scholarly journals Functional results of endoscopic arytenoid abduction lateropexy for bilateral vocal fold palsy

2021 ◽  
Author(s):  
László Rovó ◽  
Vera Matievics ◽  
Balázs Sztanó ◽  
László Szakács ◽  
Dóra Pálinkó ◽  
...  
Keyword(s):  
Vocal Fold ◽  
Voice Quality ◽  
Functional Results ◽  
Severity Index ◽  
Invasive Treatment ◽  
Maximum Phonation Time ◽  
Motion Recovery ◽  
Bilateral Vocal Fold Paralysis ◽  
Vocal Fold Palsy ◽  
False Vocal

Abstract Purpose Endoscopic arytenoid abduction lateropexy (EAAL) is a reliable surgical solution for the minimally invasive treatment of bilateral vocal fold palsy (BVFP), providing a stable airway by the lateralization of the arytenoid cartilages with a simple suture. The nondestructive manner of the intervention theoretically leads to higher regeneration potential, thus better voice quality. The study aimed to investigate the respiratory and phonatory outcomes of this treatment concept. Methods 61 BVFP patients with significant dyspnea associated with thyroid/parathyroid surgery were treated by unilateral EAAL. Jitter, Shimmer, Harmonics to Noise Ratio, Maximum Phonation Time, Fundamental frequency, Voice Handicap Index, Dysphonia Severity Index, Friedrich’s Dysphonia Index, Global-Roughness-Breathiness scale, Quality of Life, and Peak Inspiratory Flow were evaluated 18 months after EAAL. Results All patients had a stable and adequate airway during the follow-up. Ten patients (16.4%) experienced complete bilateral motion recovery with objective acoustic parameters in the physiological ranges. Most functional results of the 13 patients (21.3%) with unilateral recovery also reached the normal values. Fifteen patients (24.6%) had unilateral adduction recovery only, with slightly impaired voice quality. Eleven patients (18.0%) had false vocal fold phonation with socially acceptable voice. In 12 patients (19.7%) no significant motion recovery was detected on the glottic level. Conclusion EAAL does not interfere with the potential regeneration process and meets the most important phoniatric requirements while guaranteeing the reversibility of the procedure—therefore serving patients with transient palsy. Further, a socially acceptable voice quality and an adequate airway are ensured even in cases of permanent bilateral vocal fold paralysis.

Vocal fold paralysis: role of bilateral transverse cordotomy

2009 ◽  
Vol 123 (12) ◽  
pp. 1348-1351 ◽  
Author(s):  
Y Bajaj ◽  
N Sethi ◽  
A Shayah ◽  
A T Harris ◽  
P Henshaw ◽  
...  
Keyword(s):  
Treatment Option ◽  
Vocal Fold ◽  
Voice Quality ◽  
Vocal Fold Paralysis ◽  
Significant Loss ◽  
Tissue Loss ◽  
Swallowing Function ◽  
Simple Modification ◽  
Bilateral Vocal Fold Paralysis ◽  
Vocal Fold Palsy

AbstractObjective:Although modern endoscopic laser techniques aim to avoid a permanent tracheostomy by augmenting the glottic aperture in cases of bilateral vocal fold palsy, loss of tissue from the posterior glottis risks compromising voice quality and swallowing function. The objective of this study was to describe our experience with bilateral transverse posterior cordotomy.Methods:This was a retrospective analysis of functional outcomes in a series of consecutive patients undergoing a simple modification of the classical laser cordectomy procedure, which avoids tissue loss. The procedure was confined to the complete release of the vocal ligament from the arytenoid cartilage on both sides, while avoiding any significant loss of mucosa or cartilage.Results:Post-operative voice quality and quality of life were rated as good by most patients, which makes bilateral transverse cordotomy an attractive treatment option for bilateral vocal fold paralysis.Conclusion:Bilateral transverse cordotomy is a reliable treatment option for patients with bilateral vocal fold paralysis, and aims to avoid the morbidity associated with a permanent tracheostomy.

