Laryngeal Electromyography-Guided Hyaluronic Acid Vocal Fold Injections for Glottic Insufficiency

2020 ◽  
Vol 129 (11) ◽  
pp. 1063-1070
Author(s):  
Alice Q. Liu ◽  
Joel Singer ◽  
Terry Lee ◽  
Amanda Hu
Keyword(s):  
Hyaluronic Acid ◽  
Fundamental Frequency ◽  
Vocal Fold ◽  
The Novel ◽  
Completion Rates ◽  
Laryngeal Electromyography ◽  
Glottic Insufficiency ◽  
Maximum Phonation Time ◽  
Novel Technique ◽  
Glottal Insufficiency

Objectives: To assess voice outcomes using the novel technique of in-office laryngeal electromyography-guided vocal fold injections (LEVFI) with hyaluronic acid to treat glottal insufficiency. Secondary objectives included determining the complication/completion rates and if any factors were associated with improved voice outcomes. Methods: Retrospective review of patients who received their first LEVFI from August 2017 to December 2018. Three- and six-month voice outcomes were assessed. Outcomes included voice handicap index-10 (VHI-10), maximum phonation time (MPT), perceptual analysis of voice (GRBAS), fundamental frequency, and stroboscopy. Results: Of the 121 eligible patients (55.4% male, age 63.7 years), 94 (77.7%) had complete 3-month data and 59 (48.8%) had complete 6-month data. VHI-10 was significantly improved from 25.7 ± 7.5 to 20.9 ± 10.9 at 3 months ( P < .001) and to 19.1 ± 11.5 at 6 months ( P < .001). MPT improved from 6.2 ± 5.4 seconds to 9.4 ± 7.1 seconds at 3 months ( P < .001) and to 11.3 ± 8.2 seconds at 6 months ( P < .001). GRBAS was improved in 74.8% of patients ([65.2, 82.8] 95% CI) at 3 months and 80.8% ([69.9, 89.1]) 95% CI) at 6 months. Stroboscopy showed a glottic gap improvement in 74.8% of patients ([65.8, 82.4] 95% CI) at 3 months and in 80.3% ([65.9, 88.5] 95% CI) at 6 months. Fundamental frequency was unchanged, as expected. Multivariate analysis reported that no factors were associated with better voice outcomes. Overall, 177/181 (97.8%) injections were completed. There were no complications. Conclusion: In-office LEVFI is an effective, novel technique to treat glottic insufficiency with improved voice outcomes, high completion rate, and no significant complications.

Contribution of Glottic Insufficiency to Perceived Breathiness in Classically Trained Singers

2016 ◽  
Vol 31 (3) ◽  
pp. 179-184 ◽  
Author(s):  
Ellen Graham ◽  
Vrushali Angadi ◽  
Joanna Sloggy ◽  
Joseph Stemple
Keyword(s):  
Vocal Fold ◽  
Vocal Folds ◽  
Airflow Rate ◽  
Singing Voice ◽  
Glottic Insufficiency ◽  
Maximum Phonation Time ◽  
Breath Management ◽  
Subglottal Pressure ◽  
Glottal Insufficiency ◽  
Voice Students

Breathiness in the singing voice is problematic for classical singers. Voice students and singing teachers typically attribute breathiness to breath management issues and breathing technique. The present study sought to determine whether glottic insufficiency may also contribute to breathiness in a singer’s voice. Studies have revealed a relationship between insufficient vocal fold closure and inefficiency in the speaking voice. However, the effect of insufficient vocal fold closure on vocal efficiency in singers has yet to be determined. Two groups of voice students identified with and without breathiness issues underwent aerodynamic and acoustic voice assessment as well as laryngeal stroboscopy of the vocal folds to quantify the prevalence of insufficient vocal fold closure, also known as glottic insufficiency. These assessments revealed four groups: 1) those with glottic insufficiency and no perceived voice breathiness; 2) those with glottic sufficiency and perceived voice breathiness; 3) those with glottic insufficiency and perceived breathiness; and 4) those with glottic sufficiency and no perceived breathiness. Results suggest that previously undiscovered glottal insufficiency is common in young singers, particularly women, though the correlation with identified breathiness was not statistically significant. Acoustic and aerodynamic measures including noise-to-harmonics ratio, maximum phonation time, airflow rate, subglottal pressure, and laryngeal airway resistance were most sensitive to glottic insufficiency.

scholarly journals Pre- and intraoperative acoustic and functional assessment of the novel APrevent® VOIS implant during routine medialization thyroplasty

