Speech quality of patients with oral or oropharyngeal carcinoma was assessed by perceptual and ac... more Speech quality of patients with oral or oropharyngeal carcinoma was assessed by perceptual and acoustic-phonetic analyses. Speech recordings of running speech of patients before and 6 and 12 months after treatment for oral or oropharyngeal cancer and of 18 control speakers were evaluated regarding intelligibility, nasality and articulation, which revealed deteriorated speech in 20% of the patients before treatment, and in 75% 6-12 months after treatment. Acoustic analyses comprised formant, duration, perturbation and noise measures of the vowels /i/, /a/, and /u/ and were performed on the speech samples 6 months after treatment and the controls. Patients appeared to have a smaller vowel space compared to controls, which was clearly related to speech intelligibility. Furthermore, voice perturbation appeared to be higher in patients. Although oropharyngeal treatment does not effect the function of the larynx itself, the acoustic coupling between source and filter may effect the smoothness of the voicing characteristics. The presented speech analyses may serve as part of an outcome measurement protocol for assessing efficacy of speech rehabilitation.
The new ELS classification can be used effectively and safely to differentiate malignant from ben... more The new ELS classification can be used effectively and safely to differentiate malignant from benign disease.
American Journal of Respiratory and Critical Care Medicine
An 80-year-old laryngectomized man was treated with silver nitrate (AgNO 3) application to granul... more An 80-year-old laryngectomized man was treated with silver nitrate (AgNO 3) application to granulation tissue surrounding the tracheoesophageal prosthesis. During the AgNO 3 application, the applicator tip accidentally broke off and was aspirated. Bronchoscopy 3 hours after the aspiration showed extensive mucosal injury in the trachea, right bronchial tree, and proximal left main bronchus (Figures 1A-1C, Videos 1-5; see Figures E1-E3 in the online supplement). The affected area was rinsed with saline solution; no applicator tip was identified. Two days later, during a follow-up procedure, the applicator tip was found in the right lower lobe and removed (Figures 2A and 2B; Figures E4 and E5). Three weeks later, the patient presented at the emergency department with acute dyspnea, oxygen desaturation, and hemoptysis. Bronchoscopy under general anesthesia demonstrated a blood clot blocking the left main bronchus. Removal immediately improved ventilation and oxygenation and revealed an underlying mucosal bleeding, which was electrocoagulated (Figures 3A and 3B; Figures E6 and E7). Eight months after the aspiration of silver nitrate the patient did clinically well, and tracheoscopy showed normal respiratory mucosa (Figure 4; Figure E8).
Objective In total laryngectomy, the neopharynx can be closed in several ways. It is suggested th... more Objective In total laryngectomy, the neopharynx can be closed in several ways. It is suggested that a pseudo-diverticulum is seen more frequently in patients closed with vertical closure than with ''T''-shaped closure, causing postoperative dysphagia. We report the results of patients treated with vertical closure and ''T''-shaped closure with regard to the formation of a pseudo-diverticulum and postoperative dysphagia. Methods In our retrospective cohort study, we identified 117 consecutive laryngectomized patients treated in the VU University Medical Center of Amsterdam between March 2009 and December 2013. Evaluations with statistical analysis of postoperative outcome measures (the formation of a pseudo-diverticulum and dysphagia), qualitative and quantitative variables were conducted. Results Patient demographics were similar between the vertical-shaped closure and the ''T''-shaped closure groups. In 84.6% of patients with vertical closure, a pseudo-diverticulum was seen compared to 18.5% with ''T''-shaped closure (p \ 0.001). Dysphagia was increasingly seen in patients with a pseudo-diverticulum (60.5%) compared to patients without a pseudo-diverticulum (39.5%) (p = 0.090). Conclusion Formation of a pseudo-diverticulum is more frequently seen in laryngectomy patients closed with vertical closure than in patients closed with ''T''-shaped closure of the neopharynx. It is favorable to implement ''T''shaped closure in laryngectomy. Keywords Oncology Á Head and neck surgery Á Laryngectomy Á Suture methods Á Pseudo-diverticulum Á Dysphagia Paper presented at the 225th ENT association meeting, Nieuwegein,
Het doel van dit artikel is na te gaan welke spraakkenmerken van belang zijn bij man-naar-vrouw t... more Het doel van dit artikel is na te gaan welke spraakkenmerken van belang zijn bij man-naar-vrouw transseksuelen om als vrouw over te komen en in hoeverre behandeling effectief is wat betreft genderrolgedrag (het verkrijgen van vrouwelijke spraakkenmerken) en genderidentiteit (de bijdrage van vrouwelijke stem en spraak aan genderidentiteit). In de inleiding wordt een overzicht gegeven van genderdysforie en de behandeling van transseksualiteit. Vervolgens wordt de gendervariatie in spraakkenmerken in kaart gebracht, alsmede de effectiviteit van fonochirurgische en logopedische behandeling. Tenslotte worden conclusies getrokken en aanbevelingen voor verder onderzoek uiteengezet.
