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Hackman A, Chen CH, Chen AWG, Chen MK. Automatic Segmentation of Membranous Glottal Gap Area with U-Net-Based Architecture. Laryngoscope 2024; 134:2835-2843. [PMID: 38217455 DOI: 10.1002/lary.31266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/10/2023] [Accepted: 12/21/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND While videostroboscopy is recognized as the most popular approach for investigating vocal fold function, evaluating the numerical values, such as the membranous glottal gap area, remains too time consuming for clinical applications. METHODS We used a total of 2507 videostroboscopy images from 137 patients and developed five U-Net-based deep-learning image segmentation models for automatic masking of the membranous glottal gap area. To further validate the models, we used another 410 images from 41 different patients. RESULTS During development, all five models exhibited acceptable and similar metrics. While the VGG19 U-Net had a long inference time of 1654 ms, the other four models had more practical inference times, ranging from 16 to 138 ms. During further validation, Efficient U-Net demonstrated the highest intersection over union of 0.8455, the highest Dice coefficient of 0.9163, and the lowest Hausdorff distance of 1.5626. The normalized membranous glottal gap area index was also calculated and validated. Efficient U-Net and VGG19 U-Net exhibited the lowest mean squared errors (3.5476 and 3.3842) and the lowest mean absolute errors (1.8835 and 1.8396). CONCLUSIONS Automatic segmentation of the membranous glottal gap area can be achieved through U-net-based architecture. Considering the segmentation quality and speed, Efficient U-Net is a reasonable choice for this task, while the other four models remain valuable competitors. The models' masked area enables possible calculation of the normalized membranous glottal gap area and analysis of the glottal area waveform, revealing promising clinical applications for this model. LEVEL OF EVIDENCE NA Laryngoscope, 134:2835-2843, 2024.
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Affiliation(s)
- Acquah Hackman
- Artificial Intelligence Development Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Chih-Hua Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Andy Wei-Ge Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, Changhua Christian Hospital, Changhua, Taiwan
- Doctoral Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan
- Rong Hsing Translational Medicine Research Center, National Chung Hsing University, Taichung, Taiwan
| | - Mu-Kuan Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, Changhua Christian Hospital, Changhua, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
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Nourmahnad A, Raslan S, Ezeh UC, Rossborough J, Ma R, Anis MM. Association of Sociodemographic Factors on the Presentation and Management of Unilateral Vocal Fold Immobility. Laryngoscope 2024; 134:297-304. [PMID: 37515514 DOI: 10.1002/lary.30917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 06/12/2023] [Accepted: 07/13/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVE To determine the association of social determinants of health (SDOH) on the presentation and management of unilateral vocal fold immobility (UVFI). METHODS Retrospective chart review of 207 adult UVFI patients evaluated at a tertiary-care hospital between 2018 and 2019 was performed. Sociodemographic factors including gender, median household income, preferred language, and insurance type were recorded. Confounding clinical factors including etiology of UVFI, Voice Handicap Index-10 (VHI-10) score, laryngoscopic findings, and intervention history were extracted from medical records. Multivariable logistic regression was performed using sociodemographic and clinical factors. RESULTS Patient demographics and socioeconomic status were not associated with time to presentation. Patients presenting with glottic insufficiency and UVFI due to malignancy or recurrent laryngeal nerve (RLN) sacrifice had a shorter time to presentation. Higher household income was associated with greater number of interventions (p = 0.02), but neither income nor insurance type affected intervention type or timing. Female patients were less likely to undergo injection medialization laryngoplasty (odds ratio [OR] 0.25, p = 0.005). Older patients were more likely to undergo injection (OR 1.04, p = 0.027). Patients with large glottic gaps (OR 21.2, p = 0.014) and higher VHI-10 scores (OR 1.06, p = 0.047) were more likely to undergo surgery. CONCLUSION Higher household income was associated with greater number of interventions and longer duration of care at a private tertiary-care hospital. RLN sacrifice, known malignancy, and glottic insufficiency significantly reduced the time to presentation. Type of intervention received was a complex interplay of both demographic and clinical factors. Large prospective studies should examine the role of SDOH in the presentation and management of UVFI. LEVEL OF EVIDENCE 4 Laryngoscope, 134:297-304, 2024.
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Affiliation(s)
- Anahita Nourmahnad
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Hospital, Miami, Florida, U.S.A
| | - Shahm Raslan
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, U.S.A
| | - Uche C Ezeh
- University of Miami School of Medicine, Miami, Florida, U.S.A
| | | | - Ruixuan Ma
- Division of Biostatistics, Department of Public Health Science, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Mursalin M Anis
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Hospital, Miami, Florida, U.S.A
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Liu K, Lu Y, Chuang H, Hsin L, Lin W, Wong AMK, Pei Y, Fang T. Persistence of lower vocal intensity in vocal fold paralysis with cricothyroid impairment after hyaluronate injection. Laryngoscope Investig Otolaryngol 2022; 7:1922-1929. [PMID: 36544927 PMCID: PMC9764743 DOI: 10.1002/lio2.927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/15/2022] [Accepted: 09/06/2022] [Indexed: 12/24/2022] Open
Abstract
Background Unilateral vocal fold paralysis (UVFP) affects the glottal gap, voice, and aerodynamics, whereas injection laryngoplasty (IL) using hyaluronate is an effective treatment for UVFP by decreasing the glottal gap to improve voice. Previous studies have shown that the involvement of cricothyroid (CT) muscle in UVFP patients further affects patients' aerodynamics, but it remains unclear whether the difference remains after IL. This study investigates whether the aerodynamic features observed in UVFP with CT involvement could still be observed after IL. Methods This study recruited UVFP patients with dysphonia, and IL was performed within 6 months of initial symptoms. All subjects received assessments including videolaryngoscopy, voice analysis, and aerodynamics at three time points: before IL, 1 month after IL, and 6 months after IL. The glottal gap, voice, and aerodynamics between patients with and without CT involvement (the CT+ and CT- groups) were compared, and the change (Δ) before and after IL and repeated-measures analysis of variance (ANOVA) were also compared between the two groups. Result A total of 71 patients with UVFP (22 in the CT+ group and 49 in the CT- group) were analyzed. After IL, the CT+ group showed a lower sound pressure level (SPL), higher Δair pressure, and smaller Δaerodynamic power than the CT- group. Conclusion The CT+ group had a lower SPL, even after elevating air pressure to attempt to achieve a higher vocal intensity. The results suggest that although closure of the glottal gap was achieved by IL, the CT+ group still had a lower loudness and needed to sustain a higher peak air pressure when producing voice. Level of evidence Level 4.
