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European Journal of Pediatrics Jun 2023The main causes of voice disorders in children with adverse vocal behavior include benign lesions of the vocal folds caused by voice abuse or misuses, such as vocal fold... (Review)
Review
The main causes of voice disorders in children with adverse vocal behavior include benign lesions of the vocal folds caused by voice abuse or misuses, such as vocal fold nodules, vocal fold polyps, and laryngitis. Long-term voice disorders can affect the physical and mental health of children. Reviewing the literature of the last two decades on "Vocal Fold Nodules," "Vocal Fold Polyp," "Voice disorder," "Voice Abuse," "Voice Misuse," "Pediatrics," and "Children" with the appropriate Boolean operators. Conclusion: A total of 315 results were returned on an initial PubMed search. All articles from 2000 to 2022 written in English or Chinese were screened. Duplicate articles, those relating to adults only or concerned with the malignant lesion of the vocal cord, were excluded, resulting in 196 articles of interest. Relevant references and books have also been consulted, and we provide a review of the pathogenesis, diagnosis, and treatment of these maladaptive vocal behavioral voice disorders. What is Known: • Hoarseness is the most common voice symptom in children, and there are various causes of hoarseness in children. However, there is a lack of reviews on voice disorders caused by adverse vocal habits in children. • Voice training is a conservative treatment method for children with voice disorders , and it is important to clarify the factors that influence the effectiveness of voice training for children. What is New: • This review of the personality and family characteristics of children with adverse vocal behavioural voice disorders provides a valuable guide to the clinical planning of subsequent treatment. • This article discusses and summarises some of the factors that may influence the effectiveness of voice training in children and collates some of the scales and questionnaires currently used in children that are important in predicting the effectiveness of voice training.
Topics: Adult; Humans; Child; Hoarseness; Voice Disorders; Vocal Cords; Laryngeal Diseases; Mental Disorders
PubMed: 36973568
DOI: 10.1007/s00431-023-04879-4 -
Otolaryngology--head and Neck Surgery :... Jan 2021To measure pepsin expression in patients with vocal fold leukoplakia and elucidate its clinical significance.
OBJECTIVE
To measure pepsin expression in patients with vocal fold leukoplakia and elucidate its clinical significance.
STUDY DESIGN
Retrospective analysis of pathologic archive specimens.
SETTING
Affiliated university hospital.
SUBJECTS AND METHODS
The study included 45 patients with vocal fold leukoplakia and 19 with vocal fold polyps who underwent surgical treatment between December 2013 and July 2016. Masses were detected on both vocal cords in 5 patients with vocal fold leukoplakia and in 1 patient with vocal fold polyps. Immunohistochemistry was used to assess pepsin expression. In addition, the relationship of pepsin expression level with clinical characteristics of vocal fold leukoplakia was assessed.
RESULTS
The rate of pepsin expression was high in the polyp group (75%) and the leukoplakia group (68%); however, the difference between groups was not significant ( > .05). Pepsin expression significantly increased according to grade of dysplasia (mild, 57.1%; moderate, 88.9%; severe, 100.0%; = .034). Similarly, the percentage of lesions that exhibited strongly positive pepsin expression increased with the grade of dysplasia (mild, 37.1%; moderate, 66.7%; severe, 100.0%; = .005). The leukoplakia recurrence rate was higher in patients with positive pepsin expression than in patients with negative pepsin expression but without a significant difference ( > .05).
CONCLUSION
Our study suggests that pepsin was associated with the grade of dysplasia of vocal cord leukoplakia. Further investigation with appropriate control groups and controlling for other risk factors, such as smoking or alcohol consumption, is needed.
Topics: Adult; Aged; Biomarkers; Female; Humans; Laryngeal Diseases; Leukoplakia; Male; Middle Aged; Pepsin A; Polyps; Precancerous Conditions; Retrospective Studies; Vocal Cords
PubMed: 32692278
DOI: 10.1177/0194599820938654 -
The Laryngoscope Mar 2022Infants who undergo congenital heart surgery are at risk of developing vocal fold motion impairment (VFMI) and swallowing difficulties. This study aims to describe the...
