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Cells Nov 2020Unilateral vocal fold paralysis (UVFP) is a common disorder that may cause glottal closure insufficiency and then hoarseness of voice and aspiration during swallowing.... (Meta-Analysis)
Meta-Analysis
Unilateral vocal fold paralysis (UVFP) is a common disorder that may cause glottal closure insufficiency and then hoarseness of voice and aspiration during swallowing. We conducted a systematic review and meta-analysis to evaluate whether hyaluronic acid (HA) injection laryngoplasty (IL) is an effective treatment for patients with UVFP. Comprehensive systematic searches were undertaken using PubMed, EBSCO Medline, and Cochrane Library databases. We appraised the quality of studies according to preset inclusion and exclusion criteria. The lengths of follow-up were divided into "short-term" (3 months or shorter), "medium-term" (6 months), and "long-term" (12 months or longer). We performed random-effect meta-analysis to estimate the changes in voice-related quality of life, perceptual evaluation by grading systems, voice lab analysis of maximal phonation time, and normalized glottal gap area, before and after HA IL. Fourteen studies were eligible for the final analysis. The results showed that patients' glottal closure insufficiency could be improved; maximal phonation time could be prolonged; perceptual evaluations of the voice and quality of life were better after HA IL, but the duration of treatment effect varied among different studies. In conclusion, HA IL is an effective treatment for UVFP, which may achieve a long-term effect and therefore reduce the likelihood of requiring permanent medialization thyroplasty.
Topics: Humans; Hyaluronic Acid; Injections; Laryngoplasty; Surveys and Questionnaires; Vocal Cord Paralysis; Vocal Cords
PubMed: 33167303
DOI: 10.3390/cells9112417 -
AJNR. American Journal of Neuroradiology Sep 2016Altered communication (hoarseness, dysphonia, and breathy voice) that can result from vocal fold paralysis, secondary to numerous etiologies, may be amenable to surgical... (Review)
Review
Altered communication (hoarseness, dysphonia, and breathy voice) that can result from vocal fold paralysis, secondary to numerous etiologies, may be amenable to surgical restoration. In this article, both traditional and cutting-edge phonosurgical procedures targeting the symptoms resulting from vocal fold paralysis are reviewed, with emphasis on the characteristic imaging appearances of various injectable materials, implants, and augmentation procedures used in the treatment of vocal fold paralysis. In addition, complications of injection laryngoplasty and medialization laryngoplasty are illustrated. Familiarity with the expected imaging changes following treatment of vocal fold paralysis may prevent the misinterpretation of posttreatment changes as pathology. Identifying common complications related to injection laryngoplasty and localization of displaced implants is crucial in determining specific management in patients who have undergone phonosurgical procedures for the management of vocal fold paralysis.
Topics: Diagnostic Imaging; Female; Humans; Laryngoplasty; Male; Middle Aged; Prostheses and Implants; Retrospective Studies; Treatment Outcome; Vocal Cord Paralysis
PubMed: 27173367
DOI: 10.3174/ajnr.A4781 -
Frontiers in Endocrinology 2021A recurrent laryngeal nerve (RLN) injury resulting in vocal fold paralysis and dysphonia remains a major source of morbidity after thyroid and parathyroid surgeries.... (Review)
Review
A recurrent laryngeal nerve (RLN) injury resulting in vocal fold paralysis and dysphonia remains a major source of morbidity after thyroid and parathyroid surgeries. Intraoperative neural monitoring (IONM) is increasingly accepted as an adjunct to the standard practice of visual RLN identification. Endotracheal tube (ET) surface recording electrode systems are now widely used for IONM; however, the major limitation of the clinical use of ET-based surface electrodes is the need to maintain constant contact between the electrodes and vocal folds during surgery to obtain a high-quality recording. An ET that is malpositioned during intubation or displaced during surgical manipulation can cause a false decrease or loss of electromyography (EMG) signal. Since it may be difficult to distinguish from an EMG change caused by a true RLN injury, a false loss or decrease in EMG signal may contribute to inappropriate surgical decision making. Therefore, researchers have investigated alternative electrode systems that circumvent common causes of poor accuracy in ET-based neuromonitoring. Recent experimental and clinical studies have confirmed the hypothesis that needle or adhesive surface recording electrodes attached to the thyroid cartilage (transcartilage and percutaneous recording) or attached to the overlying neck skin (transcutaneous recording) can provide functionality similar to that of ET-based electrodes, and these recording methods enable access to the EMG response of the vocalis muscle that originates from the inner surface of the thyroid cartilage. Studies also indicate that, during surgical manipulation of the trachea, transcartilage, percutaneous, and transcutaneous anterior laryngeal (AL) recording electrodes could be more stable than ET-based surface electrodes and could be equally accurate in depicting RLN stress during IONM. These findings show that these AL electrodes have potential applications in future designs of recording electrodes and support the use of IONM as a high-quality quantitative tool in thyroid and parathyroid surgery. This article reviews the major recent developments of newly emerging transcartilage, percutaneous, and transcutaneous AL recording techniques used in IONM and evaluates their contribution to improved voice outcomes in modern thyroid surgery.
