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Journal of Voice : Official Journal of... Mar 2017
Topics: Humans; Vocal Cords; Voice; Voice Disorders
PubMed: 27005440
DOI: 10.1016/j.jvoice.2016.02.008 -
Pediatric Annals May 2016Paradoxical vocal cord motion (PVCM), also termed vocal cord dysfunction, is a poorly understood disorder of episodic dyspnea characterized by inappropriate vocal cord... (Review)
Review
Paradoxical vocal cord motion (PVCM), also termed vocal cord dysfunction, is a poorly understood disorder of episodic dyspnea characterized by inappropriate vocal cord adduction during inspiration and potentially during expiration. It can coexist or be confused with asthma, so appropriate diagnosis is key to optimizing treatment success. Although many patients with PVCM may have underlying psychologic issues, there is emerging evidence to suggest that this entity is not psychogenic in every patient. Both laryngeal irritants and exercise have been identified as additional contributing factors in PVCM. Diagnosis of PVCM requires awake laryngoscopic confirmation. However, many patients do not exhibit signs of PVCM during this examination, despite provocation during testing. Therefore, clinical history remains key in determining which patients should proceed with behavioral therapy under the guidance of a speech pathologist. In addition, treatment may include limiting patient exposure to potential sources of laryngeal irritation. Refractory patients may benefit from psychologic assessment and treatment. [Pediatr Ann. 2016;45(5):e184-e188.].
Topics: Child; Diagnosis, Differential; Humans; Laryngoscopy; Male; Pediatrics; Vocal Cord Dysfunction; Vocal Cords
PubMed: 27171808
DOI: 10.3928/00904481-20160331-01 -
European Annals of Otorhinolaryngology,... Sep 2021
Topics: Adipose Tissue; Humans; Injections; Larynx; Vocal Cord Paralysis; Vocal Cords
PubMed: 34053889
DOI: 10.1016/j.anorl.2021.04.006 -
Otolaryngology--head and Neck Surgery :... Mar 2024To review the current literature about epidemiology, etiologies and surgical management of bilateral vocal fold paralysis (BVFP). (Review)
Review
OBJECTIVE
To review the current literature about epidemiology, etiologies and surgical management of bilateral vocal fold paralysis (BVFP).
DATA SOURCES
PubMED, Scopus, and Cochrane Library.
REVIEW METHODS
A systematic review of the literature on epidemiology, etiologies, and management of adult patients with BVFP was conducted through preferred reporting items for systematic reviews and meta-analyses statements by 2 investigators.
RESULTS
Of the 360 identified papers, 245 were screened, and of these 55 were considered for review. The majority (76.6%) of BVFP cases are iatrogenic. BVFP requires immediate tracheotomy in 36.2% of cases. Laterofixation of the vocal fold was described in 9 studies and is a cost-effective alternative procedure to tracheotomy while awaiting potential recovery. Unilateral and bilateral posterior transverse cordotomy outcomes were reported in 9 and 7 studies, respectively. Both approaches are associated with a 95.1% decannulation rate, adequate airway volume, but voice quality worsening. Unilateral/bilateral partial arytenoidectomy data were described in 4 studies, which reported lower decannulation rate (83%) and better voice quality outcome than cordotomy. Revision rates and complications vary across studies, with complications mainly involving edema, granuloma, fibrosis, and scarring. Selective posterior cricoarytenoid reinnervation is being performed by more surgeons and should be a promising addition to the BVFP surgical armamentarium.
CONCLUSION
Depending on techniques, the management of BVFP may be associated with several degrees of airway improvements while worsened or unchanged voice quality. The heterogeneity between studies, the lack of large-cohort controlled randomized studies and the confusion with posterior glottic stenosis limit the draw of clear conclusion about the superiority of some techniques over others.
Topics: Adult; Humans; Vocal Cords; Treatment Outcome; Vocal Cord Paralysis; Voice Quality; Tracheotomy
PubMed: 38123531
DOI: 10.1002/ohn.616 -
Annals of Medicine 2023To compare CO laser resection and laryngeal microsurgery for vocal cord polyps and provide evidence for the optimal surgical method.
OBJECTIVE
To compare CO laser resection and laryngeal microsurgery for vocal cord polyps and provide evidence for the optimal surgical method.
METHODS
This was a retrospective cohort study that included 74 patients with vocal cord polyps who underwent either CO laser resection or laryngeal microsurgery in our hospital from August 2018 to December 2021. According to their preference, 77 patients were divided into two groups: a CO laser resection group ( = 35) and a laryngeal microsurgery group ( = 39). Patients were evaluated two days before surgery, and follow-ups were conducted one, two and four weeks after surgery. The voice handicap index (VHI-10) score, voice acoustic analysis results and electronic laryngoscopy results were collected for each patient, and the differences between the two groups were evaluated.
