Dysphagia Outcomes Following Surgical Management of Unilateral Vocal Fold Immobility: A Systematic Review and Meta-analysis

Objective To assess dysphagia outcomes following surgical management of unilateral vocal fold immobility (UVFI) in adults. Data Sources Ovid MEDLINE, Embase, Web of Science, and Cochrane Central. Review Methods A structured literature search was utilized, and a 2-researcher systematic review was performed following PRISMA guidelines. Extractable data were pooled, and a quantitative analysis was performed with a random effects model to analyze treatment outcome and complications by procedure. Results A total of 416 publications were screened and 26 met inclusion criteria. Subjects encompassed 959 patients with UVFI who underwent 916 procedures (n = 547, injection laryngoplasty; n = 357, laryngeal framework surgery; n = 12, laryngeal reinnervation). An overall 615 were identified as having dysphagia as a result of UVFI and had individually extractable outcome data, which served as the basis for a quantitative meta-analysis. In general, dysphagia outcomes after all medialization procedures were strongly positive. Quantitative analysis demonstrated a success rate estimate of 90% (95% CI, 75%-100%) for injection laryngoplasty and 92% (95% CI, 87%-97%) for laryngeal framework surgery. The estimated complication rate was 7% (95% CI, 2%-13%) for injection laryngoplasty and 15% (95% CI, 10%-20%) for laryngeal framework surgery, with minor complications predominating. Although laryngeal reinnervation could not be assessed quantitatively due to low numbers, qualitative analysis demonstrated consistent benefit for a majority of patients for each procedure. Conclusion Dysphagia due to UVFI can be improved in a majority of patients with surgical procedures intended to improve glottal competence, with a low risk of complications. Injection laryngoplasty and laryngeal framework surgery appear to be efficacious and safe, and laryngeal reinnervation may be a promising new option for select patients.

Inpatient Type 1 Thyroplasty Versus Injection Laryngoplasty for Vocal Fold Movement Impairment After Extent type I and II Aortic Repair

Importance: Vocal fold motion impairment (VFMI) due to neuronal injury is a known complication following thoracic aortic repair that can impair pulmonary toilet function and post-operative recovery. Objective: To demonstrate clinical outcomes of patients undergoing inpatient vocal fold medialization for VFMI after aortic surgery. Design: A 15-year retrospective chart review (2005-2019) of 259 patients with postoperative VFMI after thoracic aortic surgery registry was conducted. Data included demographics, surgery characteristics, laryngology exam, and postoperative clinical outcomes. Medialization procedures consisted of type 1 thyroplasty and injection laryngoplasty. Setting: Tertiary care hospital Participants: Two hundred and fifty-nine patients (median age 61, 71% male) with VFMI post-thoracic aortic repair met inclusion criteria; inpatient vocal fold medialization was performed for 203 (78%) patients. One hundred and twenty-six. (49%) received type 1 thyroplasty and 77 (30%) received injection laryngoplasty procedures at a median 7 days (IQR 5-8 days) from extubation. Main Outcomes: Primary study outcome measurements consisted of median LOS, median ICU LOS, complications intra- and postoperatively, and pulmonary complications (post-medialization bronchoscopies, pneumonia, tracheostomy, etc.). Results: Post-medialization bronchoscopy rates were significantly lower in the medialization (n = 11) versus the non-medialization group (n = 8) (5% vs 14%, P = .02) and significantly higher in the injection laryngoplasty group (n = 77) versus thyroplasty group (n = 126) (10% vs 2%, P = .02). Further analysis revealed no significant difference in overall LOS and pulmonary complications between the techniques. Conclusion: Inpatient thyroplasty and injection laryngoplasty are both effective vocal fold medialization techniques after extent I and II aortic repair. Thyroplasty may have a small pulmonary toilet advantage, as measured by need for post-medialization bronchoscopy, compared to injection laryngoplasty.