Topics: Electromyography; Humans; Intraoperative Neurophysiological Monitoring; Laryngeal Nerves; Parathyroid Glands; Recurrent Laryngeal Nerve Injuries; Thyroid Gland; Vocal Cord Paralysis; Voice
PubMed: 34777256
DOI: 10.3389/fendo.2021.763170 -
JAMA Otolaryngology-- Head & Neck... Jan 2023Vagus nerve stimulation (VNS) devices have gained widespread acceptance for treatment of resistant epilepsy and depression. The increasing number of procedures has...
IMPORTANCE
Vagus nerve stimulation (VNS) devices have gained widespread acceptance for treatment of resistant epilepsy and depression. The increasing number of procedures has resulted in an increasing number of iatrogenic injuries to the vagus nerve, which can have a significant effect on vocalization and quality of life.
OBJECTIVE
To determine the relative frequency of laryngeal adverse effects reported to the US Food and Drug Administration (FDA) after VNS implantation and to analyze associated VNS device problems.
DESIGN, SETTING, AND PARTICIPANTS
This retrospective cross-sectional analysis queried the FDA Manufacturer and User Facility Device Experience database of adverse events in the US between 1996 and 2020.
MAIN OUTCOMES AND MEASURES
The primary outcome was the percent of adverse events reported to the FDA that included patients who received VNS with laryngeal adverse effects and the associated proportion of device problems after VNS surgery.
RESULTS
A total of 12 725 iatrogenic vagus nerve issues were documented after VNS implantation, with apnea (n = 395; 3.1%) being the most common patient problem. Overall, 187 reports of laryngeal adverse effects associated with VNS devices were identified and represented the eighth most common iatrogenic vagus nerve problem reported to the FDA. Laryngeal adverse effects included 78 reports of voice alteration and 57 reports of paresis/paralysis. The VNS device problems frequently associated with laryngeal adverse effects were high impedance (n = 15, 8.02%), incorrect frequency delivery (n = 10, 5.35%), and battery problems (n = 11, 5.88%). The number of laryngeal adverse effect reports per year peaked in 2012 with 43 cases.
CONCLUSIONS AND RELEVANCE
This cross-sectional study found that although the literature demonstrates that vocal changes occur with nearly all VNS devices, the FDA receives adverse event reports of voice changes. Our results emphasize a potential need to improve patient counseling prior to VNS surgery to better set patient expectations regarding vocal changes and to prevent unnecessary patient concern. In addition, reports of vocal fold paresis/paralysis potentially suggest that patients may benefit from preoperative laryngeal assessment to differentiate preexisting vocal fold paralysis from that caused by VNS surgery.
Topics: Humans; Vagus Nerve Stimulation; Cross-Sectional Studies; Quality of Life; Retrospective Studies; Vocal Cord Paralysis; Vagus Nerve; Otolaryngology; Treatment Outcome
PubMed: 36416861
DOI: 10.1001/jamaoto.2022.3699 -
Brazilian Journal of Anesthesiology... 2018General anesthesia is a safe, frequent procedure in clinical practice. Although it is very unusual in procedures not related to head and or neck surgery, vocal cord... (Review)
Review
BACKGROUND
General anesthesia is a safe, frequent procedure in clinical practice. Although it is very unusual in procedures not related to head and or neck surgery, vocal cord paralysis is a serious and important complication. Incidence has been associated with patient age and comorbidities, as well as the position of the endotracheal tube and cuff. It can become a dangerous scenario because it predisposes aspiration.
OBJECTIVES
To present a case and analyze the risk factors associated with increased risk of vocal cord paralysis described in the literature.
