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A&A Practice Oct 2020Vagus nerve injury may complicate carotid endarterectomy (CEA). The recurrent laryngeal nerve (RLN) branches from the vagus nerve, innervating the ipsilateral vocal...
Vagus nerve injury may complicate carotid endarterectomy (CEA). The recurrent laryngeal nerve (RLN) branches from the vagus nerve, innervating the ipsilateral vocal cord. Vagus nerve injury can cause vocal cord dysfunction. Intraoperative vocal cord monitoring can detect vagus nerve injury during CEA. A patient with distorted neck anatomy from radiotherapy to treat oropharyngeal cancer and resultant right vocal cord paralysis required left CEA. Anticipating difficult neck dissection risking vagus nerve damage with associate RLN malfunction, we added vocal cord electromyography (EMG) to routine CEA electroencephalography (EEG). We recommend vocal cord EMG in anatomically complex CEA to avoid vagus nerve injury.
Topics: Endarterectomy, Carotid; Humans; Recurrent Laryngeal Nerve; Recurrent Laryngeal Nerve Injuries; Vocal Cord Paralysis; Vocal Cords
PubMed: 33094950
DOI: 10.1213/XAA.0000000000001331 -
The Annals of Otology, Rhinology, and... 1986Vocal cord paralysis in children is an uncommon but often disabling problem. It may be congenital or acquired either in the immediate period surrounding birth or as a...
Vocal cord paralysis in children is an uncommon but often disabling problem. It may be congenital or acquired either in the immediate period surrounding birth or as a postpartum event. Because even unilateral vocal cord paralysis can result in severe respiratory distress in the newborn and in small children, recognition of this problem can be critical. A logical approach to diagnosis and management requires not only that the physician be alert to the problem but also that several procedures be established that can be used together or singly to address the problem, as is most appropriate to the individual case. The usefulness of intubation, tracheotomy, surgical lateralization of the vocal folds, and reinnervation in the management of these problems is discussed, and 30 cases of vocal cord paralysis in children under the age of 5 years are presented.
Topics: Arytenoid Cartilage; Child, Preschool; Female; Humans; Infant; Injections; Male; Polytetrafluoroethylene; Speech Therapy; Tracheotomy; Vocal Cord Paralysis; Vocal Cords
PubMed: 3789595
DOI: 10.1177/000348948609500615 -
BMC Neurology Mar 2023Hypertrophic olivary degeneration (HOD) is a rare condition caused by lesions within the dentato-rubro-olivary pathway, resulting in ocular nystagmus and palatal...
BACKGROUND
Hypertrophic olivary degeneration (HOD) is a rare condition caused by lesions within the dentato-rubro-olivary pathway, resulting in ocular nystagmus and palatal myoclonus (oculopalatal tremor) but not usually dystonia. Dystonia is an uncommon association, and we present the first reported association of hypertrophic olivary degeneration with bilateral vocal cord dystonia.
CASE PRESENTATION
A 33 year old male presented initially with acute hydrocephalus on the background of previous ventriculoperitoneal (VP) shunting for previously treated medulloblastoma. After revision of the VP shunt, the patient developed progressive hiccups and stridor leading to respiratory failure requiring intubation. Ocular pendular nystagmus and palatal myoclonus at 3 Hz was observed. Flexible nasendoscopy (FNE) demonstrated bilateral tonic adduction of the vocal folds with 3 Hz coarse supraglottic, pharyngeal and palatal rhythmic myoclonus. MRI imaging demonstrated T2 hyperintensity within the bilateral inferior olivary nuclei consistent with stage 3 radiological HOD.
CONCLUSIONS
Dystonia is a rarely reported phenomenon in HOD but is not unexpected with the inferior olivary nucleus implicated in dystonic disorders. We report the association of HOD with bilateral vocal cord adductor dystonia, a potentially life threatening condition.
Topics: Male; Humans; Adult; Vocal Cords; Dystonia; Myoclonus; Olivary Nucleus; Dystonic Disorders; Nystagmus, Pathologic; Magnetic Resonance Imaging; Hypertrophy
PubMed: 36918827
DOI: 10.1186/s12883-023-03123-8 -
The Laryngoscope Apr 2021
Topics: Aftercare; Female; Hoarseness; Humans; Laryngoscopy; Middle Aged; Thyroid Dysgenesis; Treatment Outcome; Vocal Cords
PubMed: 32985681
DOI: 10.1002/lary.29063 -
JMIR MHealth and UHealth Jun 2021Currently, high-speed digital imaging (HSDI), especially endoscopic HSDI, is routinely used for the diagnosis of vocal cord disorders. However, endoscopic HSDI devices...
