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Lu YT, Tseng WH, Chiu HL, Yang TL. Improvement in swallowing safety after injection laryngoplasty in patients with unilateral vocal paralysis complicated with aspiration. J Formos Med Assoc 2024; 123:179-187. [PMID: 37517935 DOI: 10.1016/j.jfma.2023.07.012] [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: 03/13/2023] [Revised: 06/22/2023] [Accepted: 07/18/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND The benefit of injection laryngoplasty (IL) on voice for unilateral vocal fold paralysis (UVFP) is supported increasingly in literatures, yet less is known for swallowing. Also, prevalence of patient-reported dysphagia is substantially higher than instrumental studies. This prospective study focused on swallowing outcomes, with predetermined flexible endoscopic evaluation of swallowing (FEES) protocol that simulates daily life situation. METHODS Adult patients with UVFP and aspiration receiving IL were recruited. Voice outcome measurements, as well as swallowing outcomes including Eating Assessment Tool (EAT-10) and FEES, which challenged patients with different fluid volumes: 10 mL, 20 mL, and 90 mL cup sipping were evaluated. RESULTS Significant improvements were demonstrated in all voice outcomes. Significant changes were also presented inEAT-10 (P < 0.01). Pre-operatively, penetration-aspiration scale (PAS) was 1.5 ± 1.3, 1.9 ± 1.7 and 2.3 ± 1.8 for 10 mL, 20 mL and 90 mL serial sipping, and improved to 1.1 ± 0.3, 1.1 ± 0.4 and 1.4 ± 0.7 post-operatively (P < 0.01). Safe swallowing (PAS ≤ 2) was achieved in all, except for one patient, who presented with a post-injection PAS of 4 (material enters the airway, contacts the vocal folds, and is ejected from the airway) on 90 mL cup sipping, whose pre-injection PAS was 7 (residue in trachea). CONCLUSION Maintaining swallowing function suitable for social environment is important. Our results demonstrated the feasibility of the predetermined FEES protocol, and positive effects of IL on both voice and swallowing outcomes.
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Affiliation(s)
- Yu-Tung Lu
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wen-Hsuan Tseng
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Hsiang-Ling Chiu
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tsung-Lin Yang
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Research Center for Developmental Biology and Regenerative Medicine, National Taiwan University, Taipei, Taiwan
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Bhatta S, Gandhi S, Ghanpur AD, Ganesuni D. Etiology and presenting features of vocal cord paralysis: changing trends over the last two decades. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2022. [DOI: 10.1186/s43163-022-00322-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Background
The study was performed to evaluate the changing trends in etiology and presenting features of vocal cord paralysis (VCP) from March 1998 to March 2020.
Methods
Patient’s record collected from hospital database and divided into two groups, from March 1998 to March 2009 and from April 2009 to March 2020, to evaluate the changing trends in etiology and presenting features.
Results
Total of 711 VCP patients, 80.3% with unilateral (UVCP) and 19.7% with bilateral vocal cord paralysis (BVCP) included. The commonest etiology was non-surgical (57.1%) for UVCP and surgical (55.7%) for BVCP. The commonest surgical etiology was thyroid and parathyroid surgery for both UVCP (16.6%) and BVCP (38.5%). The commonest non-surgical etiology was idiopathic for UVCP (23.1%) and malignancies for BVCP (13.6%). There was increase in surgical etiology for both UVCP (39.3 to 45.3%) and BVCP (51.2 to 57.7%), and decrease in non-surgical etiology for both UVCP (60.7 to 54.6%) and BVCP (48.8 to 42.3%). The change in voice was most common presenting features for both UVCP (69.2%) and BVCP (92.8%). The frequency of the presenting features was comparable, with decrease in the duration of symptom onset over the time period.
Conclusion
The most common etiology for UVCP was idiopathic, and for BVCP was thyroid and parathyroid surgery. For both, UVCP and BVCP there was increasing trend for surgical and decreasing trend for non-surgical etiology. The change in voice was the most common presenting complain, with decrease in duration of symptom onset over time period.
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Liao LJ, Wang CT. Management of Unilateral Vocal Fold Paralysis after Thyroid Surgery with Injection Laryngoplasty: State of Art Review. Front Surg 2022; 9:876228. [PMID: 35465431 PMCID: PMC9019717 DOI: 10.3389/fsurg.2022.876228] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Unilateral vocal fold paralysis (UVFP) after thyroid surgery often leads to significant morbidity including dysphonia, dysphagia, and aspiration. Injection laryngoplasty (IL) is an effective treatment of UVFP with numerous readily available materials. However, few studies focus on IL for UVFP following thyroidectomy. Objectives This review aims to critically review current literature to determine the timing, materials, methods and outcomes of IL for UVFP after thyroid surgery. Type of Review Literature review. Methods A literature review was performed using the Pubmed, Medline and EMBASE databases. All relevant articles published in English addressing the effect of IL in post thyroid surgery related UVFP were analyzed. Studies using IL for UVFP of multiple etiologies were excluded. Meta-analysis was conducted using fixed and random effect model. Results Five original studies were identified, including 214 patients received IL for UVFP following thyroid surgery. Two studies injected autologous fat via direct suspension laryngoscope under general anesthesia, while the other 3 studies injected polyacrylamide, hyaluronic acid, and polymethyl methacrylate from cricothyroid membrane under local anesthesia. All 5 studies reported improved voice outcomes of IL for post-thyroidectomy UVFP. Meta-analysis showed MPT increased for 3.18 s (95% CI: 2.40-3.96, fix effect model) after IL. Another common acoustic parameter, jitter (%) also improved for 1.46 (95% CI: 0.73-2.19, random effects model) after IL for post-thyroidectomy UVFP. Conclusions This review supported that IL can improve the voice outcome for post-thyroidectomy UVFP. Autologous fat remains a good augmentation material with a potential longer lasting effect. More research and long-term surveys are needed to document the safety and longevity of other synthetic materials.
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Affiliation(s)
- Li-Jen Liao
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan
- Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan
| | - Chi-Te Wang
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan
- Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan
- Department of Special Education, University Of Taipei, Taipei, Taiwan
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Lai YT, Chao PZ, Chang YK, Yen YC, Shen YT, Yu TY, Dailey S, Wang YH. Iatrogenic Vocal Fold Paralysis: A Population-Based Cohort Study in Taiwan. Ann Otol Rhinol Laryngol 2021; 131:767-774. [PMID: 34470521 DOI: 10.1177/00034894211041226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Iatrogenic vocal fold paralysis is an important issue in laryngology, yet there are few population-based studies regarding the epidemiology. This study used a nationwide population-based claims database (the National Health Insurance Research Database) to investigate the epidemiology of iatrogenic unilateral and bilateral vocal fold paralysis (UVFP/BVFP) among the general adult population in Taiwan. METHOD This study analyzed patients (20-90 years old) who underwent thyroid, parathyroid, thoracic, cardiac, or anterior cervical spine operations with vocal fold paralysis among adults in Taiwan from January 1, 2007 to December 31, 2013. The codes for vocal fold paralysis were defined by International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Claims data in the Taiwan National Health Insurance Research Database were used. RESULTS The most commonly performed operations which were related to vocal fold paralysis in Taiwan were, in descending order of frequency, thyroid, cervical spine, cardiac, thoracic (esophagectomy), and parathyroid operations. The operations that put laryngeal nerves at risk (ONRs) most commonly associated with a diagnosis of UVFP were, in descending order of frequency, thoracic, thyroid, parathyroid, cardiac, and cervical spine. For both UVFP and BVFP, the most commonly associated age group was 51 to 60. For both UVFP and BVFP, the more commonly associated sex was women. Increased length of stay was associated with a higher incidence of UVFP and BVFP. Charlson medical co-morbidity index (CCI) was not associated with UVFP but BVFP was associated with higher Charlson medical co-morbidity scores. CONCLUSIONS Thyroid operations, age 51 to 60, longer hospital stays are associated with vocal fold paralysis. Overall women are more surgically affected than men. This is the first population-based study of iatrogenic vocal fold paralysis.