CASE REPORT
53 year-old diabetic man, who developed hoarseness in the postoperative period after receiving general anesthesia for an elective abdominal laparoscopic surgery. Otolaryngological evaluation showed left vocal cord paralysis.
CONCLUSIONS
Vocal cord paralysis can be a serious complication of general anesthesia because of important voice dysfunction and risk of aspiration. The management is not yet fully established, so prevention and early diagnosis is essential.
Topics: Anesthesia, General; Humans; Intubation, Intratracheal; Male; Middle Aged; Risk Factors; Vocal Cord Paralysis
PubMed: 29628155
DOI: 10.1016/j.bjan.2017.12.011 -
The Medical Journal of Malaysia Dec 2006Congenital upper airway obstruction is a relatively rare but important cause of major respiratory problems in the neonatal period. Vocal cord paralysis is the second...
Congenital upper airway obstruction is a relatively rare but important cause of major respiratory problems in the neonatal period. Vocal cord paralysis is the second most common cause of congenital airway obstruction presenting with neonatal stridor. It is often the reason for the failure of neonates to wean from the respiratory support. A retrospective analysis of medical record review was conducted. There were seven paediatric patients diagnosed with bilateral vocal fold paralysis in the past three years, of which five were recently diagnosed. All patients underwent flexible with/without rigid bronchoscopes to confirm the diagnosis. This case series highlight our experience in managing the problem of bilateral vocal cord paralysis in the paediatric population, with particular emphasis on their clinical presentations, associated complications and both upper and lower airway abnormalities. The management options and outcome of these patients will also be discussed.
Topics: Airway Obstruction; Female; Humans; Infant; Infant, Newborn; Male; Retrospective Studies; Tracheotomy; Treatment Outcome; Vocal Cord Paralysis; Vocal Cords
PubMed: 17623966
DOI: No ID Found -
Brazilian Journal of Cardiovascular... Dec 2020To give an overview of the Ortner's syndrome caused by an aortic arch aneurysm. (Review)
Review
OBJECTIVE
To give an overview of the Ortner's syndrome caused by an aortic arch aneurysm.
METHODS
By comprehensive retrieval of the pertinent literature published in the past two decades, 75 reports including 86 patients were collected and recruited into this study along with a recent case of our own.
RESULTS
The aortic arch aneurysms causing hoarseness were most commonly mycotic aneurysms. In this patient setting, in addition to the left recurrent laryngeal nerve, trachea was the most commonly affected structure by the aortic arch aneurysm. Surgical/interventional/hybrid treatments led to a hoarseness-relieving rate of 64.3%, much higher than that of patients receiving conservative treatment. However, hoarseness recovery took longer time in the surgically treated patients than in the interventionally treated patients.
CONCLUSION
The surgical and interventional treatments offered similar hoarseness-relieving effects. Surgical or interventional treatment is warranted in such patients for both treatment of arch aneurysms and relief of hoarseness.
Topics: Aorta, Thoracic; Aortic Aneurysm; Hoarseness; Humans; Syndrome; Vocal Cord Paralysis
PubMed: 33306323
DOI: 10.21470/1678-9741-2019-0352 -
Otolaryngology--head and Neck Surgery :... Feb 2021To examine and compare the outcomes of various types of glottic widening surgery (GWS) for initial management of bilateral vocal fold paralysis (BVFP) in children, the... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To examine and compare the outcomes of various types of glottic widening surgery (GWS) for initial management of bilateral vocal fold paralysis (BVFP) in children, the outcomes of different GWS procedures in children who underwent initial tracheostomy, and the rate of decannulation in children who underwent tracheostomy alone versus tracheostomy followed by GWS.
DATA SOURCES
PubMed, Web of Science, Cochrane Library, and Embase were searched following the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses) on September 9, 2019, with no date restriction.
REVIEW METHODS
Articles focusing on GWS or tracheostomy for initial management of BVFP were included. Articles describing patients who received no surgical intervention for BVFP were excluded.
RESULTS
A total of 5989 articles were reviewed: 67 articles met inclusion criteria, and 240 patients were incorporated into the analysis. Patients who underwent primary GWS had an eventual tracheostomy rate of 6.0% (5/83). There were no statistically significant differences in the rate of tracheostomy, reoperation, or mortality among cricoid split, suture lateralization, and cordectomy/cordotomy. Patients who underwent primary tracheostomy failed to achieve decannulation in 36.9% (58/157) of cases. Decannulation was more likely in tracheostomized children who received GWS than those who did not (odds ratio, 6.336; < .0001).