Benign Laryngeal Lesions

Benign laryngeal lesions represent a diverse set of pathologies whose clinical presentation may range from no symptoms to dyspnea and/or dysphonia. Flexible fiberoptic laryngoscopy and videolaryngostroboscopy are important in distinguishingdifferent types of lesions, and management and treatment are dependent on the identification of these lesions, as they have different etiologies. Some lesions such as vocal fold nodules and polyps are primarily phonotraumatic and may benefit fromspeech therapy and vocal hygiene as initial approaches. Vocal fold cysts and benign tumors may benefit from microlaryngeal approaches, while capillary ectasias, polypoid corditis, laryngoceles, saccular cysts, and papilloma may benefit from laser therapy. Vocal fold granulomas may arise from various etiologies such as intubation, traumatic behaviors, or reflux. Polypoid corditis arises from smoking. This review is intended to provide an overview of the variety of lesions that encompass non-malignant laryngeal lesions that is both suitable for junior and senior residents. This review contains 12 figures, 5 tables, and 64 references Keywords: Benign laryngeal lesions, Laryngocele, Polyp, Cyst, Polypoid Corditis, Papilloma

Mucosal Bridge Reconstruction: A Novel Approach for the Vocal Fold Mucosal Bridge

Introduction: Mucosal Bridges (MBs) are defined as benign connective tissue abnormalities of unclear etiology that extend over the free surface of the vocal fold, are attached to the front and back of the vocal fold but are not attached to its free surface, and are histologically covered by stratified squamous epithelium. In order to overcome these drawbacks, we aimed to retrospectively evaluate and present the preoperative and postoperative results of patients with MB, who were applied the method we call “Mucosal Bridge Reconstruction” (MBR), which we apply as suturing rather than resection of the MB. Methods: Between January 2016 and February 2020, 5 patients who applied to the voice clinic due to dysphonia and were diagnosed with MB via laryngostroboscopic examination and direct laryngoscopy under general anesthesia were included in the study. Dr Speech software was used for acoustic analysis; mean fundamental frequency (fo), jitter %, shimmer %, and noise to harmonic ratio (NHR) were objectively measured and recorded. Voice Handicap Index-10 (VHI-10) was used for positive self-reporting of the severity of vocal symptoms. GRBAS scale (G: Grade, R: Roughness, B: Breathiness, A: Asthenia, and S: Strain) was also used (by the same clinician) for clinic subjective evaluation. Results: Patient age ranged from 33 to 55 years and mean patient age was 42 years. Mean duration of symptoms was 22 months (range 16-30). Mean postoperative follow-up time was 14 months (range 6-24). Unilateral MB was observed in all patients (2 left, 3 right). There was a significant improvement in objective and subjective assessment methods in all our patients after surgery. Conclusions: According to the results of our few patients, MBR offers a physiological and anatomical approach to the treatment of patients with MB. The outcomes of delicate microlaryngeal surgery are promising.

Evaluation and management of voice disorders: Our experiences

Background: Change in voice is one of the most common complains among patients visiting to ENT outpatient. The causes are numerous and need to be evaluated before approaching to curative intent of treatment. Aims and Objectives: The current study was designed with an aim to analyze the spectrum of voice disorders and their management option. Materials and Methods: Prospective study conducted between June 25, 2020, and November 30, 2021. Clinical, demographic profiles were recorded. Fiber-optic laryngoscopy was performed in all the cases. Radiology examination computed tomography/magnetic resonance imaging was supplemented only in required cases. Treatment was executed based of etiological profile analysis. Minimum 3 months follow-up was collected post-therapy. Statistical analysis was performed using Statistical Package for the Social Sciences version 24. Pearson Chi-square test was used for see the association between parameters. P-value was considered significant while being <0.05. Results: Out of 218 patients, the most patients (approx. 70%) occupied in the age group of 30–50 years. There was male predominance (76.6%). Voice change secondary to laryngopharyngeal reflux was seen in 56.4% of cases. Benign vocal fold lesions (nodule/cyst/polyp) were noticed in 26.5% of cases. Malignant lesions were seen in 1.8% of cases. Benign vocal fold lesions (polyp and cyst) were treated by microlaryngeal surgery (MLS). Pre-malignant lesion (leukoplakia) was treated with MLS stripping. Out of four malignant lesions, one was in early stage and underwent supraglottic laryngectomy while others were in advanced stage (T4) and treated by total laryngectomy. Conclusions: Voice disorders comprise wide etiological profile from reflux to malignant lesion. Timely proper evaluation followed by definitive management achieves good treatment outcomes.

