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Revue Medicale Suisse Oct 2020The surgical management of unilateral and bilateral vocal cord paralysis depends on the severity of the condition, the potential for spontaneous recovery, the patient's... (Review)
Review
The surgical management of unilateral and bilateral vocal cord paralysis depends on the severity of the condition, the potential for spontaneous recovery, the patient's age and vocal expectations. Standardized re-innervation surgeries, unilateral non-selective and bilateral selective, are viable alternatives to static procedures currently under evaluation in prospective studies. Neurorraphy of the ansa cervicalis loop to the recurrent laryngeal nerve allows lasting vocal recovery and potentially superior results to medialization and thyroplasty, by maintaining the visco-elastic properties of the vocal cord and preventing its atrophy. Selective bilateral reinnervation shows potential for recovery of inspiratory abduction with improved respiratory function without vocal deterioration.
Topics: Humans; Larynx; Prospective Studies; Recurrent Laryngeal Nerve; Vocal Cord Paralysis; Vocal Cords
PubMed: 33026725
DOI: No ID Found -
HNO Sep 2021Neurological and neurophysiological knowledge of neuromuscular diseases is combined in neurolaryngology with experience from laryngology. Laryngeal electromyography... (Review)
Review
Neurological and neurophysiological knowledge of neuromuscular diseases is combined in neurolaryngology with experience from laryngology. Laryngeal electromyography (LEMG) is the most important diagnostic and prognostic tool in neurolaryngology. It can be combined with diagnostic electrostimulation. Interest in LEMG today extends beyond the thyroarytenoid muscle to all accessible laryngeal muscles. LEMG should be performed and interpreted according to a standardized protocol. Main applications of LEMG are confirmation, topodiagnostic and prognostic assessment of vocal fold paralysis. It is possible to differentiate fresh from old recurrent laryngeal nerve lesions as well as mechanical vocal fold fixations from paralysis. Needle guidance for botulinum toxin injections in spasmodic dysphonia and for augmentation laryngoplasty can be supported by LEMG, but also by laryngeal ultrasound. The timing of therapy for temporary and permanent augmentations, thyroplasty and reinnervation surgery may be better defined with experience from neurolaryngology. The use of diagnostic neurostimulation can reveal any remaining active movement potential of a vocal fold and thus help identify candidates for future laryngeal pacemaker treatments. Other topics in neurolaryngology include spasmodic dysphonia and underlying neurological diseases such as stroke, central vocal fold paralysis, essential tremor and Parkinson's disease. Laryngoscopic, clinical and LEMG characteristics of these diseases are presented.
Topics: Dysphonia; Humans; Laryngeal Muscles; Recurrent Laryngeal Nerve; Vocal Cord Paralysis; Vocal Cords
PubMed: 34125237
DOI: 10.1007/s00106-021-01064-7 -
Otolaryngologic Clinics of North America Aug 2019Sulcus vocalis, defined as a type of groove along the free edge of the vocal fold, disrupts the normal, pliable vocal fold cover, causing alterations in the intrinsic... (Review)
Review
Sulcus vocalis, defined as a type of groove along the free edge of the vocal fold, disrupts the normal, pliable vocal fold cover, causing alterations in the intrinsic mucosal wave. The primary symptom is breathy, effortful dysphonia. Diagnosis may be challenging, and this classically has led to difficulties with identification and management. Treatment options, although often promising, have been notoriously unreliable. Current understanding, considerations for management, and future treatment options are explored.
Topics: Diagnosis, Differential; Dysphonia; Glottis; Humans; Laryngeal Mucosa; Otorhinolaryngologic Surgical Procedures; Plastic Surgery Procedures; Secondary Prevention; Stroboscopy; Vocal Cords
PubMed: 31088694
DOI: 10.1016/j.otc.2019.03.016 -
Otolaryngologic Clinics of North America Aug 2019This article discusses vocal fold paresis as a separate and distinct condition from vocal fold paralysis. The signs and symptoms of paresis may be different and less... (Review)
Review
This article discusses vocal fold paresis as a separate and distinct condition from vocal fold paralysis. The signs and symptoms of paresis may be different and less obvious than those for paralysis, so this condition is often misdiagnosed or underdiagnosed. Elements necessary to heighten clinical suspicion are included to assist in educating practitioners on these subtle findings. Once paresis is suspected, associated respiratory or sensory abnormalities also should be sought, because these may change the treatment plan when recognized. Utility of laryngeal electromyography is discussed along with potential treatment options for both the motor and often-present sensory symptoms.
Topics: Diagnosis, Differential; Electromyography; Humans; Paresis; Prognosis; Stroboscopy; Vocal Cord Paralysis; Vocal Cords
PubMed: 31088695
DOI: 10.1016/j.otc.2019.03.008 -
Ugeskrift For Laeger Nov 2022Injection augmentation of the vocal cords is a recognized treatment modality in patients with glottal closure deficiency caused by paresis or paralysis of the vocal... (Review)
Review
Injection augmentation of the vocal cords is a recognized treatment modality in patients with glottal closure deficiency caused by paresis or paralysis of the vocal cord. The treatment can improve voice quality and also quality of life. It is preferable to minimize waiting time for the procedure for patients with lung cancer and mediastinal involvement, because the one-year mortality is above 40%, as argued in this review.
