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Ramírez Ruiz RD, Quintillá M, Sandoval M, León L, Costa JM, Quer M. Current opinion on laryngeal electromyography. Acta Otorrinolaringol Esp (Engl Ed) 2023:S2173-5735(23)00096-0. [PMID: 37913988 DOI: 10.1016/j.otoeng.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 07/03/2023] [Indexed: 11/03/2023]
Abstract
PURPOSE This study evaluates expert opinion on laryngeal electromyography (LEMG). METHODS A cross-sectional design was used to conduct an online survey of LEMG experts in 2021. They were questioned about the number LEMG performed annually, type of electrodes used, sector worked in, pain during the test, placement of the needle electrodes, interpretation of electrical muscle parameters, diagnosis of neuromuscular injury, prognostic sensitivity in vocal fold paralysis (VFP), laryngeal dystonia, tremor and synkinesis and quantifying LEMG. RESULTS Thirty-seven professionals answered (23 Spanish and 14 from other countries), with a response rate of 21.56%. All physicians used LEMG. 91.9% had one- or two-years' experience and 56.8% performed 10-40 LEMG per year. 70.3% were otolaryngologists and 27%, neurologists. In 89.1% of cases, a team of electrodiagnostic physician and otolaryngologist performed LEMG. 91.3% of Spanish respondents worked in Public Health, 7.14% of other nationalities; 37.8% in a university department. Bipolar concentric needles electrodes were used by 45.9% and monopolar concentric by 40.5%. 57% professionals considered good patients' tolerance to the test. LEMG sensitivity was regarded as strong, median and interquartile range were 80.0 [60.0;90.0] to diagnose peripheral nerve injuries, less for other levels of lesions, and strong to evaluate prognosis, 70.0 [50.0;80.0]. Respondents believe locate the thyroarytenoid and the cricothyroid muscles with the needle, 80.0 [70.0;90.0], as opposed to 20.0 [0.00;60.0] the posterior cricoarytenoid. The interpretation of the electrical parts of the LEMG was strong, 80.0 [60.0;90.0]. LEMG identify movements disorders, 60.0 [20.0;80.0], and synkinesis, 70.0 [30.0;80.0]. The professionals prefer quantitative LEMG, 90.0 [60.0;90.0]. CONCLUSIONS The experts surveyed consider LEMG that is well tolerated by patients. The insertional and spontaneous activity, recruitment and waveform morphology can be assessed easily. LEMG is mainly useful in the study of peripheral nerve injuries, and its value in VFP prognosis is considered strong.
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Affiliation(s)
| | - Mariam Quintillá
- Department of Neurology, Hospital Moisès Broggi de Sant Joan Despí, Barcelona, Spain
| | - Marta Sandoval
- Department of Otolaryngology, HospitalClínico, Barcelona, Spain
| | - Lucía León
- Department of Neurology, Hospital Moisès Broggi de Sant Joan Despí, Barcelona, Spain
| | | | - Miquel Quer
- Department of Otolaryngology, Hospital Santa Creu i Sant Pau, Barcelona, Spain
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Yao J, Zhou F, Cai L, Zhang G, Lin L, Zhao X, Gao N. Can Transcutaneous Laryngeal Ultrasonography Systematically Quantify Vocal Fold Movement?-A Feasibility Study. J Voice 2023:S0892-1997(23)00297-7. [PMID: 37867072 DOI: 10.1016/j.jvoice.2023.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/21/2023] [Accepted: 09/21/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVES Several studies have assessed adult vocal fold movement using transcutaneous laryngeal ultrasonography (TLUSG) during the perioperative period of thyroidectomy. However, the movement was not objectively quantified. This study aimed to provide a feasible and objective method for assessing vocal fold movement using TLUSG. STUDY DESIGN Feasibility study. METHODS TLUSG was performed during calm breathing and breath-holding in healthy adult volunteers. The morphology and anatomy of the larynx were observed and measured using an ultrasonic self-contained measurement function. At the end of the calm inspiratory and breath-holding phases, vocal fold angle, vocal fold length, distance from vocal process to the midline, distance from anterior vocal commissure to arytenoid cartilage, distance from false vocal fold to the midline, and distance from the anterior horn of thyroid cartilage to false vocal fold were measured. Data were analyzed using a t test (significance <0.05). RESULTS The ultrasonic images were satisfactory in all 40 healthy adult volunteers (age 19-35 years; body mass index 18.55-23.93 kg/m2; 20 men and 20 women). There were no significant differences in all laryngeal parameters between the left and right sides in both phases (P > 0.05). Moreover, all differences in laryngeal parameters between the end of the calm inspiratory phase and the breath-holding phase were statistically significant (P < 0.05), regardless of sex. CONCLUSION The relevant positional parameters of the vocal fold, arytenoid cartilage, and false vocal fold and their differences before and after vocal fold movement in healthy adult volunteers can be obtained objectively using TLUSG.
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Affiliation(s)
- Jing Yao
- Department of Ultrasound Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Fusheng Zhou
- Department of Gastroenterology, Huashan Hospital, Fudan University, Shanghai, China
| | - Lihui Cai
- Department of Otolaryngology-Head and Neck Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Guoliang Zhang
- Department of Otolaryngology-Head and Neck Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Lin Lin
- Department of Otolaryngology-Head and Neck Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Xia Zhao
- Department of Otolaryngology-Head and Neck Surgery, Huashan Hospital, Fudan University, Shanghai, China.
| | - Nan Gao
- Department of Otolaryngology-Head and Neck Surgery, Huashan Hospital, Fudan University, Shanghai, China.
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Candelo E, Menton S, Rutt A. Quantitative Analysis of Unilateral and Bilateral Vocal Fold Immobility. J Voice 2023:S0892-1997(23)00121-2. [PMID: 37121840 DOI: 10.1016/j.jvoice.2023.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVE To analyze the correlation between clinical and video laryngoscopy findings for 89 patients with bilateral vocal fold immobility (BVFI), unilateral vocal fold immobility (UVFI), and healthy controls by quantitative analysis of normalized laryngeal outlet (NLO), bowing index (BI), and supraglottic compression (SGC). METHODS Laryngoscope pictures were taken by two reviewers, and all pictures were standardized by scaling and calibrating to the same width and height in Image J. Three reviewers used quantitative measures to calculate BI, NLO, and SGC in Image J. We assessed reliability for each measurement by two-factor analysis of variance (ANOVA) without replication to calculate the interclass correlation coefficient. Analysis was broken down for each measurement in each group of interest by using a one-way test. The total glottic area was obtained by calculating the normalized glottal gap area from each image of maximum glottal closure during phonation. RESULTS Overall reliability of all the measurements was 0.69 (IQ 0.58-0.83). Mean NLO from UVFI, BVFI, and control groups differed significantly. There was no significant difference between control and BVFI. The total glottic area did not consistently predict normalized laryngeal outlet values. Mean normalized laryngeal outlet values of UVFI and BVFI were significantly smaller in the BVFI groups compared with controls and UVFI. BI values consistently predicted total glottic area in the BVFI group. Static SGC measurement did not predict a difference between groups. CONCLUSION This is a reliable novel technique, which can be utilized in clinical settings. These measurements have clinical relevance for managing voice disorders. NLO is the most accurate measurement correlating with glottal incompetence. BI findings are sufficiently specific to identify between UVFI and BVFI.
