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Fan R‘S, Yiu Y, Kulesz PA, Dueppen A, Procter T, Goodwin ME, Thekdi AA, Joshi A. Clinical Voice Outcomes for Two Voice Rest Protocols after Phonomicrosurgery. Laryngoscope 2024; 134:2812-2818. [PMID: 38217412 PMCID: PMC11078619 DOI: 10.1002/lary.31250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 12/04/2023] [Accepted: 12/18/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVES Voice rest is commonly recommended for patients with benign vocal fold lesions (BVFLs) after phonomicrosurgery. The study compares the clinical voice outcomes of two protocols, 7-day complete voice rest (CVR) and 3-day CVR followed by 4-day relative voice rest (CVR + RVR), for patients with BVFLs after phonomicrosurgery. STUDY DESIGN Prospective, randomized controlled trial. METHOD Patients with BVFLs undergoing phonomicrosurgery were recruited prospectively and randomly assigned to either protocol. Outcomes were assessed on objective measures of acoustics (fundamental frequency, frequency range, mean intensity, cepstral peak analysis) and aerodynamics (vital capacity, airflow rate, subglottal pressure, phonation threshold pressure), as well as subjective measures, both provider-reported through the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V), and patient-reported through the Voice Handicap Index (VHI). Clinical measures were collected at three-time points: preoperatively, 1-week postoperatively (on voice rest), and 1-month postoperatively. In addition, adherence was estimated using a vocal dosimeter. RESULTS Twenty-five patients were recruited and randomized to 7-day CVR (n = 13) and CVR + RVR regimen (n = 12). Statistically significant changes were found within both groups for subglottal pressure (p = 0.03) and VHI score (p < 0.001) comparing pre-operative baseline to 1-month postoperative follow-up. There were no statistically significant differences between the groups. Regardless of group assignment, a significant decrease in overall severity ratings for the CAPE-V was found by comparing the preoperative scores to postoperative scores at 1-week (p < 0.001) and 1-month (p < 0.001). CONCLUSION Both groups improved their overall voice quality comparably 1 month after undergoing phonomicrosurgery as measured by objective and subjective parameters. LEVELS OF EVIDENCE 2. Laryngoscope, 134:2812-2818, 2024.
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Affiliation(s)
| | - Yin Yiu
- Texas Voice Center, Houston Methodist Department of Otolaryngology-Head & Neck Surgery, Houston, Texas
| | - Paulina A Kulesz
- Department of Psychology, Texas Institute for Measurement, Evaluation, and Statistics, University of Houston, Houston, Texas
| | - Abigail Dueppen
- Dept. of Communication Sciences and Disorders, University of Houston, Houston, Texas
- Texas Voice Center, Houston Methodist Department of Otolaryngology-Head & Neck Surgery, Houston, Texas
| | - Teresa Procter
- Texas Voice Center, Houston Methodist Department of Otolaryngology-Head & Neck Surgery, Houston, Texas
| | - Maurice E. Goodwin
- Texas Voice Center, Houston Methodist Department of Otolaryngology-Head & Neck Surgery, Houston, Texas
| | - Apurva A Thekdi
- Texas Voice Center, Houston Methodist Department of Otolaryngology-Head & Neck Surgery, Houston, Texas
| | - Ashwini Joshi
- Dept. of Communication Sciences and Disorders, University of Houston, Houston, Texas
- Texas Voice Center, Houston Methodist Department of Otolaryngology-Head & Neck Surgery, Houston, Texas
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Övünç O, Yiğit Ö, Sünter AV, Huq GE. Vocal Fold Submucosal Mesna Injection and Microflap Elevation in a Rabbit Model. J Voice 2024; 38:47-52. [PMID: 34404583 DOI: 10.1016/j.jvoice.