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Otolaryngologic Clinics of North America Feb 2020Electrical stimulation of the recurrent laryngeal nerve is a safe and promising therapeutic approach with the potentiality to overcome the shortcomings of conventional... (Review)
Review
Electrical stimulation of the recurrent laryngeal nerve is a safe and promising therapeutic approach with the potentiality to overcome the shortcomings of conventional surgical glottal enlargement. Although aberrant or synkinetic reinnervation is commonly considered an unfavorable condition, particularly for recovery of vocal fold movement, its presence is essential to ensure the effective clinical performance of laryngeal pacemakers. Thus, the effective selection of patients who can profit from laryngeal pacemakers implantation demands the implementation of new diagnostic tools based on tests capable of reliably detecting the presence of viable reinnervation on at least one vocal fold.
Topics: Animals; Electric Stimulation Therapy; Electromyography; Humans; Implantable Neurostimulators; Laryngeal Muscles; Prosthesis Implantation; Recurrent Laryngeal Nerve; Treatment Outcome; Vocal Cord Paralysis; Vocal Cords
PubMed: 31648825
DOI: 10.1016/j.otc.2019.09.009 -
JAMA Otolaryngology-- Head & Neck... Feb 2024
Topics: Humans; Vocal Cords; Laryngeal Diseases; Polyps
PubMed: 38095882
DOI: 10.1001/jamaoto.2023.3698 -
European Archives of... Jun 2021Cervical ultrasound allows real-time visualization of the laryngeal structures. We describe its application for injection laryngoplasty in the voice clinic.
BACKGROUND
Cervical ultrasound allows real-time visualization of the laryngeal structures. We describe its application for injection laryngoplasty in the voice clinic.
METHODS
Hyaluronic acid infiltration of the vocal fold under ultrasonographic control.
CONCLUSIONS
With this technique, the position of the needle in the depth of the vocal fold and its spatial relations with nearby structures can be assessed. This allows for an accurate infiltration of the material in contrast to other techniques and avoids discomfort related to the gag reflex with nasofibrolaryngoscopy. No specific complications have been observed so far, however, this technique may be difficult in cases with calcified cartilages or uncooperative patients.
Topics: Humans; Injections; Laryngoplasty; Treatment Outcome; Vocal Cord Paralysis; Vocal Cords; Voice
PubMed: 33738568
DOI: 10.1007/s00405-021-06666-z -
American Journal of Surgery May 2022Early diagnosis of vocal cord iatrogenic injury is crucial, as is perioperative vocal cord evaluation. (Review)
Review
BACKGROUND
Early diagnosis of vocal cord iatrogenic injury is crucial, as is perioperative vocal cord evaluation.
METHODS
Vocal cord mobility detected via transcutaneous laryngeal ultrasonography was compared with that detected via laryngoscopy (the reference). The vocal cord visualization rate of ultrasonography for evaluation of mobility was explored.
RESULTS
The diagnostic odds ratio of transcutaneous laryngeal ultrasonography was 303.2212 (95% CI, [86.7944; 1059.3198]). The area under the summary receiver operating characteristic curve was 0.944. The sensitivity, specificity, and negative predictive value were 0.9154 [0.8471; 0.9548], 0.9771 [0.9541; 0.9887], and 0.9915 [0.9868; 0.9946], respectively. The vocal cord visualization of ultrasonography used to evaluate vocal cord mobility was high (0.9572 [0.9091; 0.9804]).
CONCLUSIONS
Since transcutaneous laryngeal ultrasonography has the advantage in vocal cord visualization, it can be considered when laryngoscopy is unavailable or patients refuse laryngoscopy. Also, it is diagnostically accurate regardless of the used landmarks, VCP definition, and timing for application.
Topics: Humans; Laryngeal Diseases; Thyroid Gland; Thyroidectomy; Ultrasonography; Vocal Cord Paralysis; Vocal Cords
PubMed: 34412901
DOI: 10.1016/j.amjsurg.2021.08.019 -
The Laryngoscope Oct 2022This scoping review aims to provide a broad overview of the applications of artificial intelligence (AI) to office laryngoscopy to identify gaps in knowledge and guide... (Review)
Review
OBJECTIVES/HYPOTHESIS
This scoping review aims to provide a broad overview of the applications of artificial intelligence (AI) to office laryngoscopy to identify gaps in knowledge and guide future research.
STUDY DESIGN
Scoping Review.
METHODS
Searches for studies on AI and office laryngoscopy were conducted in five databases. Title and abstract and then full-text screening were performed. Primary research studies published in English of any date were included. Studies were summarized by: AI applications, targeted conditions, imaging modalities, author affiliations, and dataset characteristics.
