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Muscle & Nerve Jul 2021Temporary vocal fold injection (VFI) is a common treatment for acute and subacute vocal fold paralysis (VFP). Laryngeal electromyography (LEMG) is useful for diagnosing...
INTRODUCTION/AIMS
Temporary vocal fold injection (VFI) is a common treatment for acute and subacute vocal fold paralysis (VFP). Laryngeal electromyography (LEMG) is useful for diagnosing neurogenic causes of VFP. This study evaluated whether the presence of VFI material prevents interpretation of LEMG in patients with acute and subacute VFP.
METHODS
Patients with acute and subacute unilateral VFP (onset ≤6 mo) who underwent temporary VFI within 3 mo preceding LEMG were evaluated. A matched control group that did not undergo VFI was also studied. The LEMG team (laryngologist and electromyographer) performed and interpreted LEMG using a pre-specified protocol, including qualitative and quantitative motor unit analysis.
RESULTS
Eighteen patients with VFI underwent LEMG successfully with interpretation of spontaneous activity and motor unit recruitment. Fourteen patients were seen in follow-up to determine accuracy of established LEMG prognosis. Seven of seven subjects with poor LEMG prognosis did not recover vocal fold motion. Five of seven subjects with fair LEMG prognosis recovered vocal fold motion. Findings were similar for the control group.
DISCUSSION
VFI augmentation material did not prevent interpretation of meaningful LEMG data in patients with acute and subacute VFP, and accurate prognoses of vocal fold motion recovery were established.
Topics: Adult; Aged; Cellulase; Electromyography; Female; Humans; Larynx; Male; Middle Aged; Vocal Cord Paralysis; Vocal Cords; Young Adult
PubMed: 33961288
DOI: 10.1002/mus.27262 -
Clinical Otolaryngology : Official... Jul 2022We aimed to evaluate the reliability of laryngoscopic features of vocal fold atrophy as assessed by novice otolaryngology trainees and expert laryngologists.
OBJECTIVES
We aimed to evaluate the reliability of laryngoscopic features of vocal fold atrophy as assessed by novice otolaryngology trainees and expert laryngologists.
DESIGN
Two expert fellowship-trained laryngologists and three non-expert otolaryngology resident trainees were recruited to view 50 anonymised laryngo-stroboscopic examinations of patients presenting with dysphonia and non-voice, laryngeal complaints. Reviewers were asked to stratify the patient's age, provide an opinion about the presence of age-related vocal fold atrophy and specify which laryngoscopy features were present to make the diagnosis.
SETTING
Tertiary care laryngology practice.
PARTICIPANTS
Two fellowship-trained laryngologists and three trainee otolaryngologists.
MAIN OUTCOME MEASURES
Accuracy of age categorisation was determined and Kappa analysis was performed to assess inter-rater agreement.
RESULTS
The mean age of patients was 54.9 years old with near equal male to female distribution. The overall accuracy of age category determination by raters was only 30.8%. Kappa analysis demonstrated fair agreement regarding the presence of vocal fold atrophy in non-expert reviewers, and moderate agreement amongst expert reviewers. Features of glottic gap, muscular atrophy of vocal folds and prominent vocal processes were all identified with high agreement (>80.0%).
CONCLUSION
Our study illustrates that while raters can agree on the presence of age-related vocal fold atrophy, the findings may be non-specific and do not necessarily correlate with age.
Topics: Atrophy; Female; Humans; Laryngoscopy; Male; Middle Aged; Reproducibility of Results; Vocal Cord Paralysis; Vocal Cords
PubMed: 35397140
DOI: 10.1111/coa.13936 -
Ear, Nose, & Throat Journal Nov 2022Leukoplakia is a precancerous lesion considered to be within the spectrum of histopathological results from parakeratosis, through stages of dysplasia to invasive... (Review)
Review
INTRODUCTION
Leukoplakia is a precancerous lesion considered to be within the spectrum of histopathological results from parakeratosis, through stages of dysplasia to invasive cancer. Narrow band imaging (NBI) endoscopy has been introduced to improve early diagnosis of benign and malignant laryngeal lesions. The aim of this literature review was to evaluate the accuracy of preoperative evaluation of vocal fold leukoplakia with NBI endoscopy in comparison with histology.
