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Choi N, Jin H, Kim HJ, Son YI. Early Injection Laryngoplasty With a Long-Lasting Material in Patients With Potentially Recoverable Unilateral Vocal Fold Paralysis. Clin Exp Otorhinolaryngol 2019; 12:427-432. [PMID: 31446749 PMCID: PMC6787478 DOI: 10.21053/ceo.2019.00444] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 06/26/2019] [Indexed: 11/22/2022] Open
Abstract
Objectives. Injection laryngoplasty (IL) is one of the major options for treatment of unilateral vocal fold paralysis (UVFP). Early IL in patients with abrupt-onset UVFP can reduce hoarseness and aspiration-related discomfort and complications. Temporary or short-lasting materials are recommended for the early IL since permanent or long-lasting materials may negatively affect the voice quality when vocal fold motion is spontaneously recovered. Methods. Patients who received IL with a long-lasting material (ArteSense) within 1 month following development of postoperative UVFP were enrolled for this study. They were categorized into a spontaneously recovered group (n=30) and unrecovered group (n=276) from UVFP. The subjective and objective voice parameters were collected before and 6 months after IL. Patients’ demographics and collected voice parameters were compared between the two groups. Results. Age and sex distributions were not different between the two groups. Aspiration symptom, maximum phonation time (MPT), jitter, shimmer, noise to harmonic ratio (NHR), overall grade (G) and breathiness (B) of GRBAS (grade of dysphonia, roughness, breathiness, asthenia, strain) scale score, and voice handicap index (VHI) were significantly improved after IL in both groups. The amounts of improvement in MPT, jitter, shimmer, NHR and VHI were significantly greater in the recovered group. There was no IL-related complication including granuloma formation, hypersensitivity to injection material, or worsening of hoarseness. Conclusion. Early IL with a long-lasting material can be safely performed to improve voice quality and to reduce aspiration episode for the patients with postoperative UVFP, regardless of recovery from the paralysis. The amounts of improvement in the subjective and objective voice parameters were significantly greater in patients who showed spontaneous recovery from UVFP when compared with those in patients who did not.
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Affiliation(s)
- Nayeon Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - HoKyung Jin
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hack Jung Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Ik Son
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Enver N, Asya O, Abuzaid G, Gürol E. A Very Rare Complication of Hyaluronic Acid Injection for Medialization Laryngoplasty: A Case With Laryngeal Abscess. J Voice 2019; 34:812.e5-812.e8. [PMID: 31005447 DOI: 10.1016/j.jvoice.2019.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/20/2019] [Accepted: 03/21/2019] [Indexed: 10/27/2022]
Abstract
Hyaluronic acid injection for medialization laryngoplasty is a safe procedure performed on patients with glottic incompetence. Laryngeal abscess formation as a complication of injection laryngoplasty is a very rare complication, and, as we know from the literature, there has been only one case of laryngeal abscess after injection laryngoplasty in a patient with a type-I laryngeal cleft. We document for the first time a laryngeal abscess resulting from hyaluronic acid injection laryngoplasty for unilateral vocal fold paralysis. Prompt evaluation of the patient was necessary. Our patient was treated with antibiotics and corticosteroids without a need for intubation. One year after injection, the patient's Voice Handicap Index-10 score was still good and within the range of normal values.
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Affiliation(s)
- Necati Enver
- Department of Otolaryngology, Pendik Training and Research Hospital, Marmara University, Istanbul, Turkey.
| | - Orhan Asya
- Department of Otolaryngology, Pendik Training and Research Hospital, Marmara University, Istanbul, Turkey
| | - Ghazi Abuzaid
- Department of Otolaryngology, Pendik Training and Research Hospital, Marmara University, Istanbul, Turkey
| | - Ece Gürol
- Department of Otolaryngology, Pendik Training and Research Hospital, Marmara University, Istanbul, Turkey
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Nelson RC, Bryson PC, Reghunathan S, Benninger MS. Medical and Surgical Advances in the Treatment of Unilateral Vocal Fold Paralysis. ACTA ACUST UNITED AC 2019. [DOI: 10.1044/2019_pers-sig3-2018-0017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Purpose
In this chapter, unilateral vocal fold paralysis is described, and treatment options are discussed with emphasis on recent developments in treatment.
Conclusion
Unilateral vocal fold paralysis is a disorder commonly encountered by otolaryngologists and speech-language pathologists alike and is caused by dysfunction of one of the recurrent laryngeal nerves leading to dysphonia and dysphagia. The etiology of this disorder can include malignancy, iatrogenic injury, or traumatic injury or may be due to idiopathic causes, and evidence has suggested that the rates of different etiologies have changed over time. Treatment options include a variety of approaches and range from expectant management, voice therapy, as well as surgical and procedural approaches. Surgical approaches generally aim to augment the affected vocal fold to medialize its position, thereby reducing glottic insufficiency, and can include injection laryngoplasty and laryngeal framework surgery. Recurrent laryngeal nerve reinnervation is also an option for certain patients and can improve vocal fold bulk by restoring basal neurologic stimulation. Though it is a well-described phenomenon, with new developments in procedural interventions, unilateral vocal fold paralysis remains a dynamic entity in the field.
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Ricci Maccarini A, Stacchini M, Mozzanica F, Schindler A, Basile E, DE Rossi G, Woo P, Remacle M, Magnani M. Efficacy of trans-nasal fiberendoscopic injection laryngoplasty with centrifuged autologous fat in the treatment of glottic insufficiency due to unilateral vocal fold paralysis. ACTA ACUST UNITED AC 2019; 38:204-213. [PMID: 29984796 DOI: 10.14639/0392-100x-2012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 01/11/2018] [Indexed: 11/23/2022]
Abstract
SUMMARY The objective of this work is to evaluate the safety, feasibility and efficacy of trans-nasal fiberendoscopic injection laryngoplasty (IL) with centrifuged autologous fat, performed under local anaesthesia, in the treatment of glottic insufficiency due to unilateral vocal fold paralysis (UVFP). It is a within-subject study with follow-up 1 week after phonosurgery and after 6 months. A total of 22 patients with chronic dysphonia caused by glottic insufficiency due to UVFP were enrolled. Each patient underwent trans-nasal IL with centrifuged autologous fat through flexible operative endoscope under local anaesthesia and was evaluated before and twice (1 week and 6 months) after phonosurgery, using a multidimensional set of investigations. The assessment protocol included videolaryngostroboscopy, perceptual evaluation of dysphonia, maximum phonation time and patient's self-assessment on voice-related quality of life (QOL) with the Voice Handicap Index-10 and the comparative self-assessment on vocal fatigue and voice quality pre-post treatment. Trans-nasal IL with centrifuged autologous fat was performed in all 22 patients and there were no complications in any case. Significant improvements in videolaryngostroboscopic findings, perceptual evaluation of dysphonia, maximum phonation time and QoL self-assessment were reported after 1 week and were maintained at 6 months. In one patient, the result after 6 months was not satisfactory and this patient then underwent a medialization laryngoplasty (thyroplasty type I) with satisfactory long-term results. In conclusion, trans-nasal fiberendoscopic IL with centrifuged autologous fat seems to be a safe, feasible and efficacious phonosurgical procedure for treatment of glottic insufficiency due to unilateral vocal fold paralysis.
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Affiliation(s)
| | - M Stacchini
- ENT Department, M. Bufalini Hospital, Cesena, Italy
| | - F Mozzanica
- Department of Biomedical and Clinical Sciences, L. Sacco Hospital, University of Milan, Milan, Italy
| | - A Schindler
- Department of Biomedical and Clinical Sciences, L. Sacco Hospital, University of Milan, Milan, Italy
| | - E Basile
- ENT Clinic, University of Messina, Messina, Italy
| | - G DE Rossi
- Medical Center of Phoniatrics and Phonosurgery, Padua, Italy
| | - P Woo
- Clinical Professor, Department Of Otolaryngology Head and Neck Surgery, Icahn School of Medicine, New York, USA
| | - M Remacle
- Department of Otorhinolaryngology Head and Neck Surgery, Centre Hospitalier Luxemburg, Luxemburg
| | - M Magnani
- ENT Department, M. Bufalini Hospital, Cesena, Italy
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Fang TJ, Chuang HF, Chiang HC, Pei YC. The impact of cricothyroid involvement on adductor recovery in unilateral vocal fold paralysis. Laryngoscope 2019; 130:139-145. [PMID: 30761540 DOI: 10.1002/lary.27868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Wide variation in postinjury functional recovery is a hallmark of unilateral vocal fold paralysis (UVFP), ranging from zero to full recovery. The present study examined the impact of cricothyroid (CT) muscle involvement on recovery using quantitative laryngeal electromyography (LEMG) of the thyroarytenoid-lateral cricoarytenoid (TA-LCA) muscle complex at multiple times postinjury. STUDY DESIGN Prospective cohort study in a medical center. METHODS Eighty-one patients with UVFP (37 males and 44 females) received an initial assessment of quantitative LEMG, stroboscope, acoustic voice analysis and 36-Item Short Form Survey quality-of-life questionnaire at 3 to 6 months after UVFP onset and a follow-up assessment at 12 months after UVFP onset. RESULTS The initial and follow-up assessments were performed at 4.3 ± 1.9 and 12.5 ± 1.3 months after UVFP onset, respectively. The peak turn frequency of the TA-LCA muscle complex on the lesion side was improved at the follow-up (470 ± 294 Hz) compared with the initial assessment (300 ± 204 Hz) (P < .001). Patients were also divided into two groups with (n = 27) and without (n = 54) CT involvement, respectively. TA-LCA muscle complex turn frequency improved in patients without CT involvement (from 277 ± 198 to 511 ± 301 Hz; P < .001), but not in those with CT involvement (from 345 ± 211 to 386 ± 265 Hz; P = .46). Seventy-one of all patients received early intervention with intracordal hyaluronate injection, showing similar therapeutic effects in those with and without CT involvement. CONCLUSIONS Acute UVFP with combined TA-LCA muscle complex and CT muscle involvement has a poor prognosis, with poorer recovery of TA-LCA muscle complex recruitment. Early interventions should be considered in patients with UVFP with CT involvement. LEVEL OF EVIDENCE 2 Laryngoscope, 130:139-145, 2020.
