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Hernández-Sandemetrio R, Oishi N, López-Sánchez I, García-López I, Zapater E. Validation of the 10-Item Unilateral Vocal Fold Paralysis-Handicap Index quality of life questionnaire. Clin Otolaryngol 2024; 49:185-190. [PMID: 37926511 DOI: 10.1111/coa.14120] [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: 08/02/2023] [Accepted: 10/14/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES To validate and test the reliability of the 10-Item Unilateral Vocal Fold Paralysis-Voice Handicap Index (UVFP-HI-10) quality of life (QoL) questionnaire for patients with UVFP. DESIGN Prospective describe study based on perceptive surveys. PARTICIPANTS We recruited 61 patients with UVFP and 53 healthy individuals comprised the control group. MAIN OUTCOME MEASURES Both the patients and controls completed the UVFP-HI-10 questionnaire. A statistical analysis was performed to assess the internal consistency and validity of the survey. In addition, maximum phonation time (MPT) was used to objectively measure patient QoL. RESULTS Internal consistency was high (α = .914) and the correlation with MPT was significant (rs = -0.722). The estimated marginal mean in the discriminant validity study was around seven times higher in the UVFP group compared to the controls. The UVFP-HI-10 cut-off value was more than 0.9 and the sensitivity and specificity were more than 0.8. CONCLUSIONS The UVFP-HI-10 is a self-administered patient-reported outcome questionnaire with a high reliability and excellent criterion-based validity. This questionnaire can be used to evaluate specific clinical complaints (e.g., vocalisation, swallowing, and breathing) in terms of their impact on QoL in patients with UVFP. Thus, its use is appropriate as a basic assessment tool as part of a specific UVFP treatment protocol.
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Affiliation(s)
| | - Natsuki Oishi
- ENT Department, University General Hospital of Valencia, Valencia School of Medicine, Valencia, Spain
| | - Isabel López-Sánchez
- ENT Department, University General Hospital of Valencia, Valencia School of Medicine, Valencia, Spain
| | | | - Enrique Zapater
- ENT Department, University General Hospital of Valencia, Valencia School of Medicine, Valencia, Spain
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Wang H, Wang H, Li X, Xu W. MuRF-1 is Involved in Laryngeal Muscle Denervation Atrophy by Regulating G-Actin Ubiquitination. Laryngoscope 2024; 134:855-864. [PMID: 37658726 DOI: 10.1002/lary.31021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/05/2023] [Accepted: 08/16/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE Muscle RING-finger protein-1 (MuRF-1), an E3 ubiquitin ligase, has been reported to aggravate skeletal muscle denervated atrophy by mediating the ubiquitination degradation of multiple proteins, whereas the molecular mechanism underlying MuRF-1-mediated internal laryngeal muscle denervated atrophy remains unknown. METHODS A rat unilateral recurrent laryngeal nerve (RLN) transection model was established to evaluate denervated muscle atrophy of the larynx. The expression of MuRF-1, G- and F-actin in thyroarytenoid muscle (TA) myocytes before and after RLN injury was analyzed by immunofluorescence and Western blotting. Coimmunoprecipitation experiments detected molecular interactions between MuRF-1 and G-actin. Immunoprecipitation tested MuRF-1-mediated ubiquitination of G-actin in denervated and innervated TA muscle tissues. The shRNA-MuRF-1 AAV was used to suppress MuRF-1 expression in denervated TA muscles in vivo. RESULTS First, MuRF-1 expression was significantly elevated in denervated TA muscle compared to innervated TA muscle (p < 0.001). Second, there was a progressive increase in the G/F-actin ratio in TA myocytes from day 3 to 14 after RLNI (p < 0.01). Furthermore, colocalization of MuRF-1 and G-actin in denervated TA myocytes was observed. Moreover, the upregulation of MuRF-1 was closely associated with the ubiquitination of G-actin in denervated TA myocytes and muscle tissues. Knockdown of MuRF-1 decelerated the degree of TA muscle atrophy compared with that in the Blank and NC groups (p < 0.001) but seemed to promote the compensatory movement of the healthy side. CONCLUSION Collectively, we illustrate a novel molecular mechanism underlying MuRF-1-mediated internal laryngeal muscle denervated atrophy in that MuRF-1 could promote disequilibrium of the G/F-actin ratio by regulating G-actin ubiquitination. LEVEL OF EVIDENCE NA Laryngoscope, 134:855-864, 2024.
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Affiliation(s)
- Hong Wang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, China
| | - Haizhou Wang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, China
| | - Xueyan Li
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, China
| | - Wen Xu
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, China
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Niermeyer W, Diao G, Bielamowicz SA, Stager SV. Predicting Airflow from Measures Sensitive to Mid-cord Glottal Gap During the COVID-19 Pandemic. Ann Otol Rhinol Laryngol 2023; 132:1543-1549. [PMID: 37096374 DOI: 10.1177/00034894231170937] [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] [Indexed: 04/26/2023]
Abstract
OBJECTIVES To determine if trans-laryngeal airflow, important in assessing vocal function in paresis/paralysis and presbylarynges patients with mid-cord glottal gaps, could be predicted by other measures sensitive to mid-cord glottal gap size but with smaller risks of spreading COVID-19, and if any patient factors need consideration. METHODS Four populations were: unilateral vocal fold paresis/paralysis (UVFP, 148), aging and UVFP (UVFP plus aging, 22), bilateral vocal fold paresis/paralysis without airway obstruction (BVFP, 49), and presbylarynges (66). Five measures were selected from the initial clinic visit: mean airflow from repeated /pi/ syllables, longer of 2 /s/ and 2 /z/ productions, higher of 2 cepstral peak prominence smoothed for vowel /a/ (CPPSa), and Glottal Function Index (GFI). S/Z ratios were computed. Stepwise regression models used 3 measures and 5 patient factors (age, sex, etiology, diagnosis, and potentially impaired power source for voicing) to predict airflow. RESULTS Log-transformations were required to normalize distributions of airflow and S/Z ratio. The final model revealed age, sex, impaired power source, log-transformed S/Z ratio, and GFI predicted log-transformed airflow (R2 = .275, F[5,278] = 21.1; P < .001). CONCLUSIONS The amount of variance explained by the model was not high, suggesting adding other predictive variables to the model might increase the variance explained.
