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The Laryngoscope Jan 2024The rat is a widely used model for studying vocal fold (VF) function after recurrent laryngeal nerve injury, but common techniques for evaluating rat VF motion remain...
OBJECTIVE
The rat is a widely used model for studying vocal fold (VF) function after recurrent laryngeal nerve injury, but common techniques for evaluating rat VF motion remain subjective and imprecise. To address this, we developed a software package, called RatVocalTracker1.0 (RVT1.0), to quantify VF motion and tested it on rats with iatrogenic unilateral vocal fold paralysis (VFP).
METHODS
A deep neural network was trained to identify the positions of the VFs and arytenoid cartilages (ACs) in transoral laryngoscope videos of the rat glottis. Software was developed to estimate glottic midline, VF displacement, VF velocity, and AC angle. The software was applied to laryngoscope videos of adult rats before and after right recurrent and superior laryngeal nerve transection (N = 15; 6M, 9F). All software calculated metrics were compared before and after injury and validated against manually calculated metrics.
RESULTS
RVT1.0 accurately tracked and quantified VF displacement, VF velocity, and AC angle. Significant differences were found before and after surgery for all RVT1.0 calculated metrics. There was strong agreement between programmatically and manually calculated measures. Automated analysis was also more efficient than nearly all manual methods.
CONCLUSION
This approach provides fast, accurate assessment of VF motion in rats with minimal labor and allows for quantitative comparison of lateral differences in movement. Through this novel analysis method, we can differentiate healthy movement from unilateral VFP. RVT1.0 is open-source and will be a valuable tool for researchers using the rat model for laryngology research.
LEVEL OF EVIDENCE
NA Laryngoscope, 134:340-346, 2024.
Topics: Rats; Animals; Vocal Cords; Vocal Cord Paralysis; Glottis; Software
PubMed: 37543969
DOI: 10.1002/lary.30930 -
American Family Physician May 2022
Topics: Diabetes Mellitus; Humans; Periodontal Diseases; Phototherapy; Vocal Cord Dysfunction; Vocal Cords
PubMed: 35559628
DOI: No ID Found -
European Archives of... Jan 2015The aim of this study was to evaluate patients with vocal fold polyps using laryngeal electromyography (LEMG) for the presence of vocal fold paresis and to compare...
The aim of this study was to evaluate patients with vocal fold polyps using laryngeal electromyography (LEMG) for the presence of vocal fold paresis and to compare transnasal fiberoptic and rigid stroboscopic findings between polyp patients with normal LEMG and with vocal fold paresis. Thirty-five patients with a vocal fold polyp underwent transnasal fiberoptic laryngoscopy, rigid laryngostroboscopy, and LEMG. The findings were compared between the LEMG-confirmed vocal fold paresis patients and the normal LEMG patients. LEMG resulted in a diagnosis of unilateral or bilateral vocal fold paresis in 17 of 35 patients (48.6 %). More men than women with vocal fold polyps had vocal fold paresis (p < 0.05). The vocal fold paresis group had higher presence of axial rotation and hypomobility of vocal folds, higher asymmetry of vertical height of vocal folds, and less presence of longitudinal stretch of vocal folds (p < 0.05). Medial-lateral compression of the false vocal folds and anterior-posterior approximation of the larynx did not show any difference between the groups. No significant difference was found in vibratory wave characteristics between the groups through rigid laryngostroboscopy. Vocal fold paresis was present in almost half of the patients with vocal fold polyps. Paresis can only be accurately diagnosed with LEMG. Transnasal fiberoptic laryngoscopic examination is helpful to recognize vocal fold paresis in vocal fold polyp patients, while stroboscopic examination is not useful to identify it in vocal fold polyp patients.
Topics: Adult; Diagnosis, Differential; Electromyography; Female; Follow-Up Studies; Humans; Laryngeal Diseases; Laryngoscopy; Male; Middle Aged; Polyps; Retrospective Studies; Stroboscopy; Vocal Cord Paralysis; Vocal Cords; Young Adult
PubMed: 25138152
DOI: 10.1007/s00405-014-3227-8 -
European Archives of... Feb 2022Optical image enhancement techniques are widely used in endoscopy to improve the visualization of blood vessels for diagnostic and therapeutic purposes. These techniques...
PURPOSE
Optical image enhancement techniques are widely used in endoscopy to improve the visualization of blood vessels for diagnostic and therapeutic purposes. These techniques are monitor-based and therefore not available for direct microscopy. In this study, a novel optical microscope filter, Hemoglobin absorption spectral imaging (H.A.S.I.) was tested for use in microlaryngoscopy.
