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The Annals of Otology, Rhinology, and... Oct 2023Fat injection laryngoplasty (FIL) is a common procedure used to correct glottic insufficiency. Nevertheless, few studies have discussed potential treatments for cases...
OBJECTIVE
Fat injection laryngoplasty (FIL) is a common procedure used to correct glottic insufficiency. Nevertheless, few studies have discussed potential treatments for cases with poor voice recovery after FIL.
METHODS
Eighteen patients with unfavorable vocal outcomes from FIL were analyzed. Each of these patients presented persistent dysphonia for more than 2 months following FIL, together with bulging vocal folds and poor mucosal wave. We applied microsurgery as the standard treatment to remove excessive fat. Vocal fold steroid injection (VFSI) was administered to patients that were hesitant or declined to undergo microsurgery. Voice outcomes were evaluated using the Voice Handicap Index-10 (VHI-10), grade-roughness-breathiness (GRB) scores, and smoothed cepstral peak prominence (CPPs).
RESULTS
Six patients underwent microsurgery directly, 6 patients received only VFSIs as a salvage treatment, and the remaining 6 patients received 1 to 3 courses of VFSIs before the decision to undergo microsurgery. Pathology reports were available for 10 patients, and contained 5 instances of adipose tissues, 3 of fat necrosis, 1 of chronic inflammation, and 1 of fibrosis. Seventeen patients reported satisfactory or improved outcomes. We found remarkable improvements in VHI-10, GRB, and CPPs (all < .05) after salvage treatments for FIL. Subgroup analyses showed comparable voice outcomes for patients undergoing direct microsurgery, VFSI alone, and VFSI followed by microsurgery ( > .05).
CONCLUSIONS
This study demonstrated that fat overinjection and/or fibrotic change in the injected vocal folds may cause poor voice outcomes after FIL. Both microsurgery and VFSI could be applied as salvage treatments with good voice recovery profiles.
LEVEL OF EVIDENCE
Level 4.
Topics: Humans; Salvage Therapy; Laryngoplasty; Treatment Outcome; Voice; Vocal Cords; Dysphonia; Retrospective Studies
PubMed: 36510646
DOI: 10.1177/00034894221140777 -
Indian Journal of Otolaryngology and... Sep 2023Thyroid surgery is performed by ENT head and neck (ENT-HNS), endocrine (ES) and general surgeons (GS). Each modality adopts different surgical techniques causing...
Thyroid surgery is performed by ENT head and neck (ENT-HNS), endocrine (ES) and general surgeons (GS). Each modality adopts different surgical techniques causing difference in outcome, operative time and postoperative complication. A retrospective chart review of thyroid surgeries performed by two ENT-HNS, three ES of a single tertiary center was conducted. We compared the use of neuromonitoring and surgical loupe and subsequent patient outcomes between surgeries performed by ENT-HNS versus ES, focusing on parathyroid gland identification, operative duration, vocal cord paralysis and length of hospital stay. A total of 167 patients underwent thyroid surgery. Surgical loupes were used in all the surgeries performed by ENT-HNS vs. 85% by the ES. Parathyroid glands were identified in all the surgeries performed by ENT-HNS versus 95% by ES. Neuromonitoring was used in all the surgeries performed by ENT-HNS, and none by the ES. Vocal cord paralysis developed in two patients of ES versus none in the ENT-HNS. Mean operative duration for total thyroidectomy in ENT-HN surgeries, 183.7 min vs. 151 min in the ES. The mean hospital stay of patients was 3.6 ± 1.6 days for ENT-HNS, and 5.45 ± 3 days for ES. Identification of parathyroid gland and recurrent laryngeal nerve by neuromonitoring and surgical loupes may increase operative time but decrease the rate of vocal cord paralysis and increases the chance of parathyroid gland identification.
PubMed: 37636681
DOI: 10.1007/s12070-023-03627-2 -
Ear, Nose, & Throat Journal Apr 2024Primary vocal cord aspergillosis is extremely rare in immunocompetent individuals, in whom lesions are mainly confined to the larynx, with the possibility of tracheal...
Primary vocal cord aspergillosis is extremely rare in immunocompetent individuals, in whom lesions are mainly confined to the larynx, with the possibility of tracheal and bronchial infection largely ignored. In this article, we present a case of primary vocal cord aspergillosis involving the trachea and bronchus in a previously healthy 55-year-old woman. Our case highlights that vocal cord aspergillosis can involve the trachea and bronchus and that laryngoscopy alone may be insufficient to secure a comprehensive diagnosis in healthy patients presenting with hoarseness, pharyngalgia, and normal chest radiography. Furthermore, influenza B virus infection may be a risk factor for this rare disease.
