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Cureus Aug 2023Infantile laryngeal hemangiomas are relatively common. However, adult vocal cord hemangiomas are extremely rare. A 46-year-old woman was referred to our department for...
Infantile laryngeal hemangiomas are relatively common. However, adult vocal cord hemangiomas are extremely rare. A 46-year-old woman was referred to our department for hoarseness, which continued for 18 months. A laryngeal fiberscope revealed a small protuberant tumor resembling a polyp on her right vocal cord, and the narrow-band imaging showed abundant vascularity. Laryngeal microsurgery with a cold instrument under general anesthesia completely resected the tumor on the vocal cord. Histopathologically, the resected tumor consisted of vessels with thick walls and was diagnosed as a cavernous hemangioma of the vocal cord. After the surgery, she has never complained of hoarseness and has had no local recurrence for six months.
PubMed: 37746482
DOI: 10.7759/cureus.44042 -
The American Journal of Emergency... Dec 2023This study aimed to compare ultrasonography (US) measurements of the upper airway to computerized tomography (CT) measurements. Our study's primary outcome is to...
INTRODUCTION
This study aimed to compare ultrasonography (US) measurements of the upper airway to computerized tomography (CT) measurements. Our study's primary outcome is to research the accuracy of US measurements in the evaluation of upper airway diameters when CT is taken as the gold standard; the secondary outcome is to determine the time required to obtain US measurements.
METHODS
This prospective study included patients ≥18 years old that had undergone thoracic or neck CT due to current clinical necessity. The US measurement for each patient was performed by two researchers with different levels of experience, both of whom were blinded to each other and the CT measurements. Measurements were obtained from the vocal cords and subglottic region. The duration of the US performance was also recorded.
RESULTS
The US and CT measurements were obtained from 94 patients. Concordance between US and CT measurements was found in the Bland-Altman analysis, with a mean -0.05 mm difference for vocal cord diameter and -1.2 mm for subglottic diameter. The intra-class correlation coefficients (ICC) between the CT and US measurements were 0.993, and 0.609 for vocal cord and subglottic diameter measurements, respectively. The ICC between US performers was 0.992 for vocal cord diameter and 0.959 for subglottic diameter. The US's mean time for vocal cord diameter measurement was 38 ± 23 s, and the mean time for subglottic diameter measurement was 49 ± 30 s.
CONCLUSION
The concordance between US and CT measurements is high and the measurements of different practitioners with different experience levels are compatible with each other.
Topics: Humans; Adolescent; Prospective Studies; Larynx; Trachea; Ultrasonography; Tomography, X-Ray Computed; Intubation, Intratracheal
PubMed: 37738893
DOI: 10.1016/j.ajem.2023.09.013 -
Journal of Voice : Official Journal of... Nov 2023Military drill instructors have extreme vocal demands that place them at risk for phonotrauma. Characterization of laryngeal pathology and vibratory characteristics... (Review)
Review
OBJECTIVE
Military drill instructors have extreme vocal demands that place them at risk for phonotrauma. Characterization of laryngeal pathology and vibratory characteristics among drill instructors presenting for specialized voice care is lacking.
METHODS
A retrospective review in a specialized voice clinic over a two-year period was conducted. Patients identified as current drill instructors between the ages of 28-43 with a diagnosis of dysphonia were included. Laryngeal pathology was diagnosed by a fellowship trained laryngologist and vibratory characteristics were evaluated utilizing the Voice-Vibratory Assessment with Laryngeal Imaging (VALI) rating form. All patients were also evaluated by a speech-language pathologist. Patient reported outcome measures were collected along with perceptual voice evaluations utilizing the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V).
RESULTS
Twelve current drill instructors were identified, and all had phonotraumatic lesions. Lesions were categorized as vocal fold hemorrhage (8%), ectasia (25%), unilateral epithelial thickening (33.3%), bilateral epithelial thickening (58.3%), ventricular cyst (8%), polyp (25%), and sulcus vocalis (25%). Vibratory abnormalities were assessed with the VALI rating scale and correlated to CAPE-V perceptual ratings with 83% having reduced mucosal wave, 75% reduced amplitude of lateral excursion, 50% aperiodic vibrations, 50% asymmetric or chasing wave, 58% glottal insufficiency, 100% supraglottic hyperfunction, and an average CAPE-V overall severity of 50% with severe perceptual dysphonia. The average Voice Handicap Index (VHI-10) and Reflux Symptom Index (RSI) score was 15.5 and 14.7, respectively.
