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Yamamoto Y, Kimura S, Kuniyoshi H, Hiroe T, Terui T, Kase Y. Novice residents' endotracheal intubation skill retention on a simulated mannequin after rotating at an anaesthesiology department: a randomized controlled study. J Int Med Res 2023; 51:3000605231206313. [PMID: 37848388 PMCID: PMC10586008 DOI: 10.1177/03000605231206313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/21/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVE To compare the endotracheal intubation skill retention of the McGRATH™ MAC video laryngoscope with that of the Macintosh laryngoscope in first-year residents rotating at an anaesthesiology department. METHODS This randomized controlled study enrolled first-year residents who completed a 2-month rotation at an anaesthesiology department. Each rotation group was randomly assigned to the Macintosh laryngoscope (ML) or McGRATH™ MAC video laryngoscope (MML) group. Endotracheal intubation skills were evaluated on a mannequin after the rotation and at 3 and 6 months later. The primary endpoint was the time required for intubation. The secondary endpoint was the percentage of glottic opening (POGO) score. RESULTS Forty-six residents participated in this study and were assigned to the ML group (n = 23) or the MML group (n = 23). There were no significant differences between the sex, age and the number of endotracheal intubation procedures performed between the two groups. The time required for intubation was significantly shorter in the MML group compared with the ML group. The POGO scores did not show any significant differences between the two groups. CONCLUSION Compared with endotracheal intubation training using the Macintosh laryngoscope, the McGRATH™ MAC video laryngoscope shortened the intubation procedure and its effect remained even after 6 months. TRIAL REGISTRATION UMIN-CTR Clinical Trials, UMIN000036643, URL: https://www.umin.ac.jp.
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Park JB, Kang PY, Kim T, Ji SH, Jang YE, Kim EH, Kim JT, Kim HS, Lee JH. Usefulness of C-curved stylet for intubation with the C-MAC® Miller videolaryngoscope in neonates and infants: a prospective randomized controlled trial. Korean J Anesthesiol 2023; 76:433-441. [PMID: 36550777 PMCID: PMC10562063 DOI: 10.4097/kja.22716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/07/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Optimizing endotracheal tube (ETT) shape is important for successful videolaryngoscope-aided intubation. This prospective randomized controlled study aimed to compare the tube-handling time between a C-curved and hockey stick-shaped stylet in infants and neonates using the C-MAC® videolaryngoscope Miller blade. METHODS A total of 110 infants (age < 1 year) were randomly assigned to either the hockey stick-curved stylet group (group H, n = 53) or the C-curved stylet group (group C, n = 57). The primary outcome was tube handling time after glottis visualization and the secondary outcomes were the total intubation time, incidence of successful intubation, initial tube tip location at the laryngeal inlet, and numerical rating scale for ease of intubation. RESULTS Tube insertion time and total intubation duration (both in seconds) were significantly shorter in group C than in group H (13.3 ± 8.9 vs. 25.1 ± 27.0, P = 0.002; 19.9 ± 9.4 vs. 32.8 ± 27.1, P = 0.001, respectively). Group C displayed a higher rate of intubation success within 30 s than group H (87.7% vs. 69.8%, P = 0.029). The initial tube tip was located at the center in 34 children in group C (59.6%) and 12 children in group H (26.1%, P < 0.001). Laryngoscope operators rated intubation as easier when provided with a C-curved stylet. CONCLUSIONS In neonates and infants, modification of the ETT shape into a C-curve may reduce tube handling time compared to the conventional hockey stick-shaped tube during intubation using a C-MAC® video laryngoscope Miller blade.
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Wang G, Ren TA, Lai J, Bai L, Ren H. Domain adaptive Sim-to-Real segmentation of oropharyngeal organs. Med Biol Eng Comput 2023; 61:2745-2755. [PMID: 37462791 DOI: 10.1007/s11517-023-02877-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 06/25/2023] [Indexed: 09/28/2023]
Abstract
Video-assisted transoral tracheal intubation (TI) necessitates using an endoscope that helps the physician insert a tracheal tube into the glottis instead of the esophagus. The growing trend of robotic-assisted TI would require a medical robot to distinguish anatomical features like an experienced physician which can be imitated by utilizing supervised deep-learning techniques. However, the real datasets of oropharyngeal organs are often inaccessible due to limited open-source data and patient privacy. In this work, we propose a domain adaptive Sim-to-Real framework called IoU-Ranking Blend-ArtFlow (IRB-AF) for image segmentation of oropharyngeal organs. The framework includes an image blending strategy called IoU-Ranking Blend (IRB) and style-transfer method ArtFlow. Here, IRB alleviates the problem of poor segmentation performance caused by significant datasets domain differences, while ArtFlow is introduced to reduce the discrepancies between datasets further. A virtual oropharynx image dataset generated by the SOFA framework is used as the learning subject for semantic segmentation to deal with the limited availability of actual endoscopic images. We adapted IRB-AF with the state-of-the-art domain adaptive segmentation models. The results demonstrate the superior performance of our approach in further improving the segmentation accuracy and training stability.