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Affiliation(s)
- Ying-Ta Lai
- Department of Otolaryngology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Pin-Zhir Chao
- Department of Otolaryngology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yu-Kang Chang
- Department of Medical Research, Tungs' Taichung Metroharbor Hospital, Taichung, Taiwan
| | - Yu-Chun Yen
- Biostatistics Center, Office of Data Science, Taipei Medical University, Taipei, Taiwan
| | - Yu-Ting Shen
- Medical Research Department, Center for Big Medical Data and AI Computing, Chi Mei Medical Center, Tainan, Taiwan
| | - Tzu-Yun Yu
- Biostatistics Center, Office of Data Science, Taipei Medical University, Taipei, Taiwan
| | - Seth Dailey
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Yuan-Hung Wang
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Medical Research, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
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Tibbetts KM, Simpson CB. Adult Bilateral Vocal Fold Paralysis. CURRENT OTORHINOLARYNGOLOGY REPORTS 2021. [DOI: 10.1007/s40136-021-00359-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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6
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Fiorelli RKA, Duarte AJV, Quadros Teixeira A, Montenegro TS, Portari Filho PE, Morard MRS, da Silva Ascenção AM, Oliveira CAB, Novellino P. Anatomical and developmental aspects of iatrogenic injury to the right recurrent laryngeal nerve in surgical resections of substernal goiter. Anat Rec (Hoboken) 2021; 304:1242-1254. [DOI: 10.1002/ar.24629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 02/16/2021] [Accepted: 03/16/2021] [Indexed: 12/20/2022]
Affiliation(s)
| | | | - Aline Quadros Teixeira
- Hospital Universitario Gaffree e Guinle, Universidade Federal do Estado do Rio de Janeiro Rio de Janeiro Brazil
| | - Thiago Scharth Montenegro
- Hospital Universitario Gaffree e Guinle, Universidade Federal do Estado do Rio de Janeiro Rio de Janeiro Brazil
| | - Pedro Eder Portari Filho
- Hospital Universitario Gaffree e Guinle, Universidade Federal do Estado do Rio de Janeiro Rio de Janeiro Brazil
| | - Maria Ribeiro Santos Morard
- Hospital Universitario Gaffree e Guinle, Universidade Federal do Estado do Rio de Janeiro Rio de Janeiro Brazil
| | | | | | - Pietro Novellino
- Hospital Universitario Gaffree e Guinle, Universidade Federal do Estado do Rio de Janeiro Rio de Janeiro Brazil
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7
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Early voice therapy for unilateral vocal fold paralysis improves subglottal pressure and glottal closure. Am J Otolaryngol 2020; 41:102727. [PMID: 32979665 DOI: 10.1016/j.amjoto.2020.102727] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/29/2020] [Accepted: 09/08/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE In cases of unilateral vocal fold paralysis (UVFP), voice disorders caused by glottic insufficiency can lead to a considerable reduction in the patient's quality of life. Voice therapy (VT) is an effective treatment that must be started early after the onset of vocal fold paralysis. This study examined the effect of early VT for patients with UVFP occurring after esophagectomy. MATERIALS AND METHODS Patients who had residual UVFP at 1 month postoperatively after esophagectomy for esophageal cancer between November 2014 and March 2017 were evaluated. Seventeen patients were divided into the VT group (n = 6) and non-VT group (n = 11). We compared these two groups and retrospectively examined the effect of early VT. The study endpoints included aerodynamic tests, laryngeal endoscopy, laryngeal stroboscopy, and glottal closure. All of these evaluations were performed at preoperatively and at 1 and 3 months postoperatively. RESULTS Subglottal pressure reduced notably in the VT group, and both the mean flow rate and maximum phonation time tended to improve after VT. Conversely, there were no significant differences in MFR and MPT in the non-VT group. Furthermore, although UVFP remained after VT, we achieved glottal closure for all three patients. Conversely, only two of the six patients with glottic insufficiency in the non-VT group achieved glottal closure. CONCLUSION VT may be effective for improving impaired vocal function in patients with UVFP. It is reasonable to expect that VT can be initiated 1 month after the onset of vocal fold paralysis.
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8
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Patel J, Boon M, Spiegel J, Huntley C. Safety of Outpatient Type 1 Thyroplasty. EAR, NOSE & THROAT JOURNAL 2020; 100:608S-613S. [PMID: 31903781 DOI: 10.1177/0145561319894414] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Type 1 thyroplasty is an established procedure for the treatment of vocal fold paralysis to improve voice and swallowing outcomes. At our institution, we commonly perform this procedure on an outpatient basis in medically stable patients. With this study, we assess the safety of outpatient thyroplasty by examining complication and readmission rates, need for revision surgery, and predictors of these outcome measures. METHODS We performed a retrospective review of patients undergoing outpatient type 1 thyroplasty for vocal fold paralysis between 2013 and 2018 at our institution. We documented the etiology of paralysis, comorbidities, and demographic data. Our primary outcome measures were complications, need for readmission, and need for revision surgery. RESULTS During the study period, 160 patients met our inclusion criteria. Mean age at time of surgery was 62.1 ± 13.9 years; there were 82 (51%) males and 78 (49%) females. Nine (5.6%) patients experienced major complications after surgery and 7 (4.4%) patients required unplanned readmission. Mean time to complication was 6.9 ± 9.7 days. There were no instances of postoperative airway compromise requiring intervention. There were no mortalities. Of those who underwent primary surgery, 22 (14%) patients required revision surgery. CONCLUSION Given that complications tend to occur in a delayed fashion rather than in the acute postoperative period, same-day discharge seems reasonable as compared to overnight observation in medically stable patients undergoing type 1 thyroplasty. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Jena Patel
- Department of Otolaryngology-Head and Neck Surgery, 6559Thomas Jefferson University, Philadelphia, PA, USA
| | - Maurits Boon
- Department of Otolaryngology-Head and Neck Surgery, 6559Thomas Jefferson University, Philadelphia, PA, USA
| | - Joseph Spiegel
- Department of Otolaryngology-Head and Neck Surgery, 6559Thomas Jefferson University, Philadelphia, PA, USA
| | - Colin Huntley
- Department of Otolaryngology-Head and Neck Surgery, 6559Thomas Jefferson University, Philadelphia, PA, USA
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9
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Fernandes-Taylor S, Damico Smith C, Arroyo N, Bonnet K, Schlundt D, Wichmann M, Feurer I, Francis DO. Study protocol to develop a patient-reported outcome measuring disability associated with unilateral vocal fold paralysis: a mixed-methods approach with the CoPE collaborative. BMJ Open 2019; 9:e030151. [PMID: 31666263 PMCID: PMC6830693 DOI: 10.1136/bmjopen-2019-030151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 09/13/2019] [Accepted: 09/18/2019] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Patient-reported outcome (PRO) measures are increasingly developed with multisite, representative patient populations so that they can serve as a primary endpoint in clinical trials and longitudinal studies. Creating multisite infrastructure during PRO measure development can facilitate future comparative effectiveness trials. We describe our protocol to simultaneously develop a PRO measure and create a collaborative of tertiary care centres to address the needs of patients with unilateral vocal fold paralysis (UVFP). We describe the stakeholder engagement, information technology and regulatory foundations for PRO measure development and how the process enables plans for multisite trials comparing treatments for this largely iatrogenic condition. METHODS AND ANALYSIS The study has three phases: systematic review, measure development and measure validation. Systematic reviews and qualitative interviews (n=75) will inform the development of a conceptual framework. Qualitative interviews with patients with UVFP will characterise the lived experience of the condition. Candidate PRO measure items will be derived verbatim from patient interviews and refined using cognitive interviews and expert input. The PRO measure will be administered to a large, multisite cohort of adult patients with UVFP via the CoPE (vocal Cord Paralysis Experience) Collaborative. We will establish CoPE to facilitate measure development and to create preliminary infrastructure for future trials, including online data capture, stakeholder engagement, and the identification of barriers and facilitators to participation. Classical test theory psychometrics and grounded theory characterise our approach, and validation includes assessment of latent structure, reliability and validity. ETHICS AND DISSEMINATION Our study is approved by the University of Wisconsin Health Sciences Institutional Review Board. Findings from this project will be published in open-access journals and presented at international conferences. Subsequent use of the PRO measure will include comparative effectiveness trials of treatments for UVFP at CoPE Collaborative sites.