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Affiliation(s)
- Weston Niermeyer
- Division of Otolaryngology, The George Washington University, Washington, DC, USA
| | - Guoqing Diao
- Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Steven A Bielamowicz
- Division of Otolaryngology, The George Washington University, Washington, DC, USA
| | - Sheila V Stager
- Division of Otolaryngology, The George Washington University, Washington, DC, USA
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Lechien JR, Geneid A, Bohlender JE, Cantarella G, Avellaneda JC, Desuter G, Sjogren EV, Finck C, Hans S, Hess M, Oguz H, Remacle MJ, Schneider-Stickler B, Tedla M, Schindler A, Vilaseca I, Zabrodsky M, Dikkers FG, Crevier-Buchman L. Consensus for voice quality assessment in clinical practice: guidelines of the European Laryngological Society and Union of the European Phoniatricians. Eur Arch Otorhinolaryngol 2023; 280:5459-5473. [PMID: 37707614 DOI: 10.1007/s00405-023-08211-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 09/15/2023]
Abstract
INTRODUCTION To update the European guidelines for the assessment of voice quality (VQ) in clinical practice. METHODS Nineteen laryngologists-phoniatricians of the European Laryngological Society (ELS) and the Union of the European Phoniatricians (UEP) participated to a modified Delphi process to propose statements about subjective and objective VQ assessments. Two anonymized voting rounds determined a consensus statement to be acceptable when 80% of experts agreed with a rating of at least 3/4. The statements with ≥ 3/4 score by 60-80% of experts were improved and resubmitted to voting until they were validated or rejected. RESULTS Of the 90 initial statements, 51 were validated after two voting rounds. A multidimensional set of minimal VQ evaluations was proposed and included: baseline VQ anamnesis (e.g., allergy, medical and surgical history, medication, addiction, singing practice, job, and posture), videolaryngostroboscopy (mucosal wave symmetry, amplitude, morphology, and movements), patient-reported VQ assessment (30- or 10-voice handicap index), perception (Grade, Roughness, Breathiness, Asthenia, and Strain), aerodynamics (maximum phonation time), acoustics (Mean F0, Jitter, Shimmer, and noise-to-harmonic ratio), and clinical instruments associated with voice comorbidities (reflux symptom score, reflux sign assessment, eating-assessment tool-10, and dysphagia handicap index). For perception, aerodynamics and acoustics, experts provided guidelines for the methods of measurement. Some additional VQ evaluations are proposed for voice professionals or patients with some laryngeal diseases. CONCLUSION The ELS-UEP consensus for VQ assessment provides clinical statements for the baseline and pre- to post-treatment evaluations of VQ and to improve collaborative research by adopting common and validated VQ evaluation approach.
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Affiliation(s)
- Jerome R Lechien
- Department of Otolaryngology-Head Neck Surgery, Foch Hospital, University of Paris Saclay, Paris, France.
- Department of Otolaryngology-Head Neck Surgery, CHU Saint-Pierre, Brussels, Belgium.
- Department of Laryngology and Broncho-Esophagology, EpiCURA Hospital, Anatomy Department of University of Mons, Mons, Belgium.
- Phonetics and Phonology Laboratory (UMR 7018 CNRS, Université Sorbonne Nouvelle/Paris 3), Paris, France.
| | - Ahmed Geneid
- Department of Otolaryngology and Phoniatrics-Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jörg E Bohlender
- Department of Phoniatrics and Speech Pathology, Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Giovanna Cantarella
- Department of Otolaryngology and Head and Neck Surgery Fondazione, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health Università degli Studi di Milano, Milan, Italy
| | - Juan C Avellaneda
- Department of Surgery, Otolaryngology Service. Hospital Universitario Mayor Mederi, Universidad del Rosario, Bogotá, Colombia
| | - Gauthier Desuter
- ENT, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Elisabeth V Sjogren
- Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Camille Finck
- Department of Otorhinolaryngology-Head and Neck Surgery, CHU de Liege, Université de Liège, Liège, Belgium
| | - Stephane Hans
- Department of Otolaryngology-Head Neck Surgery, Foch Hospital, University of Paris Saclay, Paris, France
- Phonetics and Phonology Laboratory (UMR 7018 CNRS, Université Sorbonne Nouvelle/Paris 3), Paris, France
| | - Markus Hess
- Medical Voice Center (MEVOC), Hamburg, Germany
| | - Haldun Oguz
- Department of Otolaryngology, Fonomer, Ankara, Turkey
| | - Marc J Remacle
- Department of Otolaryngology-Head Neck Surgery, Foch Hospital, University of Paris Saclay, Paris, France
- Department of Otorhinolaryngology-Head and Neck Surgery, Center Hospitalier de Luxembourg, Eich, Luxembourg
| | | | - Miroslav Tedla
- Department of Otolaryngology, Head and Neck Surgery, Comenius University, University Hospital, Bratislava, Slovakia
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, Italy
| | - Isabel Vilaseca
- Department of Otorhinolaryngology, Hospital Clínic, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Michal Zabrodsky
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Motol, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Frederik G Dikkers
- Department of Otorhinolaryngology-Head and Neck Surgery, Amsterdam UMC Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Lise Crevier-Buchman
- Department of Otolaryngology-Head Neck Surgery, Foch Hospital, University of Paris Saclay, Paris, France
- Phonetics and Phonology Laboratory (UMR 7018 CNRS, Université Sorbonne Nouvelle/Paris 3), Paris, France
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Andersen HS, Egsgaard MH, Ringsted HR, Grøntved ÅM, Godballe C, Printz T. Normative Voice Range Profile of the Young Female Voice. J Voice 2023; 37:546-552. [PMID: 34049760 DOI: 10.1016/j.jvoice.2021.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 03/18/2021] [Accepted: 03/23/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Normative data are important in the clinical setting of Speech and Language Pathology. The purpose of this study was to develop a normative reference dataset of voice range profiles from young females. STUDY DESIGN Descriptive study including a prospective collection of voice range profile data. METHODS Voice range profile recordings from 39 females with healthy voices aged 18 to 28 years were conducted. Seven voice range profile variables were analyzed: minimum and maximum fundamental frequency and intensity, semitone and intensity ranges, and voice range profile area. Descriptive statistical methods were applied. RESULTS An age-specific voice range profile normative dataset was established. The mean values and standard deviations were as follows: semitone range 34.7 ± 3.9 ST, minimum fundamental frequency 143.6 ± 21.7 hertz, maximum fundamental frequency 1063.5 ± 160 hertz, intensity range 65.6 ± 5.0 dB, minimum intensity 43.2 ± 2.5 dB SPL, maximum SPL 108.9 ± 5.1 dB SPL, and voice range profile area 1346 ± 222 cells. CONCLUSION A normative dataset usable for optimization of future voice assessments has been established. It may especially benefit evaluation and treatment planning for younger females suffering from vocal fold nodules.
