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Journal of Voice : Official Journal of... May 2024Vocal fold nodules are the most common etiology of chronic dysphonia in the pediatric population. Voice therapy is an effective first line of treatment, with increasing...
BACKGROUND
Vocal fold nodules are the most common etiology of chronic dysphonia in the pediatric population. Voice therapy is an effective first line of treatment, with increasing evidence supporting the use of telepractice in speech pathology. Despite this, there is limited data on its effectiveness in the pediatric population. The aim of this retrospective study was to investigate the feasibility and efficacy of telepractice in delivering voice therapy to children diagnosed with vocal fold nodules.
METHODS
A retrospective review was conducted of patients treated with virtual voice therapy from April 2020 to June 2021. Patients were included if diagnosed with vocal fold nodules, 2-18 years of age, and completed therapy in a virtual format. Data includes demographics, Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) scores and pediatric Voice Handicap Index (pVHI) scores.
RESULTS
Twenty-three children were included, 17 (74%) male and six (26%) female (with an age range of 2.4-9.9 years at the start of therapy). Prior to treatment, the average CAPE-V Overall Severity score was 37.9 (SD 13.8); the average posttreatment score was 22.4 (SD 10.2). The average pVHI total score prior to treatment was 26.3 (SD 12.1), with an average posttreatment score of 20.2 (SD 11.7). Patients who underwent virtual voice therapy had improved posttreatment CAPE-V severity scores than those prior to treatment (average difference = -15.5 points; 95% CI: -8.3 to -22.7; P < 0.001). An increased number of therapy sessions was associated with both higher initial CAPE-V severity scores (r = 0.72; P < 0.01) and a greater decrease in posttreatment CAPE-V scores (r = -0.55; P < 0.01).
CONCLUSION
Virtual voice therapy may be feasible and efficacious in treating dysphonic children diagnosed with vocal fold nodules. Significant improvements were found in perceptual CAPE-V scores in overall severity; positive changes were also seen in parental measures of quality of life. Delivery of voice therapy in a telehealth format may increase access of care and should be considered as a treatment option.
Topics: Humans; Dysphonia; Female; Male; Child; Retrospective Studies; Voice Training; Child, Preschool; Voice Quality; Treatment Outcome; Adolescent; Telemedicine; Feasibility Studies; Disability Evaluation; Age Factors; Vocal Cords; Recovery of Function
PubMed: 34969557
DOI: 10.1016/j.jvoice.2021.11.007 -
Allergy and Asthma Proceedings Sep 2023We present a case of a 37 year old man with a history of human immunodeficiency virus, latent syphilis, anxiety, posttraumatic stress disorder. attention...
We present a case of a 37 year old man with a history of human immunodeficiency virus, latent syphilis, anxiety, posttraumatic stress disorder. attention deficit/hyperactivity disorder, multiple drug intolerance syndrome who presented with concerns of recurrent episodes of rash and respiratory symptoms with questionable "anaphylaxis" episodes without clear etiology or known trigger. To evaluate some of the potential causes of recurrent anaphylaxis in our patient. Further evaluation through laboratory analysis and ultimately direct visualization of the patient's vocal cords by laryngoscopy assisted in the final diagnosis. Inappropriate adduction of the vocal cords was observed during an acute reaction. The patient's presentation was consistent with inducible laryngeal obstruction and highlights the importance of confirming a suspected diagnosis of anaphylaxis and keeping a broad differential when establishing an etiology.
Topics: Male; Humans; Adult; Anaphylaxis; Anxiety; Exanthema; Syndrome
PubMed: 37641215
DOI: 10.2500/aap.2023.44.230048 -
Journal of Voice : Official Journal of... Sep 2023Qualitative laryngoscopy belongs to a diagnostic routine. Nevertheless, quantitative morphometric measurements of laryngeal structures remain challenging. This study...
INTRODUCTION
Qualitative laryngoscopy belongs to a diagnostic routine. Nevertheless, quantitative morphometric measurements of laryngeal structures remain challenging. This study aimed to introduce a special laser projection device that can facilitate computer-assisted digitalized analysis and provide important quantitative information for diagnostics and treatment planning.
MATERIALS AND METHODS
The laryngeal images were captured with our device, which contained two parallel laser beams in order to provide the scaling reference. The maximum length of the vocal fold during respiration and vibration (phonation), vocal width at midpoint, total fold area, maximum cross-sectional area of the glottic space, and maximum vocal fold angle were determined and calculated. These parameters were analyzed and compared on the basis of age, sex, body height, body weight and body mass index.
