Utility of Eating Assessment Tool–10 in Predicting Aspiration in Patients with Unilateral Vocal Fold Paralysis

2018 ◽  
Vol 159 (1) ◽  
pp. 92-96 ◽  
Author(s):  
Steven A. Zuniga ◽  
Barbara Ebersole ◽  
Nausheen Jamal
Keyword(s):  
Diagnostic Accuracy ◽  
Vocal Fold ◽  
Assessment Tool ◽  
Case Series ◽  
Patient Perception ◽  
Cancer Center ◽  
Aspiration Risk ◽  
Scale Scores ◽  
Vocal Fold Immobility ◽  
Penetration Aspiration Scale

Objective Examine the incidence of penetration/aspiration in patients with unilateral vocal fold immobility and investigate the relationship with self-reported perception of dysphagia. Study Design Case series with chart review. Setting Academic cancer center. Subjects and Methods Adult patients with unilateral vocal fold immobility diagnosed between 2014 and 2016 were reviewed. Patients were stratified into an aspiration group and a nonaspiration group using objective findings on flexible endoscopic evaluation of swallowing, as scored using Rosenbek’s Penetration Aspiration Scale. Objective findings were compared to patient perception of dysphagia. Bivariate linear correlation analysis was performed to evaluate correlation between Eating Assessment Tool–10 scores and presence of aspiration. Tests of diagnostic accuracy were calculated to investigate the predictive value of Eating Assessment Tool–10 scores >9 on aspiration risk. Results Of the 35 patients with new-onset unilateral vocal fold immobility were evaluated, 25.7% (9/35) demonstrated tracheal aspiration. Mean ± SD Eating Assessment Tool–10 scores were 19.2 ± 13.7 for aspirators and 7.0 ± 7.8 for nonaspirators ( P = .016). A statistically significant correlation was demonstrated between increasing Eating Assessment Tool–10 scores and Penetration Aspiration Scale scores ( r = 0.511, P = .002). Diagnostic accuracy analysis for aspiration risk in patients with an Eating Assessment Tool–10 score >9 revealed a sensitivity of 77.8% and a specificity of 73.1%. Conclusion Patient perception of swallowing difficulty may have utility in predicting aspiration risk. An EAT–10 of >9 in patients with unilateral vocal fold immobility may portend up to a 5 times greater risk of aspiration. Routine swallow testing to assess for penetration/aspiration may be indicated in patients with unilateral vocal fold immobility.

scholarly journals Improved Swallow Outcomes after Injection Laryngoplasty in Unilateral Vocal Fold Immobility

2018 ◽  
Vol 97 (8) ◽  
pp. 250-256 ◽  
Author(s):  
Steven Zuniga ◽  
Barbara Ebersole ◽  
Nausheen Jamal
Keyword(s):  
Vocal Fold ◽  
Assessment Tool ◽  
Oral Intake ◽  
Injection Laryngoplasty ◽  
Percutaneous Injection ◽  
Scale Scores ◽  
Vocal Fold Immobility ◽  
Functional Oral Intake Scale ◽  
The Impact ◽  
Swallow Function

While the impact of injection laryngoplasty on voice outcomes in unilateral vocal fold immobility has been well characterized, there is a relative paucity of literature investigating its influence on swallow function and outcomes. We performed a retrospective chart review of patients presenting to an academic cancer center between January 2014 and January 2016 to evaluate the clinical impact of percutaneous injection laryngoplasty on reduction of aspiration risk, patient perception of swallowing, and recommended safe diet in patients with vocal fold immobility after head and neck and thoracic surgery. A consecutive sample of patients diagnosed with unilateral vocal fold immobility with patient- or clinician-identified abnormal swallow function who underwent bedside or in-office vocal fold injection was included in the study. Fiberoptic endoscopic evaluation of swallowing, Eating Assessment Tool-10 scores, Functional Oral Intake Scale scores, and patient perceptual assessment of swallow were evaluated pre- and postinjection. Twenty-one patients with new-onset unilateral vocal fold immobility who underwent injection laryngoplasty were evaluated. Median Eating Assessment Tool-10 and Functional Oral Intake Scale scores postinjection were significantly improved from preinjection. Patients who initially required restricted oral diets, or were nil per os, were able to advance their diet after injection laryngoplasty. Injection laryngoplasty is a safe and effective intervention for improvement of dysphagia in patients with unilateral vocal fold immobility. A single treatment may markedly reduce or eliminate risk of aspiration and potential sequelae.

