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Onifade A, Vincent E, Tolley N. Systematic review and meta-analysis of laryngeal reinnervation techniques in adults with unilateral and bilateral vocal fold palsies. J Laryngol Otol 2023:1-15. [PMID: 37982255 DOI: 10.1017/s0022215123001950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
OBJECTIVE To evaluate the outcomes of reinnervation techniques for the treatment of adult unilateral vocal fold paralysis and bilateral vocal fold paralysis. METHODS A literature review was conducted in the Embase and Medline databases in English, with no limitations on the publication date. The outcome parameters of interest included visual, subjective perceptual, acoustic, aerodynamic analysis and electromyography. A meta-analysis with a random-effects model and inverse variance was calculated. RESULTS The systematic Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach resulted in 27 studies, totalling 803 patients (747 unilateral cases and 56 bilateral cases). Thyroid cancer and/or surgery had caused unilateral vocal fold paralysis in 74.8 per cent of cases and bilateral vocal fold paralysis in 69.6 per cent of cases. Statistically significant improvements in patients were observed for voice, deglutition and decannulation (bilateral vocal fold paralysis). Meta-analysis of 10 reinnervation techniques was calculated for the maximum phonation time of 184 patients. CONCLUSION Reinnervation was shown to improve voice, swallowing and decannulation, but studies lacked control groups, limiting generalisability. Larger studies with controls are needed.
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Watanabe K, Hirano A, Kobayashi Y, Sato T, Honkura Y, Katori Y. Long-term voice evaluation after arytenoid adduction surgery in patients with unilateral vocal fold paralysis. Eur Arch Otorhinolaryngol 2023; 280:5011-5017. [PMID: 37584751 PMCID: PMC10756884 DOI: 10.1007/s00405-023-08165-9] [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: 07/14/2023] [Accepted: 07/28/2023] [Indexed: 08/17/2023]
Abstract
PURPOSE Laryngeal framework surgery, including medialization laryngoplasty and arytenoid adduction (AA), is expected to have a lasting or permanent effect in patients with unilateral vocal fold paralysis (UVFP); however, there are few reports about the long-term outcomes of AA. This study aimed to evaluate the long-term postoperative effects of AA surgery and examine its stability and reliability. METHODS This study collected the voice handicap index (VHI) questionnaire from patients with UVFP who underwent AA more than 2 years previously. The VHI values preoperatively and 3 months postoperatively (early postoperative evaluation) were retrospectively calculated, and VHI values more than 2 years after surgery (late postoperative evaluation) were collected by mailing a sheet to the patients and asking to fill and return it. Possible influenced subscales such as age, sex, causes of UVFP, affected side, and surgeons were also analyzed. RESULTS A total of 77 patients with UVFP who underwent AA had significantly lower early and late postoperative evaluations than preoperative evaluations. In 38 patients with no missing values, there were no significant differences between early and late postoperative evaluations, measured at a median of approximately 5 years. There were also no significant differences between early and late postoperative evaluations in any of the subscale groups. CONCLUSION Patients with UVFP who underwent AA surgery achieved stable voice improvement in the long term after surgery.
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Affiliation(s)
- Kenichi Watanabe
- Department of Otolaryngology, Tohoku Rosai Hospital, 4-3-21 Dainohara, Aoba-ku, Sendai, Miyagi, 981-8563, Japan.
