How can we reduce the risk of getting a coronavirus infection?

Coronavirus pandemic COVID-19 has revealed that in a complicated epidemiological situation, it is important to pay special attention to hygiene, to strengthen measures for sanitary disposal of premises, to follow carefully all the rules developed by the Ministry of health and Roszdravnadzor.

Impex international work with doctors from different countries and areas of medicine allows us to keep up-to-date with the information about the ways of the virus spreading and take protection measures timely.

The main route of virus infection.

We present the main recommendations that will help to reduce the risk of contamination of coronavirus infection COVID-19.

The major route of infecting of the viral coronavirus infection COVID-19 is by droplet spread. In view of this, it is highly recommended to avoid public places, to keep the distance no less than 1 metre. It is better to avoid being in one place with the infected people for a long time.

What is more, people can be infected through the physical contact with infected surfaces as this infection is transferred to the mucous membranes of the nose, mouth, and eyes through touching the face.

That is why it is so important to use hand sanitizers, wash your hands with an antibacterial agent or soap, and clean work surfaces such as pens, keys, mobile phones and computer keyboards.

Disinfect your hands and do not touch your face — the gold standard of protection against infection.

About antiseptics and soaps.

A pathogen virus is easily killed by a detergent. The fact is that it is not very tenacious of life in the conditions of disinfection.

Since the virus is enclosed in a so-called fat cover, soap has a great ability to dissolve this cover, due to its chemical structure.

That is why WHO is for washing hands with soap as the main measure to prevent infection with coronavirus. However, it is important to wash your hands for at least 30 seconds.

Antiseptic is a great alternative way to clean the skin if there is no soap or tap nearby. WHO has decided that an effective antiseptic must contain at least 62% alcohol by its volume.

Compounds based on ethanol, propanol and isopropanol effectively inactivate the virus. As alcohol-free antiseptics are based on chlorhexidine , they are less effective against the virus.

Impex contributes to the fight against COVID-19

We have been working with medical organizations since 2014, keeping up to date with the latest news and laws related to the health sector around the world. Our goal is to support the medical community in the fight against the pandemic, so we make sure that the medical supplies and the equipment have all the necessary quality certificates and are shipped on time.

Voice feminization

Examination and diagnostics methods

Executive checkup is carried out by patients with glottis incompetence. It includes video fiberoptic laryngoscopy which allows the doctors to assess the condition of the upper respiratory tract and to get the view of the vocal folds as close as possible. This procedure is fast and painless, it is done during the consultation and as a rule, it doesn’t require any special preparation. ENT specialist, a patient and his attendants can see the whole examination on the screen of the monitor that is why disclosing and interpretation of a disease (nodes, polyps and tumors) of the vocal folds are simple and clear.
In addition, executive checkup includes stroboscopy. During this procedure the vocal folds movements are slowing down, so it allows to have a thorough look at them. In usual conditions the vocal folds vibrate too quickly so it is complicated to examine them.
Stroboscopy is peculiarly important for people whose jobs are connected with voice and speech activities (singers, actors, teachers, salesmen, newsreaders), for children and grown-ups with permanent or temporary voice disorders, for any people who regardless of their professional occupations have periods of vocal activities (singing, theatre etc), as well as for early cancer detection.
If the patient has already got the voice feminization surgery, he needs to send endoscopy of the larynx (laryngoscopy) to his treating doctor in order to check if the surgery is possible. First of all it is necessary to eliminate the consequences of the previous surgeries and only then to perform a new one using the method of VFSRAC (vocal fold shortening and retrodisplacement of the anterior commissure). At this stage, our main priority is to restore the quality of the patient’s voice, rather than raising the tone. The voice tone may become higher after repeated surgery. However, the voice pitch will be limited due to the damaged vocal folds and dependent muscles. Before the surgery the patient is highly recommended to give up bad habits such as smoking and alcohol abuse. General and biochemical blood tests, clinical urinalysis need to be done. These tests allow us to identify the presence of current pathological processes in the body, which may become a contraindication to performing vocal fold aesthetic surgery. In addition, more blood tests are assigned to indicate the presence or absence of HIV infection, hepatitis B and C, syphilis, and rhesus blood factor. Moreover, coagulation test, ECG and chest X-ray examination are performed.

