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.

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.

scholarly journals Management of Advanced Medullary Thyroid Carcinoma with Vandetanib: Case Series

2021 ◽  
Vol 5 (1) ◽  
pp. 01-07
Author(s):  
Andrés Flórez R
Keyword(s):  
Partial Response ◽  
Adverse Events ◽  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Stable Disease ◽  
Case Series ◽  
Medullary Thyroid ◽  
The Mean ◽  
Grade 3

Objective: To describe the tumor response and adverse events in patients with advanced medullary thyroid carcinoma (MTC) treated with vandetanib at the National Cancer Institute in Bogotá, Colombia. Materials and Methods: Case series including five patients with advanced MTC treated with vandetanib from April 2011 to August 2018 and a minimum follow-up of 6 months. Results: 5 patients met the inclusion criteria, including 3 women. The mean age was 49 years. A total of 4 patients underwent total thyroidectomy prior to starting vandetanib. The main indication for vandetanib was progression of liver metastasis (4 patients). Regarding treatment response, 3 patients presented stable disease, 1 patient showed partial response, and 1 had disease progression. The mean treatment duration was 16.5 months. Grade 3 or 4 adverse events were observed in three patients, 1 with diarrhea, 1 with hypertension, and 1 with rash. All symptoms improved with dose reduction or temporary suspension of vandetanib. Conclusions: The management of advanced MTC with vandetanib allows for prolonged disease control (stable disease or partial response). Although adverse events are frequent, most are mild and severe cases are manageable.

Vocal Fold Immobility Following Vaccination

2020 ◽  
pp. 000348942096563
Author(s):  
Guy Talmor ◽  
Brandon Nguyen ◽  
Corina Din-Lovinescu ◽  
Boris Paskhover ◽  
Rachel Kaye
Keyword(s):  
Adverse Event ◽  
Adverse Events ◽  
Symptom Onset ◽  
Vocal Fold ◽  
Rare Complication ◽  
Adverse Event Reporting System ◽  
Vaccine Administration ◽  
Presenting Symptoms ◽  
Vocal Fold Immobility ◽  
The Relationship

Objective: Vocal fold immobility (VFI) may severely affect quality of life due to dysphonia and respiratory distress. Many etiologies of this disorder have been evaluated, however the relationship between VFI and vaccination has yet to be explored. The objective of this study was to identify the relationship between VFI and vaccine administration. Methods: The Vaccine Adverse Event Reporting System (VAERS) database was queried for patients exhibiting symptoms of VFI following vaccination. Patient demographics and clinical information including presenting symptoms, time of symptom onset, laterality, outcomes, and adverse events were documented. Results: Twenty-two patients were found to have VFI following vaccination. Of those reported, 13 patients were female (59.1%) and 8 were male (36.4%) with an average age of 48.4 years. Vaccinations for influenza, shingles, pneumococcus, and hepatitis B were reported. A majority of these cases were unilateral in nature (73.3%). Mean lag time from vaccination to symptom onset was 6.3 days (range 0-45 days). Five adverse events were reported, with 4 patients requiring intubation and tracheostomy. Conclusion: Vaccine administration may be associated with VFI and physicians should be cognizant of this potential adverse event. This is a rare complication with less reported cases than other post-vaccination cranial neuropathies. The difficulty in establishing an initial diagnosis and need for specialized evaluation by an otolaryngologist may result in under-reporting of such events. Further research is needed to delineate the exact pathophysiology of this complication and determine whether a causal relationship exists.

scholarly journals Endoscopic posterior cordotomy for treatment of dyspnea due to vocal fold immobility

2020 ◽  
Vol 15 ◽  
Author(s):  
Narin Nard Carmel Neiderman ◽  
Max Chason ◽  
Anat Wengier ◽  
Oshri Wasserzug ◽  
Oren Cavel ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Respiratory Distress ◽  
Surgical Procedures ◽  
Medical Records ◽  
Vocal Fold ◽  
Surgical Intervention ◽  
Acute Setting ◽  
Vocal Fold Immobility ◽  
The Mean

