Unilateral vocal fold paralysis may cause incomplete closure of the glottis and a poor voice. Thyroplasty is a relative new operation to improve the voice by‘medialization’of the paralysed vocal fold. In our series of 29 patients 24 (83%) were satisfied and 26 (90%) had a better voice. After the operation the voice was louder, clearer and easier to understand. The dynamic and melodic ranges on the phonetogram were wider; maximum loudness and maximum phonation time were improved. There were no complications during the follow‐up of 4 months to 5 years. In the three patients whose voice was not improved, the vocal fold paralysis was due to local trauma and scarring

Suspected aspiration of a radiopaque foreign body can easily be confirmed by a chest film. We report a case of a boy with chest-film confirmed aspiration of a needle into his right main bronchus, in whom no needle was found during bronchoscopy. In retrospect, the boy had expectorated the needle without noticing it in the interval between making the diagnosis and the actual bronchoscopy. We propose to reconfirm aspiration of a radiopaque foreign body by fluoroscopy shortly before commencing bronchoscopy.

No abstract

To the Editor.\p=m-\During the past few years, there has been a widespread use of silicone-rubber valves, which are inserted into tracheoesophageal fistulas to facilitate the voice restoration of laryngectomees. In the beginning, one of the major problems encountered in using these "voice prostheses" was the daily routine of the mandatory removal, cleaning, and replacement, a routine that proved to be difficult for many patients and that resulted in several complications.The Groningen button is one of these silicone-rubber valves\p=m-\itwas one of the first prostheses that was self-retaining and self-cleaning, resulting in a placement for a longer period; a period that varies considerably between patients. The mean device lifetime of the button is slightly more than three months, and the range varies from a few weeks to more than 30 months. A relationship was suspected between this varying, but limited lifetime and the deposits that were found on the removed buttons.Until now, no mention of these deposits was encountered in the liter¬ ature. Experience with more than 90 patients in four years established that these deposits were mostly found on the esophageal side of the prosthesis where the valve part is formed by a slit in the silicone-rubber material.The patients experienced no discom¬ fort from these deposits and com¬ plaints concerning swallowing disor¬ ders, pain, or local infection were few. Chemical analysis of the deposits showed that these did not consist of lime or other salt-deposits. Bactério¬ logie cultures of ten removed buttons showed an extremely high concentra¬ tion of Candida species in all sam¬ ples. Scanning electron microscopic ex¬ amination of the deposits on the but¬ tons demonstrated yeastbuds and hyphenated fungal vegetations, typi¬ cal of Candida species, growing into the esophageal surface and the valve surface of the prosthesis. Bulges of silicone material, filled with fungal vegetations, were also found to be situated on these surfaces. The expanding forces of the fungal vegeta¬ tions inside these bulges, will eventu¬ ally result in rupture, thus tearing the silicone-rubber material.Despite the fact that high concen¬ trations of Candida species were found on the buttons and in the tra¬ cheoesophageal fistulas, no relation¬ ship could be established between these concentrations and clinical manifestations of infection.It is our considered opinion that if the growth of Candida species on the button could be prevented, the life¬ time of the prosthesis will be pro¬ longed. The results of our study may also be of interest in matters concern¬ ing the implantation of other siliconerubber devices in the upper digestive tract. A more detailed report of this study will be presented shortly.

BackgroundEven in anonymous evaluations of a postgraduate medical education (PGME) program, residents may be reluctant to provide an honest evaluation of their PGME program, because they fear embarrassment or repercussions from their supervisors if their anonymity as a respondent is endangered. This study was set up to test the hypothesis that current residents in a PGME program provide more positive evaluations of their PGME program than residents having completed it. We therefore compared PGME learning environment evaluations of current residents in the program to leaving residents having completed it.MethodsThis observational study used data gathered routinely in the quality cycle of PGME programs at two Dutch teaching hospitals to test our hypothesis. At both hospitals, all current PGME residents are requested to complete the Scan of Postgraduate Education Environment Domains (SPEED) annually. Residents leaving the hospital after completion of the PGME program are also asked to complete the SPEED after an exit interview with the hospital’s independent residency coordinator. All SPEED evaluations are collected and analysed anonymously. We compared the residents’ grades (on a continuous scale ranging from 0 (poor) to 10 (excellent)) on the three SPEED domains (content, atmosphere, and organization of the program) and their mean (overall department grade) between current and leaving residents.ResultsMean (SD) overall SPEED department grades were 8.00 (0.52) for 287 current residents in 39 PGME programs and 8.07 (0.48) for 170 leaving residents in 39 programs. Neither the overall SPEED department grades (t test, p = 0.53, 95% CI for difference − 0.16 to 0.31) nor the department SPEED domain grades (MANOVA, F(3, 62) = 0.79, p = 0.51) were significantly different between current and leaving residents.ConclusionsResidents leaving the program did not provide more critical evaluations of their PGME learning environment than current residents in the program. This suggests that current residents’ evaluations of their postgraduate learning environment were not affected by social desirability bias or fear of repercussions from faculty.