2019 ◽  
Vol 277 (3) ◽  
pp. 809-817
Author(s):  
Guan-Yuh Ho ◽  
Matthias Leonhard ◽  
Doris-Maria Denk-Linnert ◽  
Berit Schneider-Stickler
Keyword(s):  
Vocal Fold ◽  
Type I ◽  
The Novel ◽  
Glottal Closure ◽  
Medialization Thyroplasty ◽  
Before And After ◽  
Glottal Insufficiency ◽  
The Mean ◽  
Acoustic Analyses ◽  
Short Time

Abstract Purpose Persistent unilateral vocal fold paralysis (UFVP) with glottal insufficiency often requires type I medialization thyroplasty (MT). Previous implants cannot be adjusted postoperatively if necessary. The newly developed APrevent® VOIS implant (VOIS) can provide postoperative re-adjustment to avoid revision MT. The objective of this pilot study is to evaluate the VOIS intraoperatively concerning voice improvement, surgical feasibility and device handling. Methods During routine MT, VOIS was applied short time in eight patients before the regular implantation of the Titanium Vocal Fold Medialization Implant (TVFMI™). In all patients, perceptual voice sound analysis using R(oughness)–B(reathiness)–H(oarseness)-scale, measurement of M(aximum)–P(honation)–T(ime) and glottal closure in videolaryngoscopy were performed before and after implanting VOIS/TVFMI™. Acoustic analyses of voice recordings were performed using freeware praat. Surgical feasibility, operative handling and device fitting of VOIS and TVFMI™ were assessed by the surgeon using V(isual)-A(nalog)-S(cale). Data were statistically analyzed with paired t test. Result All patients showed significant improvement of voice sound parameters after VOIS/TVFMI™ implantation. The mean RBH-scale improved from preoperative R = 2.1, B = 2.3, H = 2.5 to R = 0.6, B = 0.3, H = 0.8 after VOIS and R = 0.5, B = 0.3, H = 0.8 after TVFMI™ implantation. The mean MPT increased from preoperative 7.9 to 14.6 s after VOIS and 13.8 s after TVFMI™ implantation. VOIS/TVFMI™ achieved complete glottal closure in 7/8 patients. The satisfaction with intraoperative device fitting and device handling of VOIS was as good as that of TVFMI™. Conclusion The novel APrevent® VOIS implant showed similar intraoperative voice improvement compared to routinely used TVFMI™ without adverse device events and with safe device fitting.

scholarly journals Acoustic Analysis of Voice in School Teachers

2018 ◽  
Vol 56 (211) ◽  
pp. 658-661 ◽  
Author(s):  
Nain Bahadur Mahato ◽  
Meera Bista ◽  
Deepak Regmi ◽  
Pema Sherpa
Keyword(s):  
Fundamental Frequency ◽  
Tissue Damage ◽  
Vocal Fold ◽  
Teaching Practice ◽  
Acoustic Analysis ◽  
School Teachers ◽  
Maximum Phonation Time ◽  
Professional Voice Users ◽  
Professional Voice

Introduction: The term ‘voice' is the acoustic energy generated from the vocal tract that are characterized by their dependence on vocal fold vibratory pattern. Teachers as professional voice users are afflicted with dysphonia and are discouraged with their jobs and seek alternative employment. Loud speaking and voice straining may lead to vocal fatigue and vocal fold tissue damage.  Methods: Sixty teachers from various schools, volunteered to participate in this study. Acoustic analysis Doctor Speech Tiger Electronics, USA was used to assess the voice quality of the school teachers before and after teaching practice. The data were collected and analyzed using Doctor Speech Tiger Electronics, USA. Analysis was performed in terms of perturbation (jitter and shimmer), fundamental frequency, harmonic to noise ratio and maximum phonation time. Results: We found statistically significant difference in all the four parameters except the Jitter value. The fundamental frequency and shimmer value has significantly increased (P<0.001) and (P=0.002) respectively after teaching practice. Unlikely, there was significant decrease in harmonic to noise ratio value (P<0.001) and maximum phonation time value (P<0.01) after teaching practice. Conclusions: Vocal abuse, overuse, or misuse in teaching practice over a long period of time can result in inadequate phonatory pattern due to vocal fold tissue damage, which ultimately results in vocal nodules or polyps. So voice evaluation is particularly important for professional voice users and for the people who are concerned about their quality of voice.

scholarly journals Laryngeal Electromyography-Guided Hyaluronic Acid Vocal Fold Injection for Unilateral Vocal Fold Paralysis