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Affiliation(s)
- Kuo‐Cheng Liu
- Department of Physical Medicine and RehabilitationNew Taipei Municipal TuCheng Hospital (Built and Operated by Chang Gung Medical Foundation)New Taipei CityTaiwan
- Department of Physical Medicine and RehabilitationChang Gung Memorial Hospital at LinkouTaoyuanTaiwan
- Graduate School of Science Design Program in Innovation for Smart MedicineChang Gung UniversityTaoyuanTaiwan
| | - Yi‐An Lu
- Department of OtolaryngologyChang Gung Memorial Hospital at LinkouTaoyuanTaiwan
| | - Hsiu‐Feng Chuang
- Department of OtolaryngologyChang Gung Memorial Hospital at LinkouTaoyuanTaiwan
| | - Li‐Jen Hsin
- Department of OtolaryngologyChang Gung Memorial Hospital at LinkouTaoyuanTaiwan
- School of MedicineChang Gung UniversityTaoyuanTaiwan
| | - Wan‐Ni Lin
- Department of OtolaryngologyChang Gung Memorial Hospital at LinkouTaoyuanTaiwan
- School of MedicineChang Gung UniversityTaoyuanTaiwan
| | - Alice M. K. Wong
- Department of Physical Medicine and RehabilitationChang Gung Memorial Hospital at LinkouTaoyuanTaiwan
| | - Yu‐Cheng Pei
- Department of Physical Medicine and RehabilitationChang Gung Memorial Hospital at LinkouTaoyuanTaiwan
- Graduate School of Science Design Program in Innovation for Smart MedicineChang Gung UniversityTaoyuanTaiwan
- School of MedicineChang Gung UniversityTaoyuanTaiwan
- Center of Vascularized Tissue AllograftChang Gung Memorial Hospital at LinkouTaoyuanTaiwan
| | - Tuan‐Jen Fang
- Department of OtolaryngologyChang Gung Memorial Hospital at LinkouTaoyuanTaiwan
- School of MedicineChang Gung UniversityTaoyuanTaiwan
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Injection laryngoplasty as an effective treatment method for glottal insufficiency in aged patients. Am J Otolaryngol 2022; 43:103353. [PMID: 34991019 DOI: 10.1016/j.amjoto.2021.103353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 12/13/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE The purpose of the study was to assess outcomes of injection laryngoplasty (IL) for treating glottal insufficiency in elderly patients with presbyphonia or unilateral vocal fold paralysis (UVFP). METHODS A single-center retrospective study was performed. The study group consisted of 34 patients with glottal insufficiency aged between 60 and 82 years who had been treated with injection laryngoplasty. Of them, 16 patients were diagnosed with presbyphonia and 18 with UVFP. RESULTS After IL, glottal closure improved in both groups. The change was statistically significant in the patients with presbyphonia (marginal homogeneity test MH = 3.80; p < 0.001) and in the UVFP patients (MH = 4.04; p < 0.001). Voice quality improved after IL and 12 months after surgical intervention remained significantly better compared to before augmentation (MH tests were statistically significant at p < 0.05 for R, B, A, and S parameters). In the patients with UVFP, significant improvement was observed in 7 of 12 evaluated parameters (Jitt, RAP, PPQ, Shim, APQ, sAPQ, and NHR) but in the patients with presbyphonia only average fundamental frequency (F0) improved significantly. Comparison of the Voice Handicap Index outcomes before and 12 months after surgery showed improvement of subjectively assessed voice quality in both groups; however, the change was statistically significant only in the UVFP patients. CONCLUSIONS Injection laryngoplasty is a safe and effective treatment method for glottal insufficiency in the elderly. This study shows a significant and clinically relevant improvement to at least12 months, especially in patients with UVFP.
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Black RJ, Novakovic D, Plit M, Miles A, MacDonald P, Madill C. Swallowing and laryngeal complications in lung and heart transplantation: Etiologies and diagnosis. J Heart Lung Transplant 2021; 40:1483-1494. [PMID: 34836605 DOI: 10.1016/j.healun.2021.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/29/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022] Open
Abstract
Despite continued surgical advancements in the field of cardiothoracic transplantation, post-operative complications remain a burden for the patient and the multidisciplinary team. Lesser-known complications including swallowing disorders (dysphagia), and voice disorders (dysphonia), are now being reported. Such disorders are known to be associated with increased morbidity and mortality in other medical populations, however their etiology amongst the heart and lung transplant populations has received little attention in the literature. This paper explores the potential mechanisms of oropharyngeal dysphagia and dysphonia following transplantation and discusses optimal modalities of diagnostic evaluation and management. A greater understanding of the implications of swallowing and laryngeal dysfunction in the heart and lung transplant populations is important to expedite early diagnosis and management in order to optimize patient outcomes, minimize allograft injury and improve quality of life.