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Affiliation(s)
| | | | - Helena Rask Ringsted
- Department of ORL Head & Neck Surgery, Odense University Hospital, Odense C, Denmark
| | - Ågot Møller Grøntved
- Department of ORL Head & Neck Surgery, Odense University Hospital, Odense C, Denmark
| | - Christian Godballe
- Department of ORL Head & Neck Surgery, Odense University Hospital, Odense C, Denmark
| | - Trine Printz
- Department of ORL Head & Neck Surgery, Odense University Hospital, Odense C, Denmark
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Hasukawa A, Mochizuki R, Sakamoto H, Shibano A, Kitahara T. Type I Thyroplasty or Fat Injection Laryngoplasty Versus Arytenoid Adduction: Effects of Surgery on Voice Recovery in Patients With Unilateral Vocal Fold Paralysis. EAR, NOSE & THROAT JOURNAL 2023:1455613231176153. [PMID: 37203347 DOI: 10.1177/01455613231176153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Objective: Type I (medialization) thyroplasty (MT), fat injection laryngoplasty (FIL), and arytenoid adduction (AA) are the 3 most common surgical treatments for unilateral vocal fold paralysis (UVFP). While MT and FIL involve medialization of the paralyzed vocal fold, the goal of AA is to reduce the glottal-level difference. The current study compared the effects of these surgical treatments on voice quality in patients with UVFP. Methods: This retrospective study included 87 patients with UVFP who underwent MT (n = 12), FIL (n = 31), AA (n = 6), or AA with MT (n = 38). Patients who underwent the former 2 surgical treatments were included in the thyroplasty (TP) group, while those who underwent the latter 2 were included in the AA group. Maximum phonation time (MPT), pitch period perturbation quotient (PPQ), amplitude perturbation quotient, and harmonic-to-noise ratio (HNR) were evaluated in all patients before and 1 month after surgery. Results: The TP group exhibited significant improvements in MPT (P < .001) and PPQ (P = .012), while the AA group exhibited significant improvements in all parameters (P < .001). Before surgery, voice quality was significantly worse in the AA group than in the TP group for all measures. However, there were no significant differences between the groups after treatment. Conclusion: Surgeries in both groups were effective for voice recovery in patients with UVFP under the appropriate surgical selection. Our results also highlight the importance of preoperative evaluation and the potential value of etiology for selecting the appropriate procedure.
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Affiliation(s)
- Akihito Hasukawa
- Department of Otolaryngology and Head and Neck Surgery, Nara Medical University, Nara, Japan
- Department of Otolaryngology and Osaka Voice Center, Osaka Kaisei Hospital, Osaka, Japan
| | - Ryuichi Mochizuki
- Department of Otolaryngology and Head and Neck Surgery, Nara Medical University, Nara, Japan
- Department of Otolaryngology and Osaka Voice Center, Osaka Kaisei Hospital, Osaka, Japan
- Sakamoto ENT Clinic, Osaka, Japan
| | | | - Akira Shibano
- Department of Otolaryngology and Osaka Voice Center, Osaka Kaisei Hospital, Osaka, Japan
| | - Tadashi Kitahara
- Department of Otolaryngology and Head and Neck Surgery, Nara Medical University, Nara, Japan
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Smatanová K, Burián A, Dršata J, Krtičková J, Kőnig-Péter A, Mejzlík J, Chrobok V. Comparison of Short and Long-Term Results after Injection Laryngoplasty with Radiesse® Voice and Thyroplasty Type I in Unilateral Vocal Fold Palsy. ACTA MEDICA (HRADEC KRALOVE) 2023; 66:107-111. [PMID: 38511420 DOI: 10.14712/18059694.2024.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
OBJECTIVES Unilateral vocal fold palsy independently of etiology results in glottic insufficiency leading to unfavorable short or long-term impact on voice quality. Our aim was to evaluate the effect of injection laryngoplasty using Radiesse® Voice and thyroplasty type I on glottic closure, voice quality and aerodynamics by comparing preoperative, short- and long-term results. MATERIALS AND METHODS Data of 32 consent patients were reviewed between 2012 and 2023. All patients underwent either injection laryngoplasty (14 patients) or thyroplasty type I (18 patients) under local anesthesia. Maximum phonation time, glottic closure based on videolaryngostroboscopy, VHI-30 values and GRBAS scale were recorded prior, short-term (3 month) and long-term (12 months) after procedures for statistical comparison. Friedman test, Mann-Whitney test and Wilcoxon signed rank tests were used for statistical analysis. RESULTS In injection laryngoplasty group, we found significant improvement in maximum phonation time (p = 0.002), grade of hoarseness (p = 0.002) and breathiness (p = 0.000) when comparing results before and short-term after procedure. In thyroplasty type I group we saw significant improvement of maximum phonation time (p = 0.000), glottic insufficiency (p = 0.000), all three VHI-30 components (p = 0.000), as well as grade of hoarseness, breathiness (both p = 0.000) and roughness (p = 0.011) of GRBAS scale when comparing voice outcome before and short-term after procedure. There was no significant difference in voice outcome results neither between short and long-term results nor between the two groups in any parameter. CONCLUSION These results demonstrate both short and long-term efficiency of injection laryngoplasty and thyroplasty type I in the improvement of voice quality and glottic closure.
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Affiliation(s)
- Katarína Smatanová
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Hradec Králové, Charles University, Faculty of Medicine in Hradec Králové, Czech Republic.