RESULTS
A total of 87 subjects were enrolled in this study, comprising 39 males and 48 females. The age range for all subjects was 21 to 80 years old. The maximum value of the glottic area and vocal angle showed no significant gender difference. Both the respiration and vibration vocal fold length was significantly longer in males than in females. The vocal width revealed no gender difference, but the fold area during both respiration and phonation was significantly larger in men than in women. As for the respiration-to-vibration ratio of the vocal length, there was a trend, but without statistical significance (P = 0.06), toward a higher length compression ratio in men than in women. Meanwhile, age was found to have a strong relationship with vocal width during phonation. The width of vibration vocal fold decreased with aging significantly.
CONCLUSION
Our innovative module can provide reference parameters, which makes it possible to directly estimate the objective absolute values of relevant laryngeal structures. Our non-invasive approach can be used during routine laryngoscopy and the findings easily documented. In future, we can extend its clinical application to measure subtle laryngeal or hypopharyngeal changes, which are difficult to objectively quantify.
Topics: Male; Humans; Adult; Female; Young Adult; Middle Aged; Aged; Aged, 80 and over; Vocal Cords; Larynx; Glottis; Phonation; Laryngoscopy; Vibration
PubMed: 34175171
DOI: 10.1016/j.jvoice.2021.04.003 -
Journal of Speech, Language, and... Sep 2023An experiment with controllable boundaries was designed to assess the influence of the recording angle and distance on two-dimensional (2D) imaging in laryngoscopy and...
OBJECTIVE
An experiment with controllable boundaries was designed to assess the influence of the recording angle and distance on two-dimensional (2D) imaging in laryngoscopy and resulting 2D parameter calculation derived from the glottal area waveform (GAW).
METHOD
Two high-speed camera setups were used to synchronously record an oscillating synthetic vocal fold (VF) model, simulating a high-speed videoendoscopy. One camera recorded at variable lateral recording angles and a reference camera in superior perspective. This was performed at different physiological recording distances and for two oscillation modes (with/without contacting VFs). The GAW was derived from the segmented glottis, and two parameters each for the categories of symmetry, periodicity, and closure were calculated, as well as two derivative measures. The percentage difference between the variable and reference camera value pairs was calculated, and the angle and height dependencies were quantified using linear regression.
RESULTS
The visual perception of a laryngoscopy was found to be influenced by the lateral recording angle, which may lead to misinterpretation of VF symmetry among inexperienced observers. The strongest influence of recording angle was observed for symmetry parameters, the strongest being the Amplitude Symmetry Index with up to 2.6%/° ( < .05). A dependence on the recording distance was only found for the Maximum Area Declination Rate.
CONCLUSIONS
The recording angle in 2D laryngoscopy should be carefully considered during visual inspection of the VF dynamics. Most of the investigated objective parameters were unaffected by the examined perspective distortion. However, especially left-right symmetry measures should only be used under controlled boundary conditions to avoid misdiagnosis and misinterpretation.
SUPPLEMENTAL MATERIAL
https://doi.org/10.23641/asha.23961183.
Topics: Humans; Laryngoscopy; Glottis; Vocal Cords; Linear Models; Reference Values
PubMed: 37652062
DOI: 10.1044/2023_JSLHR-23-00027 -
Journal of Voice : Official Journal of... Jan 2024To correlate the surgical results of vocal fold mass excision with pre-operative existence of vocal fold paresis.
OBJECTIVE
To correlate the surgical results of vocal fold mass excision with pre-operative existence of vocal fold paresis.
METHODS
Data were collected on 66 patients who underwent excision of benign vocal fold masses from 2015 to 2020. The pre- and post-operative strobovideolaryngoscopy (SVL) examinations for all patients included were evaluated blindly by three otolaryngologists using THE Voice-Vibratory Assessment with Laryngeal Imaging (VALI) Form for scar severity, mucosal wave, free edge contour, glottal closure, and phase closure. The success of mass excision surgery was determined based on the presence of the following criteria post-operatively: 1) improved mucosal wave motion 2) improved phase closure or glottic closure 3) improved free edge contour and 4) lack of worsening of vocal fold scar severity. Surgery was considered successful if 3 or 4 criteria were met, partially successful if 1 or 2 criteria were met, and unsuccessful if no criteria were met. The percent recruitment of the thyroarytenoid, posterior cricoarytenoid (PCA), and cricothyroid muscles were used evaluated the severity of paresis as mild (70-99% recruitment), moderate (40-60% recruitment), or severe (0-39% recruitment). VHI-10 scores were used as subjective measures of pre- and post-operative voice.