OBJECTIVES/HYPOTHESIS
Infants who undergo congenital heart surgery are at risk of developing vocal fold motion impairment (VFMI) and swallowing difficulties. This study aims to describe the dysphagia in this population and explore the associations between surgical complexity and vocal fold mobility with dysphagia and airway protection.
STUDY DESIGN
Retrospective chart review.
METHODS
This is a retrospective chart review of infants (age <12 months) who underwent congenital heart surgery between 7/2008 and 1/2018 and received a subsequent videofluoroscopic swallow study (VFSS). Demographic information, Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) category of each surgery, vocal fold mobility status, and VFSS findings were collected and analyzed.
RESULTS
Three hundred and seventy-four patients were included in the study. Fifty-four percent of patients were male, 24% were premature, and the average age at the time of VFSS was 59 days. Sixty percent of patients had oral dysphagia and 64% of patients had pharyngeal dysphagia. Fifty-one percent of patients had laryngeal penetration and 45% had tracheal aspiration. Seventy-three percent of these aspirations were silent. There was no association between surgical complexity, as defined by the STAT category, and dysphagia or airway protection findings. Patients with VFMI after surgery were more likely to have silent aspiration (odds ratio = 1.94, P < .01), even when adjusting for other risk factors.
CONCLUSION
Infants who undergo congenital heart surgery are at high risk for VFMI and aspiration across all five STAT categories. This study demonstrates the high prevalence of silent aspiration in this population and the need for thorough postoperative swallow evaluation.
LEVEL OF EVIDENCE
4 Laryngoscope, 132:701-705, 2022.
Topics: Cardiac Surgical Procedures; Deglutition Disorders; Female; Fluoroscopy; Heart Defects, Congenital; Humans; Infant; Infant, Newborn; Male; Retrospective Studies; Vocal Cord Dysfunction; Vocal Cords
PubMed: 34378798
DOI: 10.1002/lary.29817 -
Advances in Oto-rhino-laryngology 2020Injection laryngoplasty as used in this chapter is synonymous with the term "injection augmentation." Injection augmentation is a technique designed to enhance glottic... (Review)
Review
Injection laryngoplasty as used in this chapter is synonymous with the term "injection augmentation." Injection augmentation is a technique designed to enhance glottic closure in patients with glottic insufficiency, or failure of glottic closure, by injecting material into the lateral aspect of the vocal fold to move the vibrating surface to the midline. This type of injection augments the vocal fold and improves glottic closure. Injection augmentation originated over 100 years ago. However, the current indications, techniques, and materials have changed significantly. Paralysis, defined as loss of function due to neu-rological injury, remains a common cause of glottic insufficiency. In cases of paralysis, nerve function to adduct the vocal folds for voice production and coughing is interrupted, bilaterally or unilaterally, and the glottis becomes insufficient. While unilateral vocal fold paralysis remains the most common indication for vocal fold injection augmentation, due to the development of newer injectable materials and less invasive injectable techniques, surgeons routinely perform injection augmentation for glottic insufficiency due to other causes such as vocal fold paresis, vocal fold atrophy, presbylarynx, vocal fold scar, and soft tissue loss. Additionally, there is an increasing performance of vocal fold injection in the awake patient. This allows for immediate feedback and reduced anesthetic risk. Outcomes assessment for injection augmentation remains varied by lack of consensus and large-scale studies to identify the factors most instrumental in documenting optimal results. We review the history of injection laryngoplasty, the indications for injection, choice of injectate, outcomes, complications, and future directions of injection laryngoplasty for augmentation.
Topics: Humans; Injections; Laryngoplasty; Patient Selection; Vocal Cord Paralysis; Vocal Cords
PubMed: 33166968
DOI: 10.1159/000456684 -
Journal of Voice : Official Journal of... May 2024Vocal fold nodules are the most common etiology of chronic dysphonia in the pediatric population. Voice therapy is an effective first line of treatment, with increasing...
BACKGROUND
Vocal fold nodules are the most common etiology of chronic dysphonia in the pediatric population. Voice therapy is an effective first line of treatment, with increasing evidence supporting the use of telepractice in speech pathology. Despite this, there is limited data on its effectiveness in the pediatric population. The aim of this retrospective study was to investigate the feasibility and efficacy of telepractice in delivering voice therapy to children diagnosed with vocal fold nodules.