Impact of speech therapy on the improvement of voice quality in patients with unilateral vocal fold paralysis

2018 ◽  
Vol 7 (4) ◽  
pp. 1-7
Author(s):  
Anna Kuligowska ◽  
Barbara Jamróz ◽  
Joanna Chmielewska ◽  
Katarzyna Jędra ◽  
Tomasz Czernicki ◽  
...  
Keyword(s):  
Vocal Fold ◽  
Speech Therapy ◽  
Acoustic Analysis ◽  
Vocal Tract ◽  
Voice Quality ◽  
Maximum Phonation Time ◽  
Before And After ◽  
Vocal Fold Palsy ◽  
The Voice

Aim of study: Evaluation of the speech therapy on voice quality in patients with unilateral vocal fold palsy. Material and methods: The study group included 11 patients, 8 women and 3 men, in age between 16 to 72 years, with unilateral vocal fold palsy, diagnosed in ENT Department of Warsaw Medical University between 2017-2018. Each person completed questionnaires: the voice disability self-assessment scale (VHI), the voice-based quality of life (VRQoL) scale, the vocal tract discomfort scale (VTD). All questionnaires were completed twice, before and after the voice therapy. In addition, the acoustic analysis of the voice, the assessment of the maximum phonation time and the breathing tract were performed twice in each patient. Each of the patients had a voice rehabilitation consisting of a series of 10 meetings. Results: Statistical analysis of the results of maximum phonation time, the self-assessment of voice disability, the quality of life depending on the voice, discomfort of the vocal tract voice acoustic analysis showed statistically significant differences in the results before and after rehabilitation (p <0.005). In addition, the improvement of the respiratory tract was observed in the majority of patients. Conclusions: Speech therapy significantly affects the voice quality of patients with unilateral laryngeal nerve palsy.

C02 Laser-assisted Phonosurgery for Benign Glottic Lesions

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P48-P48
Author(s):  
Marcel Geyer ◽  
Gian-Peppino Ledda ◽  
Neil C Tan ◽  
Roberto Puxeddu Consultant
Keyword(s):  
Co2 Laser ◽  
Vocal Fold ◽  
Voice Quality ◽  
Case Series ◽  
Functional Results ◽  
Disease Recurrence ◽  
Wilcoxon Test ◽  
Control Group ◽  
Retrospective Case ◽  
False Vocal

Objective (1) To determine glottic function following carbon dioxide (CO2) laser-assisted phonosurgery of benign laryngeal disease. (2) To evaluate post-operative glottic morphology and disease recurrence rate. Methods Comparative retrospective case series of patients with benign glottic pathology treated by laser-assisted phonosurgery over 10 years. 235 consecutive patients had pre- and postoperative data collected from objective laryngeal examination, videostroboscopy recording of vocal fold mucosal wave movement, electroacoustic voice analysis of fundamental frequency, jitter, shimmer, and harmonics to noise ratio, as well as perceptual voice evaluation. This data was also compared to that of 20 healthy volunteers. (Statistical analysis: Wilcoxon test and Mann-Whitney test respectively). Definitive voice and morphologic evaluation was completed after 6 months. Results Evaluation of the pre- and postoperative functional results demonstrated a statistically significant improvement in all spectrographically analysed objective voice parameters (p<0.001), with a restored voice quality as good as the control group (p<0.001). Postoperative morphological analysis using videostroboscopic examination confirmed 3 recurrences of granuloma and 1 of Reinke's oedema. Recurrence was estimated objectively if the lesion was analogous to the original pathology. Glottic closure was complete in 96.5% of cases. False vocal fold adduction was normal in 88.5% of cases, with forced hyper-adduction being present in 11.5%. Phonatory vibration was cord-cord type in 100% of cases. Conclusions Our study demonstrates a statistically significant improvement in all acoustic parameters recorded. Postoperative vocal fold function and mucosal wave morphology were largely restored. CO2 laser-assisted voice restoration for benign glottic disease is effective.

scholarly journals Stroboscopic and Multiparametric Acoustic Analysis of Voice after Vocal Loading Task

2011 ◽  
Vol 1 (2) ◽  
pp. 47-51 ◽  
Author(s):  
John Samuel ◽  
Shenbagavalli Mahalingam ◽  
Subramaniyam Balasubramaniyam ◽  
Prakash Boominathan ◽  
Ravikumar Arunachalam
Keyword(s):  
Vocal Fold ◽  
Acoustic Analysis ◽  
Voice Quality ◽  
Severity Index ◽  
Adult Males ◽  
Voice Assessment ◽  
Functional Changes ◽  
Maximum Phonation Time ◽  
Amplitude Maximum ◽  
Normal Limits