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Affiliation(s)
- Estephania Candelo
- Otolaryngology and Head-Neck Surgery Department, Mayo Clinic Jacksonville, Jacksonville, FL
| | - Stacey Menton
- Otolaryngology and Head-Neck Surgery Department, Mayo Clinic Jacksonville, Jacksonville, FL
| | - Amy Rutt
- Otolaryngology and Head-Neck Surgery Department, Mayo Clinic Jacksonville, Jacksonville, FL.
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Ayoub N, Balakrishnan K, Meister K, Grimm D, Johnson A, Maida K, Sidell DR. Safety and effectiveness of vocal fold injection laryngoplasty in infants less than one year of age. Int J Pediatr Otorhinolaryngol 2023; 168:111542. [PMID: 37058865 DOI: 10.1016/j.ijporl.2023.111542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 04/16/2023]
Abstract
INTRODUCTION Injection laryngoplasty (IL) is commonly performed for unilateral vocal fold immobility (UVFI). However, the safety and efficacy in patients <1 year of age are not widely recognized. This study analyzes the safety and swallow outcomes in a cohort of patients <1 year who underwent IL. METHODS This retrospective analysis evaluated patients at a tertiary children's institution between 2015 and 2022. Patients were eligible if they underwent IL for UVFI and were <1 year at time of injection. Baseline characteristics, perioperative data, oral diet tolerance, and preoperative and postoperative swallow data were collected. RESULTS 49 patients were included, 12 (24%) of whom were premature. The average age at injection was 3.9 months (SD 3.8), time from UVFI onset to injection 1.3 months (2.0), and weight at injection 4.8 kg (2.1). The baseline American Association of Anesthesiologists physical status classification scores were 2 (14%), 3 (61%), and 4 (24%). 89% of patients had improvements in objective swallow function postoperatively. Of the 35 patients who were preoperatively enterally-dependent and did not have medical circumstances precluding advancement to oral feeds, 32 (n = 91%) tolerated an oral diet postoperatively. There were no long-term sequelae. Two patients had intraoperative laryngospasm, one intraoperative bronchospasm, and one with subglottic and posterior glottic stenosis was intubated for <12 h for increased work of breathing. CONCLUSIONS IL is a safe and effective intervention that can reduce aspiration and improve diet in patients <1 year old. This procedure can be considered at institutions with the appropriate personnel, resources, and infrastructure.
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Affiliation(s)
- Noel Ayoub
- Lucile Packard Children's Hospital Pediatric Aerodigestive and Airway Reconstruction Center, USA; Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology Stanford University School of Medicine, USA.
| | - Karthik Balakrishnan
- Lucile Packard Children's Hospital Pediatric Aerodigestive and Airway Reconstruction Center, USA; Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology Stanford University School of Medicine, USA; Lucile Packard Children's Hospital Center for Pediatric Voice and Swallowing Disorders, USA
| | - Kara Meister
- Lucile Packard Children's Hospital Pediatric Aerodigestive and Airway Reconstruction Center, USA; Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology Stanford University School of Medicine, USA; Lucile Packard Children's Hospital Center for Pediatric Voice and Swallowing Disorders, USA
| | - David Grimm
- Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology Stanford University School of Medicine, USA
| | - April Johnson
- Lucile Packard Children's Hospital Pediatric Aerodigestive and Airway Reconstruction Center, USA; Lucile Packard Children's Hospital Center for Pediatric Voice and Swallowing Disorders, USA; Lucile Packard Children's Hospital Rehabilitation Services, USA
| | - Kelli Maida
- Lucile Packard Children's Hospital Rehabilitation Services, USA
| | - Douglas Ryan Sidell
- Lucile Packard Children's Hospital Pediatric Aerodigestive and Airway Reconstruction Center, USA; Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology Stanford University School of Medicine, USA; Lucile Packard Children's Hospital Center for Pediatric Voice and Swallowing Disorders, USA
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Aragón-Ramos P, García-López I, Santiago S, Martínez A, Gavilán J. Laryngeal electromyography, a useful tool in difficult cases of pediatric laryngeal mobility disorders. Int J Pediatr Otorhinolaryngol 2022; 161:111264. [PMID: 35969967 DOI: 10.1016/j.ijporl.2022.111264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/26/2022] [Accepted: 07/29/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Pediatric laryngeal mobility disorders constitute a challenge in terms of diagnosis and treatment, especially in small children and those complex patients with prior history of prolonged intubation or surgery. Laryngeal electromyography (L-EMG) may help to distinguish vocal fold paralysis from fixation. MATERIAL AND METHODS Ten children with laryngeal mobility disorders (including bilateral vocal fold immobility (BVFI) or unilateral vocal fold immobility (UVFI) with contralateral hypomobility) underwent suspension laryngoscopy and L-EMG between July 2019 and March 2021. The EMG data were acquired simultaneously in both thyroarytenoid muscles. Anesthesia was lightened until volitional activity appeared like cough, cry or spontaneous Valsalva maneuver. RESULTS We found secondary airway lesions in 2 patients and 3 vocal fold fixation. L-EMG recordings were pathologic in 4 patients (3 moderate and 1 severe nerve lesion). No recurrent laryngeal nerve injury was found in congenital BVFI cases. The data from both suspension laryngoscopy and L-EMG recordings influenced clinical decision-making. CONCLUSIONS L-EMG adds value to suspension laryngoscopy in the management of pediatric patients with laryngeal mobility disorders. Selected cases such as patients with iatrogenic BVFI, UVFI with associated contralateral hypomobility or patients with combined pathologies may obtain the greatest benefit.
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Affiliation(s)
- Paula Aragón-Ramos
- Pediatric Otolaryngology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046, Madrid, Spain.
| | - Isabel García-López
- Otolaryngology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046, Madrid, Spain.
| | - Susana Santiago
- Neurophysiology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046, Madrid, Spain.
| | - Almudena Martínez
- Neurophysiology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046, Madrid, Spain.
| | - Javier Gavilán
- Otolaryngology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046, Madrid, Spain.
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Voss S, Vutlapalli SC, Saalfeld P, Arens C, Janiga G. CFD simulations of inhalation through a subject-specific human larynx - Impact of the unilateral vocal fold immobility. Comput Biol Med 2022; 143:105243. [PMID: 35139455 DOI: 10.1016/j.compbiomed.2022.105243] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/13/2022] [Accepted: 01/17/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND The larynx of the human respiratory tract plays a vital role in breathing and voice production. Both can be influenced by functional and/or morphological changes of the larynx, e.g., immobility of one or both vocal folds (VF). The immobile VF can become stationary in different positions such as the median, paramedian, intermediate or lateral position. The impact of unilateral vocal fold immobility (UVFI) on inhalation is the focus of this study. METHODS Transient numerical simulations of the inhalation process in patient-specific airways are performed. Five configurations are considered: paramedian and intermediate VF positions on the left and right, and healthy. Large eddy simulations are used to describe the complex laryngeal turbulent flow. Airway resistance, power loss, and spectral entropy are calculated to quantify the work of inspiration and evaluate flow regimes. RESULTS The laryngeal jet intensity and flow disturbance increase with the severity of immobility. In comparison to the healthy configuration, UVFI with right/left intermediate and right/left paramedian VF position increases the airway resistance over the oropharynx to the trachea by 69%/58% and 310%/285%, respectively. When the entire respiratory system is considered, an increase of up to 48% is estimated. Spectral entropy increases of up to 2.5 times indicate higher turbulence levels due to UVFI. CONCLUSIONS Surgery of immobile VF aims to improve glottis closure. However, this can have a negative impact on breathing efficiency. To that end, this study provides initial insights into the conflicting objectives of open versus closed VFs.
