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Revue de Laryngologie - Otologie -... 1988
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Endokrynologia Polska 2020Bilateral vocal fold paralysis presents as their complete or partial immobilisation. The median or paramedian position of vocal folds contributes to the narrowing of the... (Review)
Review
Bilateral vocal fold paralysis presents as their complete or partial immobilisation. The median or paramedian position of vocal folds contributes to the narrowing of the airway at the level of the glottis and manifests as inspiratory dyspnoea. For many years iatrogenic injury of recurrent laryngeal nerves during thyroidectomy has been viewed as the most common underlying reason. It is very often a lifethreatening condition requiring not only corticosteroid administration and intubation, which only constitute a short-term symptomatic therapy, but also surgical intervention, including tracheostomy. The most common surgical methods implemented in bilateral vocal fold paralysis include posterior cordectomy, arytenoidectomy, and, more and more commonly, re-innervation. Other techniques used in restoring airway patency include laterofixation, botulinum toxin injection, and laryngeal stimulation, which is still under research. Stem cell and gene therapy are also being researched. Notably, the main purpose of surgical treatment is the provision of airway patency with the preservation of the phonatory and protective functions of the larynx.
Topics: Female; Humans; Laryngoscopy; Male; Thyroidectomy; Treatment Outcome; Vocal Cord Paralysis; Vocal Cords; Voice Quality; Voice Training
PubMed: 32852048
DOI: 10.5603/EP.a2020.0042 -
The Annals of Otology, Rhinology, and... 1977The effects of asymmetrical tension on the vibratory pattern of the vocal cords were studied in two kinds of experiments: 1) high speed motion picture photography of...
The effects of asymmetrical tension on the vibratory pattern of the vocal cords were studied in two kinds of experiments: 1) high speed motion picture photography of artificial voice production in excised canine and human larynges, and 2) computer synthesis of voice and vocal cord vibration via a theoretical model incorporating the physiological parameters required for phonation. In both approaches the asymmetrically tensed vocal cords consistently vibrated in three distinct modes which depend partly on the rest positions of the vocal cords; Type I. For rest positions at or near closure, the two cords vibrate at the same frequency with glottal closure every period, and with tense cord preceding the lax one in phase and with the line of contact moving toward the tenser cord during the closed phase. The voice produced is not hoarse; Type II. For wider rest positions glottal closure occurs irregularly, the vibrations become complex and less periodic, and the voice becomes hoarse; Type III. The glottis never closes and the vibrations become more periodic with reduced amplitude. Supplementary stroboscopic observations suggest a precedure for diagnosing tension asymmetry and the implications for surgical treatment for disorders of vocal pitch are discussed.
Topics: Animals; Computers; Dogs; Humans; Models, Biological; Motion Pictures; Vibration; Vocal Cords
PubMed: 835973
DOI: 10.1177/000348947708600109 -
PloS One 2023Oblique orientation of vocal cord demands strict compliance, by technicians and clinicians, to the recommended parallel plane CT scan of larynx. Repercussions of...
Oblique orientation of vocal cord demands strict compliance, by technicians and clinicians, to the recommended parallel plane CT scan of larynx. Repercussions of non-compliance has never been investigated before. We aimed to observe influence of non-parallel vocal cord plane CT scan on qualitative and quantitative glottic parameters, keeping parallel plane CT as a standard for comparison. Simultaneous identification of potential suboptimal imaging sequelae as a result of unformatted CT plane was also identified. In this study we included 95 normal adult glottides and retrospectively analyzed their anatomy in two axial planes, non-parallel plane ① and parallel to vocal cord plane ②. Qualitative (shape, structures at glottic level) and quantitative (anterior commissure ACom, vocal cord width VCw, anteroposterior AP, transverse Tr, cross-sectional area CSA) glottic variables were recorded. Multivariate statistical analysis was used to predict pattern and their impact on glottic anatomy. Plane ① displayed supraglottic features in glottis; adipose (90.5%) and split thyroid laminae (70.6%). Other categorical variables: atypical shape, submental structures and multilevel vertebral crossing were also in majority. All glottic dimensions varied significantly between two planes with most in ACom (-5.8mm) and CSA (-15.0 mm2). In contrast, plane ② manifested higher VCw (>73%), Tr (66.3%), CSA (64.2%) and AP (44.2%) measurements. On correlation analysis, variation in ACom, CSA, Tr was positively associated with VC or plane obliquity (p<0.05). This variability was more in obese and short necked subjects. Change in one parameter also modified other significantly i.e., ACom versus AP and CSA versus Tr. Results indicated statistically significant change in subjective and objective anatomical parameters of glottis on non-application of appropriate CT larynx protocol for image analysis hence highlighting importance of image reformation.
Topics: Adult; Humans; Vocal Cords; Retrospective Studies; Glottis; Larynx; Tomography, X-Ray Computed; Laryngeal Neoplasms
PubMed: 37903145
DOI: 10.1371/journal.pone.0293659 -
European Archives of... Feb 2017Classical understanding of the function of the pharyngeal plexus in humans is that it relies on both motor branches for innervation of the majority of pharyngeal muscles...
