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Chest Dec 2002To determine whether methacholine challenge testing (MCT) provokes vocal cord dysfunction (VCD), as evidenced by inspiratory vocal cord closure on direct laryngoscopy,... (Clinical Trial)
Clinical Trial
STUDY OBJECTIVES
To determine whether methacholine challenge testing (MCT) provokes vocal cord dysfunction (VCD), as evidenced by inspiratory vocal cord closure on direct laryngoscopy, and whether spirometry and flow-volume loops (FVLs) demonstrate any changes that are suggestive of VCD.
DESIGN
Prospective, controlled study.
SETTING
Army medical center.
PATIENTS
Thirty-four subjects all with normal baseline spirometry. Ten subjects had documented evidence of VCD, 12 subjects had exercise-induced asthma (EIA) and reactive MCT, and 12 subjects served as healthy asymptomatic control subjects.
METHODS
Measurement of spirometry with FVLs and direct laryngoscopy of the vocal cords performed immediately before and after subjects had undergone MCT.
RESULTS
Evidence of inspiratory vocal cord adduction was found in four VCD patients. Two patients had adducted vocal cords at baseline, and their conditions were unchanged after undergoing MCT. Two other patients had normal conditions at baseline and demonstrated acute inspiratory vocal cord adduction after undergoing MCT. None of the patients in the EIA or control groups had evidence of VCD at baseline or after undergoing MCT. Truncation of the inspiratory limb of the FVL after MCT was noted in five patients, which correlated with evidence of VCD in 60% of these patients. One EIA patient had truncation of the inspiratory FVL after MCT, and no changes were found in the control group. A comparison of spirometry between EIA patients and VCD patients with and without evidence of inspiratory vocal cord adduction during MCT showed no significant differences.
CONCLUSIONS
The findings suggest that MCT may cause an acute episode of vocal cord adduction and that positive results may not reflect underlying reactive airways disease. However, a flattening or truncation of the inspiratory FVL after the patient undergoes MCT is not diagnostic for the presence of inspiratory vocal cord adduction.
Topics: Adolescent; Adult; Aged; Asthma, Exercise-Induced; Female; Humans; Laryngeal Diseases; Laryngoscopy; Male; Methacholine Chloride; Prospective Studies; Spirometry; Vocal Cords
PubMed: 12475837
DOI: 10.1378/chest.122.6.1988 -
Otolaryngology--head and Neck Surgery :... Apr 2024Accurate vocal cord leukoplakia classification is instructive for clinical diagnosis and surgical treatment. This article introduces a reliable very deep Siamese network...
OBJECTIVE
Accurate vocal cord leukoplakia classification is instructive for clinical diagnosis and surgical treatment. This article introduces a reliable very deep Siamese network for accurate vocal cord leukoplakia classification.
STUDY DESIGN
A study of a classification network based on a retrospective database.
SETTING
Academic university and hospital.
METHODS
The white light image datasets of vocal cord leukoplakia used in this article were classified into 6 classes: normal tissues, inflammatory keratosis, mild dysplasia, moderate dysplasia, severe dysplasia, and squamous cell carcinoma. The classification performance was assessed by comparing it with 6 classical deep learning models, including AlexNet, VGG Net, Google Inception, ResNet, DenseNet, and Vision Transformer.
RESULTS
Experiments show the superior classification performance of our proposed network compared to state-of-the-art methods. The overall accuracy is 0.9756. The values of sensitivity and specificity are very high as well. The confusion matrix provides information for the 6-class classification task and demonstrates the superiority of our proposed network.
CONCLUSION
Our very deep Siamese network can provide accurate classification results of vocal cord leukoplakia, which facilitates early detection, clinical diagnosis, and surgical treatment. The excellent performance obtained in white light images can reduce the cost for patients, especially those living in developing countries.
Topics: Humans; Vocal Cords; Retrospective Studies; Narrow Band Imaging; Laryngeal Diseases; Endoscopy; Leukoplakia; Hyperplasia
PubMed: 38037413
DOI: 10.1002/ohn.591 -
Radiotherapy and Oncology : Journal of... Aug 1990
Topics: Humans; Laryngeal Neoplasms; Movement; Neoplasm Invasiveness; Neoplasm Staging; Vocal Cords
PubMed: 2244023
DOI: 10.1016/0167-8140(90)90117-f -
The Journal of the Association of... May 2002Vocal cord dysfunction (VCD) is a relatively rare condition that may mimic asthma or upper airway obstruction. In contrast to initial reports, recent work emphasizes... (Review)
Review
Vocal cord dysfunction (VCD) is a relatively rare condition that may mimic asthma or upper airway obstruction. In contrast to initial reports, recent work emphasizes that patients with VCD often may have both asthma and VCD concurrently. VCD presents a formidable diagnostic challenge. Spirometry often gives variable results. The diagnosis is confirmed at direct laryngoscopy by observing abnormal vocal cord movements without other pathologic processes. Therapy of VCD involves removal of unnecessary medications, efforts to minimize vocal cord irritation, and aggressive speech therapy. In selected cases, anxiolytic medications and psychiatric consultation may be beneficial.