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/29/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Mesna triggers chemical dissection in tissues by breaking down disulfide bonds and is used during surgical dissections in several areas. In this study, we aimed to investigate the effect of submucosal mesna infiltration on microflap elevation and the histopathological findings of its effects on the vocal fold lamina propria in a rabbit model. METHODS Eight adult male New Zealand white rabbits were used in the study. Each vocal fold was randomized, and 0.1 mL of mesna was injected into one-fold and 0.1 mL of saline to the contralateral fold. An incision was made on the epithelium and elevation was performed. The animals were sacrificed after two weeks, and the vocal folds were excised. Inflammatory response, fibrosis, and epithelial thickness were evaluated with hematoxylin eosin and Masson's Trichrome staining. Elevation time and histopathological features were compared between the two groups. RESULTS The elevation time (20.9 ± 1.6 second) in the saline group was significantly higher (P < 0.05) than in the mesna group (15.0 ± 3.4 second). The inflammation (1.3 ± 0.5 vs. 1.1 ± 1.0, respectively) and fibrosis scores (1.0 ± 0.8 vs. 0.8 ± 0.7, respectively) did not differ significantly (P > 0.05 in both). Epithelial thickness (12.5 ± 4.7 vs. 10.3 ± 5.3, respectively) did not differ significantly (P ˃ 0.05) in the mesna and saline groups either. CONCLUSION We determined that mesna facilitates the microflap elevation of the vocal folds in rabbits and does not damage the histological structure of vocal folds. This study encourages future studies to evaluate the use of mesna, now actively used across disciplines, in phonosurgery as well.
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Affiliation(s)
- Okan Övünç
- Istanbul Training and Research Hospital, Ear Nose Throat Department, University of Health Sciences, Istanbul, Turkey.
| | - Özgür Yiğit
- Istanbul Training and Research Hospital, Ear Nose Throat Department, University of Health Sciences, Istanbul, Turkey
| | - Ahmet Volkan Sünter
- Istanbul Training and Research Hospital, Ear Nose Throat Department, University of Health Sciences, Istanbul, Turkey
| | - Gülben Erdem Huq
- Istanbul Training and Research Hospital, Pathology Department, University of Health Sciences, Istanbul, Turkey
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Swift WM, Churnin IT, Hamdi OA, Strumpf AM, Koehn HA, Cottler PS, Daniero JJ. A Simple and Reproducible In Vivo Rabbit Phonation Model for Glottic Insufficiency. Otolaryngol Head Neck Surg 2023; 168:203-209. [PMID: 35763368 DOI: 10.1177/01945998221107813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/27/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of this study is to describe an in vivo rabbit phonation model for glottic insufficiency that is simple and reproducible by means of unilateral transcricothyroid laryngeal muscle stimulation and high-speed video recordings of evoked phonation. STUDY DESIGN Nonrandomized controlled animal trial. SETTING Academic medical center. METHODS A single operation including evoked phonation with bilateral and unilateral transcricothyroid laryngeal muscle stimulation conditions was modeled using 6 New Zealand white rabbits. The effect of stimulation method on glottic cycle, pitch, and loudness was compared. Endoscopic recordings using 5000 frames-per-second image capture technology and audiologic recordings were obtained for all phonation conditions. Primary outcome measures included means of maximum glottal area (MGA)/length pixel ratio, right and left amplitude/length pixel ratios, calculated cycle frequency, auditory recorded frequency, and maximum auditory intensity. Measurements were obtained via pixel counts using ImageJ. RESULTS Mean MGA/length was significantly greater with unilateral, 20.30, vs bilateral, 9.62, stimulation (P = .043). Mean frequency of 479.92 Hz vs 683.46 Hz (P = .027) and mean maximum intensity of 76.3 dB vs 83.5 dB (P = .013) were significantly increased from unilateral to bilateral stimulation. There was no significant difference in mean right amplitude/length between unilateral and bilateral. CONCLUSION The described model demonstrates a simple and reproducible means of producing glottic insufficiency due to unilateral vocal fold bowing and represents a pathway for better understanding the biomechanics and pathophysiology of glottic insufficiency due to superior laryngeal nerve injury and vocal fold immobility and offers the potential to compare treatment modalities through in vivo study.
