Tracking outcomes after phonosurgery for sulcus vocalis: a case report

Diagnostic and therapeutic pitfalls in benign vocal fold diseases

More than half of patients presenting with hoarseness show benign vocal fold changes. The clinician should be familiar with the anatomy, physiology and functional aspects of voice disorders and also the modern diagnostic and therapeutic possibilities in order to ensure an optimal and patient specific management. This review article focuses on the diagnostic and therapeutic limitations and difficulties of treatment of benign vocal fold tumors, the management and prevention of scarred vocal folds and the issue of unilateral vocal fold paresis.

Nonlinear dynamic-based analysis of severe dysphonia in patients with vocal fold scar and sulcus vocalis

OBJECTIVE

The primary goal of this study was to evaluate a nonlinear dynamic approach to the acoustic analysis of dysphonia associated with vocal fold scar and sulcus vocalis.

STUDY DESIGN

Case-control study.

METHODS

Acoustic voice samples from scar/sulcus patients and age-/sex-matched controls were analyzed using correlation dimension (D2) and phase plots, time-domain based perturbation indices (jitter, shimmer, signal-to-noise ratio [SNR]), and an auditory-perceptual rating scheme. Signal typing was performed to identify samples with bifurcations and aperiodicity.

RESULTS

Type 2 and 3 acoustic signals were highly represented in the scar/sulcus patient group. When data were analyzed irrespective of signal type, all perceptual and acoustic indices successfully distinguished scar/sulcus patients from controls. Removal of type 2 and 3 signals eliminated the previously identified differences between experimental groups for all acoustic indices except D2. The strongest perceptual-acoustic correlation in our data set was observed for SNR and the weakest correlation was observed for D2.

CONCLUSIONS

These findings suggest that D2 is inferior to time-domain based perturbation measures for the analysis of dysphonia associated with scar/sulcus; however, time-domain based algorithms are inherently susceptible to inflation under highly aperiodic (ie, type 2 and 3) signal conditions. Auditory-perceptual analysis, unhindered by signal aperiodicity, is therefore a robust strategy for distinguishing scar/sulcus patient voices from normal voices. Future acoustic analysis research in this area should consider alternative (e.g., frequency- and quefrency-domain based) measures alongside additional nonlinear approaches.

Prospective multi-arm evaluation of surgical treatments for vocal fold scar and pathologic sulcus vocalis

OBJECTIVES/HYPOTHESIS

The purpose of this study was to compare the clinical effectiveness of type I thyroplasty, injection laryngoplasty, and graft implantation for the treatment of vocal fold scar and pathologic sulcus vocalis.

STUDY DESIGN

Prospective, multi-arm, quasi-experimental research design.

METHODS

Twenty-eight patients with newly diagnosed vocal fold scar and/or pathologic sulcus vocalis were assigned to one of three treatment modalities: type I thyroplasty (n = 9), injection laryngoplasty (n = 9), and graft implantation (n = 10). Psychosocial, auditory-perceptual, acoustic, aerodynamic, and videostroboscopic data were collected pretreatment and at 1, 6, 12, and 18 months posttreatment.

RESULTS

Type I thyroplasty and graft implantation both resulted in reduced voice handicap with no concomitant improvement in auditory-perceptual, acoustic, aerodynamic, or vocal fold physiologic performance. Injection laryngoplasty resulted in no improvement on any vocal function index. Patients who underwent graft implantation exhibited the slowest improvement trajectory across the 18-month follow-up period.

CONCLUSIONS

A persistent challenge in this area is that no single treatment modality is successful for the majority of patients, and there is no evidence-based decision algorithm for matching a given treatment to a given patient. Progress therefore requires the identification and categorization of predictive clinical features that can drive evidence-based treatment assignment.

Implantation of gelatin sponge combined with injection of autologous fat for sulcus vocalis

OBJECTIVE

To evaluate the effectiveness of gelatin sponge implantation combined with the injection of autologous fat for the treatment of sulcus vocalis.

STUDY DESIGN

Prospective cohort study.

SETTING

The research was conducted at the Eye, Ear, Nose, and Throat Hospital of Fudan University.

SUBJECTS AND METHODS

Twelve cases of sulcus vocalis were treated. The fibrotic tissue was dissected and a gelatin sponge was implanted into the affected vocal fold followed by injection of autologous fat. Videostroboscopy, maximum phonation time (MPT), and acoustic data were completed before and after surgery.

