atlanta GA; San Francisco CA
Objectives: To evaluate the accuracy of serum calcium levels in detecting, localizing, and treating mediastinal parathyroid adenomas after cervical exploration. Methods: A retrospective cohort study of 83 patients with primary hyperparathyroidism during a 13-year period was reviewed; 86% of these patients had cervical adenomas, and 14% had naediastinal adenomas. Neck exploration was performed for all cervical adenomas, and mediary sternotomy was performed in patients with mediastural adenomas. Results: Serum calcium levels dropped in patients with cervical adenomas if an adenoma remained in the neck. No decline in calcium levels was noted in patients with mediastinal adenomas. CT scans were of little value in localizing parathyroid adenomas. Accurate localization and detection of parathyroid adenomas was most successful when selective venous evaluation of PTH levels in the great veins was performed. Conclusion: Mediastinal parathyroid adenomas should be suspected if serum calcium levels do not fall after cervical exploration. 159 The Drug Effects on Voice Quality: Review of Literature NATASHA M A B R A G A MD; D O M I N G O S H TSUJI MD; SILVIA REBELO PINHO PHD; LUIZ U SENNES M D PHD; Sao Paulo Brazil
Objectives: Many drugs affect vocal production by distinct mechanisms. However, laryngostroboscopy and the perceptual analysis of the voice usually fail to determine the specific characteristics of this alteration. The aim of this study is to review the literature, classifying the voice alterations by the many groups of drugs and correlating with its pharmacological effect. Methods: The perceptual and acoustic analysis of the voice affected by the different drugs was reviewed. The pharmacology of the drugs was also reviewed. Then we correlated the pharmacological effects of the drugs according to subjective and objective vocal parameters, trying to determine the mechanism of influence. Results: The antihistamines, diuretics, vitamin C, and antitussive agents promote dehydration of vocal folds and increase phonation threshold pressure. Contraceptive drugs cause edema on the superficial layer of the lamina propria, lowering the vocal pitch and F0. Salicylic acid predisposes submucosa hemorrhage in vocal abuse. Anabolic steroids cause edema and hyperplasia of the connective tissue, decreasing pitch and increasing voice instability and creakiness. Neuroleptic drugs causes tardive dyskinesia, and neurostimulant drugs cause vocal tremor, rapid speech rate, and phonic tics.
Scientific Posters P253
Conclusion: The unknown undesirable effects of different drugs on the vocal quality and the lack of alterations in laryngoscopy contribute to misdiagnosis. The otolaryngologist and speech-language pathologist should be aware of this cause of dysphonia. 160
Quality of Life in Patients with Vestibular Disease THOMAS Y HUNG MD; DEBARA L TUCCI MD; DAVID L WITSELL MD; Durham NC
Objectives: Health-related quality of life was evaluated in 6400 patients seen in academic and private practice settings. Methods: All patients completed the Short Form Health Survey (SF-12) as a general health assessment. The survey measures physical, social, and emotional functioning; mental health; and general health perception. Scores are reported in 2 parts: a physical component score (PCS) and a mental component score. Results: The PCS was significantly reduced in patients with dizziness when compared with that in healthy controls. This reduced PCS score was equivalent to scores seen in patients with severe chronic diseases such as congestive heart failure or diabetes. Conclusion: Patients with vestibular disease severe enough to require medical attention perceive that these symptoms decrease their quality of life. 161
Sinusitis in HIV-Infected Patients: A Clinical and CT Scan Review IVAN DIEB MlZlARA MD: MARIO VALENTINI JR MD; Sao Paulo Brazil
Objectives: To describe the clinical and CT scan features of sinus disease in HIV-infected individuals, under antiviral treatment. Methods: Twenty-nine patients with a history and clinic diagnosis of sinusitis, receiving antiviral drugs, identified from 214 consecutive admissions to the HIV group of the ENT department of the Hospital das Clinicas (Sao Paulo University Medical School), between July 1995 and November 1998, were given a complete physical examination, laboratory evaluation, and CT scan of paranasal sinus. Results: A history of respiratory infections such as bacterial pneumonia and rhinitis was very common in those patients. We found predominantly individuals with a CD4 lymphocyte counts of less than 250/mm3. Although nasal congestion, headache, and postnasal drainage were found in the majority of patients, symptoms of sinusitis were nonspecific. CT was performed to define the extent of the disease, and the opacification of each sinus cavity was scored such that 0 = normal, 1 = <25%, 2 = 25% to 75%, and 3 = >75%. We found bilateral sinus disease in 16 patients (55.1%) and pansinusitis in 4
158