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Affiliation(s)
- Samuel Voss
- Laboratory of Fluid Dynamics and Technical Flows, University of Magdeburg, Universitätsplatz 2, 39106, Magdeburg, Germany
| | - Swetha Chowdary Vutlapalli
- Laboratory of Fluid Dynamics and Technical Flows, University of Magdeburg, Universitätsplatz 2, 39106, Magdeburg, Germany; Mechanical and Aerospace Engineering, Monash University, Clayton, Australia
| | - Patrick Saalfeld
- Department of Simulation and Graphics, Faculty of Computer Science, University of Magdeburg, Universitätsplatz 2, 39106, Magdeburg, Germany
| | - Christoph Arens
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Giessen, Justus Liebig University Giessen, Germany
| | - Gabor Janiga
- Laboratory of Fluid Dynamics and Technical Flows, University of Magdeburg, Universitätsplatz 2, 39106, Magdeburg, Germany.
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Martínez-Martínez M, García-López I, Santiago-Pérez S. Vocal fold immobility with normal LEMG: A range of possibilities. Acta Otorrinolaringol Esp (Engl Ed) 2022; 73:77-81. [PMID: 35397827 DOI: 10.1016/j.otoeng.2020.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 12/01/2020] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The objective of this paper is to study the etiology of vocal fold immobility with non-pathological LEMG. METHODS A retrospective study was performed on patients who presented with vocal fold immobility and underwent LEMG from 2009 to 2017. Those patients with normal LEMG findings were selected. The different causes of vocal fold impairment were studied. RESULTS Of the 120 patients included in this study, 15 had a normal LEMG recording. The different etiologies of vocal fold immobility were idiopathic, central nervous system damage, iatrogenic, and external compression. CONCLUSIONS Vocal fold immobility and vocal fold paralysis are not equal terms. Vocal fold immobility with normal LEMG has a heterogeneous group of causes. It is not correct to assume that the major cause of immobility in patients with normal LEMG is always cricoarytenoid joint fixation.
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Affiliation(s)
- Marta Martínez-Martínez
- Department of Otolaryngology, IdiPAZ Health Research Institute, La Paz University Hospital, Madrid, Spain.
| | - Isabel García-López
- Department of Otolaryngology, IdiPAZ Health Research Institute, La Paz University Hospital, Madrid, Spain
| | - Susana Santiago-Pérez
- Department of Clinical Neurophysiology, Hospital Universitario La Paz, Madrid, Spain
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Hamdi OA, Jonas RH, Daniero JJ. Vocal Fold Paralysis Following COVID-19 Vaccination: Query of VAERS Database. J Voice 2022:S0892-1997(22)00017-0. [PMID: 35193788 PMCID: PMC8784575 DOI: 10.1016/j.jvoice.2022.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/13/2022] [Accepted: 01/18/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Vocal fold paresis or paralysis (VFP) may severely affect quality of life due to dysphonia and respiratory distress. As an increasing percentage of the United States population receives the COVID-19 vaccination, the objective of this study is to determine the correlation of COVID-19 postvaccination recurrent laryngeal neuropathy and resulting VFP. METHODS The Vaccine Adverse Event Reporting System database was queried for patients exhibiting symptoms of VFP following COVID-19 vaccination. Patient demographics and clinical information including presenting symptoms, time of symptom onset, time of diagnosis and laterality. RESULTS Twenty patients were found to have laryngoscopy confirmed VFP following COVID-19 vaccination. Vaccinations for Pfizer-BioNTech, Moderna, and Janssen were reported. Of those reported, 13 patients were female (65.0%) and seven were male (35.0%), with a mean age of 61.8 years. The most common presenting symptom was a hoarse voice (30.0%). A majority of these cases were unilateral in nature (64.0%). Mean time from vaccination to symptom onset was 12.1 days and mean time from vaccination to diagnosis was 37.6 days. CONCLUSION For patients presenting with voice or swallowing complaints after receiving the COVID-19 vaccine, prompt evaluation by an otolaryngologist should occur. However, the potential VFP side effect of vaccination is very rarely cited in the literature and largely outweighed by the benefits of vaccination. Further research is needed to delineate the exact pathophysiology of this complication and determine whether a causal relationship exists.
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Affiliation(s)
- Osama A Hamdi
- Department of Otolaryngology - Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Rachel H Jonas
- Department of Otolaryngology - Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - James J Daniero
- Department of Otolaryngology - Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia.
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Martínez-Martínez M, García-López I, Santiago-Pérez S. Vocal fold immobility with normal LEMG: A range of possibilities. Acta Otorrinolaringol Esp (Engl Ed) 2021; 73:S0001-6519(21)00033-9. [PMID: 34148655 DOI: 10.1016/j.otorri.2020.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/09/2020] [Accepted: 12/01/2020] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The objective of this paper is to study the etiology of vocal fold immobility with non-pathological LEMG. METHODS A retrospective study was performed on patients who presented with vocal fold immobility and underwent LEMG from 2009 to 2017. Those patients with normal LEMG findings were selected. The different causes of vocal fold impairment were studied. RESULTS Of the 120 patients included in this study, 15 had a normal LEMG recording. The different etiologies of vocal fold immobility were idiopathic, central nervous system damage, iatrogenic, and external compression. CONCLUSIONS Vocal fold immobility and vocal fold paralysis are not equal terms. Vocal fold immobility with normal LEMG has a heterogeneous group of causes. It is not correct to assume that the major cause of immobility in patients with normal LEMG is always cricoarytenoid joint fixation.
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Affiliation(s)
- Marta Martínez-Martínez
- Department of Otolaryngology, IdiPAZ Health Research Institute, La Paz University Hospital, Madrid, Spain.
| | - Isabel García-López
- Department of Otolaryngology, IdiPAZ Health Research Institute, La Paz University Hospital, Madrid, Spain
| | - Susana Santiago-Pérez
- Department of Clinical Neurophysiology, Hospital Universitario La Paz, Madrid, Spain
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Stanisz I, Leonhard M, Denk-Linnert DM, Schneider-Stickler B. Diagnostic limitation of laryngostroboscopy in comparison to laryngeal electromyography in synkinesis in unilateral vocal fold paralysis. Eur Arch Otorhinolaryngol 2021; 278:2387-2395. [PMID: 33689023 PMCID: PMC8165067 DOI: 10.1007/s00405-021-06714-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/22/2021] [Indexed: 11/08/2022]
Abstract
Purpose In clinical practice, laryngo(strobo)scopy (LS) is still mainly used for diagnostics and management of unilateral vocal fold paralysis (UFVP), although only laryngeal electromyography (LEMG) can provide information on causes of vocal fold immobility, especially on possible synkinetic reinnervation after recurrent laryngeal nerve (RLN) injury. The goal of this retrospective study was the evaluation whether signs of synkinetic reinnervation in LS can be objectified in comparison to LEMG data. Methods Between 1/2015 and 2/2018, 50 patients with laryngostroboscopically suspected UVFP received routine LEMG examination. The LEMG findings were retrospectively compared with LS findings. The LEMG data analysis focused on the diagnosis of synkinetic reinnervation of the TA/LCA and/or PCA. The digital LS recordings were retrospectively re-evaluated by phoniatricians considering 22 selected laryngostroboscopic parameters. Results LEMG revealed synkinesis in 23 (46%) and absence of synkinesis in 27 (54%) patients. None of the 22 parameters showed significant association between patients with synkinetic reinnervation and LS findings. The only laryngostroboscopic parameter that was significantly associated with a silent LEMG signal compared to single fiber activity in LEMG was a length difference on the side of the UVFP (p-value 0.0001; OR 14.5 (95% CI 3.047–66.81; Sensitivity 0.5; Specificity 0.9355). Conclusion Our findings show that synkinesis cannot be diagnosed using only LS. This study underlines the importance of LEMG in clinical routine for detection of laryngeal synkinesis in patients with UVFP before any further therapeutic steps are initiated to avoid later therapy failure.