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Affiliation(s)
- William M Swift
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California, USA
| | - Ian T Churnin
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Osama A Hamdi
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Andrew M Strumpf
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Heather A Koehn
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia, Augusta, Georgia, USA
| | - Patrick S Cottler
- Department of Plastic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - James J Daniero
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
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Sayce L, Zimmerman Z, Gartling G, Rousseau B, Branski RC. Epithelial response to vocal fold microflap injury in a preclinical model. Laryngoscope 2023; 133:350-356. [PMID: 35538915 PMCID: PMC11066888 DOI: 10.1002/lary.30169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/01/2022] [Accepted: 04/05/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Functional outcomes following microflap surgery for vocal fold pathology are favorable. Although the stratified squamous epithelium appears to heal rapidly, persistent physiologic tissue alterations are likely. We sought to elucidate key biochemical processes including recruitment of immune cells, regulation of cellular junction proteins, and long-term alterations to epithelial tissue permeability following microflap with an eye toward enhanced clinical outcomes. METHODS Forty New Zealand rabbits were assigned to eight groups (n = 5/group): no-injury control or bilateral microflap with survival for 0 h, 12 h, 1 day, 3 days, 7 days, 30 days, and 60 days post-microflap. The epithelium was dissected from one vocal fold and transepithelial resistance was quantified. The contralateral fold was subjected to transmission electron microscopy. Images were evaluated by a blinded rater and paracellular space dilation was quantified using ImageJ. Immune cell infiltration was evaluated and recorded qualitatively. RESULTS Increased innate immune response was observed 12 h as well as 7 and 30 days after microflap. At 60 days following injury, decreased epithelial resistance was observed. Paracellular spaces were dilated at all time-points following injury. CONCLUSIONS The vocal fold epithelium was significantly altered at 60 days following microflap. The implications for this tissue phenotype are unclear. However, compromised epithelial barrier function is implicated in various diseases and may increase the risk of subsequent injury. LEVEL OF EVIDENCE NA Laryngoscope, 133:350-356, 2023.
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Affiliation(s)
- Lea Sayce
- Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Zachary Zimmerman
- Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Gary Gartling
- Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
- Rehabilitation Medicine, NYU Grossman School of Medicine, New York, U.S.A
| | - Bernard Rousseau
- Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Ryan C Branski
- Rehabilitation Medicine, NYU Grossman School of Medicine, New York, U.S.A
- Otolaryngology-Head and Neck Surgery, NYU Grossman School of Medicine, New York, U.S.A
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King RE, Novaleski CK, Rousseau B. Voice Handicap Index Changes After Microflap Surgery for Benign Vocal Fold Lesions Are Not Associated With Recommended Absolute Voice Rest Duration. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:912-922. [PMID: 35179998 PMCID: PMC9150674 DOI: 10.1044/2021_ajslp-21-00115] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/27/2021] [Accepted: 11/14/2021] [Indexed: 06/01/2023]
Abstract
PURPOSE Voice rest is frequently prescribed after phonosurgery, but optimal type and duration for voice outcomes have not been demonstrated. Studies to date have been characterized by heterogeneity in surgical procedures and laryngeal diagnoses. We sought to analyze the effect of recommended absolute voice rest duration on outcomes of microflap surgery for benign vocal fold lesions. A secondary purpose was to identify patient factors associated with postoperative voice outcomes. METHOD Forty-three patients were included in this retrospective review of patients aged 18 years and above who underwent direct microlaryngoscopy with microflap for vocal fold polyp or cyst over a 5-year period at a multidisciplinary voice center. Duration of recommended postoperative absolute voice rest was classified as less than 7 days, 7 days, and more than 7 days. Demographic and vocal hygiene data and voice treatment history were collected. Outcome measures consisted of one pre- and two postoperative Voice Handicap Index (VHI) scores. Effects of recommended voice rest on outcomes were analyzed using mixed models for repeated measures. Effects of patient factors on outcomes were analyzed as exploratory measures. Stroboscopy ratings were analyzed descriptively. RESULTS Thirteen patients were recommended 7 days of absolute voice rest, 15 were recommended less than 7 days, and 15 were recommended more than 7 days. Postoperatively, VHI scores significantly improved for all patients. Voice rest as a continuous variable was associated with the Functional subscale score in the short term, but there was no effect on VHI total score and no longer term effect of voice rest on any outcome. Age, sex, and preoperative voice therapy were associated with at least one VHI subscale score on at least one time point. CONCLUSION VHI outcomes of microflap surgery for polyps and cysts do not differ by duration of recommended absolute postoperative voice rest. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.19178459.