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
| | - Ai Hirano
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Yuta Kobayashi
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Takeshi Sato
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Yohei Honkura
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Yukio Katori
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
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Nishimoto K, Yumoto E, Sanuki T, Kodama N, Kuraoka K, Miyamoto T, Miyamaru S, Orita Y. Effect of Aging on Vocal Outcomes After Laryngeal Reinnervation Combined With Arytenoid Adduction. J Voice 2023:S0892-1997(23)00282-5. [PMID: 37833111 DOI: 10.1016/j.jvoice.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 10/15/2023]
Abstract
OBJECTIVE To evaluate the impact of aging on vocal function following laryngeal reinnervation combined with arytenoid adduction (AA) in the treatment of paralytic dysphonia. METHODS Sixty-eight patients with unilateral vocal fold paralysis who underwent refined nerve-muscle pedicle flap (NMP) implantation and AA were classified into four groups according to age: under 50 years (-50), in their 50s, 60s, and 70 years and older (70+). These groups consisted of 15, 14, 22, and 17 patients, respectively. Their vocal function was followed periodically for 24 months after surgery. RESULTS Vocal function in all groups showed significant improvement after surgery. Significant improvements in vocal function were observed during a 24-month follow-up period: maximum phonation time in the -50 and 50 seconds groups; pitch range and voice handicap index-10 in the -50, 50s, and 60s groups; "Grade" in the -50, 50s, and 70+ groups; and "Breathiness" and voice-related quality of life in all groups. There were no significant differences in vocal function among the four groups, except for pitch range, at the 24-month postoperative assessment. CONCLUSIONS Although the younger groups tended to exhibit better vocal function compared to the older groups 24 months postoperatively, the refined NMP+AA proved effective in the treatment of breathy dysphonia resulting from unilateral vocal fold paralysis, not only in the younger population but also in the older population.
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Affiliation(s)
- Kohei Nishimoto
- Department of Otolaryngology-Head and Neck Surgery, Kumamoto University Graduate School of Medicine, Kumamoto, Japan.
| | - Eiji Yumoto
- Department of Otolaryngology, Asahino General Hospital, Kumamoto, Japan
| | - Tetsuji Sanuki
- Department of Otolaryngology-Head and Neck Surgery, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Narihiro Kodama
- Department of Speech-Language pathology and Audiology, Faculty of Rehabilitation, Kawasaki University of Medical Welfare, Okayama, Japan
| | - Kaoruko Kuraoka
- Department of Otolaryngology-Head and Neck Surgery, Kumamoto University Graduate School of Medicine, Kumamoto, Japan
| | - Takumi Miyamoto
- Department of Otolaryngology-Head and Neck Surgery, Kumamoto University Graduate School of Medicine, Kumamoto, Japan
| | - Satoru Miyamaru
- Department of Otolaryngology-Head and Neck Surgery, Kumamoto University Graduate School of Medicine, Kumamoto, Japan
| | - Yorihisa Orita
- Department of Otolaryngology-Head and Neck Surgery, Kumamoto University Graduate School of Medicine, Kumamoto, Japan
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Kodama N, Yumoto E, Sanuki T. Effect of Voice Therapy as a Supplement After Reinnervation Surgery for Breathy Dysphonia Due to Unilateral Vocal Fold Paralysis. J Voice 2022:S0892-1997(22)00149-7. [PMID: 35760630 DOI: 10.1016/j.jvoice.2022.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To evaluate whether vocal function exercises (VFE) could be an adjunct treatment for patients with unilateral vocal fold paralysis (UVFP) who were not satisfied with their postoperative voices after reinnervation surgeries. STUDY DESIGN Retrospective. METHODS Medical records of the patients with UVFP who underwent laryngeal reinnervation between October 2011 and October 2014 were reviewed. Patients were classified into two groups: one received VFE according to patients' desire (VFE group) and the other did not have voice therapy (control group). Effects of VFE were assessed by vocal fold vibration (regularity, amplitude and glottal gap), aerodynamic measurements (maximum phonation time (MPT) and mean airflow rate (MFR)), GRBAS scale, acoustic parameters (pitch range, pitch perturbation and amplitude perturbation quotients (PPQ, APQ), and noise-to-harmonics ratio (NHR)) and subjective evaluation by patients (Voice Handicap Index-10 (VHI-10)). Phonatory function was also compared between the two groups at three time points: before reinnervation surgery, before VFE, and after VFE. RESULTS Thirty patients were enrolled (11 men, 19 women). The VFE group included eight patients, and 22 patients served as controls. In the VFE group, several parameters (amplitude, MPT, MFR, pitch range, APQ, and NHR) did not improve significantly after surgery, while all parameters examined improved significantly in the control group. After VFE, amplitude, glottal gap, MFR, B score, pitch range, and PPQ showed significant improvement, while the control group did not show a significant improvement except in VHI-10, during the corresponding period. Significant differences in G and B scores and VHI-10 between the two groups were observed at the third time point. CONCLUSIONS VFE may be used as an adjunct treatment for patients with UVFP who are not satisfied with their voices after reinnervation surgery. However, phonatory function after VFE may not reach the same level as for those who are satisfied with their voices after reinnervation surgery.