- Department of Paediatric Otolaryngology, University of Pécs, Clinical Centre, Hungary.
| | - András Burián
- Department of Otolaryngology and Head and Neck Surgery, University of Pécs, Clinical Centre, Hungary
| | - Jakub Dršata
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Hradec Králové, Charles University, Faculty of Medicine in Hradec Králové, Czech Republic
| | - Jana Krtičková
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Hradec Králové, Charles University, Faculty of Medicine in Hradec Králové, Czech Republic
| | - Anikó Kőnig-Péter
- University of Pécs, Faculty of Medicine, Department of Bioanalysis, Hungary
| | - Jan Mejzlík
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Hradec Králové, Charles University, Faculty of Medicine in Hradec Králové, Czech Republic
| | - Viktor Chrobok
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Hradec Králové, Charles University, Faculty of Medicine in Hradec Králové, Czech Republic
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Dedry M, Dricot L, Van Parys V, Boucquey D, Delinte N, van Lith-Bijl J, Szmalec A, Maryn Y, Desuter G. Brain adaptation following various unilateral vocal fold paralysis treatments: A magnetic resonance imaging based longitudinal case series. Front Neurosci 2022; 16:947390. [PMID: 36278014 PMCID: PMC9580273 DOI: 10.3389/fnins.2022.947390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/17/2022] [Indexed: 12/02/2022] Open
Abstract
Aim Examination of central compensatory mechanisms following peripheral vocal nerve injury and recovery is essential to build knowledge about plasticity of the neural network underlying phonation. The objective of this prospective multiple-cases longitudinal study is to describe brain activity in response to unilateral vocal fold paralysis (UVFP) management and to follow central nervous system adaptation over time in three patients with different nervous and vocal recovery profiles. Materials and methods Participants were enrolled within 3 months of the onset of UVFP. Within 1 year of the injury, the first patient did not recover voice or vocal fold mobility despite voice therapy, the second patient recovered voice and mobility in absence of treatment and the third patient recovered voice and vocal fold mobility following an injection augmentation with hyaluronic acid in the paralyzed vocal fold. These different evolutions allowed comparison of individual outcomes according to nervous and vocal recovery. All three patients underwent functional magnetic resonance imaging (fMRI task and resting-state) scans at three (patient 1) or four (patients 2 and 3) time points. The fMRI task included three conditions: a condition of phonation and audition of the sustained [a:] vowel for 3 s, an audition condition of this vowel and a resting condition. Acoustic and aerodynamic measures as well as laryngostroboscopic images and laryngeal electromyographic data were collected. Results and conclusion This study highlighted for the first time two key findings. First, hyperactivation during the fMRI phonation task was observed at the first time point following the onset of UVFP and this hyperactivation was related to an increase in resting-state connectivity between previoulsy described phonatory regions of interest. Second, for the patient who received an augmentation injection in the paralyzed vocal fold, we subsequently observed a bilateral activation of the voice-related nuclei in the brainstem. This new observation, along with the fact that for this patient the resting-state connectivity between the voice motor/sensory brainstem nuclei and other brain regions of interest correlated with an aerodynamic measure of voice, support the idea that there is a need to investigate whether the neural recovery process can be enhanced by promoting the restoration of proprioceptive feedback.
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Affiliation(s)
- Marie Dedry
- Psychological Sciences Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
- *Correspondence: Marie Dedry,
| | - Laurence Dricot
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Vinciane Van Parys
- Neuromuscular Reference Center, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Donatienne Boucquey
- Otolaryngology, Head and Neck Surgery Department, Voice and Swallowing Clinic, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Nicolas Delinte
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
- Institute of Information and Communication Technologies, Electronics and Applied Mathematics (ICTM), Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | | | - Arnaud Szmalec
- Psychological Sciences Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
- Department of Experimental Psychology, Faculty of Psychology and Educational Science, Ghent University, Ghent, Belgium
| | - Youri Maryn
- Department of Otorhinolaryngology and Head and Neck Surgery, European Institute for ORL-HNS, Sint-Augustinus (GZA), Antwerp, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Faculty of Education, Health and Social Work, University College Ghent, Ghent, Belgium
- Phonanium, Lokeren, Belgium
| | - Gauthier Desuter
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
- Otolaryngology, Head and Neck Surgery Department, Voice and Swallowing Clinic, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
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Sjogren E, Hendriksma M, Piazza C, Hartl DM, Suarez C, Cohen O, de Bree R, Quer M, Poorten VV, Rodrigo JP, Civantos F, Genden E, Kowalski LP, Makitie A, Shaha A, Takes RP, Sanabria A, Guntinas-Lichius O, Rinaldo A, Ferlito A. Voice Outcome After Carbon Dioxide Transoral Laser Microsurgery for Glottic Cancer According to the European Laryngological Society Classification of Cordectomy Types - A Systematic Review. J Voice 2022:S0892-1997(22)00069-8. [PMID: 35422356 DOI: 10.1016/j.jvoice.2022.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/06/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Voice outcome after carbon dioxide transoral laser microsurgery (CO2TOLMS) for glottic cancer is of prime importance. However, a comprehensive overview according to the European Laryngological Society (ELS) classification of cordectomies is still lacking. The aim of this systematic review is to summarize data on voice outcome associated with individual types of ELS glottic cordectomy after CO2TOLMS. MATERIALS AND METHODS A systematic review of the literature was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. The initial search identified 936 records of which 25 publications were then included. Voice outcome data (Voice Handicap Index [VHI] version 30, grade of dysphonia [G] and maximum phonation time [MPT]) were extracted per resection type. Weighted averages were calculated. RESULTS Data show a gradual increase in the VHI scores although they were still similar for all cordectomy types (range 14.2 to 21.5). The grade of dysphonia showed a gradual increase with increasing resection depth (range 1.0 to 1.9). There was a gradual decrease in the MPT (range 15.2 to 7.2). CONCLUSION Voice outcome is related to cordectomy type with mild dysphonia characterizing ELS type I, II and III cordectomies, while more extended cordectomies (ELS type IV, V and VI) result in moderate dysphonia and shortness of breath during phonation. The voice handicap experienced by patients is limited even in the more extended cordectomies.