Classical understanding of the function of the pharyngeal plexus in humans is that it relies on both motor branches for innervation of the majority of pharyngeal muscles and sensory branches for the pharyngeal wall sensation. To date there has been no reported data on the role of the pharyngeal plexus in vocal cord innervation. The aim of this study is to evaluate whether or not the plexus pharyngeus contributes to the innervation of the vocal cords. One hundred twenty-five sides from 79 patients (59 female, 20 male) undergoing thyroid surgery with intraoperative neuromonitoring were prospectively evaluated. While vocal cord function was evaluated with endotracheal tube surface electrodes, cricothyroid and cricopharyngeal muscle electromyographic recordings were obtained with a pair of needle electrodes. The ipsilateral pharyngeal plexus, external branch of the superior laryngeal nerve, and recurrent laryngeal nerve were stimulated with a monopolar probe at 1 mA. With stimulation of the plexus pharyngeus on 125 operated sides, positive electromyographic waveforms were detected from five ipsilateral vocal cords (accounting for 3.2% of all vocal cords monitored and 6.3% of patients). The mean EMG amplitude of the vocal cords with stimulation of the plexus pharyngeus was 147 ± 35.5 μV (range 110-203). In one case, the long latency time of 19.8 ms correlated with innervation by the glottic closure reflex pathway. The short latencies seen in the other four cases [3.9 ± 1.1 ms (range 3.2-5.5)] correlated with direct innervation. In some cases, the plexus pharyngeus may contribute to vocal cord innervation by reflex or direct innervation patterns in humans.
Topics: Adult; Aged; Electromyography; Female; Humans; Laryngeal Muscles; Laryngeal Nerves; Male; Middle Aged; Pharyngeal Muscles; Prospective Studies; Recurrent Laryngeal Nerve; Vocal Cords
PubMed: 27812786
DOI: 10.1007/s00405-016-4369-7 -
Mycoses Sep 2011
Topics: Adult; Aspergillosis; Female; Histocytochemistry; Humans; Laryngoscopy; Microscopy, Electron, Scanning; Mycological Typing Techniques; Mycology; Vocal Cords
PubMed: 21535453
DOI: 10.1111/j.1439-0507.2010.01954.x -
Folia Phoniatrica 1974
Topics: Humans; Vibration; Vocal Cords
PubMed: 4845615
DOI: 10.1159/000263771 -
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 -
ANZ Journal of Surgery Dec 2001To evaluate whether grey-scale, real-time, B-mode ultrasound (US) is a reliable alternative to nasopharyngoscopy for assessing vocal cord function post-thyroid and... (Comparative Study)
Comparative Study
BACKGROUND
To evaluate whether grey-scale, real-time, B-mode ultrasound (US) is a reliable alternative to nasopharyngoscopy for assessing vocal cord function post-thyroid and post-parathyroid surgery.
METHODS
A prospective validation study was undertaken comparing grey-scale, real-time, B-mode vocal cord US with the standard of nasopharyngoscopy in 100 consecutive patients undergoing thyroid and parathyroid surgery between 1 February 1999 and 31 August 1999, with seven patients with known cord palsy. The sensitivity and specificity of grey-scale, real-time vocal cord US for the detection of vocal cord palsy when compared to the standard of nasopharyngoscopy was analysed.
RESULTS
In the postsurgical group, there were six nerves (3.2% of the nerves at risk) transient and no permanent vocal cord palsies. US identified four of six transient palsies and reported two false negatives and three false positives. US identified four of seven cord palsies in the non-surgical group with known cord palsy. Analysis of the 107 combined patients showed US had sensitivity of 62% (8/13), specificity of 97% (91/94), a positive predictive value of 73% (8/11) and a negative predictive value of 95% (91/96) for detecting cord paralysis compared to the standard of nasopharyngoscopy.
CONCLUSION
Despite the enthusiasm of earlier reports, our initial experience with grey-scale, real-time, B-mode US suggests it is not a reliable alternative to nasopharyngoscopy for assessing vocal cord function post-thyroid and post-parathyroid surgery. Further recruitment of patients with known vocal cord palsy is required to confirm or refute these initial impressions.
Topics: Female; Humans; Laryngoscopy; Male; Middle Aged; Parathyroid Diseases; Parathyroidectomy; Postoperative Care; Predictive Value of Tests; Prospective Studies; Sensitivity and Specificity; Thyroid Diseases; Thyroidectomy; Ultrasonography; Vocal Cord Paralysis; Vocal Cords
PubMed: 11906389
DOI: 10.1046/j.1445-1433.2001.02257.x -
Journal of Investigative Surgery : the... Feb 2018
Topics: Adult; Aged; Asymptomatic Diseases; Female; Humans; Laryngeal Nerve Injuries; Laryngoscopy; Male; Middle Aged; Postoperative Complications; Reproducibility of Results; Thyroidectomy; Ultrasonography; Vocal Cord Paralysis; Vocal Cords; Young Adult
PubMed: 28060566
DOI: 10.1080/08941939.2016.1269855