METHODS
A retrospective review was conducted of patients treated with virtual voice therapy from April 2020 to June 2021. Patients were included if diagnosed with vocal fold nodules, 2-18 years of age, and completed therapy in a virtual format. Data includes demographics, Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) scores and pediatric Voice Handicap Index (pVHI) scores.
RESULTS
Twenty-three children were included, 17 (74%) male and six (26%) female (with an age range of 2.4-9.9 years at the start of therapy). Prior to treatment, the average CAPE-V Overall Severity score was 37.9 (SD 13.8); the average posttreatment score was 22.4 (SD 10.2). The average pVHI total score prior to treatment was 26.3 (SD 12.1), with an average posttreatment score of 20.2 (SD 11.7). Patients who underwent virtual voice therapy had improved posttreatment CAPE-V severity scores than those prior to treatment (average difference = -15.5 points; 95% CI: -8.3 to -22.7; P < 0.001). An increased number of therapy sessions was associated with both higher initial CAPE-V severity scores (r = 0.72; P < 0.01) and a greater decrease in posttreatment CAPE-V scores (r = -0.55; P < 0.01).
CONCLUSION
Virtual voice therapy may be feasible and efficacious in treating dysphonic children diagnosed with vocal fold nodules. Significant improvements were found in perceptual CAPE-V scores in overall severity; positive changes were also seen in parental measures of quality of life. Delivery of voice therapy in a telehealth format may increase access of care and should be considered as a treatment option.
Topics: Humans; Dysphonia; Female; Male; Child; Retrospective Studies; Voice Training; Child, Preschool; Voice Quality; Treatment Outcome; Adolescent; Telemedicine; Feasibility Studies; Disability Evaluation; Age Factors; Vocal Cords; Recovery of Function
PubMed: 34969557
DOI: 10.1016/j.jvoice.2021.11.007 -
European Archives of... Dec 2022This systematic review aims to provide an overview of the current evidence-base for paediatric surgical reinnervation in unilateral and bilateral vocal fold palsies in... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This systematic review aims to provide an overview of the current evidence-base for paediatric surgical reinnervation in unilateral and bilateral vocal fold palsies in clinical practice. We aim to assess patient demographics, surgical technique and pre- and post-operative outcome measures.
METHODS
A systematic literature review was performed and reported according to international PRISMA recommendations. A comprehensive search of PubMed, Embase, and Cochrane CENTRAL databases for relevant publications for all available dates with appropriate MESH search criteria was performed. Articles were categorised by four authors independently. A pooled summative analysis was carried out to allow review of demographic and outcome data.
RESULTS
Our systematic PRISMA approach resulted in 19 papers being selected for inclusion and analysis with 179 patients undergoing reinnervation (153 unilateral, 26 bilateral). The youngest patient was 1.9 years. Iatrogenic injury to recurrent laryngeal nerve most common aetiology (65.4% and 19.2% of unilateral and bilateral vocal fold palsies, respectively). Patent ductus arteriosus ligation was the single most common procedure resulting in unilateral vocal fold palsies (43.1% of cases). Statistically significant improvements in subjective and objective outcomes for both voice and swallowing were seen. Meta-analysis was able to be performed on the particularly evident improvements in GRBAS score and Maximum Phonation Time (MPT). GRBAS scores improved by 3.64 (p < 0.01, 95% CI 2.65 to 4.63). MPT showed a statistically significant improvement of 5.26 s (p < 0.05, 95% CI 4.28 to 6.24). No major complications were reported.
CONCLUSION
The current published evidence on one-hundred and seventy-nine paediatric surgical reinnervation procedures demonstrates its role as a safe and effective treatment for both unilateral and bilateral vocal fold palsies. Anatomically it has been shown to improve vocal fold tone, bulk and position. Both post-operative voice and swallowing outcomes show improvement as well as associated quality of life measures.