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Affiliation(s)
- Renee E. King
- Department of Surgery, University of Wisconsin–Madison
- Department of Communication Sciences and Disorders, University of Wisconsin–Madison
- Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, TN
| | - Carolyn K. Novaleski
- Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, TN
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing
| | - Bernard Rousseau
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN
- Department of Communication Sciences and Disorders, University of Pittsburgh, PA
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Cohen JT, Fridman E, Trushin V, Benyamini L, Duek I, Shinnawi S, Keshet Y, Cohen A, Paker M. The role of voice rest after micro-laryngeal surgery for benign vocal fold lesions. Eur Arch Otorhinolaryngol 2021; 279:835-842. [PMID: 34773168 DOI: 10.1007/s00405-021-07114-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 09/29/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare post-operative vocal outcomes of a voice rest regimen versus no voice restrictions following micro-laryngeal surgery for benign glottic lesions. METHODS This was a combined prospective and retrospective cohort study on 167 patients who underwent micro-laryngeal surgery for benign focal fold lesion removal. Participants were divided into two regimens: standard voice rest (n = 92) or no voice restriction (n = 75). The primary outcome was post-operative vocal improvement, evaluated using voice handicap index questionnaire (VHI-10), GRBAS scale, and computerised acoustic analysis (shimmer, jitter, and the harmonic-to-noise ratio). The secondary outcome was emergence of vocal fold mucosal abnormalities in the immediate post-operative period. Parameters were collected at baseline and at the last clinical visit. RESULTS There was no statistically significant difference between the voice rest and no-voice rest groups regarding baseline parameters of age, gender, laryngeal pathology, and voice use. Improvement in GRBAS scale values and VHI-10 scores between pre- and post-operative periods between groups did not demonstrate any statistically significant differences (P = 0.5303 and P = 0.1457, respectively). Similarly, the results of computerized voice analysis also showed no differences between groups in terms of shimmer (P = 0.9590), jitter (P = 0.5692), and harmonic-to-noise ratio (P = 0.1871). No correlation was found between the post-operative vocal fold's mucosal abnormalities and the type of voice rest regimen. CONCLUSION Voice quality and wound healing were similar regardless of the type of voice rest regimen applied. No voice rest at all was as good as voice rest after micro-laryngeal surgery.
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Affiliation(s)
- Jacob T Cohen
- Department of Otolaryngology Head and Neck Surgery, Rambam Health Care Campus, Rambam Medical Centre, The Technion, Israel Institute of Technology, 6 Ha'Aliya Street, POB 9602, 31096, Haifa, Israel.
