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Otolaryngology--head and Neck Surgery :... Dec 2017Objectives To describe the present understanding of birth trauma-related vocal fold immobility and quantitatively compare it with idiopathic congenital vocal fold... (Review)
Review
Objectives To describe the present understanding of birth trauma-related vocal fold immobility and quantitatively compare it with idiopathic congenital vocal fold immobility to explore whether it is a discrete entity. Data Sources PubMed, Ovid, and Cochrane databases. Review Methods English-language, observational, or experimental studies involving infants with idiopathic congenital or birth trauma-related vocal fold immobility were included. Data from these studies were pooled with our institution's vocal fold immobility database, with the resultant idiopathic congenital and birth trauma cohorts compared regarding patterns and outcomes of immobility. Results The search returned 288 articles, with 24 meeting inclusion criteria. Of studies reviewing all-cause immobility, 8 of 9 (88.9%) identified birth trauma as an etiology, although birth trauma definitions and proposed mechanisms of immobility varied. The study subjects, combined with our institution's database, yielded 188 idiopathic congenital and 113 birth trauma cases. Compared with idiopathic congenital cases, birth trauma cases had a higher proportion of unilateral immobility (72 of 113 [63.7%] vs 52 of 188 [27.7%], P < .001) and rate of resolution (41 of 51 [80.4%] vs 91 of 159 [57.2%], P = .003). Resolution occurred in 24 of 26 (91.3%) unilateral and 17 of 25 (68.0%) bilateral birth trauma cases and in 30 of 40 (75.0%) unilateral and 59 of 109 (54.1%) bilateral idiopathic congenital cases ( P = .11 and .20, respectively). Conclusion While the definition and mechanism of birth trauma-related vocal fold immobility warrant further investigation, these findings suggest that it is distinct from idiopathic congenital vocal fold immobility, with a unique presentation and potentially more favorable outcomes. This can inform counseling and management for infants with otherwise unexplained immobility but known birth trauma.
Topics: Birth Injuries; Humans; Vocal Cord Paralysis; Vocal Cords
PubMed: 28871836
DOI: 10.1177/0194599817726773 -
The Journal of Allergy and Clinical... May 2024Asthma and vocal cord dysfunction (VCD), also known as inducible laryngeal obstruction (ILO), may coexist, resulting in worse outcomes for patients. The experience of...
BACKGROUND
Asthma and vocal cord dysfunction (VCD), also known as inducible laryngeal obstruction (ILO), may coexist, resulting in worse outcomes for patients. The experience of people with VCD/ILO and coexisting asthma is unknown.
OBJECTIVE
We sought to determine whether coexistent VCD/ILO and asthma have deleterious impacts on quality of life.
METHODS
We undertook a descriptive qualitative study using one-to-one semistructured interviews with 30 purposively recruited adult participants with a prior confirmed doctor asthma diagnosis and laryngoscopy-confirmed VCD/ILO. A thematic and content analysis was conducted to explore the data.
RESULTS
Participants were mostly female (63%), mean ± SD age 63 ± 12 years. Four themes were identified: trapped voice, altered life, knowledge about VCD/ILO, and looking for solutions. Participants reported their voice being trapped in their throat or the voice being suddenly cut off when talking or singing. Self-reported VCD/ILO symptoms including throat tightness and breathlessness were highlighted by participants. The second theme described how patients struggle to communicate or tended to shorten conversations. Insufficient knowledge and existing confusion regarding whether asthma was causing the breathlessness was described in the third theme. Looking for solutions depicted participants' diagnostic journey and how they sought an explanation for the symptoms.
CONCLUSIONS
People with asthma and coexisting VCD/ILO experience a substantial burden affecting the quality of life. These data describe the impact on patients with coexisting conditions and should be used to increase clinician awareness of the experience of VCD/ILO from patients' perspectives to support a personalized approach to care.
Topics: Humans; Female; Asthma; Male; Middle Aged; Vocal Cord Dysfunction; Quality of Life; Aged; Adult; Airway Obstruction; Vocal Cords
PubMed: 38290607
DOI: 10.1016/j.jaip.2024.01.028 -
Journal of Voice : Official Journal of... Nov 2014To perform a systematic literature review to evaluate the type and timing of therapy for vocal fold paresis/paralysis after thyroidectomy and develop a primary... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To perform a systematic literature review to evaluate the type and timing of therapy for vocal fold paresis/paralysis after thyroidectomy and develop a primary decision-making pathway.