Detection and Treatment of Mediastinal Parathyroid Adenomas JAMES K FORTSON MD MBA; LANERDO THOMPSON MD; Atlanta GA; San Francisco CA
Objectives: To evaluate the accuracy of serum calcium levels in detecting, localizing, and treating mediastinal parathyroid adenomas after cervical exploration. Methods: A retrospective cohort study of 83 patients with primary hyperparathyroidism during a 13-year period was reviewed; 86% of these patients had cervical adenomas, and 14% had naediastinal adenomas. Neck exploration was performed for all cervical adenomas, and mediary sternotomy was performed in patients with mediastural adenomas. Results: Serum calcium levels dropped in patients with cervical adenomas if an adenoma remained in the neck. No decline in calcium levels was noted in patients with mediastinal adenomas. CT scans were of little value in localizing parathyroid adenomas. Accurate localization and detection of parathyroid adenomas was most successful when selective venous evaluation of PTH levels in the great veins was performed. Conclusion: Mediastinal parathyroid adenomas should be suspected if serum calcium levels do not fall after cervical exploration. 159 The Drug Effects on Voice Quality: Review of Literature NATASHA M A B R A G A MD; D O M I N G O S H TSUJI MD; SILVIA REBELO PINHO PHD; LUIZ U SENNES M D PHD; Sao Paulo Brazil
Objectives: Many drugs affect vocal production by distinct mechanisms. However, laryngostroboscopy and the perceptual analysis of the voice usually fail to determine the specific characteristics of this alteration. The aim of this study is to review the literature, classifying the voice alterations by the many groups of drugs and correlating with its pharmacological effect. Methods: The perceptual and acoustic analysis of the voice affected by the different drugs was reviewed. The pharmacology of the drugs was also reviewed. Then we correlated the pharmacological effects of the drugs according to subjective and objective vocal parameters, trying to determine the mechanism of influence. Results: The antihistamines, diuretics, vitamin C, and antitussive agents promote dehydration of vocal folds and increase phonation threshold pressure. Contraceptive drugs cause edema on the superficial layer of the lamina propria, lowering the vocal pitch and F0. Salicylic acid predisposes submucosa hemorrhage in vocal abuse. Anabolic steroids cause edema and hyperplasia of the connective tissue, decreasing pitch and increasing voice instability and creakiness. Neuroleptic drugs causes tardive dyskinesia, and neurostimulant drugs cause vocal tremor, rapid speech rate, and phonic tics.
Scientific Posters P253
Conclusion: The unknown undesirable effects of different drugs on the vocal quality and the lack of alterations in laryngoscopy contribute to misdiagnosis. The otolaryngologist and speech-language pathologist should be aware of this cause of dysphonia. 160
Quality of Life in Patients with Vestibular Disease THOMAS Y HUNG MD; DEBARA L TUCCI MD; DAVID L WITSELL MD; Durham NC
Objectives: Health-related quality of life was evaluated in 6400 patients seen in academic and private practice settings. Methods: All patients completed the Short Form Health Survey (SF-12) as a general health assessment. The survey measures physical, social, and emotional functioning; mental health; and general health perception. Scores are reported in 2 parts: a physical component score (PCS) and a mental component score. Results: The PCS was significantly reduced in patients with dizziness when compared with that in healthy controls. This reduced PCS score was equivalent to scores seen in patients with severe chronic diseases such as congestive heart failure or diabetes. Conclusion: Patients with vestibular disease severe enough to require medical attention perceive that these symptoms decrease their quality of life. 161
Sinusitis in HIV-Infected Patients: A Clinical and CT Scan Review IVAN DIEB MlZlARA MD: MARIO VALENTINI JR MD; Sao Paulo Brazil
Objectives: To describe the clinical and CT scan features of sinus disease in HIV-infected individuals, under antiviral treatment. Methods: Twenty-nine patients with a history and clinic diagnosis of sinusitis, receiving antiviral drugs, identified from 214 consecutive admissions to the HIV group of the ENT department of the Hospital das Clinicas (Sao Paulo University Medical School), between July 1995 and November 1998, were given a complete physical examination, laboratory evaluation, and CT scan of paranasal sinus. Results: A history of respiratory infections such as bacterial pneumonia and rhinitis was very common in those patients. We found predominantly individuals with a CD4 lymphocyte counts of less than 250/mm3. Although nasal congestion, headache, and postnasal drainage were found in the majority of patients, symptoms of sinusitis were nonspecific. CT was performed to define the extent of the disease, and the opacification of each sinus cavity was scored such that 0 = normal, 1 = <25%, 2 = 25% to 75%, and 3 = >75%. We found bilateral sinus disease in 16 patients (55.1%) and pansinusitis in 4