METHODS
A systematic review of the literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using 3 different databases: PubMed, Embase, and Scopus. The included articles in the systematic review were identified combining each of the following terms: "narrow band imaging" OR "NBI," [AND] with each of these terms: "laryngeal leukoplakia," OR "vocal fold leukoplakia," OR "vocal cord leukoplakia."
RESULTS
The articles that fully met the inclusion criteria were 5 case series, conducted between January 2010 and February 2018, and published between 2017 and 2019. The selected articles included 312 patients (86% males and 14% females), affected by 382 vocal cord leukoplakia, evaluated with NBI endoscopy and that underwent surgical microlaryngoscopy with biopsy. Based on the studies included in the review, accuracy of NBI in predicting malignancy within leukoplakia ranged from 81% to 97.8%, demonstrating to be an accurate method to predict the risk of malignant transformation of vocal fold leukoplakia.
CONCLUSION
Narrow band imaging can help otolaryngologists in the decision-making process on the necessity to perform a biopsy and transoral surgery or long-term follow-up. Larger studies are necessary to confirm the high association of NBI evaluation of the epithelium surrounding the leukoplakia with the histological diagnosis.
Topics: Endoscopy; Endoscopy, Gastrointestinal; Female; Humans; Laryngeal Neoplasms; Leukoplakia; Male; Narrow Band Imaging; Vocal Cords
PubMed: 33213196
DOI: 10.1177/0145561320973770 -
European Annals of Otorhinolaryngology,... Jun 2019Vocal fold paralysis in adduction can result in significant breathing difficulties. Techniques such as vocal fold lateralization and/or arytenoidopexy help to improve...
Vocal fold paralysis in adduction can result in significant breathing difficulties. Techniques such as vocal fold lateralization and/or arytenoidopexy help to improve respiratory function in this setting. These techniques require open approach or specific instruments. The authors describe an original vocal fold lateralization technique performed exclusively via an endoscopic approach. This technique helps to enlarge the glottic aperture, while preserving laryngeal architecture, and permanently improves respiratory function in patients with vocal fold paralysis in adduction.
Topics: Anesthesia, General; Arytenoid Cartilage; Humans; Laryngoscopy; Larynx; Suture Techniques; Vocal Cord Paralysis; Vocal Cords
PubMed: 30420321
DOI: 10.1016/j.anorl.2018.10.014 -
Otolaryngology--head and Neck Surgery :... Feb 2023The objective of this study is to describe an in vivo rabbit phonation model for glottic insufficiency that is simple and reproducible by means of unilateral...
OBJECTIVE
The objective of this study is to describe an in vivo rabbit phonation model for glottic insufficiency that is simple and reproducible by means of unilateral transcricothyroid laryngeal muscle stimulation and high-speed video recordings of evoked phonation.
STUDY DESIGN
Nonrandomized controlled animal trial.
SETTING
Academic medical center.
METHODS
A single operation including evoked phonation with bilateral and unilateral transcricothyroid laryngeal muscle stimulation conditions was modeled using 6 New Zealand white rabbits. The effect of stimulation method on glottic cycle, pitch, and loudness was compared. Endoscopic recordings using 5000 frames-per-second image capture technology and audiologic recordings were obtained for all phonation conditions. Primary outcome measures included means of maximum glottal area (MGA)/length pixel ratio, right and left amplitude/length pixel ratios, calculated cycle frequency, auditory recorded frequency, and maximum auditory intensity. Measurements were obtained via pixel counts using ImageJ.
RESULTS
Mean MGA/length was significantly greater with unilateral, 20.30, vs bilateral, 9.62, stimulation (P = .043). Mean frequency of 479.92 Hz vs 683.46 Hz (P = .027) and mean maximum intensity of 76.3 dB vs 83.5 dB (P = .013) were significantly increased from unilateral to bilateral stimulation. There was no significant difference in mean right amplitude/length between unilateral and bilateral.
CONCLUSION
The described model demonstrates a simple and reproducible means of producing glottic insufficiency due to unilateral vocal fold bowing and represents a pathway for better understanding the biomechanics and pathophysiology of glottic insufficiency due to superior laryngeal nerve injury and vocal fold immobility and offers the potential to compare treatment modalities through in vivo study.
