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Molecular Carcinogenesis May 2022Severe dysplasia of vocal cord leukoplakia (VCL) is more likely to occur in laryngeal carcinoma. Alcohol dehydrogenase and acetaldehyde dehydrogenase are both important...
Severe dysplasia of vocal cord leukoplakia (VCL) is more likely to occur in laryngeal carcinoma. Alcohol dehydrogenase and acetaldehyde dehydrogenase are both important enzymes in alcohol metabolism. This study aimed to investigate the incidence rate of malignant transformation in patients with VCL and the role of drinking habits and ALDH2 and ADH1B genetic polymorphisms in the malignant transformation of VCL. From January 2007 to January 2017, 136 cases of VCL were included in this retrospective analysis. Information on medical history, alcohol and tobacco consumption habits, ALDH2 and ADH1B genotypes, gastroesophageal reflux, and clinical pathological characteristics of VCL was collected. As a result, patients had a median follow-up of 9.6 years (interquartile range: 7.5-12.5 years). Twenty-three of 136 VCL patients finally developed laryngeal carcinoma, resulting in a cumulative malignant transformation rate of 16.9%. Cox regression analysis demonstrated that the independent risk factors for the malignant transformation of VCL included age over 60 years (hazard ratio [HR]: 13.872, p < 0.001), ALDH2 *2 allele status (HR: 9.694, p < 0.001), alcohol (HR: 10.011, p < 0.001) and tobacco (HR: 8.869, p < 0.001) exposure after operation, and drinking frequency (HR: 2.178, p = 0.016). Therefore, among patients over 60 years old, an ALDH2-inactivating mutation and excessive ethanol and tobacco consumption are potential contributors to the malignant transformation of VCL.
Topics: Alcohol Dehydrogenase; Alcohol Drinking; Aldehyde Dehydrogenase; Aldehyde Dehydrogenase, Mitochondrial; Aldehyde Oxidoreductases; Carcinoma; China; Ethanol; Genotype; Humans; Leukoplakia; Middle Aged; Polymorphism, Genetic; Retrospective Studies; Vocal Cords
PubMed: 35040215
DOI: 10.1002/mc.23391 -
Thyroid : Official Journal of the... May 2020The correlation between the injured recurrent laryngeal nerve (RLN) with incomplete loss of signal (LOS) and the outcomes of vocal cord function is still not well...
The correlation between the injured recurrent laryngeal nerve (RLN) with incomplete loss of signal (LOS) and the outcomes of vocal cord function is still not well understood. This large cohort validation study was aimed to evaluate the effectiveness of the warning criterion, the reduction of the R2p/R2d ratio, in neuromonitoring during thyroidectomy. A total of 1108 consecutive patients (1764 nerves) with normal vocal cord function undergoing monitored thyroidectomy were included. Standardized intraoperative neuromonitoring procedures were strictly followed, after complete dissection of RLN, the exposed RLN was routinely stimulated at the lowest proximal end (R2p signal) and the most distal end near the laryngeal entry point (R2d signal). If the reduction of the R2p/R2d ratio (([R2d - R2p]/R2d) × 100%) reached >20%, the whole exposed RLN would be checked to pinpoint the injured area of the nerve. Visual anatomical integrity of the RLN was ensured in all 1764 nerves. Eighteen nerves had complete LOS, and the other 97 nerves had incomplete LOS where the reduction of the R2p/R2d ratio ranged from 21% to 84%. Postoperative temporary vocal cord paralysis (VCP) was noted in 11 (61.1%) RLNs with complete LOS and 16 (16.5%) RLNs with incomplete LOS, where the reduction of the R2p/R2d ratio ranged from 63% to 84%. The positive predictive value of a R2p/R2d ratio >63% for postoperative VCP was 79.4%. Testing and comparing the R2p and R2d signals were useful to detect RLN neurophysiologic injury, elucidating the mechanism of nerve injury and predicting vocal cord function. Determining R2p-R2d was found to be essential and can be applied in routine neuromonitoring thyroidectomy.
Topics: Adult; Female; Humans; Intraoperative Neurophysiological Monitoring; Male; Recurrent Laryngeal Nerve; Recurrent Laryngeal Nerve Injuries; Thyroid Neoplasms; Thyroidectomy; Treatment Outcome; Vocal Cord Paralysis; Vocal Cords
PubMed: 31880997
DOI: 10.1089/thy.2019.0361 -
Acta Otorrinolaringologica Espanola 2022The objective of this paper is to study the etiology of vocal fold immobility with non-pathological LEMG.
OBJECTIVE
The objective of this paper is to study the etiology of vocal fold immobility with non-pathological LEMG.
