No abstract

Recurrent laryngeal papillomatosis is a benign disease of the larynx often leading to organic and functional restrictions. The therapeutic treatment of choice in larynx-obstructing papillomatosis is at present surgical laser ablation. The effectiveness of adjuvant intralesional injection of the virustaticum Cidofovir has been investigated recently in a variety of therapeutic models. The present case study deals with the treatment of recurrent laryngeal papillomatosis by means of surgical laser ablation of the laryngeal papillomas with adjuvant local injection of the virustaticum Cidofovir (dose of 5 mg/1 ml). Within the period from October 2001 to August 2004, ten patients aged between 5- and 70 years were treated with intralesional injections of Cidofovir. Papillomatosis was confirmed histologically in all cases, and the virus types were defined in part. Each of the patients underwent clinical-phoniatric examinations and was photographed for documentation. After 2-7 treatments with surgical laser papilloma ablation and intralesional Cidofovir injections, all patients showed a definite papilloma reduction, while in six cases complete remission was achieved. During the follow-up period of 8-30 months, not a single recurrence of the laryngeal papillomatosis occurred. In the majority of patients, a clear improvement in the voice was achieved. There were no local or systemic side effects caused by the virustaticum. Intralesional injection of Cidofovir is an adjuvant, but not a curative therapeutic option in recurrent laryngeal papillomatosis. Remission of previously frequently recurrent laryngeal papillomas can be achieved, but recurrence after longer treatment-free intervals is also possible.

Objectives: This study attempted to determine the prevalence of mental disorders among laryngectomees and to assess the current status of the supplied psychooncological care. Patients and Methods: Patients who were laryngectomized between 1970 and 2001 were recruited at 6 different otolaryngology clinics in the region of Central Germany. 189 interviews were conducted. Structured clinical interviews (SCID) and standardized questionnaires (HADS, KFA) were used to assess patients’ mental health. The past and the current status of received psychotherapeutic care was evaluated. Results: 23% of the patients were diagnosed with mental disorders. The most frequently occurring disorder was alcohol dependency with 8%, followed by affective disorders (7% major depression, 5% minor depression). Only one patient was currently receiving psychotherapeutic or psychiatric treatment. Conclusion: Only a small fraction of the laryngectomy patients suffering from mental illness were receiving appropriate treatment.

ZusammenfassungMann-zu-Frau-Transsexuelle leiden nach erfolgter geschlechtsangleichender Operation sehr häufig unter der unverändert männlichen Stimme, die in Diskrepanz zum weiblichen äuûeren Erscheinungsbild steht und somit die soziale Integration als Frau erheblich stört. Als grundlegende geschlechtsspezifische stimmliche Merkmale gelten die Grundfrequenz und das von den Formantfrequenzen beeinflusste Timbre. Da durch die Hormonbehandlung bzw. eine alleinige logopädische Therapie keine dauerhafte Stimmerhöhung zu erreichen ist, sind hierfür phonochirurgische Maûnahmen in Erwägung zu ziehen. Eine Möglichkeit zur dauerhaften Erhöhung der mittleren Sprechstimmlage bei gleichzeitig geringerem Kraftaufwand stellt die Cricothyroidopexie in einer von uns modifizierten Technik nach Isshiki dar. Die dadurch erreichte höhere Stimmlippenspannung bewirkt eine beständige Anhebung der mittleren Sprechstimmlage um durchschnittlich 5 ± 6 Halbtöne. Von Oktober 1993 bis Dezember 2000 unterzogen sich 59 Patientinnen dieser Operation. Die Stimmbeurteilung erfolgte präoperativ, 1 Woche postoperativ und nach ca. 1 / 2 Jahr auditiv sowie computergestützt einschlieûlich Aufzeichnung des Sprech-und Singstimmfeldes und Auswertung der Formantfrequenzen. Während präoperativ keine Patientin eine weibliche Sprechstimme (³ f [175 Hz]) aufwies, bewegten sich postoperativ ca. 30 % im weiblichen Bereich und 32 % erreichten zumindest eine indifferente Stimmlage. In der Langzeitbeobachtung erwiesen sich die Ergebnisse als dauerhaft und in 45 % der Fälle konnte sogar noch eine weitere Erhöhung verzeichnet werden. Patientinnen, die sich postoperativ einer logopädischen Therapie unterzogen, zeigten über einen längeren Zeitraum im Vergleich zu Patientinnen ohne eine postoperative Stimmübungsbehandlung stabilere Ergebnisse bzw. eine stärkere Tendenz zu einer weiteren Erhöhung der Sprechstimme. AbstractMale-to-female transsexuals often suffer from their masculine voice after a sex reversal operation, since their social integration as a woman is significantly disturbed. Basic sex-specific characteristics of the vocal pitch are the fundamental frequency and the timbre, which depend on formant frequencies. Treatment with hormonal drugs or mere speech therapy cannot raise the voice permanently, therefore an operative procedure needs to be considered. One way to raise the voice is the modified cricothyroidopexy based on the method of Isshiki, which we prefer. The higher tension of the vocal folds achieved through this method allow a permanent rising of the vocal pitch by 5 ± 6 semitones. From October 1993 till December 2000, 59 patients underwent this operation. The patients were examined with regard to the fundamental and formant frequencies, voice range profile and voice dynamics. The examination was auditively conducted and computerized prior to operation, one week after surgical intervention, and half a year postoperatively. While preoperatively none of the patients had a feminine voice (³ f [175 Hz]), postoperative results showed 30 % of the patients ...

Real rhabdomyomas belong to the rarest tumors in the human body. The origin of these benign neoplasms is in the cardiac or skeletal muscle, in the beginning, there are no significant symptoms and the tumor grows very slowly. Extracardiac rhabdomyomas seldom occur and are mostly located in the head and neck region. A multilocular occurrence represents a rarity. We describe a 77-year-old female patient with a multilocular adult rhabdomyoma in the parapharyngeal and paratracheal space. The tumor was accidentally found; the patient had not complained of any specific symptoms. After histological examination, complete resection was carried out. On discharge the patient showed no functional deficits. Long-term follow-up is necessary because local recurrences have been described.