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Affiliation(s)
| | - Cara Damico Smith
- Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA
| | - Natalia Arroyo
- Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA
| | - Kemberlee Bonnet
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
| | - David Schlundt
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
| | - Margarete Wichmann
- University of Wisconsin Survey Center, University of Wisconsin, Madison, Wisconsin, USA
| | - Irene Feurer
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
| | - David O Francis
- Division of Otolaryngology, Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA
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10
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Francis DO, Sherman AE, Hovis KL, Bonnet K, Schlundt D, Garrett CG, Davies L. Life Experience of Patients With Unilateral Vocal Fold Paralysis. JAMA Otolaryngol Head Neck Surg 2019; 144:433-439. [PMID: 29621392 DOI: 10.1001/jamaoto.2018.0067] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Clinicians and patients benefit when they have a clear understanding of how medical conditions influence patients' life experiences. Patients' perspectives on life with unilateral vocal fold paralysis have not been well described. Objective To promote patient-centered care by characterizing the patient experiences of living with unilateral vocal fold paralysis. Design, Setting, and Participants This study used mixed methods: surveys using the voice and dysphagia handicap indexes (VHI and DHI) and semistructured interviews with adults with unilateral vocal cord paralysis recruited from a tertiary voice center. Recorded interviews were transcribed, coded using a hierarchical coding system, and analyzed using an iterative inductive-deductive approach. Main Outcomes and Measures Symptom domains of the patient experience. Results In 36 patients (26 [72%] were female, and the median age and interquartile range [IQR] were 63 years [48-68 years]; median interview duration, 42 minutes), median VHI and DHI scores were 96 (IQR, 77-108) and 55.5 (IQR, 35-89) at the time of interviews, respectively. Frustration, isolation, fear, and altered self-identity were primary themes permeating patients' experiences. Frustrations related to limitations in communication, employment, and the medical system. Sources of fear included a loss of control, fear of further dysfunction or permanent disability, concern for health consequences (eg, aspiration pneumonia), and/or an inability to call for help in emergency situations. These experiences were modified by the following factors: resilience, self-efficacy, perceived sense of control, and social support systems. Conclusions and Relevance Effects of unilateral vocal fold paralysis extend beyond impaired voice and other somatic symptoms. Awareness of the extent to which these patients experience frustration, isolation, fear, and altered self-identity is important. A patient-centered approach to optimizing unilateral vocal fold paralysis treatment is enhanced by an understanding of both the physical dimension of this condition and how patients cope with the considerable emotional and social consequences. Recognizing the psychosocial dimensions of disease allows clinicians to communicate more effectively, be more empathetic, and to better personalize treatment plans, which may lead to improved patient care and patient satisfaction.
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Affiliation(s)
- David O Francis
- Division of Otolaryngology, Department of Surgery, Wisconsin Surgical Outcomes Research, University of Wisconsin, Madison
| | - Ariel E Sherman
- Division of Otolaryngology, Department of Surgery, Wisconsin Surgical Outcomes Research, University of Wisconsin, Madison
| | - Kristen L Hovis
- Vanderbilt Voice Center, Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kemberlee Bonnet
- Vanderbilt Qualitative Research Core, Institute for Medicine and Public Health, Department of Psychology, Vanderbilt University, Nashville, Tennessee
| | - David Schlundt
- Vanderbilt Qualitative Research Core, Institute for Medicine and Public Health, Department of Psychology, Vanderbilt University, Nashville, Tennessee
| | - C Gaelyn Garrett
- Vanderbilt Voice Center, Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Louise Davies
- VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, Vermont.,Section of Otolaryngology in Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.,The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
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11
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Buyukatalay ZC, Brisebois S, Sirin S, Merati AL. Does Dysphagia Improve Following Laryngeal Reinnervation for Treatment of Hoarseness in Unilateral Vocal Fold Paralysis? J Voice 2019; 35:307-311. [PMID: 31488315 DOI: 10.1016/j.jvoice.2019.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 08/04/2019] [Accepted: 08/06/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE There are many reports of the efficacy of laryngeal reinnervation on voice, but there is a paucity of literature regarding its impact on swallowing function. The goal of this study was to explore the impact of laryngeal reinnervation on swallowing outcomes among unilateral vocal fold paralysis (UVFP) patients. METHODS We reviewed 22 UVFP cases treated with laryngeal reinnervation at our institution. Ten patients had complete datasets, including Eating Assessment Tool (EAT-10) scores and appropriate follow-up. Wilcoxon signed-rank test was used to compare pre- and postoperative scores. RESULTS Over the study period, 10 cases (mean age 45.7 ± 13.3 years; 6/10 men) with UVFP underwent ansa cervicalis to recurrent laryngeal nerve anastomosis (6/10) or nerve-muscle pedicle procedure (4/10). The median time between injury and surgical reinnervation was 12.4 months (range 2.7-88.5 months). Based on EAT-10 scores 6/10 patients were found to have dysphagia. Of these, four improved their score after surgery, one remained stable, and one deteriorated. The median EAT-10 score of these patients improved from 13 to 7 after surgery, but this difference was not statistically significant (P = 0.138). CONCLUSION Laryngeal reinnervation procedure has the potential for restoring a near normal voice in UVFP. Laryngeal reinnervation of the vocal fold may be associated with a tendency toward improvement in the EAT-10 score in patients after surgery for hoarseness in the setting of UVFP.