CONCLUSION
Phonotraumatic lesions were universally present in drill instructors complaining of hoarseness, suggesting early referral, and intervention may be warranted in this population.
LEVEL OF EVIDENCE
4.
Topics: Humans; Adult; Vocal Cords; Dysphonia; Military Personnel; Voice Quality; Laryngeal Muscles
PubMed: 34256981
DOI: 10.1016/j.jvoice.2021.05.013 -
Clinical Otolaryngology : Official... Nov 2023In this study, we retrospectively reviewed and compared the treatment outcomes and complications of office transnasal vocal fold polypectomy (TVFP) with those of...
OBJECTIVES
In this study, we retrospectively reviewed and compared the treatment outcomes and complications of office transnasal vocal fold polypectomy (TVFP) with those of microplarygoscopic surgery (MLS) for different clinical and histopathological features of broad-based sessile vocal fold polyps.
METHODS
We retrospectively reviewed the records of 159 consecutive patients with broad-based sessile vocal fold polyps treated by TVFP or MLS. The differences in efficacy and complication between these two surgical techniques were compared according to the different types of vocal fold polyps.
RESULTS
Satisfactory outcomes of both TVFP and MLS treatments were reported in patients with oedematous, gelatinous and vascular types of vocal fold polyps (p > .05). The efficacy of TVFP was slightly worse than MLS in fibrous polyps group (p < .05). The TVFP-treated patients did not exhibit obvious complications, whereas several MLS-treated patients had suffered different complications.
CONCLUSION
The therapeutic effects of both TVFP and MLS on the treatment of broad-based sessile vocal cord polyps are related to their clinical characteristics and histological types. Satisfactory outcomes are achieved in oedematous, gelatinous, and vascular types of polyps after either surgical procedure. TVFP has fewer surgical complications than MLS which can be a preferred option for the treatment of broad-based sessile vocal cord polyps at outpatient setting. TVFP also can be an alternative surgery option for patients who could not tolerate general anaesthesia or laryngeal suspension. In contrast, MLS has proven to be a particularly advantageous treatment in patients who have fibrous type of polyps.
PubMed: 37532258
DOI: 10.1111/coa.14090 -
The Laryngoscope Aug 2023Studies showed that photodynamic therapy (PDT) might be able to prevent vocal fold scar formation when treating laryngeal lesions. We aim to investigate if PDT improves...
OBJECTIVE
Studies showed that photodynamic therapy (PDT) might be able to prevent vocal fold scar formation when treating laryngeal lesions. We aim to investigate if PDT improves vocal wound healing and reduces scar formation in both prophylactic and remodeling procedures performed in vivo.
STUDY DESIGN
In vivo.
METHODS
Vocal fold stripping was performed in Sprague-Dawley rats. PDT was performed with intraperitoneal injection of 100 mg/kg 5-Aminolevulinic Acid (5-ALA) and 635 nm laser irradiation of 20, 40, and 60 J/cm . PDT was performed immediately after surgery to study the prophylactic effect and 4 weeks after surgery to study the remodeling effect. Gene expression was evaluated with real-time PCR at 1 week after PDT. Histologic evaluations were performed 12 weeks after PDT, including hematoxylin-eosin, Masson, Alcian blue staining, and immunohistochemical staining of collagen I and III.
RESULTS
PDT induced similar effects on the vocal fold wound healing outcomes in both prophylactic and remodeling procedures. Expression of MMP8, MMP13, HAS2, and TGFβ1 was significantly elevated. Histologic evaluation revealed significantly increased thickness, decreased density of collagen, and increased deposition of hyaluronic acid in the lamina propria. Immunohistochemistry also revealed better distribution and reduced density of collagen I and III. The most obvious changes were seen in the 60 J/cm PDT group.
CONCLUSION
PDT could significantly improve vocal wound healing by providing both prophylactic effects and remodeling effects. It may be a minimally invasive treatment for vocal fold lesions with slight vocal scarring, and may be used to treat acute or chronic vocal injury to reduce vocal scarring.
LEVEL OF EVIDENCE
N/A Laryngoscope, 133:1943-1951, 2023.