2015 ◽  
Vol 141 (3) ◽  
pp. 264 ◽  
Author(s):  
Chen-Chi Wang ◽  
Ming-Hong Chang ◽  
Rong-San Jiang ◽  
Hsiu-Chin Lai ◽  
Armando De Virgilio ◽  
...  
Keyword(s):  
Hyaluronic Acid ◽  
Vocal Fold ◽  
Vocal Fold Paralysis ◽  
Unilateral Vocal Fold Paralysis ◽  
Laryngeal Electromyography ◽  
Vocal Fold Injection

Vocal Function following Hemilaryngectomy

1987 ◽  
Vol 96 (5) ◽  
pp. 586-589 ◽  
Author(s):  
Minoru Hirano ◽  
Shigejiro Kurita ◽  
Hidetaka Matsuoka
Keyword(s):  
Fundamental Frequency ◽  
Vocal Fold ◽  
Skin Flap ◽  
Muscle Flap ◽  
Airflow Rate ◽  
Vocal Function ◽  
Maximum Phonation Time ◽  
The Voice

Vocal function following hemilaryngectomy was investigated in 54 cases in which a superiorly based sternohyoid muscle flap was used for glottic reconstruction. Four types of material were employed for covering the muscle flap: Hypopharyngeal mucosa, lip mucosa, thyroid perichondrium, and island cervical skin flap. The vocal function varied greatly from individual to individual; however, the following tendencies were observed in many cases: 1) the glottis did not close completely; 2) supraglottic structures (false fold, arytenoid region, and epiglottis) were hyperfunctional and vibrated instead of or together with the unaffected vocal fold; 3) vibrations of the laryngeal structures were irregular; 4) maximum phonation time was short; 5) mean airflow rate was high; 6) fundamental frequency and intensity ranges of phonation were limited; 7) the voice was rough, breathy, and/or strained; and 8) cases with poor vocal function were most frequent in the skin flap group and least frequent in the lip mucosa group.

scholarly journals Acute Vocal Fold Paresis and Paralysis After COVID-19 Infection: A Case Series

2021 ◽  
pp. 000348942110478
Author(s):  
Sarah K. Rapoport ◽  
Ghiath Alnouri ◽  
Robert T. Sataloff ◽  
Peak Woo
Keyword(s):  
Vocal Fold ◽  
Case Series ◽  
The Novel ◽  
Demographic Information ◽  
Laryngeal Electromyography ◽  
Vocal Fold Paresis ◽  
Presenting Symptoms ◽  
History Of ◽  
Vagal Neuropathy ◽  
New Onset

Objective: Evidence demonstrates neurotropism is a common feature of coronaviruses. In our laryngology clinics we have noted an increase in cases of “idiopathic” vocal fold paralysis and paresis in patients with no history of intubation who are recovering from the novel SARS-Cov-2 coronavirus (COVID-19). This finding is concerning for a post-viral vagal neuropathy (PVVN) as a result of infection with COVID-19. Our objective is to raise the possibility that vocal fold paresis may be an additional neuropathic sequela of infection with COVID-19. Methods: Retrospective review of patients who tested positive for COVID-19, had no history of intubation as a result of their infection, and subsequently presented with vocal fold paresis between May 2020 and January 2021. Charts were reviewed for demographic information, confirmation of COVID-19 infection, presenting symptoms, laryngoscopy and stroboscopy exam findings, and laryngeal electromyography (LEMG) results. Results: Sixteen patients presented with new-onset dysphonia during and after recovering from a COVID-19 infection and were found to have unilateral or bilateral vocal fold paresis or paralysis. LEMG was performed in 25% of patients and confirmed the diagnosis of neuropathy in these cases. Conclusions: We believe that COVID-19 can cause a PVVN resulting in abnormal vocal fold mobility. This diagnosis should be included in the constellation of morbidities that can result from COVID-19 as the otolaryngologist can identify this entity through careful history and examination.

