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Barillari MR, Nacci A, Bastiani L, Mirra G, Costa G, Maniaci A, Docimo L, Tolone S, Giumello F, Minichilli F, Chiesa Estomba CM, Lechien JR, Carroll TL. Is there a role for voice therapy in the treatment of laryngopharyngeal reflux? A pilot study. Acta Otorhinolaryngol Ital 2024; 44:27-35. [PMID: 38420719 PMCID: PMC10914355 DOI: 10.14639/0392-100x-n2742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/13/2023] [Indexed: 03/02/2024]
Abstract
Objective The aim of this study was to compare the efficacy of voice therapy combined with standard anti-reflux therapy in reducing symptoms and signs of laryngopharyngeal reflux (LPR). Methods A randomised clinical trial was conducted. Fifty-two patients with LPR diagnosed by 24 h multichannel intraluminal impedance-pH monitoring were randomly allocated in two groups: medical treatment (MT) and medical plus voice therapy (VT). Clinical symptoms and laryngeal signs were assessed at baseline and after 3 months of treatment with the Reflux Symptom Index (RSI), Reflux Finding Score (RFS), Voice Handicap Index (VHI) and GRBAS scales. Results Groups had similar scores at baseline. At 3-month follow-up, a significant decrease in RSI and RFS total scores were found in both groups although it appeared to be more robust in the VT group. G and R scores of the GRBAS scale significantly improved after treatment in both groups, with better results in the VT group. The VHI total score at 3 months improved more in the VT group (VHI delta 9.54) than in the MT group (VHI delta 5.38) (p < 0.001). Conclusions The addition of voice therapy to medications and diet appears to be more effective in improving treatment outcomes in subjects with LPR. Voice therapy warrants consideration in addition to medication and diet when treating patients with LPR.
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Affiliation(s)
- Maria Rosaria Barillari
- Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, “L. Vanvitelli” University, Naples, Italy
- Laryngology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS)
| | - Andrea Nacci
- ENT Audiology and Phoniatric Unit, University of Pisa, Pisa, Italy
| | - Luca Bastiani
- Clinical Physiology Institute, Consiglio Nazionale delle Ricerche Area della Ricerca di Pisa (CNR), Pisa, Italy
| | - Giuseppina Mirra
- Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, “L. Vanvitelli” University, Naples, Italy
| | - Giuseppe Costa
- Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, “L. Vanvitelli” University, Naples, Italy
| | - Antonino Maniaci
- Laryngology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS)
- Department of Medical, Surgical and Advanced Technologies G.F. Ingrassia, ENT Section, University of Catania, Italy
| | - Ludovico Docimo
- Division of General, Mininvasive and Bariatric Surgery, “L. Vanvitelli” University, Naples, Italy
| | - Salvatore Tolone
- Division of General, Mininvasive and Bariatric Surgery, “L. Vanvitelli” University, Naples, Italy
| | - Federica Giumello
- Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, “L. Vanvitelli” University, Naples, Italy
| | - Fabrizio Minichilli
- Clinical Physiology Institute, Consiglio Nazionale delle Ricerche Area della Ricerca di Pisa (CNR), Pisa, Italy
| | - Carlos M. Chiesa Estomba
- Laryngology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS)
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Donostia-Biodonostia Health Research Institute, Donostia-San Sebastian, Spain
| | - Jerome R. Lechien
- Laryngology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS)
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, Paris Saclay University, Paris, France
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium
| | - Thomas L. Carroll
- Department of Otolaryngology-Head and Neck Surgery, BWH Voice Program, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
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Barillari MR, Volpe U, Mirra G, Giugliano F, Barillari U. Surgery or Rehabilitation: A Randomized Clinical Trial Comparing the Treatment of Vocal Fold Polyps via Phonosurgery and Traditional Voice Therapy with “Voice Therapy Expulsion” Training. J Voice 2017; 31:379.e13-379.e20. [DOI: 10.1016/j.jvoice.2016.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 07/04/2016] [Accepted: 07/06/2016] [Indexed: 10/21/2022]
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Vangieri B, Parlato A, Mirra G, Russo A, Gattoni A. [Secondary pulmonary hypertension in the elderly: pathophysiological and clinical aspects from an observed case]. Clin Ter 2007; 158:317-323. [PMID: 17953283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The authors report the case of a 76-year-old woman with severe pulmonary hypertension (80 mmHg). She had been suffering for years from chronic bronchitis and presented tricuspid insufficiency. The case report refers to the association between valvular insufficiency and/or chronic bronchitis and pulmonary hypertension. This condition--if severe--results in progressive disability and death. The treatment of severe pulmonary hypertension has not been taken into account, since it has proven to be ineffective and has side effects. The early detection and the prevention of the underlying causes represent the only available therapy. Sclerotic valvulopathy occurs more frequently in the elderly; it represents the major cause of valvular insufficiency/stenosis, especially if compared to the significant decrease in rheumatic disease in Western countries. Chronic bronchitis is characterized by a slow progression, in patients younger than fifty, by a decay worsened by aging. These data show that symptomatic pulmonary hypertension may often occur in the elderly (age > or =65 years). This paper results from our clinical experience on preventive measures in elderly patients with symptomatic pulmonary hypertension. If the material presented in this work succeeds in promoting new research or possible preventive measures to arrest or to slow down the course of this condition in the elderly, it will hit its target.