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Affiliation(s)
- Zahide C Buyukatalay
- Department of Otorhinolaryngology, Head and Neck Surgery, Ibni Sina Hospital, Ankara University School of Medicine, Ankara, Turkey.
| | - Simon Brisebois
- Department of Surgery, Division of Otolaryngology, Head and Neck Surgery, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Seher Sirin
- Department of Otorhinolaryngology, Head and Neck Surgery, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Albert L Merati
- Department of Otolaryngology, Head and Neck Surgery, University of Washington Medical Center, Seattle, Washington
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12
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Zimmermann TM, Orbelo DM, Pittelko RL, Youssef SJ, Lohse CM, Ekbom DC. Voice outcomes following medialization laryngoplasty with and without arytenoid adduction. Laryngoscope 2018; 129:1876-1881. [PMID: 30582612 DOI: 10.1002/lary.27684] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Voice outcomes following medialization laryngoplasty (ML) for unilateral vocal fold paralysis (UVFP) were compared to those who underwent ML plus arytenoid adduction (AA) (ML+AA). METHODS Single institution retrospective review of patients with UVFP undergoing ML and ML+AA (2009-2017). Demographic information and history of laryngeal procedures were collected. Preoperative and postoperative Voice Handicap Index-10 (VHI-10) and Consensus Perceptual Auditory Evaluation of Voice (CAPE-V) were assessed. RESULTS Of 236 patients, 119 met study criteria. Of those, 70 (59%) underwent ML and 49 (41%) underwent ML+AA. Significant differences between groups at baseline were found for age at time of thyroplasty (P = 0.046), VHI-10 scores (P < 0.001), and CAPE-V scores (P = 0.007). Baseline VHI-10 scores for ML+AA (28 ± 7) were greater than those for ML alone (24 ± 7). At 12 months, overall VHI-10 scores improved compared to baseline for both groups (ML+AA = 9 ± 7, ML = 16 ± 9); however, there was greater improvement for the ML+AA group compared to ML group (P = 0.001). CAPE-V scores at 3 or 12 months improved, but differences between the groups were not statistically significant once controlled for covariates. CONCLUSION Based on current findings, patients who undergo ML+AA likely have greater voice handicap at baseline compared to those undergoing ML alone. Patients selected for ML+AA improve as much or more than those who underwent ML alone. This highlights the importance of appropriate selection of candidates for AA. LEVEL OF EVIDENCE 4 Laryngoscope, 129:1876-1881, 2019.
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Affiliation(s)
| | - Diana M Orbelo
- Department of Otorhinolaryngology, Rochester, Minnesota, U.S.A
| | | | | | - Christine M Lohse
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Dale C Ekbom
- Department of Otorhinolaryngology, Rochester, Minnesota, U.S.A
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13
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The incidence and recovery rate of idiopathic vocal fold paralysis: a population-based study. Eur Arch Otorhinolaryngol 2018; 276:153-158. [PMID: 30443781 DOI: 10.1007/s00405-018-5207-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 11/09/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE To determine the incidence and spontaneous recovery rate of idiopathic vocal fold paralysis (IVFP) and paresis (IVFp), and the impact of steroid treatment on rates of recovery. METHODS This retrospective cohort study included all patients with IVFP or IVFp within a large integrated health-care system between January 1, 2008 and December 31, 2014. Patient demographics and clinical characteristics, including time to diagnosis, spontaneous recovery status, time to recovery, and treatment, were examined. RESULTS A total of 264 patients were identified, 183 (69.3%) with IVFP and 81 (30.7%) with IVFp. Nearly all cases (96.6%) were unilateral and 89.8% of patients were over the age of 45. The combined (IVFP and IVFp) 7-year mean incidence was 1.04 cases per 100,000 persons each year with the highest 7-year mean annual incidence in white patients (1.60 per 100,000). The total rate of spontaneous recovery was 29.5%, where 21.2% had endoscopic evidence of resolution and 8.3% had clinical improvement in their voice without endoscopic confirmation. The median time to symptom resolution was 4.0 months. Use of steroids was not linked with spontaneous recovery in multivariable analyses. CONCLUSION The annual incidence of VFP (IVFP and IVFp) was 1.04 cases per 100,000 persons, with spontaneous recovery occurring in nearly a third of patients, regardless of steroid use.
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Rosko AJ, Kupfer RA, Oh SS, Haring CT, Feldman EL, Hogikyan ND. Immunohistologic analysis of spontaneous recurrent laryngeal nerve reinnervation in a rat model. Laryngoscope 2017; 128:E117-E122. [DOI: 10.1002/lary.27004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2017] [Indexed: 01/29/2023]
Affiliation(s)
- Andrew J. Rosko
- Department of Otolaryngology-Head and Neck Surgery; University of Michigan Health Center; Ann Arbor Michigan U.S.A
| | - Robbi A. Kupfer
- Department of Otolaryngology-Head and Neck Surgery; University of Michigan Health Center; Ann Arbor Michigan U.S.A
| | - Sang S. Oh
- Department of Neurology; University of Michigan Medical School; Ann Arbor Michigan U.S.A
| | - Catherine T. Haring
- Department of Otolaryngology-Head and Neck Surgery; University of Michigan Health Center; Ann Arbor Michigan U.S.A
| | - Eva L. Feldman
- Department of Neurology; University of Michigan Medical School; Ann Arbor Michigan U.S.A
| | - Norman D. Hogikyan
- Department of Otolaryngology-Head and Neck Surgery; University of Michigan Health Center; Ann Arbor Michigan U.S.A
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Unilateral vocal fold immobility: a tertiary hospital’s experience over 5 years. Eur Arch Otorhinolaryngol 2017; 274:2855-2859. [DOI: 10.1007/s00405-017-4528-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 03/06/2017] [Indexed: 11/26/2022]
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16
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Pardo-Maza A, García-Lopez I, Santiago-Pérez S, Gavilán J. Laryngeal Electromyography for Prognosis of Vocal Fold Paralysis. J Voice 2017; 31:90-93. [DOI: 10.1016/j.jvoice.2016.02.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 02/22/2016] [Indexed: 11/28/2022]
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17
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Yu S, Lin J, Chen C, Lin J, Han Z, Lin W, Kang M. Recurrent laryngeal nerve lymph node dissection may not be suitable for all early stage esophageal squamous cell carcinoma patients: an 8-year experience. J Thorac Dis 2016; 8:2803-2812. [PMID: 27867556 DOI: 10.21037/jtd.2016.10.34] [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] [Indexed: 01/20/2023]
Abstract
BACKGROUND Recurrent laryngeal nerve (RLN) injury is one of the most frequent postoperative complications of esophageal squamous cell carcinoma (ESCC) radical resection. This study aims to develop a novel scoring system to predict recurrent laryngeal nerve lymph node (RLNLN) metastases in early ESCC and explore the indications for precise RLN lymphadenectomy. METHODS Early stage ESCC patients from 2006 to 2014 were analyzed. Patient and pathologic characteristics were compared between patients with RLNLN metastases and those without. Univariate and multivariate analyses were performed to establish a scoring system that estimates the risks of RLNLN metastases. The indications for RLNLN dissection were validated by survival rate, postoperative complications, and metastases rate. RESULTS A total of 311 cases selected from 1,466 ESCC patients were divided into the dissection group and the control group. Age, tumor length, macroscopic tumor type, T stage, tumor location and tumor differentiation were independent predictors of RLNLN metastases. The weighted scoring system included age (+2 for <56 years), tumor length (+2 for over 4.45 cm), tumor location (+4 for upper thoracic, +2 for mid-thoracic) and macroscopic tumor type (+1 for advanced type). The total number of points estimated the probability of RLNLN metastases [low-risk (0-2 point), 0%; moderate-risk (3-4 points), 9.8%; and high-risk (>4 points), 43.4%]. Besides, the dissection group had more complications and similar survival rate when compared with the control group. CONCLUSIONS We developed a novel scoring system that accurately estimated the risk of RLNLN metastases in early ESCC patients. RLN lymphadenectomy may be safely omitted for the patients in the low-risk subgroup.
