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Otolaryngology--head and Neck Surgery :... May 2017Objectives Different surgical techniques have been described in the literature to increase vocal pitch. The purpose of this study is to systematically review these... (Meta-Analysis)
Meta-Analysis Review
Objectives Different surgical techniques have been described in the literature to increase vocal pitch. The purpose of this study is to systematically review these surgeries and perform a meta-analysis to determine which technique increases pitch the most. Data Sources CINAHL, Cochrane, Embase, Medline, PubMed, and Science Direct. Review Methods A systematic review and meta-analysis of the literature was performed using the CINAHL, Cochrane, Embase, Medline, PubMed, and Science Direct databases. Studies were eligible for inclusion if they evaluated pitch-elevating phonosurgical techniques in live humans and performed pre- and postoperative acoustic analysis. Data were gathered regarding surgical technique, pre- and postoperative fundamental frequencies, perioperative care measures, and complications. Results Twenty-nine studies were identified. After applying inclusion and exclusion criteria, a total of 13 studies were included in the meta-analysis. Mechanisms of pitch elevation included increasing vocal cord tension (cricothyroid approximation), shortening the vocal cord length (cold knife glottoplasty, laser-shortening glottoplasty), and decreasing mass (laser reduction glottoplasty). The most common interventions were shortening techniques and cricothyroid approximation (6 studies each). The largest increase in fundamental frequency was seen with techniques that shortened the vocal cords. Preoperative speech therapy, postoperative voice rest, and reporting of patient satisfaction were inconsistent. Many of the studies were limited by low power and short length of follow-up. Conclusions Multiple techniques for elevation of vocal pitch exist, but vocal cord shortening procedures appear to result in the largest increase in fundamental frequency.
Topics: Female; Humans; Laryngoplasty; Male; Patient Satisfaction; Phonetics; Pitch Discrimination; Transgender Persons; Vocal Cords; Voice Quality
PubMed: 28349733
DOI: 10.1177/0194599817697050 -
Pediatric Annals Jul 2021Vocal fold immobility in children can affect breathing, swallowing, and speech function. Although sometimes idiopathic, it is often caused by injury to the recurrent...
Vocal fold immobility in children can affect breathing, swallowing, and speech function. Although sometimes idiopathic, it is often caused by injury to the recurrent laryngeal nerve during cardiac surgery. A detailed history and physical examination can identify risk factors, which affect the rate of resolution and overall prognosis. Fiberoptic laryngoscopy can be used to confirm the diagnosis and evaluate laryngeal anatomy. Many treatment options exist to improve function and quality of life, including vocal fold injection and laryngeal innervation. .
Topics: Child; Humans; Laryngoscopy; Prognosis; Quality of Life; Vocal Cord Paralysis; Vocal Cords
PubMed: 34264797
DOI: 10.3928/19382359-20210628-01 -
International Journal of Environmental... Apr 2023Sulcus vocalis (SV) is a longitudinal groove in the free edge of the true vocal cord. It may impair phonation with incomplete glottic closure, phonasthenia and...
BACKGROUND
Sulcus vocalis (SV) is a longitudinal groove in the free edge of the true vocal cord. It may impair phonation with incomplete glottic closure, phonasthenia and hoarseness. This study aims to detect a correlation between benign vocal cord lesions and the incidence of the SV.
METHODS
A retrospective study was carried out on patients who underwent transoral surgery due to benign vocal fold lesions and were selected according to strict criteria. Patients were divided into a group with sulcus vocalis (Group wSV) and a group without sulcus vocalis (Group w/oSV). The possible correlations between variables were assessed by the Pearson chi-square test ( < 0.05).
RESULTS
The study included 232 vocal cord lesions in 229 patients: 62.88% were females whose mean age was 46.61 ± 14.04. The most frequent diseases were polyps (37.94%), nodules (18.53%) and Reinke's edema (21.12%). Statistically significant relationships were found between age and SV (-value 0.0005) and between mild dysplasia and SV (-value 0.03).
CONCLUSIONS
This study did not detect a cause-effect relationship between SV and benign vocal fold lesions. SV within vocal fold lesions is more common in younger patients, suggesting a congenital nature of SV. In conclusion, in the case of a benign vocal fold lesion, a possible SV should be considered and researched to provide the patient the best healthcare.