METHODS
A novel dichroic filter was designed to improve contrast in small blood vessels by highlighting transmission in the spectrum range of hemoglobin absorption maxima. A surgical microscope equipped with the novel H.A.S.I. filter was installed in one operating room in our institution. 68 consecutive patients referred to our ENT department for endoscopy were examined using white light and the novel H.A.S.I. filter during microlaryngoscopy. Surgeons described the blood vessels of the vocal cords using a classification chart and assessed for suspected malignancy using both white light and H.A.S.I.
RESULTS
77 consecutive microlaryngoscopies were performed on 68 patients. 142 vocal cords were visualized in microlaryngoscopy and the blood vessels classified according to the chart. With white light, 152 blood vessel characteristics were documented and 157 with H.A.S.I. Notably, pathologies like benign horizontal blood vessel changes, leukoplakia, and vertical blood vessel changes like dots and loops were seen more frequently with H.A.S.I. Finally, seven lesions were treated by transoral laser microsurgery (TLM) with H.A.S.I. to test the practicability of the method for microlaryngoscopic laser surgery.
CONCLUSION
This is the first study describing H.A.S.I. as an optical staining method for microlaryngoscopy. In our experience, the method was practical and improved the evaluation of vocal cord blood vessels. In some cases, the use of H.A.S.I. led to a change in diagnosis and treatment. Also, H.A.S.I. was found to be helpful in microlaryngeal laser surgery for demarcating resection margins. This is, to our knowledge, the first optical staining method integrated into a surgical microscope and can be conveniently used during microlaryngeal laser surgery and does not require further equipment.
Topics: Endoscopy; Hemoglobins; Humans; Laryngoscopy; Microsurgery; Staining and Labeling; Vocal Cords
PubMed: 34581854
DOI: 10.1007/s00405-021-07090-z -
Journal of Voice : Official Journal of... Sep 2022Between 2006 and 2016 in a Tertiary Academic Center, 11 patients underwent phonomicrosurgery with tragal perichondrium graft placement in Reinke's space for the...
Between 2006 and 2016 in a Tertiary Academic Center, 11 patients underwent phonomicrosurgery with tragal perichondrium graft placement in Reinke's space for the treatment of sulcus (Ford type 2) and vocal fold scar. A total of six patients out of 11 had an additional autologous fat implantation in order to improve the glottic closure. We evaluated the functional outcome using the Spanish validated version of the VHI- 30 before and 6 months after the surgery. We also measured the subjective appreciation of the obtained outcome, a perceptual voice evaluation using GRBAS scale, and changes in videostroboscopy examinations concerning mucosal wave and glottic closure. In the VHI-30 questionnaire, we observed an improvement in all patients (six of which showed an improvement of 50% or more) with statistically significant results (P = 0.003), and no significant differences between sulcus (Ford type 2) and vocal cord scar patients (P = 0.7579). The results obtained from the single question assessing changes in voice quality showed a high improvement in seven patients. According to the GRBAS scale, all cases improved. Concerning the results of the videostroboscopy, two patients obtained very favorable results, eight of them presented a moderate recovery and only one improved slightly. The following complications were identified: two granulomas, a graft extrusion and a tragal infection. The tragal perichondrium used as an autograft in Reinke's space appears to be a safe and satisfactory choice, comparable to other grafts such as temporalis fascia or autologous fat.
Topics: Autografts; Cicatrix; Humans; Laryngeal Muscles; Treatment Outcome; Vocal Cords; Voice Quality
PubMed: 33934935
DOI: 10.1016/j.jvoice.2020.08.024 -
Journal of Voice : Official Journal of... Sep 2020The goal of this study was to introduce two novel techniques in phonomicrosurgery, air injection (AIR), and transillumination (TI), to improve the diagnosis and surgical...
OBJECTIVES/HYPOTHESIS
The goal of this study was to introduce two novel techniques in phonomicrosurgery, air injection (AIR), and transillumination (TI), to improve the diagnosis and surgical excision of pathological tissue in vocal folds during suspension laryngoscopy while preserving the healthy tissue as much as possible.
STUDY DESIGN
Prospective clinical case series.