BACKGROUND
Currently, high-speed digital imaging (HSDI), especially endoscopic HSDI, is routinely used for the diagnosis of vocal cord disorders. However, endoscopic HSDI devices are usually large and costly, which limits access to patients in underdeveloped countries and in regions with inadequate medical infrastructure. Modern smartphones have sufficient functionality to process the complex calculations that are required for processing high-resolution images and videos with a high frame rate. Recently, several attempts have been made to integrate medical endoscopes with smartphones to make them more accessible to people in underdeveloped countries.
OBJECTIVE
This study aims to develop a smartphone adaptor for endoscopes, which enables smartphone-based vocal cord imaging, to demonstrate the feasibility of performing high-speed vocal cord imaging via the high-speed imaging functions of a high-performance smartphone camera, and to determine the acceptability of the smartphone-based high-speed vocal cord imaging system for clinical applications in developing countries.
METHODS
A customized smartphone adaptor optical relay was designed for clinical endoscopy using selective laser melting-based 3D printing. A standard laryngoscope was attached to the smartphone adaptor to acquire high-speed vocal cord endoscopic images. Only existing basic functions of the smartphone camera were used for HSDI of the vocal cords. Extracted still frames were observed for qualitative glottal volume and shape. For image processing, segmented glottal and vocal cord areas were calculated from whole HSDI frames to characterize the amplitude of the vibrations on each side of the glottis, including the frequency, edge length, glottal areas, base cord, and lateral phase differences over the acquisition time. The device was incorporated into a preclinical videokymography diagnosis routine to compare functionality.
RESULTS
Smartphone-based HSDI with the smartphone-endoscope adaptor could achieve 940 frames per second and a resolution of 1280 by 720 frames, which corresponds to the detection of 3 to 8 frames per vocal cycle at double the spatial resolution of existing devices. The device was used to image the vocal cords of 4 volunteers: 1 healthy individual and 3 patients with vocal cord paralysis, chronic laryngitis, or vocal cord polyps. The resultant image stacks were sufficient for most diagnostic purposes. The cost of the device including the smartphone was lower than that of existing HSDI devices. The image processing and analytics demonstrated the successful calculation of relevant diagnostic variables from the acquired images. Patients with vocal pathologies were easily differentiable in the quantitative data.
CONCLUSIONS
A smartphone-based HSDI endoscope system can function as a point-of-care clinical diagnostic device. The resulting analysis is of higher quality than that accessible by videostroboscopy and promises comparable quality and greater accessibility than HSDI. In particular, this system is suitable for use as an accessible diagnostic tool in underdeveloped areas with inadequate medical service infrastructure.
Topics: Humans; Kymography; Laryngoscopes; Pharynx; Smartphone; Vocal Cords
PubMed: 34142978
DOI: 10.2196/25816 -
Computers in Biology and Medicine Feb 2015Changes in laryngeal airflow dynamics during episodes of vocal cord dysfunction (VCD) have not been well described. Very little is known about how inspiratory airflow is...
BACKGROUND
Changes in laryngeal airflow dynamics during episodes of vocal cord dysfunction (VCD) have not been well described. Very little is known about how inspiratory airflow is impacted when the vocal cords transition from normal inhalation state to a paradoxical adducted state; and how much change in laryngeal airflow and resistance occur before symptoms of stridor and air hunger emerge. This study provides new insight on the effects of VCD on respiratory airflow using computational fluid dynamics (CFD) techniques.
METHODS
Computed tomography images of a subject with normal vocal cords opening at the time of scanning were digitally modified to mimic an episode of VCD. To quantify and compare changes in inspiratory flow during VCD attack and normal inhalation, steady-state, laminar simulations were performed for three different breathing rates.
RESULTS
Pressure-flow analysis during VCD revealed that increasing inspiratory effort is not as efficient as in normal inhalation. Airflow resistance at the epiglottis was higher in the normal state (0.04Pa.s/mL versus 0.02Pa.s/mL) than in VCD; while resistance at the glottis and trachea remained roughly the same (0.04Pa.s/mL) during normal inhalation, it escalated during VCD (0.11Pa.s/mL and 0.13Pa.s/mL at the glottis and trachea, respectively). Peak airflow velocity and vorticity occurred around the glottis during VCD, and at the epiglottis during normal inhalation.
CONCLUSIONS
This pilot study demonstrates that attempting to force more inspired air will yield greater glottal resistance during VCD. Furthermore, there were evidence of abrupt laryngeal pressure gradient, chaotic airflow and high concentration of shear stresses in the glottal region.