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Affiliation(s)
- Elisabeth Sjogren
- Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands.
| | - Martine Hendriksma
- Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Cesare Piazza
- Department of Otorhinolaryngology- Head and Neck Surgery, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Dana M Hartl
- Department of Otolaryngology Head and Neck Surgery, Institut Gustave Roussy and University Paris-Sud, Villejuif Cedex, France
| | - Carlos Suarez
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Oded Cohen
- Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Miquel Quer
- Department of Otorhinolaryngology and Head and Neck Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Vincent Vander Poorten
- Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium; Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Juan Pablo Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, IUOPA, University of Oviedo, Centro de Investigación Biomédica en Red de Cancer (CIBERONC), Oviedo, Spain
| | - Francisco Civantos
- Department of Otolaryngology-Head and Neck Surgery, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - Eric Genden
- Ear, Nose, Throat / Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Luiz P Kowalski
- Head and Neck Surgery and Otorhinolarynglology Department, A C Camargo Cancer Center, and Head and Neck Surgery Department, University of São Paulo Medical School
| | - Antti Makitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ashok Shaha
- Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia/Hospital Universitario San Vicente Fundación, Medellín, Colombia.; CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín, Colombia
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, Jena, Germany
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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Mes SD, Smajlović E, Heijnen BJ, Hendriksma M, Jansen JC, Langeveld APM, Sjögren EV. Multidimensional assessment of voice quality after injection augmentation of the vocal fold with autologous adipose tissue or calcium hydroxylapatite. Eur Arch Otorhinolaryngol 2021; 279:1967-1978. [PMID: 34846572 DOI: 10.1007/s00405-021-07193-7] [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] [Received: 09/28/2021] [Accepted: 11/17/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to evaluate short- and long-term outcome of injection augmentation with autologous adipose tissue (AAT) and calcium hydroxylapatite injection (CAHA) in patients with a unilateral vocal fold paralysis (UVFP). DESIGN/METHODS A retrospective cohort study was performed in patients diagnosed with UVFP, who had received injection augmentation with AAT or CAHA. Multidimensional voice analysis was performed before, 3 and 12 months after injection. This analysis included patient self-assessment (Voice Handicap Index-30), perceptual (overall dysphonia grade according to the GRBAS scale), aerodynamic (MPT, s/z ratio) and acoustic (fundamental frequency, dynamic range) parameters. Effects were assessed using a linear mixed model analysis. RESULTS Forty-six patients were available for evaluation, with a total of 53 injection augmentations (AAT n = 39; CAHA n = 14). We found significant improvement of patient self-assessment and perceptive voice outcome at 3 months, which were maintained at 12 months. In the CAHA group, s/z ratio and dynamic range of extreme frequencies also improved significantly over time. No statistically significant differences were found between the two treatments (AAT vs. CAHA). No major complications were reported. CONCLUSION This study, using a guide-line recommended panel of outcome parameters, shows a high success rate of injection augmentation with AAT or CAHA for patients with UVFP at 12 months with significant improvement in most voice outcome parameters, although voices do not completely normalize. There is no significant difference in outcome between the two materials.
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Affiliation(s)
- Stephanie D Mes
- Department of ENT, Head and Neck Surgery H5-Q, Leiden University Medical Center, Albinusdreef 2, Postbus 9600, 2300 RC, Leiden, The Netherlands.
| | - Edela Smajlović
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Bas J Heijnen
- Department of ENT, Head and Neck Surgery H5-Q, Leiden University Medical Center, Albinusdreef 2, Postbus 9600, 2300 RC, Leiden, The Netherlands
| | - Martine Hendriksma
- Department of ENT, Head and Neck Surgery H5-Q, Leiden University Medical Center, Albinusdreef 2, Postbus 9600, 2300 RC, Leiden, The Netherlands
| | - Jeroen C Jansen
- Department of ENT, Head and Neck Surgery H5-Q, Leiden University Medical Center, Albinusdreef 2, Postbus 9600, 2300 RC, Leiden, The Netherlands
| | - Antonius P M Langeveld
- Department of ENT, Head and Neck Surgery H5-Q, Leiden University Medical Center, Albinusdreef 2, Postbus 9600, 2300 RC, Leiden, The Netherlands
| | - Elisabeth V Sjögren
- Department of ENT, Head and Neck Surgery H5-Q, Leiden University Medical Center, Albinusdreef 2, Postbus 9600, 2300 RC, Leiden, The Netherlands
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Long-term voice outcomes of laryngeal framework surgery for unilateral vocal fold paralysis. Eur Arch Otorhinolaryngol 2021; 279:1957-1965. [PMID: 34787700 DOI: 10.1007/s00405-021-07177-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/03/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the short- and long-term voice outcomes after unilateral medialization thyroplasty (MT) and unilateral medialization thyroplasty with arytenoid adduction (MT + AA) in patients with unilateral vocal fold paralysis. METHODS Voice outcomes were assessed preoperatively, and postoperatively at 3 and 12 months according to a standardized protocol. Voice assessment was performed using Voice Handicap Index (VHI), GRBAS Grade, Maximum Phonation Time (MPT), s/z-ratio and subjective numeric rating scales on voice quality, effort, performance and influence on life. RESULTS Sixty-one patients were included (34 MT and 27 MT + AA). Significant pre- to postoperative improvements were seen in all voice outcome parameters. No significant differences in post-operative values were identified between the groups. CONCLUSION Based on our findings, we conclude that patients with unilateral vocal fold paralysis who undergo MT and MT + AA achieve comparable and significant long time voice improvement, although voices do not completely normalize. We also conclude that this does not mean that AA is a superfluous procedure, but can indicate the accurate identification of patients in need of the additional AA procedure based on clinical parameters.
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12
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Reksodiputro MH, Hutauruk SM, Koento T, Fardizza F, Hakim RYR, Audindra S, Yosia M. Randomised clinical trial: Effect of administering platelet-rich fibrin to autologous fat tissue in injection laryngoplasty for vocal cord paralysis. Ann Med Surg (Lond) 2021; 68:102564. [PMID: 34367634 PMCID: PMC8326719 DOI: 10.1016/j.amsu.2021.102564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 07/10/2021] [Accepted: 07/13/2021] [Indexed: 12/03/2022] Open
Abstract
The vocal cord in humans is essential in producing voice used in communication and interaction between us. Vocal cord paralysis causes dysphonia, which interferes with communication, causing disruptions towards social activity and daily activities. One of the managements for vocal cord paralysis is medialization and augmentation of the vocal cord through injection laryngoplasty. Autologous fat is one of the best fillers used in this procedure, but it is highly absorbable and can be reabsorbed very quickly when injected into body tissues. Platelet Rich Fibrin (PRF) is a biomaterial consisting of growth factors that are thought to improve fat tissue viability by increasing adipogenesis and angiogenesis. Improvement in fat viability will improve clinical outcomes after the laryngoplasty procedure, potentially reducing the number of repeated injections needed to achieve a satisfactory resolution to vocal cord paralysis. The study evaluates a combination of PRF and autologous microlobular fat compared with autologous microlobular fat alone on laryngoplasty. This single-blinded randomised control trial recruit a total of 18 patients, which are then randomised into the treatment and control groups. The evaluation was done via computerized acoustic analysis/Multidimensional Voice Program (MDVP) parameters and maximum phonation time. The MDVP results and maximum phonation time in both groups showed clinical improvement after the operation with no statistically significant differences. PRF and PRP are platelet-derived products commonly used tissue engineering procedure. PRF is an enhanced version of PRP believed to have superior growth factor release quality. Microlobular fat containing adipose stem cell is used as filler in injection laryngoplasty for medialization of vocal cord. This study observed combination of PRF and autologous microlobular fat filler for injection laryngoplasty. The MDVP results and maximum phonation time showed clinical improvement after the injection laryngoplasty.