Topics: Rats; Animals; Cicatrix; Vocal Cords; Aminolevulinic Acid; Rats, Sprague-Dawley; Wound Healing; Collagen; Collagen Type I; Photochemotherapy
PubMed: 36278803
DOI: 10.1002/lary.30427 -
Journal of Voice : Official Journal of... Mar 2024The purpose of the study was to examine gender-related differences in benign vocal fold mass treatment.
OBJECTIVE
The purpose of the study was to examine gender-related differences in benign vocal fold mass treatment.
METHODS
Adult patient with vocal fold mass diagnosed on strobovideolaryngoscopy examination were reviewed retrospectively. Patient demographics, past medical history, laboratory data, and examination findings during the initial visit and at follow-up were collected. The duration of voice therapy and the prevalence of surgery were analyzed for males and females.
RESULTS
One hundred and fifty-eight patients (76 male and 82 female) were included. The percentage of professional voice users differed significantly between males and females. Vocal folds of females had a higher percent of reactive masses present. Females were also more likely to have a pseudocyst. Vocal folds of males showed a higher percent of masses of unspecified category on strobovideolaryngoscopy examination. A significantly greater proportion of females had abnormal high shimmer values, and abnormal low maximum phonation time; and a significantly greater proportion of females compared to males chose to participate in voice therapy. The average number of voice therapy sessions for males did not differ, nor did duration of voice therapy. A similar proportion of males and females underwent surgical mass excision. The treatment plan completed differed significantly between males and females with a higher percentage of males choosing to receive no treatment. For 45.54% of males and 59.70% of females the treatment plan consisted of voice therapy only. For 33.33% of males and 37.31% of females, the treatment plan included both voice therapy and surgery. Although gender was the strongest predictor for participation in voice therapy, professional voice uses also predicted participation in voice therapy in both men and women significantly. Professional singing in particular was not a significant predictor for participation in voice therapy. Males were significantly more likely than females to be lost to follow-up before treatment outcome could be assessed CONCLUSION: More females than males were found to have pseudocysts while more males than females had unspecified masses. Females and professional voice users were more willing than males to utilize voice therapy. No difference was found between males and females who decided to have surgery. The best treatment regimen for vocal fold mass is a combination of voice therapy and surgery, when necessary, but gender-specific differences merit further research as well as reconsideration of therapy approaches and strategies to optimize patient compliance.
Topics: Adult; Humans; Male; Female; Vocal Cords; Sex Factors; Retrospective Studies; Laryngeal Diseases; Voice; Cysts
PubMed: 34852953
DOI: 10.1016/j.jvoice.2021.10.002 -
Respiratory Investigation Sep 2023Here, we report a case of idiopathic pleuroparenchymal fibroelastosis (PPFE) that progressed to pulmonary aspergilloma, aspiration pneumonia, and left vocal cord... (Review)
Review
Here, we report a case of idiopathic pleuroparenchymal fibroelastosis (PPFE) that progressed to pulmonary aspergilloma, aspiration pneumonia, and left vocal cord paralysis (VCP). To date, five cases of PPFE with VCP have been reported, including the present case. Aspiration pneumonia occurred in three cases, leading to death in two cases. Four cases had left-sided paralysis, in two of which, the paralysis occurred on side opposite to the predominant side (right side) of PPFE. Structural mechanisms underlying the recurrent laryngeal nerve could be involved. This report may further highlight the existence of hoarseness and dysphagia in PPFE.
Topics: Humans; Vocal Cord Paralysis; Lung; Pneumonia, Aspiration; Pulmonary Aspergillosis
PubMed: 37331124
DOI: 10.1016/j.resinv.2023.05.003 -
Scientific Reports Dec 2023Human vocal folds are highly deformable non-linear oscillators. During phonation, they stretch up to 50% under the complex action of laryngeal muscles. Exploring the...
