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European Archives of... Sep 2023The current study aimed to profile vocal fold morphology, vocal fold symmetry, gender and task-specific data for vocal fold length (VFL) and vocal fold displacement...
PURPOSE
The current study aimed to profile vocal fold morphology, vocal fold symmetry, gender and task-specific data for vocal fold length (VFL) and vocal fold displacement velocity (VFDV) in young normophonic adults in the age range of 18-30 years using ultrasonography (USG).
METHODS
Participants underwent USG across quiet breathing, /a/ phonation and /i/ phonation tasks, and acoustic analysis was conducted to explore the relationship between USG and acoustic measures.
RESULTS
The study found that males have longer vocal folds than females, and overall greater velocities were observed in /a/ phonation, followed by /i/ phonation, with the lowest velocity observed in the quiet breathing task.
CONCLUSIONS
The obtained norms can be used as a quantitative benchmark for analyzing the vocal fold behavior in young adults.
Topics: Male; Female; Young Adult; Humans; Adolescent; Adult; Vocal Cords; Phonation; Ultrasonography; Acoustics; Vibration
PubMed: 37221308
DOI: 10.1007/s00405-023-08025-6 -
European Journal of Pediatric Surgery :... Feb 2024Etiology of vocal cord paralysis (VCP) and laryngeal dysfunction may be congenital or surgical trauma of recurrent and superior laryngeal nerves. We assessed the...
OBJECTIVE
Etiology of vocal cord paralysis (VCP) and laryngeal dysfunction may be congenital or surgical trauma of recurrent and superior laryngeal nerves. We assessed the incidence, risk factors, and morbidity of VCP after repair of esophageal atresia (EA).
METHODS
Medical records of 201 EA patients from 2000 to 2022 were reviewed for this retrospective study. Postrepair vocal cord examination (VCE) included awake nasolaryngeal fiberoscopy by otolaryngologist or laryngoscopy under spontaneous breathing anesthesia. Before 2017, postoperative VCE was performed in symptomatic patients only and routinely after 2017.
MAIN RESULTS
Overall, VCE was performed on 79 (38%) patients (52 asymptomatic), whereas 122 asymptomatic patients underwent no VCE. VCP was diagnosed in 32 of 79 patients (right 12, left 10, and bilateral 10; symptomatic 25 and asymptomatic unilateral 7) corresponding with extrapolated overall VCP incidence of 16 to 24% among 201 patients including asymptomatic ones. Ten patients (bilateral VCP 8 and left VCP 2) required tracheostomy. Of 10 patients with bilateral VCP, three underwent laryngotracheal expansion surgery (left VC lateralization in one and laryngoplasty in two with acquired subglottic stenosis), three remained tracheostomy dependent, three were off tracheostomy, and one died of complications after redo esophageal reconstruction. All patients with unilateral VCP managed without tracheostomy. Cervical dissection or ostomy formation was a major risk factor of VCP.
CONCLUSION
Repair of EA is associated with a considerable risk of VCP and associated morbidity. Cervical EA surgery significantly increased the risk of VCP. Bilateral VCP may eventually require laryngotracheal expansion surgery.
Topics: Humans; Vocal Cord Paralysis; Esophageal Atresia; Retrospective Studies; Postoperative Complications; Incidence
PubMed: 37669755
DOI: 10.1055/s-0043-1774370 -
The Laryngoscope Oct 2023Current protocols for bedside swallow evaluation have high rates of false negative results. Though experts are not consistently able to screen for aspiration risk by...
BACKGROUND
Current protocols for bedside swallow evaluation have high rates of false negative results. Though experts are not consistently able to screen for aspiration risk by assessing vocal quality, there is emerging evidence that vocal acoustic parameters are significantly different in patients at risk of aspiration. Herein, we aimed to determine whether the presence of material on the vocal folds in an excised canine laryngeal model may have an impact on acoustic and aerodynamic measures.
METHODS
Two ex vivo canine larynges were tested. Three liquids of different viscosities (1:100 diluted glycerin, pure glycerin, and honey-thick Varibar) were placed on the vocal folds at a constant volume. Acoustic and aerodynamic measures were obtained in both adducted and abducted vocal fold configurations. Intraglottal high-speed imaging was used to approximate the maximum divergence angle of the larynges in the studied conditions and examine its relationship to vocal efficiency (VE) and acoustic measures.
RESULTS
In glottic insufficiency conditions only, we found that several acoustic parameters could predict the presence of material on the vocal folds. Based on the combination of the aerodynamic and acoustic data, we found that decreased spectral energy in the higher harmonics was associated with decreased VE in the presence of material on the vocal folds and/or glottic insufficiency.
CONCLUSION
Decreased spectral energy in the higher harmonics of the voice was found to be a potential biomarker of swallowing dysfunction, as it correlates with decreased vocal efficiency due to material on the vocal folds and/or glottic insufficiency, both of which are known risk factors for aspiration.
LEVEL OF EVIDENCE
NA Laryngoscope, 133:2517-2524, 2023.
Topics: Animals; Dogs; Glycerol; Larynx; Vocal Cords; Glottis; Acoustics; Phonation
PubMed: 36533566
DOI: 10.1002/lary.30525 -
Clinical Otolaryngology : Official... Sep 2023This systematic review and meta-analysis examines if intralaryngeal injection of basic fibroblast growth factor 2 (FGF2) can improve voice outcomes in those with vocal... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
This systematic review and meta-analysis examines if intralaryngeal injection of basic fibroblast growth factor 2 (FGF2) can improve voice outcomes in those with vocal disability.