RESULTS
Studies focused on vocal fold vibration analysis (43%), lesion recognition (24%), and vocal fold movement determination (19%). The most frequently automated tasks were recognition of vocal fold nodules (19%), polyp (14%), paralysis (11%), paresis (8%), and cyst (7%). Imaging modalities included high-speed laryngeal videos (45%), stroboscopy (29%), and narrow band imaging endoscopy (7%). The body of literature was primarily authored by science, technology, engineering, and math (STEM) specialists (76%) with only 30 studies (31%) involving co-authorship by STEM specialists and otolaryngologists. Datasets were mostly from single institution (84%) and most commonly originated from Germany (23%), USA (16%), Spain (9%), Italy (8%), and China (8%). Demographic information was only reported in 39 studies (40%), with age and sex being the most commonly reported, whereas race/ethnicity and gender were not reported in any studies.
CONCLUSION
More interdisciplinary collaboration between STEM and otolaryngology research teams improved demographic reporting especially of race and ethnicity to ensure broad representation, and larger and more geographically diverse datasets will be crucial to future research on AI in office laryngoscopy.
LEVEL OF EVIDENCE
NA Laryngoscope, 132:1993-2016, 2022.
Topics: Artificial Intelligence; Humans; Laryngoscopy; Polyps; Stroboscopy; Vocal Cord Paralysis; Vocal Cords
PubMed: 34582043
DOI: 10.1002/lary.29886 -
BMJ Case Reports Feb 2022A 24-year-old woman visited the Ear Nose Throat (ENT) outpatient department with complaints of hoarseness for 2 months not responding to conservative management....
A 24-year-old woman visited the Ear Nose Throat (ENT) outpatient department with complaints of hoarseness for 2 months not responding to conservative management. Laryngoscopic examination revealed a whitish ulceroproliferative lesion in the anterior commissure and anterior two-thirds of bilateral true vocal cords with surrounding necrosis. In view of the above findings, the patient was planned for biopsy under general anaesthesia. Intraoperative findings showed multiple whitish necrotic friable tissue involving anterior two-thirds of bilateral false vocal cords, ventricle, bilateral true vocal cords, both aryepiglottic folds and laryngeal surface of epiglottis. Postoperative histopathology was consistent with tuberculosis. A pulmonology consultation was taken, and the patient was started on anti-tuberculosis chemotherapy. One month post therapy, the voice was symptomatically better. A flexible fibreoptic laryngoscopic examination was done, which revealed almost complete resolution of the lesion with minimal ulceration at the anterior one-third of right true vocal cord.
Topics: Adult; Female; Hoarseness; Humans; Laryngoscopy; Larynx; Tuberculosis, Laryngeal; Vocal Cords; Young Adult
PubMed: 35131802
DOI: 10.1136/bcr-2021-248095 -
Journal of Speech, Language, and... Oct 2014Vocal fold epithelium is composed of layers of individual epithelial cells joined by junctional complexes constituting a unique interface with the external environment.... (Review)
Review
PURPOSE
Vocal fold epithelium is composed of layers of individual epithelial cells joined by junctional complexes constituting a unique interface with the external environment. This barrier provides structural stability to the vocal folds and protects underlying connective tissue from injury while being nearly continuously exposed to potentially hazardous insults, including environmental or systemic-based irritants such as pollutants and reflux, surgical procedures, and vibratory trauma. Small disruptions in the epithelial barrier may have a large impact on susceptibility to injury and overall vocal health. The purpose of this article is to provide a broad-based review of current knowledge of the vocal fold epithelial barrier.
METHOD
A comprehensive review of the literature was conducted. Details of the structure of the vocal fold epithelial barrier are presented and evaluated in the context of function in injury and pathology. The importance of the epithelial-associated vocal fold mucus barrier is also introduced.
RESULTS/CONCLUSIONS
Information presented in this review is valuable for clinicians and researchers as it highlights the importance of this understudied portion of the vocal folds to overall vocal health and disease. Prevention and treatment of injury to the epithelial barrier is a significant area awaiting further investigation.
Topics: Air Pollutants; Animals; Aquaporins; Cell Membrane; Disease Models, Animal; Humans; Intercellular Junctions; Intraoperative Complications; Ion Transport; Irritants; Mucus; Rats; Respiratory Mucosa; Tobacco Smoke Pollution; Vibration; Vocal Cord Dysfunction; Vocal Cords
PubMed: 24686981
DOI: 10.1044/2014_JSLHR-S-13-0283 -
The Laryngoscope May 2022Vocal fold (VF) lipoaugmentation can be employed to treat glottal insufficiency although variable data exist on its length of effectiveness. We aimed to review published... (Review)
Review
OBJECTIVES/HYPOTHESIS
Vocal fold (VF) lipoaugmentation can be employed to treat glottal insufficiency although variable data exist on its length of effectiveness. We aimed to review published long-term outcomes following lipoaugmentation across the literature and compile outcome data.
STUDY DESIGN
Systematic review.
METHODS
A systematic search in September 2020 of PubMed, MEDLINE, Cochrane Library, and Web of Science used the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines to identify 128 relevant articles related to VF lipoaugmentation effectiveness duration. Primary search terms included the following: vocal cord, fat, lipo, and atrophy. Forty-eight full-text articles were reviewed and 31 were included in the final analysis. Primary endpoints included the following: duration of effectiveness per patient-reported outcome measures, objective findings, and additional procedures performed. In addition, fat harvest location and processing techniques were recorded.
