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Scientific Reports Jun 2021Vocal fold (VF) fibrosis is a major cause of intractable voice-related disability and reduced quality of life. Excision of fibrotic regions is suboptimal and associated...
Vocal fold (VF) fibrosis is a major cause of intractable voice-related disability and reduced quality of life. Excision of fibrotic regions is suboptimal and associated with scar recurrence and/or further iatrogenic damage. Non-surgical interventions are limited, putatively related to limited insight regarding biochemical events underlying fibrosis, and downstream, the lack of therapeutic targets. YAP/TAZ integrates diverse cell signaling events and interacts with signaling pathways related to fibrosis, including the TGF-β/SMAD pathway. We investigated the expression of YAP/TAZ following vocal fold injury in vivo as well as the effects of TGF-β1 on YAP/TAZ activity in human vocal fold fibroblasts, fibroblast-myofibroblast transition, and TGF-β/SMAD signaling. Iatrogenic injury increased nuclear localization of YAP and TAZ in fibrotic rat vocal folds. In vitro, TGF-β1 activated YAP and TAZ in human VF fibroblasts, and inhibition of YAP/TAZ reversed TGF-β1-stimulated fibroplastic gene upregulation. Additionally, TGF-β1 induced localization of YAP and TAZ in close proximity to SMAD2/3, and nuclear accumulation of SMAD2/3 was inhibited by a YAP/TAZ inhibitor. Collectively, YAP and TAZ were synergistically activated with the TGF-β/SMAD pathway, and likely essential for the fibroplastic phenotypic shift in VF fibroblasts. Based on these data, YAP/TAZ may evolve as an attractive therapeutic target for VF fibrosis.
Topics: Adaptor Proteins, Signal Transducing; Animals; Female; Fibrosis; Humans; Intracellular Signaling Peptides and Proteins; Rats; Rats, Sprague-Dawley; Signal Transduction; Smad Proteins; Transcription Factors; Transcriptional Coactivator with PDZ-Binding Motif Proteins; Vocal Cord Dysfunction; Vocal Cords; YAP-Signaling Proteins
PubMed: 34188130
DOI: 10.1038/s41598-021-92871-z -
Journal of Voice : Official Journal of... May 2023Adult laryngeal hemangiomas are rare and uncommon. Hemangioma isolated to the free-edge of vocal cord is very rare. We report five cases diagnosed at our voice clinic... (Review)
Review
Adult laryngeal hemangiomas are rare and uncommon. Hemangioma isolated to the free-edge of vocal cord is very rare. We report five cases diagnosed at our voice clinic during 18 months-period from July 2016 to December 2017. All the five patients presented with hoarseness and the laryngoscopy examination detected a pink mass at the vocal edge with the histopathology indicating hemangioma. Direct laryngoscopy with laryngeal carbon dioxide (CO2) laser microscopic surgery was performed uneventfully and no recurrence was found. We suggest that Microscopic Laser Laryngoscopy (CO2) is the treatment option of vocal fold hemangioma with no intraoperative massive bleeding.
Topics: Humans; Adult; Vocal Cords; Carbon Dioxide; Larynx; Hemangioma; Laryngoscopy
PubMed: 33750625
DOI: 10.1016/j.jvoice.2021.01.022 -
Respirology (Carlton, Vic.) Aug 2019
Topics: Humans; Patient Care Team; Vocal Cord Dysfunction; Vocal Cords
PubMed: 30977222
DOI: 10.1111/resp.13560 -
Journal of Voice : Official Journal of... Jul 2021To discuss the correlation between benign vocal fold lesions and sulcus vocalis.
PURPOSE
To discuss the correlation between benign vocal fold lesions and sulcus vocalis.
METHODS
Analysis of the surgical data of 457 patients with benign vocal fold lesions and occult sulcus vocalis and preoperative voice evaluation and postoperative follow-up data from collected patients.
RESULTS
A total of 61.7% of the patients had bilateral sulcus vocalis. Of the patients with bilateral sulcus vocalis, 64.9% had bilateral benign vocal fold lesions, and 35.1% had unilateral vocal fold benign lesions. Of the patients with unilateral sulcus vocalis, 74.3% showed associated ipsilateral vocal fold benign lesions, and 22.3% showed associated contralateral vocal fold lesions. In the 739 sides affected by sulcus vocalis, 255 sides of sulcus vocalis type I were not treated. There were 11 cases with 13 sides affected by mucosal bridges. The satisfaction rate for sound improvement was 79.6% by half a year after the operation.
CONCLUSION
The occurrence of benign vocal fold lesions may be related to occult sulcus vocalis. We should attach importance to the treatment of sulcus vocalis in the diagnosis and treatment of vocal fold diseases.