Topics: Female; Humans; Adult; Middle Aged; Male; Vocal Cords; Laryngeal Diseases; Retrospective Studies; Phonation; Polyps
PubMed: 37174173
DOI: 10.3390/ijerph20095654 -
Clinical Rheumatology Mar 2023The aim of this study was to describe the clinical features of vocal cord lesions in patients with representative autoimmune diseases including systemic lupus...
OBJECTIVE
The aim of this study was to describe the clinical features of vocal cord lesions in patients with representative autoimmune diseases including systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA).
METHOD
A total of 31 SLE/RA patients (14 SLE and 17 RA) complicated with vocal cord lesions (SLE/RA-VC group) who had been admitted to Peking Union Medical College Hospital were retrieved from the electronic registration system. Ninety-three age and sex-matched SLE/RA patients (42 SLE and 51 RA) without vocal cord lesions (SLE/RA-nVC group) admitted during the same period were chosen randomly as controls. Medical files were reviewed and clinical data collected for comparisons.
RESULTS
Vocal cord paralysis (n = 12, 38.7%) and vocal cord mass (n = 14, 45.2%) were the most common types of vocal cord lesions in this cohort. Unilateral lesions were more common than bilateral lesions (67.8% vs 32.3%) and the two sides were affected equally. Two cases of vocal cord bamboo node lesion were observed in SLE-VC group even as an initial manifestation and SLE-VC group had a slightly higher disease activity index (SLEDAI-2K) than their control counterparts (18.56 ± 8.23 vs 13.63 ± 5.89, p = 0.041). The RA-VC group had less pulmonary interstitial disease (29.4% vs 63%, p = 0.017) and lower CRP levels (p = 0.006) than their controls. As for the treatment, 71% of SLE/RA-VC patients had received glucocorticoids and immunosuppressants and 30% had undergone surgery. 45.2% of SLE/RA-VC patients got improvement at the time of discharge.
CONCLUSIONS
The association of vocal cord lesions with disease activity can be observed in SLE patients but not in RA patients. Vocal cord lesions in SLE/RA patients should be considered as a part of the systemic involvement and should be treated accordingly. Key Points • Vocal cord paralysis and vocal cord mass were the main types of vocal cord lesions in patients with SLE/RA. • Vocal cord lesions in SLE patients may associate with disease activity and vocal cord bamboo node lesions could be an initial manifestation. • Glucocorticoid and immunosuppressants could be effective for vocal cord lesions in SLE/RA patients.
Topics: Humans; Vocal Cords; Vocal Cord Paralysis; Autoimmune Diseases; Arthritis, Rheumatoid; Lupus Erythematosus, Systemic; Glucocorticoids; Immunosuppressive Agents
PubMed: 36269532
DOI: 10.1007/s10067-022-06411-9 -
Annals of Emergency Medicine Jan 2017Paradoxical vocal fold motion disorder, also commonly termed vocal cord dysfunction, is a poorly understood cause of acute upper airway obstruction. Patients with... (Review)
Review
Paradoxical vocal fold motion disorder, also commonly termed vocal cord dysfunction, is a poorly understood cause of acute upper airway obstruction. Patients with paradoxical vocal fold motion frequently present to the emergency department (ED) with acute respiratory distress and stridor. Lack of familiarity with this disorder may lead to delayed diagnosis or misdiagnosis and unnecessary intubations or surgical airway procedures. Although long-term management of paradoxical vocal fold motion is well described, there is a paucity of information about acute evaluation and management. This article aims to summarize the ED presentation and management of paradoxical vocal fold motion.