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Affiliation(s)
- Tuan-Jen Fang
- Department of Otolaryngology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsiu-Feng Chuang
- Department of Otolaryngology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Hui-Chen Chiang
- Graduate School of Management, Ming Chun University, Taipei, Taiwan
| | - Yu-Cheng Pei
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.,Center for Vascularized Composite Allotransplantation, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Zeitels SM, Lombardo PJ, Chaves JL, Faquin WC, Hillman RE, Heaton JT, Kobler JB. Vocal Fold Injection of Absorbable Materials: A Histologic Analysis With Clinical Ramifications. Ann Otol Rhinol Laryngol 2019; 128:71S-81S. [DOI: 10.1177/0003489418805503] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Gels composed of carboxymethylcellulose (CMC) and cross-linked hyaluronic acid are commonly used as temporary or resorbable injectable materials for vocal fold medialization. However, there is limited information about tissue injection patterns, soft tissue reaction, degradation, and residence time, particularly for the newer CMC gels. Study Design: Prospective, laboratory. Methods: Ten canines underwent paraglottic (deep to the vocal ligament) microlaryngoscopic injection with about 100 µL (0.1 mL) of cross-linked hyaluronic acid (Restylane) in the right vocal fold and about 100 µl (0.1 mL) of CMC gel in the left vocal fold. Two commercial CMC gels of similar formulation (Prolaryn Gel and Renú Gel) were used in 5 animals each. Two subjects were sacrificed for histologic analysis at 3, 13, 29, 42, and 55 days. Results: Histology showed that injected Restylane formed cohesive ovoid-shaped aggregated implants with minimal dispersion, inflammation, or cellular invasion in all subjects. Approximately 86% of Restylane injected remained at 8 weeks, as estimated from postmortem, high-resolution magnetic resonance imaging scans. In contrast, histology showed that both CMC gels dispersed widely through fascial planes during and after injection within and outside the thyroarytenoid muscle fascicles. There was a robust macrophage and histiocyte phagocytic response, with moderate to severe inflammation noted around residual CMC gel at early time points, and at 6 to 8 weeks, very little free gel was observed. Conclusions: None of the studied materials induced a clinical inflammatory reaction on laryngoscopy such that they would be considered problematic or dangerous. Restylane demonstrated superior injection localization, tissue compatibility, and residence time. Both CMC gels did not localize well in the paraglottic region, and there was a robust inflammatory response, with clearance by macrophages and short residence time. These results suggest that CMC gels may have a more limited application than previously thought for vocal fold medialization in patients in whom the injection is being used to achieve voice enhancement while awaiting reinnervation. Level of Evidence: NA
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Affiliation(s)
- Steven M. Zeitels
- Department of Surgery, Harvard Medical School, Boston, MA, USA
- Division of Laryngeal Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Patrick J. Lombardo
- Division of Laryngeal Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Jaime L. Chaves
- Division of Laryngeal Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - William C. Faquin
- Department of Pathology, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
| | - Robert E. Hillman
- Department of Surgery, Harvard Medical School, Boston, MA, USA
- Division of Laryngeal Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - James T. Heaton
- Department of Surgery, Harvard Medical School, Boston, MA, USA
- Division of Laryngeal Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - James B. Kobler
- Department of Surgery, Harvard Medical School, Boston, MA, USA
- Division of Laryngeal Surgery, Massachusetts General Hospital, Boston, MA, USA
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Nouraei SAR, Heathcote KJ. An anatomically consistent approach for performing transthyrohyoid injection laryngoplasty. Clin Otolaryngol 2019; 44:487-489. [PMID: 30615270 DOI: 10.1111/coa.13283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/14/2018] [Accepted: 07/15/2018] [Indexed: 11/28/2022]
Affiliation(s)
- S A Reza Nouraei
- The Robert White Centre for Airway Voice and Swallowing, Poole Hospital NHS Foundation Trust, Poole, UK
| | - Kate J Heathcote
- The Robert White Centre for Airway Voice and Swallowing, Poole Hospital NHS Foundation Trust, Poole, UK
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58
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Kim GH, Lee JS, Lee CY, Lee YW, Bae IH, Park HJ, Lee BJ, Kwon SB. Effects of Injection Laryngoplasty with Hyaluronic Acid in Patients with Vocal Fold Paralysis. Osong Public Health Res Perspect 2018; 9:354-361. [PMID: 30584500 PMCID: PMC6296810 DOI: 10.24171/j.phrp.2018.9.6.10] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives The purpose of this study was to explore the effects of injection laryngoplasty (IL) with hyaluronic acid in patients with vocal fold paralysis (VFP). Methods A total of 50 patients with VFP participated in this study. Pre- and post-IL assessments were performed, which included analyzing the sustained vowel /a/ phonation, and the patient reading 1 Korean sentence from the "Walk" passage that comprised 25 syllables in 10 words. To investigate the effect of IL on vocal fold function, acoustic analysis (acoustic voice quality index, cepstral peak prominence, maximum phonation time, speaking fundamental frequency) was conducted and auditory-perceptual (grade and overall severity), visual judgment (gap), and self-questionnaire (voice handicap index-10) assessments were performed. Results The patients with VFP showed statistically significant differences between pre-and post-IL assessments for acoustic and auditory-perception, visual judgment, and self-questionnaire assessments. Conclusion The patients with VFP showed positive change in vocal fold function between pre- and post-IL measurements. The findings showed that IL with hyaluronic acid is an effective method to improve vocal fold function in patients with VFP.
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Affiliation(s)
- Geun-Hyo Kim
- Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jae-Seok Lee
- Department of Otolaryngology, Gyeongsang National University Hospital, Jinju, Korea
| | - Chang-Yoon Lee
- Department of Otorhinolaryngology, Dongnam Institute of Radiological & Medical Sciences, Busan, Korea
| | - Yeon-Woo Lee
- Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - In-Ho Bae
- Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hee-June Park
- Department of Speech Rehabilitation, Choonhae College of Health Sciences, Ulsan, Korea
| | - Byung-Joo Lee
- Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Soon-Bok Kwon
- Department of Humanities, Language and Information, Pusan National University, Busan, Korea
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Meister KD, Johnson A, Sidell DR. Injection Laryngoplasty for Children with Unilateral Vocal Fold Paralysis: Procedural Limitations and Swallow Outcomes. Otolaryngol Head Neck Surg 2018; 160:540-545. [DOI: 10.1177/0194599818813002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
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.
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Affiliation(s)
- Kara D. Meister
- Department of Otolaryngology–Head and Neck Surgery, Stanford University, Palo Alto, California, USA
| | - April Johnson
- Department of Rehabilitation Services, Lucile Packard Children’s Hospital Stanford, Palo Alto, California, USA
| | - Douglas R. Sidell
- Department of Otolaryngology–Head and Neck Surgery, Stanford University, Palo Alto, California, USA
- Pediatric Aerodigestive Center, Lucile Packard Children’s Hospital Stanford, Palo Alto, California, USA
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Wolter NE, Ayele N, Kawai K, Hseu A, Nuss R. Medialization Laryngoplasty in Pediatric Patients With Unilateral Vocal Fold Immobility: A Case Series. Ann Otol Rhinol Laryngol 2018; 128:145-151. [DOI: 10.1177/0003489418814276] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Nikolaus E. Wolter
- Department of Otolaryngology – Head & Neck Surgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Nohamin Ayele
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, MA, USA
| | - Kosuke Kawai
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, MA, USA
| | - Anne Hseu
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, MA, USA
| | - Roger Nuss
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, MA, USA
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Howlett J, Bigsby R, Sharma A. Prolonged intubation and delayed tracheostomy in traumatic laryngotracheal separation. OTOLARYNGOLOGY CASE REPORTS 2018. [DOI: 10.1016/j.xocr.2018.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Tracy LF, Kwak PE, Bayan SL, Van Stan JH, Burns JA. Vocal Fold Motion Recovery in Patients With Iatrogenic Unilateral Immobility: Cervical Versus Thoracic Injury. Ann Otol Rhinol Laryngol 2018; 128:44-49. [DOI: 10.1177/0003489418808306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objectives: Prognostic information about the return of vocal fold mobility in patients with iatrogenic unilateral vocal fold immobility (UVFI) can help with informed decisions about temporary and permanent treatment options. Although many variables can influence the likelihood of recovery, clinical experience suggests that cervical versus thoracic injury is a determining factor. The purpose of this study was to compare recovery rates from UVFI between cervical and thoracic injuries. Methods: A retrospective review of the medical record was performed on all adult patients diagnosed with complete iatrogenic UVFI from 2005 to 2015 (n = 923). Patients with incomplete data and etiologies of idiopathic, malignancy, or stenosis were excluded, leaving a study cohort of 502 patients who were categorized as having UVFI after cervical (n = 329) or thoracic (n = 173) injury. Data regarding site of iatrogenic injury (cervical vs thoracic), mobility status, and time interval to recovery or surgical intervention were recorded and compared using χ2 analyses. Results: Overall, 15% of patients recovered vocal fold mobility at a median of 4.1 months. Patients with cervical injury (65 of 329 [20%]) were significantly more likely to recover mobility than patients with thoracic injury (11 of 173 [6.4%]) (odds ratio, 3.63). The cervical cohort contained more women (68% vs 31%) and was younger (mean age, 60.4 ± 13.8 vs 64.1 ± 16.1 years; Cohen’s D = 0.25). Conclusions: Patients with cervical injuries resulting in UVFI are 4 times more likely to recover mobility than patients with thoracic injuries. This information can be valuable in counseling patients with UVFI and may affect clinical decision making.