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Rameau A, Andreadis K, Ganesan V, Lachs MS, Rosen T, Wang F, Maddox A, Klinck H, Khosla SM, de Luzan CF, Madhusudhana S. Acoustic Screening of the "Wet voice": Proof of Concept in an ex vivo Canine Laryngeal Model. Laryngoscope 2023; 133:2517-2524. [PMID: 36533566 PMCID: PMC10277308 DOI: 10.1002/lary.30525] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/14/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Current protocols for bedside swallow evaluation have high rates of false negative results. Though experts are not consistently able to screen for aspiration risk by assessing vocal quality, there is emerging evidence that vocal acoustic parameters are significantly different in patients at risk of aspiration. Herein, we aimed to determine whether the presence of material on the vocal folds in an excised canine laryngeal model may have an impact on acoustic and aerodynamic measures. METHODS Two ex vivo canine larynges were tested. Three liquids of different viscosities (1:100 diluted glycerin, pure glycerin, and honey-thick Varibar) were placed on the vocal folds at a constant volume. Acoustic and aerodynamic measures were obtained in both adducted and abducted vocal fold configurations. Intraglottal high-speed imaging was used to approximate the maximum divergence angle of the larynges in the studied conditions and examine its relationship to vocal efficiency (VE) and acoustic measures. RESULTS In glottic insufficiency conditions only, we found that several acoustic parameters could predict the presence of material on the vocal folds. Based on the combination of the aerodynamic and acoustic data, we found that decreased spectral energy in the higher harmonics was associated with decreased VE in the presence of material on the vocal folds and/or glottic insufficiency. CONCLUSION Decreased spectral energy in the higher harmonics of the voice was found to be a potential biomarker of swallowing dysfunction, as it correlates with decreased vocal efficiency due to material on the vocal folds and/or glottic insufficiency, both of which are known risk factors for aspiration. LEVEL OF EVIDENCE NA Laryngoscope, 133:2517-2524, 2023.
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Choi S, Lee DJ, Shin KW, Kim YJ, Park HP, Oh H. Direct versus indirect epi glottis elevation in cervical spine movement during videolaryngoscopic intubation under manual in-line stabilization: a randomized controlled trial. BMC Anesthesiol 2023; 23:303. [PMID: 37679737 PMCID: PMC10483787 DOI: 10.1186/s12871-023-02259-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/25/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND During videolaryngoscopic intubation, direct epiglottis elevation provides a higher percentage of glottic opening score than indirect epiglottis elevation. In this randomized controlled trial, we compared cervical spine movement during videolaryngoscopic intubation under manual in-line stabilization between the two glottis exposure methods. METHODS Videolaryngoscopic intubation under manual in-line stabilization was performed using C-MAC® D-blade: direct (n = 51) and indirect (n = 51) epiglottis elevation groups. The percentage of glottic opening score was set equally at 50% during videolaryngoscopic intubation in both groups. The primary outcome measure was cervical spine movement during videolaryngoscopic intubation at the occiput-C1, C1-C2, and C2-C5. The secondary outcome measures included intubation performance (intubation success rate and intubation time). RESULTS Cervical spine movement during videolaryngoscopic intubation was significantly smaller at the occiput-C1 in the direct epiglottis elevation group than in the indirect epiglottis elevation group (mean [standard deviation] 3.9 [4.0] vs. 5.8 [3.4] °, P = 0.011), whereas it was not significantly different at the C1-C2 and C2-C5 between the two groups. All intubations were successful on the first attempt, achieving a percentage of glottic opening score of 50% in both groups. Intubation time was longer in the direct epiglottis elevation group (median [interquartile range] 29.0 [24.0-35.0] vs. 22.0 [18.0-27.0] s, P < 0.001). CONCLUSIONS When performing videolaryngoscopic intubation under manual in-line stabilization, direct epiglottis elevation can be more beneficial than indirect epiglottis elevation in reducing cervical spine movement during videolaryngoscopic intubation at the occiput-C1. TRIAL REGISTRATION Clinical Research Information Service (number: KCT0006239, date: 10/06/2021).
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Perrine BL, Scherer RC. Using a vertical three-mass computational model of the vocal folds to match human phonation of three adult males. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2023; 154:1505-1525. [PMID: 37695295 PMCID: PMC10497319 DOI: 10.1121/10.0020847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 08/10/2023] [Accepted: 08/19/2023] [Indexed: 09/12/2023]
Abstract
Computer models of phonation are used to study various parameters that are difficult to control, measure, and observe in human subjects. Imitating human phonation by varying the prephonatory conditions of computer models offers insight into the variations that occur across human phonatory production. In the present study, a vertical three-mass computer model of phonation [Perrine, Scherer, Fulcher, and Zhai (2020). J. Acoust. Soc. Am. 147, 1727-1737], driven by empirical pressures from a physical model of the vocal folds (model M5), with a vocal tract following the design of Ishizaka and Flanagan [(1972). Bell Sys. Tech. J. 51, 1233-1268] was used to match prolonged vowels produced by three male subjects using various pitch and loudness levels. The prephonatory conditions of tissue mass and tension, subglottal pressure, glottal diameter and angle, posterior glottal gap, false vocal fold gap, and vocal tract cross-sectional areas were varied in the model to match the model output with the fundamental frequency, alternating current airflow, direct current airflow, skewing quotient, open quotient, maximum flow negative derivative, and the first three formant frequencies from the human production. Parameters were matched between the model and human subjects with an average overall percent mismatch of 4.40% (standard deviation = 6.75%), suggesting a reasonable ability of the simple low dimensional model to mimic these variables.