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Affiliation(s)
- Isabella Stanisz
- Department of Otorhinolaryngology, Division of Phoniatrics and Speech Language Therapy, Medical University of Vienna/Vienna General Hospital, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Matthias Leonhard
- Department of Otorhinolaryngology, Division of Phoniatrics and Speech Language Therapy, Medical University of Vienna/Vienna General Hospital, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Doris-Maria Denk-Linnert
- Department of Otorhinolaryngology, Division of Phoniatrics and Speech Language Therapy, Medical University of Vienna/Vienna General Hospital, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Berit Schneider-Stickler
- Department of Otorhinolaryngology, Division of Phoniatrics and Speech Language Therapy, Medical University of Vienna/Vienna General Hospital, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Nasir ZM, Azman M, Baki MM, Mohamed AS, Kew TY, Zaki FM. A proposal for needle projections in transcutaneous injection laryngoplasty using three-dimensionally reconstructed CT scans. Surg Radiol Anat 2021; 43:1225-33. [PMID: 33388863 DOI: 10.1007/s00276-020-02639-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 11/21/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE This study aims to determine laryngeal dimension in relation to all three transcutaneous injection laryngoplasty (TIL) approaches (thyrohyoid, transthyroid and cricothyroid) using three-dimensionally reconstructed Computed Tomography (CT) scan and compare the measurements between sex, age group and ethnicity. METHODS CT scans of the neck of two hundred patients were analysed by two groups of raters. For thyrohyoid approach, mean distance from the superior border of the thyroid cartilage to the laryngeal cavity (THd) and mean angle from the superior border of the thyroid cartilage to mid-true cords (THa) were measured. For transthyroid approach, mean distance from mid-thyroid cartilage to mid-true cords (TTd) and Hounsfield unit (HU) at mid-thyroid cartilage (TTc) were measured. For cricothyroid approach, mean distance from the inferior border of the thyroid cartilage to the laryngeal cavity (CTd) and mean angle from the inferior border of the thyroid cartilage to mid-true cords (CTa) were measured. RESULTS There were statistically significant differences between males and females for all measurements except for CTa (p < 0.0001). No significant difference across age groups and ethnicities were found for all three approaches (p > 0.05). There was a significant fair positive correlation between age and TTc (p = 0.0002). For all measurements obtained, there were moderate to excellent inter-group consistency and intra-rater reliability. CONCLUSION This study demonstrated a significant sex dimorphism that may influence the three TIL approaches except for needle angulation in the cricothyroid approach. The knowledge of laryngeal dimension is important to increase success in TIL procedure.
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耿 志, 高 为, 王 东. [Clinical outcomes of vocal fold immobility after tracheal intubation]. Beijing Da Xue Xue Bao Yi Xue Ban 2020; 53:337-340. [PMID: 33879908 PMCID: PMC8072416 DOI: 10.19723/j.issn.1671-167x.2021.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To assess the incidence of postoperative vocal cord immobility in patients following endotracheal intubation underwent general anesthesia. METHODS We retrospectively enrolled patients who underwent surgical procedures with endotracheal intubation under general anesthesia from January 2014 to December 2018 in Peking University First Hospital. Demographic and treatment data were obtained for patients with hoarseness and vocal cord fixation. The incidence of postoperative hoarseness and vocal cord fixation were presented and clinical outcomes were further analyzed. RESULTS A total of 85 998 patients following tracheal intubation and general anesthesia were enrolled in this study. Hoarseness was observed in 222 (0.26%) patients postoperatively. Sixteen patients (73%) were accomplished with symptoms of choking on water, dysphonia and sore throat. Twenty-nine patients with persistent hoarseness on the third postoperative day needed further treatment by otolaryngologists. Among them, seven patients had pharyngolaryngitis and twenty-two patients (0.026%) were demonstrated postoperative vocal cord immobility. There were seventeen patients (77%) with left-side vocal cord fixation and five patients (23%) with right-side vocal cord fixation. Nine patients were identified with arytenoid dislocation. Seven patients had left vocal cord fixation and two patients had right-side vocal cord fixation. Seven patients were intubated under the guidance of visual laryngoscope. One patient was confirmed difficult airway and intubated with light wand. One patient was inserted with laryngeal mask airway. One patient was suspected to have hoarseness caused by gastric tube before anesthesia. One patient showed simultaneously left recurrent laryngeal nerve abnormality on laryngeal electromyography result. The symptom of hoarseness ranged between 6 and 31 days. Three patients underwent closed reduction under local anesthesia and one patient demonstrated spontaneous recovery. Among the remaining thirteen patients with vocal cord immobility, two patients were demonstrated vocal cord paralysis. Eleven patients underwent neck surgery, thyroid surgery and cardiothoracic surgery and further examinations including laryn-geal electromyography and computed tomography help to determine the diagnosis were not performed. All patients were treated with inhaled corticosteroid conservatively. Five patients had significant improvement of symptom and almost regained normal voice. One patient had slight improvement and sixteen patients were not relieved before discharge. CONCLUSION Patients with hoarseness and vocal fold immobility after endotracheal intubation should be treated properly and immediately.
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Affiliation(s)
- 志宇 耿
- 北京大学第一医院麻醉科,北京 100034Department of Anesthesiology, First Hospital, Peking University, Beijing 100034, China
| | - 为华 高
- 北京大学第一医院耳鼻喉与头颈外科,北京 100034Department of Otolaryngology-Head and Neck Surgery, First Hospital, Peking University, Beijing 100034, China
| | - 东信 王
- 北京大学第一医院麻醉科,北京 100034Department of Anesthesiology, First Hospital, Peking University, Beijing 100034, China
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Kneisz L, Volk GF, Mayr W, Leonhard M, Pototschnig C, Schneider-Stickler B. Objectivation of laryngeal electromyography (LEMG) data: turn number vs. qualitative analysis. Eur Arch Otorhinolaryngol 2020; 277:1409-15. [PMID: 32067097 DOI: 10.1007/s00405-020-05846-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 02/04/2020] [Indexed: 11/18/2022]
Abstract
Purpose This paper describes a first attempt to quantify LEMG data based on turn number calculation. The results obtained for both healthy and ailing thyroarytenoid (TA) muscles of patients with unilateral vocal fold immobility (UVFI) were compared with the respective qualitative evaluation concerning volitional activity to determine whether the two types of analyses deliver similar results. Methods LEMG data obtained from 44 adults with UVFI were considered for the study. Semiquantitative evaluation of TA volitional activity and turn number were assessed for the ailing and the healthy TA and the difference in percentage was calculated. Paired data were compared with the Wilcoxon signed-rank test. The volitional activity assessment and the turn number evaluation were compared with the Kruskal–Wallis test, and their relationship was tested with the Kendall rank correlation. Results Datasets of 27 patients were considered compatible with turns/s calculation. The results showed that complete paralysis correlated with no turns; single fiber volitional activity with 62–208 turns/s, strongly decreased volitional activity with 198–501 turns/s; and dense volitional activity with 441–1234 turns/s. On the ailing VF only, the Kruskal–Wallis test showed a statistically significant difference (p = 0.0001), and the Kendall rank correlation a positive relationship (r = 0.853,p ≤ 0.0001) between the volitional activity rating and the turn number assessment. Conclusions Our preliminary results showed that turn number evaluation is an effective tool to confirm LEMG qualitative analysis, and that, in combination with laryngostroboscopy and voice assessment, can help improving the accuracy of the diagnosis and prognosis and the effectiveness of the chosen therapy.