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Affiliation(s)
- M H Reksodiputro
- Facial Plastic Reconstructive Division, Department of Otorhinolaryngology - Head and Neck Surgery, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia
| | - S M Hutauruk
- Larynx Pharynx Division, Department of Otorhinolaryngology - Head and Neck Surgery, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia
| | - T Koento
- Facial Plastic Reconstructive Division, Department of Otorhinolaryngology - Head and Neck Surgery, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia
| | - F Fardizza
- Larynx Pharynx Division, Department of Otorhinolaryngology - Head and Neck Surgery, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia
| | - R Y R Hakim
- Department of Otorhinolaryngology - Head and Neck Surgery, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia
| | - S Audindra
- Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia
| | - M Yosia
- Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia
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Aires MM, Marinho CB, Vasconcelos SJD. Surgical interventions for pediatric unilateral vocal fold paralysis: A systematic review and meta-analysis. Int J Pediatr Otorhinolaryngol 2021; 141:110553. [PMID: 33333340 DOI: 10.1016/j.ijporl.2020.110553] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate outcomes of injection laryngoplasty (IL) and laryngeal reinnervation for the treatment of pediatric Unilateral Vocal Fold Paralysis (UVFP), especially on swallowing and quality of voice. METHODS A literature review was performed in Medline/PubMed and Cochrane Library, following PRISMA guidelines, with no constraints on publication date. We included studies in English, Portuguese or Spanish about surgical treatment for UVFP on the pediatric population (0-21 years) that documented outcomes for one of the following techniques: IL or laryngeal reinnervation. Study characteristics, patient demographics, technical aspects of each procedure, complications, and outcomes for voice and swallowing were extracted. A meta-analysis with inverse variance, random-effects model was performed. RESULTS The PRISMA approach yielded 22 studies, totaling 267 patients. Seven reinnervation articles were included in meta-analysis for maximum phonation time (MPT) and quality of voice measured by Grade, Roughness, Breathiness, Asthenia and Strain (GRBAS) scale. Cardiac surgery had caused UVFP in 62.8% (142/226) of the cases. The main indication for IL was aspiration and for reinnervation was dysphonia. For IL, there was an improvement of 84.5% (confidence interval [CI] 82.6-88.4%) in swallowing and 81.4% (CI 74.6-88.1%) in voice. For reinnervation, there was an improvement of 91.6% (CI 88.2-94.9%) in swallowing and 96.8% (CI 95.5-98.0%) in voice. We found an increase of 6.19 s (CI 1.00 to 11.38) in MPT and a mean difference in GRBAS sum of -3.53 points (CI -6.15 to -0.91) after reinnervation. CONCLUSION Retrospective cohort studies suggest that injection laryngoplasty and reinnervation are both effective in improving swallowing and voice in children with UVFP. There was clinical evidence of improvement in the MPT and GRBAS scale meta-analysis in patients undergoing reinnervation.
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Affiliation(s)
- Mateus Morais Aires
- Department of Otolaryngology-Head and Neck Surgery of Hospital Das Clínicas da Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.
| | - Camila Barbosa Marinho
- Department of Otolaryngology-Head and Neck Surgery of Hospital Das Clínicas da Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Silvio José de Vasconcelos
- Department of Otolaryngology-Head and Neck Surgery of Hospital Das Clínicas da Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
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Hasukawa A, Mochizuki R, Sakamoto H, Shibano A, Kitahara T. Surgical effects of type-I thyroplasty and fat injection laryngoplasty on voice recovery. Auris Nasus Larynx 2020; 48:302-309. [PMID: 32958328 DOI: 10.1016/j.anl.2020.08.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/18/2020] [Accepted: 08/27/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Type-I thryroplasty, also known as medialization thyroplasty (MT) and autologous fat injection laryngoplasty (FIL) are one of the main surgical treatments for unilateral vocal fold paralysis (UVFP). Both procedures have the same concept of completing the glottal closure by medializing the vocal fold, although the surgical approaches are quite different. In order to assess these surgical effects, we examined the treatment outcomes and benefits of the two surgeries. METHODS We collected data from the 135 phonosurgeries that we performed out of 375 patients with UVFP at Osaka Voice Center, Osaka Kaisei Hospital from January 2009 to February 2013. After excluding cases with glottal level differences on phonation, either MT or FIL were performed on 80 cases. The inclusion criteria for the present study were: (1) patients had no history of previous phonosurgery, and (2) functional evaluations were available before/after surgery. Consequently, 43 participants (12 for MT and 31 for FIL) were enrolled in this study. Surgical effects were evaluated by means of the maximum phonation time (MPT), pitch period perturbation quotient (PPQ), amplitude perturbation quotient (APQ), and harmonic to noise ratio (HNR) just before, one month, and 6 months after surgery. RESULTS Both MT and FIL showed significant improvement in MPT (MT, p = 0.005; FIL, p < 0.001) and PPQ (MT, p = 0.047; FIL, p = 0.041) at 1 month postoperation. We also compared the variation of each variable between the two procedures, but there were no significant differences in these parameters. However, MPT, APQ, and HNR at the post-MT after 6 months worsened compared to those at 1 month posttreatment, whereas MPT showed only a slight decrease from the 1st month to the 6th month in those with FIL. CONCLUSION Both MT and FIL were effective for the voice recovery in patients with UVFP. Our findings suggest that surgical results in FIL might be better than those in MT 6 months after surgery, although there were no significant differences between these two procedures 1 month postoperation.