Vocal Fold Vibration Characteristics during SOVTE using a Vibration Simulator and Digital Kymography

Objectives: The purpose of this study is to investigate the characteristics of vocal fold vibration during sustained vowel /a/ phonation and various semi-occluded vocal tract exercise (SOVTEs) using a vibration simulator and digital kymography (DKG).Methods: A total of 12 normal young speakers (6 males, 6 females) aged 20-30 years participated in the study. They phonated a sustained /a/ vowel and performed SOVTE. The vocal fold vibration characteristics were measured according to the number of vibration sources (single vs. double), and vocal tract occlusion degree using a vibration simulator and DKG. Glottal gap quotient (GQ, %), speed quotient (SQ, %) and amplitude (pixel) were estimated quantitatively from the DKG image.Results: The results showed that significantly higher GQ (p = .000) and SQ (p = .000) were observed in the humming and bilabial fricative /β/ compared to open vowels. The amplitude was significantly higher in the open vowel /a/ than in humming (p = .018) and bilabial fricative /β/ (p = .003). Also, when comparing the vocal fold vibration parameters according to vibration type (single source: straw phonation vs. double source: straw phonation with water), the double source presented a significantly higher GQ (p = .000) as well as SQ (p = .008) in comparison with a single source.Conclusion: SOVTE showed a glottal gap that is different from the opened vowel /a/. It also had a longer opening of the vocal fold and a smaller amplitude than the vowel. This suggests that SOVTE may be helpful for facilitating vocal fold vibration and good voice quality in clinical practice. The current study can be meaningful in providing theoretical and clinical evidence for SOVTE.

Predictive Factors for the Efficacy of Voice Therapy for Pediatric Vocal Fold Nodule

Background and Objectives Voice therapy (VT) is considered to be the gold standard of treatment of vocal fold nodule in children. This study was designed to analyze the success rate of pediatric VT and investigate the predictive factors for good response of periatic VT for vocal fold nodule.Materials and Method This was a retrospective cohort study of 23 patients under 18 years old who were diagnosed with vocal fold nodule and received pediatric VT. We divided the patients into responding and non-responding groups. We analyzed clinical and voice parameters related to the voice results.Results Twelve patients showed improved findings after VT. By univariate analysis, female patients (85.7%) and adolescence children (100%) showed a good response to VT. In multivariate analysis, female sex (p<0.05) and adolescence children (p<0.05) were significantly related to a successful voice response. Proton pump inhibitor or antihistamine, mucolytics treatment and pre-VT voice parameters did not significantly influence voice outcomes.Conclusion Pediatric VT is more effective in female and adolescence children.

A Case of Paradoxical Vocal Fold Movement Due to Psychological Causes

Paradoxical vocal fold movement (PVFM) is a dystonic laryngeal disorder characterized by involuntary vocal fold adduction during inspiration and/or expiration. PVFM is uncommon and may aggravate airway obstruction. And patients with PVFM have a specific etiology; therefore, treatment must be individualized and given immediately. We present a case of 63-year-old male presenting with intermittent dyspnea. After multidisciplinary workup, we presumed psychogenic PVFM and evaluated with speech-language pathologist and psychologist. In this report, we describe a rare case of psychogenic PVFM patient.