scholarly journals Improved Swallow Outcomes after Injection Laryngoplasty in Unilateral Vocal Fold Immobility

2018 ◽  
Vol 97 (7) ◽  
pp. 250-256 ◽  
Author(s):  
Steven Zuniga ◽  
Barbara Ebersole ◽  
Nausheen Jamal
Keyword(s):  
Vocal Fold ◽  
Assessment Tool ◽  
Oral Intake ◽  
Injection Laryngoplasty ◽  
Percutaneous Injection ◽  
Scale Scores ◽  
Vocal Fold Immobility ◽  
Functional Oral Intake Scale ◽  
The Impact ◽  
Swallow Function

While the impact of injection laryngoplasty on voice outcomes in unilateral vocal fold immobility has been well characterized, there is a relative paucity of literature investigating its influence on swallow function and outcomes. We performed a retrospective chart review of patients presenting to an academic cancer center between January 2014 and January 2016 to evaluate the clinical impact of percutaneous injection laryngoplasty on reduction of aspiration risk, patient perception of swallowing, and recommended safe diet in patients with vocal fold immobility after head and neck and thoracic surgery. A consecutive sample of patients diagnosed with unilateral vocal fold immobility with patient- or clinician-identified abnormal swallow function who underwent bedside or in-office vocal fold injection was included in the study. Fiberoptic endoscopic evaluation of swallowing, Eating Assessment Tool-10 scores, Functional Oral Intake Scale scores, and patient perceptual assessment of swallow were evaluated pre- and postinjection. Twenty-one patients with new-onset unilateral vocal fold immobility who underwent injection laryngoplasty were evaluated. Median Eating Assessment Tool-10 and Functional Oral Intake Scale scores postinjection were significantly improved from preinjection. Patients who initially required restricted oral diets, or were nil per os, were able to advance their diet after injection laryngoplasty. Injection laryngoplasty is a safe and effective intervention for improvement of dysphagia in patients with unilateral vocal fold immobility. A single treatment may markedly reduce or eliminate risk of aspiration and potential sequelae.

Unilateral transverse cordotomy for bilateral abductor vocal fold immobility

2012 ◽  
Vol 126 (9) ◽  
pp. 913-917 ◽  
Author(s):  
J M Bernstein ◽  
S M Jones ◽  
P H Jones
Keyword(s):  
Vocal Fold ◽  
Case Series ◽  
University Hospital ◽  
Symptom Scale ◽  
Voice Change ◽  
Airway Function ◽  
Scale Scores ◽  
Before And After ◽  
Vocal Fold Immobility

AbstractObjective:We present a case series with airway compromise due to bilateral abductor vocal fold paralysis or fixation, treated with unilateral transverse cordotomy.Methods:Of eight consecutive patients with dyspnoea due to bilateral paramedian vocal fold immobility, seven underwent unilateral transverse cordotomy between August 2006 and April 2010 at University Hospital of South Manchester, UK. Airway and voice outcomes were compared before and after surgery.Results:All seven treated cases derived subjective airway function improvement; there was no aspiration. The eighth case had inadequate access. None of the seven treated patients required contralateral cordotomy or permanent tracheostomy. One treated case required a temporary tracheostomy; unilateral transverse cordotomy facilitated eventual decannulation. Two patients died of cancer at five and six weeks, variously. At a mean follow up of 22 months, four cases showed unchanged or slightly worse Voice Symptom Scale and Grade-Roughness-Breathiness-Asthenia-Strain scale scores.Conclusion:In patients with bilateral abductor vocal fold immobility, unilateral transverse cordotomy results in improved dyspnoea with either no voice change or only slight worsening. This is a more conservative procedure than bilateral transverse cordotomy, with the potential for better preservation of voice and breath support.