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Affiliation(s)
- Lauren F. Tracy
- Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, MA, USA
| | - Paul E. Kwak
- Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, MA, USA
| | - Semirra L. Bayan
- Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, MA, USA
| | - Jarrad H. Van Stan
- Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, MA, USA
- Department of Communication Sciences and Disorders, Massachusetts General Hospital Institute of Health Professions, Boston, MA, USA
| | - James A. Burns
- Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, MA, USA
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Dhillon VK, Rettig E, Noureldine SI, Genther DJ, Hassoon A, Al Khadem MG, Ozgursoy OB, Tufano RP. The incidence of vocal fold motion impairment after primary thyroid and parathyroid surgery for a single high-volume academic surgeon determined by pre- and immediate post-operative fiberoptic laryngoscopy. Int J Surg 2018; 56:73-78. [PMID: 29908329 DOI: 10.1016/j.ijsu.2018.06.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 04/16/2018] [Accepted: 06/12/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Vocal fold motion impairment (VFMI) is a well-recognized complication of thyroid and parathyroid surgery. Preoperative counseling requires a thorough understanding of the incidence, risk factors, and value of early diagnosis of postoperative VFMI. Our objective is to describe the incidence of and risk factors for VFMI for a single high-volume academic surgeon, and to assess the utility of immediate postoperative fiberoptic laryngoscopy (FOL) in early diagnosis of VFMI. METHODS Retrospective cohort study of patients undergoing primary thyroid and parathyroid procedures by a single high-volume surgeon at an academic tertiary care center. All patients underwent preoperative and immediate postoperative FOL. The primary outcome was incidence of VFMI, either temporary (<1 year) or permanent (1 year or more). The unit of analysis was number of recurrent laryngeal nerves (RLN) at risk. Risk factors for VFMI were analyzed using logistic regression, reporting unadjusted and adjusted odds ratios (OR and aOR) and 95% confidence intervals (CI). RESULTS The study population comprised 1547 patients undergoing 1580 procedures for a total of 2527 nerves at risk, excluding the 27 nerves found to have motion impairment on preoperative FOL. Sixty-seven new incidents of VFMI were identified on postoperative FOL, with an additional six new incidents detected after voice complaints prompted FOL upon follow-up. Thus, the incidence of postoperative VFMI was 2.9% of RLNs at risk (73 of 2527). The sensitivity and negative predictive value of immediate postoperative FOL were 92% and 99.8% respectively. Permanent VFMI occurred in 9 cases (0.4%), 3 of which were from intentional RLN transection for malignancy. Odds of VFMI were significantly lower after parathyroidectomy (aOR = 0.1, 95%CI = 0.01-0.8 compared with hemithryoidectomy) and higher with central neck dissection (aOR = 2.4, 95CI = 1.0-5.9). Among cases of malignancy, odds of VFMI increased significantly with increasing T-stage (adjusted ptrend<0.001). CONCLUSION VFMI is rare and usually temporary after primary thyroid and parathyroid procedures, with increased risk associated with larger primary malignancies and the inclusion of central neck dissection. Immediate postoperative FOL is useful for early detection of VFMI that may allow for clear definition of temporary and permanent immobility rehabilitation especially if there is evidence to support early intervention.
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Affiliation(s)
- Vaninder K Dhillon
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eleni Rettig
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Salem I Noureldine
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dane J Genther
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ahmed Hassoon
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mai G Al Khadem
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ozan B Ozgursoy
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ralph P Tufano
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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64
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Anis MM, Memon Z. Injection medialization laryngoplasty improves dysphagia in patients with unilateral vocal fold immobility. World J Otorhinolaryngol Head Neck Surg 2018; 4:126-129. [PMID: 30101222 PMCID: PMC6074009 DOI: 10.1016/j.wjorl.2018.05.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 05/11/2018] [Indexed: 11/26/2022] Open
Abstract
Objective To assess patient reported swallowing outcomes before and after injection medialization laryngoplasty in patients with unilateral vocal fold immobility (UVFI). Methods Case series with chart review of patients with UVFI who underwent injection medialization laryngoplasty at a community laryngology practice by a single clinician between October 2015 and December 2017. Patient-reported validated surveys of swallowing impairment, Eating Assessment Tool (EAT-10), demographics, etiology and duration of symptoms were recorded before and after injection. A paired t test was done on EAT-10 surveys before and after IML to assess for statistical significance. Results Twenty-one patients with UVFI and glottic insufficiency underwent IML between October 2015 and December 2017. Nineteen of 21 patients (90%) presented with dysphagia (EAT-10 ≥ 3). 76% of patients with dysphagia reported improvement in swallowing function after IML. The EAT-10 scores of UVFI patients with dysphagia before and after IML were 17.0 ± 14.0 and 4.2 ± 9.6, respectively (p = 0.004). Conclusions Nearly all patients with UVFI and glottic insufficiency report associated dysphagia. Three fourths of these patients perceive improvement in their swallowing function after injection medialization laryngoplasty. Patients with idiopathic UVFI may have a more sustained improvement and those with severe preop dysphagia may not benefit. Further research is necessary to refine patient selection and to assess duration of improved swallowing function.
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Affiliation(s)
- Mursalin M Anis
- Coastal Ear, Nose and Throat, Neptune, NJ, USA.,Department of Otolaryngology, University of Miami, Miami, FL, USA
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Puccinelli C, Modzeski MC, Orbelo D, Ekbom DC. Symptomatic unilateral vocal fold paralysis following cardiothoracic surgery. Am J Otolaryngol 2018; 39:175-179. [PMID: 29254704 DOI: 10.1016/j.amjoto.2017.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 11/28/2017] [Indexed: 11/19/2022]
Abstract
PURPOSE Unilateral vocal fold paralysis (UVFP) is a complication associated with cardiothoracic procedures that presents clinically as dysphonia and/or dysphagia with or without aspiration. The literature lacks both data on recovery of mobility and consensus on best management. Herein, our goals are to 1) Identify cardiothoracic procedures associated with symptomatic UVFP at our institution; 2) Review timing and nature of laryngology diagnosis and management; 3) Report spontaneous recovery rate of vocal fold mobility. MATERIALS AND METHODS Retrospective case series at single tertiary referral center between 2002 and 2015. 141 patients were included who underwent laryngology interventions (micronized acellular dermis injection laryngoplasty and/or type 1 thyroplasty) to treat symptomatic UVFP diagnosed subsequent to cardiothoracic surgery. RESULTS Pulmonary procedures were most often associated with UVFP (n=50/141; 35.5%). 87.2% had left-sided paralysis (n=123/141). Median time to diagnosis was 42days (x¯=114±348). Over time, UVFP was diagnosed progressively earlier after cardiothoracic surgery. 63.4% of patients (n=95/141) underwent injection laryngoplasty as their initial intervention with median time from diagnosis to injection of 11days (x¯=29.6±54). 41.1% (n=58/141) ultimately underwent type 1 thyroplasty at a median of 232.5days (x¯=367±510.2) after cardiothoracic surgery. 10.2% (n=9/88) of those with adequate follow-up recovered full vocal fold mobility. CONCLUSIONS Many cardiothoracic procedures are associated with symptomatic UVFP, predominantly left-sided. Our data showed poor recovery of vocal fold mobility relative to other studies. Early diagnosis and potential surgical medialization is important in the care of these patients.
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Affiliation(s)
- Cassandra Puccinelli
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Mara C Modzeski
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Diana Orbelo
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Dale C Ekbom
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA.
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Vila PM, Bhatt NK, Paniello RC. Early-injection laryngoplasty may lower risk of thyroplasty: A systematic review and meta-analysis. Laryngoscope 2018; 128:935-940. [DOI: 10.1002/lary.26894] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Peter M. Vila
- Department of Otolaryngology-Head and Neck Surgery; Washington University School of Medicine in St. Louis; St. Louis Missouri U.S.A
| | - Neel K. Bhatt
- Department of Otolaryngology-Head and Neck Surgery; Washington University School of Medicine in St. Louis; St. Louis Missouri U.S.A
| | - Randal C. Paniello
- Department of Otolaryngology-Head and Neck Surgery; Washington University School of Medicine in St. Louis; St. Louis Missouri U.S.A
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Pei YC, Chuang HF, Chang CF, Chang TL, Chiang HC, Fang TJ. Voice Range Change After Injection Laryngoplasty for Unilateral Vocal Fold Paralysis. J Voice 2017; 32:625-632. [PMID: 29248388 DOI: 10.1016/j.jvoice.2017.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 07/23/2017] [Accepted: 07/25/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Patients with unilateral vocal fold paralysis (UVFP) caused by nerve injury manifest with voice changes. This study investigated vocal performance measured by voice range profile (VRP) in patients with UVFP and changes in VRP in response to intracordal hyaluronate injection. METHODS Eighty-five patients with UVFP were enrolled prospectively, among whom 68 received intracordal hyaluronate injections. The outcome measurements included VRP, acoustic and aerodynamic analyses, peak turn frequency of thyroarytenoid-lateral cricoarytenoid muscle complex (TA-LCA) measured by laryngeal electromyography, and normalized glottal gap area by videolaryngostroboscopy. RESULTS The peak turn frequency of the paralyzed TA-LCA showed a modest correlation with max fundamental frequency (F0) and F0 range. Closed-phase normalized glottal gap area showed modest negative correlations with max F0 and F0 semitone range. Regarding conventional acoustic and aerodynamic analyses, the paralyzed TA-LCA peak turn frequency was only correlated with maximal phonation time. Intracordal hyaluronate injection improved VRP performance by increasing max F0, decreasing min F0, increasing F0 range, and increasing semitone range (all P <0.01) with small or medium strength of effect size (Cohen d, 0.39-0.76). CONCLUSIONS Change in voice pitch in patients with UVFP can partly predict impairment of neuromuscular functions and glottal gap. VRP provides a more sensitive reflection of the severity of neuromuscular impairment, compared with conventional voice analysis. The validity of VRP is further supported by a robust response to voice improvements following injection laryngoplasty.