Topics: Adult; Biomechanical Phenomena; Computer Simulation; Humans; Hydrodynamics; Imaging, Three-Dimensional; Male; Pulmonary Ventilation; Tomography, X-Ray Computed; Vocal Cord Dysfunction; Vocal Cords
PubMed: 25546469
DOI: 10.1016/j.compbiomed.2014.12.004 -
Archives of Disease in Childhood. Fetal... Jul 2014
Topics: Equipment Design; Humans; Infant, Newborn; Intubation, Intratracheal; Vocal Cords
PubMed: 24723694
DOI: 10.1136/archdischild-2014-306028 -
Canadian Journal of Anaesthesia =... Jul 1997
Topics: Diagnosis, Differential; Humans; Laryngeal Diseases; Postoperative Complications; Respiratory Sounds; Vocal Cords
PubMed: 9232315
DOI: 10.1007/BF03013399 -
World Journal of Surgery Jan 2018Ultrasonography is a non-invasive technique that is commonly used by endocrinologists and endocrine surgeons to examine the thyroid region and could be useful for the... (Clinical Trial)
Clinical Trial
BACKGROUND
Ultrasonography is a non-invasive technique that is commonly used by endocrinologists and endocrine surgeons to examine the thyroid region and could be useful for the assessment of vocal cord movement by these specialists. However, previous studies reported a low rate of successful visualization of vocal cord movement by ultrasonography. To address this issue, we devised a novel ultrasonographic procedure for assessing vocal cord movement indirectly by observing the arytenoid movement from a lateral view.
METHODS
Subjects were 188 individuals, including 23 patients with vocal cord paralysis and 13 with vocal cord paresis. We performed ultrasonographic assessment of vocal cord movement using two different procedures: the conventional middle transverse procedure and the novel lateral vertical procedure.
RESULTS
The rate of visualization of vocal cords with the middle transverse procedure was 70.2% and that of the arytenoid cartilage with the lateral vertical procedure was 98.4%. The lateral vertical procedure enabled visualization of all patients with vocal cord paresis/paralysis and detected all 23 patients with vocal paralysis; only one of 13 patients with vocal cord paresis was positively identified. The conventional procedure enabled visualization of 21 of 36 patients with vocal cord paresis/paralysis with high accuracy. There was no false-positive case in either procedure.
CONCLUSION
The proposed lateral vertical procedure improved the rate of visualization of vocal cord movement by ultrasonography, suggesting that it is a useful technique to screen for vocal cord paralysis by ultrasonography.
Topics: Adult; Aged; Arytenoid Cartilage; Female; Humans; Male; Middle Aged; Movement; Ultrasonography; Vocal Cord Paralysis; Vocal Cords
PubMed: 28752427
DOI: 10.1007/s00268-017-4151-z -
Journal of Speech, Language, and... Oct 2014Vocal fold epithelium is composed of layers of individual epithelial cells joined by junctional complexes constituting a unique interface with the external environment.... (Review)
Review
PURPOSE
Vocal fold epithelium is composed of layers of individual epithelial cells joined by junctional complexes constituting a unique interface with the external environment. This barrier provides structural stability to the vocal folds and protects underlying connective tissue from injury while being nearly continuously exposed to potentially hazardous insults, including environmental or systemic-based irritants such as pollutants and reflux, surgical procedures, and vibratory trauma. Small disruptions in the epithelial barrier may have a large impact on susceptibility to injury and overall vocal health. The purpose of this article is to provide a broad-based review of current knowledge of the vocal fold epithelial barrier.
METHOD
A comprehensive review of the literature was conducted. Details of the structure of the vocal fold epithelial barrier are presented and evaluated in the context of function in injury and pathology. The importance of the epithelial-associated vocal fold mucus barrier is also introduced.
RESULTS/CONCLUSIONS
Information presented in this review is valuable for clinicians and researchers as it highlights the importance of this understudied portion of the vocal folds to overall vocal health and disease. Prevention and treatment of injury to the epithelial barrier is a significant area awaiting further investigation.
Topics: Air Pollutants; Animals; Aquaporins; Cell Membrane; Disease Models, Animal; Humans; Intercellular Junctions; Intraoperative Complications; Ion Transport; Irritants; Mucus; Rats; Respiratory Mucosa; Tobacco Smoke Pollution; Vibration; Vocal Cord Dysfunction; Vocal Cords
PubMed: 24686981
DOI: 10.1044/2014_JSLHR-S-13-0283