FINDINGS
Thirty-one studies totaling 764 patients were included in the review. Indications for augmentation were VF paralysis (N = 690) and atrophy (N = 74). Fat was harvested from the abdominal region in 21 studies (529 patients), the thigh/abdomen in 5 studies (91 patients), and buccal/submental region in 2 studies (33 patients). Processing techniques and injectable volume varied. Across included studies, only 11 of 764 patients (1.4%) reported no improvement in voice and/or swallowing. Within the first year, 71 of 608 patients (11.7%) reported a regression toward baseline. Beyond 1 year and up to 8 years, 27 of 214 patients (12.6%) reported regression from initial improvement. Thirty-three patients underwent additional procedures.
CONCLUSION
Although improvements in voice and swallowing after lipoaugmentation taper over time, most patients experienced long-term benefit. Laryngoscope, 132:1042-1053, 2022.
Topics: Atrophy; Humans; Transplantation, Autologous; Vocal Cord Paralysis; Vocal Cords
PubMed: 34375001
DOI: 10.1002/lary.29802 -
Journal of Voice : Official Journal of... Jul 2018Since the development of distal chip endoscopes with a working channel, diagnostic and therapeutic possibilities in the outpatient clinic in the management of laryngeal... (Review)
Review
INTRODUCTION
Since the development of distal chip endoscopes with a working channel, diagnostic and therapeutic possibilities in the outpatient clinic in the management of laryngeal pathology have increased. Which of these office-based procedures are currently available, and their clinical indications and possible advantages, remains unclear.
MATERIAL AND METHODS
Review of literature on office-based procedures in laryngology and head and neck oncology.
RESULTS
Flexible endoscopic biopsy (FEB), vocal cord injection, and laser surgery are well-established office-based procedures that can be performed under topical anesthesia. These procedures demonstrate good patient tolerability and multiple advantages.
CONCLUSION
Office-based procedures under topical anesthesia are currently an established method in the management of laryngeal pathology. These procedures offer medical and economic advantages compared with operating room-performed procedures. Furthermore, office-based procedures enhance the speed and timing of the diagnostic and therapeutic process.
Topics: Ambulatory Surgical Procedures; Anesthesia, Local; Biopsy; Humans; Injections; Laryngeal Diseases; Laryngoscopes; Laryngoscopy; Larynx; Laser Therapy; Office Visits; Predictive Value of Tests; Treatment Outcome; Vocal Cords; Voice Disorders
PubMed: 28935210
DOI: 10.1016/j.jvoice.2017.07.018 -
BMC Cancer Apr 2021Radiotherapy, along with laser surgery, is considered a standard treatment option for patients with early glottic squamous cell cancer (SCC). Historically, patients have... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Radiotherapy, along with laser surgery, is considered a standard treatment option for patients with early glottic squamous cell cancer (SCC). Historically, patients have received complete larynx radiotherapy (CL-RT) due to fear of swallowing and respiratory laryngeal motion and this remains the standard approach in many academic institutions. Local control (LC) rates with CL-RT have been excellent, however this treatment can carry significant toxicities include adverse voice and swallowing outcomes, along with increased long-term risk of cerebrovascular morbidity. A recent retrospective study reported improved voice quality and similar local control outcomes with focused vocal cord radiotherapy (VC-RT) compared to CL-RT. There is currently no prospective evidence on the safety of VC-RT. The primary objective of this Bayesian Phase II trial is to compare the LC of VC-RT to that of CL-RT in patients with T1N0 glottic SCC.
METHODS
One hundred and fifty-five patients with T1a-b N0 SCC of the true vocal cords that are n ot candidate or declined laser surgery, will be randomized in a 1:3 ratio the control arm (CL-RT) and the experimental arm (VC-RT). Randomisation will be stratified by tumor stage (T1a/T1b) and by site (each site will be allowed to select one preferred radiation dose regimen, to be used in both arms). CL-RT volumes will correspond to the conventional RT volumes, with the planning target volume extending from the top of thyroid cartilage lamina superiorly to the bottom of the cricoid inferiorly. VC-RT volumes will include the involved vocal cord(s) and a margin accounting for respiration and set-up uncertainty. The primary endpoint will be LC at 2-years, while secondary endpoints will include patient-reported outcomes (voice impairment, dysphagia and symptom burden), acute and late toxicity radiation-induced toxicity, overall survival, progression free survival, as well as an optional component of acoustic and objective measures of voice analysis using the Consensus Auditory-Perceptual Evaluation of Voice.
DISCUSSION
This study would constitute the first prospective evidence on the efficacy and safety of VC-RT in early glottic cancer. If positive, this study would result in the adoption of VC-RT as standard approach in early glottic cancer.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT03759431 Registration date: November 30, 2018.
Topics: Bayes Theorem; Carcinoma, Squamous Cell; Female; Glottis; Humans; Larynx; Magnetic Resonance Imaging; Male; Neoplasm Staging; Radiotherapy; Tomography, X-Ray Computed; Treatment Outcome; Tumor Burden; Vocal Cords
PubMed: 33888069
DOI: 10.1186/s12885-021-08195-8