RESULTS

One month after surgery, the affected vocal fold displayed mild swelling, without evidence of a sulcus and with satisfactory glottal closure. Three months later, vocal vibration and mucosal wave were improved with the vocal fold displaying a more normal shape. Although voices did not achieve complete normalcy, the patients exhibited a better voice, with improved fundamental frequency, jitter, shimmer, normalized noise energy, and a significantly longer maximum phonation time (P < 0.05).

CONCLUSION

Implantation of gelatin sponge combined with injection of autologous fat can be used to treat sulcus vocalis. The absorbable gelatin sponge can be used to fill the superficial lamina propria temporarily to prevent the readhesion of the detached mucosa at the bottom of the sulcus to the underlying tissue, while the injected fat adequately diminishes the insufficient glottal closure.

Avaliação acústica e perceptivo-auditiva da voz nos momentos pré e pós-operatório da cirurgia de implante de pré-fáscia do músculo temporal

OBJETIVO: analisar os parâmetros vocais acústicos e perceptivo-auditivos que se alteram com a cirurgia de implante de pré-fáscia do músculo temporal para sulco vocal estria maior. MÉTODOS: registraram-se as emissões vocais de 9 pacientes, 6 do sexo feminino e 3 do masculino, nas condições pré e pós-tratamento cirúrgico. As amostras vocais foram submetidas à avaliação perceptivo-auditiva por três fonoaudiólogas com experiência na área de voz, por meio de consenso utilizando a escala GRBAS e a análise acústica espectrográfica foi realizada por meio de consenso entre três estudantes do curso de Fonoaudiologia após treinamento visual com a duração de três horas, utilizando o programa GRAM 5.1. RESULTADOS: houve tendência de a freqüência fundamental apresentar-se mais grave e o tempo máximo de fonação aumentou. Por meio da análise estatística observou-se que somente o parâmetro B apresentou melhora estatisticamente significante (t>1,734), os outros parâmetros G, R e S não mostraram melhora estatisticamente significante. Na análise espectrográfica observou-se que a forma e a continuidade do traçado permaneceram estáveis, a presença de ruído diminuiu e número de harmônicos aumentou. CONCLUSÃO: os pacientes submetidos à cirurgia de implante de Pré-Fáscia do Músculo Temporal apresentaram melhora no aspecto perceptivo-auditivo de soprosidade (B), na freqüência fundamental, tempo máximo de fonação e nos aspectos espectrográficos de presença de ruído e aumento do número de harmônicos, houve também tendência da freqüência fundamental apresentar-se mais grave após a cirurgia.

The psychosocial consequences of BOTOX injections for spasmodic dysphonia: a qualitative study of patients' experiences

OBJECTIVES/HYPOTHESIS

The purpose of this study is to examine the psychosocial consequences of BOTOX (Allergan, Inc. Irvine, CA) treatment for spasmodic dysphonia (SD). This article also explores how patients judge the success of treatment and make decisions about future treatment based on psychosocial issues relevant to them.

STUDY DESIGN

This study follows the phenomenological tradition of qualitative inquiry in which the objective is to explore the lived experiences of a group of persons who share a common phenomenon, in this case receiving BOTOX injections for SD.

METHODS

Six adults with SD who had been receiving BOTOX injections on a long-term basis participated in face-to-face interviews. The interviews were recorded, transcribed, and analyzed according to phenomenological guidelines to identify consistent themes as well as differences among participants' experiences.

RESULTS

The results are summarized in three primary themes that suggest (1) participants' experiences vary over time based on changes in factors such as lifestyle and personal priorities; (2) BOTOX has multidimensional psychosocial implications in physical, personal, and social domains; and (3) participants individualize their treatment regimens, taking into consideration the burden of treatment, scheduling priorities, and other strategies to maximize the benefits of BOTOX.

CONCLUSIONS

Based on this study, suggestions are provided for future research into a psychosocial outcome measurement, including longitudinal evaluations that accommodate changing patient priorities over time; multidimensional evaluations that incorporate physical, personal, and social issues; evaluations that include a measure of the burden of treatment; and evaluations that support a shared decision-making model with the voice clinicians.