Effect of Unilateral Cordotomy on Perception of Dysphagia

2019 ◽  
Vol 129 (6) ◽  
pp. 536-541
Author(s):  
Melissa Conklin ◽  
Matthew S. Clary ◽  
Elizabeth M. Cuadrado ◽  
Marie E. Jetté
Keyword(s):  
Vocal Fold ◽  
Assessment Tool ◽  
Swallowing Function ◽  
Post Surgery ◽  
Bilateral Vocal Fold Paralysis ◽  
Patient Reported ◽  
Specific Outcome ◽  
Vocal Fold Immobility ◽  
Bilateral Vocal Fold Immobility

Objectives: CO2 laser medial transverse cordotomy is a permanent static procedure performed to achieve adequate functional airway in cases of posterior glottic stenosis and bilateral vocal fold paralysis. Although it is the preferred method to manage long-term bilateral vocal fold immobility, it is widely believed that cordotomy has the potential to cause aspiration. The minimal existing data on the effect surgical enlargement of the glottic airway on swallowing function is heterogeneous. Through investigation of dysphagia after cordotomy, we hope to better understand the influence of glottic function and its role in dysphagia. The Eating Assessment Tool (EAT-10), is a validated dysphagia symptom-specific outcome measure. We hypothesized that EAT-10 scores would not change after CO2 laser cordotomy despite causing glottic insufficiency. Methods: Retrospective review was performed on sequential patients having undergone unilateral CO2 laser cordotomy with complete pre- and postoperative EAT-10 questionnaire data available for evaluation. Results: Fifteen patients were available for analysis; 10 patients underwent primary unilateral medial transverse cordotomy, 5 patients underwent revision cordotomy, and 20 unique procedures were included in the dataset. The median EAT-10 score during the visit prior to surgery was 3.5, whereas the post-surgery median score was 2. Furthermore, the median difference of 0 was statistically non-significant ( P = .91). Conclusion: CO2 laser cordotomy does not contribute to patient-reported dysphagia despite creating glottic incompetence. This suggests vocal fold apposition may play a less significant role in normal swallowing function than widely believed.

Medialization Laryngoplasty in Pediatric Patients With Unilateral Vocal Fold Immobility: A Case Series

2018 ◽  
Vol 128 (2) ◽  
pp. 145-151 ◽  
Author(s):  
Nikolaus E. Wolter ◽  
Nohamin Ayele ◽  
Kosuke Kawai ◽  
Anne Hseu ◽  
Roger Nuss
Keyword(s):  
Vocal Fold ◽  
Pediatric Population ◽  
Voice Quality ◽  
Case Series ◽  
Swallowing Function ◽  
Age At Surgery ◽  
Significant Difference ◽  
Vocal Fold Immobility ◽  
The Impact ◽  
Medialization Laryngoplasty

Objectives: The aims of this study were to describe the impact of laryngoplasty in pediatric unilateral vocal fold immobility (UVFI) and to determine the impact of etiology and technique on voice and swallowing. Methods: A retrospective review was conducted of all children with UVFI undergoing medialization laryngoplasty at a pediatric hospital (2010-2017). Data including demographics, etiology, subjective voice quality, and swallowing function were collected. Results: The median age at first surgery among 25 patients with UVFI was 11 years (range, 1.2-25 years). The causes of UVFI were iatrogenic (76%), congenital (16%), and idiopathic (8%). A total of 38 laryngoplasties (24 injections, 11 Silastic implants, 3 Gore-Tex) were performed. Postoperatively, 78% of patients reported improvements in voice and 81% in swallowing. The median duration of voice improvement was 1.0 years (range, 0.1-10 years), with no significant difference by etiology or laryngoplasty technique. Patients who were ⩾10 years of age at surgery reported voice improvement significantly more often than patients <10 years of age at surgery (94% vs 61%, P = .04). Conclusions: UVFI has a significant impact on health and quality of life. In this study we found that laryngoplasty is an effective way to address both voice and swallowing in pediatric UVFI. A greater proportion of children with improved voice quality were older at injection. Surprisingly, there was no difference in duration of voice improvement between permanent and absorbable materials. Although this duration would be considered acceptable for many injectable materials, the limited duration in permanent implantation techniques may represent the challenges of managing UVFI in the growing larynx of the pediatric population. Injection laryngoplasty with absorbable materials may serve as an adequate method of addressing UVFI in this population.

