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- Unilateral Vocal Fold Paralysis and Voice Therapy: Predictors of Long-Term Quality of LifePublication . Sousa, Francisco Alves de; Santos, Mariline; Azevedo, Sara; Pinto, Ana; Freitas, Susana Vaz; Coutinho, Miguel; Almeida e Sousa, Cecília; Moreira da Silva, ÁlvaroTo date, little is known about the long-term predictors of quality of life (QoL) in unilateral vocal fold paralysis (UVFP). The main objective of this study was to evaluate the predictors of long-term QoL in UVFP patients submitted to voice therapy (VT) exclusively. Data from patients diagnosed with UVFP who followed a VT program between 2013 and 2019 were reviewed. Video laryngoscopy (VL) records were obtained at the beginning and at the end of VT. To assess QoL, Voice Handicap Index 30 (VHI-30) score was assessed in three temporal frames: before voice therapy (pre-VT), at the last VT session (post-VT), and in the present (cur-VHI). A longitudinal analysis was performed regarding the evolution of QoL and the factors influencing QoL through time were analyzed. Seventy-eight percent of patients had iatrogenic UVFP. The mean time of follow-up after VT was 3.942 years (range 6 months-7 years). There was a significant improvement in QoL through all time points (F (2,88)=72.179, p<0.001), with VHI-30 decrease from the baseline pre-VT to post-VT(p<0.001) and from post-VT to cur-VT (p=0.0013). In the iatrogenic UVFP population, patients starting VT earlier showed better long-term QoL (p=0.023). UVFP patients with dysphagia at presentation showed significantly worse QoL in the late follow-up (p=0.016). Hence, iatrogenic UVFP patients beginning VT rapidly may show better QoL in the future. Also, our results suggest that dysphagia at UVFP onset may predict higher morbidity later in life.
- Hyperacusis and stapes surgery: An observation in fifty patients after stapedotomyPublication . Santos, Mariline; Reis-Rego, Angela; Lino, João; Coutinho, Miguel; Sousa, Cecília AlmeidaObjective: To assess hyperacusis after stapedotomy and its possible influencing factors. Study design: Prospective, interventional, and longitudinal study. Setting: A tertiary referral center. Patients: Fifty consecutive patients (35 females, mean age = 46.8 years). Intervention: All patients underwent stapedotomy. The validated Portuguese version of the "Hyperacusis Questionnaire" (HQ) was administered before and two weeks and one month after surgery. Results: No hyperacusis was reported by any patient before surgery. At two weeks after surgery, all patients experienced hyperacusis, with a mean HQ at 16.88 ± 6.54 (range 4-25). One month after surgery, hyperacusis had already resolved in most patients. Gender, preoperative presentation or surgeon had no influence on HQ scores (p > 0.05). Patients with previous contralateral stapedotomy showed lower HQ scores (p = 0.001). Audiological parameters improvement measured at one month after surgery (PTA, SRT and contralateral SRT) were associated with HQ higher scores. Conclusion: This study confirms that hyperacusis is a common complaint after stapedotomy that usually resolves in one month after surgery. The HQ highest scores were registered among patients with the highest audiological gain after surgery. This suggests that hyperacusis may be a positive prognostic factor for audiological success after stapedotomy.