Topics: Humans; Laryngeal Diseases; Laryngeal Muscles; Mucous Membrane; Vocal Cords
PubMed: 31899029
DOI: 10.1016/j.jvoice.2019.12.006 -
Muscle & Nerve Jul 2021Temporary vocal fold injection (VFI) is a common treatment for acute and subacute vocal fold paralysis (VFP). Laryngeal electromyography (LEMG) is useful for diagnosing...
INTRODUCTION/AIMS
Temporary vocal fold injection (VFI) is a common treatment for acute and subacute vocal fold paralysis (VFP). Laryngeal electromyography (LEMG) is useful for diagnosing neurogenic causes of VFP. This study evaluated whether the presence of VFI material prevents interpretation of LEMG in patients with acute and subacute VFP.
METHODS
Patients with acute and subacute unilateral VFP (onset ≤6 mo) who underwent temporary VFI within 3 mo preceding LEMG were evaluated. A matched control group that did not undergo VFI was also studied. The LEMG team (laryngologist and electromyographer) performed and interpreted LEMG using a pre-specified protocol, including qualitative and quantitative motor unit analysis.
RESULTS
Eighteen patients with VFI underwent LEMG successfully with interpretation of spontaneous activity and motor unit recruitment. Fourteen patients were seen in follow-up to determine accuracy of established LEMG prognosis. Seven of seven subjects with poor LEMG prognosis did not recover vocal fold motion. Five of seven subjects with fair LEMG prognosis recovered vocal fold motion. Findings were similar for the control group.
DISCUSSION
VFI augmentation material did not prevent interpretation of meaningful LEMG data in patients with acute and subacute VFP, and accurate prognoses of vocal fold motion recovery were established.
Topics: Adult; Aged; Cellulase; Electromyography; Female; Humans; Larynx; Male; Middle Aged; Vocal Cord Paralysis; Vocal Cords; Young Adult
PubMed: 33961288
DOI: 10.1002/mus.27262 -
Clinical Otolaryngology : Official... Jul 2022We aimed to evaluate the reliability of laryngoscopic features of vocal fold atrophy as assessed by novice otolaryngology trainees and expert laryngologists.
OBJECTIVES
We aimed to evaluate the reliability of laryngoscopic features of vocal fold atrophy as assessed by novice otolaryngology trainees and expert laryngologists.
DESIGN
Two expert fellowship-trained laryngologists and three non-expert otolaryngology resident trainees were recruited to view 50 anonymised laryngo-stroboscopic examinations of patients presenting with dysphonia and non-voice, laryngeal complaints. Reviewers were asked to stratify the patient's age, provide an opinion about the presence of age-related vocal fold atrophy and specify which laryngoscopy features were present to make the diagnosis.
SETTING
Tertiary care laryngology practice.
PARTICIPANTS
Two fellowship-trained laryngologists and three trainee otolaryngologists.
MAIN OUTCOME MEASURES
Accuracy of age categorisation was determined and Kappa analysis was performed to assess inter-rater agreement.
RESULTS
The mean age of patients was 54.9 years old with near equal male to female distribution. The overall accuracy of age category determination by raters was only 30.8%. Kappa analysis demonstrated fair agreement regarding the presence of vocal fold atrophy in non-expert reviewers, and moderate agreement amongst expert reviewers. Features of glottic gap, muscular atrophy of vocal folds and prominent vocal processes were all identified with high agreement (>80.0%).
CONCLUSION
Our study illustrates that while raters can agree on the presence of age-related vocal fold atrophy, the findings may be non-specific and do not necessarily correlate with age.
Topics: Atrophy; Female; Humans; Laryngoscopy; Male; Middle Aged; Reproducibility of Results; Vocal Cord Paralysis; Vocal Cords
PubMed: 35397140
DOI: 10.1111/coa.13936 -
Otolaryngology--head and Neck Surgery :... Feb 2023The objective of this study is to describe an in vivo rabbit phonation model for glottic insufficiency that is simple and reproducible by means of unilateral...
OBJECTIVE
The objective of this study is to describe an in vivo rabbit phonation model for glottic insufficiency that is simple and reproducible by means of unilateral transcricothyroid laryngeal muscle stimulation and high-speed video recordings of evoked phonation.
STUDY DESIGN
Nonrandomized controlled animal trial.
SETTING
Academic medical center.
METHODS
A single operation including evoked phonation with bilateral and unilateral transcricothyroid laryngeal muscle stimulation conditions was modeled using 6 New Zealand white rabbits. The effect of stimulation method on glottic cycle, pitch, and loudness was compared. Endoscopic recordings using 5000 frames-per-second image capture technology and audiologic recordings were obtained for all phonation conditions. Primary outcome measures included means of maximum glottal area (MGA)/length pixel ratio, right and left amplitude/length pixel ratios, calculated cycle frequency, auditory recorded frequency, and maximum auditory intensity. Measurements were obtained via pixel counts using ImageJ.