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Affiliation(s)
- Narihiro Kodama
- Department of Rehabilitation Kumamoto Health Science University, Kumamoto, Japan.
| | - Eiji Yumoto
- Department of Otolaryngology, Asahino General Hospital, Kumamoto, Japan
| | - Tetsuji Sanuki
- Department of Otolaryngology-Head and Neck Surgery, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
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Müller A. Active and Passive Bioimplants for Vocal Fold Paralysis. Laryngorhinootologie 2022; 101:S144-S159. [PMID: 35605617 DOI: 10.1055/a-1708-2881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Vocal fold paralysis is one of the diseases that particularly affect quality of life. While unilateral paralysis leads to glottis closure insufficiency and hoarseness, bilateral paralysis compromises respiration and limits the exercise tolerance. Bioimplants have been used to treat persistent paralysis for over 100 years. The spectrum ranges from autologous tissue transfer and resorbable or permanent injection materials to composite thyroplasty implants and active electrical implants for neurostimulation of the larynx. If bioimplants are used in accordance with the recommendations, the quality of life of affected patients can be significantly improved today.
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Nagai H, Nishiyama K, Seino Y, Tabata Y, Yamashita T. Effect of Fascia Implantation and Controlled Release of Basic Fibroblast Growth Factor for Muscle Atrophy in Rat Laryngeal Paralysis. Otolaryngol Head Neck Surg 2021; 167:319-326. [PMID: 34665680 DOI: 10.1177/01945998211052895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To improve lateral thyroarytenoid (TA) muscle atrophy after laryngeal paralysis, reconstruction of the vascular network of the atrophied muscle is necessary. We therefore evaluated whether the controlled release of basic fibroblast growth factor (bFGF) with autologous fascia implantation could affect vascular reconstruction in the lateral TA muscle. STUDY DESIGN Animal experiment. SETTING Laboratory. METHODS Unilateral laryngeal paralysis was induced in 20 rats. The rats were implanted with autologous fascia and a gelatin hydrogel sheet with or without 1 µg of bFGF (fascia and bFGF + fascia groups; n = 5 each) and with only a gelatin hydrogel sheet with bFGF (bFGF group: n = 5). Another group remained untreated (n = 5) at 4 months after paralysis. At 3 months since transplantation, intra- and intergroup comparisons of the muscle volumes and total area of blood vessels in the lateral TA muscle were performed. RESULTS When compared with the untreated group, the bFGF + fascia group showed a significant increase in muscle volume (P =.0008) and vascular area (P =.0002) in the lateral TA muscle, whereas the other 2 treated groups demonstrated an insufficient effect. CONCLUSION bFGF + fascia implantation showed histologic improvement in severe laryngeal paralysis. We demonstrated that the decrease in lateral TA muscle mass after paralysis might be countered by the reconstruction of the vascular network. Our findings indicate that hypovascular and denervated areas of the laryngeal muscle can be regenerated by the implantation of growth factors and scaffolds with surgical stress. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Hiromi Nagai
- Department of Otolaryngology, Yamato Municipal Hospital, Kanagawa, Japan
| | | | - Yutomo Seino
- Department of Otolaryngology-Head and Neck Surgery, Kitasato University, Kanagawa, Japan
| | - Yasuhiko Tabata
- Department of Regeneration Science and Engineering Lab of Biomaterials, Kyoto University, Kyoto, Japan
| | - Taku Yamashita
- Department of Otolaryngology-Head and Neck Surgery, Kitasato University, Kanagawa, Japan
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Dual laryngeal reinnervation in bilateral vocal fold paralysis: anatomical pitfalls. Surg Radiol Anat 2021; 43:1745-1751. [PMID: 34453198 DOI: 10.1007/s00276-021-02698-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 01/23/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Bilateral laryngeal reinnervation can be a promising procedure for reanimation of laryngeal muscles, but currently not yet standardized. Besides patient conditions some intraoperative anatomical pitfalls need to be solved. METHODS Twelve human head and neck specimens (24 sides) have been studied using microdissection and histological serial sections of the nerves. The surgical anatomy of the dual reinnervation procedure according to JP Marie was investigated notably the branching pattern of the phrenic nerve (PN), the Ansa cervicalis (AC) and the recurrent laryngeal nerve (RLN). RESULTS Despite variations of the AC, a prominent inferior common trunk for sterno-hyoid and sterno-thyroid muscles can be used in more than 90% of the specimens. If the AC is missing because of previous surgery, the tiny nerve of the thyro-hyoid muscle can be used preferred. The PN display a double roots pattern from C3 to C4 cervical plexus in 50% of the specimens. A single root pattern can be found and an end-to-lateral neurorraphy can be used. Intra-laryngeal nerves pattern of the RLN display tiny collaterals which cannot be selected for abduction-adduction activity. Direct implantation of the Y-shape great auricular nerve within the posterior crico-arytenoid muscles can be a reliable method leading to challenging mechanical and functional conditions. CONCLUSION Several anatomical pitfalls, including intra-operative choices and variants of the donor nerves, but also the challenging intra-laryngeal dissection of the inferior laryngeal nerve need to be solved. A successful laryngeal reinnervation still needs further studies for a simplified procedure.