ABSTRACT Introduction Voice overuse may result in roughness, fatigue and pain while speaking. Vocal loading tasks have been used to assess changes in voice quality under different controlled settings. This study was done to document changes in voice characteristics before, immediately and 24 hours post-vocal loading task (VLT) using stroboscopic and acoustic analysis. Materials and methods Ten healthy adult males (age range: 20 to 40 years) with no apparent comorbid illness participated in the study. They were instructed to read the standard Rainbow passage at intensity above 75 dB SPL until they perceived any symptoms of fatigue/ strain. Stroboscopy and comprehensive voice assessment were done on all subjects before, immediate post VLT and 24 hours post VLT. Results Symptoms of vocal fatigue were noted on an average of 45 minutes of loud reading. Vocal fold edema, ventricular band hyperadduction and arytenoid congestion were noticed in immediate post task. The vocal fold movements were asymmetric and aperiodic with reduced mucosal wave and amplitude. Maximum phonation time (MPT) revealed statistically significant decrease (approximately 7 sec). Multiparametric acoustic analysis revealed a statistically significant increase in fundamental frequency, perturbation measures and lowest intensity with significant decrease in dysphonia severity index (DSI). All parameters (stroboscopic findings, perceptual, aerodynamic and acoustic analysis) showed values within normal limits after 24 hours post-task indicating recovery at 24 hours after vocal loading. Stroboscopy served as an evidence for structural and functional changes in the vocal fold. Changes in voice characteristics and recovery following vocal loading task can be documented using comprehensive voice assessment.

The Dysphonia Severity Index

2000 ◽  
Vol 43 (3) ◽  
pp. 796-809 ◽  
Author(s):  
Floris L. Wuyts ◽  
Marc S. De Bodt ◽  
Geert Molenberghs ◽  
Marc Remacle ◽  
Louis Heylen ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Voice Quality ◽  
Severity Index ◽  
Voice Handicap Index ◽  
Objective Measures ◽  
Maximum Phonation Time ◽  
Vocal Quality ◽  
The Voice ◽  
Weighted Combination

The vocal quality of a patient is modeled by means of a Dysphonia Severity Index (DSI), which is designed to establish an objective and quantitative correlate of the perceived vocal quality. The DSI is based on the weighted combination of the following selected set of voice measurements: highest frequency (F 0 -High in Hz), lowest intensity (I-Low in dB), maximum phonation time (MPT in s), and jitter (%). The DSI is derived from a multivariate analysis of 387 subjects with the goal of describing, purely based on objective measures, the perceived voice quality. It is constructed as DSI=0.13 x MPT + 0.0053 x F 0 -High – 0.26 x I-Low – 1.18 x Jitter (%) + 12.4. The DSI for perceptually normal voices equals +5 and for severely dysphonic voices –5. The more negative the patient's index, the worse is his or her vocal quality. As such, the DSI is especially useful to evaluate therapeutic evolution of dysphonic patients. Additionally, there is a high correlation between the DSI and the Voice Handicap Index score.

Early results for treatment of unilateral vocal fold palsy with injection medialisation under local anaesthetic

2009 ◽  
Vol 123 (8) ◽  
pp. 873-876 ◽  
Author(s):  
R Pratap ◽  
P Mehta ◽  
B Blagnys ◽  
P Q Montgomery
Keyword(s):  
Local Anaesthetic ◽  
Vocal Fold ◽  
Voice Quality ◽  
Therapy Outcome ◽  
Collagen Injection ◽  
Early Results ◽  
Vocal Fold Palsy ◽  
Quality Of Voice ◽  
Perceptual Assessment

AbstractBackground:The diagnosis and treatment of unilateral vocal fold palsy is a common part of otolaryngology practice. In those patients in whom resolution of symptoms is slow, the resulting dysphonia can have a dramatic effect on the patient's quality of voice and life. We have previously described the procedure of direct phonoplasty under local anaesthesia using the transnasal laryngoesophagoscope.Objective:To examine the subjective and objective data for the first five patients to undergo this procedure, in the form of laryngographic speech analysis, perceptual assessment and therapy outcome measures.Results:Analysis showed a statistically significant improvement in voice quality, in all the above assessment categories, following local anaesthetic direct phonoplasty using the transnasal laryngoesophagoscope.Conclusion:Collagen injection via transnasal flexible laryngoesophagoscopy is a particularly useful technique for treating vocal fold medialisation, especially in palliative care patients and those with shortened life expectancy.