Topics: Animals; Rabbits; Dysphonia; Glottis; Laryngeal Muscles; Phonation; Vocal Cords
PubMed: 35763368
DOI: 10.1177/01945998221107813 -
Intensive Care Medicine Dec 2018Ultrasound can be used to non-invasively and rapidly examine airway conditions, but vocal cord visualization with the traditional approaches is poor. Our aim was to...
PURPOSE
Ultrasound can be used to non-invasively and rapidly examine airway conditions, but vocal cord visualization with the traditional approaches is poor. Our aim was to compare the accuracies of front-side transverse-axis ultrasound (FTU), lateral-side longitudinal-axis ultrasound (LLU), and the combination of both approaches for vocal cord movement disorder diagnoses (e.g., vocal cord paralysis or arytenoid cartilage dislocation).
METHODS
We compared FTU, LLU, and the combination of both methods for patients in the intensive care unit (ICU). We used nasal fiber-optic endoscopy to confirm vocal cord injury.
RESULTS
Among the 120 patients examined, 24 (20%) had vocal cord paralysis. The visualization rate of vocal cords for FTU was 71.7% (assessable, 86; non-assessable, 34), that for LLU was 88.3% (assessable, 106; non-assessable, 14), and that for the combined approach was 96.7% (assessable, 116; non-assessable, 4). The sensitivities and specificities were 58.3% (14/24) and 75% (72/96) for FTU, 91.7% (22/24) and 87.5% (84/96) for LLU, and 100% (24/24) and 95.8% (92/96) for the combined approach. Visualization rates for LLU were significantly higher than for FTU (P = 0.002); FTU + LLU rates were higher than those for FTU (P = 0.001). The difference between LLU and FTU + LLU was not statistically significant (P = 0.025).
CONCLUSION
LLU can be used to evaluate arytenoid cartilage activity in ICUs, and the results are highly correlated with the diagnosis of nasal fiber-optic endoscopy. The combination of FTU and LLU shows promise as a rapid primary screening method for vocal cord injury.
Topics: Adult; Aged; Arytenoid Cartilage; Critical Care; Female; Humans; Male; Middle Aged; Movement; Sensitivity and Specificity; Ultrasonography; Video Recording; Vocal Cord Paralysis; Vocal Cords
PubMed: 30460501
DOI: 10.1007/s00134-018-5469-1 -
Head & Neck Sep 2023The objective of this study was to assess the performance and application of a self-developed deep learning (DL) algorithm for the real-time localization and...
BACKGROUND
The objective of this study was to assess the performance and application of a self-developed deep learning (DL) algorithm for the real-time localization and classification of both vocal cord carcinoma and benign vocal cord lesions.
METHODS
The algorithm was trained and validated upon a dataset of videos and photos collected from our own department, as well as an open-access dataset named "Laryngoscope8".
RESULTS
The algorithm correctly localizes and classifies vocal cord carcinoma on still images with a sensitivity between 71% and 78% and benign vocal cord lesions with a sensitivity between 70% and 82%. Furthermore, the best algorithm had an average frame per second rate of 63, thus making it suitable to use in an outpatient clinic setting for real-time detection of laryngeal pathology.
CONCLUSION
We have demonstrated that our developed DL algorithm is able to localize and classify benign and malignant laryngeal pathology during endoscopy.
Topics: Humans; Laryngoscopy; Artificial Intelligence; Endoscopy; Larynx; Laryngeal Neoplasms; Vocal Cords; Endoscopy, Gastrointestinal; Carcinoma
PubMed: 37377069
DOI: 10.1002/hed.27441 -
Turk Patoloji Dergisi 2020Myxomas are rare in the vocal cords. A 69-year-old man was admitted with one-year history of progressive dysphonia. Laryngoscopy revealed a polypoid mass on the right... (Review)
Review
Myxomas are rare in the vocal cords. A 69-year-old man was admitted with one-year history of progressive dysphonia. Laryngoscopy revealed a polypoid mass on the right vocal cord. The diagnosis was cellular myxoma. A review of the literature including the present case revealed eleven reported cases of myxoma. Ten cases were classic myxoma. To the best of our knowledge, cellular myxoma has not been previously reported in the vocal cord. Hypercellularity does not affect the behavior of cellular myxoma. However, its recognition is important to prevent confusion with the group of low-grade myxoid sarcomas. Cellular myxoma should be considered in the differential diagnosis of any vocal cord mass.