| | - Eran Fridman
- Department of Otolaryngology Head and Neck Surgery, Rambam Health Care Campus, Rambam Medical Centre, The Technion, Israel Institute of Technology, 6 Ha'Aliya Street, POB 9602, 31096, Haifa, Israel
| | - Vladimir Trushin
- Department of Otolaryngology Head and Neck Surgery, Barzilai Medical Centre, Ashkelon, Israel
| | - Limor Benyamini
- Department of Otolaryngology Head and Neck Surgery, Sheba Medical Centre, Tel-Hashomer, Israel
| | - Irit Duek
- Department of Otolaryngology Head and Neck Surgery, Sourasky Medical Centre, Tel Aviv, Israel
| | - Shadi Shinnawi
- Department of Otolaryngology Head and Neck Surgery, Rambam Health Care Campus, Rambam Medical Centre, The Technion, Israel Institute of Technology, 6 Ha'Aliya Street, POB 9602, 31096, Haifa, Israel
| | - Yosi Keshet
- Department of Computer Science, Bar-Ilan University, Ramat-Gan, Israel
| | - Alma Cohen
- Berglas School of Economics, Tel Aviv University, Tel Aviv, Israel
| | - Miki Paker
- Department of Otolaryngology Head and Neck Surgery, Ha'Emek Medical Center, Afula, Israel
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Lin RJ, Iakovlev V, Streutker C, Lee D, Al-Ali M, Anderson J. Blue Light Laser Results in Less Vocal Fold Scarring Compared to KTP Laser in Normal Rat Vocal Folds. Laryngoscope 2021; 131:853-858. [PMID: 32750168 DOI: 10.1002/lary.28892] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Preliminary investigations suggest that a novel blue light (BL) laser with a wavelength of 445 nm is comparable to the commonly utilized potassium titanyl phosphate (KTP) laser (532 nm) for treatment of various laryngeal pathologies. The objective of the current study is to make a direct histological comparison of the degree of vocal fold scarring after either BL or KTP laser treatment in an animal model. STUDY DESIGN This was a randomized controlled study using rats. METHODS Twenty-four Sprague-Dawley rats were randomized to BL or KTP laser treatment. Laser was delivered in non-overlapping pulses to normal rat vocal folds. Larynges in each group were harvested at three time points: post-operative day 1, 30, and 90. Three animals served as negative controls. The excised whole larynges were sectioned transversely and stained with hematoxylin/eosin and trichrome. Presence of subepithelial inflammation and protein deposition/fibrosis indicative of scarring were scored semi-quantitatively (from grade 1-3) by two pathologists blinded to treatment groups. RESULTS Between-group comparison showed that both laser treatments resulted in significantly elevated subepithelial protein deposition/fibrosis 90 days after treatment compared to negative controls (BL: 2 ± 0; KTP: 2.67 ± 0.29; control: 1.17 ± 0.29; P < .05). However, the degree of protein deposition/fibrosis was significantly higher in the KTP group compared to the BL group (P = .016). Within-group comparison showed that the KTP group showed evidence of fibrosis as early as 30 days after treatment, which was not observed in the BL group. CONCLUSIONS The current study suggests that the degree of scarring is significantly less after BL laser treatment compared to KTP in normal rat vocal fold tissue. LEVEL OF EVIDENCE NA Laryngoscope, 131:853-858, 2021.
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Affiliation(s)
- R Jun Lin
- Department of Otolaryngology-Head & Neck Surgery, Laryngology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Vladimir Iakovlev
- Department of Laboratory Medicine & Pathobiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Catherine Streutker
- Department of Laboratory Medicine & Pathobiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Lee
- Department of Otolaryngology-Head & Neck Surgery, Laryngology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Mohammed Al-Ali
- Department of Otolaryngology-Head & Neck Surgery, Laryngology, Sheikh Khalifa Medical City, Abu Dhabi, UAE
| | - Jennifer Anderson
- Department of Otolaryngology-Head & Neck Surgery, Laryngology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Bailey TW, Dos Santos AP, do Nascimento NC, Xie S, Thimmapuram J, Sivasankar MP, Cox A. RNA sequencing identifies transcriptional changes in the rabbit larynx in response to low humidity challenge. BMC Genomics 2020; 21:888. [PMID: 33308144 PMCID: PMC7733274 DOI: 10.1186/s12864-020-07301-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 12/04/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Voice disorders are a worldwide problem impacting human health, particularly for occupational voice users. Avoidance of surface dehydration is commonly prescribed as a protective factor against the development of dysphonia. The available literature inconclusively supports this practice and a biological mechanism for how surface dehydration of the laryngeal tissue affects voice has not been described. In this study, we used an in vivo male New Zealand white rabbit model to elucidate biological changes based on gene expression within the vocal folds from surface dehydration. Surface dehydration was induced by exposure to low humidity air (18.6% + 4.3%) for 8 h. Exposure to moderate humidity (43.0% + 4.3%) served as the control condition. Ilumina-based RNA sequencing was performed and used for transcriptome analysis with validation by RT-qPCR. RESULTS There were 103 statistically significant differentially expressed genes identified through Cuffdiff with 61 genes meeting significance by both false discovery rate and fold change. Functional annotation enrichment and predicted protein interaction mapping showed enrichment of various loci, including cellular stress and inflammatory response, ciliary function, and keratinocyte development. Eight genes were selected for RT-qPCR validation. Matrix metalloproteinase 12 (MMP12) and macrophage cationic peptide 1 (MCP1) were significantly upregulated and an epithelial chloride channel protein (ECCP) was significantly downregulated after surface dehydration by RNA-Seq and RT-qPCR. Suprabasin (SPBN) and zinc activated cationic channel (ZACN) were marginally, but non-significantly down- and upregulated as evidenced by RT-qPCR, respectively. CONCLUSIONS The data together support the notion that surface dehydration induces physiological changes in the vocal folds and justifies targeted analysis to further explore the underlying biology of compensatory fluid/ion flux and inflammatory mediators in response to airway surface dehydration.