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Viana Baptista SIR, Lott DG, Almeida SCC, Cid MO, Vera-Cruz PS, Zagalo C. Preoperative Voice Characteristics in Thyroid Patients. J Voice 2020; 35:809.e1-809.e6. [PMID: 32005624 DOI: 10.1016/j.jvoice.2019.12.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 12/24/2019] [Accepted: 12/26/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Thyroid surgery outcomes have evolved from mortality control strategies to morbidity control measures. Most vocal outcomes research in thyroid surgery are focused on recurrent nerve anatomic and functional preservation. However, there are likely multiple causes of vocal dysfunction in thyroid patients. We prospectively analyzed preoperative patients with thyroid disease to define preoperative vocal characteristics of this population. OBJECTIVE Quantify vocal and laryngeal baseline conditions in thyroid surgical patients. METHODS Prospective study of preoperative stroboscopy findings and vocal function assessing the correlation between thyroid disease, compressive symptoms, baseline vocal conditions and laryngoscopy results. RESULTS Vocal quantitative scores were positive for dysphonia in 36% of patients and the Vocal Handicap Index confirmed either slight or Moderate impairment in most patients. Stroboscopy results were abnormal in 60% of cases with no diagnoses of immobility. Correlation was established for diagnosis of cancer and the absence of symptoms. CONCLUSIONS These results point to a multifactorial cause for vocal impairment in thyroid surgery patients. Research on vocal impairment in thyroid surgery should not be centered exclusively on recurrent nerve neuromonitoring and functional preservation, but also on other variables that may contribute to vocal change in thyroid disease and surgery.
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Affiliation(s)
- Sara I R Viana Baptista
- Serviço de Otorrinolaringologia, Hospital da Luz, Lisboa, Portugal; Nova Medical School, Lisboa, Portugal.
| | - David G Lott
- Department of Otorhinolaryngology, Mayo Clinic Arizona, Arizona
| | | | | | - Paulo S Vera-Cruz
- Serviço de Otorrinolaringologia, Hospital da Luz, Lisboa, Portugal; Nova Medical School, Lisboa, Portugal
| | - Carlos Zagalo
- Instituto Português de Oncologia de Francisco Gentil, Lisboa, Portugal CiiEM- Centro de Investigação Interdisciplinar de Egas Moniz, Monte da Caparica, Portugal
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Pinna BR, Herbella FAM, de Biase N. Pharyngeal motility in patients submitted to type I thyroplasty. Braz J Otorhinolaryngol 2020; 87:538-544. [PMID: 31932212 PMCID: PMC9422657 DOI: 10.1016/j.bjorl.2019.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/09/2019] [Accepted: 11/22/2019] [Indexed: 11/28/2022] Open
Abstract
Introduction Type 1 thyroplasty is performed to improve glottis closure as well as dysphagic symptoms in patients with unilateral vocal fold immobility. Objectives This study aims to compare the motility of the pharynx and upper esophageal sphincter in patients with unilateral vocal fold immobility before and after thyroplasty Type I. Methods We prospectively studied 15 patients with unilateral vocal fold immobility who underwent thyroplasty Type I. Subjects were divided according to the topography of vagal injury and presence of dysphagia. High resolution manometry was performed before and 30 days after surgery. Time and pressure manometric parameters at the topography of the velopharynx, epiglottis and upper esophageal sphincter were recorded. Results Dysphagia was present in 67% of patients. 63% had lower vagal injuries. Manometric parameters did not change after thyroplasty for the whole population. The group of dysphagic patients, however, had an increase in residual pressure at the upper esophageal sphincter after thyroplasty (1.2 vs. 5.2 mmHg; p = 0.05). Patients with low vagal injury developed higher peak pressure (100 vs. 108.9 mmHg p ≤ 0.001), lower rise time (347 vs. 330 ms p = 0.04), and higher up stroke (260 vs. 266.2 mmHg/ms p = 0.04) at the topography of the velopharynx after thyroplasty. Conclusion Pharyngeal motility is affected by thyroplasty Type I in patients with dysphagia and low vagal injury.
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Affiliation(s)
- Bruno Rezende Pinna
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil.
| | - Fernando A M Herbella
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Cirurgia, São Paulo, SP, Brazil
| | - Noemi de Biase
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil; Pontifícia Universidade Católica de São Paulo, São Paulo, SP, Brazil
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Rohlfing ML, Anderson TD, Noordzij JP. Magnetic Laryngeal Reanimation as a Novel Treatment of Vocal Fold Immobility. J Voice 2021; 35:151-5. [PMID: 31350114 DOI: 10.1016/j.jvoice.2019.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/01/2019] [Accepted: 07/02/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Vocal fold paralysis may result from surgical complications, trauma, tumor, or unknown causes. When both cords are affected, paramedian fixation can lead to life-threatening obstruction. Current treatments, including tracheostomy, cordotomy, and arytenoidectomy, compromise speech and swallow function to maintain a safe airway. To preserve all three critical laryngeal functions, Otolaryngologists need a solution for bilateral vocal fold paralysis that restores motion. This study uses implantable electromagnet technology to create dynamic vocal fold movement in a proof-of-concept, preliminary model. METHODS A prototype was constructed from a neodymium disk magnet and cylindrical solenoid electromagnet coupled to a battery and 3-way switch. The disk magnet was implanted in an ex vivo porcine larynx model lateral to the arytenoid, affixed with suture. The electromagnet was seated in a window cut in the thyroid cartilage. RESULTS By driving current in two directions through the electromagnet, the vocal fold was successfully moved towards and away from the electromagnet. The neutral vocal fold opening was 5.8 mm, and the maximal opening was 7.7 mm, representing a 31.4% increase in the cross-sectional area of the glottis. CONCLUSION This model demonstrated proof of concept of a magnetic laryngeal reanimation device. The full device will include a respiratory effort sensor and implantable processor to time the action of the magnets with respirations. There is currently no effective treatment to re-establish vocal fold motion in patients with vocal fold paralysis. This system has the potential to give patients with bilateral vocal fold paralysis a surgical option to restore vocal fold motion.