METHODS
Thirty-four patients with benign vocal cord lesions who underwent phonomicrosurgery between January 2016 and May 2017 were evaluated. Pre- and intraoperative recordings were evaluated by three experienced laryngologists. Stroboscopic video images taken during the preoperative diagnosis and interoperative video recordings made before and after AIR and TI were performed were reviewed and compared. During the preoperative evaluation, the surgeons declared their surgical plans and noted changes while observing the intraoperative evaluation during AIR and TI.
RESULTS
Sixty-eight vocal folds were evaluated. The initial diagnosis was found to be consistent with the final diagnosis in only 10 patients (29.4%). The diagnoses of 29 vocal folds (42.6%) and the surgical plans changed after AIR and TI. In six cases, submucosal bands, additional morphological structures in the vicinity of the primary pathology, were observed; these could only be visualized with AIR and TI. AIR and TI revealed new pathologies in four vocal folds that were noted to be normal in the preoperative evaluation.
CONCLUSION
AIR and TI are useful and promising techniques to identify undiagnosed lesions in vocal folds and to increase the success of minimally invasive phonosurgery.
Topics: Humans; Laryngoscopy; Prospective Studies; Stroboscopy; Transillumination; Vocal Cords
PubMed: 30987858
DOI: 10.1016/j.jvoice.2019.03.009 -
Respiratory Medicine Jul 2020Vocal Cord Dysfunction (VCD) and chronic cough (CC) are challenging conditions which lead to significant quality of life impairment. The underlying mechanisms are poorly...
BACKGROUND AND AIM
Vocal Cord Dysfunction (VCD) and chronic cough (CC) are challenging conditions which lead to significant quality of life impairment. The underlying mechanisms are poorly understood, but laryngeal dysfunction may be common to both conditions. The aim of this study was to determine the characteristics of cough in VCD and whether patients with cough have coexisting VCD.
METHOD
Participants included 51 patients with VCD and a comparison group of 39 patients with chronic cough that was refractory to medical treatment. Participants underwent a comprehensive assessment including questionnaires, laryngoscopy, cough frequency monitoring and voice testing.
RESULTS
Patients with VCD had significant cough morbidity with an increased cough frequency of 17.3 coughs/hour and reduced cough quality of life with mean Leicester Cough Questionnaire Score of 12.8. Breathing pattern abnormalities were also common in VCD and there was a strong correlation between the number of breathing pattern abnormalities and cough frequency (r = -0.827, p = 0.002). Cough measures were not significantly different between patients with VCD and those with CC. Moderate-severe PVFM was present in 69% of patients with CC. Abnormal vocal fold closure during phonation was also present in patients with chronic cough and was similar between the VCD (n = 40, 78.4%) and cough (n = 25, 64.1%) groups, p = 0.240.
CONCLUSION
Cough is an important symptom in VCD. Patients presenting with chronic cough may have underlying VCD as a cause of their cough. Since cough and VCD symptoms co-occur clinicians need to consider cough when are treating VCD and VCD when treating chronic cough.
Topics: Adult; Aged; Chronic Disease; Cough; Female; Humans; Laryngeal Diseases; Laryngoscopy; Male; Middle Aged; Morbidity; Phonation; Respiration; Respiration Disorders; Surveys and Questionnaires; Vocal Cord Dysfunction; Vocal Cords
PubMed: 32364960
DOI: 10.1016/j.rmed.2020.105990 -
Journal of Healthcare Engineering 2022The use of high-speed video-endoscopy (HSV) in the study of phonatory processes linked to speech needs the precise identification of vocal fold boundaries at the time of...
The use of high-speed video-endoscopy (HSV) in the study of phonatory processes linked to speech needs the precise identification of vocal fold boundaries at the time of vibration. The HSV is a unique laryngeal imaging technology that captures intracycle vocal fold vibrations at a higher frame rate without the need for auditory inputs. The HSV is also effective in identifying the vibrational characteristics of the vocal folds with an increased temporal resolution during retained phonation and flowing speech. Clinically significant vocal fold vibratory characteristics in running speech can be retrieved by creating automated algorithms for extracting HSV-based vocal fold vibration data. The best deep learning-based diagnosis and categorization of vocal fold abnormalities is due to the usage of HSV (ODL-VFDDC). The suggested ODL-VFDDC technique starts with temporal segmentation and motion correction to identify vocalized regions from the HSV recording and gathers the position of movable vocal folds across frames. The attributes gathered are fed into the deep belief network (DBN) model. Furthermore, the agricultural fertility algorithm (AFA) is used to optimize the hyperparameter tuning of the DBN model, which improves classification results. In terms of vocal fold disorder classification, the testing results demonstrated that the ODL-VFDDC technique beats the other existing methodologies. The farmland fertility algorithm (FFA) is then used to accurately determine the glottal limits of vibrating vocal folds. The suggested method has successfully tracked the speech fold boundaries across frames with minimum processing cost and high resilience to picture noise. This method gives a way to look at how the vocal folds move during a connected speech that is completely done by itself.