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Miyamaru S, Murakami D, Nishimoto K, Kodama N, Tashiro J, Miyamoto Y, Saito H, Takeda H, Ise M, Orita Y. Optimal Management of the Unilateral Recurrent Laryngeal Nerve Involvement in Patients with Thyroid Cancer. Cancers (Basel) 2021; 13:cancers13092129. [PMID: 33925053 PMCID: PMC8125658 DOI: 10.3390/cancers13092129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 12/04/2022] Open
Abstract
Simple Summary Recurrent laryngeal nerve (RLN) is the second most common structure invaded by primary or metastatic thyroid cancer. However, little is known about the optimal procedure for maintaining vocal function in patients with unilateral RLN involvement in thyroid cancer. This study aimed to evaluate various parameters of vocal function to establish the optimal management of thyroid cancer patients with unilateral RLN involvement. Based on our findings, we propose that for optimal management of unilateral RLN involvement in thyroid cancer, first, sharp dissection should be performed, and if this is impossible, a simultaneous RLN reconstruction procedure should be adopted whenever possible. These findings may help improve management of RLN involvement in patients with thyroid cancer and ensure vocal function preservation. Abstract We aimed to determine the optimal management of recurrent laryngeal nerve (RLN) involvement in thyroid cancer. We enrolled 80 patients with unilateral RLN involvement in thyroid cancer between 2000 and 2016. Eleven patients with preoperatively functional vocal folds (VFs) underwent sharp tumor resection to preserve the RLN (shaving group). Thirty-three patients underwent RLN reconstruction with RLN resection (reconstruction group). We divided the reconstruction group into two subgroups based on preoperative VF mobility (normal-reconstruction and paralyzed-reconstruction subgroups). In the cases where RLN reconstruction was difficult, phonosurgeries including arytenoid adduction (AA), with or without thyroplasty type I, or nerve muscle pedicle implantation with AA were performed later (phonosurgery group). We evaluated and compared vocal function among the evaluated periods and different groups. Postoperative vocal function in the shaving and normal-reconstruction subgroups was favorable. There were no significant differences between the two groups. In the paralyzed-reconstruction and phonosurgery groups, postoperative vocal function was significantly improved, and vocal function in the paralyzed-reconstruction subgroup was significantly better than that in the phonosurgery group. For optimal management of unilateral RLN involvement in thyroid cancer, first, sharp dissection should be performed, and if this is impossible, a simultaneous RLN reconstruction procedure should be adopted whenever possible.
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Affiliation(s)
- Satoru Miyamaru
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kumamoto University, Kumamoto 860-8555, Japan; (D.M.); (K.N.); (J.T.); (Y.M.); (H.S.); (H.T.); (M.I.); (Y.O.)