Topics: Airway Obstruction; Dyspnea; Emergency Service, Hospital; Humans; Vocal Cord Dysfunction; Vocal Cords
PubMed: 27522309
DOI: 10.1016/j.annemergmed.2016.06.045 -
Respirology (Carlton, Vic.) Jul 2023Vocal cord dysfunction/inducible laryngeal obstruction (VCD/ILO), is a common condition characterized by breathlessness associated with inappropriate laryngeal... (Review)
Review
Vocal cord dysfunction/inducible laryngeal obstruction (VCD/ILO), is a common condition characterized by breathlessness associated with inappropriate laryngeal narrowing. Important questions remain unresolved, and to improve collaboration and harmonization in the field, we convened an international Roundtable conference on VCD/ILO in Melbourne, Australia. The aims were to delineate a consistent approach to VCD/ILO diagnosis, appraise disease pathogenesis, outline current management and model(s) of care and identify key research questions. This report summarizes discussions, frames key questions and details recommendations. Participants discussed clinical, research and conceptual advances in the context of recent evidence. The condition presents in a heterogenous manner, and diagnosis is often delayed. Definitive diagnosis of VCD/ILO conventionally utilizes laryngoscopy demonstrating inspiratory vocal fold narrowing >50%. Computed tomography of the larynx is a new technology with potential for swift diagnosis that requires validation in clinical pathways. Disease pathogenesis and multimorbidity interactions are complex reflecting a multi-factorial, complex condition, with no single overarching disease mechanism. Currently there is no evidence-based standard of care since randomized trials for treatment are non-existent. Recent multidisciplinary models of care need to be clearly articulated and prospectively investigated. Patient impact and healthcare utilization can be formidable but have largely escaped inquiry and patient perspectives have not been explored. Roundtable participants expressed optimism as collective understanding of this complex condition evolves. The Melbourne VCD/ILO Roundtable 2022 identified clear priorities and future directions for this impactful condition.
Topics: Humans; Vocal Cord Dysfunction; Laryngeal Diseases; Airway Obstruction; Vocal Cords; Laryngoscopy; Diagnosis, Differential
PubMed: 37221142
DOI: 10.1111/resp.14518 -
European Archives of... Aug 2016The terms used to describe vocal fold motion impairment are confusing and not standardized. This results in a failure to communicate accurately and to major limitations... (Review)
Review
The terms used to describe vocal fold motion impairment are confusing and not standardized. This results in a failure to communicate accurately and to major limitations of interpreting research studies involving vocal fold impairment. We propose standard nomenclature for reporting vocal fold impairment. Overarching terms of vocal fold immobility and hypomobility are rigorously defined. This includes assessment techniques and inclusion and exclusion criteria for determining vocal fold immobility and hypomobility. In addition, criteria for use of the following terms have been outlined in detail: vocal fold paralysis, vocal fold paresis, vocal fold immobility/hypomobility associated with mechanical impairment of the crico-arytenoid joint and vocal fold immobility/hypomobility related to laryngeal malignant disease. This represents the first rigorously defined vocal fold motion impairment nomenclature system. This provides detailed definitions to the terms vocal fold paralysis and vocal fold paresis.
Topics: Humans; Laryngeal Neoplasms; Reference Standards; Terminology as Topic; Vocal Cord Dysfunction; Vocal Cord Paralysis; Vocal Cords
PubMed: 26036851
DOI: 10.1007/s00405-015-3663-0 -
ANZ Journal of Surgery Mar 2022Clinical voice assessment prior to thyroid and parathyroid surgery is essential, but the paradigm of indirect laryngoscopy (IDL), when indicated, has been challenged by... (Review)
Review
BACKGROUND
Clinical voice assessment prior to thyroid and parathyroid surgery is essential, but the paradigm of indirect laryngoscopy (IDL), when indicated, has been challenged by the risk of aerosolised SARS-Cov-2 during endoscopy of the aerodigestive tract. Translaryngeal ultrasound (TLUS) to assess the vocal cords has been proposed as a safe, non-invasive and sensitive alternative. The aim of this review was to verify TLUS as a viable tool for perioperative laryngeal assessment.
METHOD
A literature review was performed using Medline, Embase, Cochrane Database of Systematic Reviews, Cochrane Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials and Scopus with the following search strategy: (vocal cord OR vocal fold OR glottic OR glottis OR vocal ligaments OR rima glottidis) AND (ultras* OR sonograph* OR echography OR echotomography).
RESULTS
Fifteen studies were included in this review. All studies compared TLUS to IDL in visualizing the vocal cords in adults. Ten studies compared pre-operative TLUS to IDL where 50.6-100% of vocal cords were successfully visualized. Nine studies compared post-operative TLUS to IDL and reported visualization between 39.6% and 100%. Pre- and post-operative negative predictive values ranged from 60% to 100%.