Proceedings of the National Academy of Sciences, 2016
Complex interactions between DNA herpesviruses and host factors determine the establishment of a ... more Complex interactions between DNA herpesviruses and host factors determine the establishment of a life-long asymptomatic latent infection. The lymphotropic Epstein–Barr virus (EBV) seems to avoid recognition by innate sensors despite massive transcription of immunostimulatory small RNAs (EBV-EBERs). Here we demonstrate that in latently infected B cells, EBER1 transcripts interact with the lupus antigen (La) ribonucleoprotein, avoiding cytoplasmic RNA sensors. However, in coculture experiments we observed that latent-infected cells trigger antiviral immunity in dendritic cells (DCs) through selective release and transfer of RNA via exosomes. In ex vivo tonsillar cultures, we observed that EBER1-loaded exosomes are preferentially captured and internalized by human plasmacytoid DCs (pDCs) that express the TIM1 phosphatidylserine receptor, a known viral- and exosomal target. Using an EBER-deficient EBV strain, enzymatic removal of 5′ppp, in vitro transcripts, and coculture experiments, w...
ostomy care, (3) voice prosthesis care, (4) speech rehabilitation, (5) smell rehabilitation, and ... more ostomy care, (3) voice prosthesis care, (4) speech rehabilitation, (5) smell rehabilitation, and (6) mobility of head, neck, and shoulder muscles. Expert users expressed concerns regarding tailored exercises, indicated a positive intent to implement the intervention in routine care, and expressed a need for guidance when implementing the intervention. End users and expert users appreciated the content completeness and multimedia-based information built into the application. Conclusion: The participatory design is a valuable approach to develop a self-care program to help meet users' needs.
Robin Sequence (RS) is usually defined as the combination of micrognathia, glossoptosis and upper... more Robin Sequence (RS) is usually defined as the combination of micrognathia, glossoptosis and upper airway obstruction. No objective criteria to diagnose RS exist. To compare management strategy results, a single RS definition using objective criteria is needed. The most frequently used primary diagnostic tool for glossoptosis is awake Flexible Fiberoptic Laryngoscopy (aFFL). To determine the reliability of the aFFL videos as an independent diagnostic tool itself, rather than on the complete evaluation of a patient. All RS individuals from an existing cohort with an available aFFL video were included retrospectively. Thirty age-matched patients without pathologic findings on aFFL were used as controls. aFFL videos were scored by six otolaryngologists as: a. Marked glossoptosis, b. Mild glossoptosis, c. Severity unknown, d. No glossoptosis, e. Insufficient video quality. Videos were anonymized and rated twice, in altered sequences, after a washout period of minimally 2 weeks. Inter-rater and intra-rater agreement. 26 videos of 16 RS patients and 30 videos of controls were included. Inter-rater agreement was fair in the whole group (κ: 0.320) and RS group (κ: 0.226), and fair to moderate in determining presence of glossoptosis (total group κ: 0.430; RS κ: 0.302; controls κ: 0.212). The intra-rater agreement for presence of glossoptosis in RS was moderate (κ: 0.541). aFFL offers fair to moderate inter-rater agreement, with moderate intra-rater agreement, in evaluating glossoptosis in RS. Using aFFL as the single tool in choosing management strategies in RS seems insufficient. There is need for a more reliable, patient friendly diagnostic tool or an internationally accepted aFFL scoring system, to diagnose glossoptosis in RS. This article is protected by copyright. All rights reserved.
European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, Jan 14, 2015
The objective of this study is to assess swallowing and speech outcome after chemoradiation thera... more The objective of this study is to assess swallowing and speech outcome after chemoradiation therapy for head and neck cancer, based on the patient-reported outcome measures Swallowing Quality of Life Questionnaire (SWAL-QOL) and Speech Handicap Index (SHI), both provided with cut-off scores. This is a cross-sectional study. Department of Otolaryngology/Head and Neck Surgery of a University Medical Center. Sixty patients, 6 months to 5 years after chemoradiation for head and neck squamous cell carcinoma. Swallowing Quality of Life Questionnaire (SWAL-QOL) and SHI, both validated in Dutch and provided with cut-off scores. Associations were tested between the outcome measures and independent variables (age, gender, tumor stage and site, and radiotherapy technique, time since treatment, comorbidity and food intake). Fifty-two patients returned the SWAL-QOL and 47 the SHI (response rate 87 and 78 %, respectively). Swallowing and speech problems were present in 79 and 55 %, respectively. ...