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Affiliation(s)
- Shaobin Yu
- The Second Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Jihong Lin
- The Second Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Chenshu Chen
- The Second Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Jiangbo Lin
- The Second Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Ziyang Han
- The Second Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Wenwei Lin
- The Second Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Mingqiang Kang
- The Second Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
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Kay-Rivest E, Mitmaker E, Payne RJ, Hier MP, Mlynarek AM, Young J, Forest VI. Preoperative vocal cord paralysis and its association with malignant thyroid disease and other pathological features. J Otolaryngol Head Neck Surg 2015; 44:35. [PMID: 26362432 PMCID: PMC4567777 DOI: 10.1186/s40463-015-0087-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 08/31/2015] [Indexed: 11/16/2022] Open
Abstract
Background Vocal cord paralysis (VCP) is found in both benign and malignant thyroid disease. This study was performed to determine if the presence of preoperative VCP predicts malignancy. Methods A retrospective analysis was performed on a cohort of 1923 consecutive patients undergoing thyroid surgery. The incidence of preoperative VCP was recorded. Patient and nodule characteristics were correlated with final pathology. Results 1.3 % of our cohort was found to have preoperative VCP. Malignant pathology was discovered in 76 % of patients with preoperative VCP. Among these patients, 72 % had a left sided paralysis. 10.5 % of patients with preoperative VCP had perineural invasion (PNI) on final pathology, compared to 1.1 % of patients with normal VC function. Conclusion Preoperative VCP appears to be a strong, though not an absolute, indicator of malignancy. Most VCP were on the left side. Assessing for preoperative VCP is crucial in all patients who need thyroid surgery, as even benign nodules can be accompanied by preoperative vocal cord paralysis.
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Affiliation(s)
- Emily Kay-Rivest
- Department of Otolaryngology - Head and Neck surgery, McGill University, Montreal, QC, Canada
| | - Elliot Mitmaker
- Department of General surgery, McGill University, Montreal, QC, Canada
| | - Richard J Payne
- Division of Head and Neck Surgery, Department of Otolaryngology - Head and Neck surgery, Jewish General Hospital, McGill University, Montreal, QC, H3T 1E2, Canada
| | - Michael P Hier
- Division of Head and Neck Surgery, Department of Otolaryngology - Head and Neck surgery, Jewish General Hospital, McGill University, Montreal, QC, H3T 1E2, Canada
| | - Alex M Mlynarek
- Division of Head and Neck Surgery, Department of Otolaryngology - Head and Neck surgery, Jewish General Hospital, McGill University, Montreal, QC, H3T 1E2, Canada
| | - Jonathan Young
- Division of Head and Neck Surgery, Department of Otolaryngology - Head and Neck surgery, Jewish General Hospital, McGill University, Montreal, QC, H3T 1E2, Canada
| | - Véronique-Isabelle Forest
- Division of Head and Neck Surgery, Department of Otolaryngology - Head and Neck surgery, Jewish General Hospital, McGill University, Montreal, QC, H3T 1E2, Canada.
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Paddle PM, Mansor MB, Song PC, Franco RA. Diagnostic Yield of Computed Tomography in the Evaluation of Idiopathic Vocal Fold Paresis. Otolaryngol Head Neck Surg 2015; 153:414-9. [DOI: 10.1177/0194599815593268] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 06/05/2015] [Indexed: 11/15/2022]
Abstract
Objective To determine the diagnostic yield of computed tomography (CT) in establishing an etiology in patients with idiopathic unilateral vocal fold paresis (IUVFP). To determine the proportion of CT scans yielding incidental findings requiring further patient management. Study Design Case series with chart review. Setting Tertiary laryngology practice. Subjects Laryngology clinic patients under the care of the 2 senior authors. Methods All clinic patients were identified who had a diagnosis of IUVFP and underwent CT of the skull base to the upper mediastinum from 2004 to 2014. Demographic, historical, examination, and investigation data were extracted. CT reports and endoscopic recordings were reviewed. Patients were excluded if there were insufficient clinical findings recorded or if there was a known neurologic disorder, complete vocal fold immobility, or bilateral involvement. Results A total of 174 patients with IUVFP who had also undergone contrast-enhanced CT were identified. Of the 174 patients, 5 had a cause for their paresis identified on CT. This equated to a diagnostic yield of 2.9% (95% confidence interval, 0.94% to 6.6%). Of the 174 patients, 48 had other incidental lesions identified that required further follow-up, investigation, or treatment. This equated to an incidental yield of 27.6% (95% confidence interval, 21.1% to 34.9%). Conclusion This is the second and largest study to evaluate the diagnostic yield of CT in the evaluation of IUVFP. It demonstrates a low diagnostic yield and a high incidental yield. These findings suggest that the routine use of CT in the evaluation of idiopathic vocal fold paresis should be given careful consideration and that a tailored approach to investigation with good otolaryngologic follow-up is warranted.