Methods of surgery performance

The average male vocal folds are between 100 – 150 Hz, the female vocal folds are between 200 – 250 Hz. The male vocal folds are thicker, longer, heavier than the female ones that is why the male voices are lower pitched. After the surgery the vocal folds get shorter, thinner and lighter, so the patient receives the female voice. Males and females have a significant difference between the voice pitch. Raising the voice pitch can be interesting for women who find their voices irritatingly low and for transgender groups.

Comparison of the methods

Vocal fold surgery (phonosurgery) is performed in case of inefficiency of conservative methods of treatment of vocal fold disorders. The surgery is performed under a microscope, and often with the use of a CO2 laser, which allows doctors to perform the procedure with the highest accuracy almost without bleeding and postoperative pain, with accelerated and successful healing process. At present there are several surgical methods for the voice feminization. One of the most popular ones is vocal fold shortening and retrodisplacement of the anterior commissure (VFSRAC). This method perfectly modifies the features of male vocal folds into those of female vocal folds without a necessity of a skin incision. This is achieved by endoscopically removing of 1/3 of the vocal fold membrane and internal tissue and then suturing the new structures tight with permanent suture material.

Voice feminization

Vocal folds.

Efficiency of the methods

It is implicated that VFSRAC method can achieve an average raise in the patient’s vocal fundamental frequency of 73.6 Hz in the transgender group allowing it to shift from the male range (100 Hz – 150 Hz) into the female range (200 Hz – 250 Hz). The average time period needed to gain a fully feminized voice pitch ranges from 6 to 12 months and in 92 % of cases patients are satisfied with the surgeries. Removing of the 1/3 of the vocal folds and restoring the anterior commissure is the technology of utmost importance which allows for a smooth glottic air flow resulting in a natural and clear voice. This method helps to shorten the vocal folds and achieve a higher pitch which allows the patient to get a natural female voice without damaging any of 50 larynx muscles. After the surgery, thanks to these method peculiarities, the patient’s voice has its natural tone and ability to sing.

Preparation for surgery

Voice feminization starts with the detailed discussion and patient’s examinations such as video fiberoptic laryngoscopy and stroboscopy. If it is required, additional examinations can be asked to be done, depending on the situation. It is necessary to disclose diseases of the gastrointestinal tract that may interfere with the results of the surgery. It is recommended as well to pass the thyroid function test and check the endocrine profile at thyroid specialist.

Surgery and postoperative care

During and after the surgery the patients are under experienced and highly qualified medical staff. Patients are usually discharged the day after surgery. The resting voice period for 1 month is recommended. All procedures prescribed by your doctor should be followed. Patients should stick to healthy diet, work with phonopaedists, avoid too much of physical activities.

Process of the voice changing over time

Adaptation to the new form of vocal folds takes place within a year. In order to achieve adaptation successfully, it is necessary to perform rehabilitation exercises daily for several months. Please be aware that this surgical approach requires the patient to train female resonance patterns, adapt to the new laryngeal biofeedback reflex system – the key moments of adaptation to be able to use the new vocal folds.

Possible complications

Voice feminization surgery is a very safe procedure with minimized risks. In rare cases, there could be temporary complications such as pitch instability, foreign body sensation on throat, hoarseness, neck pain, bleeding, sputum or cough. All these symptoms can be eliminated with the help of medicine prescribed by your doctor. Voice quality and clarity can be self-controlled, including regularly performing exercises for the voice repair.

To sum up

Surgical procedures on the vocal folds are orientated to the voice repair and its improvement. As a result of a timely surgery, you will completely restore your speech functions, physiologically normal breathing and will acquire a strong voice that will appeal to you.

Specialist in aesthetics voice surgery:

oncology specialist, phoniatrist Liliya Budeykina

Liliya Budeykina

ENT oncology specialist, phoniatrist, pediatric surgeon. Areas of specialization: phonosurgery, classical operative otorhinolaryngology in adults and children.