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Codino J, Jackson-Menaldi MC, Rubin A, Torres ME. Automated Quantification of Inflection Events in The Electroglottographic Signal. J Voice 2023; 37:640-647. [PMID: 34162494 DOI: 10.1016/j.jvoice.2021.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 05/01/2021] [Accepted: 05/10/2021] [Indexed: 11/26/2022]
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De Leo AN, Dagan R. Early Glottic Cancer With Adverse Features: Can Larynx-Only RT Cut It Without Needing to Eventually Cut It Out? Int J Radiat Oncol Biol Phys 2023; 117:6-7. [PMID: 37574246 DOI: 10.1016/j.ijrobp.2022.06.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/05/2022] [Indexed: 08/15/2023]
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Su WF, Liu SC, Hsu YC. The Management in Patients With Bilateral Vocal Fold Immobility: 15 Years' Experience at a Tertiary Centre. J Voice 2023; 37:800.e7-800.e15. [PMID: 33752929 DOI: 10.1016/j.jvoice.2021.02.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 01/27/2021] [Accepted: 02/11/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE In order to correct the varying vocal fold positions to meet the various clinical requirements in patients with bilateral vocal fold immobility, we present pertinent surgical methods to treat them. MATERIALS AND METHODS From 2005 to 2020, 115 patients diagnosed with bilateral vocal fold immobility were addressed for ventilation in 89 patients and for phonation in 26 patients. In the ventilation surgery group, all the neurogenic subjects received mere suture lateralization (SL) procedures and the mechanical ones underwent arytenoid release (AR) plus SL procedures if the cricoarytenoid joint fixation (CAJF) could be confirmed before operation. In the phonation group, neurogenic subjects received nonsurgical treatment and the mechanical ones underwent AR plus arytenoid adduction (AA) procedure. The decannulation rate and respiratory comfort rate for each subgroup will be calculated and the phonatory tests were conducted. RESULTS In the ventilation group, 55% (49/89) of subjects received related surgeries. Mere SL offered 40 successful decannulation or respiratory comfort in 42 neurogenic subjects (95.2%). The single episode rate was high as 95%. An AR plus SL procedure also obtained 100% of decannulation or respiratory comfort with a single episode of surgical procedure if the CAJF could be confirmed preoperatively. In the phonation group, 15% (4/26) of subjects received appropriate surgeries. Single AR plus AA procedures also led to 100% (4/4) of the appropriate candidates serviceable sound. CONCLUSION SL procedure keeping intact laryngeal mucosa usually offered permanent glottis enlarging effect or decannulation with a single episode of procedure. The use of arytenoid release for CAJF has led to remarkable advances in the ultimate surgical outcomes of both the ventilation and phonation in terms of decreasing revision surgeries. LEVELS OF EVIDENCE level 4.
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Sundberg J, Lã F, Granqvist S. Fundamental frequency disturbances in female and male singers' pitch glides through long tube with varied resistances. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2023; 154:801-807. [PMID: 37556565 DOI: 10.1121/10.0020569] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 07/20/2023] [Indexed: 08/11/2023]
Abstract
Source-filter interaction can disturb vocal fold vibration frequency. Resonance frequency/bandwidth ratios (Q-values) may affect such interaction. Occurrences of fundamental frequency (fo) disturbances were measured in ascending pitch glides produced by four female and five male singers phonating into a 70 cm long tube. Pitch glides were produced with varied resonance Q-values of the vocal tract + tube compound (VT + tube): (i) tube end open, (ii) tube end open with nasalization, and (iii) with a piece of cotton wool in the tube end (conditions Op, Ns, and Ct, respectively). Disturbances of fo were identified by calculating the derivative of the low-pass filtered fo curve. Resonance frequencies of the compound VT+tube system were determined from ringings and glottal aspiration noise observed in narrowband spectrograms. Disturbances of fo tended to occur when a partial was close to a resonance of the compound VT+tube system. The number of such disturbances was significantly lower when the resonance Q-values were reduced (conditions Ns and Ct), particularly for the males. In some participants, resonance Q-values seemed less influential, suggesting little effect of source-filter interaction. The study sheds light on factors affecting source-filter interaction and fo control and is, therefore, relevant to voice pedagogy and theory of voice production.