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Matsushima K, Ohira S, Matsui H, Fukuo A, Honma N, Wada K, Matsuura K. IgG4-related disease with pseudotumor formation in the larynx. Auris Nasus Larynx 2019; 47:305-308. [PMID: 31230814 DOI: 10.1016/j.anl.2019.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 03/15/2019] [Accepted: 05/28/2019] [Indexed: 12/24/2022]
Abstract
Mikulicz's disease, an immunoglobulin G4-related disease (IgG4-RD) occurs frequently in the head and neck region but rarely in the larynx. We report a case of IgG4-RD with pseudotumor formation in the larynx. A 50-year-old man presented at our facility for a complete physical examination and diagnostic testing of a left arytenoid tumor. On examination, a large supraglottic mass was noted with signs of dyspnea. Movement disorder of the vocal fold was absent. The patient underwent surgery with general anesthesia to improve respiratory symptoms and a resected specimen was submitted for diagnosis. The pathology findings revealed lymph follicle formation, interstitial follicular fibrosis, angiogenesis, and inflammatory cell infiltration with plasmacytosis. Immunohistologic staining at high magnification revealed one hundred or more IgG4-positive plasma cells and fifty percent IgG4/IgG. In addition, obliterative phlebitis was observed. Medical history was positive for retroperitoneal fibrosis with serum IgG4 levels below the diagnostic criteria of IgG4-RD, but histological characteristics of IgG4-RD were met. The diagnosis of IgG4-RD was established, oral treatment with prednisolone (0.6 mg/kg/day) was initiated, and the tumor reduced in size. IgG4-RD may cause irreversible functional impairment. Early diagnosis and treatment are important in reducing the risk of permanent impairment of vocal fold mobility.
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Affiliation(s)
- Koji Matsushima
- Department of Otolaryngology, Toho University School of Medicine, Tokyo, Japan.
| | - Shinya Ohira
- Department of Otolaryngology, Toho University School of Medicine, Tokyo, Japan
| | - Hidehito Matsui
- Department of Otolaryngology, Toho University School of Medicine, Tokyo, Japan
| | - Akira Fukuo
- Department of Otolaryngology, Toho University School of Medicine, Tokyo, Japan
| | - Naoko Honma
- Department of Pathology, Toho University School of Medicine, Tokyo, Japan
| | - Kota Wada
- Department of Otolaryngology, Toho University School of Medicine, Tokyo, Japan
| | - Kentaro Matsuura
- Department of Otolaryngology, Toho University School of Medicine, Tokyo, Japan
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18
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Ringel B, Horowitz G, Shilo S, Carmel Neiderman NN, Abergel A, Fliss DM, Oestreicher-Kedem Y. Acute supraglottic laryngitis complicated by vocal fold immobility: prognosis and management. Eur Arch Otorhinolaryngol 2019; 276:2507-2512. [PMID: 31214824 DOI: 10.1007/s00405-019-05508-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 06/05/2019] [Indexed: 05/30/2023]
Abstract
PURPOSE Acute supraglottic laryngitis (ASL) is manifested by supraglottic inflammation that has the potential for rapid and fatal airway obstruction. Complete/incomplete vocal fold immobility (VFIm) in the setting of ASL may contribute to airway obstruction. The rate of VFIm complicating ASL is not known, and it is not clear whether its occurrence alters the course and the management of ASL, particularly the need to secure the airway (by endotracheal intubation/tracheostomy). This study seeks to describe the natural history of VFIm associated with ASL (ASLIm) and to determine the added effect of VFIm on ASL severity, management, and the need for intervention to secure the airway. METHODS This is a retrospective cohort study in a tertiary referral center. The medical records of all patients hospitalized due to ASL between January 2007 and December 2016 were reviewed. RESULTS Of the 214 patients admitted due to ASL, VFIm was identified in 9 (4.2%). The VFIms resolved within 1-90 days in all 8 patients with available follow-up of 1-3 months. One patient required endotracheal intubation. The 9 ASLIm patients had significantly higher rates of hoarseness and a history of diabetes mellitus. There was no group difference in the need to secure the airway. CONCLUSIONS VFIm is an apparently uncommon finding among patients with ASL. It appears to be usually transient, short-lasting, and full recovery can be expected. VFIm did not alter the ASL course, nor did it put our patients at increased risk for the need for intervention to secure the airway. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Barak Ringel
- The Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel-Aviv University, 6 Weizman St., Tel-Aviv, 6423906, Israel
| | - Gilad Horowitz
- The Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel-Aviv University, 6 Weizman St., Tel-Aviv, 6423906, Israel
| | - Shahaf Shilo
- The Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel-Aviv University, 6 Weizman St., Tel-Aviv, 6423906, Israel
| | - Narin N Carmel Neiderman
- The Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel-Aviv University, 6 Weizman St., Tel-Aviv, 6423906, Israel
| | - Avraham Abergel
- The Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel-Aviv University, 6 Weizman St., Tel-Aviv, 6423906, Israel
| | - Dan M Fliss
- The Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel-Aviv University, 6 Weizman St., Tel-Aviv, 6423906, Israel
| | - Yael Oestreicher-Kedem
- The Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel-Aviv University, 6 Weizman St., Tel-Aviv, 6423906, Israel.
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Bowe SN, Wentland CJ, Hartnick CJ. Pediatric laryngeal electromyography technique for vocal fold immobility using bipolar double hookwire electrodes. Int J Pediatr Otorhinolaryngol 2019; 119:75-78. [PMID: 30684689 DOI: 10.1016/j.ijporl.2019.01.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 01/14/2019] [Accepted: 01/14/2019] [Indexed: 10/27/2022]
Abstract
Vocal fold immobility (VFI) is a common cause of dysphonia and dysphagia in children. Laryngeal electromyography (LEMG) is an important adjunctive test in its diagnosis and treatment. In this study, we present an alternative technique in which bipolar double hookwire electrodes allow simultaneous placement and recordings from the bilateral thyroarytenoid and posterior cricoarytenoid muscles. Details of the technique are shown for a 5 y/o F with history of Neurofibromatosis Type 2 with left VFI and aspiration and dysphonia. This modified technique for pediatric LEMG has the potential to be a useful tool in predicting return of laryngeal function.
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Affiliation(s)
- Sarah N Bowe
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye & Ear Infirmary, Boston, MA, USA
| | - Carissa J Wentland
- Department of Otolaryngology, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH, USA
| | - Christopher J Hartnick
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye & Ear Infirmary, Boston, MA, USA; Department of Otology & Laryngology, Harvard Medical School, Boston, MA, USA.
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Sztanó B, Bach Á, Matievics V, Erdélyi E, Szegesdi I, Wootten CT, Rovó L. Endoscopic arytenoid abduction lateropexy for the treatment of neonatal bilateral vocal cord paralysis - Long-term results. Int J Pediatr Otorhinolaryngol 2019; 119:147-150. [PMID: 30708182 DOI: 10.1016/j.ijporl.2019.01.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/08/2019] [Accepted: 01/19/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Bilateral vocal cord paralysis often causes severe dyspnea requiring an early airway intervention in neonates. Endoscopic arytenoid abduction lateropexy (EAAL) with suture is a quick, reversible, minimally-invasive vocal cord lateralizing technique to enlarge the glottis. The arytenoid cartilage is directly lateralized to a normal abducted position. It can be performed even in early childhood with the recently-introduced pediatric endoscopic thread guide instrument. The long-term results and the stability of the lateralization were evaluated. METHODS Three newborns had inspiratory stridor immediately after birth. Laryngo-tracheoscopy revealed bilateral vocal cord paralysis. Unilateral, left-sided endoscopic arytenoid abduction lateropexy was performed with supraglottic jet ventilation. The follow-up period was >3 years. RESULTS After extubation on the 4-7th postoperative day no dyspnea or swallowing disorder occurred. Laryngo-tracheoscopy, clinical growth charts and voice analysis showed satisfactory functional results. CONCLUSIONS The endoscopic arytenoid abduction lateropexy might be a favorable solution for neonatal bilateral vocal cord paralysis. In one step, airway patency can be achieved without irreversible damage to the glottic structures. Normal swallowing function was preserved. The results are durable, and neither medialization nor dyspnea re-appeared during observation.