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Affiliation(s)
- Taylor W Bailey
- Department of Comparative Pathobiology, Purdue University, West Lafayette, IN, 47907, USA.,Department of Public Health, Purdue University, West Lafayette, IN, 47907, USA
| | | | | | - Shaojun Xie
- Bioinformatics Core, Purdue University, West Lafayette, Indiana, 47907, USA
| | - Jyothi Thimmapuram
- Bioinformatics Core, Purdue University, West Lafayette, Indiana, 47907, USA
| | - M Preeti Sivasankar
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN, 47907, USA
| | - Abigail Cox
- Department of Comparative Pathobiology, Purdue University, West Lafayette, IN, 47907, USA.
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Combining Voice Rest and Steroids to Improve Diagnostic Clarity in Phonotraumatic Vocal Fold Injury. J Voice 2020; 36:403-409. [PMID: 32654865 DOI: 10.1016/j.jvoice.2020.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/02/2020] [Accepted: 06/04/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVES (1) To describe a combination voice rest and steroid regimen to clarify ambiguous diagnoses in singers who present with phonotraumatic lesions and (2) to determine which videostroboscopic parameters show the most consistent response to this regimen. STUDY DESIGN Chart review. METHODS Singers with phonotraumatic vocal fold lesions seen at a tertiary care voice center over a 10-year period were identified. Those who had uncertain diagnoses on initial presentation, completed a combination regimen including voice rest and steroids, and had follow-up examinations were included in the analysis. The effect of this combination regimen was assessed by ratings of pre- and postregimen videostroboscopy examinations and by auditory perceptual ratings. Whether the combination regimen clarified the diagnosis was noted. RESULTS Twenty-nine singers were prescribed the combination regimen with the intent to clarify the diagnosis. In 79% (23/29) of these singers, the regimen helped clarify diagnosis, for example, ruling in or ruling out specific lesions, confirming areas of scar, or distinguishing acute from chronic phonotraumatic injury. Stroboscopic exams were improved in 86% (25/29). The most common stroboscopic finding was a reduction in the lesion size (66%). Auditory perceptual ratings improved in 48% (14/29) of patients. CONCLUSIONS A "cool down" combination of voice rest and steroids can improve diagnostic clarity in a subset of singers with phonotraumatic lesions. This combination regimen can be considered, with both the side effect profile of steroids and possible financial ramifications of strict voice rest in mind, when the initial diagnosis is unclear.