DESIGN
A Systematic review of original human studies reporting voice outcomes following intra-laryngeal injection of basic fibroblast growth factor 2 in those with vocal dysfunction. Databases searched were Medline (1946-July 2022), Embase (1947-July 2022), Cochrane database and Google Scholar.
SETTING
Secondary or tertiary care centres that undertook the management of voice pathology Hospital.
PARTICIPANTS
Inclusion criteria were original human studies reporting voice outcome measurements following intralaryngeal injection of FGF2 to treat vocal fold atrophy, vocal fold scarring, vocal fold sulcus or vocal fold palsy. Articles not written in English, studies that did not include human subjects and studies where voice outcome measures were not recorded before and after FGF2 injection were excluded from the review.
MAIN OUTCOME MEASURES
The primary outcome measure was maximum phonation time. Secondary outcome measures included acoustic analysis, glottic closure, mucosal wave formation, voice handicap index and GRBAS scale.
RESULTS
Fourteen articles were included out of a search of 1023 and one article was included from scanning reference lists. All studies had a single arm design without control groups. Conditions treated were vocal fold atrophy (n = 186), vocal cord paralysis (n = 74), vocal fold fibrosis (n = 74) and vocal fold sulcus (n = 56). A meta-analysis of six articles reporting on the use of FGF2 in patients with vocal fold atrophy showed a significant increase of mean maximum phonation time of 5.2 s (95% CI: 3.4-7.0) at 3-6 months following injection. A significant improvement in maximum phonation time, voice handicap index and glottic closure was found following injection in most studies assessed. No major adverse events were reported following injection.
CONCLUSIONS
To date, intralaryngeal injection of basic FGF2 appears to be safe and it may be able to improve voice outcomes in those with vocal dysfunction, especially vocal fold atrophy. Randomised controlled trials are needed to further evaluate efficacy and support the wider use of this therapy.
Topics: Humans; Fibroblast Growth Factor 2; Plastic Surgery Procedures; Vocal Cord Paralysis; Laryngeal Diseases; Atrophy
PubMed: 37246756
DOI: 10.1111/coa.14073 -
The Tohoku Journal of Experimental... Jul 2023Long-term voice abuse or sudden vocal fold microvascular disruption may lead to injury and subsequent repair/remodeling in the vocal fold mucosa. Periostin is known to...
Long-term voice abuse or sudden vocal fold microvascular disruption may lead to injury and subsequent repair/remodeling in the vocal fold mucosa. Periostin is known to be involved in airway remodeling and also in various otolaryngological diseases. D-β-aspartic acid is the major isomer of D-aspartic acid found in elderly tissue. In this study we investigated the expression and the role of D-β-aspartic acid and periostin in the formation of vocal fold polyps. The expression patterns of D-β-aspartic acid and periostin in 36 surgical specimens of vocal fold polyps from 36 patients were investigated immunohistochemically. In the epithelium of vocal polyps, D-β-aspartic acid was expressed in all cases. Expression of D-β-aspartic acid was detected in 25 samples obtained from patients with vocal fold polyps stroma. Expression of periostin was detected in 28 samples obtained from patients with vocal fold polyps. Two patterns of D-β-aspartic acid expression were observed in vocal fold polyps stroma: positive type and negative type. The following four patterns of periostin expression were observed in vocal fold polyps: negative type, superficial type, infiltrative type, and diffuse type. An association was observed between D-β-aspartic acid expression patterns and periostin expression patterns. From these findings we speculate that periostin and D-β-aspartic acid participate in certain pathological changes in vocal fold polyps, such as extracellular matrix accumulation, local fibrosis, and the formation and development of vocal fold polyps.
Topics: Humans; Aged; Vocal Cords; Isoaspartic Acid; Laryngeal Diseases; Polyps
PubMed: 37100601
DOI: 10.1620/tjem.2023.J035 -
The New England Journal of Medicine Jan 2024
PubMed: 38198185
DOI: 10.1056/NEJMicm2307437 -
The Journal of Laryngology and Otology Nov 2023To evaluate the outcomes of reinnervation techniques for the treatment of adult unilateral vocal fold paralysis and bilateral vocal fold paralysis.
OBJECTIVE
To evaluate the outcomes of reinnervation techniques for the treatment of adult unilateral vocal fold paralysis and bilateral vocal fold paralysis.
METHODS
A literature review was conducted in the Embase and Medline databases in English, with no limitations on the publication date. The outcome parameters of interest included visual, subjective perceptual, acoustic, aerodynamic analysis and electromyography. A meta-analysis with a random-effects model and inverse variance was calculated.
RESULTS
The systematic Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach resulted in 27 studies, totalling 803 patients (747 unilateral cases and 56 bilateral cases). Thyroid cancer and/or surgery had caused unilateral vocal fold paralysis in 74.8 per cent of cases and bilateral vocal fold paralysis in 69.6 per cent of cases. Statistically significant improvements in patients were observed for voice, deglutition and decannulation (bilateral vocal fold paralysis). Meta-analysis of 10 reinnervation techniques was calculated for the maximum phonation time of 184 patients.
CONCLUSION
Reinnervation was shown to improve voice, swallowing and decannulation, but studies lacked control groups, limiting generalisability. Larger studies with controls are needed.
PubMed: 37982255
DOI: 10.1017/S0022215123001950 -
Acta Otorhinolaryngologica Italica :... Feb 2024
Topics: Humans; Laryngopharyngeal Reflux; Vocal Cords; Cicatrix; Risk Factors
PubMed: 37814979
DOI: 10.14639/0392-100X-N2625 -
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