Topics: Asthma; Diagnosis, Differential; Humans; Laryngeal Diseases; Speech Therapy; Spirometry; Vocal Cords
PubMed: 12186132
DOI: No ID Found -
The Laryngoscope May 1992Since 1987, the authors have used a new technique for the augmentation and medialization of the paralyzed vocal cord. Eleven patients with paralyzed vocal cords and one...
Since 1987, the authors have used a new technique for the augmentation and medialization of the paralyzed vocal cord. Eleven patients with paralyzed vocal cords and one patient with a surgical defect of the vocal cord have been treated with intracordal injections of autogenous fat harvested by suction from the abdominal wall. Treatment efficacy was evaluated by both subjective and objective (videostroboscopic) analyses. Patient follow-up has ranged from 5 to 42 months. All patients showed significant improvement in voice characteristics. Marked reduction in air flow and increased vocal intensity were observed. Correction of glottic insufficiency has been lasting, indicating that the implanted fat cells are viable. At this time, there has been no evidence of loss of vocal cord substance. The natural qualities of autogenous fat appear to make it an excellent alternative to Teflon or collagen. The fat is readily available, and easily harvested and injected. A larger patient population and longer follow-up periods will help determine if these initial findings are consistent.
Topics: Adipose Tissue; Adult; Aged; Female; Follow-Up Studies; Glottis; Humans; Laryngoscopy; Male; Middle Aged; Phonation; Time Factors; Video Recording; Vocal Cord Paralysis; Vocal Cords; Voice
PubMed: 1573944
DOI: 10.1288/00005537-199205000-00005 -
American Journal of Respiratory and... Jul 2011Upper airway dysfunction may complicate asthma but has been largely ignored as an etiological factor. Diagnosis using endoscopic evaluation of vocal cord function is...
RATIONALE
Upper airway dysfunction may complicate asthma but has been largely ignored as an etiological factor. Diagnosis using endoscopic evaluation of vocal cord function is difficult to quantify, with limited clinical application.
OBJECTIVES
A novel imaging technique, dynamic 320-slice computerized tomography (CT), was used to examine laryngeal behavior in healthy individuals and individuals with asthma.
METHODS
Vocal cord movement was imaged using 320-slice CT larynx. Healthy volunteers were studied to develop and validate an analysis algorithm for quantification of normal vocal cord function. Further studies were then conducted in 46 patients with difficult-to-treat asthma.
MEASUREMENTS AND MAIN RESULTS
Vocal cord movement was quantified over the breathing cycle by CT using the ratio of vocal cord diameter to tracheal diameter. Normal limits were calculated, validated, and applied to evaluate difficult-to-treat asthma. Vocal cord movement was abnormal with excessive narrowing in 23 of 46 (50%) patients with asthma and severe in 9 (19%) patients (abnormal > 50% of inspiration or expiration time). Imaging also revealed that laryngeal dysfunction characterized the movement abnormality rather than isolated vocal cord dysfunction.
CONCLUSIONS
Noninvasive quantification of laryngeal movement was achieved using CT larynx. Significant numbers of patients with difficult-to-treat asthma had excessive narrowing of the vocal cords. This new approach has identified frequent upper airway dysfunction in asthma with potential implications for disease control and treatment.
Topics: Adolescent; Adult; Aged; Asthma; Female; Humans; Image Processing, Computer-Assisted; Laryngoscopy; Larynx; Male; Middle Aged; Tomography, X-Ray Computed; Vocal Cords; Young Adult
PubMed: 21471099
DOI: 10.1164/rccm.201010-1604OC -
World Journal of Surgery Oct 2012Preoperative detection of vocal cord palsy is important in thyroid and parathyroid surgery. However, routine fiberoptic laryngoscopy may bring patients unnecessary...
BACKGROUND
Preoperative detection of vocal cord palsy is important in thyroid and parathyroid surgery. However, routine fiberoptic laryngoscopy may bring patients unnecessary discomfort. The aim of this study was to determine the feasibility of using surgeon-performed ultrasonography (US) as a screening tool for preoperative assessment of vocal cord movement.
METHODS
In the first phase, patients had both laryngoscopic and US examination before surgery. In the second phase, patients had US evaluation first. Those with abnormal vocal cord movement on US, with invisible cord movement, or presenting with significant vocal symptoms underwent laryngeal examination.
RESULTS
In all, 93 (82 %) of 114 patients had successful US evaluation of vocal cord movement during the first phase. Two of them had vocal cord paralysis. In the second phase, vocal cord movement could be evaluated by US in 349 (84 %) of 415 patients. Four patients with abnormal movement were confirmed to have vocal cord palsy by laryngoscopy. None of 46 symptomatic patients with normal movement on US had vocal cord palsy. One other patient whose cord movement could not be seen by US had vocal cord palsy on laryngoscopic examination.