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Affiliation(s)
- B Vangieri
- Dipartimento di Clinica e Medicina Sperimentale F. Magrassi, II Università, Scuola di Medicina, Napoli, Italia
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Palombo C, Kozakova M, Morizzo C, Andreuccetti F, Tondini A, Palchetti P, Mirra G, Parenti G, Pandian NG. Ultrafast three-dimensional ultrasound: application to carotid artery imaging. Stroke 1998; 29:1631-7. [PMID: 9707205 DOI: 10.1161/01.str.29.8.1631] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Three-dimensional (3-D) vascular ultrasound can be expected to improve qualitative evaluation of vessel pathology and to provide quantitative data on vascular morphology and function. The objective of this study was to develop an ultrafast 3-D vascular system and to validate its performance for quantitation of atherosclerosis and assessment of regional arterial distensibility. METHODS The quantitative analysis of focal atherosclerotic lesions was validated in vitro on 27 phantoms of fibroadipous plaques of known volume (range, 100 to 600 mm3). In vivo reproducibility of plaque volume measurement was tested in 33 patients who had a total of 47 predominantly fibroadipous carotid plaques. Distensibility assessment was validated indirectly through the evaluation of age-related changes in distensibility of common carotid artery in healthy and hypertensive subjects (25 men in each group). RESULTS The volume of plaque phantoms measured from the 3-D data set showed a very close correlation with the true volume (r=0.99; y=0.96x+12.38; P<0.01), with the mean difference between the 2 measurements being -3.12+/-15.1 mm3. High reproducibility was found for measurement of carotid plaque volume in vivo: the mean difference between measurements from 2 observers for the same data set was 0.60+/-11.2 mm3. Indexes of arterial distensibility decreased with age in healthy population, whereas this relationship was lost in hypertensive subjects. CONCLUSIONS Ultrafast 3-D ultrasound imaging of carotid artery demonstrates good accuracy and reproducibility for atherosclerotic plaque volume measurements. The system also allows the study of age-related degenerative vascular changes.
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Affiliation(s)
- C Palombo
- Institute of Clinical Physiology, CNR, and Department of Medicine, University of Pisa, Italy.
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Link MS, Wang PJ, Pandian NG, Bharati S, Udelson JE, Lee MY, Vecchiotti MA, VanderBrink BA, Mirra G, Maron BJ, Estes NA. An experimental model of sudden death due to low-energy chest-wall impact (commotio cordis). N Engl J Med 1998; 338:1805-11. [PMID: 9632447 DOI: 10.1056/nejm199806183382504] [Citation(s) in RCA: 222] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The syndrome of sudden death due to low-energy trauma to the chest wall (commotio cordis) has been described in young sports participants, but the mechanism is unknown. METHODS We developed a swine model of commotio cordis in which a low-energy impact to the chest wall was produced by a wooden object the size and weight of a regulation baseball. This projectile was thrust at a velocity of 30 miles per hour and was timed to the cardiac cycle. RESULTS We first studied 18 young pigs, 6 subjected to multiple chest impacts and 12 to single impacts. Of the 10 impacts occurring within the window from 30 to 15 msec before the peak of the T wave on the electrocardiogram, 9 produced ventricular fibrillation. Ventricular fibrillation was not produced by impacts at any other time during the cardiac cycle. Of the 10 impacts sustained during the QRS complex, 4 resulted in transient complete heart block. We also studied whether the use of safety baseballs, which are softer than standard ones, would reduce the risk of arrhythmia. A total of 48 additional animals sustained up to three impacts during the T-wave window of vulnerability to ventricular fibrillation with a regulation baseball and safety baseballs of three degrees of hardness. We found that the likelihood of ventricular fibrillation was proportional to the hardness of the ball, with the softest balls associated with the lowest risk (two instances of ventricular fibrillation after 26 impacts, as compared with eight instances after 23 impacts with regulation baseballs). CONCLUSIONS This experimental model of commotio cordis closely resembles the clinical profile of this catastrophic event. Whether ventricular fibrillation occurred depended on the precise timing of the impact. Safety baseballs, as compared with regulation balls, may reduce the risk of commotio cordis.