STUDY DESIGN
Meta-analysis.
METHODS
Four databases and one journal were searched using the key words of "thyroidectomy," "vocal cord paresis/paralysis," and "therapy." Study quality was evaluated using the Cochrane Collaboration's risk of bias tools. Data regarding type and timing of therapy were extracted from 39 articles. Odds ratios (ORs), relative risk (RR), 95% confidence interval, and heterogeneity were recorded. Logistic regression analysis was performed to determine the relationships between timing and OR/RR.
RESULTS
Among the 13 studies investigating unilateral paresis/paralysis, five focused on early therapy (0-6 months). In these studies, the OR for clinical heterogeneity was significantly higher after neurolysis than after injection laryngoplasty and voice training (Q = 17.002, I(2) = 78%, P = 0.000), and the RR for heterogeneity was significantly higher after injection laryngoplasty at ≥12 months than <12 months (Q = 9.984, I(2) = 89.9%, P = 0.002). In the 26 studies that investigated bilateral paresis/paralysis, the OR for heterogeneity was significantly higher for bilateral posterior cordectomy than for endolaryngeal laterofixation (Q = 3.510, I(2) = 71.5%, P = 0.061) and laser arytenoidectomy with posterior cordectomy (Q = 2.90, I(2) = 65.6%, P = 0.088).
CONCLUSIONS
For unilateral vocal fold paresis/paralysis after thyroidectomy, we recommend absorbable mass injection laryngoplasty, voice training, and neurolysis during the first 12 months but laryngeal reinnervation after 12 months. For bilateral vocal fold paresis/paralysis, we recommend early laterofixation and combined laser arytenoidectomy with posterior cordectomy after 12 months.
Topics: Humans; Laryngoplasty; Logistic Models; Nerve Block; Odds Ratio; Phonation; Recovery of Function; Recurrent Laryngeal Nerve Injuries; Reoperation; Risk Factors; Thyroidectomy; Time Factors; Time-to-Treatment; Treatment Outcome; Vocal Cord Paralysis; Vocal Cords; Voice; Voice Training
PubMed: 24739443
DOI: 10.1016/j.jvoice.2014.02.003 -
European Archives of... Jul 2015The aim of this study was to define the predictive risk factors of vocal cord leukoplakia recurrence and malignant transformation. From January 2009 to December 2013, 63...
The aim of this study was to define the predictive risk factors of vocal cord leukoplakia recurrence and malignant transformation. From January 2009 to December 2013, 63 patients with a diagnosis of vocal cord leukoplakia were identified based on their medical records. The 63 patients comprised 62 males and one female. This study showed that the extent of vocal cord leukoplakia resulted in statistically significant differences for both the recurrence of vocal cord leukoplakia and malignant transformation (p < 0.05). In addition, this study revealed that the degree of dysplasia resulted in statistically significant differences for both the recurrence of vocal cord leukoplakia and malignant transformation (p < 0.05). We suggest that the extent of lesion and the degree of dysplasia are predictive factors for the risk of recurrence and malignant transformation.
Topics: Aged; Cell Transformation, Neoplastic; Dissection; Female; Humans; Hyperplasia; Laryngeal Diseases; Laryngeal Neoplasms; Leukoplakia; Male; Medical Records; Middle Aged; Otorhinolaryngologic Surgical Procedures; Prognosis; Recurrence; Retrospective Studies; Risk Factors; Vocal Cords
PubMed: 25749613
DOI: 10.1007/s00405-015-3587-8 -
Scientific Reports Jun 2021Vocal fold (VF) fibrosis is a major cause of intractable voice-related disability and reduced quality of life. Excision of fibrotic regions is suboptimal and associated...