CONCLUSIONS
Surgeon-performed US appears to be a relatively accurate method for assessing vocal cord movement in the preoperative setting. It can be used to select patients to undergo laryngoscopic examination before thyroidectomy and parathyroidectomy.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Feasibility Studies; Female; Humans; Male; Middle Aged; Movement; Parathyroidectomy; Preoperative Care; Prospective Studies; Thyroidectomy; Ultrasonography; Vocal Cords; Young Adult
PubMed: 22689020
DOI: 10.1007/s00268-012-1674-1 -
Effects of phenytoin injection on vocal cord healing after mechanical trauma: An experimental study.Turkish Journal of Medical Sciences Oct 2019Phenytoin is an anticonvulsant drug which causes fibroblast proliferation, collagen synthesis, and an increase in epidermal growth factor. Therefore, the aim of the...
BACKGROUND/AIM
Phenytoin is an anticonvulsant drug which causes fibroblast proliferation, collagen synthesis, and an increase in epidermal growth factor. Therefore, the aim of the present study is to evaluate the effect of phenytoin injection on the wound healing process in rats with vocal cord injury by histopathological methods.
MATERIALS AND METHODS
The vocal cords of 10 albino Wistar rats were damaged bilaterally; the left vocal cord was kept as the control group. Phenytoin was injected in the right vocal cord. Ten rats were sacrificed. The thickness of the lamina propria and density of the fibroblast and collagen were evaluated histopathologically.
RESULTS
Thickness of the lamina propria was 18.0 ± 7.1 μm in the control group, 65.5 ± 10.7 μm in the phenytoin group. The density of fibroblast and collagen were statistically lower in the control group compared the phenytoin group (P < 0.05).
CONCLUSION
Phenytoin injection in rats after vocal cord injury significantly increased the thickness of the lamina propria and density of fibroblast and regular and mature collagen in the lamina propria. The findings in our study provide a feasible scientific view for adding phenytoin treatment to vocal cord surgeries in otolaryngology practice, but further studies are needed in order to evaluate the use of phenytoin in preventing the formation of scar tissue and possible effects on vocal cord vibration in humans after vocal cord injury.
Topics: Animals; Injections, Intralesional; Phenytoin; Rats; Rats, Wistar; Vocal Cords; Wound Healing; Wounds and Injuries
PubMed: 31652040
DOI: 10.3906/sag-1903-63 -
The Laryngoscope Jul 2019Acquired laryngotracheal stenosis is a potentially life-threatening situation and a very difficult and challenging problem in laryngology. Therefore, new trends and...
OBJECTIVE
Acquired laryngotracheal stenosis is a potentially life-threatening situation and a very difficult and challenging problem in laryngology. Therefore, new trends and innovative approaches based on antifibrotic drugs and minimally invasive regimens are being developed to attenuate laryngotracheal fibrosis and scarring. The purpose of this study was to examine the efficacy of mitomycin-C (MMC) to reverse the transforming growth factor (TGF)-β-induced differentiation of MRC-5 fibroblast and human primary vocal cord fibroblasts to reveal the possible applicability of MMC to laryngotracheal fibrotic conditions.
METHODS
Human primary fibroblast cells were isolated from vocal cord specimens of patients undergoing total laryngectomy. The established primary vocal cord fibroblast cell cultures as well as the MRC-5 human fibroblast cells were treated with 5 ng/mL TGF-β alone and then with 0.5 µg/mL MMC for 24 hours. Differentiation of fibroblasts was characterized by α-smooth muscle actin (α-SMA) immunhistochemistry, Western blot analysis, and real-time polymerase chain reaction. Cell motility was assessed by wound-healing assay.
RESULTS
Elevated α-SMA mRNA and protein expression as well as increased cell motility were observed upon TGF-β exposures. However, after MMC treatments the TGF-β-induced fibroblasts exhibited a significant decrease in α-SMA expression and wound-healing activity. Therefore, TGF-β-stimulated fibroblast-myofibroblast transformation was reversed at least in part by MMC treatment. Histopathological examinations of tissue specimens of a laryngotracheal stenosis patient supported these findings.
CONCLUSION
Antifibrotic effects of MMC were demonstrated on the human MRC-5 cell line and on primary vocal cord fibroblast cultures. These results verify that MMC can be used with success to reverse upper airway stenosis by reverting the myofibroblast phenotype.
LEVEL OF EVIDENCE
NA Laryngoscope, 129:E255-E262, 2019.
Topics: Actins; Cell Culture Techniques; Cell Line; Fibroblasts; Fibrosis; Humans; Laryngectomy; Mitomycin; Transforming Growth Factor beta; Vocal Cords; Wound Healing
PubMed: 30618152
DOI: 10.1002/lary.27657 -
Thorax Apr 2002
Topics: Autonomic Nervous System Diseases; Humans; Laryngeal Diseases; Respiration Disorders; Vagus Nerve Diseases; Vocal Cords
PubMed: 11923544
DOI: 10.1136/thorax.57.4.284