METHODS
A retrospective study was performed on patients who presented with vocal fold immobility and underwent LEMG from 2009 to 2017. Those patients with normal LEMG findings were selected. The different causes of vocal fold impairment were studied.
RESULTS
Of the 120 patients included in this study, 15 had a normal LEMG recording. The different etiologies of vocal fold immobility were idiopathic, central nervous system damage, iatrogenic, and external compression.
CONCLUSIONS
Vocal fold immobility and vocal fold paralysis are not equal terms. Vocal fold immobility with normal LEMG has a heterogeneous group of causes. It is not correct to assume that the major cause of immobility in patients with normal LEMG is always cricoarytenoid joint fixation.
Topics: Electromyography; Humans; Laryngeal Diseases; Retrospective Studies; Vocal Cord Paralysis; Vocal Cords
PubMed: 35397827
DOI: 10.1016/j.otoeng.2020.12.002 -
International Journal of Pediatric... Nov 2020Vocal fold nodules (VFNs) are benign lesions at the junction of the anterior and middle third of the vocal folds. Although VFNs are often a result of vocal cord trauma...
OBJECTIVES
Vocal fold nodules (VFNs) are benign lesions at the junction of the anterior and middle third of the vocal folds. Although VFNs are often a result of vocal cord trauma due to vocal abuse, childhood allergic diseases, and medications may be a cause. We aimed to investigate the association of detected VFNs with allergic diseases in childhood patients with vocal abuse.
METHODS
This is a prospective, cross-sectional, case-control study. Caucasian children in ages 3-12, who speak loud, vocal abuse confirmed with Turkish Children's voice handicap index-10 (TR-CVHI-10) above 9 were enrolled to the study. 33 children with VFN were included as the study group and age-matched 26 healthy children without VFN were included as the control group. Children questioned and tested for allergic diseases with Allergometric tests.
RESULTS
Asthma was detected in 42.4% of the study group and absent in the control group. The history of inhaler or nasal steroid use was positive in 30.3% of the study group and 7.7% of the control group (p = 0.032). Dysphonia and the presence of allergic diseases were determined as independent risk factors for the study group (p = 0.001; 0.021, respectively). The median values of blood lymphocyte counts were significantly different among study and control groups (2900 μl vs 2335 μl, respectively; p = 0.04).
CONCLUSION
Investigating allergic diseases, especially asthma, for success in the treatment of pediatric patients with VFNs is of utmost importance.
Topics: Case-Control Studies; Child; Child, Preschool; Cross-Sectional Studies; Humans; Laryngeal Diseases; Prospective Studies; Vocal Cords
PubMed: 33152989
DOI: 10.1016/j.ijporl.2020.110404 -
Annals of the Royal College of Surgeons... Jan 2024Flexible nasendoscopy (FNE) is the principal assessment method for vocal cord movement. Because the procedure is inherently subjective it may not be possible for...
INTRODUCTION
Flexible nasendoscopy (FNE) is the principal assessment method for vocal cord movement. Because the procedure is inherently subjective it may not be possible for clinicians to grade the degree of vocal cord movement reliably. The aim of this study was to assess the accuracy and consistency of grading vocal cord movement as viewed via FNE.
METHODS
Thirty FNE videos, without sound or clinical information, were assessed by six consultant head and neck surgeons. The surgeons were asked to assess and grade right and left vocal cord movement independently, based on a five-category scale. This process was repeated three times on separate occasions. Agreement and reliability were assessed.
RESULTS
Mean overall observed inter-rater agreement was 67.7% (sd 1.9) with the five-category scale, increasing to 91.4% (sd 1.9) when a three-category scale was derived. Mean overall observed intra-rater agreement was 78.3% (sd 9.7) for five categories, increasing to 93.1% (sd 3.3) for three categories. Discriminating vocal cord motion was less reliable using the five-category scale ( = 0.52) than with the three-category scale ( = 0.68).
CONCLUSIONS
This study demonstrates quantitatively that it is challenging to accurately and consistently grade subtle differences in vocal cord movement, as proven by the reduced agreement and reliability when using a five-point scale instead of a three-point scale. The study highlights the need for an objective measure to help in the assessment of vocal cord movement.
Topics: Humans; Vocal Cords; Vocal Cord Paralysis; Reproducibility of Results; Laryngoscopy; Observer Variation
PubMed: 36263913
DOI: 10.1308/rcsann.2022.0091 -
American Journal of Otolaryngology 2023To collect a dataset with adequate laryngoscopy images and identify the appearance of vocal folds and their lesions in flexible laryngoscopy images by objective deep...
PURPOSE
To collect a dataset with adequate laryngoscopy images and identify the appearance of vocal folds and their lesions in flexible laryngoscopy images by objective deep learning models.