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Affiliation(s)
- Paul M. Paddle
- Harvard Medical School, Division of Laryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Masaany B. Mansor
- Harvard Medical School, Division of Laryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Phillip C. Song
- Harvard Medical School, Division of Laryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Ramon A. Franco
- Harvard Medical School, Division of Laryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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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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Yang J, Hong L, Feng F, Li M, Sun L, Cai L, Zhang H. Accurate lymphadenectomy along the recurrent laryngeal nerve based on precise positioning during thoracoscopic-laparoscopic oesophagectomy: A retrospective cohort study. SURGICAL PRACTICE 2015. [DOI: 10.1111/1744-1633.12104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Jianjun Yang
- Xijing Hospital of Digestive Diseases; Xijing Hospital; Fourth Military Medical University; Xi'an China
| | - Liu Hong
- Xijing Hospital of Digestive Diseases; Xijing Hospital; Fourth Military Medical University; Xi'an China
| | - Fan Feng
- Xijing Hospital of Digestive Diseases; Xijing Hospital; Fourth Military Medical University; Xi'an China
| | - Mengbin Li
- Xijing Hospital of Digestive Diseases; Xijing Hospital; Fourth Military Medical University; Xi'an China
| | - Li Sun
- Xijing Hospital of Digestive Diseases; Xijing Hospital; Fourth Military Medical University; Xi'an China
| | - Lei Cai
- Xijing Hospital of Digestive Diseases; Xijing Hospital; Fourth Military Medical University; Xi'an China
| | - Hongwei Zhang
- Xijing Hospital of Digestive Diseases; Xijing Hospital; Fourth Military Medical University; Xi'an China
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Vocal fold paresis accompanying vocal fold polyps. Eur Arch Otorhinolaryngol 2014; 272:149-57. [DOI: 10.1007/s00405-014-3227-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 07/29/2014] [Indexed: 11/26/2022]
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Francis DO, McKiever ME, Garrett CG, Jacobson B, Penson DF. Assessment of patient experience with unilateral vocal fold immobility: a preliminary study. J Voice 2014; 28:636-43. [PMID: 24739444 DOI: 10.1016/j.jvoice.2014.01.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 01/09/2014] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Systematically moving toward patient-centered care for unilateral vocal fold immobility (UVFI) requires comprehensive understanding of the variability of actual patient experiences. This rigorous qualitative study assesses UVFI-related disability and proposes a preliminary taxonomy of UVFI patient experience. STUDY DESIGN (1) Semistructured interviews and (2) taxonomy development. METHODS Consecutive UVFI patients presenting July to September, 2012, prospectively underwent open-ended interviews investigating how UVFI affected their quality of life (QOL) and had caused disability. Comments reported by >20% were synthesized into axes based on content similarity. Variables were arranged into a preliminary taxonomy of UVFI patient experience, which was evaluated for four attributes of face validity. RESULTS The majority of 39 patients had "extensive" baseline voice use (56%) and an iatrogenic etiology (62%). Taxonomy of patient experience included three main axes of symptomatic classification: (1) voice, (2) swallowing, and (3) breathing-all with intrinsic (physical and emotional) and extrinsic (social) subaxes that describe major impacts on QOL. Voice complaints were 100% penetrant, whereas breathing and swallowing symptoms afflicted 76% and 66%, respectively, of interviewees. Of affected patients, solid and liquid dysphagia was experienced by 70% and 63%, respectively. Of dyspneic patients, shortness of breath existed with talking (97%) and exercise (72%). Persistent throat congestion (76%), weakened cough (62%), globus (62%), and dysfunctional valsalva (41%) were frequent. CONCLUSIONS Patient experience with UVFI has been incompletely characterized. This qualitative assessment and preliminary taxonomy highlight several related patient experiences not well documented in the literature or incorporated into currently available metrics.
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Affiliation(s)
- David O Francis
- Vanderbilt Voice Center, Department of Otoaryngology, Bill Wilkerson Center, Nashville, Tennessee; Center for Surgical Quality and Outcomes Research, Nashville, Tennessee.
| | - Monique E McKiever
- Vanderbilt Voice Center, Department of Otoaryngology, Bill Wilkerson Center, Nashville, Tennessee
| | - C Gaelyn Garrett
- Vanderbilt Voice Center, Department of Otoaryngology, Bill Wilkerson Center, Nashville, Tennessee
| | - Barbara Jacobson
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David F Penson
- Center for Surgical Quality and Outcomes Research, Nashville, Tennessee; Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee; Geriatric Research Education and Clinical Center, Veterans Administration Tennessee Valley Healthcare System, Nashville, Tennessee
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Daniero JJ, Garrett CG, Francis DO. Framework Surgery for Treatment of Unilateral Vocal Fold Paralysis. CURRENT OTORHINOLARYNGOLOGY REPORTS 2014; 2:119-130. [PMID: 24883239 DOI: 10.1007/s40136-014-0044-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Laryngeal framework surgery is the current gold standard treatment for unilateral vocal fold paralysis. It provides a permanent solution to glottic insufficiency caused by injury to the recurrent laryngeal nerve. Various modifications to the original Isshiki type I laryngoplasty procedure have been described to improve voice and swallowing outcomes. The success of this procedure is highly dependent on the experience of the surgeon as it epitomizes the intersection of art and science in the field. The following article reviews the evidence, controversies, and complications related to laryngoplasty for unilateral vocal fold paralysis. It also provides a detailed analysis of how and when arytenoid-positioning procedures should be considered, and summarizes the literature on postoperative outcomes.
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Affiliation(s)
- James J Daniero
- Vanderbilt Voice Center, Department of Otolaryngology, Bill Wilkerson Center
| | - C Gaelyn Garrett
- Vanderbilt Voice Center, Department of Otolaryngology, Bill Wilkerson Center
| | - David O Francis
- Vanderbilt Voice Center, Department of Otolaryngology, Bill Wilkerson Center ; Center for Surgical Quality & Outcomes Research, Institute for Medicine and Public Health, Vanderbilt University Medical Center
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Kupfer RA, Meyer TK. Evaluation of Unilateral Vocal Fold Immobility. CURRENT OTORHINOLARYNGOLOGY REPORTS 2014. [DOI: 10.1007/s40136-014-0043-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Chiu HK, Ledbetter D, Richter MW, Iyer RS, Merati AL. Reversible left recurrent laryngeal nerve palsy in pediatric Graves' disease. Pediatrics 2013; 132:e1704-8. [PMID: 24249820 DOI: 10.1542/peds.2013-0437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Vocal cord paralysis associated with goiter usually indicates the presence of a malignancy. Pediatric patients retain significant thymic tissue that regresses only later in life. This thymic tissue can develop significant hyperplasia during an acute autoimmune process. We describe a case of a 17-year-old girl who presented with a goiter secondary to severe Graves' disease and a 2-month history of hoarseness, choking on liquid intake, and small-volume vomiting especially after eating. She demonstrated a left vocal cord paralysis probably secondary to a unilateral left recurrent laryngeal nerve palsy. A marked enlargement of the thymus was discovered on thoracic imaging. Treatment was initiated with methimazole, with near complete remission of her vocal cord paralysis within 3 months. Given the immunomodulatory effects of methimazole, a potential mechanism of the left recurrent laryngeal nerve palsy was autoimmune hyperstimulation of the thymus and consequent hyperplasia, resulting in distension of the nerve. Attenuation of the hyperactive immune process with methimazole may have resulted in regression of the mass effect of the thymus and associated reduction of the nerve distension. This case illustrates the unique risk of left recurrent laryngeal nerve palsy in pediatric patients with an acute immune stimulation and hyperplasia of the thymus and the reversibility in the context of mitigation of the immune hyperactivity. Methimazole may be an optimal initial treatment choice in pediatric patients with Graves' disease and left recurrent laryngeal nerve palsy.
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Affiliation(s)
- Harvey K Chiu
- David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, MDCC 22-315, Los Angeles, CA 90095.