RESULTS
The basic demographic characteristics of the 74 patients were comparable, and all patients completed postoperative follow-up observations. A total of 30 (85.71%) patients in the CO laser resection group and 22 (56.41%) patients in the laryngeal microsurgery group were healed. The total effectiveness rate of the CO laser resection group (94.29%) was significantly higher than that of the laryngeal microsurgery group (82.05%), and the difference between the two groups was statistically significant ( = .037). Both surgical methods had a positive effect on reducing VHI-10 scores with the effect of CO laser resection being more obvious. The difference between the two groups in this regard was statistically significant ( < .001). The effects of each surgical method on the average fundamental frequency perturbation (jitter), amplitude perturbation (shimmer), maximum phonation time and dysphonia severity index were not statistically significant ( > .05).
CONCLUSION
CO laser resection and laryngeal microsurgery have similar effects on voice quality, but CO laser resection has higher clinical efficacy.
Topics: Humans; Microsurgery; Vocal Cords; Carbon Dioxide; Retrospective Studies; Laryngeal Diseases; Treatment Outcome; Lasers, Gas; Polyps
PubMed: 38010099
DOI: 10.1080/07853890.2023.2280228 -
Endokrynologia Polska 2020Bilateral vocal fold paralysis presents as their complete or partial immobilisation. The median or paramedian position of vocal folds contributes to the narrowing of the... (Review)
Review
Bilateral vocal fold paralysis presents as their complete or partial immobilisation. The median or paramedian position of vocal folds contributes to the narrowing of the airway at the level of the glottis and manifests as inspiratory dyspnoea. For many years iatrogenic injury of recurrent laryngeal nerves during thyroidectomy has been viewed as the most common underlying reason. It is very often a lifethreatening condition requiring not only corticosteroid administration and intubation, which only constitute a short-term symptomatic therapy, but also surgical intervention, including tracheostomy. The most common surgical methods implemented in bilateral vocal fold paralysis include posterior cordectomy, arytenoidectomy, and, more and more commonly, re-innervation. Other techniques used in restoring airway patency include laterofixation, botulinum toxin injection, and laryngeal stimulation, which is still under research. Stem cell and gene therapy are also being researched. Notably, the main purpose of surgical treatment is the provision of airway patency with the preservation of the phonatory and protective functions of the larynx.
Topics: Female; Humans; Laryngoscopy; Male; Thyroidectomy; Treatment Outcome; Vocal Cord Paralysis; Vocal Cords; Voice Quality; Voice Training
PubMed: 32852048
DOI: 10.5603/EP.a2020.0042 -
The Laryngoscope May 2021Injection laryngoplasty of materials for unilateral vocal-fold paralysis has shown various results regarding the long-term stability of the injected material. We...
OBJECTIVES/HYPOTHESIS
Injection laryngoplasty of materials for unilateral vocal-fold paralysis has shown various results regarding the long-term stability of the injected material. We evaluated a fibrin-gel based cell suspension with autologous chondrocytes in-vitro and in-vivo as long-term-stable vocal-fold augmentation material in an animal model.
STUDY DESIGN
This study compises an in vitro cell-culture part as well as an in vivo animal study with New Zealand White Rabbits.
METHODS
In in-vitro experiments, auricular chondrocytes harvested from 24 New Zealand White Rabbits cadavers were cultivated in pellet cultures to evaluate cartilage formation for 4 weeks using long-term-stable fibrin gel as carrier. Injectability and injection volume for the laryngoplasty was determined in-vitro using harvested cadaveric larynxes. In-vivo 24 Rabbits were biopsied for elastic cartilage of the ear and autologous P1 cells were injected lateral of one vocal cord into the paraglottic space suspended in a long-term-stable fibrin gel. Histologic evaluation was performed after 2, 4, 12, and 24 weeks.
RESULTS
During 12-week pellet culture, we found extracellular matrix formation and weight-stable cartilage of mature appearance. In-vivo, mature cartilage was found in two larynxes (n = 6) at 4 weeks, in four (n = 6) at 12 weeks, and in five (n = 6) at 24 weeks mostly located in the paraglottic space and sometimes with spurs into the vocalis muscle. Surrounding tissue was often infiltrated with inflammatory cells. Material tended to dislocate through the cricothyroid space into the extraglottic surrounding tissue.
CONCLUSIONS
A cell-based approach with chondrocytes for permanent vocal-fold augmentation has not previously been reported. We have achieved the formation of structurally mature cartilage in the paraglottic space, but this is accompanied by difficulties with dislocated material, deformation of the augmentation, and inflammation.
LEVEL OF EVIDENCE
N/A Laryngoscope, 131:E1624-E1632, 2021.
