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International Journal of Environmental... Apr 2023Sulcus vocalis (SV) is a longitudinal groove in the free edge of the true vocal cord. It may impair phonation with incomplete glottic closure, phonasthenia and...
BACKGROUND
Sulcus vocalis (SV) is a longitudinal groove in the free edge of the true vocal cord. It may impair phonation with incomplete glottic closure, phonasthenia and hoarseness. This study aims to detect a correlation between benign vocal cord lesions and the incidence of the SV.
METHODS
A retrospective study was carried out on patients who underwent transoral surgery due to benign vocal fold lesions and were selected according to strict criteria. Patients were divided into a group with sulcus vocalis (Group wSV) and a group without sulcus vocalis (Group w/oSV). The possible correlations between variables were assessed by the Pearson chi-square test ( < 0.05).
RESULTS
The study included 232 vocal cord lesions in 229 patients: 62.88% were females whose mean age was 46.61 ± 14.04. The most frequent diseases were polyps (37.94%), nodules (18.53%) and Reinke's edema (21.12%). Statistically significant relationships were found between age and SV (-value 0.0005) and between mild dysplasia and SV (-value 0.03).
CONCLUSIONS
This study did not detect a cause-effect relationship between SV and benign vocal fold lesions. SV within vocal fold lesions is more common in younger patients, suggesting a congenital nature of SV. In conclusion, in the case of a benign vocal fold lesion, a possible SV should be considered and researched to provide the patient the best healthcare.
Topics: Female; Humans; Adult; Middle Aged; Male; Vocal Cords; Laryngeal Diseases; Retrospective Studies; Phonation; Polyps
PubMed: 37174173
DOI: 10.3390/ijerph20095654 -
Clinical Rheumatology Mar 2023The aim of this study was to describe the clinical features of vocal cord lesions in patients with representative autoimmune diseases including systemic lupus...
OBJECTIVE
The aim of this study was to describe the clinical features of vocal cord lesions in patients with representative autoimmune diseases including systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA).
METHOD
A total of 31 SLE/RA patients (14 SLE and 17 RA) complicated with vocal cord lesions (SLE/RA-VC group) who had been admitted to Peking Union Medical College Hospital were retrieved from the electronic registration system. Ninety-three age and sex-matched SLE/RA patients (42 SLE and 51 RA) without vocal cord lesions (SLE/RA-nVC group) admitted during the same period were chosen randomly as controls. Medical files were reviewed and clinical data collected for comparisons.
RESULTS
Vocal cord paralysis (n = 12, 38.7%) and vocal cord mass (n = 14, 45.2%) were the most common types of vocal cord lesions in this cohort. Unilateral lesions were more common than bilateral lesions (67.8% vs 32.3%) and the two sides were affected equally. Two cases of vocal cord bamboo node lesion were observed in SLE-VC group even as an initial manifestation and SLE-VC group had a slightly higher disease activity index (SLEDAI-2K) than their control counterparts (18.56 ± 8.23 vs 13.63 ± 5.89, p = 0.041). The RA-VC group had less pulmonary interstitial disease (29.4% vs 63%, p = 0.017) and lower CRP levels (p = 0.006) than their controls. As for the treatment, 71% of SLE/RA-VC patients had received glucocorticoids and immunosuppressants and 30% had undergone surgery. 45.2% of SLE/RA-VC patients got improvement at the time of discharge.
CONCLUSIONS
The association of vocal cord lesions with disease activity can be observed in SLE patients but not in RA patients. Vocal cord lesions in SLE/RA patients should be considered as a part of the systemic involvement and should be treated accordingly. Key Points • Vocal cord paralysis and vocal cord mass were the main types of vocal cord lesions in patients with SLE/RA. • Vocal cord lesions in SLE patients may associate with disease activity and vocal cord bamboo node lesions could be an initial manifestation. • Glucocorticoid and immunosuppressants could be effective for vocal cord lesions in SLE/RA patients.