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Affiliation(s)
- Akihito Hasukawa
- Department of Otolaryngology and Head & Neck Surgery, Nara Medical University, 840 Shijo-cho, Kashihara-city, Nara 634-8522, Japan; Department of Otolaryngology and Osaka Voice Center, Osaka Kaisei Hospital, Japan.
| | - Ryuichi Mochizuki
- Department of Otolaryngology and Head & Neck Surgery, Nara Medical University, 840 Shijo-cho, Kashihara-city, Nara 634-8522, Japan; Department of Otolaryngology and Osaka Voice Center, Osaka Kaisei Hospital, Japan; Sakamoto ENT clinic, Japan
| | | | - Akira Shibano
- Department of Otolaryngology and Osaka Voice Center, Osaka Kaisei Hospital, Japan
| | - Tadashi Kitahara
- Department of Otolaryngology and Head & Neck Surgery, Nara Medical University, 840 Shijo-cho, Kashihara-city, Nara 634-8522, Japan
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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: 5] [Impact Index Per Article: 1.3] [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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Wang W, Sun J, Tang H, Gao Y, Chen S, Li M, Zheng H. Main branch of ACN-to-RLN for management of laryngospasm due to unilateral vocal cord paralysis. Laryngoscope 2019; 130:2412-2419. [PMID: 31782810 DOI: 10.1002/lary.28426] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/12/2019] [Accepted: 11/04/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS This study explored the feasibility and efficiency of main branch of ansa cervicalis nerve (ACN)-to-recurrent laryngeal nerve (RLN) anastomosis for management of paroxysmal laryngospasm due to unilateral vocal cord paralysis (UVCP). METHODS Thirteen patients who underwent main branch of ACN-to-RLN anastomosis for management of paroxysmal laryngospasm due to UVCP were enrolled in the present study. Multidimensional assessments, including videostroboscopy, voice assessment, and laryngeal electromyography (LEMG), were performed preoperatively and postoperatively. RESULTS This series was limited to UVCP with iatrogenic causes, including thyroidectomy, cervical spine surgery, and thoracic surgery. After main branch of ACN-to-RLN anastomosis, all cases showed significant airway improvement, and laryngospasm was completely abolished in 92.3% (12 of 13) of cases. Videostroboscopy showed that the bulging and paradoxical adduction of the affected vocal cord during a sniff were abolished immediately after operation, and there was no significant difference in vocal fold position or glottal closure before versus after the operation. LEMG showed that the postoperative recruitment and amplitude of voluntary motor unit potential in the affected thyroarytenoid muscle during a sniff were significantly decreased compared to preoperative values, and postoperative recruitment showed significant improvement during phonation compared to that preoperatively. Voice assessment showed that there were no significant differences in overall grade, roughness, breathiness, jitter (local), shimmer (local), noise-to-harmonics ratio, or maximum phonation time after the operation compared to the preoperative values. CONCLUSIONS Main branch of ACN-to-RLN anastomosis could have long-lasting efficacy in the management of paroxysmal laryngospasm due to UVCP, with no apparent compromise of voice quality. LEVEL OF EVIDENCE 4 Laryngoscope, 130:2412-2419, 2020.
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Affiliation(s)
- Wei Wang
- Department of Otolaryngology-Head & Neck Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, the People's Republic of China
| | - Jianxiong Sun
- Department of Otolaryngology-Head & Neck Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, the People's Republic of China
| | - Haihong Tang
- Department of Otolaryngology-Head & Neck Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, the People's Republic of China
| | - Yingna Gao
- Department of Otolaryngology-Head & Neck Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, the People's Republic of China
| | - Shicai Chen
- Department of Otolaryngology-Head & Neck Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, the People's Republic of China
| | - Meng Li
- Department of Otolaryngology-Head & Neck Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, the People's Republic of China
| | - Hongliang Zheng
- Department of Otolaryngology-Head & Neck Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, the People's Republic of China
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Ab Rani A, Azman M, Ubaidah MA, Mohamad Yunus MR, Sani A, Mat Baki M. Nonselective Laryngeal Reinnervation versus Type 1 Thyroplasty in Patients with Unilateral Vocal Fold Paralysis: A Single Tertiary Centre Experience. J Voice 2019; 35:487-492. [PMID: 31732294 DOI: 10.1016/j.jvoice.2019.09.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/21/2019] [Accepted: 09/26/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This study compared the voice outcomes of selected patients with unilateral vocal fold palsy (UVFP) who underwent either nonselective laryngeal reinnervation (LR) or Type 1 thyroplasty (thyroplasty) in a Malaysian tertiary centre using multidimensional voice assessments. PARTICIPANTS The study included 16 patients with UVFP who underwent either LR (9 patients) or thyroplasty (7 patients) between 2015 and 2018 who fulfilled the inclusion criteria. MAIN OUTCOME MEASURES The outcomes were measured subjectively and objectively with: (1) voice handicap index-10 (VHI-10- Malay version); (2) auditory perceptual evaluation using the breathiness component of Grade, Roughness, Breathiness, Asthenia, Strain scale; (3) maximum phonation time (MPT); and (4) acoustic analysis (jitter%, shimmer%, and NHR) using OperaVOXTM. The outcomes were measured at baseline, 6 and 12-months postoperative. The comparison of outcomes between pre and postoperative of each group was evaluated using one-way ANOVA test. Mann-Whitney test was used to compare the outcomes between the two groups. RESULTS Comparison of each group at different time points showed significant improvement of VHI-10 and MPT of LR group between baseline and 12 months (P ≤ 0.05) whereas, the improvement in thyroplasty group was observed at all time points (P ≤ 0.05). When comparing between the two groups at 12 months, the VHI-10 and MPT was significantly better in the LR group than thyroplasty group with P = 0.004 and P = 0.001 respectively. Other outcome measures did not reveal significant difference between the two groups. CONCLUSION This observational study showed that LR may be better than thyroplasty in improving VHI-10 and MPT in selected patients with UVFP.
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Affiliation(s)
- Azlina Ab Rani
- Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
| | - Mawaddah Azman
- Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
| | - Muhammad Azhan Ubaidah
- Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
| | - Mohd Razif Mohamad Yunus
- Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
| | - Abdullah Sani
- Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
| | - Marina Mat Baki
- Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia.