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Affiliation(s)
- Yu-Cheng Pei
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Center of Vascularized Tissue Allograft, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsiu-Feng Chuang
- Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chia-Fen Chang
- Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Tzu-Ling Chang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Hui-Chen Chiang
- Graduate School of Management, Ming Chung University, Taipei, Taiwan
| | - Tuan-Jen Fang
- School of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
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Tanrivermis Sayit A, Elmali M, Kemal O, Terzi Y. Radiological, clinical and audiological evaluation of jugular bulb-vestibular aqueduct dehiscence. Acta Otolaryngol 2017; 137:1221-1225. [PMID: 28799451 DOI: 10.1080/00016489.2017.1360516] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of this study is to determine the prevalence of jugular bulb-vestibular aqueduct dehiscence (JBVAD) in patients undergoing temporal bone multidetector computed tomography (MDCT) and assess the relationship between JBVAD and hearing loss with the findings of audiometry. METHODS About 1503 temporal bone MDCT scans were evaluated for the prevalence of JBVAD. Correlation of the imaging findings and audiometric data was performed. Patients were divided into two groups, those with and those without hearing loss, and were statistically compared. RESULTS Jugular bulb-vestibular aqueduct dehiscence was detected in 124 of the 1503 patients with a prevalence of 8.2%. MDCT images of 56 of the 124 patients were normal except for JBVAD (n = 38) and close proximity of the jugular bulb (JB) and vestibular aqueduct (VA) (n = 18). A total of 23 of 38 patients with JBVAD and 7 of 18 patients with close proximity of the JB and VA had hearing loss detected by audiometric evaluation. CONCLUSIONS The most common hearing loss was detected as sensorineural hearing loss in patients with JBVAD. Also, median air and bone conduction and air bone gap values were found statistically higher in patients with hearing loss versus those without hearing loss.
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Affiliation(s)
| | - Muzaffer Elmali
- Department of Radiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Ozgur Kemal
- Department of Otorhinolaryngology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Yuksel Terzi
- Department of Statistics, Faculty of Art and Science, Ondokuz Mayis University, Samsun, Turkey
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69
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McLaughlin CW, Swendseid B, Courey MS, Schneider S, Gartner-Schmidt JL, Yung KC. Long-term outcomes in unilateral vocal fold paralysis patients. Laryngoscope 2017; 128:430-436. [DOI: 10.1002/lary.26900] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 08/11/2017] [Accepted: 08/14/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Conor W. McLaughlin
- Department of Otolaryngology-Head and Neck Surgery; University of California San Francisco; San Francisco California U.S.A
| | - Brian Swendseid
- Department of General Surgery; University of California San Francisco; San Francisco California U.S.A
| | - Mark S. Courey
- Department of Otolaryngology-Head and Neck Surgery; Icahn School of Medicine at Mount Sinai; New York New York U.S.A
| | - Sarah Schneider
- Department of Otolaryngology-Head and Neck Surgery; University of California San Francisco; San Francisco California U.S.A
| | - Jackie L. Gartner-Schmidt
- Department of Otolaryngology; University of Pittsburgh School of Medicine; Pittsburgh Pennsylvania U.S.A
| | - Katherine C. Yung
- Department of Otolaryngology-Head and Neck Surgery; University of California San Francisco; San Francisco California U.S.A
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Nishio N, Fujimoto Y, Hiramatsu M, Maruo T, Suga K, Tsuzuki H, Mukoyama N, Shimono M, Toriyama K, Takanari K, Kamei Y, Sone M. Computed tomographic assessment of autologous fat injection augmentation for vocal fold paralysis. Laryngoscope Investig Otolaryngol 2017; 2:459-465. [PMID: 29299524 PMCID: PMC5743153 DOI: 10.1002/lio2.125] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 09/30/2017] [Accepted: 10/24/2017] [Indexed: 01/18/2023] Open
Abstract
Objective To perform a quantitative computed tomography (CT) assessment of short‐ and long‐term outcomes of autologous fat injection augmentation in patients with unilateral vocal fold paralysis. Study Design Retrospective case series. Methods Twelve patients who had undergone autologous fat injection augmentation for unilateral vocal fold paralysis in our hospital between 2011 and 2015 were enrolled in this study. The autologous fat for injection was acquired from periumbilical subcutaneous tissue and was injected orally using a special‐purpose laryngeal injection needle. To evaluate the injected fat at the follow‐up assessments, CT was performed at several times after surgery in clinical practice. All thin‐section CT images were transferred to a workstation, and the volume of the injected fat was calculated. Results Patients comprised 6 men and 6 women with a mean age at the time of surgery of 62.9 years (range, 46–82 years). The actual injected fat volume was 1.1–2.5 ml (mean, 1.6 ml). In seven patients assessed by CT two days after surgery, the average residual rate of the injected fat was 63.9%. The mean residual rates of the injected fat were 30.0% at 3 months, 33.7% at 6 months, 29.2% at 12 months, and 32.0% at 24 months. Conclusions Although the injected fat volume decreased within the first three months and the residual rate of the injected fat was 30.0% at three months after injection, the residual fat volume remained at the same level for 24 months after injection. Level of Evidence 4
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Affiliation(s)
- Naoki Nishio
- Department of Otorhinolaryngology Nagoya University Graduate School of Medicine Nagoya Japan
| | - Yasushi Fujimoto
- Department of Otorhinolaryngology Nagoya University Graduate School of Medicine Nagoya Japan
| | - Mariko Hiramatsu
- Department of Otorhinolaryngology Nagoya University Graduate School of Medicine Nagoya Japan
| | - Takashi Maruo
- Department of Otorhinolaryngology Nagoya University Graduate School of Medicine Nagoya Japan
| | - Kenji Suga
- Department of Otorhinolaryngology Nagoya University Graduate School of Medicine Nagoya Japan
| | - Hidenori Tsuzuki
- Department of Otorhinolaryngology Nagoya University Graduate School of Medicine Nagoya Japan
| | - Nobuaki Mukoyama
- Department of Otorhinolaryngology Nagoya University Graduate School of Medicine Nagoya Japan
| | - Mariko Shimono
- Department of Otorhinolaryngology Nagoya University Graduate School of Medicine Nagoya Japan
| | - Kazuhiro Toriyama
- Department of Otorhinolaryngology Nagoya University Graduate School of Medicine Nagoya Japan
| | - Keisuke Takanari
- Department of Plastic and Reconstructive Surgery Nagoya University Graduate School of Medicine Nagoya Japan.,Department of Plastic and Reconstructive Surgery Nagoya City University Hospital Nagoya Japan
| | - Yuzuru Kamei
- Department of Plastic and Reconstructive Surgery Nagoya University Graduate School of Medicine Nagoya Japan
| | - Michihiko Sone
- Department of Otorhinolaryngology Nagoya University Graduate School of Medicine Nagoya Japan
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Gotxi-Erezuma I, Ortega-Galán M, Laso-Elguezabal A, Prieto Puga G, Bullido-Alonso C, García-Gutiérrez S, Anton-Ladislao A, Moreno-Alonso E. Electromyography-Guided Hyaluronic Acid Injection Laryngoplasty in Early Stage of Unilateral Vocal Fold Paralysis. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2017. [DOI: 10.1016/j.otoeng.2017.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Husain S, Sadoughi B, Mor N, Levin AM, Sulica L. Time course of recovery of idiopathic vocal fold paralysis. Laryngoscope 2017; 128:148-152. [PMID: 28736846 DOI: 10.1002/lary.26762] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 05/18/2017] [Accepted: 06/01/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS To clarify the time course of recovery in patients with idiopathic vocal fold paralysis. STUDY DESIGN Retrospective chart review. METHODS Medical records for all patients with idiopathic vocal fold paralysis over a 10-year period were reviewed to obtain demographic and clinical information, including onset of disease and recovery of vocal function. Stroboscopic exams of patients who recovered voice were reviewed blindly to assess return of vocal fold motion. RESULTS Thirty-eight of 55 patients (69%) recovered vocal function. Time course of recovery could be assessed in 34 patients who did not undergo injection augmentation. The mean time to recovery was 152.8 ± 109.3 days (left, 179.8 ± 111.3 days; right, 105.3 ± 93.7 days; P = .088). Two-thirds of patients recovered within 6 months. Probability of recovery declined over time. Five of 22 patients who recovered voice had return of vocal fold motion; 17 did not. The mean time to recovery did not differ between these groups (return of motion, 127.4 ± 132.3 days; no return of motion, 160.1 ± 105.1 days; P = .290). CONCLUSIONS Sixty-nine percent of patients with idiopathic vocal fold paralysis recovered vocal function, two-thirds doing so within 6 months of onset. Age, gender, laterality, use of injection augmentation did not influence recovery rate. Declining probability of recovery over time leads us to consider framework surgery after 6 months in patients with idiopathic paralysis. LEVEL OF EVIDENCE 4. Laryngoscope, 128:148-152, 2018.