Topics: Humans; Vocal Cords; Vocal Cord Paralysis; Autoimmune Diseases; Arthritis, Rheumatoid; Lupus Erythematosus, Systemic; Glucocorticoids; Immunosuppressive Agents
PubMed: 36269532
DOI: 10.1007/s10067-022-06411-9 -
Respirology (Carlton, Vic.) Jul 2023Vocal cord dysfunction/inducible laryngeal obstruction (VCD/ILO), is a common condition characterized by breathlessness associated with inappropriate laryngeal... (Review)
Review
Vocal cord dysfunction/inducible laryngeal obstruction (VCD/ILO), is a common condition characterized by breathlessness associated with inappropriate laryngeal narrowing. Important questions remain unresolved, and to improve collaboration and harmonization in the field, we convened an international Roundtable conference on VCD/ILO in Melbourne, Australia. The aims were to delineate a consistent approach to VCD/ILO diagnosis, appraise disease pathogenesis, outline current management and model(s) of care and identify key research questions. This report summarizes discussions, frames key questions and details recommendations. Participants discussed clinical, research and conceptual advances in the context of recent evidence. The condition presents in a heterogenous manner, and diagnosis is often delayed. Definitive diagnosis of VCD/ILO conventionally utilizes laryngoscopy demonstrating inspiratory vocal fold narrowing >50%. Computed tomography of the larynx is a new technology with potential for swift diagnosis that requires validation in clinical pathways. Disease pathogenesis and multimorbidity interactions are complex reflecting a multi-factorial, complex condition, with no single overarching disease mechanism. Currently there is no evidence-based standard of care since randomized trials for treatment are non-existent. Recent multidisciplinary models of care need to be clearly articulated and prospectively investigated. Patient impact and healthcare utilization can be formidable but have largely escaped inquiry and patient perspectives have not been explored. Roundtable participants expressed optimism as collective understanding of this complex condition evolves. The Melbourne VCD/ILO Roundtable 2022 identified clear priorities and future directions for this impactful condition.
Topics: Humans; Vocal Cord Dysfunction; Laryngeal Diseases; Airway Obstruction; Vocal Cords; Laryngoscopy; Diagnosis, Differential
PubMed: 37221142
DOI: 10.1111/resp.14518 -
ANZ Journal of Surgery Mar 2022Clinical voice assessment prior to thyroid and parathyroid surgery is essential, but the paradigm of indirect laryngoscopy (IDL), when indicated, has been challenged by... (Review)
Review
BACKGROUND
Clinical voice assessment prior to thyroid and parathyroid surgery is essential, but the paradigm of indirect laryngoscopy (IDL), when indicated, has been challenged by the risk of aerosolised SARS-Cov-2 during endoscopy of the aerodigestive tract. Translaryngeal ultrasound (TLUS) to assess the vocal cords has been proposed as a safe, non-invasive and sensitive alternative. The aim of this review was to verify TLUS as a viable tool for perioperative laryngeal assessment.
METHOD
A literature review was performed using Medline, Embase, Cochrane Database of Systematic Reviews, Cochrane Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials and Scopus with the following search strategy: (vocal cord OR vocal fold OR glottic OR glottis OR vocal ligaments OR rima glottidis) AND (ultras* OR sonograph* OR echography OR echotomography).
RESULTS
Fifteen studies were included in this review. All studies compared TLUS to IDL in visualizing the vocal cords in adults. Ten studies compared pre-operative TLUS to IDL where 50.6-100% of vocal cords were successfully visualized. Nine studies compared post-operative TLUS to IDL and reported visualization between 39.6% and 100%. Pre- and post-operative negative predictive values ranged from 60% to 100%.
CONCLUSION
Whilst promising, successful visualization of the cords is limited by inter-user variability, older age and male gender. Thus, we see the role of TLUS as an alternative to IDL in the post-operative setting in the young patient following uncomplicated surgery with a normal voice on clinical examination, to confirm recurrent laryngeal nerve integrity while minimizing the risk of aerosolization.
Topics: Adult; COVID-19; Humans; Laryngoscopy; Male; SARS-CoV-2; Systematic Reviews as Topic; Thyroid Gland; Thyroidectomy; Ultrasonography; Vocal Cord Paralysis; Vocal Cords
PubMed: 35133056
DOI: 10.1111/ans.17530 -
The Laryngoscope Oct 2022This scoping review aims to provide a broad overview of the applications of artificial intelligence (AI) to office laryngoscopy to identify gaps in knowledge and guide... (Review)
Review
OBJECTIVES/HYPOTHESIS
This scoping review aims to provide a broad overview of the applications of artificial intelligence (AI) to office laryngoscopy to identify gaps in knowledge and guide future research.