Vocal fold (VF) fibrosis is a major cause of intractable voice-related disability and reduced quality of life. Excision of fibrotic regions is suboptimal and associated with scar recurrence and/or further iatrogenic damage. Non-surgical interventions are limited, putatively related to limited insight regarding biochemical events underlying fibrosis, and downstream, the lack of therapeutic targets. YAP/TAZ integrates diverse cell signaling events and interacts with signaling pathways related to fibrosis, including the TGF-β/SMAD pathway. We investigated the expression of YAP/TAZ following vocal fold injury in vivo as well as the effects of TGF-β1 on YAP/TAZ activity in human vocal fold fibroblasts, fibroblast-myofibroblast transition, and TGF-β/SMAD signaling. Iatrogenic injury increased nuclear localization of YAP and TAZ in fibrotic rat vocal folds. In vitro, TGF-β1 activated YAP and TAZ in human VF fibroblasts, and inhibition of YAP/TAZ reversed TGF-β1-stimulated fibroplastic gene upregulation. Additionally, TGF-β1 induced localization of YAP and TAZ in close proximity to SMAD2/3, and nuclear accumulation of SMAD2/3 was inhibited by a YAP/TAZ inhibitor. Collectively, YAP and TAZ were synergistically activated with the TGF-β/SMAD pathway, and likely essential for the fibroplastic phenotypic shift in VF fibroblasts. Based on these data, YAP/TAZ may evolve as an attractive therapeutic target for VF fibrosis.
Topics: Adaptor Proteins, Signal Transducing; Animals; Female; Fibrosis; Humans; Intracellular Signaling Peptides and Proteins; Rats; Rats, Sprague-Dawley; Signal Transduction; Smad Proteins; Transcription Factors; Transcriptional Coactivator with PDZ-Binding Motif Proteins; Vocal Cord Dysfunction; Vocal Cords; YAP-Signaling Proteins
PubMed: 34188130
DOI: 10.1038/s41598-021-92871-z -
The Laryngoscope Apr 2017To assess the long-term impact of vocal fold hemorrhage (VFH) on vocal function and health, and compare these parameters to those in similar patients who have not had... (Comparative Study)
Comparative Study
OBJECTIVES/HYPOTHESIS
To assess the long-term impact of vocal fold hemorrhage (VFH) on vocal function and health, and compare these parameters to those in similar patients who have not had VFH.
STUDY DESIGN
Retrospective cohort study.
METHODS
Patients with a history of VFH (N = 41) were characterized through a review of records and assessed by means of a survey for vocal health and professional functioning as well as the Voice Handicap Index-10 (VHI-10) and, if appropriate (n = 30, 73.2%), the Singing Voice Handicap Index (SVHI-10). They were compared to a group of demographically and occupationally similar patients without VFH (N = 25, 60.9%). Patients with multiple episodes of VFH (n = 9, 22.0%) were compared to patients with a single event.
RESULTS
After a median of 41 months follow-up, patients with VFH had favorable vocal function assessment and low median VHI-10 and SVHI-10 scores (4 and 6, respectively), substantially similar to patients without VFH (VHI-10, P = .905 and SVHI 10, P =.991). The two groups showed similarly low rates of change in occupation (7.3%vs. 8.0%, P =.999). Patients with VFH were more likely to have missed days of work due to a voice problem. Analysis of patients with one versus multiple VFH episodes showed no differences, except patients with multiple episodes had significantly greater confidence in their ability to address future VFH.
CONCLUSIONS
Contrary to commonly held belief, VFH appears to have no significant long-term impact on vocational stability, subjective voice quality, or perceptions of vocal function. Moreover, among those with VFH, recurrence seems only to diminish anxiety over this transient injury.
LEVEL OF EVIDENCE
4 Laryngoscope, 127:900-906, 2017.
Topics: Adult; Age Factors; Case-Control Studies; Disease Progression; Female; Follow-Up Studies; Hemorrhage; Humans; Male; Middle Aged; Quality of Life; Reference Values; Retrospective Studies; Severity of Illness Index; Sex Factors; Surveys and Questionnaires; Time Factors; Vocal Cord Dysfunction; Vocal Cords; Voice Disorders; Voice Quality; Young Adult
PubMed: 27714858
DOI: 10.1002/lary.26302 -
The Journal of Allergy and Clinical... Feb 2022Vocal cord dysfunction (VCD) is present in 25% to 50% of patients with asthma. When both diagnoses are suspected, accurate diagnosis and targeted management represent a...
BACKGROUND
Vocal cord dysfunction (VCD) is present in 25% to 50% of patients with asthma. When both diagnoses are suspected, accurate diagnosis and targeted management represent a clinical challenge.