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Affiliation(s)
| | - Babak Sadoughi
- Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, New York, New York
| | - Niv Mor
- Voice and Swallowing Disorders, Division of Otolaryngology Head and Neck Surgery, Maimonides Medical Center, Brooklyn, New York, U.S.A
| | | | - Lucian Sulica
- Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, New York, New York
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Chiarovano E, Cheng K, Mukherjee P. Utility of vestibular testing and new technologies in a complex cholesteatoma. ACTA OTO-LARYNGOLOGICA CASE REPORTS 2017. [DOI: 10.1080/23772484.2017.1350109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
| | - Kai Cheng
- School of Psychology, University of Sydney, Sydney, Australia
- Institute of Academic Surgery, Royal Prince Alfred Hospital (RPA), Sydney, Australia
| | - Payal Mukherjee
- Institute of Academic Surgery, Royal Prince Alfred Hospital (RPA), Sydney, Australia
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Chen DW, Price MD, LeMaire SA, Coselli JS, Liou NE, Ongkasuwan J. Early versus late inpatient awake transcervical injection laryngoplasty after thoracic aortic repair. Laryngoscope 2017; 128:144-147. [DOI: 10.1002/lary.26747] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 05/12/2017] [Accepted: 05/23/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Diane W. Chen
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine; Houston Texas U.S.A
| | - Matt D. Price
- Department of Cardiothoracic Surgery; Baylor College of Medicine; Houston Texas U.S.A
| | - Scott A. LeMaire
- Department of Cardiothoracic Surgery; Baylor College of Medicine; Houston Texas U.S.A
| | - Joseph S. Coselli
- Department of Cardiothoracic Surgery; Baylor College of Medicine; Houston Texas U.S.A
| | - N. Eddie Liou
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine; Houston Texas U.S.A
| | - Julina Ongkasuwan
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine; Houston Texas U.S.A
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Functional assessment of glottal insufficiency treated by hyaluronic acid injection: Retrospective 20-case series. Eur Ann Otorhinolaryngol Head Neck Dis 2017; 134:145-149. [DOI: 10.1016/j.anorl.2016.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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76
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Lynch J, Parameswaran R. Management of unilateral recurrent laryngeal nerve injury after thyroid surgery: A review. Head Neck 2017; 39:1470-1478. [DOI: 10.1002/hed.24772] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 12/13/2016] [Accepted: 02/08/2017] [Indexed: 02/06/2023] Open
Affiliation(s)
- Jeremy Lynch
- Specialist Registrar in General Surgery; Chelsea and Westminister Hospital; London United Kingdom
| | - Rajeev Parameswaran
- Department of Endocrine Surgery; National University Hospital; Lower Kent Ridge Road Singapore
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Inpatient injection laryngoplasty for vocal fold immobility: When is it really necessary? Am J Otolaryngol 2017; 38:222-225. [PMID: 28131551 DOI: 10.1016/j.amjoto.2017.01.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 01/17/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare pulmonary and swallow outcomes of injection laryngoplasty when performed in the acute versus subacute setting in head & neck and thoracic cancer patients presenting with new onset unilateral vocal fold immobility. MATERIALS AND METHODS Case series with chart review at an academic cancer center over a 2year period. Based on swallow evaluation, patients diagnosed with vocal fold immobility were grouped into an unsafe swallow group, injected as inpatients, and a safe swallow group, for whom injection laryngoplasty was delayed to the outpatient setting or not performed. Rates of pneumonia, diet recommendations, and swallow outcomes were compared between groups. RESULTS 24 patients with new-onset vocal fold immobility were evaluated. 7 underwent injection in the inpatient setting, 12 in the outpatient setting, and 5 did not undergo injection. There was no perceived difference in speech and swallow outcomes between the inpatient and outpatient injection groups. CONCLUSIONS Injection laryngoplasty shows promise as an effective intervention for reducing aspiration risk and improving diet normalcy in patients with dysphagia as a result of unilateral vocal fold immobility. In patients determined to have a safe swallow, delay of injection laryngoplasty is not detrimental to swallow outcomes.
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Electromyography-guided hyaluronic acid injection laryngoplasty in early stage of unilateral vocal fold paralysis. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2017; 68:274-283. [PMID: 28238367 DOI: 10.1016/j.otorri.2016.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 11/23/2016] [Accepted: 12/06/2016] [Indexed: 11/20/2022]
Abstract
INTRODUCTION AND OBJECTIVE To assess the effectiveness of electromyography-guided hyaluronic acid injection laryngoplasty in the early stage of unilateral vocal fold paralysis in terms of patient recovery from dysphonia and quality of life. METHODS Between January and December 2014, 28 patients with unilateral vocal fold paralysis underwent electromyography and injection of hyaluronic acid in the thyroarytenoid muscle. We compared the voice handicap index, grade, roughness, breathiness, asthenia, strain scale (GRBAS), videostroboscopic parameters and maximum phonation time assessed before, 15 days and 6 months after the intervention, using the non-parametric Wilcoxon rank test. RESULTS Out of the 28 patients, 1 had a haematoma in the injected vocal fold (3.57%) and 6 required second injections. The maximum phonation time of the vowel /e/ increased from 6.07 to 12.14 sec. (15 days post-intervention) and subsequently 12.75 (6 months post-intervention). There was also a significant improvement in the grade, roughness, breathiness, asthenia, strain scale in parameters G, B and A both 15 days and 6 months after the intervention. The voice handicap index score decreased from 58.29 to 37.63 (15 days post-intervention) and 29.64 (6 months post-intervention). CONCLUSIONS Electromyography-guided hyaluronic injection laryngoplasty in unilateral vocal fold paralysis enables, in the same intervention, neuromuscular assessment and temporary treatment of glottic insufficiency with a low risk of complications and improvement in patient's quality of life. This may reduce the need for subsequent treatments, but further research is required to confirm these findings.
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Lin RJ, Munin MC, Rosen CA, Smith LJ. Effect of intralaryngeal muscle synkinesis on perception of voice handicap in patients with unilateral vocal fold paralysis. Laryngoscope 2017; 127:1628-1632. [DOI: 10.1002/lary.26390] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 09/12/2016] [Accepted: 09/27/2016] [Indexed: 11/08/2022]
Affiliation(s)
- R. Jun Lin
- University of Pittsburgh Voice Center; Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh; Pittsburgh Pennsylvania U.S.A
| | - Michael C. Munin
- University of Pittsburgh Voice Center; Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh; Pittsburgh Pennsylvania U.S.A
- Department of Physical Medicine and Rehabilitation; University of Pittsburgh Medical Center; Pittsburgh Pennsylvania U.S.A
| | - Clark A. Rosen
- University of Pittsburgh Voice Center; Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh; Pittsburgh Pennsylvania U.S.A
| | - Libby J. Smith
- University of Pittsburgh Voice Center; Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh; Pittsburgh Pennsylvania U.S.A
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80
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One hundred years of external approach medialisation thyroplasty. The Journal of Laryngology & Otology 2017; 131:202-208. [DOI: 10.1017/s0022215116010033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractIt has been 100 years since Erwin Payr first developed an operation to improve the effects of a paralysed vocal fold, and operations based on this technique are still in use today. This technique, medialisation thyroplasty, aims to improve the symptoms caused by vocal fold palsy by realigning the lateralised vocal fold into the midline.Whilst the effects of vocal fold palsy were recognised in antiquity, it was only with the development of indirect laryngoscopy in the late nineteenth century that the vocal fold paralysis could be identified as an aetiology for poor phonation and dysphagia. Payr, in 1915, was the first to perform a recognisable form of medialisation thyroplasty, which was further developed in the early twentieth century, but medialisation thyroplasty did not begin to be widely used until the development of the modern technique by Isshiki et al., in 1974.Since then, medialisation thyroplasty has continued to be developed and is currently the most widely used technique for correcting the effects of vocal fold palsy. However, a wide array of therapeutic options is now available for vocal fold palsy and it is impossible to say whether or not medialisation thyroplasty will still be used in another 100 years.
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Busto-Crespo O, Uzcanga-Lacabe M, Abad-Marco A, Berasategui I, García L, Maraví E, Aguilera-Albesa S, Fernández-Montero A, Fernández-González S. Longitudinal Voice Outcomes After Voice Therapy in Unilateral Vocal Fold Paralysis. J Voice 2016; 30:767.e9-767.e15. [DOI: 10.1016/j.jvoice.2015.10.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 10/27/2015] [Indexed: 10/22/2022]
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Diagnostic and prognostic contribution of laryngeal electromyography in unilateral vocal-fold immobility in adults. Eur Ann Otorhinolaryngol Head Neck Dis 2016; 134:13-18. [PMID: 27720373 DOI: 10.1016/j.anorl.2016.09.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To study the diagnostic and prognostic contribution of laryngeal electromyography in unilateral vocal-fold immobility in adults. MATERIAL AND METHODS A retrospective study included patients with unilateral vocal-fold immobility undergoing laryngeal electromyography between 2007 and 2015. Neurogenic, normal or myogenic findings were compared to the clinical aspect. Prognosis for recovery was assessed from motor unit potentials on laryngeal electromyography, and compared to subsequent progress on laryngoscopy. RESULTS Sixty-three patients (mean age, 59 years) were initially included; 2 were subsequently excluded from analysis. Mean time from onset of immobility to laryngeal electromyography was 7 months. 85% of the 61 patients showed neurogenic findings, indicating neural lesion; 13% showed normal electromyography, indicating cricoarytenoid joint ankylosis; and 1 patient showed a myogenic pattern. Neurogenic cases were usually secondary to cervical surgery. Thirty-eight patients were followed up. In total, 75% of patients showing reinnervation potentials recovered. The positive predictive value of laryngeal electromyography was 69.2%. CONCLUSION Laryngeal electromyography is effective in specifying the origin of unilateral vocal-fold immobility in adults. It also has a prognostic role, lack of reinnervation potentials being a possible indication for early medialization surgery.
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Konomi U, Tokashiki R, Hiramatsu H, Kumada M. Diagnosis and management of unilateral thyroarytenoid muscle palsy. Eur Arch Otorhinolaryngol 2016; 273:3803-3811. [PMID: 27342405 DOI: 10.1007/s00405-016-4134-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 06/03/2016] [Indexed: 10/21/2022]
Abstract
The objective of this study is to assess and propose a method of diagnosis and management of patients with unilateral thyroarytenoid muscle palsy (TAMP). This is a retrospective review of clinical records. The records of seven patients diagnosed as having idiopathic TAMP were reviewed. Despite the adductive and abductive functions of the vocal folds being within normal range, apparent palsy was seen in the unilateral thyroarytenoid muscle of these patients. TAMP was confirmed by laryngeal electromyography, and the adductive and abductive movements of the vocal folds were evaluated as the mobility of the arytenoid cartilages by three-dimensional computed tomography and endoscopy. Most of patients with TAMP had been diagnosed as having other diseases or normal, and in one patient, it took over 6 years to establish a correct diagnosis. Two patients recovered by conservative treatment; however, in five patients, TAMP remained even after 6 months. In 4 of those 5 patients, treatment with hyaluronic acid injections was performed. In the remaining patient, surgical treatment, namely, nerve-muscle pedicle flap implantation was performed, which resulted in a favorable recovery of phonation. The average maximum phonation time (MPT) of all patients was extended from 11.4 (±4.4) s before treatment to 19.9 (±4.3) s after treatment, and the pitch range was also increased from 25.1 (±7.2) to 34.6 (±5.8) semitones following our management course. Our results indicate that there is a possibility that TAMP can be diagnosed and treated sufficiently. Therefore, further research toward establishing the concept of and treatment for TAMP is anticipated.