Speech quality of patients with oral or oropharyngeal carcinoma was assessed by perceptual and ac... more Speech quality of patients with oral or oropharyngeal carcinoma was assessed by perceptual and acoustic-phonetic analyses. Speech recordings of running speech of patients before and 6 and 12 months after treatment for oral or oropharyngeal cancer and of 18 control speakers were evaluated regarding intelligibility, nasality and articulation, which revealed deteriorated speech in 20% of the patients before treatment, and in 75% 6-12 months after treatment. Acoustic analyses comprised formant, duration, perturbation and noise measures of the vowels /i/, /a/, and /u/ and were performed on the speech samples 6 months after treatment and the controls. Patients appeared to have a smaller vowel space compared to controls, which was clearly related to speech intelligibility. Furthermore, voice perturbation appeared to be higher in patients. Although oropharyngeal treatment does not effect the function of the larynx itself, the acoustic coupling between source and filter may effect the smoothness of the voicing characteristics. The presented speech analyses may serve as part of an outcome measurement protocol for assessing efficacy of speech rehabilitation.
The new ELS classification can be used effectively and safely to differentiate malignant from ben... more The new ELS classification can be used effectively and safely to differentiate malignant from benign disease.
American Journal of Respiratory and Critical Care Medicine
An 80-year-old laryngectomized man was treated with silver nitrate (AgNO 3) application to granul... more An 80-year-old laryngectomized man was treated with silver nitrate (AgNO 3) application to granulation tissue surrounding the tracheoesophageal prosthesis. During the AgNO 3 application, the applicator tip accidentally broke off and was aspirated. Bronchoscopy 3 hours after the aspiration showed extensive mucosal injury in the trachea, right bronchial tree, and proximal left main bronchus (Figures 1A-1C, Videos 1-5; see Figures E1-E3 in the online supplement). The affected area was rinsed with saline solution; no applicator tip was identified. Two days later, during a follow-up procedure, the applicator tip was found in the right lower lobe and removed (Figures 2A and 2B; Figures E4 and E5). Three weeks later, the patient presented at the emergency department with acute dyspnea, oxygen desaturation, and hemoptysis. Bronchoscopy under general anesthesia demonstrated a blood clot blocking the left main bronchus. Removal immediately improved ventilation and oxygenation and revealed an underlying mucosal bleeding, which was electrocoagulated (Figures 3A and 3B; Figures E6 and E7). Eight months after the aspiration of silver nitrate the patient did clinically well, and tracheoscopy showed normal respiratory mucosa (Figure 4; Figure E8).
Objective In total laryngectomy, the neopharynx can be closed in several ways. It is suggested th... more Objective In total laryngectomy, the neopharynx can be closed in several ways. It is suggested that a pseudo-diverticulum is seen more frequently in patients closed with vertical closure than with ''T''-shaped closure, causing postoperative dysphagia. We report the results of patients treated with vertical closure and ''T''-shaped closure with regard to the formation of a pseudo-diverticulum and postoperative dysphagia. Methods In our retrospective cohort study, we identified 117 consecutive laryngectomized patients treated in the VU University Medical Center of Amsterdam between March 2009 and December 2013. Evaluations with statistical analysis of postoperative outcome measures (the formation of a pseudo-diverticulum and dysphagia), qualitative and quantitative variables were conducted. Results Patient demographics were similar between the vertical-shaped closure and the ''T''-shaped closure groups. In 84.6% of patients with vertical closure, a pseudo-diverticulum was seen compared to 18.5% with ''T''-shaped closure (p \ 0.001). Dysphagia was increasingly seen in patients with a pseudo-diverticulum (60.5%) compared to patients without a pseudo-diverticulum (39.5%) (p = 0.090). Conclusion Formation of a pseudo-diverticulum is more frequently seen in laryngectomy patients closed with vertical closure than in patients closed with ''T''-shaped closure of the neopharynx. It is favorable to implement ''T''shaped closure in laryngectomy. Keywords Oncology Á Head and neck surgery Á Laryngectomy Á Suture methods Á Pseudo-diverticulum Á Dysphagia Paper presented at the 225th ENT association meeting, Nieuwegein,
Het doel van dit artikel is na te gaan welke spraakkenmerken van belang zijn bij man-naar-vrouw t... more Het doel van dit artikel is na te gaan welke spraakkenmerken van belang zijn bij man-naar-vrouw transseksuelen om als vrouw over te komen en in hoeverre behandeling effectief is wat betreft genderrolgedrag (het verkrijgen van vrouwelijke spraakkenmerken) en genderidentiteit (de bijdrage van vrouwelijke stem en spraak aan genderidentiteit). In de inleiding wordt een overzicht gegeven van genderdysforie en de behandeling van transseksualiteit. Vervolgens wordt de gendervariatie in spraakkenmerken in kaart gebracht, alsmede de effectiviteit van fonochirurgische en logopedische behandeling. Tenslotte worden conclusies getrokken en aanbevelingen voor verder onderzoek uiteengezet.