RESULTS
Sixty-six patients (26 male, 40 female) were included in this study, with a mean age of 37.25 ± 16.6 (range 18-78). Twelve patients had no evidence of VF paresis noted during the initial clinical evaluation; and 52 patients had paresis and had undergone laryngeal EMG. 81% of these patients had mild paresis, 12.8% had moderate paresis, and 5.8% had severe paresis. Based on pre- and post-operative strobovideolaryngoscopy, there was improvement in mucosal wave in 44.9% of cases, improvement of phase or glottic closure in 85.4% of cases, improved free edge contour in 95.5% of cases, and worsening of scar in 38.5% of cases. 39.6% of surgeries were fully successful, 33.3% of surgeries were partially successful, and 27.1% were not successful. There was a significant correlation between female gender and vocal fold paresis (P = 0.048). Paresis severity did not correlate with complete or partial surgical success (P = 0.956), pre-operative VHI-10 scores (P = 0.519), post-operative VHI-10 scores (P = 0.563), or strobovideolaryngoscopy parameters. Unilateral and bilateral paresis did not correlate with any other parameter of surgical success (P >0.05).
CONCLUSION
This study suggests that there is no correlation between pre-operative vocal fold paresis and voice outcomes after mass excision surgery, that the majority of mass excision surgeries (72.9%) are successful based on improvement in stroboscopic parameters, and that the proportion of patients with moderate and severe paresis is consistent across all laryngeal nerves.
Topics: Humans; Male; Female; Young Adult; Adult; Middle Aged; Vocal Cords; Cicatrix; Voice Quality; Vocal Cord Paralysis; Laryngeal Diseases; Laryngeal Muscles; Paresis
PubMed: 34474936
DOI: 10.1016/j.jvoice.2021.07.014 -
The Laryngoscope Sep 2023Transfeminine patients (transwomen/feminine nonbinary folks assigned male at birth) can undergo chondrolaryngoplasty ("tracheal shave") to feminize their neck...
OBJECTIVE
Transfeminine patients (transwomen/feminine nonbinary folks assigned male at birth) can undergo chondrolaryngoplasty ("tracheal shave") to feminize their neck appearance. While isolated cases of vocal complications have been reported following the procedure, aggregated outcomes have not been quantitatively studied. We present acoustic and stroboscopic data to describe a patient cohort with vocal complications after chondrolaryngoplasty and discuss reparative surgical technique.
METHODS
Subjective and objective data, including videostroboscopy, were collected from patients with voice complaints after chondrolaryngoplasty. Dislocated anterior commissures were reconstructed with feminization laryngoplasty. Postoperative voice data were recorded and statistically compared to preoperative data using paired t-tests.
RESULTS
On consecutive chart review, of the 94 transfeminine women with prior outside history of chondrolaryngoplasty, 27 (29%) reported chronic postoperative hoarseness, deepened pitch, or loss of upper register. On endoscopy, short, lax vocal folds with persistent anterior glottic gap and phase asymmetry were commonly noted; anterior commissure dislocation was confirmed in-office by using needle localization through absent thyroid cartilage. After open resuspension of the anterior commissure with feminization laryngoplasty, post-repair modal-speaking, minimum, and maximum fundamental frequencies (F0) increased on average by 7, 8, and 5 semitones, respectively (p < 0.01), when compared to pre-repair values. On average, perioperative maximum phonation time did not change significantly (p = 0.15). Average self-assessment of vocal femininity increased by 48% (p < 0.01).
CONCLUSION
Anterior commissure dislocation should be suspected with signs of vocal impairment after chondrolaryngoplasty. Following proper diagnosis, resuspension of the anterior commissure via feminization laryngoplasty approach can be an effective reparative technique.
LEVEL OF EVIDENCE
This work represents a 2011 OCEBM Level 4 evidence as a case series Laryngoscope, 133:2301-2307, 2023.