RESULTS
Mean MGA/length was significantly greater with unilateral, 20.30, vs bilateral, 9.62, stimulation (P = .043). Mean frequency of 479.92 Hz vs 683.46 Hz (P = .027) and mean maximum intensity of 76.3 dB vs 83.5 dB (P = .013) were significantly increased from unilateral to bilateral stimulation. There was no significant difference in mean right amplitude/length between unilateral and bilateral.
CONCLUSION
The described model demonstrates a simple and reproducible means of producing glottic insufficiency due to unilateral vocal fold bowing and represents a pathway for better understanding the biomechanics and pathophysiology of glottic insufficiency due to superior laryngeal nerve injury and vocal fold immobility and offers the potential to compare treatment modalities through in vivo study.
Topics: Animals; Rabbits; Dysphonia; Glottis; Laryngeal Muscles; Phonation; Vocal Cords
PubMed: 35763368
DOI: 10.1177/01945998221107813 -
Turk Patoloji Dergisi 2020Myxomas are rare in the vocal cords. A 69-year-old man was admitted with one-year history of progressive dysphonia. Laryngoscopy revealed a polypoid mass on the right... (Review)
Review
Myxomas are rare in the vocal cords. A 69-year-old man was admitted with one-year history of progressive dysphonia. Laryngoscopy revealed a polypoid mass on the right vocal cord. The diagnosis was cellular myxoma. A review of the literature including the present case revealed eleven reported cases of myxoma. Ten cases were classic myxoma. To the best of our knowledge, cellular myxoma has not been previously reported in the vocal cord. Hypercellularity does not affect the behavior of cellular myxoma. However, its recognition is important to prevent confusion with the group of low-grade myxoid sarcomas. Cellular myxoma should be considered in the differential diagnosis of any vocal cord mass.
Topics: Aged; Humans; Laryngeal Neoplasms; Male; Myxoma; Treatment Outcome; Vocal Cords
PubMed: 29235612
DOI: 10.5146/tjpath.2017.01417 -
Head & Neck Sep 2023The objective of this study was to assess the performance and application of a self-developed deep learning (DL) algorithm for the real-time localization and...
BACKGROUND
The objective of this study was to assess the performance and application of a self-developed deep learning (DL) algorithm for the real-time localization and classification of both vocal cord carcinoma and benign vocal cord lesions.
METHODS
The algorithm was trained and validated upon a dataset of videos and photos collected from our own department, as well as an open-access dataset named "Laryngoscope8".
RESULTS
The algorithm correctly localizes and classifies vocal cord carcinoma on still images with a sensitivity between 71% and 78% and benign vocal cord lesions with a sensitivity between 70% and 82%. Furthermore, the best algorithm had an average frame per second rate of 63, thus making it suitable to use in an outpatient clinic setting for real-time detection of laryngeal pathology.
CONCLUSION
We have demonstrated that our developed DL algorithm is able to localize and classify benign and malignant laryngeal pathology during endoscopy.
Topics: Humans; Laryngoscopy; Artificial Intelligence; Endoscopy; Larynx; Laryngeal Neoplasms; Vocal Cords; Endoscopy, Gastrointestinal; Carcinoma
PubMed: 37377069
DOI: 10.1002/hed.27441 -
Acta Cirurgica Brasileira 2022To present a detailed, reproducible, cost-efficient surgical model for controlled subepithelial endoscopic vocal fold injury in the rat model.
PURPOSE
To present a detailed, reproducible, cost-efficient surgical model for controlled subepithelial endoscopic vocal fold injury in the rat model.
METHODS
Six male Sprague Dawley rats were enrolled in the experiment. The left vocal folds were used to carry out the injury model, and the right vocal fold served as control. After deep sedation, the rats were placed on a custom operating platform. The vocal fold injury by subepithelial stripping was carried out using custom-made microsurgical instruments under endoscopic guidance. Data were analyzed for procedural time and post-procedural pain. Microcomputed tomography (micro-CT) scan and histologic images were obtained to assess the length, area, and depth of injury to the vocal fold.
RESULTS
The mean procedural time was 112 s. The mean control vocal fold length was 0.96 ± 0.04 mm. The mean vocal fold injury length was 0.53 ± 0.04 mm. The mean vocal fold surface was 0.18 ± 0.01 mm2 with a mean lesion area of 0.05 ± 0.00 mm2. Mean vocal fold injury depth was 375.4 ± 42.8 μm. The lesion length to vocal fold length ratio was 0.55 ± 0.03, as well as lesion area to vocal fold surface area was 0.29 ± 0.02.
CONCLUSIONS
Our described experimental vocal fold injury model in rats is found to be fast, safe, cost-efficient, and reproducible with a rapid learning curve.
Topics: Animals; Endoscopy; Male; Models, Theoretical; Rats; Rats, Sprague-Dawley; Vocal Cords; X-Ray Microtomography
PubMed: 35416860
DOI: 10.1590/acb370106