CONCLUSION
Whilst promising, successful visualization of the cords is limited by inter-user variability, older age and male gender. Thus, we see the role of TLUS as an alternative to IDL in the post-operative setting in the young patient following uncomplicated surgery with a normal voice on clinical examination, to confirm recurrent laryngeal nerve integrity while minimizing the risk of aerosolization.
Topics: Adult; COVID-19; Humans; Laryngoscopy; Male; SARS-CoV-2; Systematic Reviews as Topic; Thyroid Gland; Thyroidectomy; Ultrasonography; Vocal Cord Paralysis; Vocal Cords
PubMed: 35133056
DOI: 10.1111/ans.17530 -
Revue Des Maladies Respiratoires Jan 2018Vocal cord dyskinesia or vocal cord dysfunction (VCD) is characterized by intermittent abnormal adduction of the vocal cords leading to airflow limitation at the level...
INTRODUCTION
Vocal cord dyskinesia or vocal cord dysfunction (VCD) is characterized by intermittent abnormal adduction of the vocal cords leading to airflow limitation at the level of the larynx, in the absence of local organic disease. It may occur in isolation or in association with asthma. The pathophysiology is complex and poorly understood. Wheeze, stridor or apparent upper airway obstruction are the most common symptoms. It occurs in a wide age range, more commonly in women, and diagnosis is often delayed and leads to unnecessary treatments (intubation, tracheostomy and high dose steroids).
METHODS
A retrospective study of 15 cases of VCD (8 cases of isolated VCD and 7 cases of VCD with associated asthma) describing the main clinical features and the diagnosis strategy.
RESULTS
Apparent upper airway obstruction, with or without associated asthma, requires an ear nose and throat examination with laryngoscopy to confirm the paradoxical adduction of the vocal cords during an acute episode of dyspnoea or during a provocation test with triggers like exercise or exposure to irritants, and for the purpose of differential diagnosis.
CONCLUSIONS
VCD remains under-appreciated and misdiagnosed, often by mimicking asthma with which it can be associated. A delayed diagnosis by emergency specialists, pulmonologists and ear nose and throat surgeons leads to unnecessary treatments and morbidity before specific therapy can be given.
Topics: Adolescent; Adult; Aged; Asthma; Diagnosis, Differential; Dyskinesias; Dyspnea; Female; Humans; Laryngoscopy; Male; Middle Aged; Respiratory Sounds; Retrospective Studies; Vocal Cord Dysfunction; Vocal Cords; Young Adult
PubMed: 29397301
DOI: 10.1016/j.rmr.2017.11.001 -
Anaesthesia Sep 2022Numerous studies support the idea that neuromuscular blockade facilitates facemask ventilation after induction of anaesthesia. Although improved airway patency or... (Observational Study)
Observational Study
Numerous studies support the idea that neuromuscular blockade facilitates facemask ventilation after induction of anaesthesia. Although improved airway patency or pulmonary compliance and a resolution of laryngospasm have been suggested as possible causes, the exact mechanism remains unclear. We aimed to assess whether neuromuscular blockade improves facemask ventilation and to clarify whether this phenomenon is associated with the vocal cord angle. This prospective observational study included patients aged between 20 and 65 years scheduled for elective surgery under general anaesthesia. After induction of anaesthesia, patients' lungs were ventilated with pressure-controlled ventilation using a facemask. During facemask ventilation, a flexible bronchoscope was inserted through a self-sealing diaphragm at the elbow connector attached to the facemask and breathing circuit and positioned to allow a continuous view of the vocal cords. The mean tidal volume and vocal cord angle were measured before and after administration of neuromuscular blocking drugs. Of 108 patients, 100 completed the study. Mean (SD) tidal volume ((11.0 (3.9) ml.kg vs. 13.6 (2.6) ml.kg ; p < 0.001) and mean (SD) vocal cord angle (17° (10°) vs. 26° (5°); p < 0.001) increased significantly after neuromuscular blockade. The proportional increase in mean tidal volume after neuromuscular blockade was positively correlated with vocal cord angle (Spearman's ρ = 0.803; p < 0.001). In conclusion, neuromuscular blockade facilitated facemask ventilation, and the improvement was correlated with further opening of the vocal cords.
Topics: Adult; Aged; Anesthesia, General; Humans; Lung; Masks; Middle Aged; Neuromuscular Blockade; Vocal Cords; Young Adult
PubMed: 35727620
DOI: 10.1111/anae.15786