Immediate selective laryngeal reinnervation in vagal paraganglioma patients

2018 ◽  
Vol 132 (9) ◽  
pp. 846-851
Author(s):  
M Mat Baki ◽  
P Clarke ◽  
M A Birchall
Keyword(s):  
Outcome Measures ◽  
Phrenic Nerve ◽  
Vocal Fold ◽  
Assessment Tool ◽  
Case Series ◽  
Ansa Cervicalis ◽  
Laryngeal Reinnervation ◽  
Post Operation ◽  
Prospective Case Series ◽  
The Voice

AbstractObjectiveThis prospective case series aimed to present the outcomes of immediate selective laryngeal reinnervation.MethodsTwo middle-aged women with vagal paraganglioma undergoing an excision operation underwent immediate selective laryngeal reinnervation using the phrenic nerve and ansa cervicalis as the donor nerve. Multidimensional outcome measures were employed pre-operatively, and at 1, 6 and 12 months post-operatively.ResultsThe voice handicap index-10 score improved from 23 (patient 1) and 18 (patient 2) at 1 month post-operation, to 5 (patient 1) and 1 (patient 2) at 12 months. The Eating Assessment Tool 10 score improved from 20 (patient 1) and 24 (patient 2) at 1 month post-operation, to 3 (patient 1) and 1 (patient 2) at 12 months. There was slight vocal fold abduction observed in patient one and no obvious abduction in patient two.ConclusionSelective reinnervation is safe to perform following vagal paraganglioma excision conducted on the same side. Voice and swallowing improvements were demonstrated, but no significant vocal fold abduction was achieved.

Injection Laryngoplasty for Children with Unilateral Vocal Fold Paralysis: Procedural Limitations and Swallow Outcomes

2018 ◽  
Vol 160 (3) ◽  
pp. 540-545 ◽  
Author(s):  
Kara D. Meister ◽  
April Johnson ◽  
Douglas R. Sidell
Keyword(s):  
Adverse Events ◽  
Vocal Fold ◽  
Pediatric Population ◽  
Case Series ◽  
Study Data ◽  
Injection Laryngoplasty ◽  
Swallow Study ◽  
Vocal Fold Immobility ◽  
The Mean ◽  
Room Time

Objective Vocal fold immobility with resultant dysphagia is a known cause of morbidity in the pediatric population. Herein we evaluate the efficacy and adverse events of injection laryngoplasty in children. Study Design Case series with chart review. Setting Tertiary academic children’s hospital. Subjects and Methods Patients <12 years of age with unilateral vocal fold immobility, dysphagia, and objective swallow study data were included. Primary outcome measures included perioperative adverse events and the ability to advance the diet, as defined by initiation of oral feeds or reduction in thickener following postoperative swallow study. Results The mean age of the cohort (N = 41) was 43.83 months (range, 0.5-144 months), and 46.3% of patients were <18 months old. Perioperative adverse events included increased oxygen requirement (n = 3), prolonged operating room time secondary to tenuous cardiopulmonary status (n = 2), and postoperative readmission within 30 days (n = 1). A total of 63.63% (n = 21 of 33) of patients safely advanced their diet following objective improvement on swallow study. Patients undergoing injection laryngoplasty ≤6 months of the onset of vocal fold immobility were more likely to advance their diet following surgery. Conclusion Injection laryngoplasty has the potential to advance or initiate an oral diet for children with vocal fold immobility, including those in the first months of life. It is relatively free of adverse events, but certain limitations in the pediatric population must be considered. Preoperative characteristics, including timing of injection and premorbidity diet, may guide clinicians in predicting those patients most likely to advance their diet following injection laryngoplasty.