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Affiliation(s)
- Balázs Sztanó
- Department of Otorhinolaryngology and Head and Neck Surgery Faculty of Medicine, University of Szeged, Szeged, Hungary.
| | - Ádám Bach
- Department of Otorhinolaryngology and Head and Neck Surgery Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Vera Matievics
- Department of Otorhinolaryngology and Head and Neck Surgery Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Eszter Erdélyi
- Department of Otorhinolaryngology and Head and Neck Surgery Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Ilona Szegesdi
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | | | - László Rovó
- Department of Otorhinolaryngology and Head and Neck Surgery Faculty of Medicine, University of Szeged, Szeged, Hungary
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Shapiro SZ, Brietzke SE, Shah SV, Ostrower ST. Injection laryngoplasty in neonates and young children with unilateral vocal fold immobility. Int J Pediatr Otorhinolaryngol 2019; 117:127-130. [PMID: 30579066 DOI: 10.1016/j.ijporl.2018.11.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/14/2018] [Accepted: 11/15/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Although injection laryngoplasty (IL) is a well-accepted treatment strategy in older children and adults with unilateral vocal fold immobility (UVFI), its efficacy and safety have not been well studied in neonates and young children. OBJECTIVES The main objective of this study was to evaluate the clinical and radiographic effects of IL on aspiration & dysphagia in neonates and young children with UVFI. METHODS This was a retrospective chart review of infants and children who underwent IL at a tertiary children's hospital. The primary endpoints were improved aspiration and avoidance of gastrostomy tube placement. Additional endpoints included adverse airway and swallowing effects of IL. RESULTS Eight patients were included in this case series. A total of 10 injection laryngoplasties were performed. Average corrected age of patients undergoing IL was 1.22 years(range 0.5-3.6 y). Seven out of 8 patients had preoperative modified barium swallow (MBS). Five out of seven showed improvement in aspiration. Three out of six (50%) patients who did not have gastrostomy tube preoperatively, were able to avoid gastrostomy tube. No adverse effects were noted following IL. One patient with severe tracheomalacia ultimately required tracheostomy 5 months after IL. CONCLUSION Injection laryngoplasty appears to be a safe and effective therapeutic option in neonates and young children with unilateral vocal cord immobility and associated aspiration. It may be an effective treatment to improve aspiration and avoid gastrostomy tube placement. Further investigation is warranted. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Stephen Z Shapiro
- Florida Atlantic University, Charles E. Schmidt College of Medicine, USA
| | - Scott E Brietzke
- Florida Atlantic University, Charles E. Schmidt College of Medicine, USA; Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | - Sweeti V Shah
- Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | - Samuel T Ostrower
- Florida Atlantic University, Charles E. Schmidt College of Medicine, USA; Joe DiMaggio Children's Hospital, Hollywood, FL, USA.
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Volk GF, Themel S, Gugatschka M, Pototschnig C, Sittel C, Müller AH, Guntinas-Lichius O; Working Group on Laryngology and Tracheal Diseases of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery and the Working Group on Neurolaryngology of the European Laryngological Society (ELS). Vocal fold paresis: Medical specialists' opinions on standard diagnostics and laryngeal findings. Eur Arch Otorhinolaryngol 2018; 275:2535-40. [PMID: 30141109 DOI: 10.1007/s00405-018-5102-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 08/20/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE There is still no clear consensus on the diagnostic value of specific laryngeal findings in patients with suspected vocal fold paresis (VFP). The aim of the study was to establish expert opinion on criteria for the diagnosis of VFP in Europe. METHODS A cross-sectional survey using the questionnaire introduced by Wu and Sulica for US American experts was addressed to laryngeal experts in Germany, Austria, and Switzerland and in a second survey wave to members of the European Laryngological Society. RESULTS 100 respondents returned survey 1 (response rate 47.2%). 26% worked at a university department. 28% regularly used laryngeal electromyography (LEMG). A pathologic test results in LEMG was considered to have the strongest positive predictive value for VFP (79 ± 23%), followed by a decreased vocal fold abduction (70 ± 29%), decreased vocal fold adduction (61 ± 34%), and atrophy of the hemilarynx (61 ± 31%). The multivariate analysis showed the predictive value of LEMG was estimated lower by respondents from non-university hospital (β = - 16.33; confidence interval (CI) = - 25.63 to - 7.02; p = 0.001) and higher in hospitals with higher frequency of VFP patients per months (β = 1.57; CI = - 0.98 to 2.16; p < 0.0001). 30 ELS members returned survey 2 (response rate, 8.4%). Their answers were not significantly different to survey 1. CONCLUSIONS The laryngology experts in Europe rely on LEMG for diagnosis of VFP like the US American experts, but paradoxically only a minority uses LEMG frequently. Next to LEMG, motion abnormities were considered to have the best predictive value for the diagnosis of VFP.
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Abstract
INTRODUCTION Vocal fold immobility (VFI) is an important sequela of preterm birth due to patent ductus arteriosus (PDA) ligation and invasive ventilation. A minority of these patients experience VFI resolution. The purpose of this study is to determine factors associated with VFI resolution in preterm infants. METHODS This is a case control study of preterm (<37 weeks gestation) infants admitted to a metropolitan Level IV neonatal intensive care unit from 2006 to 2012. All patients diagnosed with VFI by flexible nasolaryngoscopy were divided into 2 cohorts: those with and without laryngoscopic resolution of VFI during follow-up. Univariate and multivariate analyses were performed to determine factors associated with VFI resolution. RESULTS Of 71 patients with VFI and adequate follow-up, 17 (23.9%) experienced resolution. Median (range) follow-up was 25.7 (0.4-91.3) months and time to resolution 4.4 (0.4-38.8) months. Compared to the ongoing-VFI cohort, those who experienced resolution had higher median gestational age (31 vs 25 weeks, p = 0.006) and birth weight (1550 vs 765 g, p = 0.02), and lower likelihood of undergoing PDA ligation (47.1% vs 77.8%, p = 0.02). On multivariate analysis, history of PDA ligation remained independently associated with a lower likelihood of VFI resolution (p = 0.02, OR 0.2, 95% CI 0.1-0.8). Among PDA ligation patients, birth weight >1000 g was more common in the resolution cohort compared to the ongoing-VFI cohort (62.5% vs 24.4%, p = 0.047). CONCLUSION While lower birth weight and gestational age are known risk factors for VFI following PDA ligation, in this study, these factors were also associated with a decreased likelihood of VFI resolution. Furthermore, PDA ligation appears to be a risk for both the development and persistence of VFI. This evidence should inform prognosis and intervention decisions for preterm infants with VFI.
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Affiliation(s)
- Jad Jabbour
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital/Harvard Medical School, 300 Longwood Ave, BCH 3129, Boston, MA 02115, USA.
| | - Thomas Robey
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, USA; Division of Pediatric Otolaryngology, Children's Hospital of Wisconsin, 8915 W Connell Ct, Milwaukee, WI 53226, USA.
