scholarly journals Methods of sparing surgical treatment of chronic edematous-polypous laryngitis, edema Reinke

2021 ◽  
pp. 184-191
Author(s):  
B. Z. Abdullaev ◽  
I. I. Nazhmudinov ◽  
Kh. Sh. Davudov ◽  
T. I. Garashchenko ◽  
I. Kh. Guseynov ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Mucous Membrane ◽  
Vocal Fold ◽  
Carbon Dioxide Laser ◽  
General Structure ◽  
Vocal Folds ◽  
Endoscopic Examination ◽  
Upper Respiratory Tract ◽  
Maximum Phonation Time ◽  
The Voice

Introduction. Laryngeal pathology occupies a leading place in the general structure of diseases of the upper respiratory tract, chronic edematous-polypous laryngitis, Reinke-Gayek edema accounts for 5.5% of all benign diseases of the vocal folds. The main method of treating Reinke-Gayek's disease is surgical treatment, which consists in removing excess mucosa, or “stripping” - tearing a strip of mucosa with forceps from the vocal fold. One of the main principles of laryngeal surgery is the maximum preservation of the structures of the vocal fold, obtaining a flexible vibration of the muscular-membranous part and the mucous membrane of the vocal fold.Purpose. The purpose of our work is to improve the effectiveness of treatment of chronic edematous-polypous laryngitis using a CO2 laser.Tasks. To develop a differentiated approach to the surgical treatment of chronic edematous-polypous laryngitis using a carbon dioxide laser.Materials and Methods. We treated 46 patients with Reinke-Gayek disease, including 35 women and 11 men. The age of the patients ranged from 40 to 67 years. Preoperative examination included endoscopic examination, laryngostroboscopy. The type was determined according to the classification of H. Yonekawa, for the choice of further surgical tactics. In type II, an incision of the mucosa, aspiration of gelatinous matter from the Reinke space, and laying of the mucosa were performed. With type III, it is made by forming M-shaped flap to close the defect.Results. All patients in the preoperative period were surveyed with the VOICE HANDICAP INDEX(VHI-30) questionnaire, laryn-gostroboscopy, and maximum phonation time. In the postoperative period, the examination was performed twice, 1 month after the operation and 3 months after the operation. There is a significant increase in indicators, an increase in the maximum phonation time, a decrease in VHI-30 points.Conclusion. The use of this technique allowed to significantly accelerate the recovery of the voice, reduce the time spent in the hospital, minimally damaging the structure of the mucous membrane of the vocal folds.

Impact of unilateral carbon dioxide laser posterior transverse cordotomy on vocal and aerodynamic parameters in bilateral vocal fold paralysis

2016 ◽  
Vol 130 (4) ◽  
pp. 373-379 ◽  
Author(s):  
M B Asik ◽  
O Karasimav ◽  
H Birkent ◽  
A L Merati ◽  
M Gerek ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Vocal Fold ◽  
Carbon Dioxide Laser ◽  
Vocal Fold Paralysis ◽  
Bicycle Ergometry ◽  
Maximum Phonation Time ◽  
Post Operative Period ◽  
Bilateral Vocal Fold Paralysis ◽  
Aerodynamic Parameters ◽  
The Voice

AbstractObjectives:Carbon dioxide laser posterior transverse cordotomy is a common option for bilateral vocal fold paralysis. This study prospectively evaluated aerodynamic and acoustic effects of unilateral carbon dioxide laser posterior transverse cordotomy in bilateral vocal fold paralysis patients.Methods:The study comprised 11 bilateral vocal fold paralysis patients (9 females, 2 males), with a mean age of 46.6 ± 14.1 years. All patients were treated by laser posterior transverse cordotomy. Pre-operative and two-month post-operative assessments were conducted, including: dyspnoea scales, maximum phonation time measurement, spirometry and bicycle ergometry.Results:All subjective and objective aerodynamic parameters showed statistically significant improvements between the pre- and post-operative period. Objective spirometric and ergometric parameters showed a significant increase post-operatively. The changes in objective voice parameters (fundamental frequency (f0), jitter, shimmer, soft phonation index and noise-to-harmonic ratio) were statistically non-significant; however, there was a significant improvement in subjective voice parameters post-operatively, as assessed by the voice handicap index and grade-roughness-breathiness-asthenia-strain scale (p = 0.026 and p = 0.018 respectively).Conclusion:Unilateral carbon dioxide laser posterior transverse cordotomy is an effective procedure that results in improved dyspnoea and aerodynamic performance with some worsening of voice parameters.

