Publications by authors named "Carla Napolitano"

8 Publications

  • Page 1 of 1

Bamboo Nodes as an Autoimmune Disease Laryngeal Manifestation. Case Series.

J Voice 2021 Mar 17. Epub 2021 Mar 17.

Otolaryngology Department Pontificia Universidad Católica de Chile. Diagonal Paraguay 362, 7º piso, Edificio Académico, Dpto. Otorrinolaringología, Facultad de Medicina, Pontificia Universidad Católica de Chile. Santiago Centro, Santiago, Chile.

Introduction: Bamboo nodes are transverse creamy-yellow subepithelial nodes in the vocal folds (VF) midpoint, usually bilateral, resembling a bamboo stem. They appear almost exclusively in females, and are associated with underlying autoimmune diseases.

Case Summary: Six female patients, 45.5 years median age, with underlying autoimmune diseases, consulted due to dysphonia. The laryngeal stroboscopy showed bilateral VF bamboo nodes in four patients, and unilateral in the remaining two. VF mobility was normal in all patients, while the mucosal wave was impaired in four of them. Treatment with speech therapy and proton pump inhibitors was indicated. All the patients were referred for rheumatologic evaluation and immunosuppressive treatment optimization. Follow-up in five patients showed vocal function self-perception and GRBAS scores improvement.

Discussion: VF bamboo nodes are an infrequent cause for dysphonia, associated with phonotrauma and autoimmune diseases. Speech therapy and a rheumatologic workup must be indicated, for immunosuppressive treatment enhancement.
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March 2021

How the COVID-19 pandemic affects specialty training: An analysis of a nationwide survey among otolaryngology residents in Chile.

Medwave 2021 Jan 8;21(1):e8098. Epub 2021 Jan 8.

Departamento Otorrinolaringología, Facultad de Medicina, Universidad de Católica del Norte, Coquimbo, Chile. ORCID: 000-0002-1775-0057.

Introduction: Coronavirus disease 2019, or COVID-19, has become a global pandemic. Given that the highest viral load of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is found in the airway, otolaryngologists are at high risk of infection. As a result, multiple recommendations have emerged regarding protective measures for surgical teams, including suspending non-urgent procedures and surgeries.

Objectives: To evaluate the impact of the COVID-19 pandemic on otolaryngology residency training programs nationwide.

Methods: A cross-sectional survey-based study was completed in April 2020. The participants were recruited through an online survey, sent by email to all Chilean otolaryngology residents. Demographics, clinical activities, on-call shifts, COVID-19 infection status, exposure to COVID-19 patients, deployment to other specialties, diagnostic/therapeutic procedures, and surgeries performed were analyzed. Self-reported surgical data logs from previous years were used to compare results.

Results: Forty-seven residents completed the survey (84% response rate); 64% of residents refer seeing patients ten days or less during April 2020. Commonly performed procedures such as flexible nasolaryngoscopy, rigid nasal endoscopy, and peritonsillar abscess drainage were not performed by over 40% of the residents in that month. Only 38% participated in surgeries, with an average of 0.6 surgeries as a first surgeon, a dramatic decrease in surgical exposure when comparing the data logs from previous years. Most residents refer the following measures taken by their residency program to improve residency training: bibliographic videoconferences (87%), online clinical case seminars (60%), weekly journal clubs (38%), among others.

Conclusions: Clinical and surgical opportunities decreased dramatically during April 2020. Adjustments to the regular academic curricula should be considered to decrease the negative impact of this pandemic on residency training.
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January 2021

Prevalence of Voice Disorders in Healthcare Workers in the Universal Masking COVID-19 Era.

Laryngoscope 2021 04 12;131(4):E1227-E1233. Epub 2020 Oct 12.

Otolaryngology Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.

Objectives/hypothesis: To determine the prevalence and associated risk factors of voice disorders in healthcare workers of high-risk hospital care units during the 2019 coronavirus disease (COVID-19) pandemic.

Study Design: Cross-sectional study.

Methods: Questionnaire survey to healthcare personnel of COVID-19 high-risk hospital units was conducted, regarding demographic data, clinical activity, the pattern of usage of personal protective equipment, medical and vocal history, vocal symptoms, and Spanish validated Voice Handicap Index (VHI)-10 questionnaire.