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Affiliation(s)
- Rebecca J Black
- Speech Pathology Department, St Vincent's Hospital, Darlinghurst, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Australia.
| | - Daniel Novakovic
- Faculty of Medicine and Health, The University of Sydney, Australia
| | | | | | - Peter MacDonald
- Faculty of Medicine and Health, The University of Sydney, Australia
| | - Catherine Madill
- Faculty of Medicine and Health, The University of Sydney, Australia
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Lee YC, Pei YC, Lu YA, Chung HF, Li HY, Lee LA, Fang TJ. Long-Lasting Effect after Single Hyaluronate Injection for Unilateral Vocal Fold Paralysis: Does Concentration Matter? Biomolecules 2021; 11:1580. [PMID: 34827578 PMCID: PMC8615747 DOI: 10.3390/biom11111580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/18/2021] [Accepted: 10/21/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Early injection laryngoplasty (EIL) using hyaluronic acid (HA) is an effective treatment for glottic insufficiency in patients with acute unilateral vocal fold paralysis (UVFP). Most patients benefit by showing improvement in voice and quality of life and implied reduced need for permanent laryngoplasty. However, injected HA might resolve within a short period, so its long-term outcomes and the need for secondary procedures need to be clarified. METHODS Patients who underwent EIL with HA for acute UVFP from January 2015 to December 2018 were included. The factors that may associate with the prognosis including voice performance and laryngeal configuration at presentation, the cause of UVFP, and the type of HA for EIL were analyzed. RESULTS Ninety-four patients were included for analysis, with a mean follow-up period of 25.1 months (95% CI: 22.8-27.4 months). After primary HA injection, 22 patients (23.4%) underwent secondary procedures (rate: 13.1% per person-year), and most (63.6%) of the events occurred after one year from the first injection. The rate of secondary procedures within the first 12 months was 9.0% (14.1% and 4.3% for low-concentrated HA (LHA) and high-concentrated HA (HHA), respectively). The incidence of the secondary procedures was higher in the LHA group (18.2%) (p = 0.026) than in the HHA group (7.5%). CONCLUSIONS The rate of secondary procedures was lower than the prediction based on the resorption time of HA, a finding that could be partly accounted for by both natural nerve recovery and a long-lasting effect of EIL. EIL with HHA had a lower rate of re-treatment than that with LHA, suggesting a better clinical utility for acute UVFP.
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Affiliation(s)
- Yi-Chieh Lee
- Department of Otolaryngology Head & Neck Surgery, Chang Gung Memorial Hospital at Linkou, 5 Fushing St., Taoyuan 333, Taiwan; (Y.-C.L.); (Y.-A.L.); (H.-F.C.); (H.-Y.L.); (L.-A.L.)
- London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Yu-Cheng Pei
- School of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Taoyuan 333, Taiwan;
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou and Taoyuan, 5 Fushing St., Taoyuan 333, Taiwan
- Center for Vascularized Composite Allotransplantation, Chang Gung Memorial Hospital, 5 Fushing St., Taoyuan 333, Taiwan
- Healthy Ageing Research Center, Chang Gung University, 259 Wen-Hwa 1st Road, Taoyuan 333, Taiwan
| | - Yi-An Lu
- Department of Otolaryngology Head & Neck Surgery, Chang Gung Memorial Hospital at Linkou, 5 Fushing St., Taoyuan 333, Taiwan; (Y.-C.L.); (Y.-A.L.); (H.-F.C.); (H.-Y.L.); (L.-A.L.)
| | - Hsiu-Feng Chung
- Department of Otolaryngology Head & Neck Surgery, Chang Gung Memorial Hospital at Linkou, 5 Fushing St., Taoyuan 333, Taiwan; (Y.-C.L.); (Y.-A.L.); (H.-F.C.); (H.-Y.L.); (L.-A.L.)
| | - Hsueh-Yu Li
- Department of Otolaryngology Head & Neck Surgery, Chang Gung Memorial Hospital at Linkou, 5 Fushing St., Taoyuan 333, Taiwan; (Y.-C.L.); (Y.-A.L.); (H.-F.C.); (H.-Y.L.); (L.-A.L.)
- School of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Taoyuan 333, Taiwan;
| | - Li-Ang Lee
- Department of Otolaryngology Head & Neck Surgery, Chang Gung Memorial Hospital at Linkou, 5 Fushing St., Taoyuan 333, Taiwan; (Y.-C.L.); (Y.-A.L.); (H.-F.C.); (H.-Y.L.); (L.-A.L.)
- School of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Taoyuan 333, Taiwan;
| | - Tuan-Jen Fang
- Department of Otolaryngology Head & Neck Surgery, Chang Gung Memorial Hospital at Linkou, 5 Fushing St., Taoyuan 333, Taiwan; (Y.-C.L.); (Y.-A.L.); (H.-F.C.); (H.-Y.L.); (L.-A.L.)
- School of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Taoyuan 333, Taiwan;
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Miaśkiewicz B, Panasiewicz A, Gos E, Krasnodębska P, Skarżyński PH, Szkiełkowska A. Can preoperative results predict the need for future reintervention following injection laryngoplasty for unilateral vocal fold paralysis? Eur Arch Otorhinolaryngol 2021; 278:3883-3890. [PMID: 34109479 PMCID: PMC8382642 DOI: 10.1007/s00405-021-06925-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/31/2021] [Indexed: 11/09/2022]
Abstract
Purpose The objective was to investigate whether a patient’s preoperative test results can predict the need for future reoperation in unilateral vocal fold paralysis (UVFP). Methods A single-centre retrospective study was performed. The study group consisted of 18 patients with UVFP who had been treated with injection laryngoplasty but who required further treatment and were augmentated again within 36 months. The control group consisted of 33 injected patients who had not required reintervention up to 36 months later. Results Only glottal gap was associated with a relative risk for reinjection. Glottal gap was found to be severe in 77.8% of the patients from the study group compared to 42.4% of the controls, and the difference was statistically significant. The kind of injected material (calcium hydroxylapatite or hyaluronic acid), age, and voice assessment (perceptual, objective, or subjective) did not seem to affect the likelihood of reoperation being needed. There were no between-group statistically significant differences in individual aspects of the GRBAS scale. The global score was slightly higher in the study group, but it did not reach statistical significance (U = 198.5; p = 0.09). A comparison of VHI scores did not yield statistically significant differences between the study and control groups. No significant differences in objective acoustic voice parameters were observed between the groups. Conclusion Only glottal gap occurred to be associated with a relative risk for reinjection. A kind of injected material (CaHA or HA), age, perceptual, objective and subjective voice assessment do not seem to impact the likelihood of reoperation in patients with UVFP.