PubMed: 38676418
DOI: 10.1177/01455613241249097 -
Pepsin Increases the Proliferation of Vocal Cord Leukoplakia Epithelial Cells by Inducing Autophagy.Otolaryngology--head and Neck Surgery :... Nov 2023To investigate the role of H /K ATPase in the proliferation of pepsin-induced vocal cord leukoplakia (VCL) cells.
OBJECTIVE
To investigate the role of H /K ATPase in the proliferation of pepsin-induced vocal cord leukoplakia (VCL) cells.
STUDY DESIGN
Translation research.
SETTING
Affiliated Hospital of University.
METHODS
Immunohistochemistry was used to detect pepsin, H /K ATPase (ATP4A and ATP4B subunits) in VCL cells with varying degrees of dysplasia. After primary cultures of VCL cells had been established, the effects of acidified pepsin on the proliferation, autophagy, and H /K -ATPase distribution of VCL cells were investigated.
RESULTS
The levels of pepsin, ATP4A, and ATP4B were significantly higher in VCL tissue with moderate-to-severe dysplasia than in normal tissue (p < .05); these levels gradually increased according to dysplasia severity. The expression levels of ATP4A and ATP4B were significantly correlated with the amount of pepsin in VCL cells (p < .01). Acidified pepsin enhanced the levels of proliferation and autophagy in human VCL epithelial cells. The cloning- and autophagy-promoting effects of acidified pepsin on VCL cells were partially reversed by pantoprazole; these effects were completely blocked by the autophagy inhibitor chloroquine. Finally, acidified pepsin promoted the colocalization of H /K -ATPase and lysosomes in VCL cells; it also mediated lysosome acidification.
CONCLUSION
Pepsin and H /K -ATPase may contribute to the progression of VCL. Specifically, acidified pepsin may regulate lysosome acidification by promoting lysosomal localization of H /K -ATPase.
Topics: Humans; Pepsin A; Vocal Cords; Laryngeal Diseases; Autophagy; Epithelial Cells; Adenosine Triphosphatases; Cell Proliferation; Leukoplakia
PubMed: 37264983
DOI: 10.1002/ohn.390 -
Cureus Oct 2023Vocal cord dysfunction (VCD) is the inappropriate adduction of the vocal cords during inhalation and sometimes, exhalation. Vocal cord dysfunction is often misdiagnosed...
Vocal cord dysfunction (VCD) is the inappropriate adduction of the vocal cords during inhalation and sometimes, exhalation. Vocal cord dysfunction is often misdiagnosed in the emergency room as asthma exacerbation or laryngeal angioedema, leading to unnecessary and potentially harmful interventions including intubation and mechanical ventilation. Based on this, it is especially important to recognize this condition early to avoid intubation, which can further worsen VCD. This case presents a 74-year-old female with a history of hypertension and colon cancer who presented to the emergency department (ED) with respiratory distress associated with stridor and wheezing. Our literature review sheds light on identifying key clinical features, physical exam findings, diagnostic tests, existing treatment options for this condition, and preventive measures to minimize its occurrence.
PubMed: 37933370
DOI: 10.7759/cureus.46551 -
Pathology Dec 2023
Topics: Humans; Vocal Cords; Cystadenoma; Parotid Neoplasms
PubMed: 37558598
DOI: 10.1016/j.pathol.2023.05.014 -
Journal of Voice : Official Journal of... Jan 2024The distorted voices, commonly called vocal drives in Brazil and in some other South American countries, are vocal ornaments belonging to the aesthetics of popular... (Review)
Review
The distorted voices, commonly called vocal drives in Brazil and in some other South American countries, are vocal ornaments belonging to the aesthetics of popular singing and desired by singers of different styles. The advances in vocal sciences have allowed the demystification of this type of technique in the last four decades, classifying them as glottal, supraglottic or mixed distortions/drives. The interdisciplinary approach in the evaluation of singers who use glottal distortions is fundamental for a broad understanding of the particularities of each case. The present study has as main objective to describe the anatomophysiological and spectral findings of the glottal distortions, identified in the practice of many singers. A sample of three singers in a sung emission with and without vocal distortions was collected. PreSonus® AudioBox Studio One kit was used to record the voice during the nasolaryngoscopic evaluation. The singers underwent vocal warm-up and functional evaluation of the larynx based on two studies on contemporary singers. The singers performed the Snarl Voice and Phaser distortions and both showed particular anatomophysiological behaviors. The larynx was low in the first distortion and the level of the clean voice in the second, with the posterior opening of the glottis in both distortions being observed, with opening of the middle third of the glottis for the first as well. Formants vary according to the vocal tract settings used for the distortions. The glottic distortions present a complex anatomophysiological behavior in their composition, with fundamental participation of the transverse interarytenoid muscle and lateral cricoarytenoids, as well as the the participation of the vocal fold in the frequency break. F3 varied according to the longitudinal length and F4 with the diameter, both being related to the three-dimensional adjustments of the vocal tract.