Vocal Fold Atrophy and its Surgical Treatment

1996 ◽  
Vol 105 (3) ◽  
pp. 182-188 ◽  
Author(s):  
Nobuhiko Isshiki ◽  
Kazuhiko Shoji ◽  
Hisayoshi Kojima ◽  
Shigeru Hirano
Keyword(s):  
Decision Making ◽  
Surgical Treatment ◽  
Vocal Fold ◽  
Voice Quality ◽  
Vocal Folds ◽  
Decision Making Process ◽  
Type I ◽  
Vocal Fold Atrophy ◽  
The Voice ◽  
Type I Thyroplasty

The effectiveness of surgical treatment for vocal fold atrophy of various causes was examined. Type I thyroplasty was performed on 31 patients with vocal fold atrophy, often bilaterally and occasionally combined with type III thyroplasty. Of these 31 patients, 3 patients underwent the operation twice, for a total of 34 operations. The surgery was found to be effective in improving the voice quality and the ease of phonation. When a scar or sulcus was present, the results were not as satisfactory. The intraoperative decision-making process as to which procedure to perform is extremely important for achieving an optimal voice, and should be based on the intraoperative voice quality, fiberoptic findings, and manual tests. In operations for vocal fold atrophy in which the vocal folds are mobile, a silicone shim should be firmly fixed to prevent migration. Overcorrection is generally recommended. No complications were encountered. It was often the increased ease of phonation rather than the improved voice quality that patients appreciated after surgery.

The role of stroboscopy in the management of a patient with a unilateral vocal fold paralysis

1996 ◽  
Vol 110 (2) ◽  
pp. 141-143 ◽  
Author(s):  
Meredydd Lloyd Harries ◽  
Murray Morrison
Keyword(s):  
Surgical Treatment ◽  
Diagnostic Tool ◽  
Vocal Fold ◽  
Speech Therapy ◽  
Muscle Tone ◽  
Vocal Folds ◽  
Vocal Fold Paralysis ◽  
Unilateral Vocal Fold Paralysis

AbstractStroboscopy is well established as an essential diagnostic tool in the assessment of the vocal folds during phonation. This paper analyses the stroboscopic findings in 100 patients with a unilateral vocal fold paralysis. Reliable stroboscopic signals were only obtained in patients with the paralysed fold close to the midline. These patients seldom require surgery however, usually responding to speech therapy with laryngeal compensation giving a good voice. Most patients that require surgery have a large glottal deficiency, but in this series these patients did not give an adequate signal for analysis. Although useful in the assessment of the muscle tone of the paralysed fold, the influence of stroboscopy on the surgical treatment in this series was limited.

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.

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.

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.

Vocal fold lateralization using carbon dioxide laser and fibrin glue

1992 ◽  
Vol 106 (3) ◽  
pp. 226-230 ◽  
Author(s):  
Arne Linder ◽  
Carl-Eric Lindholm
Keyword(s):  
Carbon Dioxide ◽  
Fibrin Glue ◽  
Vocal Fold ◽  
Carbon Dioxide Laser ◽  
Vocal Folds ◽  
Lateral Position ◽  
Endoscopic Method ◽  
Bilateral Vocal Fold Paralysis ◽  
Recent Method

AbstractLateralization of one or both vocal folds is a generally accepted surgical principle for the relief of the airway obstruction caused by bilateral vocal fold paralysis. A modified, entirely endoscopic method of lateralization has been developed, employing a carbon dioxide laser to reduce the bulk of the fold, and fibrin glue to maintain the lateral position. The results of 18 operations on 15 patients, including six who had unsatisfactory results after previous surgery, were analyzed and compared retrospectively with the results from 22 patients operated on before the introduction of the method. The patient's ability to perform everyday activities improved in 12 cases, which paralleled the results of the previous, more cumbersome methods. The incidence of re-operation was comparable, given the shorter follow-up after the more recent method.