Topics: Animals; Cell Culture Techniques; Chondrocytes; Chondrogenesis; Disease Models, Animal; Ear Cartilage; Female; Fibrin; Gels; Humans; Injections, Intralesional; Laryngoplasty; Male; Primary Cell Culture; Rabbits; Transplantation, Autologous; Vocal Cord Paralysis; Vocal Cords
PubMed: 33368380
DOI: 10.1002/lary.29300 -
HNO Mar 2023
Topics: Humans; Vocal Cord Paralysis; Sleep Apnea Syndromes; Vocal Cords
PubMed: 36394588
DOI: 10.1007/s00106-022-01245-y -
PloS One 2023Oblique orientation of vocal cord demands strict compliance, by technicians and clinicians, to the recommended parallel plane CT scan of larynx. Repercussions of...
Oblique orientation of vocal cord demands strict compliance, by technicians and clinicians, to the recommended parallel plane CT scan of larynx. Repercussions of non-compliance has never been investigated before. We aimed to observe influence of non-parallel vocal cord plane CT scan on qualitative and quantitative glottic parameters, keeping parallel plane CT as a standard for comparison. Simultaneous identification of potential suboptimal imaging sequelae as a result of unformatted CT plane was also identified. In this study we included 95 normal adult glottides and retrospectively analyzed their anatomy in two axial planes, non-parallel plane ① and parallel to vocal cord plane ②. Qualitative (shape, structures at glottic level) and quantitative (anterior commissure ACom, vocal cord width VCw, anteroposterior AP, transverse Tr, cross-sectional area CSA) glottic variables were recorded. Multivariate statistical analysis was used to predict pattern and their impact on glottic anatomy. Plane ① displayed supraglottic features in glottis; adipose (90.5%) and split thyroid laminae (70.6%). Other categorical variables: atypical shape, submental structures and multilevel vertebral crossing were also in majority. All glottic dimensions varied significantly between two planes with most in ACom (-5.8mm) and CSA (-15.0 mm2). In contrast, plane ② manifested higher VCw (>73%), Tr (66.3%), CSA (64.2%) and AP (44.2%) measurements. On correlation analysis, variation in ACom, CSA, Tr was positively associated with VC or plane obliquity (p<0.05). This variability was more in obese and short necked subjects. Change in one parameter also modified other significantly i.e., ACom versus AP and CSA versus Tr. Results indicated statistically significant change in subjective and objective anatomical parameters of glottis on non-application of appropriate CT larynx protocol for image analysis hence highlighting importance of image reformation.
Topics: Adult; Humans; Vocal Cords; Retrospective Studies; Glottis; Larynx; Tomography, X-Ray Computed; Laryngeal Neoplasms
PubMed: 37903145
DOI: 10.1371/journal.pone.0293659 -
Surgery Jan 2021Early recognition of postoperative vocal cord palsy enhances postoperative care. Translaryngeal ultrasonography can assess vocal cord function accurately and...
A prospective study evaluating the feasibility and accuracy of very early postoperative translaryngeal ultrasonography in the assessment of vocal cord function after neck surgery.
BACKGROUND
Early recognition of postoperative vocal cord palsy enhances postoperative care. Translaryngeal ultrasonography can assess vocal cord function accurately and noninvasively, but it is unclear whether it is feasible or accurate when done immediately after extubation in the recovery room owing to possible interference from laryngeal swelling. This study assessed the feasibility and accuracy of translaryngeal ultrasonography in this setting.
METHODS
Consecutive patients undergoing neck operations were subjected to translaryngeal ultrasonography and flexible direct laryngoscopy 1 day before and day 7 after thyroidectomy and parathyroidectomy. Translaryngeal ultrasonography was performed early in the recovery room immediately after extubation in the operating room. A standardized assessment protocol was used. Patient parameters were compared between those with assessable and unassessable vocal cords.
RESULTS
Sixty-five patients (91 recurrent laryngeal nerves-at-risk) were analyzed after excluding 2 male patients who failed preoperative translaryngeal ultrasonography. Fifty-six patients underwent thyroidectomy and 9 parathyroidectomy. The median age (range) was 57 (46-69); 44 (68%) were women. Sixty-one patients (94%) had assessable bilateral vocal cords on translaryngeal ultrasonography in the recovery room. Translaryngeal ultrasonography in the recovery room findings corresponded completely with day-7 findings on direct laryngoscopy. Long operative time was associated with nonassessable vocal cords on translaryngeal ultrasonography in the recovery room (P = .026).
CONCLUSION
Very early postoperative translaryngeal ultrasonography in the recovery room after neck surgery is highly feasible and accurate. Long operative time may hinder the use of translaryngeal ultrasonography in the recovery room.
Topics: Aged; Early Diagnosis; Endosonography; Feasibility Studies; Female; Humans; Laryngoscopy; Male; Middle Aged; Parathyroidectomy; Postoperative Complications; Prospective Studies; Recurrent Laryngeal Nerve Injuries; Thyroidectomy; Time Factors; Vocal Cord Paralysis; Vocal Cords
PubMed: 32493615
DOI: 10.1016/j.surg.2020.03.025