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Klimza H, Witkiewicz J, Jackowska J, Wierzbicka M. Difficult glottis: Diagnostic dilemma in viewof the clinical presentation. OTOLARYNGOLOGIA POLSKA 2023; 77:53-57. [PMID: 37772377 DOI: 10.5604/01.3001.0053.7263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
<br><b>Introduction:</b> The taxonomy of vocal fold lesions has been refined, and it serves as a common descriptive language for diagnosis, treatment algorithms, and reporting of outcomes. However, we observe rare cases when numerous pathologies overlap, resulting in an unclear and complicated clinical presentation of the glottis.</br> <br><b>Aim:</b> The aim of this paper is to present cases of overlapping etiopathological factors which poses a challenge when making a diagnosis and referring a patient for adequate treatment.</br> <br><b>Material and method:</b> The study presents different photographs of the glottis, including some unique and unusual images in which overlapping pathologies were captured. The photographs are accompanied by case descriptions, comments, and pathological analyses.</br> <br><b>Results:</b> Four selected photographs showed a bunch of exophytic growth lesions with foci of whitish plaques, covered by yellowish crusts, with thinned, reddened vocal folds presenting foci of leukoplakia. The study discussed possible causes of vocal folds edema, diffuse erythema, presence of crusts or exudate, whitish debris/plaques or development of leukoplakia, non-neoplastic ulceration, as well as injected and reddened mucous membrane. Chronic infectious laryngitis, idiopathic ulcerative laryngitis, and drug-induced laryngitis were also mentioned. The study also raised the issues concerning diabetics and patients treated with inhaled corticosteroids, including candidiasis and primary aspergillosis of the larynx.</br> <br><b>Conclusions:</b> To conclude, everyday clinical practice involves encountering cases of unclear onset and course, with complicated presentation of the glottis. Therefore, comprehensive history-taking and thorough investigation of systemic causes are of immense importance. Recommended management includes conducting the most meticulous differential diagnosis, implementing treatment for the most likely cause, and, whenever possible, refraining from biopsy in order to avoid permanent damage to vocal cords.</br>.
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Onal O, Onal M. Cormack-Lehane scoring system does not predict difficult intubation. J Voice 2023; 37:e1. [PMID: 35379486 DOI: 10.1016/j.jvoice.2022.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 11/18/2022]
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Villani FP, Paderno A, Fiorentino MC, Casella A, Piazza C, Moccia S. Classifying Vocal Folds Fixation from Endoscopic Videos with Machine Learning. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38082565 DOI: 10.1109/embc40787.2023.10340017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Vocal folds motility evaluation is paramount in both the assessment of functional deficits and in the accurate staging of neoplastic disease of the glottis. Diagnostic endoscopy, and in particular videoendoscopy, is nowadays the method through which the motility is estimated. The clinical diagnosis, however, relies on the examination of the videoendoscopic frames, which is a subjective and professional-dependent task. Hence, a more rigorous, objective, reliable, and repeatable method is needed. To support clinicians, this paper proposes a machine learning (ML) approach for vocal cords motility classification. From the endoscopic videos of 186 patients with both vocal cords preserved motility and fixation, a dataset of 558 images relative to the two classes was extracted. Successively, a number of features was retrieved from the images and used to train and test four well-grounded ML classifiers. From test results, the best performance was achieved using XGBoost, with precision = 0.82, recall = 0.82, F1 score = 0.82, and accuracy = 0.82. After comparing the most relevant ML models, we believe that this approach could provide precise and reliable support to clinical evaluation.Clinical Relevance- This research represents an important advancement in the state-of-the-art of computer-assisted otolaryngology, to develop an effective tool for motility assessment in the clinical practice.
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Kumar S P, B P. Optical Flow Glottovibrogram for the examination of vocal fold pathology. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38083520 DOI: 10.1109/embc40787.2023.10340075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Laryngeal high-speed video endoscopy is performed to examine the cycles of vocal fold vibrations in detail and to diagnose voice abnormalities. One of the recent image processing techniques for visualizing vocal fold vibration is optical flow-based playbacks, which include optical flow kymograms (OFKG) for local dynamics, optical flow glottovibrogram (OFGVG) and glottal optical flow waveforms (GOFW) for global dynamics. In recent times, various optical flow computing algorithms have been developed. In this paper, we used four well-known optical flow algorithms Horn Schunk, Lucas Kanade, Gunnar Farneback, and TVL1 to construct the optical flow playbacks. The proposed playback reliability is examined by comparing them to traditional representations such as Phonovibrogram (PVG). Since PVG and OFGVG are interconnected, a comparison study was carried out to better comprehend their interaction.Clinical Relevance- Both OFGVG and PVG add to the precision of interpreting pathological conditions by offering complementary information to the conventional spatiotemporal representations.