Laryngeal tuberculosis: A review of 26 cases

2007 ◽  
Vol 137 (4) ◽  
pp. 582-588 ◽  
Author(s):  
Chen-Chi Wang ◽  
Chang-Chun Lin ◽  
Ching-Ping Wang ◽  
Shih-An Liu ◽  
Rong-San Jiang
Keyword(s):  
Vocal Fold ◽  
Medical Center ◽  
Case Series ◽  
Common Symptom ◽  
Retrospective Case ◽  
Cervical Lymph Nodes ◽  
Female Patients ◽  
Mixed Features ◽  
Vocal Fold Immobility ◽  
Laryngeal Tuberculosis

Objectives To review the clinical characteristics of laryn-geal tuberculosis. Study Design Retrospective case series. Subjects and Methods Medical records of 26 histopa-thology-confirmed cases in a tertiary medical center from 1992 to 2006. Results The female patients were significantly younger than male patients. Hoarseness is the most common symptom (84.6%) because true vocal fold is most commonly involved (80.8%). Infection usually involves unilateral (66.7%) and right-side larynx but multiple subsites of the larynx (57.7%). The appearance of the affected larynx may have mixed features and change before diagnosis. Laryngeal tuberculosis is usually misdiagnosed as laryngeal cancer, especially in patients with malignant signs such as enlarged cervical lymph nodes and vocal fold immobility. Chest film is better than sputum examinations for screening. Conclusion We should be especially alert about TB infection when facing young female patients with unusual laryngeal lesions. Extensive laser excision before diagnosis should be avoided because after antituberculous treatment, prognosis is usually good and vocal fold immobility could be reversible.

scholarly journals 5 Years of Diode Laser “Π” Technique for Bilateral Vocal Fold Immobility: A Technique That Improves Airway and Is Friendly to the Voice

2020 ◽  
Vol 100 (1_suppl) ◽  
pp. 83S-86S
Author(s):  
Petros D. Karkos ◽  
Marios Stavrakas ◽  
Ioannis Koskinas ◽  
Konstantinos Markou ◽  
Stefanos Triaridis ◽  
...  
Keyword(s):  
Diode Laser ◽  
Vocal Fold ◽  
Assessment Tool ◽  
University Hospital ◽  
Significant Deterioration ◽  
Vocal Fold Immobility ◽  
Quality Of Voice ◽  
Bilateral Vocal Fold Immobility

Background: To demonstrate the efficacy of a new laser surgical technique for bilateral vocal fold immobility (BVFI) on postoperative quality of voice and swallowing. Methods: Prospective study in a tertiary university hospital and a private hospital. Patients with iatrogenic BVFI were included. Outcome measures were Voice Handicap Index 10, 10-item Eating Assessment Tool, flexible laryngoscopy, and success of decannulation. Results: Forty patients with post thyroidectomy BVFI were initially enrolled in our study; only 12 patients returned questionnaires and kept their follow-ups and were included in the study. All patients were successfully decannulated and remain decannulated up to 24-month follow-up. There was a statistically significant improvement in quality of swallowing and no significant deterioration in quality of voice. There was no need for revision up to 24-month follow up. Conclusions: The “Π” technique using diode laser technology is a new and safe technique for BVFI with excellent long-term decannulation rates and improvement in quality of life and swallowing without significant changes in voice quality.

scholarly journals Laser arytenoidectomy in children with bilateral vocal fold immobility

2006 ◽  
Vol 121 (1) ◽  
pp. 25-27 ◽  
Author(s):  
G Worley ◽  
Y Bajaj ◽  
L Cavalli ◽  
B Hartley
Keyword(s):  
Vocal Fold ◽  
Voice Quality ◽  
Case Series ◽  
Challenging Problem ◽  
Retrospective Case ◽  
Voice Outcome ◽  
Vocal Fold Immobility ◽  
The Voice ◽  
Bilateral Vocal Fold Immobility ◽  
Better Than

Bilateral vocal fold immobility in children is a challenging problem because a balance between good airway and voice quality has to be achieved. Surgery to improve the airway is often postponed or avoided because of fear of losing the voice. In this study our results of laser arytenoidectomy in children are described. This was a retrospective case notes review at a tertiary level paediatric ENT department. The six patients in this case series ranged from nine to 16 years old at the time of laser arytenoidectomy. Post-operative airway and voice quality were assessed. All children in the series had an adequate post-operative airway. Four of these patients had tracheostomies pre-operatively and achieved decannulation. All six patients rated their post-operative voice as better than pre-operatively. This is principally due to increased loudness associated with increased airflow through the larynx, particularly after tracheostomy decannulation. It is recommended that special care should be taken not to disturb the anterior two thirds of the vocal fold during the surgery in order to achieve a good post-operative voice outcome.

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