Proceedings of the National Academy of Sciences, 2016
Complex interactions between DNA herpesviruses and host factors determine the establishment of a ... more Complex interactions between DNA herpesviruses and host factors determine the establishment of a life-long asymptomatic latent infection. The lymphotropic Epstein–Barr virus (EBV) seems to avoid recognition by innate sensors despite massive transcription of immunostimulatory small RNAs (EBV-EBERs). Here we demonstrate that in latently infected B cells, EBER1 transcripts interact with the lupus antigen (La) ribonucleoprotein, avoiding cytoplasmic RNA sensors. However, in coculture experiments we observed that latent-infected cells trigger antiviral immunity in dendritic cells (DCs) through selective release and transfer of RNA via exosomes. In ex vivo tonsillar cultures, we observed that EBER1-loaded exosomes are preferentially captured and internalized by human plasmacytoid DCs (pDCs) that express the TIM1 phosphatidylserine receptor, a known viral- and exosomal target. Using an EBER-deficient EBV strain, enzymatic removal of 5′ppp, in vitro transcripts, and coculture experiments, w...
ostomy care, (3) voice prosthesis care, (4) speech rehabilitation, (5) smell rehabilitation, and ... more ostomy care, (3) voice prosthesis care, (4) speech rehabilitation, (5) smell rehabilitation, and (6) mobility of head, neck, and shoulder muscles. Expert users expressed concerns regarding tailored exercises, indicated a positive intent to implement the intervention in routine care, and expressed a need for guidance when implementing the intervention. End users and expert users appreciated the content completeness and multimedia-based information built into the application. Conclusion: The participatory design is a valuable approach to develop a self-care program to help meet users' needs.
Robin Sequence (RS) is usually defined as the combination of micrognathia, glossoptosis and upper... more Robin Sequence (RS) is usually defined as the combination of micrognathia, glossoptosis and upper airway obstruction. No objective criteria to diagnose RS exist. To compare management strategy results, a single RS definition using objective criteria is needed. The most frequently used primary diagnostic tool for glossoptosis is awake Flexible Fiberoptic Laryngoscopy (aFFL). To determine the reliability of the aFFL videos as an independent diagnostic tool itself, rather than on the complete evaluation of a patient. All RS individuals from an existing cohort with an available aFFL video were included retrospectively. Thirty age-matched patients without pathologic findings on aFFL were used as controls. aFFL videos were scored by six otolaryngologists as: a. Marked glossoptosis, b. Mild glossoptosis, c. Severity unknown, d. No glossoptosis, e. Insufficient video quality. Videos were anonymized and rated twice, in altered sequences, after a washout period of minimally 2 weeks. Inter-rater and intra-rater agreement. 26 videos of 16 RS patients and 30 videos of controls were included. Inter-rater agreement was fair in the whole group (κ: 0.320) and RS group (κ: 0.226), and fair to moderate in determining presence of glossoptosis (total group κ: 0.430; RS κ: 0.302; controls κ: 0.212). The intra-rater agreement for presence of glossoptosis in RS was moderate (κ: 0.541). aFFL offers fair to moderate inter-rater agreement, with moderate intra-rater agreement, in evaluating glossoptosis in RS. Using aFFL as the single tool in choosing management strategies in RS seems insufficient. There is need for a more reliable, patient friendly diagnostic tool or an internationally accepted aFFL scoring system, to diagnose glossoptosis in RS. This article is protected by copyright. All rights reserved.
European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, Jan 14, 2015
The objective of this study is to assess swallowing and speech outcome after chemoradiation thera... more The objective of this study is to assess swallowing and speech outcome after chemoradiation therapy for head and neck cancer, based on the patient-reported outcome measures Swallowing Quality of Life Questionnaire (SWAL-QOL) and Speech Handicap Index (SHI), both provided with cut-off scores. This is a cross-sectional study. Department of Otolaryngology/Head and Neck Surgery of a University Medical Center. Sixty patients, 6 months to 5 years after chemoradiation for head and neck squamous cell carcinoma. Swallowing Quality of Life Questionnaire (SWAL-QOL) and SHI, both validated in Dutch and provided with cut-off scores. Associations were tested between the outcome measures and independent variables (age, gender, tumor stage and site, and radiotherapy technique, time since treatment, comorbidity and food intake). Fifty-two patients returned the SWAL-QOL and 47 the SHI (response rate 87 and 78 %, respectively). Swallowing and speech problems were present in 79 and 55 %, respectively. ...
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