Topics: Humans; Vocal Cords; Quality of Life; Mediastinum; Lung Neoplasms; Palliative Care
PubMed: 36426831
DOI: No ID Found -
Pediatric Radiology Aug 2022Vocal cord paralysis is a common cause of respiratory and feeding problems in the pediatric population. While the causes of vocal cord paralysis are multiple, iatrogenic... (Review)
Review
Vocal cord paralysis is a common cause of respiratory and feeding problems in the pediatric population. While the causes of vocal cord paralysis are multiple, iatrogenic injury of the recurrent laryngeal nerve after cardiovascular surgery is the most frequent cause. Vocal cord paralysis increases the risk of swallowing dysfunction, tracheal aspiration and pneumonia. It also increases the need for nasoenteric feeds and gastrostomy tube placement. Flexible nasopharyngolaryngoscopy is considered the gold standard for diagnosing vocal cord paralysis, but it has significant drawbacks: it is uncomfortable, it can trigger a cardiovascular event in children with unstable cardiovascular status, it can be challenging to perform, and it can be difficult to interpret. Laryngeal US has become a popular imaging modality to evaluate the function of the vocal cords. Laryngeal US is well-tolerated, easy to perform, simple to interpret and has a lower physiological impact compared to flexible nasopharyngolaryngoscopy. Laryngeal US is an accurate and low-cost diagnostic test for vocal cord paralysis. In this review, we describe the anatomy of the larynx and recurrent laryngeal nerve; the causes, symptoms and pathophysiology of vocal cord paralysis; laryngeal US technique; diagnostic criteria for vocal cord paralysis; and a reporting system.
Topics: Child; Humans; Infant; Laryngoscopy; Larynx; Recurrent Laryngeal Nerve; Vocal Cord Paralysis; Vocal Cords
PubMed: 34841448
DOI: 10.1007/s00247-021-05235-0 -
American Family Physician Nov 2021Vocal cord dysfunction (i.e., vocal cords closing when they should be opening, particularly during inspiration) should be suspected in patients presenting with... (Review)
Review
Vocal cord dysfunction (i.e., vocal cords closing when they should be opening, particularly during inspiration) should be suspected in patients presenting with inspiratory stridor or wheezing; sudden, severe dyspnea (without hypoxia, tachypnea, or increased work of breathing); throat or chest tightness; and anxiety, particularly in females. Common triggers include exercise, asthma, gastroesophageal reflux disease, postnasal drip, upper or lower respiratory tract infection, and irritants. Nasolaryngoscopy and pulmonary function testing, with provocative exercise and methacholine, can help diagnose vocal cord dysfunction and are helpful to evaluate for other etiologies. Conditions that can trigger vocal cord dysfunction should be optimally treated, particularly asthma, gastroesophageal reflux disease, and postnasal drip, while avoiding potential irritants. Therapeutic breathing maneuvers and vocal cord relaxation techniques are first-line therapy for dyspnea that occurs with vocal cord dysfunction. A subset of vocal cord dysfunction leads to dysphonia, as opposed to dyspnea, secondary to abnormal laryngeal muscle spasms (vocal cord closure is less severe). OnabotulinumtoxinA injections may be helpful for spasmodic dysphonia and for treating dyspnea in certain cases, although evidence is limited.
Topics: Airway Management; Humans; Laryngoscopy; Respiratory Function Tests; Respiratory Therapy; Speech Therapy; Vocal Cord Dysfunction; Vocal Cords
PubMed: 34783512
DOI: No ID Found -
Advances in Oto-rhino-laryngology 2020In the setting of a voice clinic, the voice may be assessed in a number of different ways. As a bare minimum, assessment should include stroboscopic examination, patient... (Review)
Review
In the setting of a voice clinic, the voice may be assessed in a number of different ways. As a bare minimum, assessment should include stroboscopic examination, patient self-reported questionnaires, and clinician-reported perceptual evaluation. In addition, recordings of the voice may be analyzed using computer software: several different measures exist, but the most widely used are jitter, shimmer, and noise-to-harmonic ratio. There are, however, significant limitations of these measures, including access to the equipment, inter-test reliability of the measurements, and a lack of correlation with clinical improvement. Other mathematical techniques (nonlinear algorithms) may provide more robust measurements. A pragmatic approach to assessment in the voice clinic suggests that stroboscopic examination should be accompanied by patient-reported questionnaires and clinician-rated voice assessments.
Topics: Humans; Reproducibility of Results; Self Report; Signal Processing, Computer-Assisted; Stroboscopy; Vocal Cords; Voice Disorders; Voice Quality
PubMed: 33166976
DOI: 10.1159/000456683 -
The New England Journal of Medicine Sep 2019
Topics: Carcinoma, Renal Cell; Humans; Kidney Neoplasms; Laryngeal Neoplasms; Laryngoscopy; Lung Neoplasms; Male; Middle Aged; Tomography, X-Ray Computed; Vocal Cords
PubMed: 31483968
DOI: 10.1056/NEJMicm1815495 -
HNO Sep 2021Laryngeal framework surgery is an umbrella term for all phonosurgical procedures by which the cartilaginous structure of the larynx and thereby the position and tension... (Review)
Review
Laryngeal framework surgery is an umbrella term for all phonosurgical procedures by which the cartilaginous structure of the larynx and thereby the position and tension of the vocal folds are changed. The aim is to improve the voice. By far the best known and most frequently performed operation is thyroplasty type 1 according to Isshiki, also known as medialization thyroplasty, which is indicated for treatment of glottic insufficiency. Although the first medialization thyroplasty was successfully performed by Payr in Germany in 1915, more than 100 years later, it is still not widely used in Germany.
Topics: Glottis; Humans; Laryngoplasty; Larynx; Treatment Outcome; Vocal Cord Paralysis; Vocal Cords
PubMed: 33978776
DOI: 10.1007/s00106-021-01054-9