Results: A total of 221 healthcare workers answered the survey. Nearly 33% of them reported having trouble with their voice during the last month, and 26.24% had an abnormal score in the Spanish validated VHI-10 questionnaire. The mean VHI-10 score was 7.92 (95% confidence interval 6.98-8.85). The number of working hours, the number of hours of mask daily use, simultaneous surgical and self-filtering mask use, and working in intermediate or intensive care units were independent variables significantly associated with a higher VHI-10 score.

Conclusions: Healthcare workers of high-risk hospital care units during the universal masking COVID-19 pandemic are at risk of voice disorders.

Level Of Evidence: 3 Laryngoscope, 131:E1227-E1233, 2021.
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April 2021

Postintubation Phonatory Insufficiency: A Challenging Diagnosis.

J Voice 2020 Aug 8. Epub 2020 Aug 8.

Otolaryngology Department, Pontificia Universidad Católica de Chile, Santiago, Chile. Electronic address:

Introduction: Glottic insufficiency is an important cause of dysphonia and can be frequently overlooked in the clinical evaluation. The differential diagnoses of this entity are diverse and include postintubation phonatory insufficiency (PIPI). These patients present with glottic insufficiency symptoms, associated with normal laryngeal imaging evaluation with no evident lesions. There is scarce literature describing this entity, since it is usually underdiagnosed.

Objectives: The aim of this study is to describe two clinical cases diagnosed with PIPI at our center's Voice Unit, discuss their clinical features, diagnostic evaluation, and treatment alternatives.

Case Summary: We report two clinical cases of prolonged orotracheal intubation (OTI) that developed dysphonia, vocal fatigue, a breathy voice, and poor vocal projection after being discharged from the hospital. Laryngoscopic evaluation showed no lesions in the membranous glottis and normal vocal fold mobility. Respiratory glottis was difficult to evaluate because of redundant arytenoids. To improve visualization, a laryngotracheoscopy with transtracheal anesthesia was performed in-office, exposing scar tissue medial to the vocal processes and respiratory vocal fold, confirming PIPI.

Discussion: Prolonged OTI can damage the medial arytenoid mucosa producing a posterior glottic gap that determines symptoms of glottic insufficiency. Multiple treatment options have been described yet few achieve a sufficient closure of the defect, so management is initially based on counseling and speech therapy.

Conclusions: PIPI is usually difficult to diagnose and should be sought directly in the clinical evaluation, especially if there are no obvious lesions in the membranous glottis.
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August 2020

Otolaryngology residency strategies during the COVID-19 pandemic.

Clin Teach 2020 10 28;17(5):544-546. Epub 2020 Jul 28.

Otolaryngology Department, Hospital Clínico Universidad Católica, Pontificia Universidad Católica de Chile, Santiago, Chile.

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October 2020

Voice Disorders in Children: Experience in the Voice Unit at Universidad Católica Clinical Hospital.

J Voice 2020 May 23. Epub 2020 May 23.

Otolaryngology Department Pontificia Universidad Católica de Chile, Edificio Académico, Dpto. Otorrinolaringología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago Centro, Santiago, Chile. Electronic address:

Introduction: Dysphonia in children is a common symptom, its prevalence varies between 6% and 23%. There is a broad differential diagnosis and the recommendation is to evaluate dysphonic children with an adequate laryngeal visualization method to achieve an accurate diagnosis and treatment.

Objective: To describe the experience in the diagnosis of dysphonia in children in the voice unit at Universidad Católica Clinical Hospital Santiago, Chile.

Methods And Materials: A retrospective chart review was conducted of all new pediatric patients treated in the voice unit at Universidad Católica Clinical Hospital between 2012 and 2019. Demographic data, diagnosis, and in-office laryngoscopies were reviewed. All patients were evaluated by the same work team consisting of two Otolaryngologists specialized in vocal pathology and a speech voice therapist.

Results: A total of 126 new pediatric patients between the ages of 0 to 18 years were evaluated in the voice unit at Universidad Católica Clinical Hospital Santiago, Chile. The majority were males (54%) with an average age of 9 years. 40% of the diagnosis corresponded to vocal nodules, 26% to vocal cord cysts, the remaining to a group of less frequent diagnosis. Two different groups were studied, the first group evaluated during the years 2012-2015 with flexible fibre-optic laryngoscopy and rigid videolaryngostroboscopy (VLS); the second group evaluated between the years 2015-2019 with distal chip flexible videolaryngoscopy, distal chip flexible VLS and rigid VLS. In the second group, the diagnosis of vocal nodules decreased, and the diagnosis of vocal cord cysts increased in comparison to the first group.