- Correspondence: ; Tel.: +81-96-373-5255
| | - Daizo Murakami
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kumamoto University, Kumamoto 860-8555, Japan; (D.M.); (K.N.); (J.T.); (Y.M.); (H.S.); (H.T.); (M.I.); (Y.O.)
| | - Kohei Nishimoto
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kumamoto University, Kumamoto 860-8555, Japan; (D.M.); (K.N.); (J.T.); (Y.M.); (H.S.); (H.T.); (M.I.); (Y.O.)
| | - Narihiro Kodama
- Department of Rehabilitation, Kumamoto Health Science University, Kumamoto 860-8556, Japan;
| | - Joji Tashiro
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kumamoto University, Kumamoto 860-8555, Japan; (D.M.); (K.N.); (J.T.); (Y.M.); (H.S.); (H.T.); (M.I.); (Y.O.)
| | - Yusuke Miyamoto
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kumamoto University, Kumamoto 860-8555, Japan; (D.M.); (K.N.); (J.T.); (Y.M.); (H.S.); (H.T.); (M.I.); (Y.O.)
| | - Haruki Saito
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kumamoto University, Kumamoto 860-8555, Japan; (D.M.); (K.N.); (J.T.); (Y.M.); (H.S.); (H.T.); (M.I.); (Y.O.)
| | - Hiroki Takeda
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kumamoto University, Kumamoto 860-8555, Japan; (D.M.); (K.N.); (J.T.); (Y.M.); (H.S.); (H.T.); (M.I.); (Y.O.)
| | - Momoko Ise
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kumamoto University, Kumamoto 860-8555, Japan; (D.M.); (K.N.); (J.T.); (Y.M.); (H.S.); (H.T.); (M.I.); (Y.O.)
| | - Yorihisa Orita
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kumamoto University, Kumamoto 860-8555, Japan; (D.M.); (K.N.); (J.T.); (Y.M.); (H.S.); (H.T.); (M.I.); (Y.O.)
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Yumoto E, Sanuki T, Kumai Y, Kodama N. Modified Isshiki's arytenoid adduction without separating cricothyroid and cricoarytenoid joints. ACTA ACUST UNITED AC 2020; 40:99-105. [PMID: 32469003 PMCID: PMC7256903 DOI: 10.14639/0392-100x-n0183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 09/08/2019] [Indexed: 11/23/2022]
Affiliation(s)
- Eiji Yumoto
- Department of Otolaryngology, Asahino General Hospital 12-10, Murozono-cho, Kita-ku, Kumamoto, Japan.,Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kumamoto University 1-1-1, Honjo, Chuo-ku, Kumamoto, Japan
| | - Tetsuji Sanuki
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine Nagoya City University 1, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan
| | - Yoshihiko Kumai
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kumamoto University 1-1-1, Honjo, Chuo-ku, Kumamoto, Japan
| | - Narihiro Kodama
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kumamoto University 1-1-1, Honjo, Chuo-ku, Kumamoto, Japan.,Department of Rehabilitation, Kumamoto Health Science University 325, Izumi-cho, Kita-ku, Kumamoto, Japan
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10
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Umeno H, Hyodo M, Haji T, Hara H, Imaizumi M, Ishige M, Kumada M, Makiyama K, Nishizawa N, Saito K, Shiromoto O, Suehiro A, Takahashi G, Tateya I, Tsunoda K, Shiotani A, Omori K. A summary of the Clinical Practice Guideline for the Diagnosis and Management of Voice Disorders, 2018 in Japan. Auris Nasus Larynx 2020; 47:7-17. [DOI: 10.1016/j.anl.2019.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/29/2019] [Accepted: 09/06/2019] [Indexed: 12/01/2022]
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Bakhsh Z, Crevier-Buchman L. Stroboscopic assessment of unilateral vocal fold paralysis: a systematic review. Eur Arch Otorhinolaryngol 2019; 276:2377-2387. [PMID: 31350599 DOI: 10.1007/s00405-019-05562-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/12/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To review the relevant basic stroboscopic evaluations in unilateral vocal fold paralysis (UVFP). Our aim was twofold: (1) to determine the frequency of use of stroboscopic parameters in outcome evaluation after surgical treatment of UVFP using a Pareto diagram; and (2) to select the most relevant parameters in terms of a significant difference between pre- and post-surgical intervention for UVFP. METHODS A systematic review in PUBMED includes studies on stroboscopic evaluation in combination with UVFP and surgical treatment. The review was limited to English studies published between 1990 and March 2018. The most frequently used stroboscopic parameters were identified using a Pareto diagram. Then, 'the percentage of significance' for the most frequently stroboscopic parameters was identified by comparing the number of studies that showed a statistically significant change in pre- and post-treatment results with the total number of studies using the same parameters. RESULTS Seven stroboscopic parameters were nominated using the Pareto diagram. In decreasing order of citation frequency, periodicity, edge bowing, mucosal wave, glottic gap, position of vocal fold, amplitude, and symmetry have respective percentages of significance of 87.5%, 83.3%, 77.7%, 64.5%, 60%, 57.1%, and 50%. Five pertinent scales were selected for the most frequent and significant stroboscopic parameters. CONCLUSIONS The results indicate that periodicity, edge bowing, mucosal wave, glottic gap, and position of vocal fold represent the five most frequently used and relevant stroboscopic parameters in UVFP evaluation. The current review outlines a proposal scale of these stroboscopic parameters. PROSPERO REGISTRATION NUMBER CRD42019126786.