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Is there a role for intraoperative recurrent laryngeal nerve monitoring during high mediastinal lymph node dissection in three-stage oesophagectomy for oesophageal cancer? Int J Surg 2013; 11:370-3. [DOI: 10.1016/j.ijsu.2013.03.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 03/20/2013] [Accepted: 03/22/2013] [Indexed: 11/18/2022]
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Campbell EO, Samlan RA, McMullen NT, Cook S, Smiley-Jewell S, Barkmeier-Kraemer J. Developmental changes in the connective tissues of the porcine recurrent laryngeal nerve. J Anat 2013; 222:625-33. [PMID: 23590663 DOI: 10.1111/joa.12046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2013] [Indexed: 11/26/2022] Open
Abstract
The recurrent laryngeal nerve (RLN) branches from the vagus cranial nerve to innervate structures important for voicing and swallowing. Damage to this nerve, commonly associated with surgery or idiopathic etiologies that largely occur with aging, results in impaired voicing and swallowing (Myssiorek, 2004). Sunderland proposed a model of peripheral nerve damage whereby a nerve's ability to resist damage from stretch and compression is determined by the quantity and composition of its epineurial connective tissues (Sunderland, 1951). Thus, it would be expected that epineurium differs depending upon the forces imposed on a nerve within its anatomical setting. The purpose of this study was to investigate RLN epineurium quantity and composition with development. A porcine model (piglet vs. juvenile) was used because of the similarity between porcine and human laryngeal innervation, anatomy and function. The entire RLN was excised bilaterally, and stereological methods were used to quantify the composition of epineurial connective tissues. Compared with the piglet, the juvenile pig RLN was double the diameter. While the piglet had no differences in the percentage of epineurial collagen and adipose between proximal and distal segments of both sides of the RLN, the juvenile pig had a greater percentage of collagen in the proximal segment of both sides of the RLN and a greater percentage of adipose in the distal segment of the left RLN compared with the proximal segment. In addition, unlike the piglet, the juvenile pig had a greater number of fascicles in the proximal than distal segment of the RLN, regardless of nerve side. These findings are consistent with predicted patterns associated with the different anatomical settings of the left and right RLN, show that the RLN changes with age, and support Sunderland's model.
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Affiliation(s)
- Ellen O Campbell
- Department of Speech, Language, Hearing, University of Arizona, Tucson, AZ, USA
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Gupta J, Varshney S, Bist SS, Bhagat S. Clinico-etiolological study of vocal cord paralysis. Indian J Otolaryngol Head Neck Surg 2012; 65:16-9. [PMID: 24381912 DOI: 10.1007/s12070-012-0574-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 09/20/2012] [Indexed: 11/26/2022] Open
Abstract
The purpose of this study was to identify patients of vocal cord paralysis and to establish an etiological diagnosis. Patients with vocal cord paralysis have been followed prospectively at a tertiary referral center. 120 patients identified with vocal cord paralysis by laryngeal endoscopy were evaluated clinically, radiologically and pathologically to make an etiological diagnosis. Those patients in whom no cause was found, a CT scan from base of skull to thorax was done before labeling them as idiopathic. Most of the patients presented in 5th (26.67 %) and 6th (21.67 %) decade. Males out numbered females in the ratio 2.3:1.0. The most common symptom of vocal cord paralysis was change in voice (98.21 %). Bilateral vocal cord palsy was found in 6.67 % patients and unilateral vocal cord palsy was found in 93.33 % patients. Among patients of unilateral vocal cord paralysis left vocal cord was paralyzed in 69.64 % and right cord in 30.36 %. Malignant (34.16 %) causes accounted for largest number of patients followed by central (15.00 %) and idiopathic causes (14.16 %). VCP has got a variable etiology which varies with the laterality of the vocal cord involvement. Malignant causes predominated in our series, occurring in 34.16 %, followed by central and idiopathic causes.
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Affiliation(s)
- Jaya Gupta
- Department of ENT, Himalayan Institute of Medical Sciences, HIHT University, Swami Rama Nagar, Jolly Grant, Doiwala, Dehradun, India
| | - Saurabh Varshney
- Department of ENT, Himalayan Institute of Medical Sciences, HIHT University, Swami Rama Nagar, Jolly Grant, Doiwala, Dehradun, India
| | - S S Bist
- Department of ENT, Himalayan Institute of Medical Sciences, HIHT University, Swami Rama Nagar, Jolly Grant, Doiwala, Dehradun, India
| | - Sanjeev Bhagat
- Department of ENT, Himalayan Institute of Medical Sciences, HIHT University, Swami Rama Nagar, Jolly Grant, Doiwala, Dehradun, India
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Prevention and management of dysphonia during anterior cervical spine surgery. Laryngoscope 2012; 122:2179-83. [DOI: 10.1002/lary.23284] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 02/03/2012] [Accepted: 02/07/2012] [Indexed: 11/07/2022]
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Simpson CB, May LS, Green JK, Eller RL, Jackson CE. Vibratory Asymmetry in Mobile Vocal Folds: Is it Predictive of Vocal Fold Paresis? Ann Otol Rhinol Laryngol 2011; 120:239-42. [DOI: 10.1177/000348941112000404] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: The purpose of this study was to determine whether the videostroboscopic finding of vibratory asymmetry in mobile vocal folds is a reliable predictor of vocal fold paresis. In addition, the ability of experienced reviewers to predict the distribution (left/right/bilateral) of the paresis was investigated. Methods: This is a retrospective chart review of all patients who presented to our clinic during a 3-year period with symptoms suggestive of glottal insufficiency (vocal fatigue or reduced vocal projection) accompanied by the videostroboscopic findings of bilateral normal vocal fold mobility and vibratory asymmetry. Twenty-three of these patients underwent diagnostic laryngeal electromyography of the thyroarytenoid and cricothyroid muscles to determine the presence of vocal fold paresis. Results: Nineteen of the 23 patients (82.6%) were found to have electrophysiological evidence of vocal fold paresis, either unilaterally or bilaterally, when videostroboscopic asymmetry was present in mobile vocal folds. However, the three expert reviewers' ability to predict the distribution (left/right/bilateral) of the paresis was poor (26.3%, 36.8%, and 36.8%, respectively). Conclusions: The videostroboscopic finding of vibratory asymmetry in mobile vocal folds is a reliable predictor of vocal fold paresis in most cases. However, the ability of expert reviewers to determine the distribution (left/right/bilateral) of the paresis using videostroboscopic findings is poor. This study highlights the value of laryngeal electromyography in arriving at a correct diagnosis in this clinical situation.
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Gelpke H, Grieder F, Decurtins M, Cadosch D. Recurrent laryngeal nerve monitoring during esophagectomy and mediastinal lymph node dissection. World J Surg 2011; 34:2379-82. [PMID: 20563722 DOI: 10.1007/s00268-010-0692-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients who undergo surgery to the esophagus and lungs are in jeopardy of recurrent laryngeal nerve (RLN) damage during the procedure. This study was designed to investigate the feasibility of intraoperative monitoring of the RLN for single-lung ventilation esophagus and lung surgery. METHODS Twelve consecutive patients booked for esophagus or lung surgery were included in this prospective, observational study. Six patients underwent transthoracic esophagectomy for carcinoma of the esophagogastric junction or lower esophagus, five had a lobectomy, and one underwent a pneumonectomy for lung carcinoma. Intraoperative, noninvasive RLN identification and monitoring was performed unilaterally (n = 8) or bilaterally (n = 4) using a handheld stimulator and a laryngeal surface electrode. The correct functioning of the nerve monitoring system was tested directly at the vagus nerve. Diagnosis of postoperative RLN paralysis was performed using indirect laryngoscopy. RESULTS During the surgical procedures, we monitored a nerve signal in all 12 patients. In one patient with lower esophagus carcinoma, a nerve signal could be detected only on one side. Postoperative indirect laryngoscopy showed normal vocal cord movement in all patients. CONCLUSIONS Intraoperative RLN identification and monitoring during single-lung ventilation surgery is technically feasible, easy, and reliable. The introduction of standardized RLN monitoring during this type of surgery may reduce the incidence of permanent RLN paralysis.