Age-Related Changes of the Macula Flava of the Human Vocal Fold

1995 ◽  
Vol 104 (11) ◽  
pp. 839-844 ◽  
Author(s):  
Kiminori Sato ◽  
Minoru Hirano
Keyword(s):  
Vocal Fold ◽  
Vocal Folds ◽  
Ground Substance ◽  
Elastic Fibers ◽  
Electron Microscopic ◽  
Age Related ◽  
Transmission Electron ◽  
Abnormal Metabolism ◽  
The Voice ◽  
Age Related Changes

This investigation was carried out to determine the histologic structure and age-related changes of the macula flava of human aged vocal folds. Excised human adult senescent larynges served as the material for this study. Light microscopic and transmission electron microscopic observations were made. The results are summarized as follows. 1) The anterior and posterior maculae flavae were elliptical in shape and about 1.5 × 1.5 × 1 mm in size. 2) The macula flava was composed of fibroblasts, elastic fibers, collagenous fibers, and ground substance. 3) The number of fibroblasts decreased. 4) Components in the cytoplasm, such as Golgi apparatus and rough endoplasmic reticulum, were fewer than in younger adults. 5) Some fibroblasts and some components in the cytoplasm degenerated. 6) The accumulation of glycogen granules and lipid droplets were seen in the cytoplasm. 7) The number of collagenous and elastic fibers synthesized by the fibroblasts decreased. 8) These findings were evident to various degrees and suggested the reduction of fibroblast activation, abnormal metabolism, and degeneration. A decrease in the number and activation of fibroblasts in maculae flavae indicates decreased synthesis of fibrous components in the vocal fold mucosa. This in turn influences the viscoelasticity and stiffness of vibrating tissue and contributes partially to aging of the voice.

Microsurgery of Sulcus Vergeture with Carbon Dioxide Laser and Injectable Collagen

2000 ◽  
Vol 109 (2) ◽  
pp. 141-148 ◽  
Author(s):  
Marc Remacle ◽  
Georges Lawson ◽  
Jean-Christophe Degols ◽  
Isabelle Evrard ◽  
Jacques Jamart
Keyword(s):  
Carbon Dioxide ◽  
Vocal Fold ◽  
Carbon Dioxide Laser ◽  
Focal Length ◽  
Spot Size ◽  
Maximum Phonation Time ◽  
Pulse Microwave ◽  
Vocal Fold Vibration ◽  
Vocal Effort

Between January 1989 and June 1998, we operated on 45 patients for sulcus vergeture. The studied population encompassed 38 women (84%) and 7 men (16%). The median age was 36 (range 12 to 71 years). The surgical technique is based on a concept of Cornut and Bouchayer according to which the dissection of the epithelium adherent to the deep subepithelial plane improves the vocal fold vibration. Dissection is performed with a single-pulsed carbon dioxide laser at 2 to 3 W with a pulse duration of 0.1 second. We use the Super-pulse microwave. The Acuspot micromanipulator provides a spot size of 250 μm at 350-mm focal length. When the vocal fold is atrophic, surgery is completed with a bovine or autologous collagen injection; the median injected quantity is 0.3 mL (range 0.1 to 0.4 mL). The epithelial microflap is redraped with fibrin glue. Voice therapy is indispensable for correcting the associated hyperkinetic dysphonia. The median postoperative follow-up period is 5 months (range 1 to 18 months). In terms of median values, the maximum phonation time improved from 9 to 13 seconds, the phonation quotient improved from 296.5 to 228.5 mL/s, and the spectral analysis distribution improved by 1 class. Stroboscopic examination reveals an improvement of the vibratory symmetry, amplitude, and wave. Subjectively, the patients describe an improved ability for vocal effort and the regression or disappearance of vocal fatigue. Although the timbre is improved, the voice often remains breathy and hoarse.

Changes in the male voice at puberty: vocal fold length and its relationship to the fundamental frequency of the voice

1998 ◽  
Vol 112 (5) ◽  
pp. 451-454 ◽  
Author(s):  
Meredydd Harries ◽  
Sarah Hawkins ◽  
Jeremy Hacking ◽  
Ieuan Hughes
Keyword(s):  
Fundamental Frequency ◽  
Vocal Fold ◽  
Gradual Increase ◽  
Vocal Folds ◽  
Frequency Change ◽  
Male Voice ◽  
Pubertal Stage ◽  
Sudden Drop ◽  
Ultrasound Measurements ◽  
The Voice

AbstractUltrasound measurements of the vocal folds were taken for a number of boys passing through puberty. The boys were grouped according to their pubertal stage as defined by Tanner and there was a gradual increase in the length of the vocal folds as puberty progressed. The fundamental frequency of the boys' speaking voice was recorded via laryngography and a good correlation between the length of the vocal folds and the frequency of the voice was seen. The sudden drop in frequency seen between Tanner stages 3 and 4 did not correlate with similar changes in the length of the vocal folds at this time but stroboscopic findings suggest a change in the structure and mass of the vocal folds at this time of maximum frequency change.

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