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Xing F, Deng XM, Yang D. Goldenhar syndrome complicated with subglottic airway stenosis: a case report. BMC Anesthesiol 2023; 23:210. [PMID: 37328815 PMCID: PMC10273538 DOI: 10.1186/s12871-023-02179-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 06/14/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Goldenhar syndrome is a congenital disease that involves an absence or underdevelopment of structures that arise from the first and second pharyngeal arches and more or less severe extracranial anomalies. A variety of supraglottic malformations may be observed, including mandibular hypoplasia, mandibular asymmetry and micrognathia. Subglottic airway stenosis (SGS), which can cause difficulties in airway management during the perioperative period, is seldom emphasized in literature descriptions of Goldenhar syndrome, but can be clinically significant. CASE PRESENTATION An 18-year-old female with a history of Goldenhar syndrome presented for placement of a right mandibular distractor, right retroauricular dilator, and stage I transfer of a prefabricated expanded flap under general anesthesia. During tracheal intubation, the endotracheal tube (ETT) met resistance unexpectantly when attempting to pass through the glottis. Subsequently, we attempted the procedure with a smaller size ETT but again met resistance. With fiberoptic bronchoscope, we found that the whole segment of the trachea and bilateral bronchi were obvious narrow. Given the finding of unexpected severe airway stenosis and the associated risks with proceeding with the surgery, the operation was cancelled. We removed the ETT once the patient was fully awake. CONCLUSIONS Anesthesiologists should be aware of this clinical finding when evaluating the airway of a patient with Goldenhar syndrome. Coronal and sagittal measurements on computerized tomography (CT) and three-dimensional image reconstruction can be used to evaluate the degree of subglottic airway stenosis and measure the diameter of the trachea.
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Zhang R, Jiang X, Feng J. Difficult endotracheal intubation due to a large epiglottic cyst: A case report. Medicine (Baltimore) 2023; 102:e34026. [PMID: 37327259 PMCID: PMC10270465 DOI: 10.1097/md.0000000000034026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 05/26/2023] [Indexed: 06/18/2023] Open
Abstract
RATIONALE An epiglottic cyst is a type of benign tumor that is formed due to the obstruction of the mucinous duct and the retention of glandular secretion. In such cases, the glottis is not visible as it is covered by the enlarged epiglottic cyst. When conventional anesthesia is administered in such patients, they might have difficulty ventilation since the epiglottic cyst can easily form a flap and move with external pressure changes and can cause the blockage of the glottis due to the loss of consciousness and the relaxation of the throat muscles of the patient. If endotracheal intubation is not initiated and effective ventilation is not established, the patient may suffer from hypoxia and other accidents. PATIENT CONCERNS A 48-year-old male presented to the otolaryngology department with a foreign body sensation in the throat. DIAGNOSES A large epiglottic cyst was diagnosed. INTERVENTIONS The patient was planned to undergo epiglottis cystectomy under general anesthesia. After induction of anesthesia, the cyst severely covered the glottis and made endotracheal intubation difficult. The anesthesiologist rapidly adjusted the position of the laryngeal lens; thus, the endotracheal intubation was successful under the visual laryngoscope. OUTCOMES The endotracheal intubation was successful under the visual laryngoscope and the operation went well. LESSONS Patients with epiglottic cysts are more likely to have difficult airways after induction of anesthesia. Anesthesiologists should take preoperative airway assessment seriously, efficiently handle difficult airway and intubation failure, and make quick and correct choices to ensure patient safety.
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Kim JY, Davenport PW, Mou Y, Hegland K. Primary site of constriction during the compression phase of cough in healthy young adults. Respir Physiol Neurobiol 2023; 311:104033. [PMID: 36764504 PMCID: PMC10067529 DOI: 10.1016/j.resp.2023.104033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/27/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023]
Abstract
Glottal closure has been considered as the primary constriction point during the compression phase (CP); however, vocal fold adduction alone cannot resist the high pressures, providing motivation to explore other mechanisms contributing to that resistance. The goal of this study was to identify site(s) and degree of constriction during the CP of cough of varying types in healthy young adults. Twenty-five healthy young participants participated in this study. The experimental protocol was comprised of: 1) baseline pulmonary function measures; 2) cough practice to establish weak, moderate and strong coughs; 3) voluntary and reflex cough assessments with fluoroscopy and airflow measures. We used a repeated measures ANOVA to identify whether there are differences in constriction ratio between cough types. There was a significant difference in constriction of varying cough types. Degree of constriction in all cough strengths showed that the glottis was the most constricted area, followed by the laryngeal vestibule, nasopharynx, hypopharynx, oropharynx, and cervical trachea, in order, but stronger cough resulted in more constriction in all areas compared to weaker cough. Degree of constriction in reflex cough showed a similar pattern though there was greater constriction in the oropharynx than the hypopharynx. Airflow measures in voluntary cough were consistent with previous findings. Differences in upper airway constriction during the compression phase of cough may be attributed to differences in motor control between reflex and voluntary cough, and the increased constriction seen during strong cough may reflect increased muscle recruitment during that task. In the future, we can use this knowledge to develop novel methods for cough rehabilitation.