Topics: Humans; Child; Vocal Cord Paralysis; Quality of Life; Recurrent Laryngeal Nerve; Vocal Cords; Larynx
PubMed: 35838782
DOI: 10.1007/s00405-022-07471-y -
European Archives of... Mar 2022We investigated the role of Glut-1 and H/K-ATPase expression in pepsin-induced development of human vocal cord leukoplakia cells (HVCLCs). Next, we analyzed the...
PURPOSE
We investigated the role of Glut-1 and H/K-ATPase expression in pepsin-induced development of human vocal cord leukoplakia cells (HVCLCs). Next, we analyzed the relationship between Glut-1 and H/K-ATPase expression with the clinicopathological features of laryngeal carcinoma.
METHODS
Glut-1 and H/K-ATPase expression levels in HVCLCs were determined after treatment with artificial gastric juice containing pepsin and laryngeal carcinoma tissues.
RESULTS
Exposure to pepsin-containing artificial gastric juice significantly enhanced the migration and proliferation of VSCLCs in a time-dependent manner. The apoptotic rate of VSCLCs decreased over time after exposure to pepsin and reached a nadir on day 7 (p < 0.01). With increasing duration of exposure to pepsin, the proportion of VSCLCs in G0/G1 phase decreased and the proportions in the S and G2/M phases significantly increased (p < 0.05). After treatment with pepsin-containing artificial gastric juice, RT-PCR and Western blotting showed that the expression of Glut-1 and H/K-ATPase α, β significantly increased in HVCLCs compared to in the absence of pepsin (p < 0.05). The expression of Glut-1 and H/K-ATPase α, β gradually increased from vocal cord leukoplakia (VLC) to laryngeal carcinoma (p < 0.05). Lentivirus-mediated inhibition of Glut-1 expression in VCL significantly inhibited the cells' migration and proliferation (p < 0.05) but enhanced their apoptosis (p < 0.05). Also, inhibition of Glut-1 expression resulted in an increased proportion of cells in G0/G1 phase and a significantly decreased proportion in G2/M phase (p < 0.05).
CONCLUSIONS
Elevated Glut-1 expression may promote the development of VCL by upregulating laryngeal H/K-ATPase expression to reactivate absorbed pepsin, thus damaging the laryngeal mucosa.
Topics: Adenosine Triphosphatases; Glucose Transporter Type 1; H(+)-K(+)-Exchanging ATPase; Humans; Laryngeal Neoplasms; Laryngopharyngeal Reflux; Leukoplakia; Pepsin A; Vocal Cords
PubMed: 34800155
DOI: 10.1007/s00405-021-07172-y -
Advances in Oto-rhino-laryngology 2020Vocal fold immobility can be either unilateral or bilateral and partial or complete. The aim of this chapter is to discuss the management of unilateral paresis using... (Review)
Review
Vocal fold immobility can be either unilateral or bilateral and partial or complete. The aim of this chapter is to discuss the management of unilateral paresis using medialization thyroplasty with or without arytenoid adduction as a means of treating neurogenic causes as opposed to mechanical fixation. Medialization thyroplasty is an open surgical procedure that is performed under local or general anesthesia. Essentially, it aims to close the glottic gap, approximating both vocal folds together and thereby allowing for restoration of the efficiency of the larynx. The glottic gap results from atrophy of the affected vocal fold and in so doing results in glottic insufficiency which causes voice breathiness, strain, fatigue, aspiration, and swallowing difficulties that make up the bulk of symptoms associated with this condition. Unlike injection laryngoplasty, medialization thyroplasty does not increase the "bulk" of the atrophic vocal fold but merely brings the fold closer to its unaffected partner. Besides the obvious lateralization, there is occasionally a third dimensional component to the affected fold. The slipping and prolapse forward of the arytenoid cartilage due to atrophy of the muscles supporting it and the natural declination of the facet joint it rests on cause a vertical drop of the level of the affected vocal fold that may not be remedied with the medialization procedure, hence requiring arytenoid adduction. Although attempts to medialize the vocal fold have been described in the past with limited access, the basic premise of creating a window in the thyroid cartilage remains central. The differences between materials used, their respective strengths and weaknesses, the pitfalls and pearls in achieving a good closure and improvement in voice, swallow, and safety of the airway are all discussed accordingly.