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Affiliation(s)
- Beata Miaśkiewicz
- Audiology and Phoniatric Clinic, World Hearing Centre, Institute of Physiology and Pathology of Hearing, Mokra 17 Str., Kajetany, Nadarzyn, 05-830, Warsaw, Poland.
| | - Aleksandra Panasiewicz
- Audiology and Phoniatric Clinic, World Hearing Centre, Institute of Physiology and Pathology of Hearing, Mokra 17 Str., Kajetany, Nadarzyn, 05-830, Warsaw, Poland
| | - Elżbieta Gos
- Department of Teleaudiology and Screening, World Hearing Center, Institute of Physiology and Pathology of Hearing, Mokra 17 Str., Kajetany, Nadarzyn, 05-830, Warsaw, Poland
| | - Paulina Krasnodębska
- Audiology and Phoniatric Clinic, World Hearing Centre, Institute of Physiology and Pathology of Hearing, Mokra 17 Str., Kajetany, Nadarzyn, 05-830, Warsaw, Poland
| | - Piotr H Skarżyński
- Department of Teleaudiology and Screening, World Hearing Center, Institute of Physiology and Pathology of Hearing, Mokra 17 Str., Kajetany, Nadarzyn, 05-830, Warsaw, Poland
| | - Agata Szkiełkowska
- Audiology and Phoniatric Clinic, World Hearing Centre, Institute of Physiology and Pathology of Hearing, Mokra 17 Str., Kajetany, Nadarzyn, 05-830, Warsaw, Poland
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Ryu CH, Lee SJ, Cho JG, Choi IJ, Choi YS, Hong YT, Jung SY, Kim JW, Lee DY, Lee DK, Lee SJ, Lee YC, Lee YS, Nam IC, Park KN, Park YM, Sung ES, Son HY, Seo IH, Lee BJ, Lim JY. Care and Management of Voice Change for Thyroid Surgery: Korean Society of Laryngology, Phoniatrics and Logopedics Clinical Practice Guideline. Clin Exp Otorhinolaryngol 2021; 15:24-48. [PMID: 34098629 PMCID: PMC8901944 DOI: 10.21053/ceo.2021.00633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/31/2021] [Indexed: 11/22/2022] Open
Abstract
Voice change is a common complaint after thyroid surgery and has significant impacts on quality of life. The Korean Society of Laryngology, Phoniatrics, and Logopedics set up a task force team to establish guideline recommendations on education, care, and management related to thyroid surgery. The guideline recommendations include preoperative voice education, management of anticipated voice change during surgery, and comprehensive voice care after thyroid surgery, including in-depth information and up-to-date knowledge based on validated literature. The committee constructed 14 key questions (KQ) in three categories: preoperative (KQ1-2), intraoperative (KQ 3-8), and postoperative (KQ 9-14) management and developed 18 evidence-based recommendations. The Delphi survey reached an agreement on each recommendation. Detailed evidence profiles are presented for each recommendation. The level of evidence for each recommendation is classified into high, moderate, and low-quality. The recommendation's strengths are adjusted to consider the level of evidence resulting in the recommendation and are divided into strong and weak. The guidelines are primarily targeted toward physicians who treat thyroid surgery patients and speech-language pathologists participating in patient care. These guidelines will also help primary care physicians, nurses, healthcare policymakers, and patients improve their understanding of voice changes and voice care after thyroid surgery.
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Affiliation(s)
| | - Chang Hwan Ryu
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
| | - Seung Jin Lee
- Division of Speech Pathology and Audiology, Research Institute of Audiology and Speech Pathology, College of Natural Sciences, Hallym University, Chuncheon, Korea
| | - Jae-Gu Cho
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Ik Joon Choi
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological Medical Sciences, Seoul, Korea
| | - Yoon Seok Choi
- Department of Otorhinolaryngology Head and Neck Surgery, Yeungnam University, College of Medicine, Daegu, Korea
| | - Yong Tae Hong
- Department of Otorhinolaryngology Head and Neck Surgery, College of Medicine, Jeonbuk National University Hospital, Jeonju, Korea
| | - Soo Yeon Jung
- Department of Otorhinolaryngology Head and Neck Surgery, Ewha Womans University, College of Medicine, Seoul, Korea
| | - Ji Won Kim
- Department of Otorhinolaryngology Head and Neck Surgery, Inha University, College of Medicine, Incheon, Korea
| | - Doh Young Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University, College of Medicine, Seoul, Korea
| | - Dong Kun Lee
- Department of Otorhinolaryngology Head and Neck Surgery, College of Medicine, Dong-A University, Busan, Korea
| | - Sang Joon Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Dankook University, College of Medicine, Cheonan, Korea
| | - Young Chan Lee
- Department of Otorhinolaryngology Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Yong Sang Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Inn Chul Nam
- Department of Otorhinolaryngology Head and Neck Surgery, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Ki Nam Park
- Department of Otorhinolaryngology Head and Neck Surgery, Soonchunhyang University, College of Medicine, Bucheon, Korea
| | - Young Min Park
- Department of Otorhinolaryngology Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Eui-Suk Sung
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Hee Young Son
- Department of Otorhinolaryngology Head and Neck Surgery, Dongnam Institute Of Radiological & Medical Sciences, Busan, Korea
| | - In Hyo Seo
- Voice & Speech Clinic, College of Medicine, Dankook University, Cheonan, Korea
| | - Byung-Joo Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Jae-Yol Lim
- Department of Otorhinolaryngology Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Korea
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Wang CC, Wu SH, Tu YK, Lin WJ, Liu SA. Hyaluronic Acid Injection Laryngoplasty for Unilateral Vocal Fold Paralysis-A Systematic Review and Meta-Analysis. Cells 2020; 9:cells9112417. [PMID: 33167303 PMCID: PMC7694408 DOI: 10.3390/cells9112417] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 11/02/2020] [Indexed: 11/29/2022] Open
Abstract
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.