Topics: Humans; Deep Learning; Endoscopy; Phonation; Video Recording; Vocal Cords; Vocal Cord Paralysis
PubMed: 36353680
DOI: 10.1155/2022/4248938 -
HNO Jun 2020Unilateral vocal fold palsy is a frequent cause of hoarseness. In the presence of glottis closure insufficiency, the effectiveness of conservative voice therapy is...
Unilateral vocal fold palsy is a frequent cause of hoarseness. In the presence of glottis closure insufficiency, the effectiveness of conservative voice therapy is often limited and phonosurgery may be indicated. Injection laryngoplasty is effective for correction of insufficiency. Early intervention during the first 6 months after diagnosis is desired to avoid subsequent insufficient endogenous compensation. Particularly patients with glottic closure insufficiency ≤2 mm in stroboscopy may benefit from this procedure. With appropriate patient selection, duration of the effect exceeding 12 months has been described for hyaluronic acid, calcium hydroxylapatite, and autologous fat. Due to rare complications such as allergic swelling at the injection site, regular laryngoscopic monitoring and observation for two nights after injection are recommended. The voice must only be rested for a few hours.
Topics: Humans; Injections; Laryngoplasty; Stroboscopy; Treatment Outcome; Vocal Cord Paralysis; Vocal Cords
PubMed: 32377780
DOI: 10.1007/s00106-020-00863-8 -
Trials Oct 2022Surgery and radiotherapy are well-established standards of care for unilateral stage 0 and I early-stage glottic cancer (ESGC). Based on comparative studies and... (Randomized Controlled Trial)
Randomized Controlled Trial
VoiceS: voice quality after transoral CO laser surgery versus single vocal cord irradiation for unilateral stage 0 and I glottic larynx cancer-a randomized phase III trial.
BACKGROUND
Surgery and radiotherapy are well-established standards of care for unilateral stage 0 and I early-stage glottic cancer (ESGC). Based on comparative studies and meta-analyses, functional and oncological outcomes after both treatment modalities are similar. Historically, radiotherapy (RT) has been performed by irradiation of the whole larynx. However, only the involved vocal cord is being treated with recently introduced hypofractionated concepts that result in 8 to 10-fold smaller target volumes. Retrospective data argues for an improvement in voice quality with non-inferior local control. Based on these findings, single vocal cord irradiation (SVCI) has been implemented as a routine approach in some institutions for ESGC in recent years. However, prospective data directly comparing SVCI with surgery is lacking. The aim of VoiceS is to fill this gap.
METHODS
In this prospective randomized multi-center open-label phase III study with a superiority design, 34 patients with histopathologically confirmed, untreated, unilateral stage 0-I ESGC (unilateral cTis or cT1a) will be randomized to SVCI or transoral CO-laser microsurgical cordectomy (TLM). Average difference in voice quality, measured by using the voice handicap index (VHI) will be modeled over four time points (6, 12, 18, and 24 months). Primary endpoint of this study will be the patient-reported subjective voice quality between 6 to 24 months after randomization. Secondary endpoints will include perceptual impression of the voice via roughness - breathiness - hoarseness (RBH) assessment at the above-mentioned time points. Additionally, quantitative characteristics of voice, loco-regional tumor control at 2 and 5 years, and treatment toxicity at 2 and 5 years based on CTCAE v.5.0 will be reported.
DISCUSSION
To our knowledge, VoiceS is the first randomized phase III trial comparing SVCI with TLM. Results of this study may lead to improved decision-making in the treatment of ESGC.
TRIAL REGISTRATION
ClinicalTrials.gov NCT04057209. Registered on 15 August 2019. Cantonal Ethics Committee KEK-BE 2019-01506.
Topics: Humans; Laryngeal Neoplasms; Voice Quality; Vocal Cords; Carbon Dioxide; Retrospective Studies; Prospective Studies; Laser Therapy; Treatment Outcome
PubMed: 36303192
DOI: 10.1186/s13063-022-06841-5