Evaluation of upper oesophageal sphincter in unilateral vocal fold paralysis

AbstractObjectiveTo evaluate dysphagia and manometric changes in the upper oesophageal sphincter in patients with unilateral vocal fold paralysis.MethodsThirty patients with unilateral vocal fold paralysis due to vagal nerve paralysis scheduled for evaluation were enrolled in the study group; 24 healthy subjects were included in the control group. Upper oesophageal sphincter basal and residual pressure, relaxation time, and pharyngeal pressure values were evaluated by manometry. All patients completed the Turkish Eating Assessment Tool 10 questionnaire, the MD Anderson dysphagia questionnaire and the reflux symptom index form.ResultsSwallowing assessment questionnaires and reflux symptom index results were significantly higher in the study group. Upper oesophageal sphincter basal and relaxation pressures were lower in the study group. Upper oesophageal sphincter relaxation time was shorter in the study group, but pressure values recorded from the pharynx were higher.ConclusionUpper oesophageal sphincter manometric pressure was lower in patients with unilateral vocal fold paralysis. A hypotonic sphincter likely contributes to dysphagia and aspiration.

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Association between Laryngeal Pepsin Levels and the Presence of Vocal Fold Polyps

Otolaryngology ◽

10.1177/0194599816676471 ◽

2016 ◽

Vol 156 (1) ◽

pp. 144-151 ◽

Cited By ~ 15

Author(s):

Lu Wang ◽

Jia-Jie Tan ◽

Ting Wu ◽

Rui Zhang ◽

Jia-Nuan Wu ◽

...

Keyword(s):

Vocal Fold ◽

Laryngopharyngeal Reflux ◽

Ph Monitoring ◽

Reflux Symptom ◽

Healthy Controls ◽

Reflux Finding Score ◽

Reflux Symptom Index ◽

Symptom Index ◽

Predictive Values ◽

Laryngeal Mucosa

Objective To determine whether pepsin, the main component of refluxed gastric contents, is significantly associated with vocal fold polyps and to evaluate the diagnostic value of pepsin in vocal fold polyps’ tissues. Study Design Cross-sectional study. Setting Nanfang Hospital of Southern Medical University. Subjects and Methods The study included 32 patients with vocal fold polyps and 16 healthy controls between 2011 and 2012. Reflux symptom index and reflux finding score assessments, 24-hour combined multichannel intraluminal impedance and pH monitoring, and biopsy of the vocal fold polyp tissues or posterior laryngeal mucosa (healthy controls) for immunohistochemical pepsin staining were performed. Results The expression of pepsin was significantly higher in patients with vocal fold polyps than in controls (28/32, 75% vs 5/16, 31.25%; P < .001). The pepsin levels were significantly positively correlated with upright position pharyngeal acid reflux and esophageal reflux parameters adjusted by age. Based on pepsin staining data, the sensitivity and negative predictive values of 24-hour pH monitoring, the reflux symptom index, and the reflux finding score were 70% to 84.62%, whereas their specificity and positive predictive values were relatively low (20%-31.58%). Conclusion Pepsin reflux may be a risk factor for vocal fold polyps formation. In addition, pepsin immunohistochemical analysis of polyp biopsy samples appears to be a more sensitive and effective test for diagnosing laryngopharyngeal reflux than the reflux symptom index, the reflux finding score, and 24-hour pH monitoring in a clinical setting.

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Unilateral Vocal Fold Paralysis

American Journal of Speech-Language Pathology ◽

10.1044/1058-0360.0101.45 ◽

1991 ◽

Vol 1 (1) ◽

pp. 45-48 ◽

Cited By ~ 11

Author(s):

Stephen C. McFarlane ◽

Teri L. Holt-Romeo ◽

Alfred S. Lavorato ◽

Lyle Warner

Keyword(s):

Vocal Fold ◽

Vocal Fold Paralysis ◽

Voice Therapy ◽

Recurrent Laryngeal Nerve Paralysis ◽

Unilateral Vocal Fold Paralysis ◽

Point Scale ◽

Speech Language Pathologists ◽

Nerve Paralysis ◽

Muscle Nerve ◽

Normal Adults

Voice samples of 16 adult patients with vocal fold paralysis and 6 normal adults were recorded and evaluated by 27 listeners (9 speech-language pathologists, 9 otolaryngologists, and 9 lay listeners). The listeners rated the voices of the speakers on a 10-point scale on six vocal parameters (pitch, loudness, hoarseness, vocal roughness, breathiness, and overall quality). The 16 patients represented three different treatment approaches (teflon injection, 4; voice therapy, 6; and muscle-nerve reinnervation surgery, 6). Voice therapy and muscle nerve reinnervation surgery were both rated more successful than teflon injection in terms of improvement from pretreatment to posttreatment voices for all six vocal parameters. Normal speakers’ voices were rated higher than the voices of any treatment group. Speech-language pathologists were more reliable listeners than the other two listener groups. A case is made for using a period of trial voice therapy while waiting for possible spontaneous nerve healing in unilateral vocal fold paralysis patients who do not have aspiration problems and who have a competent cough. The majority of patients studied presented with unilateral recurrent laryngeal nerve paralysis, and none recovered vocal fold function during the course of the study.

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Can preoperative results predict the need for future reintervention following injection laryngoplasty for unilateral vocal fold paralysis?

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-021-06925-z ◽

2021 ◽

Author(s):

Beata Miaśkiewicz ◽

Aleksandra Panasiewicz ◽

Elżbieta Gos ◽

Paulina Krasnodębska ◽

Piotr H. Skarżyński ◽

...

Keyword(s):

Relative Risk ◽

Vocal Fold ◽

Statistical Significance ◽

Vocal Fold Paralysis ◽

Control Group ◽

Study Group ◽

Injection Laryngoplasty ◽

Unilateral Vocal Fold Paralysis ◽

Voice Assessment ◽

The Difference

Abstract Purpose The objective was to investigate whether a patient’s preoperative test results can predict the need for future reoperation in unilateral vocal fold paralysis (UVFP). Methods A single-centre retrospective study was performed. The study group consisted of 18 patients with UVFP who had been treated with injection laryngoplasty but who required further treatment and were augmentated again within 36 months. The control group consisted of 33 injected patients who had not required reintervention up to 36 months later. Results Only glottal gap was associated with a relative risk for reinjection. Glottal gap was found to be severe in 77.8% of the patients from the study group compared to 42.4% of the controls, and the difference was statistically significant. The kind of injected material (calcium hydroxylapatite or hyaluronic acid), age, and voice assessment (perceptual, objective, or subjective) did not seem to affect the likelihood of reoperation being needed. There were no between-group statistically significant differences in individual aspects of the GRBAS scale. The global score was slightly higher in the study group, but it did not reach statistical significance (U = 198.5; p = 0.09). A comparison of VHI scores did not yield statistically significant differences between the study and control groups. No significant differences in objective acoustic voice parameters were observed between the groups. Conclusion Only glottal gap occurred to be associated with a relative risk for reinjection. A kind of injected material (CaHA or HA), age, perceptual, objective and subjective voice assessment do not seem to impact the likelihood of reoperation in patients with UVFP.

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