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Effects of diode laser setting for laryngeal surgery in a rabbit model. Eur Arch Otorhinolaryngol 2019; 276:1431-1438. [DOI: 10.1007/s00405-019-05344-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 02/12/2019] [Indexed: 10/27/2022]
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Rousseau B, Kojima T, Novaleski CK, Kimball EE, Valenzuela CV, Mizuta M, Daniero JJ, Garrett CG, Sivasankar MP. Recovery of Vocal Fold Epithelium after Acute Phonotrauma. Cells Tissues Organs 2017; 204:93-104. [PMID: 28647731 PMCID: PMC5555600 DOI: 10.1159/000472251] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2017] [Indexed: 12/26/2022] Open
Abstract
We investigated the timeline of tissue repair of vocal fold epithelium after acute vibration exposure using an in vivo rabbit model. Sixty-five New Zealand white breeder rabbits were randomized to 120 min of modal- or raised-intensity phonation. After the larynges were harvested at 0, 4, 8, and 24 h, and at 3 and 7 days, the vocal fold tissue was evaluated using electron microscopy and quantitative real-time polymerase chain reaction. There was an immediate decrease in the microprojection depth and height following raised-intensity phonation, paired with upregulation of cyclooxygenase-2. This initial 24-h period was also characterized by the significant downregulation of junction proteins. Interleukin 1β and transforming growth factor β1 were upregulated for 3 and 7 days, respectively, followed by an increase in epithelial cell surface depth at 3 and 7 days. These data appear to demonstrate a shift from inflammatory response to the initiation of a restorative process in the vocal fold epithelium between 24 h and 3 days. Despite the initial damage from raised-intensity phonation, the vocal fold epithelium demonstrates a remarkable capacity for the expeditious recovery of structural changes from transient episodes of acute phonotrauma. While structurally intact, the return of functional barrier integrity may be delayed by repeated episodes of phonotrauma and may also play an important role in the pathophysiology of vocal fold lesions.
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Affiliation(s)
- Bernard Rousseau
- Department of Otolaryngology, Vanderbilt University School of Medicine, 1215 21 Avenue South, Nashville, TN 37232, USA**
- Department of Hearing and Speech Sciences, Vanderbilt University School of Medicine, 1215 21 Avenue South, Nashville, TN 37232, USA
| | - Tsuyoshi Kojima
- Department of Otolaryngology, Vanderbilt University School of Medicine, 1215 21 Avenue South, Nashville, TN 37232, USA**
| | - Carolyn K. Novaleski
- Department of Hearing and Speech Sciences, Vanderbilt University School of Medicine, 1215 21 Avenue South, Nashville, TN 37232, USA
| | - Emily E. Kimball
- Department of Hearing and Speech Sciences, Vanderbilt University School of Medicine, 1215 21 Avenue South, Nashville, TN 37232, USA
| | - Carla V. Valenzuela
- Department of Otolaryngology, Vanderbilt University School of Medicine, 1215 21 Avenue South, Nashville, TN 37232, USA**
| | - Masanobu Mizuta
- Department of Otolaryngology, Vanderbilt University School of Medicine, 1215 21 Avenue South, Nashville, TN 37232, USA**
| | - James J. Daniero
- Department of Otolaryngology, Vanderbilt University School of Medicine, 1215 21 Avenue South, Nashville, TN 37232, USA**
| | - C. Gaelyn Garrett
- Department of Otolaryngology, Vanderbilt University School of Medicine, 1215 21 Avenue South, Nashville, TN 37232, USA**
| | - M. Preeti Sivasankar
- Department of Speech, Language, and Hearing Sciences, Purdue University, 500 Oval Drive, Heavilon Hall, West Lafayette, IN 47907, USA
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Mizuta M, Kurita T, Kimball EE, Rousseau B. Structurally and functionally characterized in vitro model of rabbit vocal fold epithelium. Tissue Cell 2017; 49:427-434. [PMID: 28395914 PMCID: PMC5467526 DOI: 10.1016/j.tice.2017.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 03/15/2017] [Accepted: 03/16/2017] [Indexed: 12/19/2022]
Abstract
In this paper, we describe a method for primary culture of a well differentiated electrically tight rabbit vocal fold epithelial cell multilayer and the measurement of transepithelial electrical resistance (TEER) for the evaluation of epithelial barrier function in vitro. Rabbit larynges were harvested and enzymatically treated to isolate vocal fold epithelial cells and to establish primary culture. Vocal fold epithelial cells were co-cultured with mitomycin C-treated feeder cells on collagen-coated plates. After 10-14 days in primary culture, cells were passaged and cultured until they achieved 70-90% confluence on collagen-coated plates. Epithelial cells were then passaged onto collagen-coated cell culture inserts using 4.5cm2 membrane filters (1.0μm pore size) with 10% fetal bovine serum or 30μg/mL bovine pituitary extract to investigate the effects of growth-promoting additives on TEER. Additional experiments were performed to investigate optimal seeding density (1.1, 2.2, 4.4, or 8.9×105 cells/cm2), the effect of co-culture with feeder cells, and the effect of passage number on epithelial barrier function. Characterization of in vitro cultures was performed using hematoxylin and eosin staining and immunostaining for vocal fold epithelial cell markers and tight junctions. Results revealed higher TEER in cells supplemented with fetal bovine serum compared to bovine pituitary extract. TEER was highest in cells passaged at a seeding density of 2.2×104 cells/cm2, and TEER was higher in cells at passage two than passage three. Ultrastructural experiments revealed a well-differentiated epithelial cell multilayer, expressing the epithelial cell markers CK13, CK14 and the tight junction proteins occludin and ZO-1.