CONCLUSIONS
Most children who undergo primary GWS for BVFP avoid tracheostomy or reoperation. These data demonstrated no differences in surgical outcomes among the most common types of GWS for BVFP. For children who receive a tracheostomy as their first intervention for BVFP, GWS is associated with a significantly improved rate of decannulation.
Topics: Child; Humans; Laryngoscopy; Vocal Cord Paralysis; Vocal Cords; Voice Quality
PubMed: 32689890
DOI: 10.1177/0194599820944892 -
European Annals of Otorhinolaryngology,... Jun 2018To analyze the characteristics of adult idiopathic unilateral vocal-fold paralysis.
GOAL
To analyze the characteristics of adult idiopathic unilateral vocal-fold paralysis.
MATERIAL AND METHODS
Retrospective study of diagnostic problems, clinical data and recovery in an inception cohort of 100 adult patients with idiopathic unilateral vocal-fold paralysis (Group A) and comparison with a cohort of 211 patients with isolated non-idiopathic non-traumatic unilateral vocal-fold paralysis (Group B).
RESULTS
Diagnostic problems were noted in 24% of cases in Group A: eight patients with concomitant common upper aerodigestive tract infection, five patients with a concomitant condition liable to induce immunodepression and 11 patients in whom a malignant tumor occurred along the path of the ipsilateral vagus and inferior laryngeal nerves or in the ipsilateral paralyzed larynx. There was no recovery of vocal-fold motion beyond 51 months after onset of paralysis. The 5-year actuarial estimate for recovery differed significantly (P<0.0001): 53.2% in Group A versus 17.9% in Group B. In Group A, recovery occurred before the end of the second year following paralysis onset in 93% of cases. On univariate analysis, recovery in Group A was associated with younger age (P=0.0033), shorter time to consultation (P<0.0001), and absence of oncologic history (P<0.028). In case of non-recovery in Group A, malignant tumor along the ipsilateral vagus or inferior laryngeal nerve was found in 17.2% of cases, 81% of which manifesting during the 30 months following the onset of vocal-fold paralysis.
CONCLUSION
In non-traumatic vocal-fold paralysis in adult patients, without recovery of vocal-fold motion, a minimum three years' regular follow-up is recommended.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Retrospective Studies; Vocal Cord Paralysis; Young Adult
PubMed: 29402673
DOI: 10.1016/j.anorl.2018.01.004 -
Biomedical Journal Dec 2021Unilateral vocal fold paralysis (UVFP) caused by lung surgery is associated with prolonged hospital stay and increased postoperative comorbidities. We evaluated lung...
BACKGROUND
Unilateral vocal fold paralysis (UVFP) caused by lung surgery is associated with prolonged hospital stay and increased postoperative comorbidities. We evaluated lung surgery-related UVFP and compared its characteristics with UVFP caused by esophageal and thyroid surgeries, as the most common surgical causes of UVFP. We also evaluated the outcomes of intracordal hyaluronate injection laryngoplasty in these patients.
METHODS
Patients with surgery-related UVFP were evaluated by quantitative laryngeal electromyography, videolaryngostroboscopy, voice acoustic analysis, Voice Outcome Survey (VOS) questionnaire, and Short Form-36 Health Survey (SF-36) quality-of-life questionnaire. Data for the lung, esophageal, and thyroid surgery groups were compared and changes in outcome measurements induced by hyaluronate injection were compared among the three groups.
RESULTS
A total of 141 patients were recruited, including 21, 46, and 74 in the lung, esophageal, and thyroid surgery groups, respectively. Compared with the other two groups, lung surgery patients had predominantly left-sided UVFP, less involvement of the external branch of the superior laryngeal nerve, and higher jitter. Most outcome measurements improved in all three groups after office-based hyaluronate injection, with the greatest improvement in jitter in the lung surgery group.
CONCLUSIONS
Lung surgery-related UVFP showed a distinct disease presentation, and patients' voice parameters and quality of life recovered dramatically after office-based hyaluronate injection. We recommend evaluation of lung surgery-related UVFP and early intervention, such as office-based hyaluronate injection, to improve patients' voice function and quality of life.
Topics: Humans; Hyaluronic Acid; Laryngoplasty; Lung; Quality of Life; Retrospective Studies; Treatment Outcome; Vocal Cord Paralysis; Vocal Cords
PubMed: 35735079
DOI: 10.1016/j.bj.2020.07.005