METHODS
We adopted a number of novel deep learning models to train and classify 4549 flexible laryngoscopy images as no vocal fold, normal vocal folds, and abnormal vocal folds. This could help these models recognize vocal folds and their lesions within these images. Ultimately, we made a comparison between the results of the state-of-the-art deep learning models, and another comparison of the results between the computer-aided classification system and ENT doctors.
RESULTS
This study exhibited the performance of the deep learning models by evaluating laryngoscopy images collected from 876 patients. The efficiency of the Xception model was higher and steadier than almost the rest of the models. The accuracy of no vocal fold, normal vocal folds, and vocal fold abnormalities on this model were 98.90 %, 97.36 %, and 96.26 %, respectively. Compared to our ENT doctors, the Xception model produced better results than a junior doctor and was near an expert.
CONCLUSION
Our results show that current deep learning models can classify vocal fold images well and effectively assist physicians in vocal fold identification and classification of normal or abnormal vocal folds.
Topics: Humans; Laryngoscopy; Deep Learning; Vocal Cords
PubMed: 36905912
DOI: 10.1016/j.amjoto.2023.103800 -
Structure and Function of the Vocal Cords after Airway Reconstruction on Magnetic Resonance Imaging.The Laryngoscope Jul 2021Dysphonia is a common problem at long-term follow-up after airway surgery for laryngotracheal stenosis (LTS) with major impact on quality of life. Dysphonia after LTS... (Observational Study)
Observational Study
OBJECTIVES/HYPOTHESIS
Dysphonia is a common problem at long-term follow-up after airway surgery for laryngotracheal stenosis (LTS) with major impact on quality of life. Dysphonia after LTS can be caused by scar tissue from initial stenosis along with anatomical alterations after surgery. There is need for a modality to noninvasively image structure and function of the reconstructed upper airways including the vocal cords to assess voice outcome and possible treatment after LTS. Our objective was to correlate vocal cord structure and function of patients after airway reconstruction for LTS on static and dynamic magnetic resonance imaging (MRI) to voice outcome.
STUDY DESIGN
Prospective cohort study.
METHODS
Voice outcome was assessed by voice questionnaires ((pediatric) Voice Handicap Index (p)VHI)) and the Dysphonia Severity Index (DSI). Postsurgical anatomy, airway lumen, and vocal cord thickness and movement on multiplanar static high-resolution MRI and dynamic acquisitions during phonation was correlated to voice outcome.
RESULTS
Forty-eight patients (age 14.4 (range 7.5-30.7) years) and 11 healthy volunteers (15.9 (8.2-28.8) years) were included. Static MRI demonstrated vocal cord thickening in 80.9% of patients, correlated to a decrease in DSI (expected odds 0.75 [C.I. 0.58-0.96] P = .02). Dynamic MRI showed impaired vocal cord adduction during phonation in 61.7% of patients, associated with a lower DSI score (0.65 [C.I. 0.48-0.88] P = .006).
CONCLUSIONS
In LTS patients, after airway reconstruction MRI can safely provide excellent structural and functional detail of the vocal cords correlating to DSI, with further usefulness expected from technical refinements. We therefore suggest MRI as a tool for extensive imaging during LTS follow-up.
LEVEL OF EVIDENCE
3 Laryngoscope, 131:E2402-E2408, 2021.
Topics: Adolescent; Adult; Aftercare; Case-Control Studies; Child; Dysphonia; Feasibility Studies; Follow-Up Studies; Healthy Volunteers; Humans; Laryngostenosis; Magnetic Resonance Imaging; Male; Phonation; Postoperative Complications; Prospective Studies; Quality of Life; Plastic Surgery Procedures; Severity of Illness Index; Vocal Cords; Voice Quality; Young Adult
PubMed: 33459361
DOI: 10.1002/lary.29399 -
The Laryngoscope Aug 2022Lipoinjection is one of the available treatments for unilateral vocal fold paralysis. (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Lipoinjection is one of the available treatments for unilateral vocal fold paralysis.
OBJECTIVE
To evaluate lipoinjection predictability, and analyze the differences in safety and efficacy of the different techniques.
STUDY DESIGN
Systematic review and meta-analysis.