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Affiliation(s)
- M S Link
- Cardiac Arrhythmia Service, Tufts-New England Medical Center, Boston, MA 02111, USA
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Mirra G. Quantitative Evaluation of Changes in Global Left Ventricular Shape Associated With Aging in the Absence of Heart Disease. J Am Coll Cardiol 1998. [DOI: 10.1016/s0735-1097(97)85467-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Mirra G, Ogunyankin K, Avelar E, Galzerano D, Lama D, Vannan M, Pandian N. Quantitative evaluation of changes in global left ventricular shape associated with aging in the absence of heart disease. J Am Coll Cardiol 1998. [DOI: 10.1016/s0735-1097(98)80113-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Cacciapuoti F, Capasso A, Mirra G, De Nicola A, Minicucci F, Gentile S. Prevention of left ventricular hypertrophy by ACE-inhibitor, ramipril in comparison with calcium-channel antagonist, felodipine. Int J Cardiol 1998; 63:175-8. [PMID: 9510492 DOI: 10.1016/s0167-5273(97)00294-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This perspective study was performed to demonstrate the prevention of left ventricular hypertrophy by ACE-inhibitor, ramipril, in hypertensives of recent onset. Thirty-four hypertensive patients, treated with ramipril (group I), and 32 controls who received another frequently employed drug (the calcium channel-antagonist, felodipine (group II), were evaluated. Neither of two groups received any anti-hypertensive drug and did not suffer from left ventricular hypertrophy. All selected patients underwent M-mode echocardiography for measuring the following parameters: diastolic diameter of left ventricle, (DDLV); systolic diameter of left ventricle (SDLV); inter-ventricular septum (IVS); thickness of the posterior wall (PW); and left ventricular mass index (LVMI). Two anti-hypertensive drugs reduce systemic hypertension the same way. But, in hypertensives receiving ramipril (group I), the echocardiographic parameters of the left ventricle increased non-significantly. On the other hand, in those treated with felodipine (II group), these parameters significantly changed. The mechanisms of non-increase in cardiac and non-cardiac proteins, due to the ACE-inhibitors, are illustrated.
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Affiliation(s)
- F Cacciapuoti
- Department of Gerontology and Metabolic Disease, II University of Naples, Italy
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Cerciello A, Galzerano D, Mirra G, Giasi M. [Prognostic value of the exertion test in patients treated with thrombolytic therapy for acute myocardial infarct]. Minerva Cardioangiol 1996; 44:603-7. [PMID: 9053812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Prognostic value of exercise testing after thrombolytic therapy in patients with acute myocardial infarction. Few studies have evaluated the prognostic value of exercise testing in patients suffering from acute myocardial infarction (AMI) and thrombolysis. For this reason the authors studies 398 patients divided into two groups: 189 thrombolysed patients (T) and 209 non-thrombolysed patients (NT), matched for age, sex, AMI site and treatment received. Thrombolysis was performed within 6 hours of the onset of symptoms using rt-PA in an accelerated regime (90 degrees) preceded by sodium heparin infusion 5000 UI i.v. in bolus, and followed by sodium heparin for 5 days, maintaining a PTT value 2-3 times the basal level. The efficacy of thrombolytic treatment was confirmed by the presence pf at least two of the following markers: CK peak time, rapid reduction of ST overunlevelling, reperfusion arrhythmia. All patients underwent exercise testing using the cycloergometer after suspending treatment at 3 weeks and 6 months after AMI, and a echocardiographic examination on the first day and after 6 months. These data show that thrombolytic treatment reduces the myocardial damage during the course of AMI, enabling the patient to exercise longer and causes improved myocardial contractility with a lower asynergic index compared to non-reperfused patients. Moreover, significantly fewer ergometric tests that were positive for residual ischemia were observed in T compared to NT. The incidence of mortality one year after AMI was low in both groups, albeit lower in T. This confirms the important prognostic role of ergometric tests also in this population.