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Affiliation(s)
- Chen-Chi Wang
- School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan
- Department of Speech Language Pathology & Audiology, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Audiology and Speech-Language Pathology, Asia University, Taichung 41354, Taiwan
- Department of Otolaryngology-Head & Neck Surgery, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (S.-H.W.); (W.-J.L.); (S.-A.L.)
- Correspondence: ; Tel.: +886-9‐7535‐1051
| | - Shang-Heng Wu
- Department of Otolaryngology-Head & Neck Surgery, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (S.-H.W.); (W.-J.L.); (S.-A.L.)
| | - Yu-Kang Tu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei 100, Taiwan;
| | - Wen-Jiun Lin
- Department of Otolaryngology-Head & Neck Surgery, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (S.-H.W.); (W.-J.L.); (S.-A.L.)
| | - Shih-An Liu
- Department of Otolaryngology-Head & Neck Surgery, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (S.-H.W.); (W.-J.L.); (S.-A.L.)
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Ryu CH, Kwon TK, Kim H, Kim HS, Park IS, Woo JH, Lee SH, Lee SW, Lim JY, Kim ST, Jin SM, Choi SH. Guidelines for the Management of Unilateral Vocal Fold Paralysis From the Korean Society of Laryngology, Phoniatrics and Logopedics. Clin Exp Otorhinolaryngol 2020; 13:340-360. [PMID: 32877965 PMCID: PMC7669319 DOI: 10.21053/ceo.2020.00409] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 04/13/2020] [Indexed: 01/08/2023] Open
Abstract
The Korean Society of Laryngology, Phoniatrics and Logopedics appointed a task force to establish clinical practice guidelines for the management of unilateral vocal fold paralysis (UVFP). These guidelines cover a comprehensive range of management-related factors, including the diagnosis and treatment of UVFP, and provide in-depth information based on current, up-to-date knowledge. Detailed evidence profiles are provided for each recommendation. The CORE databases, including OVID Medline, Embase, the Cochrane Library, and KoreaMed, were searched to identify all relevant papers, using a predefined search strategy. When insufficient evidence existed, expert opinions and Delphi questionnaires were used to fill the evidence gap. The committee developed 16 evidence-based recommendations in six categories: initial evaluation (R1–4), spontaneous recovery (R5), medical treatment (R6), surgical treatment (R7–14), voice therapy (R15), and aspiration prevention (R16). The goal of these guidelines is to assist general otolaryngologists and speech-language pathologists who are primarily responsible for treating patients with UVFP. These guidelines are also intended to facilitate understanding of the condition among other health-care providers, including primary care physicians, nurses, and policy-makers.
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Affiliation(s)
| | | | - Chang Hwan Ryu
- Department of Otorhinolaryngology-Head Neck Surgery, National Cancer Center, Goyang, Korea
| | - Tack-Kyun Kwon
- Department of Otorhinolaryngology-Head Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Heejin Kim
- Department of Otorhinolaryngology-Head Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Han Su Kim
- Department of Otorhinolaryngology-Head Neck Surgery, Ewha Womans University College of Medcine, Seoul, Korea
| | - Il-Seok Park
- Department of Otorhinolaryngology-Head Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Joo Hyun Woo
- Department of Otorhinolaryngology-Head Neck Surgery, Gachon University College of Medicine, Incheon, Korea
| | - Sang-Hyuk Lee
- Department of Otorhinolaryngology-Head Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Won Lee
- Department of Otorhinolaryngology-Head Neck Surgery, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jae-Yol Lim
- Department of Otorhinolaryngology-Head Neck Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seong-Tae Kim
- Department of Speech-Language Pathology, Dongshin University, Naju, Korea
| | - Sung-Min Jin
- Department of Otorhinolaryngology-Head Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Ho Choi
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Pei YC, Lu YA, Wong AMK, Chuang HF, Li HY, Fang TJ. Two trajectories of functional recovery in thyroid surgery related unilateral vocal cord paralysis. Surgery 2020; 168:578-585. [PMID: 32605836 DOI: 10.1016/j.surg.2020.04.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 04/03/2020] [Accepted: 04/20/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Iatrogenic unilateral vocal fold paralysis caused by thyroid surgery induces profound physical and psychosocial distress in patients. The natural course of functional recovery over time differs substantially across subjects, but the mechanisms underlying this difference remain unclear. In this study, we examined whether the anatomic site of the lesion affected the trajectory of recovery. METHODS In this prospective case series study in a single medical center, patients with thyroid surgery-related unilateral vocal fold paralysis were evaluated using quantitative laryngeal electromyography, videolaryngostroboscopy, voice acoustic analysis, the Voice Outcome Survey, and the Short Form-36 quality-of-life questionnaire. Patients with and without superior laryngeal nerve injuries were compared. RESULTS Forty-two patients were recruited, among whom 15 and 27 were assigned to the with and without superior laryngeal nerve injury groups, respectively. Compared with the group without superior laryngeal nerve injury, the group with superior laryngeal nerve injury group demonstrated less improvement in the recruitment of vocal fold adductors, and the group also had more severe impairment of vocal fold vibration, maximum phonation time, jitter, shimmer, and harmony-to-noise ratio at the first evaluation. This difference was also found in the glottal gap and maximum phonation time 12 months after the injury. CONCLUSION Among patients with thyroid surgery-related unilateral vocal fold paralysis, superior laryngeal nerve injury induces a distinctively different recovery trajectory compared with those without superior laryngeal nerve injury characterized by less reinnervation of vocal fold adductors and worse presentation in terms of the glottal gap and maximum phonation time. This study emphasizes the importance of superior laryngeal nerve function and its preservation in thyroid surgery.