Results of Fascial Augmentation in Unilateral Vocal Fold Paralysis

2002 ◽  
Vol 111 (6) ◽  
pp. 523-529 ◽  
Author(s):  
Petri Reijonen ◽  
Sari Lehikoinen-Söderlund ◽  
Heikki Rihkanen
Keyword(s):  
Vocal Fold ◽  
Acoustic Analysis ◽  
Voice Quality ◽  
Vocal Fold Paralysis ◽  
Unilateral Vocal Fold Paralysis ◽  
Inexpensive Method ◽  
Maximum Phonation Time ◽  
Perceptual Evaluation

The objective of this study was to evaluate the effects on voice quality of augmentation by injection of minced fascia in patients with unilateral vocal fold paralysis. Preoperative and postoperative voice samples from 14 patients (6 men and 8 women; mean age, 59 years) were analyzed by computerized acoustic analysis and blinded perceptual evaluation. Statistically significant improvements were seen in perturbation measurements (jitter and shimmer), noise-to-harmonics ratio, and maximum phonation time. A panel of evaluators rated 10 of the 14 postoperative voices as normal or near-normal. Injection laryngoplasty with minced fascia offers a new, effective, well-tolerated, and inexpensive method to medialize a paralyzed vocal fold. The graft seems to survive well, as indicated by good vocal results with a follow-up ranging from 5 to 32 months.

Endoscopic treatment of glottic stenosis: a report on the safety and efficacy of CO2 laser

2011 ◽  
Vol 126 (5) ◽  
pp. 503-505 ◽  
Author(s):  
F Riffat ◽  
C E Palme ◽  
D Veivers
Keyword(s):  
Endoscopic Treatment ◽  
Vocal Fold ◽  
Functional Results ◽  
Airway Patency ◽  
Endoscopic Laser ◽  
Vocal Fold Palsy ◽  
Tracheostomy Tubes ◽  
Endoscopic Laser Surgery ◽  
Airway Calibre ◽  
Prospective Database

AbstractBackground:Treatment of glottic stenosis is a considerable challenge to the otolaryngologist. Glottic airway patency can be compromised by bilateral vocal fold palsy, anterior webbing or a posterior segment scar, which may be significant enough to impair arytenoid movement.Method:A retrospective analysis of a prospective database of patients (n = 34) treated by a specialist airway surgeon. All patients underwent endoscopic treatment with a CO2 laser in an attempt to improve airway calibre and, in 12 patients, to decannulate tracheostomy tubes.Results:Twenty-one patients had bilateral vocal fold palsy and 13 had predominantly posterior glottic stenosis. A variety of pathology-directed treatment approaches were used to achieve good functional results. Four patients required a second endoscopic procedure. The overall revision rate was 5 per cent for bilateral fold palsy and 23 per cent for posterior glottic stenosis (p < 0.05). All patients had an adequate functional airway calibre, and all 12 tracheotomised patients were decannulated.Discussion:Pathology-directed endoscopic laser surgery is safe and effective treatment for glottic stenosis. Rather prescriptive use of unilateral or bilateral cordotomy or combined cordo-arytenoidectomy, clinicians must perform the procedure that will treat the lesion most adequately. Our success rate compared favourably with the best reported results.

Simultaneous bilateral posterior cordectomy in bilateral vocal fold paralysis

2005 ◽  
Vol 132 (2) ◽  
pp. 249-250 ◽  
Author(s):  
Mohamed Chafik Khalifa
Keyword(s):  
Success Rate ◽  
Vocal Fold ◽  
Voice Quality ◽  
Cost Effective ◽  
Vocal Fold Paralysis ◽  
Granuloma Formation ◽  
Bilateral Vocal Fold Paralysis

The operation of simultaneous bilateral posterior cordectomy by CO2 laser was performed in 22 cases of bilateral vocal fold paralysis. The success rate was up to 92% with good airway and voice quality. The procedure is simple, cost-effective with virtually no complications. Problems related to deglutition, aspiration, or granuloma formation were not reported.

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