Acoustic Characteristics of Post-Thyroplasty Patients

1992 ◽  
Vol 107 (4) ◽  
pp. 558-563 ◽  
Author(s):  
Gary R. Lablance ◽  
Michael D. Maves
Keyword(s):  
Fundamental Frequency ◽  
Vocal Fold ◽  
Voice Quality ◽  
Vocal Fold Paralysis ◽  
Type I ◽  
Unilateral Vocal Fold Paralysis ◽  
Pitch Range ◽  
Acoustic Characteristics ◽  
Maximum Phonation Time ◽  
Frequency Changes

This study investigated changes in voice quality after thyroplasty type I in eight adults with unilateral vocal fold paralysis. A silicone rubber implant was inserted through a window in the thyroid ala and placed between the inner and outer perichondrium to externally medialize the abducted vocal fold. Measures of fundamental frequency (vocal pitch), pitch range, maximum phonation time, s/z ratio, pitch perturbation (vocal jitter), and amplitude perturbation (vocal shimmer) were made 1 to 2 weeks preoperatively and 1 month postoperatively. Postoperative voice quality was characterized by an improved pitch range, phonation time, s/z ratio, and pitch and amplitude perturbation. No change was noted in fundamental frequency. Changes in postoperative voice quality were unrelated to the subjects' preoperative age, sex, etiology, and duration of the paralysis.

Cirugía de feminización de voz con técnica glotoplastia de Wendler en Barranquilla, Colombia. Voice feminization surgery with Wendler glottoplasty technique in Barranquilla, Colombia.

2018 ◽  
Vol 45 (4) ◽  
pp. 247-253 ◽  
Author(s):  
Antonio J. Ballestas ◽  
Samir A. Ballestas ◽  
Rocio Cuello
Keyword(s):  
Fundamental Frequency ◽  
Speech Therapy ◽  
Vocal Cords ◽  
Maximum Phonation Time ◽  
Study Materials ◽  
Before And After ◽  
Upper Face ◽  
Expert Surgeon ◽  
Frequency Maximum ◽  
Male To Female

Introducción: La glotoplastia de Wendler es la técnica que en la actualidad ofrece mejores resultados entre los diferentes tipos de cirugías para la feminización de la voz. Objetivo: Describir nuestra experiencia con la Glotoplastia de Wendler durante el proceso de feminización de la voz de mujeres transgénero. Diseño: Pseudoexperimental (antes-después) Materiales y Métodos: 36 pacientes transexuales en proceso de transformación de hombre a mujer se sometieron a cirugía y rehabilitación con terapias de voz con el equipo de VOICEFEM - Voice Feminization Colombia. La técnica utilizada consiste en la creación de una sinequia de las cuerdas vocales (CCVV) previa desepitelización de la cara interna del tercio anterior de las mismas, 2 puntos de sutura con Vicryl 4/0 y vaporización con electrocauterio en la región lateral de la cara superior de las CCVV y utilización de goma biológica en la sinequia creada. La medición de la frecuencia fundamental, el tiempo máximo de fonación, y la realización del cuestionario TSEQ, se llevaron a cabo antes y después de la cirugía. Resultados: Se obtuvo un aumento de la Frecuencia fundamental promedio de 112Hz(P<0.05) a los 6 meses posteriores al procedimiento quirúrgico y una disminución de cerca de 30 puntos en los resultados del cuestionario TSEQ. Conclusión: La glotoplastia de Wendler, llevada a cabo por cirujanos con experiencia en este campo, ofrece resultados favorables con aumentos significativos de la frecuencia fundamental a mediano plazo y debe estar necesariamente asociada al manejo postquirúrgico con terapias de voz, para obtener el desenlace óptimo esperado.Introduction: Wendler’s Glottoplasty is the technique that offers the best resultsamong the different types of voice feminization surgeries. Male to Female Transgender patients have in this technique the last step for their successful transformation. Objective: To describe our experience in carrying out Wendler’s glottoplasty during the process of feminization of the voice of transgender women. Design: Pseudoexperimental (before-after) study. Materials and methods: In 36 Male to Female Transgender patients, Wendler’s glottoplasty was conducted by VOICEFEM - Voice Feminization Colombia’s team, with further speech therapy rehabilitation. This technique consists of the creation of a synechia of the vocal cords which is carried out after the de-epithelization of the vocal cords on the inner face of its anterior third, 2 stitches with Vicryl 4/0 and vaporization with electrocautery in the lateral region of vocal cords upper face, and the use of biological glue in the created synechia. The measurement of the Fundamental Frequency, Maximum Phonation time, and the completion of the TSEQ questionnaire were carried out before and after the surgery. Results: There was an increase of 112 Hz in the average of Fundamental Frequency(P<0.05) 6 months after the surgery, and a decrease of approximately 30 points in the TSEQ questionnaire results. Conclusion: Wendler’s Glottoplasty conducted by an expert surgeon, provides positive results with a significant increase for fundamental frequency in the medium term, and it is imperative to do also voice therapy rehabilitation posterior to the procedure in order to obtain the expected optimal outcome.

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