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Affiliation(s)
- Yu-Cheng Pei
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan; Center of Vascularized Tissue Allograft, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Yi-An Lu
- Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Alice M K Wong
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan; Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Hsiu-Feng Chuang
- Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Hsueh-Yu Li
- School of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Tuan-Jen Fang
- School of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
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12
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Alegria R, Vaz Freitas S, Manso MC. Efficacy of speech language therapy intervention in unilateral vocal fold paralysis - a systematic review and a meta-analysis of visual-perceptual outcome measures. LOGOP PHONIATR VOCO 2020; 46:86-98. [PMID: 32406287 DOI: 10.1080/14015439.2020.1762730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Unilateral vocal folds paralysis is a disorder that affects a patient's quality-of-life by disturbing their phonation, breathing, and swallowing activities. This systematic review aimed to estimate the efficacy of voice treatment on the vocal fold motility in adult patients with unilateral vocal folds paralysis. METHODS PubMed, CINAHL, CENTRAL, and Web of Science were searched for retrospective and prospective cohort, case-control, and cross-sectional with comparative studies with adults that were published between 1 January 2008 to 31 December 2018. After applying the inclusion and exclusion criteria a total of 10 studies containing morpho-functional evaluation results were included in the analysis. Pooled data analysis of the motility of the vocal folds before and after voice therapy allowed inferring about the efficacy of voice therapy intervention in patients with unilateral vocal folds paralysis. A random-effect model was used to estimate the effect size. Publication bias was considered. RESULTS The pooled data analysis of the visual-perceptual measures revealed that vocal fold motility improved in 72% (95% CI: 64.0-80.0) of all patients after the therapeutic interventions. The inconsistency index (I2 = 18.35%) of the studies included in this meta-analysis revealed an extremely low heterogeneity. Funnel plot and Cochran's Q test showed no publication bias. The systematic review was limited to only English language articles. CONCLUSION This meta-analysis supports the evidence that voice therapy intervention can have a positive effect on the vocal fold motility, that is, they can improve the glottal gap closure, irrespective of the exercises and techniques used.
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Affiliation(s)
- Rita Alegria
- Fernando Pessoa College of Health, Speech Therapy Department, University Fernando Pessoa, Porto, Portugal
| | - Susana Vaz Freitas
- Faculty of Health Sciences, Speech Therapy Department, University Fernando Pessoa, Porto, Portugal.,Speech Pathology Unit of Otolaryngology Service, Centro Hospitalar e Universitário do Porto, Porto, Portugal.,LIAAD - INESC TEC, Porto, Portugal
| | - Maria Conceição Manso
- Faculty of Health Sciences, University Fernando Pessoa, Porto, Portugal.,Fernando Pessoa Energy, Environment and Health Research Unit (FP-ENAS), University Fernando Pessoa, Porto, Portugal.,LAQV, REQUIMTE, University of Porto, Porto, Portugal
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13
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Youssef S, Bayan S, Ekbom D, Lohse C, Zimmermann T, Pittelko R, Orbelo DM. Breathiness and Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) in Patients Undergoing Medialization Laryngoplasty With or Without Arytenoid Adduction. J Voice 2019; 35:312-316. [PMID: 31606224 DOI: 10.1016/j.jvoice.2019.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/16/2019] [Accepted: 08/19/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We hypothesized that, in patients with unilateral vocal fold paralysis (UVFP), the auditory-perception of breathiness measured with Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) would be higher preoperatively in patients who undergo medialization laryngoplasty (ML) with arytenoid adduction (AA) compared to ML alone. We further hypothesized that increased breathiness would correlate with increased glottal area at maximum glottal closure. STUDY DESIGN Retrospective chart review. METHODS CAPE-V recordings were rated by expert judges in 105 subjects with UVFP (47 ML+AA and 58 ML). Component scores of the CAPE-V prior to laryngeal framework surgery and those at 3 and/or 12 months postoperatively were compared. Assessment of glottal area width during maximum glottal closure was attempted. RESULTS Breathiness scores prior to laryngeal framework surgery were significantly greater in UVFP patients having ML+AA compared to ML only (P < 0.001). Roughness was greater for ML only (P = 0.003). At 3 months, adjusted for age and previous injection laryngoplasty, the ML+AA group showed greater improvement for breathiness (P <0.001), loudness (P < 0.001), strain (P = 0.037), and pitch (P = 0.039), while the ML only group showed greater improvement in roughness (P = 0.009). Results were similar at 12 months. Only 26% of glottal area widths were ratable using methods previously described; therefore, no further analysis was attempted. CONCLUSIONS In patients with UVFP baseline perception of breathiness is greater in those clinically selected for ML+AA compared to ML only. Glottal area measurements were not representative of the UVFP cohort and more stringent criteria are needed for valid and reliable glottal area assessment when using clinical flexible stroboscopic exams. Findings support the idea that surgeons may be making decisions about AA based, to at least some degree, on auditory perceptual evaluation of voice.
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Affiliation(s)
| | - Semirra Bayan
- Mayo Clinic Department of Otolaryngology, Rochester, Minnesota
| | - Dale Ekbom
- Mayo Clinic Department of Otolaryngology, Rochester, Minnesota
| | - Christine Lohse
- Mayo Clinic Division of Biomedical Statistics and Informatics, Rochester, Minnesota
| | | | | | - Diana M Orbelo
- Mayo Clinic Department of Otolaryngology, Rochester, Minnesota.