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Affiliation(s)
- Ujimoto Konomi
- Department of Otolaryngology, Tokyo Medical University School of Medicine, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
| | - Ryoji Tokashiki
- Department of Otolaryngology, Tokyo Medical University School of Medicine, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.,Shinjuku Voice Clinic, Enikia Building 4F, 1-1-17 Kabukicho, Shinjuku-ku, Tokyo, 160-0021, Japan
| | - Hiroyuki Hiramatsu
- Department of Otolaryngology, Tokyo Medical University School of Medicine, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.,Hiramastu ENT Clinic, Diamond Building 2F, 1-7-1 Nogaya, Machida-shi, Tokyo, 195-0053, Japan
| | - Masanobu Kumada
- Kumada Clinic, L-First Building 3F, 4-2-6 Nishi-azabu, Minato-ku, Tokyo, 106-0031, Japan
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Loochtan MJ, Balcarcel D, Carroll E, Foecking EM, Thorpe EJ, Charous SJ. Vocal Fold Paralysis after Esophagectomy for Carcinoma. Otolaryngol Head Neck Surg 2016; 155:122-6. [PMID: 27143708 DOI: 10.1177/0194599816644738] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 03/25/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVES (1) To recognize factors that contribute to vocal fold paralysis (VFP) after esophagectomy. (2) To describe the morbidity associated with VFP after esophagectomy. STUDY DESIGN Retrospective cohort study. SETTING Tertiary care academic medical center. SUBJECTS AND METHODS The medical records of 91 patients undergoing esophagectomy for malignancy were reviewed (2008-2014). Twenty-two patients with postoperative VFP were compared with 69 patients without VFP with regard to preoperative variables, surgical approach (transcervical vs other), and postoperative outcomes. A subset analysis of cervical approaches was performed, including those where an otolaryngologist assisted. RESULTS There were no significant differences in preoperative variables between patients with and without VFP. Cervical approaches were associated with increased VFP (P < .0001). Recurrent laryngeal nerve (RLN) identification was associated with increased VFP (P = .0001). RLN dissection by head and neck surgeons was associated with decreased VFP (P = .0223). Patients with VFP had longer lengths of stay (P = .0078), higher rates of tracheotomy (P = .0439), and required more outpatient swallow evaluations (P = .0017). Mean time to diagnosis of VFP was 45.6 days (median, 7.5 days). CONCLUSIONS Cervical approaches are associated with increased VFP in patients undergoing esophagectomy for malignancy. When cervical approaches and mobilization are required, the inclusion of an experienced cervical surgeon to identify the RLN may improve the rate of postoperative VFP. Patients with VFP after esophagectomy experience significantly more morbidity. Due to the potential delay in diagnosis and treatment of postoperative VFP, routine assessment of inpatient vocal fold function may be beneficial.
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Affiliation(s)
- Michael J Loochtan
- Department of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Daniel Balcarcel
- Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA
| | - Elizabeth Carroll
- Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA
| | - Eileen M Foecking
- Department of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Eric J Thorpe
- Department of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Steven J Charous
- Department of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, USA
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Mor N, Wu G, Aylward A, Christos PJ, Sulica L. Predictors for Permanent Medialization Laryngoplasty in Unilateral Vocal Fold Paralysis. Otolaryngol Head Neck Surg 2016; 155:443-53. [PMID: 27143710 DOI: 10.1177/0194599816644716] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 03/25/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Early differentiation of patients with unilateral vocal fold paralysis (VFP) who recover from those who do not and consequently require permanent medialization laryngoplasty (ML) remains a challenge. The goal of this study is to identify factors that predict the need for ML. STUDY DESIGN Case series with chart review. SETTING Academic center. SUBJECTS AND METHODS A total of 507 records of patients with VFP were analyzed, of which 252 met criteria and were stratified according to whether or not they obtained ML. Demographic information and clinical features were analyzed to determine predictors of ML. A nomogram was generated according to the significance and utility of these parameters. RESULTS Of 252 patients, 86 underwent ML, and 166 did not. No differences in age or sex were observed between the ML and non-ML patients (P = .27 and P = .35, respectively). The most common cause of VFP was iatrogenic injury (62.79%, ML; 49.40%, non-ML). ML correlated with VFP secondary to neoplastic disease (odds ratio [OR], 2.14; 95% confidence interval [95% CI], 1.01-4.53) and iatrogenic injury (OR 1.73; 95% CI 1.01-2.94). ML had an inverse correlation with idiopathic VFP (OR, 0.40; 95% CI, 0.20-0.79). Patients in the ML group were more likely to have left-sided VFP, to have a history of aspiration, and to present ≥90 days from onset and less likely to have had temporary injection augmentation. CONCLUSION Clinical features may be used to predict the likelihood of a patient obtaining ML. Nomograms may be useful to counsel patients who would benefit from early definitive surgery.
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Affiliation(s)
- Niv Mor
- Voice and Swallowing Disorders, Division of Otolaryngology-Head and Neck Surgery, Maimonides Medical Center, Brooklyn, New York, USA Department of Otolaryngology-Head and Neck Surgery, Sean Parker Institute for the Voice, Weill Cornell Medical College, New York, New York, USA
| | - Guojiao Wu
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, USA
| | - Alana Aylward
- College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Paul J Christos
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, USA
| | - Lucian Sulica
- Department of Otolaryngology-Head and Neck Surgery, Sean Parker Institute for the Voice, Weill Cornell Medical College, New York, New York, USA
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Kwak PE, Tritter AG, Donovan DT, Ongkasuwan J. Long-term Voice Outcomes of Early Thyroplasty for Unilateral Vocal Fold Paralysis Following Aortic Arch Surgery. Ann Otol Rhinol Laryngol 2016; 125:559-63. [DOI: 10.1177/0003489416636127] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To describe this institution’s experience with and the long-term outcomes of early type 1 thyroplasty for unilateral vocal fold paralysis (UVFP) following surgery on the aortic arch. Study Design: Retrospective chart review with telephone questionnaire. Setting: Academic tertiary care center. Subjects and Methods: Three hundred forty-eight patients with UVFP following surgery on the aortic arch since 1999 were identified; 40 were available for follow-up. The number of revision procedures following initial thyroplasty was ascertained, and the Voice Handicap Index (VHI) was administered by telephone. The hypothesis that early thyroplasty produced voice outcomes and revision rates comparable to injection laryngoplasty was established prior to the initiation of data collection. Results: Six out of the 40 patients (15%) required revision thyroplasty following their initial procedure. Mean VHI of all patients was 36.0 (SD, 27.2). Mean VHI was significantly different in the 18 to 39 age group (13.1) when compared to the 40 to 59 (51.8) and 60+ (37.7) age groups ( P = .013). Mean follow-up since initial thyroplasty was 46.5 months (SD, 42.2). Conclusions: In the setting of aortic arch surgery with injury to the recurrent laryngeal nerve, early thyroplasty produces voice outcomes comparable to those achieved in the literature with repeated injection and delayed thyroplasty and can be considered in select populations.
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Affiliation(s)
- Paul E. Kwak
- Division of Laryngeal Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew G. Tritter
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University-Shreveport, Shreveport, Louisiana, USA
| | - Donald T. Donovan
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Julina Ongkasuwan
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
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87
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Hernandez SC, Sibley H, Fink DS, Kunduk M, Schexnaildre M, Kakade A, McWhorter AJ. Injection Laryngoplasty Using Micronized Acellular Dermis for Vocal Fold Paralysis. Otolaryngol Head Neck Surg 2016; 154:892-7. [DOI: 10.1177/0194599816630971] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 01/15/2016] [Indexed: 11/16/2022]
Abstract
Objectives Micronized acellular dermis has been used for nearly 15 years to correct glottic insufficiency. With previous demonstration of safety and efficacy, this study aims to evaluate intermediate and long-term voice outcomes in those who underwent injection laryngoplasty for unilateral vocal fold paralysis. Technique and timing of injection were also reviewed to assess their impact on outcomes. Study Design Case series with chart review. Setting Tertiary care center. Subjects and Methods Patients undergoing injection laryngoplasty from May 2007 to September 2012 were reviewed for possible inclusion. Pre- and postoperative Voice Handicap Index (VHI) scores, as well as senior speech-language pathologists’ blinded assessment of voice, were collected for analysis. The final sample included patients who underwent injection laryngoplasty for unilateral vocal fold paralysis, 33 of whom had VHI results and 37 of whom had voice recordings. Additional data were obtained, including technique and timing of injection. Results Analysis was performed on those patients above with VHI and perceptual voice grades before and at least 6 months following injection. Mean VHI improved by 28.7 points at 6 to 12 months and 22.8 points at >12 months ( P = .001). Mean perceptual voice grades improved by 17.6 points at 6 to 12 months and 16.3 points at >12 months ( P < .001). No statistically significant difference was found with technique or time to injection. Conclusion Micronized acellular dermis is a safe injectable that improved both patient-completed voice ratings and blinded reviewer voice gradings at intermediate and long-term follow-up. Further investigation may be warranted regarding technique and timing of injection.
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Affiliation(s)
- Stephen C. Hernandez
- Department of Otolaryngology–Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Haley Sibley
- Department of Otolaryngology–Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Daniel S. Fink
- Department of Otolaryngology–Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
- Voice Center, Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, USA
| | - Melda Kunduk
- Department of Otolaryngology–Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
- Voice Center, Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, USA
- Department of Communication Sciences and Disorders, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Mell Schexnaildre
- Voice Center, Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, USA
| | | | - Andrew J. McWhorter
- Department of Otolaryngology–Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
- Voice Center, Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, USA
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Change to earlier surgical interventions: contemporary management of unilateral vocal fold paralysis. Curr Opin Otolaryngol Head Neck Surg 2016; 23:181-4. [PMID: 25943963 DOI: 10.1097/moo.0000000000000156] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The management of unilateral vocal fold paralysis has undergone significant changes in the last 2 decades. This has largely been made possible by advances in endoscope technology and new injectable materials. RECENT FINDINGS This article will cover the main changes in management of patients with unilateral vocal fold paralysis and summarize the recent literature in relation to early intervention in this group. Several recent studies have suggested that early vocal fold injection medialization reduces the likelihood of needing open laryngeal framework surgery in future. SUMMARY Early injection medialization appears to give good long-term results with few complications and minimizes the need for future laryngeal framework surgery. It should be considered in centres wherein the equipment and trained staff are available.