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Affiliation(s)
- A Cerciello
- Divisione di Cardiologia ed UTIC, Ospedale Nuovo Pellegrini, Napoli
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Gentile S, Vignoli A, Tommasielli G, Gualdiero P, Mirra G, Manzella D, Varricchio A, Simeone D, Varricchio M. Effect of low dose Amiodarone on the incidence of sudden death in elderly patients with congestive heart failure: a double-bind, placebo-controlled study. Arch Gerontol Geriatr 1996; 22 Suppl 1:191-5. [PMID: 18653029 DOI: 10.1016/0167-4943(96)86934-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
To determine if low-dose Amiodarone could reduce sudden death (SD) among patients with congestive heart failure, a prospective, double-blind, placebo-controlled study was conducted. The study group consisted of 46 patients (36 men and 10 women, mean age 71 +/- 5 years) with complex ventricular ectopy documented by 48-hour Holter monitoring. Randomization divided the patients into two treatment groups: the first group received Amiodarone (400 mg/day for 1 week and then 100 mg/day), while the second group received placebo. The drug significantly reduced ventricular arrhythmias, but then was no decrease in incidence of SD. This study demonstrates not only that low-dose Amiodarone can be safely administered to elderly patients with congestive heart failure and it will significantly suppress ventricular arrhythmias, but also that reduction in ventricular arrhythmias and the risk of SD are not linearly related.
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Affiliation(s)
- S Gentile
- Department of Gerontology, Geriatric and Metabolic Diseases, Second University of Naples, Piazza Miraglia, 2, I-80138 Napoli, Italy
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Abstract
BACKGROUND Despite the increasing number of reports on lipomatous hypertrophy of interatrial septum, a standardization of measurement of the dimensions of the interatrial septum (IAS) in the different phases of cardiac cycle has not been reported. Moreover, no data on modification of thickness with age and in specific cardiac diseases are available. OBJECTIVE Our purpose was to study whether the changes of thickness and thinning of IAS may be related to age, left atrial dimension, cardiac cycle and different cardiac diseases. METHODS 248 patients (mean age 52.7 +/- 19.9 years) underwent transthoracic (TTE) and transesophageal (TEE) echocardiography. IAS was measured at the constant regions anterior and posterior to the fossa ovalis. IAS thickness (tk), thinning (th) and % thinning (% th) were measured. RESULTS IAS thickness ranged from 4 to 13 mm at the time of ventricular end-systolic phase (mean 6.7 +/- 1.9 mm) and from 6 to 16 mm at the time of atrial systole (mean 9.9 +/- 1.8 mm); significant statistical difference between these values was found (P < 0.01). IAS thinning ranged from 1 to 7 mm (mean 3.42 +/- 1.8) while % IAS thinning from 18 to 76% (mean 36.53 +/- 16.36%). Statistical analysis showed a significant positive correlation between age and ventricular end-systolic thickness and atrial systolic thickness and thinning. An insignificant correlation was found between age and % IAS thinning and between left atrial dimension and IAS tk and th. CONCLUSIONS Our results demonstrate that IAS thickness increases by age; no correlation exists between IAS thinning and age. There is no difference between IAS thickness and thinning in patients with or without cardiac disease. We believe that the thickness of IAS can be considered hypertrophic only if it exceeds the value of 15 mm during both ventricular end-systolic and atrial systolic phases of the cardiac cycle. IAS thickness and thinning might be an additional parameter to evaluate systolic atrial function particularly with regard to maintenance of synus rhythm after conversion from atrial fibrillation as well as to better understand its role in determining the filling of ventricles in different clinical conditions.
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Affiliation(s)
- D Galzerano
- Division of Cardiology, Nuovo Pellegrini Hospital, Naples, Italy
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Miraglia del Giudice M, Capristo AF, Mirra G, Maiello N, Coppola T. [Controlled double-blind study on the efficacy of clofedanol-sobrerol in the treatment of pediatric pertussis]. Minerva Pediatr 1984; 36:1199-206. [PMID: 6398399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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