Introduction: Several surgical procedures have been described for the treatment of respiratory distress secondary to vocal fold immobility (VFI), but the contribution of posterior cordotomy (PC) to tracheostomy weaning or prevention has not been studied in depth, particularly in the acute setting. The objective of this study was to show the effectiveness of PC to relieve dyspnea, prevent the need for tracheostomy, and enable decannulation in patients with VFI. Methods: We conducted a retrospective study and reviewed the medical records of all patients whose dyspnea warranted surgical intervention from January 2013 to January 2018. Data were retrieved on epidemiology, etiology, and duration of VFI, tracheostomy dependence, success in decannulation from tracheostomy or respiratory relief, number of procedures until decannulation, and complications. Results: Twelve suitable patients were identified of whom eleven had bilateral VFI and one had unilateral VFI. Five were tracheostomy-dependent. Ten patients underwent unilateral PC, and two patients underwent bilateral PC. All the patients experienced respiratory relief, eleven after a single PC and one after two PCs. All tracheostomy-dependent patients were decannulated. The mean follow-up after PC was 24.55 months during which none of the patients required a re-tracheostomy and three patients required revision of the PC. There were no surgical complications. Postoperatively, eight patients (67%) experienced a breathy voice and three patients (25%) had dysphagia for fluids. No patient had aspiration pneumonia. Conclusions: We conclude that PC is an easy, safe, and effective procedure for tracheostomy weaning and respiratory relief in patients with VFI. A revision PC may be indicated in some patients. A breathy voice is to be expected, and a few patients will experience dysphagia to fluids that may be addressed by instructing the patient to use a fluid thickener and take small sips.

Hospitalized Patients With New‐Onset Vocal Fold Immobility Warrant Inpatient Injection Laryngoplasty

2020 ◽  
Vol 131 (1) ◽  
pp. 115-120
Author(s):  
Lindsay Reder ◽  
Caitlin Bertelsen ◽  
Varun Angajala ◽  
Karla O'Dell ◽  
Laurel Fisher
Keyword(s):  
Vocal Fold ◽  
Hospitalized Patients ◽  
Injection Laryngoplasty ◽  
Vocal Fold Immobility ◽  
New Onset

scholarly journals Changes in Abnormal Muscle Tension Pattern after Fiberoptic Injection Laryngoplasty

2017 ◽  
Vol 96 (12) ◽  
pp. 472-476 ◽  
Author(s):  
Georges Ziade ◽  
Ghassan Haddad ◽  
Sarah Assaad ◽  
Maher Kasti ◽  
Abdul-Latif Hamdan
Keyword(s):  
Medical Records ◽  
Vocal Fold ◽  
Chart Review ◽  
Muscle Tension ◽  
Retrospective Chart Review ◽  
Injection Laryngoplasty ◽  
Before And After ◽  
Glottal Insufficiency ◽  
The Mean ◽  
Positive Effect

We performed a retrospective chart review to compare the presence and types of abnormal muscle tension patterns (MTPs) in patients who had been diagnosed with glottal insufficiency before and after fiberoptic injection laryngoplasty. The main cause of glottal insufficiency had been unilateral vocal fold paralysis. Our review included an analysis of the medical records and laryngeal videostroboscopic recordings of 16 patients—9 men and 7 women, aged 25 to 87 years (mean: 59). Stroboscopic frames were analyzed for the presence of one or more types of abnormal MTP. Statistical analysis was performed to determine the significance of the change in scores for type II and type III MTP before injection and 1 month after injection. Before injection laryngoplasty, 15 of the 16 patients exhibited evidence of an abnormal MTP; 10 patients had MTP II only, 2 had MTP III only, and 3 patients had both. The mean percentage of frames showing MTP (i.e., MTP score) in patients with MTP II was 66.2% before the injection and 28.9% 1 month after; the decrease was statistically significant (p = 0.001). For MTP III, the corresponding figures were 71.6 and 37.7% (p = 0.043). We conclude that injection laryngoplasty has a positive effect on reducing muscle tension in patients with glottal insufficiency.

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.