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89
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Nagai H, Nishiyama K, Seino Y, Tabata Y, Okamoto M. Evaluation of Autologous Fascia Implantation With Controlled Release of Fibroblast Growth Factor for Recurrent Laryngeal Nerve Paralysis Due to Long-term Denervation. Ann Otol Rhinol Laryngol 2016; 125:508-15. [DOI: 10.1177/0003489415625075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Paralyzed tissue due to long-term denervation is resistant to many treatments because it induces irreversible histological changes and disorders of deglutition or phonation. We sought to determine the effect of autologous transplantation of fascia into the vocal fold (ATFV) with controlled release of basic fibroblast growth factor (bFGF) on long-term unilateral vocal fold paralysis (UVFP). Methods: Unilateral recurrent laryngeal nerve (RLN) section was performed on 20 rats. Five rats were implanted with autologous fascia only (fascia group), and 10 rats were implanted with autologous fascia and a gelatin hydrogel sheet with 1 μg (1 μg bFGF + fascia group) or 0.1 μg (0.1 μg bFGF + fascia group) of bFGF 4 months after RLN section. We evaluated the normalized glottal gap and laryngeal volume and histological changes 3 months after implantation. Results: The normalized glottal gap was significantly reduced in the 3 fascia implantation groups. Normalized laryngeal volume, fat volume, and lateral thyroarytenoid muscle volume were significantly increased in the 2 fascia implantation with bFGF groups. Conclusions: The ATFV with controlled release of bFGF repaired the glottal gap and laryngeal volume after RLN section and may reduce the occurrence of aspiration and hoarseness. We speculate that this treatment improves laryngeal function in long-term RLN denervation.
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Affiliation(s)
- Hiromi Nagai
- Department of Otolaryngology, Yamato Municipal Hospital, Yamato City, Kanagawa, Japan
| | | | - Yutomo Seino
- Department of Otolaryngology Head-Neck Surgery, Kitasato University, Kanagawa, Japan
| | - Yasuhiko Tabata
- Kyoto University Institute for Frontier Medical Science, Kyoto, Japan
| | - Makito Okamoto
- Department of Otolaryngology Head-Neck Surgery, Kitasato University, Kanagawa, Japan
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90
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Yi KH, Lee EK, Kang HC, Koh Y, Kim SW, Kim IJ, Na DG, Nam KH, Park SY, Park JW, Bae SK, Baek SK, Baek JH, Lee BJ, Chung KW, Jung YS, Cheon GJ, Kim WB, Chung JH, Rho YS. 2016 Revised Korean Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Thyroid Cancer. ACTA ACUST UNITED AC 2016. [DOI: 10.11106/ijt.2016.9.2.59] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Ka Hee Yi
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Korea
| | - Eun Kyung Lee
- Department of Internal Medicine, Center for Thyroid Cancer, National Cancer Center, Korea
| | - Ho-Cheol Kang
- Department of Internal Medicine, Chonnam National University Medical School, Korea
| | - Yunwoo Koh
- Department of Otorhinolaryngology, College of Medicine, Yonsei University, Korea
| | - Sun Wook Kim
- Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - In Joo Kim
- Department of Internal Medicine, College of Medicine, Pusan National University, Korea
| | - Dong Gyu Na
- Department of Radiology, Human Medical Imaging and Intervention Center, Korea
| | - Kee-Hyun Nam
- Department of Surgery, College of Medicine, Yonsei University, Korea
| | - So Yeon Park
- Department of Pathology, Seoul National University College of Medicine, Korea
| | - Jin Woo Park
- Department of Surgery, College of Medicine, Chungbuk National University, Korea
| | - Sang Kyun Bae
- Department of Nuclear Medicine, Inje University College of Medicine, Korea
| | - Seung-Kuk Baek
- Department of Otorhinolaryngology, College of Medicine, Korea University, Korea
| | - Jung Hwan Baek
- Department of Radiology, University of Ulsan College of Medicine, Korea
| | - Byung-Joo Lee
- Department of Otorhinolaryngology, College of Medicine, Pusan National University, Korea
| | - Ki-Wook Chung
- Department of Surgery, University of Ulsan College of Medicine, Korea
| | - Yuh-Seog Jung
- Department of Otorhinolaryngology, Center for Thyroid Cancer, National Cancer Center, Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University College of Medicine, Korea
| | - Won Bae Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Korea
| | - Jae Hoon Chung
- Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Young-Soo Rho
- Department of Otorhinolaryngology, Hallym University College of Medicine, Korea
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Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016; 26:1-133. [PMID: 26462967 PMCID: PMC4739132 DOI: 10.1089/thy.2015.0020] [Citation(s) in RCA: 8617] [Impact Index Per Article: 1077.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the American Thyroid Association's (ATA's) guidelines for the management of these disorders were revised in 2009, significant scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid nodules and differentiated thyroid cancer. METHODS The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles on adults were eligible for inclusion. The American College of Physicians Guideline Grading System was used for critical appraisal of evidence and grading strength of recommendations for therapeutic interventions. We developed a similarly formatted system to appraise the quality of such studies and resultant recommendations. The guideline panel had complete editorial independence from the ATA. Competing interests of guideline task force members were regularly updated, managed, and communicated to the ATA and task force members. RESULTS The revised guidelines for the management of thyroid nodules include recommendations regarding initial evaluation, clinical and ultrasound criteria for fine-needle aspiration biopsy, interpretation of fine-needle aspiration biopsy results, use of molecular markers, and management of benign thyroid nodules. Recommendations regarding the initial management of thyroid cancer include those relating to screening for thyroid cancer, staging and risk assessment, surgical management, radioiodine remnant ablation and therapy, and thyrotropin suppression therapy using levothyroxine. Recommendations related to long-term management of differentiated thyroid cancer include those related to surveillance for recurrent disease using imaging and serum thyroglobulin, thyroid hormone therapy, management of recurrent and metastatic disease, consideration for clinical trials and targeted therapy, as well as directions for future research. CONCLUSIONS We have developed evidence-based recommendations to inform clinical decision-making in the management of thyroid nodules and differentiated thyroid cancer. They represent, in our opinion, contemporary optimal care for patients with these disorders.
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Affiliation(s)
| | - Erik K. Alexander
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Susan J. Mandel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Gregory W. Randolph
- Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anna M. Sawka
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Julie Ann Sosa
- Duke University School of Medicine, Durham, North Carolina
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92
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Sulica L, Mor N. In-Office Laryngeal Injection. CURRENT OTORHINOLARYNGOLOGY REPORTS 2015. [DOI: 10.1007/s40136-015-0100-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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93
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Reiter R, Pickhard A, Sander S, Brosch S. Prognostic Relevance of Mucosal Waves in Patients With Unilateral Vocal Fold Paralysis. Ann Otol Rhinol Laryngol 2015; 125:331-5. [PMID: 26530095 DOI: 10.1177/0003489415613801] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To analyze the prognostic relevance of mucosal waves (MWs) for recovery of unilateral vocal fold paralysis (UVP). METHODS The charts and stroboscopic examinations of 100 consecutive patients with a complete UVP were reviewed retrospectively. All had a minimal (estimated <3 mm) mucosal gap on stroboscopy. A positive or negative MW on the paralyzed vocal fold was associated with complete recovery to full adduction and abduction. All patients were followed for at least 12 months. RESULTS Causes of the paralysis were iatrogenic/traumatic (n = 82), malignancy associated (n = 10), and idiopathic (n = 8). In patients with positive MW at diagnosis (n = 80), the chance of recovery of unilateral vocal fold paralysis was 91.25%, whereas the chance of recovery with a negative mucosal wave (n = 20) was only 10%. CONCLUSION Positive MWs in stroboscopy are a predictor for recovery of (iatrogenic/traumatic) unilateral vocal fold paralysis and should be used in routine diagnostic assessment.
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Affiliation(s)
- Rudolf Reiter
- Section of Phoniatrics and Pedaudiology, Department of Otolaryngology, Head and Neck Surgery, University of Ulm, Ulm, Germany
| | - Anja Pickhard
- Department of Otolaryngology Head and Neck Surgery, Technical University, Munich, Germany
| | - Sylvia Sander
- Institute of Epidemiology and Medical Biometry, University of Ulm, Germany
| | - Sibylle Brosch
- Section of Phoniatrics and Pedaudiology, Department of Otolaryngology, Head and Neck Surgery, University of Ulm, Ulm, Germany
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94
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Fang TJ, Hsin LJ, Chung HF, Chiang HC, Li HY, Wong AMK, Pei YC. Office-Based Intracordal Hyaluronate Injections Improve Quality of Life in Thoracic-Surgery-Related Unilateral Vocal Fold Paralysis. Medicine (Baltimore) 2015; 94:e1787. [PMID: 26448034 PMCID: PMC4616733 DOI: 10.1097/md.0000000000001787] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Thoracic-surgery-related unilateral vocal fold paralysis (UVFP) may cause severe morbidity and can cause profound functional impairment and psychosocial stress in patients with pre-existing thoracic diseases. In-office intracordal hyaluronate (HA) injections have recently been applied to improve voice and quality of life in patients with vocal incompetence, but their effect on thoracic-surgery-related UVFP remains inconclusive. We therefore conducted a prospective study to clarify the effect of early HA injection on voice and quality of life in patients with thoracic-surgery-related UVFP. Patients with UVFP within 3 months after thoracic surgery who received office-based HA injection were recruited. Quantitative laryngeal electromyography, videolaryngostroboscopy, voice-related life quality (voice outcome survey), laboratory voice analysis, and health-related quality of life (SF-36) were evaluated at baseline, and at 1 month postinjection. A total of 104 consecutive patients accepted office-based HA intracordal injection during the study period, 34 of whom were treated in relation to thoracic surgery and were eligible for inclusion. Voice-related life quality, voice laboratory analysis, and most generic quality of life domains were significantly improved at 1 month after in-office HA intracordal injection. No HA-related complications were reported. Single office-based HA intracordal injection is a safe and effective treatment for thoracic-surgery-related UVFP, resulting in immediate improvements in patient quality of life, voice quality, and swallowing ability.