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Yan CL, Zhang YQY, Chen Y, Qv ZY, Zuo MZ. To compare the influence of blind insertion and up-down optimized glottic exposure manoeuvre on oropharyngeal leak pressure using SaCoVLM™ video laryngeal mask among patients undergoing general anesthesia. J Clin Monit Comput 2023; 37:593-598. [PMID: 36308611 PMCID: PMC10068663 DOI: 10.1007/s10877-022-00930-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 10/06/2022] [Indexed: 10/31/2022]
Abstract
To compare the potential influences of blind insertion and up-down optimized glottic exposure manoeuvre on the oropharyngeal leak pressure (OPLP) in using SaCoVLM™ video laryngeal mask (VLM) among patients undergoing general anesthesia. A randomized self-control study controlled was conducted to investigate the effect of two insertion techniques on OPLP. A total of 60 patients (male or female, 18-78 years, BMI 18.0-30.0 kg m-2 and ASA I-II) receiving selective surgery under general anesthesia were randomly recruited. After induction of anesthesia, the SaCoVLM™ was inserted by blind insertion manoeuvre. The glottic exposure grading(V1) of the SaCoVLM™ visual laryngeal mask and the OPLP(P1) were recorded. And the glottic exposure grading(V2) and OPLP(P2) of SaCoVLM™ were recorded again when the glottic exposure grading was optimal. The glottis exposure grading and OPLP were compared before and after different insertion manoeuver. The glottic exposure grading (V2) obtained by using up-down optimized glottic exposure manoeuvre was better than that obtained by using blind insertion manoeuvre (V1)(P < 0.001). The OPLP was significantly lower in the blind insertion manoeuvre (P1) than in the up-down optimized glottic exposure manoeuvre (P2) (32.4 ± 5.0 cmH2O vs. 36.3 ± 5.2 cmH2O, P < 0.001). In using SaCoVLM™, higher OPLP and better glottic exposure grading were achieved through up-down optimized glottic exposure manoeuvre, protecting the airway while real-time monitoring of conditions around the glottis, which significantly improves airway safety. Our results suggests that up-down optimized glottic exposure manoeuver may be a useful technique for SaCoVLM™ insertion.Trial registration: ChiCTR, ChiCTR2000028802. Registered 4 January 2020, http://www.chictr.org.cn/ChiCTR2000028802.
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Paulus R, Leonhard M, Ho GY, Kurz A, Schneider-Stickler B. Differences in Glottal Closure and Visibility of the Anterior Commissure during Rigid-90°, Rigid-70°, and Flexible Laryngostroboscopy. Folia Phoniatr Logop 2023; 75:324-333. [PMID: 37004509 PMCID: PMC10614229 DOI: 10.1159/000530454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
INTRODUCTION The conventional rigid-90° and rigid-70° laryngostroboscopy has been so far considered the gold standard in assessing the vibratory behavior of the vocal folds and the glottal closure configuration during phonation. Meanwhile, this rigid laryngostroboscopy is more and more replaced by flexible chip-on-tip systems. The aim of this study was to evaluate the influence of these different endoscopic techniques on glottal closure configuration and on visibility of the complete focal fold length including anterior commissure during phonation. METHODS Twenty-one euphonic subjects were enrolled (mean age 34.6 ± 9.5; m = 10, f = 11). They were examined with the three laryngoscopic techniques (conventional rigid-90°, rigid-70°, and flexible chip-on-tip laryngoscopy during low and high voice pitch with soft and loud voice intensity). For evaluating the degree of glottal closure, a modified classification of Södersten et al. was applied and the visibility of the anterior commissure was evaluated. The correlation of the three endoscopic techniques was assessed with Cohen and Fleiss' kappa. RESULTS In even low loud phonation, the rigid-90° and rigid-70° endoscopies revealed a complete closure of the glottis in only 47.6% of subjects but with flexible endoscopy in 81%. The complete vocal fold length with anterior commissure was best visible with flexible endoscopy in 90.5% in low-soft and high-soft phonation. The rigid-90° endoscopy showed a slight agreement in comparison with the flexible endoscopy in regard to the types of vocal fold closure with a Cohen's kappa coefficient k = 0.199. The rigid-90° endoscopy showed an almost perfect agreement with k = 0.84 when compared to the rigid-70° endoscopy. The flexible endoscopy compared to the rigid-70° endoscopy showed a fair agreement with k = 0.346. CONCLUSION We found mainly corresponding results in both rigid-90° and rigid-70° endoscopic techniques which can be explained by the same transoral approach with the tongue pulled out, whereas the flexible transnasal endoscopy mainly gives a better view on the anterior commissure. The influence of transorally or transnasally guided endoscopic techniques needs to be considered in interpretation of laryngostroboscopic parameters like vocal fold closure and supraglottal hyperactivity.