OBJECTIVE
To evaluate diagnostic and therapeutic outcomes following systematic assessment for patients with concurrent suspected VCD and asthma.
METHODS
Patients underwent systematic evaluation by clinical assessment and validated questionnaires, followed by multidisciplinary management. VCD was confirmed by visualization of paradoxical vocal fold motion at baseline or following provocation. Asthma was confirmed by demonstrating variable airflow obstruction. Asthma medications were deescalated in those with low clinical probability of asthma and no variable airflow obstruction. Response to 2 or more sessions of speech pathology was assessed by subjective report and standardized questionnaires.
RESULTS
Among 212 consecutive patients, 62 (29%) patients had both VCD and asthma, 54 (26%) had VCD alone, 51 (24%) had asthma alone, and 45 (21%) had neither. Clinician assessment and the Laryngeal Hypersensitivity Questionnaire both predicted laryngoscopy-confirmed VCD. Deescalation or discontinuation of asthma therapy was possible in 37 of 59 (63%) patients without variable airflow obstruction, and was most successful (odds ratio, 5.5) in the presence of laryngoscopy-confirmed VCD (25 of 31, or 81%) Patients with VCD responded subjectively to 2 or more sessions of speech pathology, but laryngeal questionnaire scores did not improve.
CONCLUSIONS
Expert clinician assessment and the Laryngeal Hypersensitivity Questionnaire predict the presence of laryngoscopy-confirmed VCD. Systematic assessment for both VCD and asthma facilitates deescalation or discontinuation of unnecessary asthma medications. Subjective symptom improvement following speech pathology was not paralleled by laryngeal questionnaire scores in this cohort.
Topics: Asthma; Diagnosis, Differential; Humans; Laryngoscopy; Treatment Outcome; Vocal Cord Dysfunction; Vocal Cords
PubMed: 34718212
DOI: 10.1016/j.jaip.2021.10.038 -
Journal of Voice : Official Journal of... May 2023Adult laryngeal hemangiomas are rare and uncommon. Hemangioma isolated to the free-edge of vocal cord is very rare. We report five cases diagnosed at our voice clinic... (Review)
Review
Adult laryngeal hemangiomas are rare and uncommon. Hemangioma isolated to the free-edge of vocal cord is very rare. We report five cases diagnosed at our voice clinic during 18 months-period from July 2016 to December 2017. All the five patients presented with hoarseness and the laryngoscopy examination detected a pink mass at the vocal edge with the histopathology indicating hemangioma. Direct laryngoscopy with laryngeal carbon dioxide (CO2) laser microscopic surgery was performed uneventfully and no recurrence was found. We suggest that Microscopic Laser Laryngoscopy (CO2) is the treatment option of vocal fold hemangioma with no intraoperative massive bleeding.
Topics: Humans; Adult; Vocal Cords; Carbon Dioxide; Larynx; Hemangioma; Laryngoscopy
PubMed: 33750625
DOI: 10.1016/j.jvoice.2021.01.022 -
Vestnik Otorinolaringologii 2017Vocal disorders make up one of the autoimmune pathological conditions characterized by multiple organ system dysfunction. Laryngeal pathology in this condition has an... (Review)
Review
Vocal disorders make up one of the autoimmune pathological conditions characterized by multiple organ system dysfunction. Laryngeal pathology in this condition has an autoimmune nature; it is highly diverse and poorly explored. The objective of the present work based on the analysis of the relevant literature publications was to study clinical manifestations of the autoimmune rheumatic disease affecting the larynx. 'Bamboo nodes' on the vocal folds is a rare manifestation of laryngeal autoimmune diseases. We found out references to 49 cases of this condition in the available literature. All the patients were women presenting with autoimmune diseases. The present review highlights the problems pertaining to etiology of 'bamboo nodes' on the vocal folds and the method for the treatment of this condition.
Topics: Autoimmune Diseases; Humans; Laryngeal Diseases; Rheumatic Diseases; Vocal Cords
PubMed: 29072672
DOI: 10.17116/otorino201782580-84 -
Respirology (Carlton, Vic.) Aug 2019
Topics: Humans; Patient Care Team; Vocal Cord Dysfunction; Vocal Cords
PubMed: 30977222
DOI: 10.1111/resp.13560