Topics: Aged; Humans; Laryngeal Neoplasms; Male; Myxoma; Treatment Outcome; Vocal Cords
PubMed: 29235612
DOI: 10.5146/tjpath.2017.01417 -
Otolaryngologic Clinics of North America Aug 2015Transoral and transcervical surgery to treat glottic cancer has advanced substantially over the past decade. There have been considerable innovations that enhance vocal... (Review)
Review
Transoral and transcervical surgery to treat glottic cancer has advanced substantially over the past decade. There have been considerable innovations that enhance vocal function for early disease and airway function for advanced disease. The fiber-based angiolytic 532 nm potassium titanyl phosphate laser has provided a new foundational strategy to maintain high cure rates with enhanced vocal outcomes for the treatment of early glottic disease. For advanced glottic cancer, transplanting cryopreserved aortic homograft to reconstruct wide-field laryngotracheal airway defects can provide an adequate airway caliber such that a long-term tracheotomy can frequently be avoided.
Topics: Carcinoma, Squamous Cell; Humans; Laryngeal Neoplasms; Laryngectomy; Laser Therapy; Lasers, Solid-State; Organ Sparing Treatments; Treatment Outcome; Vocal Cords; Voice Quality
PubMed: 26233792
DOI: 10.1016/j.otc.2015.04.012 -
Structure and Function of the Vocal Cords after Airway Reconstruction on Magnetic Resonance Imaging.The Laryngoscope Jul 2021Dysphonia is a common problem at long-term follow-up after airway surgery for laryngotracheal stenosis (LTS) with major impact on quality of life. Dysphonia after LTS... (Observational Study)
Observational Study
OBJECTIVES/HYPOTHESIS
Dysphonia is a common problem at long-term follow-up after airway surgery for laryngotracheal stenosis (LTS) with major impact on quality of life. Dysphonia after LTS can be caused by scar tissue from initial stenosis along with anatomical alterations after surgery. There is need for a modality to noninvasively image structure and function of the reconstructed upper airways including the vocal cords to assess voice outcome and possible treatment after LTS. Our objective was to correlate vocal cord structure and function of patients after airway reconstruction for LTS on static and dynamic magnetic resonance imaging (MRI) to voice outcome.
STUDY DESIGN
Prospective cohort study.
METHODS
Voice outcome was assessed by voice questionnaires ((pediatric) Voice Handicap Index (p)VHI)) and the Dysphonia Severity Index (DSI). Postsurgical anatomy, airway lumen, and vocal cord thickness and movement on multiplanar static high-resolution MRI and dynamic acquisitions during phonation was correlated to voice outcome.
RESULTS
Forty-eight patients (age 14.4 (range 7.5-30.7) years) and 11 healthy volunteers (15.9 (8.2-28.8) years) were included. Static MRI demonstrated vocal cord thickening in 80.9% of patients, correlated to a decrease in DSI (expected odds 0.75 [C.I. 0.58-0.96] P = .02). Dynamic MRI showed impaired vocal cord adduction during phonation in 61.7% of patients, associated with a lower DSI score (0.65 [C.I. 0.48-0.88] P = .006).
CONCLUSIONS
In LTS patients, after airway reconstruction MRI can safely provide excellent structural and functional detail of the vocal cords correlating to DSI, with further usefulness expected from technical refinements. We therefore suggest MRI as a tool for extensive imaging during LTS follow-up.
LEVEL OF EVIDENCE
3 Laryngoscope, 131:E2402-E2408, 2021.
Topics: Adolescent; Adult; Aftercare; Case-Control Studies; Child; Dysphonia; Feasibility Studies; Follow-Up Studies; Healthy Volunteers; Humans; Laryngostenosis; Magnetic Resonance Imaging; Male; Phonation; Postoperative Complications; Prospective Studies; Quality of Life; Plastic Surgery Procedures; Severity of Illness Index; Vocal Cords; Voice Quality; Young Adult
PubMed: 33459361
DOI: 10.1002/lary.29399