Subtotal Carbon Dioxide Laser Arytenoidectomy for the Treatment of Bilateral Vocal Fold Immobility: Long-Term Results

2005 ◽  
Vol 114 (2) ◽  
pp. 115-121 ◽  
Author(s):  
Isabelle Plouin-Gaudon ◽  
Jacques Jamart ◽  
Georges Lawson ◽  
Marc Remacle
Keyword(s):  
Carbon Dioxide ◽  
Vocal Fold ◽  
Carbon Dioxide Laser ◽  
Long Term Results ◽  
Median Frequency ◽  
Maximum Phonation Time ◽  
Vocal Fold Immobility ◽  
The Mean ◽  
Risk Of Aspiration ◽  
Bilateral Vocal Fold Immobility

Sixty-nine patients underwent subtotal carbon dioxide laser arytenoidectomy for treatment of bilateral vocal fold immobility between 1985 and 2000. The population included 69 patients whose mean age was 56 years (SD, 16 years; range, 11 to 82 years). The mean follow-up was 50 months (SD, 44 months; range, 1 to 181 months). The overall postoperative peak expiratory/peak inspiratory flow ratio (normal value, 1) significantly improved (closer to 1; p = .0036). Voice analyses were also undertaken for 27 patients, almost exclusively after operation, given the context of initial emergency. The maximum phonation time averaged 6.57 seconds (median, 6 seconds). The phonation quotient remained high, with a mean of 503 (median, 440), and the mean conversational voice intensity remained around 59 dB. The median frequency analysis type was 3. The advantage of subtotal arytenoidectomy lies in the fact that it maintains a certain degree of rigidity along the posterior limit of the arytenoid frame, preventing inward collapse of the mucosa and thus lowering the risk of aspiration.

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.

Fluoroscopic Swallowing Abnormalities in Dysphagic Patients Following Anterior Cervical Spine Surgery

2020 ◽  
Vol 129 (11) ◽  
pp. 1101-1109
Author(s):  
Shumon Ian Dhar ◽  
Adam M. Wegner ◽  
Pope Rodnoi ◽  
John C. Wuellner ◽  
Omid Benjamin Mehdizadeh ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Spine Surgery ◽  
Vocal Fold ◽  
Cervical Spine Surgery ◽  
Anterior Cervical Spine Surgery ◽  
Immobility Time ◽  
Swallowing Dysfunction ◽  
Vocal Fold Immobility ◽  
The Mean ◽  
Ues Opening

Objectives: To evaluate the precise objective fluoroscopic abnormalities in persons with dysphagia following anterior cervical spine surgery (ACSS). Methods: 129 patients with dysphagia after ACSS were age and sex matched to 129 healthy controls. All individuals underwent videofluoroscopic swallow study (VFSS). VFSS parameters abstracted included upper esophageal sphincter (UES) opening, penetration aspiration scale (PAS), and pharyngeal constriction ratio (PCR). Other data collected included patient-reported outcome measures of voice and swallowing, number of levels fused, type of plate, vocal fold immobility, time from surgery to VFSS, and revision surgery status. Results: The mean age of the entire cohort was 63 (SD ± 11) years. The mean number of levels fused was 2.2 (±0.9). 11.6% (15/129) were revision surgeries. The mean time from ACSS to VFSS was 58.3 months (±63.2). The majority of patients (72.9%) had anterior cervical discectomy and fusion (ACDF). For persons with dysphagia after ACSS, 7.8% (10/129) had endoscopic evidence of vocal fold immobility. The mean UES opening was 0.84 (±0.23) cm for patients after ACSS and 0.86 (±0.22) cm for controls ( P > .0125). Mean PCR was 0.12 (±0.12) for persons after ACSS and 0.08 (±0.08) for controls, indicating significant post-surgical pharyngeal weakness ( P < .0125). The median PAS was 1 (IQR 1) for persons after ACSS as well as for controls. For ACSS patients, PCR had a weak correlation with EAT-10 ( P < .0125). Conclusion: Chronic swallowing dysfunction after ACSS appears to be secondary to pharyngeal weakness and not diminished UES opening, the presence of aspiration, vocal fold immobility, or ACSS instrumentation factors. Level of Evidence: 3b

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