Blog Archives

Value of ultrasonography in diagnosis of pediatric vocal fold paralysis

Conclusion
MGA and VAA are quantitative indicators of vocal fold immobility. Ultrasound is a reliable method of diagnosis of pediatric VFP. To diagnose VFP from an ultrasound image, the criteria are: (1) abnormal mobility (this was the most important and direct evidence), (2) hyperechoic air-column band of the glottic rima during phonation, (3) flaccid vocal fold and (4) asymmetry of the glottal structures.

from the International Journal of Pediatric Otorhinolaryngology

Vocal Handicap and Quality of Life After Treatment of Advanced Squamous Carcinoma of the Larynx and/or Hypopharynx

Conclusion
Patients treated for advanced cancer of the larynx/hypopharynx present slight to moderate voice handicap and good/excellent HR-QOL. Stricter analysis of both the VHI and UW-QOL data suggests that more attention be given to the vocal handicap of the individual patient.

from the Journal of Voice

A New Hypothesis for Fluidification of Vocal-Fold Mucus: Scintigraphic Study

Conclusion
The results indicate that an increased volume of saliva enters the larynx and is adsorbed in its mucosa, producing mucus fluidification. This supports our alternative hypothesis to the unlikely concept that hydration by water ingestion is the factor responsible for reduction of the mucus viscosity of the vocal folds.

from the Journal of Voice

Dynamic Viscosity of Implantable Autologous Materials Into the Vocal Fold

Conclusion
DV of SLTF is lower than of other tissues tested.

from the Journal of Voice

Cooperative Regulation of Vocal Fold Morphology and Stress by the Cricothyroid and Thyroarytenoid Muscles

Voice is produced by vibrations of vocal folds that consist of multiple layers. The portion of the vocal fold tissue that vibrates varies depending primarily on laryngeal muscle activity. The effective depth of tissue vibration should significantly influence the vibrational behavior of the tissue and resulting voice quality. However, thus far, the effect of the activation of individual muscles on the effective depth is not well understood. In this study, a three-dimensional finite element analysis is performed to investigate the effect of the activation of two major laryngeal muscles, the cricothyroid (CT) and thyroarytenoid (TA) muscles, on vocal fold morphology and stress distribution in the tissue. Because structures that bear less stress can easily be deformed and involved in vibration, information on the morphology and stress distribution may provide a useful estimate of the effective depth. The results of the analyses indicate that the two muscles perform distinct roles, which allow cooperative control of the morphology and stress. When the CT muscle is activated, the tip region of the vocal folds becomes thinner and curves upward, resulting in the elevation of the stress magnitude all over the tissue to a certain degree that depends on the stiffness of each layer. On the other hand, the TA muscle acts to suppress the morphological change and controls the stress magnitude in a position-dependent manner. Thus, the present analyses demonstrate quantitative relationships between the two muscles in their cooperative regulation of vocal fold morphology and stress.

from the Journal of Voice

Endoscopic and Stroboscopic Presentation of the Larynx in Male-to-Female Transsexual Persons

Conclusions
MFT speakers who reported a “passing” feminine voice had glottal gap configurations more similar to anatomic females than males and tended toward more open phase closure ratios, perhaps consistent with breathy or soft voice production. Indications of vocal hyperfunction were present for all participants either by self-report or on the laryngeal examination.

from the Journal of Voice

Mucosal Bridge of the Vocal Fold: Difficulties in the Diagnosis and Treatment

Mucosal bridges are rare laryngeal lesions probably of genetic origin. They may cause dysphonia of varying degrees, especially when associated with other laryngeal lesions such as vocal sulci and cysts. Reports on mucosal bridges are rare, and the better treatment is inconclusive.

from the Journal of Voice

Prevalence of arytenoid asymmetry in relation to vocal symptoms

The prevalence of arytenoid asymmetry during adduction is common. The presence of vocal symptoms such as hoarseness, breathiness, inability to project the voice and straining does not generally seem to correlate with the prevalence of arytenoid asymmetry. However, subjects with vocal fatigue are more likely to have cuneiform asymmetry.

from the Journal of Laryngology and Otology

MRI Anatomical and Morphological Differences in the Vocal Tract Between Dysphonic and Normal Adult Women

Results obtained from this study suggest that patients with VN may present a constantly increased tension of the laryngeal muscles, even at rest; moreover, reduced anterior-posterior dimension of the larynx may be a morphological characteristic of patients with VN.

from the Journal of Voice

The Role of the Cricothyroid Joint Anatomy in Cricothyroid Approximation Surgery

Conclusions
The anatomical structure of the CTJ influences directly (1) the position of the effective rotation axis and (2) the elongation of the vocal folds.