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Affiliation(s)
- Zainab Bakhsh
- Department of Otolaryngology, Head and Neck Surgery, University of Paris 12, Paris, France.
| | - Lise Crevier-Buchman
- Department of Otolaryngology, Head and Neck Surgery, Foch Hospital, Paris, France
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12
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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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13
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Bonilha HS, Desjardins M, Garand KL, Martin-Harris B. Parameters and Scales Used to Assess and Report Findings From Stroboscopy: A Systematic Review. J Voice 2017; 32:734-755. [PMID: 29103609 DOI: 10.1016/j.jvoice.2017.09.018] [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: 06/27/2017] [Revised: 09/19/2017] [Accepted: 09/20/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Laryngeal endoscopy with stroboscopy, a critical component of the assessment of voice disorders, is rarely used as a treatment outcome measure in the scientific literature. We hypothesized that this is because of the lack of a widely used standardized, validated, and reliable method to assess and report laryngeal anatomy and physiology, and undertook a systematic literature review to determine the extent of the inconsistencies of the parameters and scales used in voice treatment outcome studies. STUDY DESIGN Systematic literature review. METHODS We searched PubMed, Ovid, and Cochrane for studies where laryngeal endoscopy with stroboscopy was used as a treatment outcome measure with search terms representing "stroboscopy" and "treatment" guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards. RESULTS In the 62 included articles, we identified 141 terms representing 49 different parameters, which were further classified into 20 broad categories. The six most common parameters were magnitude of glottal gap, mucosal wave amplitude, location or shape of glottal gap, regularity of vibration, phase symmetry, and presence and size of specific lesions. Parameters were assessed on scales ranging from binary to 100 points. The number of scales used for each parameter varied from 1 to 24, with an average of four different scales per parameter. CONCLUSIONS There is a lack of agreement in the scientific literature regarding which parameters should be assessed to measure voice treatment outcomes and which terms and scales should be used for each parameter. This greatly diminishes comparison and clinical implementation of the results of treatment outcomes research in voice disorders. We highlight a previously published tool and recommend it for future use in research and clinical settings.
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Affiliation(s)
- Heather Shaw Bonilha
- Department of Health Science and Research, Medical University of South Carolina, Charleston, South Carolina; Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Maude Desjardins
- Department of Health Science and Research, Medical University of South Carolina, Charleston, South Carolina
| | - Kendrea L Garand
- Department of Health Science and Research, Medical University of South Carolina, Charleston, South Carolina; Department of Speech Pathology and Audiology, University of South Alabama, Mobile, Alabama
| | - Bonnie Martin-Harris
- Department of Health Science and Research, Medical University of South Carolina, Charleston, South Carolina; Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina; Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois.