Conclusion: Pediatric patients with dysphonia must be evaluated by a multidisciplinary team of experts and adequate equipment. VLS should be considered the gold standard in the diagnosis of vocal cord pathology in pediatric population.
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May 2020

Spasmodic Dysphonia: Standardized Spanish Tool for Ambulatory Consult Diagnosis.

J Voice 2020 Feb 18. Epub 2020 Feb 18.

Otolaryngologyst, Assistant Professor, Otolaryngology Department Pontificia Universidad Católica de Chile, Edificio Académico, Dpto. Otorrinolaringología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago Centro, Santiago, Chile. Electronic address:

Introduction: Spasmodic dysphonia (SD) is a focal dystonia of the larynx where involuntary spasms of its intrinsic muscles are triggered by specific phonemes. The diagnosis is challenging and is performed by listening to the patient's voice, supported by nasolaryngoscopy. There is no diagnostic tool in Spanish for SD. The objective of our study is to establish phonetically studied vocal tasks in Spanish language to diagnose patients with SD.

Material And Method: This is a prospective study in three groups of patients: 11 with SD, 11 with another vocal disease, and 11 with no vocal disease, recruited in the Voice Unit of Hospital Clínico Universidad Católica. Of the patients with SD, 10 (90.9%) had adductor SD and 1 (9.1%) abductor SD. Vocal tasks phonetically studied by a speech language pathologist as laryngeal spasm triggers were recorded. The audio recordings were randomized and analyzed by nine evaluators: three experts and six otolaryngology residents. The correlation between the different professionals for the correct diagnosis was analyzed.

Results: The audio recordings were analyzed and patients with SD presented irregular voice breaks that occurred during the trigger phonemes. Evaluators classified the audio recordings: the expert group presented 100% sensitivity, 95-100% specificity and individual consistency of κ=0.73-0.82. The interrater agreement was 81.8%. The resident group presented 55-100% sensitivity, 58-95% specificity, and individual consistency of κ=0.36-0.82. The interrater agreement was 67.0%.

Discussion And Conclusions: We obtained a strong to almost perfect interrater agreement in experts and fair to almost perfect in residents. This study shows that the established list of phonetically studied and standardized words can be a useful tool for the diagnosis of SD.
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February 2020

Etiology of acute otitis media and serotype distribution of Streptococcus pneumoniae and Haemophilus influenzae in Chilean children <5 years of age.

Medicine (Baltimore) 2017 Feb;96(6):e5974

Unidad de Otorrinolaringología, Hospital Sótero del Rio, Puente Alto, Santiago, Chile Merck & Co, Sao Paulo, Brazil; at the time of the study Takeda Pharmaceuticals, Sao Paulo, Brazil GSK Pharmaceuticals Ltd, Bangalore, India GSK Buenos Aires, Argentina GSK Panama, Panamá.

The impact of bacterial conjugate vaccines on acute otitis media (AOM) is affected by several factors including population characteristics, bacterial etiology and vaccine conjugation method, carrier, and coverage. This study estimated the baseline etiology, distribution, and antibiotic susceptibility of bacterial serotypes that causes AOM in children aged <5 years in a public setting in Santiago, Chile.Children aged ≥3 months and <5 years referred to the physician for treatment of AOM episodes (with an onset of symptoms <72 h) were enrolled between September 2009 and September 2010. Middle ear fluid (MEF) was collected by tympanocentesis or by otorrhea for identification and serotyping of bacteria. Antibacterial susceptibility was tested using E-test (etrack: 112671).Of 160 children (mean age 27.10 ± 15.83 months) with AOM episodes, 164 MEF samples (1 episode each from 156 children; 2 episodes each from 4 children) were collected. Nearly 30% of AOM episodes occurred in children aged 12 to 23 months. Streptococcus pneumoniae (41.7% [58/139]) and Haemophilus influenzae (40.3% [56/139]) were predominant among the cultures that showed bacterial growth (85% [139/164]). All Streptococcus pneumoniae positive episodes were serotyped, 19F (21%) and 14 (17%) were the predominant serotypes; all Haemophilus influenzae strains were nontypeable. Streptococcus pneumoniae were resistant to penicillin (5%) and erythromycin (33%); Haemophilus influenzae were resistant to ampicillin (14%) and cefuroxime and cefotaxime (2% each).AOM in Chilean children is predominantly caused by Streptococcus pneumoniae and nontypeable Haemophilus influenzae. Use of a broad spectrum vaccine against these pathogens might aid the reduction of AOM in Chile.
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February 2017