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Chiu CH, Wen YW, Chao YK. Lymph node dissection along the recurrent laryngeal nerves in patients with oesophageal cancer who had undergone chemoradiotherapy: is it safe? Eur J Cardiothorac Surg 2019; 54:657-663. [PMID: 29608683 DOI: 10.1093/ejcts/ezy127] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 03/03/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Upper mediastinal lymph node dissection (LND)-especially along the recurrent laryngeal nerve (RN)-is the most challenging part of oesophageal cancer surgery. We investigated whether thoracoscopic RN LND may be safely performed in patients with oesophageal cancer who had undergone chemoradiotherapy (CRT). METHODS Patients with oesophageal cancer who had undergone thoracoscopic RN LND (n = 103) were divided into 2 groups according to whether they had prior treatment with CRT or not [the CRT group (n = 65) vs the upfront surgery group (n = 38), respectively]. All patients were operated on by a single surgeon. Intergroup comparisons were made in terms of (i) the number of dissected nodes, (ii) rates of RN palsy and (iii) rates of perioperative complications. The learning curve for the RN LND procedure was investigated using the cumulative sum method. RESULTS RN LND after CRT was more technically challenging when performed in the left side. Complete skeletonization of the left RN was achieved only in 66.2% of patients in the CRT group (vs 86.8% in the upfront surgery group; P = 0.022). The rate of postoperative left side RN palsy was significantly higher in the CRT group (26.6%) than in the upfront surgery group (7.9%, P = 0.022), albeit resulting in neither higher pneumonia rates nor longer hospital stays. The cumulative sum analysis revealed a steep learning curve for left RN LND in the CRT group. Unfortunately, an acceptable proficiency (left RN palsy rate: 15%) was not achievable even after treatment in 65 cases. CONCLUSIONS Thoracoscopic RN LND is safe but poses significant challenges in CRT-treated patients.
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Affiliation(s)
- Chien-Hung Chiu
- Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linko, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Wen Wen
- Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linko, Chang Gung University, Taoyuan, Taiwan.,Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Yin-Kai Chao
- Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linko, Chang Gung University, Taoyuan, Taiwan
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15
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Fang TJ, Chuang HF, Chiang HC, Pei YC. The impact of cricothyroid involvement on adductor recovery in unilateral vocal fold paralysis. Laryngoscope 2019; 130:139-145. [PMID: 30761540 DOI: 10.1002/lary.27868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Wide variation in postinjury functional recovery is a hallmark of unilateral vocal fold paralysis (UVFP), ranging from zero to full recovery. The present study examined the impact of cricothyroid (CT) muscle involvement on recovery using quantitative laryngeal electromyography (LEMG) of the thyroarytenoid-lateral cricoarytenoid (TA-LCA) muscle complex at multiple times postinjury. STUDY DESIGN Prospective cohort study in a medical center. METHODS Eighty-one patients with UVFP (37 males and 44 females) received an initial assessment of quantitative LEMG, stroboscope, acoustic voice analysis and 36-Item Short Form Survey quality-of-life questionnaire at 3 to 6 months after UVFP onset and a follow-up assessment at 12 months after UVFP onset. RESULTS The initial and follow-up assessments were performed at 4.3 ± 1.9 and 12.5 ± 1.3 months after UVFP onset, respectively. The peak turn frequency of the TA-LCA muscle complex on the lesion side was improved at the follow-up (470 ± 294 Hz) compared with the initial assessment (300 ± 204 Hz) (P < .001). Patients were also divided into two groups with (n = 27) and without (n = 54) CT involvement, respectively. TA-LCA muscle complex turn frequency improved in patients without CT involvement (from 277 ± 198 to 511 ± 301 Hz; P < .001), but not in those with CT involvement (from 345 ± 211 to 386 ± 265 Hz; P = .46). Seventy-one of all patients received early intervention with intracordal hyaluronate injection, showing similar therapeutic effects in those with and without CT involvement. CONCLUSIONS Acute UVFP with combined TA-LCA muscle complex and CT muscle involvement has a poor prognosis, with poorer recovery of TA-LCA muscle complex recruitment. Early interventions should be considered in patients with UVFP with CT involvement. LEVEL OF EVIDENCE 2 Laryngoscope, 130:139-145, 2020.
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Affiliation(s)
- Tuan-Jen Fang
- Department of Otolaryngology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsiu-Feng Chuang
- Department of Otolaryngology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Hui-Chen Chiang
- Graduate School of Management, Ming Chun University, Taipei, Taiwan
| | - Yu-Cheng Pei
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.,Center for Vascularized Composite Allotransplantation, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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16
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Chen HC, Pei YC, Fang TJ. Risk factors for thyroid surgery-related unilateral vocal fold paralysis. Laryngoscope 2018; 129:275-283. [PMID: 30284255 PMCID: PMC6585753 DOI: 10.1002/lary.27336] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2018] [Indexed: 01/02/2023]
Abstract
Objectives/Hypothesis We aimed to identify the risk factors for iatrogenic unilateral vocal fold paralysis (UVFP) caused by thyroid surgery, to allow the identification of patients requiring nerve‐protection procedures and monitoring technologies. Study Design Retrospective case study in a medical center. Methods Patients who underwent thyroid surgery from April 2011 to February 2016 and who were diagnosed with UVFP by laryngoscopy and laryngeal electromyography were included. Patient demographics, types of surgery, and characteristics of the thyroid lesions were analyzed. Results Sixty (2.1%) of 2,815 patients who received thyroid surgery developed UVFP. The risk of UVFP was higher in patients over 60 years old (odds ratio, 1.89; 95% confidence interval, 1.01‐3.26; P = .01). Involvement of the external branch of superior laryngeal nerve (EBSLN) occurred in 19 (31.7%) of the 60 UVFP patients, and was more likely to occurr in patients with diabetes mellitus (odds ratio, 14.19; 95% confidence interval, 3.80‐52.94; P < .001). The incidence of UVFP and involvement of the EBSLN differed among surgery types, and was the highest among patients undergoing total thyroidectomy with neck dissection (TTND) (10/158, 6.3% and 5/158, 3.2%, respectively). Conclusions The risk of thyroid surgery–related UVFP is higher in older patients. EBSLN involvement is more likely in patients with diabetes mellitus. TTND is associated with higher risks of UVFP and EBSLN injury than other types of surgery, implying the need of intraoperative nerve monitoring in these high‐risk characteristics. Level of Evidence 4 Laryngoscope, 129:275–283, 2019