Human vocal folds are highly deformable non-linear oscillators. During phonation, they stretch up to 50% under the complex action of laryngeal muscles. Exploring the fluid/structure/acoustic interactions on a human-scale replica to study the role of the laryngeal muscles remains a challenge. For that purpose, we designed a novel in vitro testbed to control vocal-folds pre-phonatory deformation. The testbed was used to study the vibration and the sound production of vocal-fold replicas made of (i) silicone elastomers commonly used in voice research and (ii) a gelatin-based hydrogel we recently optimized to approximate the mechanics of vocal folds during finite strains under tension, compression and shear loadings. The geometrical and mechanical parameters measured during the experiments emphasized the effect of the vocal-fold material and pre-stretch on the vibration patterns and sounds. In particular, increasing the material stiffness increases glottal flow resistance, subglottal pressure required to sustain oscillations and vibratory fundamental frequency. In addition, although the hydrogel vocal folds only oscillate at low frequencies (close to 60 Hz), the subglottal pressure they require for that purpose is realistic (within the range 0.5-2 kPa), as well as their glottal opening and contact during a vibration cycle. The results also evidence the effect of adhesion forces on vibration and sound production.
Topics: Humans; Vocal Cords; Glottis; Phonation; Voice; Vibration; Hydrogels
PubMed: 38114547
DOI: 10.1038/s41598-023-48080-x -
Journal of Neurophysiology Dec 2023Vocal fold scar formation due to vocal fold injury (VFI) is a common cause of surgery or trauma-induced voice disorders. Severe scar formation can lead to reduced voice...
Vocal fold scar formation due to vocal fold injury (VFI) is a common cause of surgery or trauma-induced voice disorders. Severe scar formation can lead to reduced voice quality or even be life-threatening. Here, we investigated the role of autophagy in VFI, focusing on fibrosis as a consequence of autophagy in inducing VFI. A VFI model was constructed in rats by dissecting the lamina propria tissue from the thyroarytenoid muscle. Real-time PCR and Western blot were used to analyze expressions of autophagy markers, including Beclin1 and Atg7, in VFI. Tgfb1 and Col1a1 were assessed to determine the correlation of fibrosis with VFI progression and autophagy levels. Rat vocal fold fibroblasts were also treated with TGF-β1 or rapamycin, which activates and suppresses autophagy respectively, to explore how autophagy regulates fibrosis in VFI. Initially, we observed that autophagy was downregulated in vocal fold mucosa after VFI in rats. This was particularly evident by the time-dependent downregulation of Beclin1 and Atg7 following VFI. Concurrently, levels of Tgfb1 and Col1a1 also surged, hinting at elevated fibrosis levels. Furthermore, our experiments with TGF-β1 stimulation revealed that it inhibited autophagy in rat vocal fold fibroblasts. Interestingly, when we introduced rapamycin, this effect was reversed. Our data suggest that autophagy is a suppressor of VFI by alleviating fibrosis, making targeting autophagy a potential therapeutic route in VFI. The study has demonstrated that autophagy is a suppressor of VFI by alleviating fibrosis, making autophagy a potential therapeutic target in VFI.
Topics: Rats; Animals; Vocal Cords; Cicatrix; Transforming Growth Factor beta1; Beclin-1; Fibrosis; Sirolimus
PubMed: 37937386
DOI: 10.1152/jn.00332.2023 -
Scientific Reports Jan 2024The paper aims to define the variables that elevate the risk of VFL recurrence after adequate primary treatment, and to present the Recurrence Risk Model with practical...
The paper aims to define the variables that elevate the risk of VFL recurrence after adequate primary treatment, and to present the Recurrence Risk Model with practical conclusions to handle pVFL and rVFL. Out of 207 patients with primary vocal fold leukoplakia (pVFL), in 41 (19.8%) recurrent VFL (rVFL) was diagnosed. All patients were assessed by using a trans-nasal flexible video-endoscope using white light, and NBI. The primary measure of our study was to investigate whether morphological features of pVFL in WL, vascular pattern in NBI, and primary histological findings could predict VFL recurrence. To create a model of risk factors, two methods were used: logistic regression and a conditional inference decision tree. The study showed smoking was the factor that significantly and most strongly increased the likelihood of rVFL, as well as the older age groups have a greater odds of rVFL. Types IV, V and VI, according to Ni 2019 classification, were associated with a significantly higher risk of rVFL. The algorithm combining patients' dependent variables and the combination of two classifications improves the predictive value of the presented VFL Recurrence Risk Model.
Topics: Humans; Aged; Vocal Cords; Laryngeal Diseases; Endoscopy; Risk Factors; Leukoplakia
PubMed: 38168150
DOI: 10.1038/s41598-023-50691-3