STUDY DESIGN
Scoping Review.
METHODS
Searches for studies on AI and office laryngoscopy were conducted in five databases. Title and abstract and then full-text screening were performed. Primary research studies published in English of any date were included. Studies were summarized by: AI applications, targeted conditions, imaging modalities, author affiliations, and dataset characteristics.
RESULTS
Studies focused on vocal fold vibration analysis (43%), lesion recognition (24%), and vocal fold movement determination (19%). The most frequently automated tasks were recognition of vocal fold nodules (19%), polyp (14%), paralysis (11%), paresis (8%), and cyst (7%). Imaging modalities included high-speed laryngeal videos (45%), stroboscopy (29%), and narrow band imaging endoscopy (7%). The body of literature was primarily authored by science, technology, engineering, and math (STEM) specialists (76%) with only 30 studies (31%) involving co-authorship by STEM specialists and otolaryngologists. Datasets were mostly from single institution (84%) and most commonly originated from Germany (23%), USA (16%), Spain (9%), Italy (8%), and China (8%). Demographic information was only reported in 39 studies (40%), with age and sex being the most commonly reported, whereas race/ethnicity and gender were not reported in any studies.
CONCLUSION
More interdisciplinary collaboration between STEM and otolaryngology research teams improved demographic reporting especially of race and ethnicity to ensure broad representation, and larger and more geographically diverse datasets will be crucial to future research on AI in office laryngoscopy.
LEVEL OF EVIDENCE
NA Laryngoscope, 132:1993-2016, 2022.
Topics: Artificial Intelligence; Humans; Laryngoscopy; Polyps; Stroboscopy; Vocal Cord Paralysis; Vocal Cords
PubMed: 34582043
DOI: 10.1002/lary.29886 -
Anaesthesia Sep 2022Numerous studies support the idea that neuromuscular blockade facilitates facemask ventilation after induction of anaesthesia. Although improved airway patency or... (Observational Study)
Observational Study
Numerous studies support the idea that neuromuscular blockade facilitates facemask ventilation after induction of anaesthesia. Although improved airway patency or pulmonary compliance and a resolution of laryngospasm have been suggested as possible causes, the exact mechanism remains unclear. We aimed to assess whether neuromuscular blockade improves facemask ventilation and to clarify whether this phenomenon is associated with the vocal cord angle. This prospective observational study included patients aged between 20 and 65 years scheduled for elective surgery under general anaesthesia. After induction of anaesthesia, patients' lungs were ventilated with pressure-controlled ventilation using a facemask. During facemask ventilation, a flexible bronchoscope was inserted through a self-sealing diaphragm at the elbow connector attached to the facemask and breathing circuit and positioned to allow a continuous view of the vocal cords. The mean tidal volume and vocal cord angle were measured before and after administration of neuromuscular blocking drugs. Of 108 patients, 100 completed the study. Mean (SD) tidal volume ((11.0 (3.9) ml.kg vs. 13.6 (2.6) ml.kg ; p < 0.001) and mean (SD) vocal cord angle (17° (10°) vs. 26° (5°); p < 0.001) increased significantly after neuromuscular blockade. The proportional increase in mean tidal volume after neuromuscular blockade was positively correlated with vocal cord angle (Spearman's ρ = 0.803; p < 0.001). In conclusion, neuromuscular blockade facilitated facemask ventilation, and the improvement was correlated with further opening of the vocal cords.
Topics: Adult; Aged; Anesthesia, General; Humans; Lung; Masks; Middle Aged; Neuromuscular Blockade; Vocal Cords; Young Adult
PubMed: 35727620
DOI: 10.1111/anae.15786 -
NEJM Evidence Jan 2023Inducible laryngeal obstruction (ILO)/vocal cord dysfunction is frequently encountered in the specialist asthma clinic, where it is often misdiagnosed as asthma or is...