Topics: Humans; Singing; Voice Quality; Voice; Vocal Cords; Larynx
PubMed: 34474938
DOI: 10.1016/j.jvoice.2021.07.018 -
Respirology (Carlton, Vic.) Oct 2023
Topics: Humans; Animals; Vocal Cord Dysfunction; Birds
PubMed: 37612245
DOI: 10.1111/resp.14574 -
Biomechanics and Modeling in... Aug 2023Neck muscles play important roles in various physiological tasks, including swallowing, head stabilization, and phonation. The mechanisms by which neck muscles influence...
Neck muscles play important roles in various physiological tasks, including swallowing, head stabilization, and phonation. The mechanisms by which neck muscles influence phonation are not well understood, with conflicting reports on the change in fundamental frequency for ostensibly the same neck muscle activation scenarios. In this work, we introduce a reduced-order muscle-controlled vocal fold model, comprising both intrinsic muscle control and extrinsic muscle effects. The model predicts that when the neck muscles pull the thyroid cartilage in the superior-anterior direction (with a sufficiently large anterior component), inferior direction, or inferior-anterior direction, tension in the vocal folds increases, leading to fundamental frequency rise during sustained phonation. On the other hand, pulling in the superior direction, superior-posterior direction, or inferior-posterior direction (with a sufficiently large posterior component) tends to decrease vocal fold tension and phonation fundamental frequency. Varying the pulling force location alters the posture and phonation biomechanics, depending on the force direction. These findings suggest potential roles of particular neck muscles in modulating phonation fundamental frequency, with implications for vocal hyperfunction.
Topics: Laryngeal Muscles; Phonation; Vocal Cords; Biomechanical Phenomena; Electric Stimulation
PubMed: 37169957
DOI: 10.1007/s10237-023-01724-3 -
Journal of Speech, Language, and... Aug 2023This study evaluated the efficacy of a 4-week straw phonation in water (SPW) exercise program on aging-related vocal fold atrophy (VFA), with a secondary objective to... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
This study evaluated the efficacy of a 4-week straw phonation in water (SPW) exercise program on aging-related vocal fold atrophy (VFA), with a secondary objective to examine the immediate effects of SPW exercises.
METHOD
Thirty-eight older adults aged 60 years and above formally diagnosed with aging-related VFA were randomly assigned into an experimental group undergoing SPW exercises with an 8-cm depth of straw submersion into water for 4 weeks plus vocal hygiene practice ( = 20), and a control group with only vocal hygiene practice ( = 18). Outcome measures included laryngeal endoscopic measures of glottal gap, auditory-perceptual ratings of voice quality, acoustic measures, aerodynamic measures, and standardized self-assessment questionnaire scores. An additional round of acoustic and aerodynamic assessment following 20 min of SPW exercises was conducted to examine the immediate effects.
RESULTS
Significant improvements in normalized glottal gap area, perceptual rating of breathiness, smoothed cepstral peak prominence, harmonics-to-noise ratio (HNR), mean oral airflow, subglottal pressure and laryngeal airway resistance at comfortable loudness, Voice-related Quality of Life scores, and Chinese Vocal Fatigue Index Factor 3 scores were observed in the experimental group relative to the control group. There were also significant immediate effects for HNR, mean oral airflow, subglottal pressure, and laryngeal airway resistance.
CONCLUSIONS
These findings suggested significant immediate improvements in vocal function following SPW exercises, with additional significant improvements in vocal function as well as significant improvements in quality of life following the 4-week SPW exercise program. Further studies with more long-term follow-up are recommended to better understand the efficacy of SPW exercises with deep levels of straw submersion into water as an effective clinical option for the management of hypofunctional dysphonia associated with aging-related VFA.
Topics: Aged; Humans; Aging; Atrophy; Dysphonia; Exercise Therapy; Phonation; Quality of Life; Vocal Cords; Voice Training; Water; Middle Aged
PubMed: 37459605
DOI: 10.1044/2023_JSLHR-23-00071