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Shin HJ, Kim HG, Park IS, Nam SW, Park JH, Hwang JW, Na HS. Change in glottic view during intubation using a KoMAC videolaryngoscope: A retrospective analysis. Medicine (Baltimore) 2023; 102:e33179. [PMID: 36862918 PMCID: PMC9981368 DOI: 10.1097/md.0000000000033179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Intubation with videolaryngoscopy has become popular in various clinical settings. However, despite the use of a videolaryngoscope, difficult intubation still exists and intubation failure has been reported. This retrospective study assessed the efficacy of the 2 maneuvers in improving the glottic view during videolaryngoscopic intubation. The medical records of patients who underwent videolaryngoscopic intubation and whose glottal images were stored in electronic medical charts were reviewed. The videolaryngoscopic images were divided into 3 categories according to the applied optimization techniques as follows: conventional method, with the blade tip located in the vallecular; backward-upward-rightward pressure (BURP) maneuver; and epiglottis lifting maneuver. Four independent anesthesiologists scored the visualization of the vocal folds using the percentage of glottic opening (POGO, 0-100%) scoring system. A total of 128 patients with 3 laryngeal images were analyzed. The glottic view was the most improved in the epiglottis lifting maneuver among all the techniques. The median POGO scores were 11.3, 36.9, and 63.1 in the conventional method, BURP, and epiglottis lifting maneuver, respectively (P < .001). There were significant differences in the distribution of POGO grades according to the application of BURP and epiglottis lifting maneuvers. In the POGO grades 3 and 4 subgroups, the epiglottis lifting maneuver was more effective than the BURP maneuver in improving the POGO score Inadequate visualization of the vocal folds occurred even when intubation was performed using a videolaryngoscope. The application of optimization maneuvers, such as BURP and epiglottis lifting by the blade tip, could improve the glottic view.
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Maddox A, Oren L, Farbos de Luzan C, Howell R, Gutmark E, Khosla S. An Ex-vivo Model Examining Acoustics and Aerodynamic Effects Following Medialization With and Without Arytenoid Adduction. Laryngoscope 2023; 133:621-627. [PMID: 35655422 PMCID: PMC9715814 DOI: 10.1002/lary.30235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 05/03/2022] [Accepted: 05/07/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Quantify differences in acoustics and intraglottal flow fields between Thyroplasty Type 1 (TT1) with and without arytenoid adduction (AA) using excised canine larynx model. STUDY DESIGN Basic science experiments using excised larynges. METHODS Surgical procedures were implemented in eight excised canine larynges. Acoustics and intraglottal flow measurements were taken at low and high subglottal pressures in each experimental setup. RESULTS In all larynges, vocal efficiency (VE) and cepstrum peak prominence (CPP) were higher, and the mean phonatory flow rate was lower in TT1 with AA than without AA. The glottal asymmetry is reduced with AA and promotes the formation of stronger vortices in the glottal flow during the closing phase of the vibrating folds. CONCLUSIONS Findings suggest a clear acoustic and aerodynamic benefit to the addition of AA when performing TT1. It shows significant improvement in CPP, translating to decreased breathiness and dysphonia and increased VE, leading to easier and more sustainable phonation. Stronger intraglottal vortices are known to be correlated with the loudness of voice produced by phonation. LEVEL OF EVIDENCE N/A Laryngoscope, 133:621-627, 2023.
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Dewi YS, Arifin H, Pradipta RO, Qona’ah A, Rosita R, Giatin CN, Dawod Kamel Gauda A. Efficacy of Intermittent and Continuous Subglottic Secretion Drainage in Preventing the Risk of Ventilator-Associated Pneumonia: A Meta-Analysis of Randomized Control Trials. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:283. [PMID: 36837483 PMCID: PMC9959238 DOI: 10.3390/medicina59020283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/20/2023] [Accepted: 01/26/2023] [Indexed: 02/04/2023]
Abstract
Ventilator-associated pneumonia (VAP) is hospital-acquired pneumonia that develops 48 h or longer following mechanical ventilation. However, cuff pressure fluctuates significantly due to patient or tube movement, which might result in microaspiration. Subglottic secretion drainage (SSD) has been suggested as a method for VAP prevention bundles. This systematic review and meta-analysis aims to investigate the efficacy and safety of subglottic SSD in preventing VAP. The secondary outcomes of this study are to investigate the intensive care unit (ICU) stay length and mortality rate regarding VAP. This study followed the Preferred Reporting Item for Systematic Review and Meta-Analysis guidelines. A thorough search of PubMed, Embase, and the Web of Science was conducted between June and August 2022. The study analysis used the Mantel-Haenszel method, and the quality of the included study was assessed using the Cochrane Risk of Bias 2. Eighteen randomized controlled trials with a total of 2537 intubated patients were included. It was found that SSD was associated with a lower risk of VAP (RR 1.44; 95% CI; 1.20-1.73; p < 0.0001). The subgroup analysis (utilizing intermittent and continuous methods) found no statistically significant difference between the two groups (p = 0.28). The secondary endpoints showed that there was no significant difference in mortality (RR 1.02; 95% CI; 0.87-1.20; p = 0.83), but there were substantial differences in ICU stays (mean difference, 3.42 days; 95% CI; 2.07-4.76; p < 0.00001) in favor of the SSD group. This was based on a very low certainty of evidence due to concerns linked to the risk of bias and inconsistency. The use of SSD was associated with a reduction in VAP incidence and ICU stay length, but there was no significant difference in the mortality rate.