Topics: Infant, Newborn; Humans; Male; Female; Voice Quality; Feminization; Transgender Persons; Voice; Vocal Cords; Laryngoplasty; Treatment Outcome
PubMed: 36576093
DOI: 10.1002/lary.30518 -
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 -
Biomedical Engineering Online Aug 2023In this study, we proposed a deep learning technique that can simultaneously detect suspicious positions of benign vocal cord tumors in laparoscopic images and classify...
BACKGROUND
In this study, we proposed a deep learning technique that can simultaneously detect suspicious positions of benign vocal cord tumors in laparoscopic images and classify the types of tumors into cysts, granulomas, leukoplakia, nodules and polyps. This technique is useful for simplified home-based self-prescreening purposes to detect the generation of tumors around the vocal cord early in the benign stage.
RESULTS
We implemented four convolutional neural network (CNN) models (two Mask R-CNNs, Yolo V4, and a single-shot detector) that were trained, validated and tested using 2183 laryngoscopic images. The experimental results demonstrated that among the four applied models, Yolo V4 showed the highest F1-score for all tumor types (0.7664, cyst; 0.9875, granuloma; 0.8214, leukoplakia; 0.8119, nodule; and 0.8271, polyp). The model with the lowest false-negative rate was different for each tumor type (Yolo V4 for cysts/granulomas and Mask R-CNN for leukoplakia/nodules/polyps). In addition, the embedded-operated Yolo V4 model showed an approximately equivalent F1-score (0.8529) to that of the computer-operated Yolo-4 model (0.8683).
CONCLUSIONS
Based on these results, we conclude that the proposed deep-learning-based home screening techniques have the potential to aid in the early detection of tumors around the vocal cord and can improve the long-term survival of patients with vocal cord tumors.
Topics: Humans; Vocal Cords; Neural Networks, Computer; Computer Simulation; Cysts; Leukoplakia
PubMed: 37596652
DOI: 10.1186/s12938-023-01139-2 -
The Laryngoscope Nov 2023The diversity of glucocorticoid (GC) properties may underlie variability of clinical efficacy for vocal fold (VF) disease. Optimized therapeutic approaches must account...
OBJECTIVE
The diversity of glucocorticoid (GC) properties may underlie variability of clinical efficacy for vocal fold (VF) disease. Optimized therapeutic approaches must account for tissue complexity as well as interactions between cell types. We previously reported that reduced GC concentrations inhibited inflammation without eliciting fibrosis in mono-cultured VF fibroblasts and macrophages. These data suggested that a refined approach to GC concentration may improve outcomes. In the current study, co-culture of VF fibroblasts and macrophages was employed to investigate the effects of different concentrations of methylprednisolone on fibrotic and inflammatory response genes in VF fibroblasts to optimize management paradigms.
STUDY DESIGN
In vitro.
METHODS
THP-1 monocyte-derived macrophages were stimulated with interferon-γ (IFN-γ), lipopolysaccharide (LPS), or transforming growth factor-β (TGF-β) to induce inflammatory (M(IFN/LPS)) and fibrotic (M(TGF)) phenotypes. Macrophages were then co-cultured with a human VF fibroblast cell line using a 0.4 μm pore membrane with or without 0.1-3000 nM methylprednisolone. Inflammatory (CXCL10, TNF, and PTGS2) and fibrotic (ACTA2, CCN2, and COL1A1) gene expression was quantified in fibroblasts.
RESULTS
Incubating VF fibroblasts with M(IFN/LPS) macrophages increased expression of TNF and PTGS2, and this effect was inhibited by methylprednisolone. Incubation of VF fibroblasts with M(TGF) macrophages increased expression of ACTA2, CCN2, and COL1A1, and this effect was enhanced by methylprednisolone. The concentration of methylprednisolone required to downregulate inflammatory genes (TNF and PTGS2) was lower than that to upregulate fibrotic genes (ACTA2, CCN2, and COL1A1).
CONCLUSION
Reduced concentration of methylprednisolone effectively suppressed inflammatory genes without enhancing fibrotic genes, suggesting that a refined approach to GC concentration may improve clinical outcomes.
LEVEL OF EVIDENCE
N/A Laryngoscope, 133:3116-3122, 2023.
Topics: Humans; Methylprednisolone; Coculture Techniques; Vocal Cords; Lipopolysaccharides; Cyclooxygenase 2; Glucocorticoids; Macrophages; Fibrosis; Fibroblasts; Cells, Cultured
PubMed: 37246727
DOI: 10.1002/lary.30763