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Affiliation(s)
- Hung-Chun Chen
- From the Department of Otolaryngology-Head and Neck Surgery, Taoyuan, Taiwan
| | - Yu-Cheng Pei
- Department of Physical Medicine and Rehabilitation, Taoyuan, Taiwan.,Center of Vascularized Tissue Allograft, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,the Healthy Aging Research Center.,the School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tuan-Jen Fang
- From the Department of Otolaryngology-Head and Neck Surgery, Taoyuan, Taiwan.,the School of Medicine, Chang Gung University, Taoyuan, Taiwan
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Vila PM, Bhatt NK, Paniello RC. Early-injection laryngoplasty may lower risk of thyroplasty: A systematic review and meta-analysis. Laryngoscope 2018; 128:935-940. [DOI: 10.1002/lary.26894] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Peter M. Vila
- Department of Otolaryngology-Head and Neck Surgery; Washington University School of Medicine in St. Louis; St. Louis Missouri U.S.A
| | - Neel K. Bhatt
- Department of Otolaryngology-Head and Neck Surgery; Washington University School of Medicine in St. Louis; St. Louis Missouri U.S.A
| | - Randal C. Paniello
- Department of Otolaryngology-Head and Neck Surgery; Washington University School of Medicine in St. Louis; St. Louis Missouri U.S.A
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McLaughlin CW, Swendseid B, Courey MS, Schneider S, Gartner-Schmidt JL, Yung KC. Long-term outcomes in unilateral vocal fold paralysis patients. Laryngoscope 2017; 128:430-436. [DOI: 10.1002/lary.26900] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 08/11/2017] [Accepted: 08/14/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Conor W. McLaughlin
- Department of Otolaryngology-Head and Neck Surgery; University of California San Francisco; San Francisco California U.S.A
| | - Brian Swendseid
- Department of General Surgery; University of California San Francisco; San Francisco California U.S.A
| | - Mark S. Courey
- Department of Otolaryngology-Head and Neck Surgery; Icahn School of Medicine at Mount Sinai; New York New York U.S.A
| | - Sarah Schneider
- Department of Otolaryngology-Head and Neck Surgery; University of California San Francisco; San Francisco California U.S.A
| | - Jackie L. Gartner-Schmidt
- Department of Otolaryngology; University of Pittsburgh School of Medicine; Pittsburgh Pennsylvania U.S.A
| | - Katherine C. Yung
- Department of Otolaryngology-Head and Neck Surgery; University of California San Francisco; San Francisco California U.S.A
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Change to earlier surgical interventions: contemporary management of unilateral vocal fold paralysis. Curr Opin Otolaryngol Head Neck Surg 2016; 23:181-4. [PMID: 25943963 DOI: 10.1097/moo.0000000000000156] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The management of unilateral vocal fold paralysis has undergone significant changes in the last 2 decades. This has largely been made possible by advances in endoscope technology and new injectable materials. RECENT FINDINGS This article will cover the main changes in management of patients with unilateral vocal fold paralysis and summarize the recent literature in relation to early intervention in this group. Several recent studies have suggested that early vocal fold injection medialization reduces the likelihood of needing open laryngeal framework surgery in future. SUMMARY Early injection medialization appears to give good long-term results with few complications and minimizes the need for future laryngeal framework surgery. It should be considered in centres wherein the equipment and trained staff are available.
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Fang TJ, Hsin LJ, Chung HF, Chiang HC, Li HY, Wong AMK, Pei YC. Office-Based Intracordal Hyaluronate Injections Improve Quality of Life in Thoracic-Surgery-Related Unilateral Vocal Fold Paralysis. Medicine (Baltimore) 2015; 94:e1787. [PMID: 26448034 PMCID: PMC4616733 DOI: 10.1097/md.0000000000001787] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Thoracic-surgery-related unilateral vocal fold paralysis (UVFP) may cause severe morbidity and can cause profound functional impairment and psychosocial stress in patients with pre-existing thoracic diseases. In-office intracordal hyaluronate (HA) injections have recently been applied to improve voice and quality of life in patients with vocal incompetence, but their effect on thoracic-surgery-related UVFP remains inconclusive. We therefore conducted a prospective study to clarify the effect of early HA injection on voice and quality of life in patients with thoracic-surgery-related UVFP. Patients with UVFP within 3 months after thoracic surgery who received office-based HA injection were recruited. Quantitative laryngeal electromyography, videolaryngostroboscopy, voice-related life quality (voice outcome survey), laboratory voice analysis, and health-related quality of life (SF-36) were evaluated at baseline, and at 1 month postinjection. A total of 104 consecutive patients accepted office-based HA intracordal injection during the study period, 34 of whom were treated in relation to thoracic surgery and were eligible for inclusion. Voice-related life quality, voice laboratory analysis, and most generic quality of life domains were significantly improved at 1 month after in-office HA intracordal injection. No HA-related complications were reported. Single office-based HA intracordal injection is a safe and effective treatment for thoracic-surgery-related UVFP, resulting in immediate improvements in patient quality of life, voice quality, and swallowing ability.
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Affiliation(s)
- Tuan-Jen Fang
- From the Department of Otolaryngology, Chang Gung Memorial Hospital, Taipei (T-JF, L-JH, H-FC, H-YL); School of Medicine, Chang Gung University, Taoyuan (T-JF, L-JH, H-YL, AMKW, Y-CP); Department of Management, Graduate School, Ming Chung University (H-CC); Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital (AMKW, Y-CP); Healthy Aging Research Center, Chang Gung University (Y-CP); and Center of Biomedical Engineering, Chang Gung University, Taipei, Taiwan, ROC (Y-CP)
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