Topics: Arytenoid Cartilage; Humans; Laryngoplasty; Patient Selection; Thyroid Cartilage; Vocal Cord Paralysis; Vocal Cords
PubMed: 33166967
DOI: 10.1159/000456686 -
Ear, Nose, & Throat Journal Mar 2022Arytenoid dislocation and subluxations commonly are reduced surgically using Holinger and straight Miller-3 laryngoscopes. We present a case of arytenoid cartilage...
Arytenoid dislocation and subluxations commonly are reduced surgically using Holinger and straight Miller-3 laryngoscopes. We present a case of arytenoid cartilage subluxation returned to good position using a 28-Jackson dilator. A 66-year-old man was diagnosed previously with right vocal fold paresis and left vocal fold paralysis following a motor vehicle accident that required a 14-day intubation and tracheotomy maintained for 3 weeks. Evaluation by strobovideolaryngoscopy 3 months following the accident showed severe left vocal fold hypomotility and arytenoid height disparity; laryngeal electromyography showed only mild-to-moderate decreased recruitment in laryngeal muscles. No abnormalities were appreciated on neck computed tomography. Upon palpation of both arytenoid cartilages in the operating room, the left joint was found to be subluxed anteriorly and immobile. A 28-Jackson dilator was used to mobilize and reduce the left arytenoid cartilage, and steroid was injected into the cricothyroid joint. Increased mobility was obtained in the operating room and the patient reported significant improvement in his voice. Six months later, we saw improvement in arytenoid height disparity and left vocal fold movement, better glottic closure, and voice handicap index was improved. A 28-Jackson dilator can be used to manipulate the cricoarytenoid joint without trauma to the vocal process.
Topics: Aged; Arytenoid Cartilage; Humans; Laryngeal Muscles; Laryngoscopes; Male; Vocal Cord Paralysis; Vocal Cords
PubMed: 32804570
DOI: 10.1177/0145561320946901 -
The Laryngoscope Sep 2019To evaluate differences in vocal motor control and central auditory processing between treated unilateral vocal fold paralysis (UVFP) and healthy control cohorts.
OBJECTIVES
To evaluate differences in vocal motor control and central auditory processing between treated unilateral vocal fold paralysis (UVFP) and healthy control cohorts.
STUDY DESIGN
Cross-sectional.
METHODS
Ten UVFP study patients treated by type I thyroplasty with stable voices were compared to 12 control subjects for vocal motor control using a pitch perturbation response task and central auditory processing performance using a battery of complex sound intelligibility assays that included adverse temporal and noise conditions. Standard clinical evaluations of voice production and peripheral audiometric sensitivity were performed.
RESULTS
Vocal motor control was impaired in treated UVFP. The UVFP cohort exhibited a 32.5% reduction in the instantaneous, subconscious compensatory response to pitch feedback perturbation in the interval between 150 ms and 550 ms following onset (P < 0.0001, linear mixed effects model). This impairment cannot simply be ascribed to vocal motor capacity insufficiency in the UVFP cohort because both cohorts demonstrated comparable functional capacity to perform the vocal motor task. The UVFP cohort also showed greater propensity for central auditory processing impairment (P < 0.05), notably for temporal compression and added noise challenges.
CONCLUSION
Combined central vocal motor control and auditory processing impairments in treated UVFP highlight reciprocal interdependency of sensory and motor systems. This pilot study suggests that peripheral motor impairment of the larynx can degrade central auditory processing, which in turn may contribute to vocal motor control impairment. A more complete restoration communicative function in UVFP will require deeper understanding of sensory, motor, and sensorimotor aspects of the human communication loop.
LEVEL OF EVIDENCE
3b Laryngoscope, 129:2112-2117, 2019.
Topics: Adult; Aged; Aged, 80 and over; Audiometry, Pure-Tone; Auditory Cortex; Cross-Sectional Studies; Female; Humans; Laryngoplasty; Male; Middle Aged; Pilot Projects; Speech Intelligibility; Speech Production Measurement; Vocal Cord Paralysis; Vocal Cords
PubMed: 30484858
DOI: 10.1002/lary.27680