METHODS AND RESULTS
A systematic review on Medline, Cochrane, and Scopus databases included 49 articles analyzing the data of 1,166 patients, concerning technical details and voice parameters changes. Lipoinjection used a mean volume of 1.3 mL, 95% confidence interval (CI) (0.92, 1.69)-average overcorrection of 30%. Meta-analysis of pre- and postoperative voice parameters' means showed a significant improvement at 6 months of mean phonation time (preoperative: 5.12, 95% CI [4.48, 5.76]-6 months: 10.46, 95% CI [9.18, 11.75]), Jitter (preoperative: 2.71, 95% CI [2.08, 3.33])-6 months: 1.37, 95% CI [1.05, 1.70]), Shimmer (preoperative: 4.55, 95% CI [3.04, 6.07]-6 months: 2.57, 95% CI [1.69, 3.45]), grade (preoperative: 2.15, 95% CI [1.73, 2.57]-6 months: 0.12, 95% CI [0.97, 1.43]), breathiness (preoperative: 2.012, 95% CI [1.48, 2.55]-6 months: 0.99, 95% CI [0.58, 1.40]), and asthenia (preoperative: 1.90, 95% CI [1.33, 2.47]-6 months: 0.75, 95% CI [0.17, 1.33]) of GRBAS (Grade, Roughness, Breathiness, Asthenia and Strain), and Voice Handicap Index-30 (preoperative: 72.06, 95% CI [54.35, 89.76]-6 months: 26.24, 95% CI [19.58, 32.90]). Subgroup analysis by harvesting technique concluded in no statistically significant difference between them. Few complications were reported. Reintervention was only required for 86 patients.
CONCLUSION
Lipoinjection seems a safe therapeutic option for unilateral vocal fold paralysis, with available data showing an efficacy lasting 6 months to 1 year. Laryngoscope, 132:1630-1640, 2022.
Topics: Asthenia; Humans; Laryngoplasty; Phonation; Treatment Outcome; Vocal Cord Paralysis; Vocal Cords
PubMed: 34894158
DOI: 10.1002/lary.29965 -
Ear, Nose, & Throat Journal Dec 2022Reinke's edema and variceal hemorrhage are complex structural pathologies that affect the vocal cord mucosa. The vocal cords are highly susceptible to environmental... (Review)
Review
Reinke's edema and variceal hemorrhage are complex structural pathologies that affect the vocal cord mucosa. The vocal cords are highly susceptible to environmental stressors, such as smoking and vocal cord usage, thus, treatment involves their corresponding cessation. Here, we report a case of a patient with severe Reinke's edema and bilateral chronic vocal cord varices. The patient had a 30-pack-year history of cigarette smoking and was obstructed with intubation due to acute variceal hemorrhage and severe swelling of Reinke's edema. Moreover, a review of the literature regarding Reinke's edema and variceal hemorrhage treatment and their complications was performed.
Topics: Humans; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Airway Obstruction; Vocal Cords; Varicose Veins; Edema
PubMed: 36052403
DOI: 10.1177/01455613221123825 -
Annals of Medicine 2023To compare CO laser resection and laryngeal microsurgery for vocal cord polyps and provide evidence for the optimal surgical method.
OBJECTIVE
To compare CO laser resection and laryngeal microsurgery for vocal cord polyps and provide evidence for the optimal surgical method.
METHODS
This was a retrospective cohort study that included 74 patients with vocal cord polyps who underwent either CO laser resection or laryngeal microsurgery in our hospital from August 2018 to December 2021. According to their preference, 77 patients were divided into two groups: a CO laser resection group ( = 35) and a laryngeal microsurgery group ( = 39). Patients were evaluated two days before surgery, and follow-ups were conducted one, two and four weeks after surgery. The voice handicap index (VHI-10) score, voice acoustic analysis results and electronic laryngoscopy results were collected for each patient, and the differences between the two groups were evaluated.
RESULTS
The basic demographic characteristics of the 74 patients were comparable, and all patients completed postoperative follow-up observations. A total of 30 (85.71%) patients in the CO laser resection group and 22 (56.41%) patients in the laryngeal microsurgery group were healed. The total effectiveness rate of the CO laser resection group (94.29%) was significantly higher than that of the laryngeal microsurgery group (82.05%), and the difference between the two groups was statistically significant ( = .037). Both surgical methods had a positive effect on reducing VHI-10 scores with the effect of CO laser resection being more obvious. The difference between the two groups in this regard was statistically significant ( < .001). The effects of each surgical method on the average fundamental frequency perturbation (jitter), amplitude perturbation (shimmer), maximum phonation time and dysphonia severity index were not statistically significant ( > .05).
CONCLUSION
CO laser resection and laryngeal microsurgery have similar effects on voice quality, but CO laser resection has higher clinical efficacy.
Topics: Humans; Microsurgery; Vocal Cords; Carbon Dioxide; Retrospective Studies; Laryngeal Diseases; Treatment Outcome; Lasers, Gas; Polyps
PubMed: 38010099
DOI: 10.1080/07853890.2023.2280228