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Affiliation(s)
- Masanobu Mizuta
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawaharacho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Takashi Kurita
- Department of Otolaryngology, Vanderbilt University Medical Center, 1215 21st Avenue South, Medical Center East, Nashville, TN 37232, USA
| | - Emily E Kimball
- Department of Hearing and Speech Sciences, Vanderbilt University School of Medicine, 1215 21st Avenue South, Medical Center East, Nashville, TN 37232, USA
| | - Bernard Rousseau
- Department of Otolaryngology, Vanderbilt University Medical Center, and Hearing and Speech Sciences and Mechanical Engineering, Vanderbilt University School of Medicine, Medical Center East, 1215 21st Avenue South, Nashville, TN 37232, USA.
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Abstract
Basic science research is part of the circle of translational research that provides the scientific underpinning for evidence-based practice. The translation from bench to bedside, however, is sometimes not obvious. This short review seeks to demonstrate ways in which basic science can inform our clinical practice as voice therapists. From in vitro molecular and cellular studies to in vivo animal models, basic science can investigate biological mechanisms of vocal health, such as vocal fold hydration, and voice use, such as voice rest and vocal exercise, in ways that are impossible in human clinical studies. Knowledge of these mechanisms inform and guide our clinical investigations and help provide evidence for behavioral voice therapy.
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Affiliation(s)
- Aaron M. Johnson
- Department of Speech and Hearing Science, University of Illinois at Urbana-Champaign
Champaign, IL
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Kojima T, Mitchell JR, Garrett CG, Rousseau B. Recovery of vibratory function after vocal fold microflap in a rabbit model. Laryngoscope 2013; 124:481-6. [PMID: 23901003 DOI: 10.1002/lary.24324] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/19/2013] [Accepted: 07/03/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS The purpose of this study was to evaluate the return of vibratory function and restoration of vibration amplitude and symmetry after vocal fold microflap surgery. STUDY DESIGN Prospective in vivo animal model. METHODS Microflap surgery was performed on 30 New Zealand white breeder rabbits. The left vocal fold received a 3-mm epithelial incision and mucosal elevation, while the contralateral vocal fold was left intact to serve as an internal control. Quantitative analysis of amplitude ratio and lateral phase difference were measured using high-speed laryngeal imaging at a frame rate of 10,000 frames per second from animals undergoing evoked phonation on postoperative days 0, 1, 3, 5, and 7. RESULTS Quantitative measures revealed a significantly reduced amplitude ratio and lateral phase difference on day 0 after microflap. These impairments of vibratory function on day 0 were associated with separation of the vocal fold's body-cover layer. Amplitude ratio increased significantly by day 3 after microflap, with further increases in vibration amplitude on days 5 and 7. While the amplitude ratio improved significantly on day 3, lateral phase difference decreased significantly on day 3, and returned to normal on days 5 and 7. CONCLUSIONS High-speed laryngeal imaging was used to investigate the natural time course of postmicroflap recovery of vibratory function. Results revealed the restoration of vibration amplitude and lateral phase difference by days 3 to 7 after microflap. The time period of improved vibratory function observed in this study coincides with the end of the well-documented inflammatory phase of vocal fold wound repair. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Tsuyoshi Kojima
- Department of Otolaryngology, Vanderbilt Bill Wilkerson Center, Vanderbilt University School of Medicine, Nashville, Tennessee, U.S.A
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