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Shilenkova VV. [On the problem of voice rehabilitation in the case of unilateral vocal fold paresis]. Vestn Otorinolaringol 2016; 81:67-72. [PMID: 27876742 DOI: 10.17116/otorino201681567-72] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Unilateral vocal fold paresis (UVFP) significantly deteriorates the patient's quality of life. The leading role in the rehabilitation of the patients presenting with UVFP belongs to stimulation therapy which consists in the activation of muscle re-innervation of the larynx and the compensatory mechanisms allowing to achieve the most complete closure of the vocal folds during phonation. AIM The objective of the present study was the optimization of the conservative treatment of patients with UVFP. MATERIAL AND METHODS Fifty patients at the age varying from 18 to 70 years presenting with UVFP (the duration of the disease less than 6 months underwent the comprehensive treatment including electrostimulation of the larynx, vitamin therapy, and speech therapy. The patients were divided into two groups: A and B comprised of 25 subjects each. Those of Group A were given, in addition to the standard treatment, a 1.5 month-long course of Neuromidin therapy. The results of the treatment were evaluated with the use of laryngostroboscopy, flowmetry, the GRBAS scale, acoustic voice analysis (lingWaves), and the VHI questionnaire. RESULTS The restoration of vocal fold mobility was achieved in 20% and 8% of the patients of groups A and B respectively. The clinical effect was absent in 12% of the patients in Group A and 28% of the patients in Group B. The differences between groups were statistically significant (p<0.05). In the remaining cases, the positive dynamics of the flowmetric characteristics, GRBAS and VHI data, maximum phonation time, Jitter, DSI, frequency and dynamic ranges as well as the intensity of voice were documented in 68% of patients in Group A and 64% of patients in Group B). CONCLUSION The results of the study confirm the usefulness of the combined treatment of UVFP consisting of electrostimulation of the larynx together with speech therapy and application of cholinergic drugs. The addition of Neuromidin to the conventional scheme of conservative treatment can further improve its efficiency from 72% to 88%.
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Affiliation(s)
- V V Shilenkova
- Yaroslavl State Medical University, Yaroslavl, Russia, 150000
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15
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Kodama N, Kumai Y, Sanuki T, Yumoto E. Arytenoid adduction combined with nerve-muscle pedicle flap implantation or type I thyroplasty. Laryngoscope 2016; 127:159-166. [PMID: 27112111 DOI: 10.1002/lary.26032] [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: 11/21/2015] [Revised: 02/11/2016] [Accepted: 03/21/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate vocal function after refined nerve-muscle pedicle (NMP) flap implantation with arytenoid adduction (AA) compared with type I thyroplasty with AA for patients with unilateral vocal fold paralysis (UVFP) and to evaluate the degree of patient satisfaction following the refined NMP with AA. STUDY DESIGN A retrospective review of clinical records of 52 patients with UVFP who received AA + NMP (NMP group, n = 40) or AA + type I thyroplasty (type I group, n = 12) as a single-stage operation between April 1999 and December 2011. METHODS Evaluation of vocal fold vibration, aerodynamic analysis, perceptual evaluation, acoustic analysis, and subjective assessment were performed preoperatively and at two different postoperative periods (short term: within 3 months and long term: >12 months). RESULTS All parameters except for glottal gap of the vocal fold vibration, maximum phonation time (MPT), and mean airflow rate revealed significant improvement between the short- and long-term assessments in the NMP group. On the contrary, the type I group did not show significant change of any parameters during postoperative periods. In the NMP group, the measurements for regularity of the vocal fold vibration and MPT at the long-term assessment were significantly favorable compared with the type I group. In the NMP group, subjective assessment (Voice Handicap Index-10 and Voice-Related Quality of Life) revealed significant improvement between the short- and long-term assessments. CONCLUSIONS In comparison with the type I group, significant improvement of vocal function patient satisfaction during the long-term follow-up period after AA combined with the refined NMP was confirmed. LEVEL OF EVIDENCE 4. Laryngoscope, 127:159-166, 2017.
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Affiliation(s)
- Narihiro Kodama
- Department of Otolaryngology-Head and Neck Surgery, Kumamoto University Graduate School of Medicine, Kumamoto, Japan
| | - Yoshihiko Kumai
- Department of Otolaryngology-Head and Neck Surgery, Kumamoto University Graduate School of Medicine, Kumamoto, Japan
| | - Tetsuji Sanuki
- Department of Otolaryngology-Head and Neck Surgery, Kumamoto University Graduate School of Medicine, Kumamoto, Japan
| | - Eiji Yumoto
- Department of Otolaryngology-Head and Neck Surgery, Kumamoto University Graduate School of Medicine, Kumamoto, Japan
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