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Affiliation(s)
- Tuan-Jen Fang
- From the Department of Otolaryngology, Chang Gung Memorial Hospital, Taipei (T-JF, L-JH, H-FC, H-YL); School of Medicine, Chang Gung University, Taoyuan (T-JF, L-JH, H-YL, AMKW, Y-CP); Department of Management, Graduate School, Ming Chung University (H-CC); Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital (AMKW, Y-CP); Healthy Aging Research Center, Chang Gung University (Y-CP); and Center of Biomedical Engineering, Chang Gung University, Taipei, Taiwan, ROC (Y-CP)
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95
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Barbu AM, Gniady JP, Vivero RJ, Friedman AD, Burns JA. Bedside Injection Medialization Laryngoplasty in Immediate Postoperative Patients. Otolaryngol Head Neck Surg 2015; 153:1007-12. [DOI: 10.1177/0194599815601393] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 07/28/2015] [Indexed: 11/17/2022]
Abstract
Objectives The morbidity of glottic insufficiency resulting from unilateral vocal fold immobility may significantly compromise postoperative recovery in patients with decreased pulmonary reserve or inability to protect their airway. Injection medialization laryngoplasty is an effective means of treating glottic insufficiency due to unilateral vocal fold immobility. The purpose of this study is to present our experience with bedside transoral injection medialization laryngoplasty in the immediate postoperative period. Study Design Case series with chart review. Setting Academic tertiary care hospital. Subjects and Methods Patient demographics, clinical characteristics, procedural details, and short-term outcome measures of oral intake were recorded in a cohort of 68 patients over 5 years with unilateral vocal cord paralysis who underwent injection medialization as a bedside procedure in the immediate postoperative period. Results Mean time to injection was 8.2 days postoperatively. At the time of injection, 40 of 68 patients were nil per os. Seventy percent (28 of 40) had their diet advanced to adequate oral intake within 5 days of injection. Greater than half of the injections (36 of 68) were performed in the intensive care unit. No complications were noted, and all patients in this cohort were able to tolerate the bedside injection. Conclusion Bedside injection medialization laryngoplasty in the immediate postoperative period via the transoral approach can be performed in patients, even in the intensive care unit, while on anticoagulation, and may be of benefit for hospitalized patients with unilateral vocal fold immobility. Further studies quantifying improvement in voice and swallowing data are merited.
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Affiliation(s)
- Anca M. Barbu
- Department of Surgery–Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation–Massachusetts General Hospital, Boston, Massachusetts, USA
| | - John P. Gniady
- Department of Surgery–Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation–Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Richard J. Vivero
- Department of Surgery–Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation–Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Aaron D. Friedman
- NorthShore University HealthSystem Department of Surgery, Evanston, Illinois, USA
| | - James A. Burns
- Department of Surgery–Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation–Massachusetts General Hospital, Boston, Massachusetts, USA
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96
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Early voice rehabilitation with injection laryngoplasty in patients with unilateral vocal cord palsy after thyroidectomy. Eur Arch Otorhinolaryngol 2015; 272:3745-50. [DOI: 10.1007/s00405-015-3720-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 07/06/2015] [Indexed: 10/23/2022]
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97
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Francis DO, Williamson K, Hovis K, Gelbard A, Merati AL, Penson DF, Netterville JL, Garrett CG. Effect of injection augmentation on need for framework surgery in unilateral vocal fold paralysis. Laryngoscope 2015; 126:128-34. [PMID: 26153268 DOI: 10.1002/lary.25431] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 05/11/2015] [Accepted: 05/18/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine whether injection augmentation reduces the likelihood of ultimately needing definitive framework surgery in unilateral vocal fold paralysis (UVFP) patients. STUDY DESIGN Retrospective cohort study. METHODS All patients diagnosed with UVFP (2008-2012) at the academic center were identified. The time from symptom onset to presentation to either community otolaryngologist and/or academic center, as well as any directed treatment(s), were recorded. Stepwise, multivariate logistic regression analysis was used to determine whether injection augmentation independently affected odds of needing definitive, framework surgery among patients who were seen within 9 months of symptom onset and had not undergone any prior rehabilitative procedures. RESULTS Cohort consisted of 633 patients (55% female, 80% Caucasian, median age 60 years) with UVFP. The majority of etiologies were either surgery (48%) or idiopathic (37%). Duration to presentation at community otolaryngologist was shorter than to the academic center (median 2 vs. 6 months). Overall, less than half of UVFP patients had any operation (46%). Multivariate logistic regression found that earlier injection augmentation did not affect odds of ultimately undergoing framework surgery (odds ratio 1.13; confidence interval, 0.92-1.40; P = 0.23). CONCLUSION Nearly half of UVFP patients do not require any rehabilitative procedure. When indicated, early injection augmentation is effective at temporarily alleviating associated symptoms but does not reduce likelihood of needing a definitive framework operation in patients with UVFP. Understanding practice patterns and fostering early detection and treatment may improve quality of life in this patient population.
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Affiliation(s)
- David O Francis
- Department of Otolaryngology, Vanderbilt Voice Center, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.,Center for Surgical Quality and Outcomes Research, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Kelly Williamson
- Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Kristen Hovis
- Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Alexander Gelbard
- Department of Otolaryngology, Vanderbilt Voice Center, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Albert L Merati
- Division of Laryngology, Department of Otolaryngology-Head & Neck Surgery, University of Washington, Seattle, Washington, U.S.A
| | - David F Penson
- Center for Surgical Quality and Outcomes Research, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.,Department of Urological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.,Geriatric Research Education and Clinical Center, Veterans Administration Tennessee Valley Healthcare System, Nashville, Tennessee, U.S.A
| | - James L Netterville
- Department of Otolaryngology, Vanderbilt Voice Center, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - C Gaelyn Garrett
- Department of Otolaryngology, Vanderbilt Voice Center, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
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98
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Mattioli F, Menichetti M, Bergamini G, Molteni G, Alberici M, Luppi M, Nizzoli F, Presutti L. Results of Early Versus Intermediate or Delayed Voice Therapy in Patients With Unilateral Vocal Fold Paralysis: Our Experience in 171 Patients. J Voice 2015; 29:455-8. [DOI: 10.1016/j.jvoice.2014.09.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 09/25/2014] [Indexed: 10/24/2022]
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99
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Li S, Shen N, Cheng Y, Sha Y, Wang Z. The effect of jugular bulb-vestibular aqueduct dehiscence on hearing and balance. Acta Otolaryngol 2015; 135:1103-7. [PMID: 26113169 DOI: 10.3109/00016489.2015.1062141] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION This study suggests that jugular bulb-vestibular aqueduct dehiscence (JBVAD) does not affect the hearing or balance functions of the inner ear. OBJECTIVES Since JBVAD may cause impairment of the inner ear and induce hearing loss, tinnitus, and vertigo, this study was to investigate the effect of JBVAD on hearing and balance. METHOD Patients undergoing temporal bone computed tomography (TBCT) scans from May 2013 to December 2013 at a tertiary referral hospital were reviewed. The topographic relationship between the jugular bulb (JB) and the vestibular aqueduct was assessed. The findings were classified as normal when there was always a bony structure between the two structures and as dehiscent when the bony coverage separating the two structures was absent. Clinical data were collected via electronic records and clinical follow-up. RESULTS A total of 1313 out of 8325 patients were diagnosed with a HJB. Forty-six patients showed JBVAD. The prevalence of dehiscence was 0.6% in patients undergoing temporal bone CT scans and 3.5% in patients with HJB. Of the 46 patients with JBVAD, 23 (50%) had sensorineural hearing loss, three (6.5%) had tinnitus, and two (4.3%) had vertigo. The correlation between JBVAD and these clinical symptoms did not achieve statistical significance.
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Affiliation(s)
- Shufeng Li
- a 1 Department of Otolaryngology, Eye & ENT Hospital of Fudan University , Shanghai, PR China
- b 2 Key Laboratory of Hearing Medicine of National Health and Family Planning Commission , Shanghai, PR China
| | - Na Shen
- a 1 Department of Otolaryngology, Eye & ENT Hospital of Fudan University , Shanghai, PR China
- b 2 Key Laboratory of Hearing Medicine of National Health and Family Planning Commission , Shanghai, PR China
| | - Yushu Cheng
- c 3 Department of Radiology, Eye & ENT Hospital of Fudan University , Shanghai, PR China
| | - Yan Sha
- c 3 Department of Radiology, Eye & ENT Hospital of Fudan University , Shanghai, PR China
| | - Zhengmin Wang
- a 1 Department of Otolaryngology, Eye & ENT Hospital of Fudan University , Shanghai, PR China
- b 2 Key Laboratory of Hearing Medicine of National Health and Family Planning Commission , Shanghai, PR China
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100
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Bear ZW, McEvoy TP, Mikulec AA. Quantification of hearing loss in patients with posterior semicircular canal dehiscence. Acta Otolaryngol 2015; 135:974-7. [PMID: 26107020 DOI: 10.3109/00016489.2015.1060630] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Patients with posterior semicircular canal dehiscence (PSCD) have low frequency conductive hearing loss similar to patients with superior semicircular canal dehiscence (SSCD) secondary to a pathologic third window. OBJECTIVES PSCD can result in conductive hearing loss, but the magnitude of this hearing loss remains to be quantified. Patients with SSCD have been shown to have low frequency conductive hearing loss. The underlying pathophysiology of hearing loss from PSCD and SSCD is similar and related to a pathologic third window. METHOD A PubMed search was completed for a meta-analysis of patients with PSCD. Articles with quality audiograms were obtained. Air conduction thresholds for ears with posterior semicircular canal dehiscence were compared to the opposite ear as well as normal control data. RESULTS Eight articles with 21 patients with PSCD and quality audiograms were included. Two patients had bilateral PSCD and one of those was excluded because hearing thresholds were at the limit of the audiometer. Patients with posterior semicircular canal dehiscence have statistically significant lower air conduction thresholds in frequencies at and below 2000 Hz.
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Affiliation(s)
- Zachary W Bear
- Saint Louis University School of Medicine , Saint Louis, MO , USA
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