Inducible laryngeal obstruction (ILO)/vocal cord dysfunction is frequently encountered in the specialist asthma clinic, where it is often misdiagnosed as asthma or is coexistent with asthma. It causes recurrent distressing episodes of acute dyspnea that can lead to hospital admissions, endotracheal intubation, and fruitless asthma treatment escalation, often including oral glucocorticoids. Early diagnosis and treatment of ILO offers the prospect of connecting patients with an effective speech- and language-based intervention earlier and avoiding these unnecessary and potentially harmful interventions.
Topics: Humans; Vocal Cords; Laryngoscopy; Airway Obstruction; Laryngeal Diseases; Asthma
PubMed: 38320096
DOI: 10.1056/EVIDe2200299 -
Otolaryngologic Clinics of North America Feb 2020Electrical stimulation of the recurrent laryngeal nerve is a safe and promising therapeutic approach with the potentiality to overcome the shortcomings of conventional... (Review)
Review
Electrical stimulation of the recurrent laryngeal nerve is a safe and promising therapeutic approach with the potentiality to overcome the shortcomings of conventional surgical glottal enlargement. Although aberrant or synkinetic reinnervation is commonly considered an unfavorable condition, particularly for recovery of vocal fold movement, its presence is essential to ensure the effective clinical performance of laryngeal pacemakers. Thus, the effective selection of patients who can profit from laryngeal pacemakers implantation demands the implementation of new diagnostic tools based on tests capable of reliably detecting the presence of viable reinnervation on at least one vocal fold.
Topics: Animals; Electric Stimulation Therapy; Electromyography; Humans; Implantable Neurostimulators; Laryngeal Muscles; Prosthesis Implantation; Recurrent Laryngeal Nerve; Treatment Outcome; Vocal Cord Paralysis; Vocal Cords
PubMed: 31648825
DOI: 10.1016/j.otc.2019.09.009 -
JAMA Otolaryngology-- Head & Neck... Feb 2024
Topics: Humans; Vocal Cords; Laryngeal Diseases; Polyps
PubMed: 38095882
DOI: 10.1001/jamaoto.2023.3698 -
Ear, Nose, & Throat Journal Sep 2021Type 1 thyroplasty is an established procedure for the treatment of vocal fold paralysis to improve voice and swallowing outcomes. At our institution, we commonly...
OBJECTIVE
Type 1 thyroplasty is an established procedure for the treatment of vocal fold paralysis to improve voice and swallowing outcomes. At our institution, we commonly perform this procedure on an outpatient basis in medically stable patients. With this study, we assess the safety of outpatient thyroplasty by examining complication and readmission rates, need for revision surgery, and predictors of these outcome measures.
METHODS
We performed a retrospective review of patients undergoing outpatient type 1 thyroplasty for vocal fold paralysis between 2013 and 2018 at our institution. We documented the etiology of paralysis, comorbidities, and demographic data. Our primary outcome measures were complications, need for readmission, and need for revision surgery.
RESULTS
During the study period, 160 patients met our inclusion criteria. Mean age at time of surgery was 62.1 ± 13.9 years; there were 82 (51%) males and 78 (49%) females. Nine (5.6%) patients experienced major complications after surgery and 7 (4.4%) patients required unplanned readmission. Mean time to complication was 6.9 ± 9.7 days. There were no instances of postoperative airway compromise requiring intervention. There were no mortalities. Of those who underwent primary surgery, 22 (14%) patients required revision surgery.
CONCLUSION
Given that complications tend to occur in a delayed fashion rather than in the acute postoperative period, same-day discharge seems reasonable as compared to overnight observation in medically stable patients undergoing type 1 thyroplasty.
LEVEL OF EVIDENCE
IV.
Topics: Adult; Aged; Aged, 80 and over; Ambulatory Surgical Procedures; Female; Hematoma; Humans; Incidence; Intraoperative Complications; Laryngoplasty; Male; Middle Aged; Postoperative Complications; Reoperation; Retrospective Studies; Vocal Cord Paralysis; Vocal Cords; Voice Quality
PubMed: 31903781
DOI: 10.1177/0145561319894414