from the Journal of Voice

Dysphonia secondary to traumatic avulsion of the vocal fold in infants

Conclusions: The mechanisms of injury, risk factors and management of the condition are discussed. Children suffering traumatic intubation require follow up throughout childhood and beyond puberty as their vocal needs and abilities change. At the time of writing, none of the reported patients had yet undergone reconstructive or medialisation surgery. However, regular specialist voice therapy evaluation is recommended for such patients, with consideration of phonosurgical techniques including injection laryngoplasty or thyroplasty.

from the Journal of Laryngology and Otology

Vocal quality of patients treated for laryngeal tuberculosis, before and after speech therapy

Conclusions: Following treatment of laryngeal tuberculosis, the incidence of dysphonia was very high. Speech therapy improved patients’ vocal quality.

from the Journal of Laryngology and Otology

Physiological Variability in the Deglutition Literature: Hyoid and Laryngeal Kinematics

A literature review was conducted on hyoid and/or laryngeal displacement during swallowing in healthy populations according to several inclusion criteria. Anterior and superior displacement measures of both structures from previously published studies were compiled for meta-analysis. Results showed a large degree of variability across studies for each structure and plane of movement. Potential sources of variation were identified, including statistical, methodological, stimulus-related, and participant-related sources.

from Dysphagia

CO2 laser-assisted microsurgery for intracordal cysts: technique and results of 49 patients

Microsurgery for intracordal cysts is a challenging procedure, because cysts are close to the vocal ligament and the risk of inducing a scar is high. In this retrospective study, our experience with the CO2-laser scanning system (Acublade®) is reported on 49 patients. There were 41% epidermoid cysts and 59% mucous retention cysts. A quarter of the patients presented with bilateral cystic lesions and 59% had a contralateral lesion other than a cyst. The cyst was removed after a minimicroflap. It was dissected away from the lamina propria and the epithelium. Collagen was injected intraoperatively if the glottal gap was considered important. The epithelium was redraped using Tissucol (Baxter, Vienna, Austria). The mean follow-up time was 160 days. We noted a statistically significant improvement in the grade of the dysphonia according to Hirano’s perceptual scale (G pre = 2, G post = 1, p = 0.002); the Vocal Handicap Index (VHI pre = 51, VHI post = 28, p = 0.001) and the maximal phonation time in milliseconds (MPT pre = 11, 1 MPT post = 12.7, p = 0.033) in all the patients. In the professional voice subgroup (20/49 patients), there was a significant improvement in the frequency range (FR pre = 310 Hz, FR post = 434 Hz, p = 0.001). The CO2-laser scanning system is reliable in the treatment of intracordal cysts.

from the European Archives of Oto-Rhino-Laryngologyl

New approach to diagnose arytenoid dislocation and subluxation using three-dimensional computed tomography

Understanding the complex three-dimensional (3D) arrangement of the arytenoid cartilage is necessary for diagnosing arytenoid dislocation (AD) and arytenoid subluxation (AS). We examined the 3D arrangements of AD and AS (AD/AS) cases by region and considered their new diagnoses. This retrospective study included 2 patients with AD, 10 with AS, and 23 with unilateral vocal fold paralysis (UVFP) for comparison. The etiologies were intubation-induced and idiopathic. We classified the AD/AS position into four joint regions: mediocaudal, laterocaudal, mediocranial, and laterocranial. We generated 3D computed tomography (3DCT) images during rest and phonation to analyze functional movements. We attempted to compare the endoscopic findings and 3DCT images of patients with UVFP and AD/AS. To examine the joint status, we especially focused on the position and movements of the muscular process (MP) on the joint because the arytenoid facet is mainly located on the back of the MP. We were able to obtain endoscopic and 3DCT findings characteristic of each AD/AS region. The dislocated MPs were localized to the mediocaudal, mediocranial, and laterocranial regions. Two AD cases were diagnosed due to complete separation of the joint surfaces during rest and phonation. The finding of MPs displacing partially outside the cricoid facet is common to both severe UVFP and AS. The most important differentiation point was that the MP in UVFP cases was located on both the medial and lateral side regions of the joint, but that of AS was on one side region only. Furthermore, no cases of passive gliding movements characteristic of UVFP that have been described previously by us were observed in AD/AS cases. AD can be diagnosed by findings of complete joint separation. AS can be diagnosed based on positions and movements distinct from those of UVFP.

from the European Archives of Oto-Rhino-Laryngologyl