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Kruse E, Döllinger M, Schützenberger A, Kist AM. GlottisNetV2: Temporal Glottal Midline Detection Using Deep Convolutional Neural Networks. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2023; 11:137-144. [PMID: 36816097 PMCID: PMC9933989 DOI: 10.1109/jtehm.2023.3237859] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/27/2022] [Accepted: 01/04/2023] [Indexed: 11/26/2023]
Abstract
High-speed videoendoscopy is a major tool for quantitative laryngology. Glottis segmentation and glottal midline detection are crucial for computing vocal fold-specific, quantitative parameters. However, fully automated solutions show limited clinical applicability. Especially unbiased glottal midline detection remains a challenging problem. We developed a multitask deep neural network for glottis segmentation and glottal midline detection. We used techniques from pose estimation to estimate the anterior and posterior points in endoscopy images. Neural networks were set up in TensorFlow/Keras and trained and evaluated with the BAGLS dataset. We found that a dual decoder deep neural network termed GlottisNetV2 outperforms the previously proposed GlottisNet in terms of MAPE on the test dataset (1.85% to 6.3%) while converging faster. Using various hyperparameter tunings, we allow fast and directed training. Using temporal variant data on an additional data set designed for this task, we can improve the median prediction accuracy from 2.1% to 1.76% when using 12 consecutive frames and additional temporal filtering. We found that temporal glottal midline detection using a dual decoder architecture together with keypoint estimation allows accurate midline prediction. We show that our proposed architecture allows stable and reliable glottal midline predictions ready for clinical use and analysis of symmetry measures.
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Yoshinaga T, Zhang Z, Iida A. Comparison of one-dimensional and three-dimensional glottal flow models in left-right asymmetric vocal fold conditions. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2022; 152:2557. [PMID: 36456298 PMCID: PMC9629867 DOI: 10.1121/10.0014949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 06/17/2023]
Abstract
While the glottal flow is often simplified as one-dimensional (1D) in computational models of phonation to reduce computational costs, the 1D flow model has not been validated in left-right asymmetric vocal fold conditions, as often occur in both normal and pathological voice production. In this study, we performed three-dimensional (3D) and 1D flow simulations coupled to a two-mass model of adult male vocal folds and compared voice production at different degrees of left-right stiffness asymmetry. The flow and acoustic fields in 3D were obtained by solving the compressible Navier-Stokes equations using the volume penalization method with the moving vocal fold wall as an immersed boundary. Despite differences in the predicted flow pressure on vocal fold surface between the 1D and 3D flow models, the results showed reasonable agreement in vocal fold vibration patterns and selected voice outcome measures between the 1D and 3D models for the range of left-right asymmetric conditions investigated. This indicates that vocal fold properties play a larger role than the glottal flow in determining the overall pattern of vocal fold vibration and the produced voice, and the 1D flow simplification is sufficient in modeling phonation, at least for the simplified glottal geometry of this study.
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Martínez-Arellano A, Campo A, Del Rio B, Garaycochea O, Fernandez S. Describing the Acoustic and Vocal Production Characteristics of the Irrintzi: Feasibility of Its Use for the Treatment of Voice Disorders. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:3789-3797. [PMID: 36083832 DOI: 10.1044/2022_jslhr-21-00394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE The aims of this study were to analyze and characterize the irrintzi (a folkloric shout emitted in a single breath used by the Basque people) acoustically and to describe the mechanism by which it is emitted. METHOD Thirty-six sound samples of 12 female volunteers were analyzed. Acoustic analysis included primarily fundamental frequency (f o), spectral analysis in the time domain with a narrowband filter, and the use of linear predictive coding (LPC). Laryngeal and pharyngeal movements while emitting an irrintzi were studied by fiberoptic nasal endoscopy. Postural and mandible movements were observed and video recorded. Movements of the larynx and the vocal tract were also studied by lateral pharyngo-laryngeal radioscopy. RESULTS The central part of an irrintzi spectrogram contains a peculiar, repeated M-shaped motif unseen in the spectrogram of any other human vocal emission, and intensity was over 90 dB SPL in all cases. f o was very high (1487 Hz) especially at the end of the irrintzi. Fiberoptic nasal endoscopy consistently revealed considerable elevation of the glottis, with the larynx swinging forward and retraction of the ventricular bands. Lateral radioscopy showed a very high larynx and a high tongue dorsum. CONCLUSIONS The irrintzi is a sound emitted in a single breath and characterized by its shrillness and loudness, qualities that make it audible in noisy environments and over large distances and the vocal technique observed when it is produced can be explained by the Estill voice model (Steinhauer et al., 2017). The use of this technique may help in the treatment of voice disorders and improve efficiency in singers, teachers, actors, and people who use their voice at high volume or at high frequency. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.20779405.
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