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Zuniga S, Ebersole B, Jamal N. Inpatient injection laryngoplasty for vocal fold immobility: When is it really necessary? Am J Otolaryngol 2017; 38:222-5. [PMID: 28131551 DOI: 10.1016/j.amjoto.2017.01.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 01/17/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare pulmonary and swallow outcomes of injection laryngoplasty when performed in the acute versus subacute setting in head & neck and thoracic cancer patients presenting with new onset unilateral vocal fold immobility. MATERIALS AND METHODS Case series with chart review at an academic cancer center over a 2year period. Based on swallow evaluation, patients diagnosed with vocal fold immobility were grouped into an unsafe swallow group, injected as inpatients, and a safe swallow group, for whom injection laryngoplasty was delayed to the outpatient setting or not performed. Rates of pneumonia, diet recommendations, and swallow outcomes were compared between groups. RESULTS 24 patients with new-onset vocal fold immobility were evaluated. 7 underwent injection in the inpatient setting, 12 in the outpatient setting, and 5 did not undergo injection. There was no perceived difference in speech and swallow outcomes between the inpatient and outpatient injection groups. CONCLUSIONS Injection laryngoplasty shows promise as an effective intervention for reducing aspiration risk and improving diet normalcy in patients with dysphagia as a result of unilateral vocal fold immobility. In patients determined to have a safe swallow, delay of injection laryngoplasty is not detrimental to swallow outcomes.
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25
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Abstract
OBJECTIVES Flexible laryngoscopy is the principle tool for the evaluation of vocal fold motion. As of yet, no consistent, unified outcome metric has been developed for vocal fold paralysis/immobility research. The goal of this study was to evaluate vocal fold motion assessment (inter- and intra-rater reliability) among general otolaryngologists and fellowship-trained laryngologists. STUDY DESIGN Prospective video perceptual analysis study. METHODS Flexible laryngoscopic examinations, with sound, of 15 unique patient cases (20 seconds each) were sent to 10 general otolaryngologists and 10 fellowship-trained laryngologists blinded to clinical history. Reviewers were given written definitions of vocal fold mobility and immobility and two video examples. The cases included bilateral vocal fold mobility (six), unilateral vocal fold immobility (five), and unilateral vocal fold hypomobility (four). Five examinations were repeated to determine intra-rater reliability. Participants were asked to judge if there was or there was no purposeful motion, as described by written definitions, for each vocal fold (800 tokens in total). RESULTS Twenty reviewers (100%) replied. Both general otolaryngologists and fellowship-trained laryngologists had an overall inter-rater reliability of 95%. Difference in inter-rater reliability between the two groups of raters was negligible: 95% for general otolaryngologists and 97.5% for fellowship-trained laryngologists. There was no variability in intra-rater reliability within either rater group (99%). CONCLUSION Intra- and inter-rater agreement in determining whether the patient had purposeful vocal fold motion on flexible laryngoscopic examination was excellent in both groups. This study demonstrates that otolaryngologists can consistently and accurately judge the presence and the absence of vocal fold motion.
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Affiliation(s)
- Lyndsay L Madden
- University of Pittsburgh Voice Center, Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Clark A Rosen
- University of Pittsburgh Voice Center, Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania..
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26
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Guha K, Sabarigirish K, Singh SK, Yadav A. Role of Laryngeal Electromyography in Predicting Recovery After Vocal Fold Paralysis. Indian J Otolaryngol Head Neck Surg 2014; 66:394-7. [PMID: 26396950 DOI: 10.1007/s12070-014-0723-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 04/17/2014] [Indexed: 10/25/2022] Open
Abstract
Accurate prognostication of the outcome of vocal fold immobility assumes great importance in the management. This study aimed to evaluate the prognostic efficacy of Laryngeal electromyography in cases of vocal fold immobility. A nonrandomized prospective study was carried out from Sep 2009 to Jun 2011. Patients were evaluated using Fiberoptic laryngoscopy and Laryngeal electromyography over a period of 24 weeks. 51 subjects participated in the study, comprised of 22 males and 29 females. All patients underwent detailed clinical examination including Fiberoptic laryngoscopy on the first visit and Laryngeal electromyography testing on the second visit. Subsequent neuromonitoring was carried out at 04, 12 and 24 weeks from date of initial recording. Outcome measures of vocal fold motion were dichotomized into persistent vocal fold immobility (unilateral or bilateral) or resolved vocal fold motion (normal). Approximately 24 weeks after onset of palsy, mobility of the paralyzed vocal cord was restored in 31 (60.78 %) of 51 cases, while 20 (39.22 %) remained immobile. Sensitivity of laryngeal electromyography was 92.53 % ; specificity 93.33 %, positive predictive value 98.77 % and negative predictive value 68.29 %. This study confirmed the utility of Laryngeal electromyography in predicting prognosis for recovery of vocal fold motion after laryngeal nerve injury. The results supported the hypothesis that Laryngeal electromyography data can be used effectively to determine a prognosis for recovery of vocal fold motion.
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Affiliation(s)
- Kuhelika Guha
- Department of ENT & HNS, Armed Forces Medical College, Pune, 411040 Maharashtra India
| | - K Sabarigirish
- Department of ENT, Command Hospital Air Force, Bangalore, 560017 India
| | - S K Singh
- Department of ENT & HNS, Armed Forces Medical College, Pune, 411040 Maharashtra India
| | - Arun Yadav
- Department of ENT & HNS, Armed Forces Medical College, Pune, 411040 Maharashtra India
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Abstract
BACKGROUND Unilateral vocal fold immobility is the neurological disorder most frequently seen in the larynx that may cause swallowing dysfunction. The objective of this investigation was to evaluate the oral and pharyngeal phases of swallowing in patients with unilateral vocal fold immobility. METHODS It was evaluated by videofluoroscopy of the swallowing of 14 patients with unilateral vocal fold immobility and 11 control subjects. The examination was performed with swallows of 5 mL and 10 mL of liquid and paste boluses. The oral transit, pharyngeal transit and clearance, the duration of upper esophageal sphincter (UES) transit, the duration of the hyoid movement, and the timing of the events were measured. RESULTS With swallows of 10 mL of liquid bolus (controls: 0.23 ± 0.04s, patients: 0.27 ± 0.05s, p = 0.03) and 5 mL of paste bolus (controls: 0.18 ± 0.04s, patients: 0.22 ± 0.04s, p = 0.01) there was a longer duration of UES transit in patients compared with controls. The UES opened earlier in the control subjects with the increase in bolus volume from 5 mL to 10 mL (p < 0.05), an effect that was not seen in patients with vocal fold immobility. CONCLUSIONS We conclude that patients with unilateral vocal fold immobility may have alteration of bolus transit through the UES and have no adaptation in the swallowing timing related to the increase in bolus volume.
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Affiliation(s)
- Geruza Costa Gonzaga Aneas
- Department of Medicine, Medical School of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Hilton Marcos Alves Ricz
- Department of Ophthalmology, Otolaryngology / Head and Neck Surgery Medical School of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Francisco Verissimo Mello-Filho
- Department of Ophthalmology, Otolaryngology / Head and Neck Surgery Medical School of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Roberto Oliveira Dantas
- Department of Medicine, Medical School of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, SP, Brazil
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