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Granato F, Martelli F, Comini LV, Luparello P, Coscarelli S, Le Seac O, Carucci S, Graziani P, Santoro R, Alderotti G, Barillari MR, Mannelli G. The surgical treatment of unilateral vocal cord paralysis (UVCP): qualitative review analysis and meta-analysis study. Eur Arch Otorhinolaryngol 2019; 276:2649-2659. [PMID: 31375895 DOI: 10.1007/s00405-019-05587-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/27/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE The objectives of this meta-analysis were to summarize the key surgical procedures for UVCP and to evaluate which of these is associated with better results in terms of vocal improvement. METHODS A systematic review of the literature was conducted in search of articles focused on the comparison of voice outcome between different techniques for the UVCP treatment. Then, a quantitative analysis was carried out for papers published from 2013 onwards, reporting only adult patients with unilateral paralysis for each study, and each surgical technique was evaluated for its capability of achieving good functional outcomes in terms of GRBAS-I scale and maximum phonation time in seconds (MPT). RESULTS The search identified 1853 publications. A total of 159 articles were stratified and included according to our selection criteria. 21 out of 159 articles were selected for quantitative synthesis. For trans-oral techniques: the mean GRBAS-I scale were 2.33 before injection and 0.41 after injection. The mean MPT before injection were 4.78 and 12.50 after injection. For open techniques the mean GRBAS-I scale were 2.43 before surgery and 0.68 after surgery. For open technique, the mean MPT were 3.50 before surgery and 12.40 after surgery. CONCLUSIONS The two types of techniques lead to an improvement in terms of vocal outcomes emphasizing that from the examined literature an indication emerges to perform an early injection because this could reduce the possible need for a more invasive intervention of permanent medialization in the future.
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Affiliation(s)
- F Granato
- Otorhinolaryngology Clinic, University of Florence, Florence, Italy
| | - F Martelli
- Otorhinolaryngology Clinic, University of Florence, Florence, Italy
| | - L V Comini
- Otorhinolaryngology Clinic, University of Florence, Florence, Italy
| | - P Luparello
- Otorhinolaryngology Clinic, University of Florence, Florence, Italy
| | - S Coscarelli
- Phoniatrics Unit, University Hospital Careggi, Florence, Italy
| | - O Le Seac
- Phoniatrics Unit, University Hospital Careggi, Florence, Italy
| | - S Carucci
- Phoniatrics Unit, University Hospital Careggi, Florence, Italy
| | - P Graziani
- Head and Neck and Robotic Surgery, Azienda Ospedaliero Universitaria Careggi, 50141, Florence, Italy
| | - R Santoro
- Head and Neck and Robotic Surgery, Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, CAP 50134, Firenze, Italy
| | - G Alderotti
- Department of Statistics Science, University "La Sapienza" of Rome, Rome, Italy
| | - M R Barillari
- Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuditta Mannelli
- Head and Neck and Robotic Surgery, Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, CAP 50134, Firenze, Italy.
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Desuter G, Cartiaux O, Pierard J, Henrard S, van Lith-Bijl J, van Benthem PP, Sjögren E. Accuracy of Thyroid Cartilage Fenestration During Montgomery Medialization Thyroplasty. J Voice 2019; 34:609-615. [PMID: 30658874 DOI: 10.1016/j.jvoice.2019.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/03/2019] [Accepted: 01/03/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Accuracy of thyroid cartilage fenestration during Montgomery thyroplasty (MTIS) is considered a key success factor. The primary aim of the study was to retrospectively evaluate the accuracy of fenestration. Furthermore, recent publications indicate a possible discrepancy in MTIS voice outcomes related to gender. The secondary aim of the study was to investigate whether the fenestration accuracy could explain this discrepancy. MATERIAL AND METHOD Study was performed by virtually drawing the fenestration on a 3D CT scan as proposed by the MTIS's instructions for use (the "expected window" (EW)), and comparing it to the actually realized fenestration (the "realized window "(RW)). Four position variables, (a) surface overlap (%), (b) the distances between RW and EW centers (mm), (c) the angle between RW and EW (°), and (d) the orientation of RW's center, were studied and compared to MPT (seconds) and VHI-30 scores outcomes. A descriptive statistical analysis and comparison between males and females were performed using a Mann-Whitney U test. Linear regression and multivariate analysis were also performed. RESULTS The median overlapping surface was 58.8 % [34.6; 75.4]. The median radius was 3.2 mm [1.7; 4.1]. The median angle was 16° [6.8; 21.2]. Results show no significant differences of overlapping surface percentage, distance, or angle by gender. Data show no correlation between voice outcome and percentage overlap, distance, or angle. However, data show better outcomes when fenestration was located in the infero-anterior orientation. All patients of this orientation were males. CONCLUSIONS Data provided by this study advocate a maximal infero-anterior positioning of the window during MTIS. This position is more difficult to obtain in female patients.
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Affiliation(s)
- Gauthier Desuter
- Otolaryngology, Head and Neck Surgery Department, Voice and Swallowing Clinic, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Otolaryngology, Head and Neck Surgery Department, Leidse Universitaire Medisch Centrum (LUMC), University of Leiden, Leiden, The Netherlands.
| | - Olivier Cartiaux
- Neuromusculoskeletal Lab (NMSK), Institut de Recherche Clinique et Expérimentale (IREC), Université catholique de Louvain, Brussels, Belgium
| | - Jonathan Pierard
- Neuromusculoskeletal Lab (NMSK), Institut de Recherche Clinique et Expérimentale (IREC), Université catholique de Louvain, Brussels, Belgium
| | - Séverine Henrard
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, and Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium
| | - Julie van Lith-Bijl
- Otolaryngology, Head and Neck Surgery Department, Voice and Swallowing Clinic, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Otolaryngology Deparment., Flevoziekenhuis, Almere, The Netherlands
| | - Peter Paul van Benthem
- Otolaryngology, Head and Neck Surgery Department, Leidse Universitaire Medisch Centrum (LUMC), University of Leiden, Leiden, The Netherlands
| | - Elisabeth Sjögren
- Otolaryngology, Head and Neck Surgery Department, Leidse Universitaire Medisch Centrum (LUMC), University of Leiden, Leiden, The Netherlands
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