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Affiliation(s)
- Hans Gelpke
- Department of Abdominal and Thoracic Surgery, State Hospital Winterthur, Winterthur, Switzerland
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Machida H, Yoda K, Arai Y, Nishida S, Masukawa A, Asanuma M, Yuhara T, Morita S, Suzuki K, Ueno E, Sabol JM. Dual-energy subtraction imaging for diagnosing vocal cord paralysis with flat panel detector radiography. Korean J Radiol 2010; 11:320-6. [PMID: 20461186 PMCID: PMC2864859 DOI: 10.3348/kjr.2010.11.3.320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2009] [Accepted: 01/04/2010] [Indexed: 11/16/2022] Open
Abstract
Objective To investigate the clinical feasibility of dual energy subtraction (DES) imaging to improve the delineation of the vocal cord and diagnostic accuracy of vocal cord paralysis as compared with the anterior-posterior view of flat panel detector (FPD) neck radiography. Materials and Methods For 122 consecutive patients who underwent both a flexible laryngoscopy and conventional/DES FPD radiography, three blinded readers retrospectively graded the radiographs during phonation and inspiration on a scale of 1 (poor) to 5 (excellent) for the delineation of the vocal cord, and in consensus, reviewed the diagnostic accuracy of vocal cord paralysis employing the laryngoscopy as the reference. We compared vocal cord delineation scores and accuracy of vocal cord paralysis diagnosis by both conventional and DES techniques using κ statistics and assessing the area under the receiver operating characteristic curve (AUC). Results Vocal cord delineation scores by DES (mean, 4.2 ± 0.4) were significantly higher than those by conventional imaging (mean, 3.3 ± 0.5) (p < 0.0001). Sensitivity for diagnosing vocal cord paralysis by the conventional technique was 25%, whereas the specificity was 94%. Sensitivity by DES was 75%, whereas the specificity was 96%. The diagnostic accuracy by DES was significantly superior (κ = 0.60, AUC = 0.909) to that by conventional technique (κ = 0.18, AUC = 0.852) (p = 0.038). Conclusion Dual energy subtraction is a superior method compared to the conventional FPD radiography for delineating the vocal cord and accurately diagnosing vocal cord paralysis.
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Affiliation(s)
- Haruhiko Machida
- Department of Radiology, Tokyo Women's Medical University Medical Center East, Arakawa-ku, Tokyo, Japan.
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Alexander MJ, Barkmeier-Kraemer JM, Vande Geest JP. Biomechanical properties of recurrent laryngeal nerve in the piglet. Ann Biomed Eng 2010; 38:2553-62. [PMID: 20369296 DOI: 10.1007/s10439-010-0013-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2009] [Accepted: 03/12/2010] [Indexed: 10/19/2022]
Abstract
Unilateral vocal fold paralysis (UVP) results from damage to the recurrent laryngeal nerve (RLN). The most common causes of UVP are associated with compromised RLN tissue. The purpose of this research was to investigate the biomechanical properties of piglet RLN and identify differences in these properties along its length and in between the left and right side. Quasi-static uniaxial tensile testing and isotropic constitutive modeling was performed on seven piglet RLNs. Stiffness and other biomechanical parameters were derived from these tests and compared from conducting two different statistical analysis for the between and within nerve comparisons. Results showed higher stiffness values in the left RLN segment than for the right. Descriptive data demonstrated a higher stiffness in RLN segments surrounding the aortic arch, indicating a more protective role of the extracellular matrix in these nerves. This research offers insight regarding the protective function of the RLN connective tissues and structural compromise due to its environment.
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Affiliation(s)
- Megan J Alexander
- Department of Aerospace and Mechanical Engineering, Soft Tissue Biomechanics Laboratory, University of Arizona, 1130 N Mountain Ave., PO Box 210119, Tucson, AZ 85721-0119, USA
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Blitzer A, Crumley RL, Dailey SH, Ford CN, Floeter MK, Hillel AD, Hoffman HT, Ludlow CL, Merati A, Munin MC, Robinson LR, Rosen C, Saxon KG, Sulica L, Thibeault SL, Titze I, Woo P, Woodson GE. Recommendations of the Neurolaryngology Study Group on laryngeal electromyography. Otolaryngol Head Neck Surg 2009; 140:782-793. [PMID: 19467391 PMCID: PMC2758662 DOI: 10.1016/j.otohns.2009.01.026] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Revised: 12/08/2008] [Accepted: 01/15/2009] [Indexed: 11/17/2022]
Abstract
The Neurolaryngology Study Group convened a multidisciplinary panel of experts in neuromuscular physiology, electromyography, physical medicine and rehabilitation, neurology, and laryngology to meet with interested members from the American Academy of Otolaryngology Head and Neck Surgery, the Neurolaryngology Subcommittee and the Neurolaryngology Study Group to address the use of laryngeal electromyography (LEMG) for electrodiagnosis of laryngeal disorders. The panel addressed the use of LEMG for: 1) diagnosis of vocal fold paresis, 2) best practice application of equipment and techniques for LEMG, 3) estimation of time of injury and prediction of recovery of neural injuries, 4) diagnosis of neuromuscular diseases of the laryngeal muscles, and, 5) differentiation between central nervous system and behaviorally based laryngeal disorders. The panel also addressed establishing standardized techniques and methods for future assessment of LEMG sensitivity, specificity and reliability for identification, assessment and prognosis of neurolaryngeal disorders. Previously an evidence-based review of the clinical utility of LEMG published in 2004 only found evidence supported that LEMG was possibly useful for guiding injections of botulinum toxin into the laryngeal muscles. An updated traditional/narrative literature review and expert opinions were used to direct discussion and format conclusions. In current clinical practice, LEMG is a qualitative and not a quantitative examination. Specific recommendations were made to standardize electrode types, muscles to be sampled, sampling techniques, and reporting requirements. Prospective studies are needed to determine the clinical utility of LEMG. Use of the standardized methods and reporting will support future studies correlating electro-diagnostic findings with voice and upper airway function.
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Affiliation(s)
| | - Roger L. Crumley
- Department of Otolaryngology-Head and neck Surgery, University of California-Irvine, CA
| | - Seth H. Dailey
- Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Charles N. Ford
- Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Mary Kay Floeter
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Allen D. Hillel
- Department of Otolaryngology – Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA
| | - Henry T. Hoffman
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, IA
| | - Christy L. Ludlow
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Albert Merati
- Department of Otolaryngology – Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA
| | - Michael C. Munin
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Lawrence R. Robinson
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA
| | - Clark Rosen
- Department of Otolaryngology, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Keith G. Saxon
- Department of Surgery, Division of Otolaryngology, Harvard Medical School, Boston MA
| | - Lucian Sulica
- Department of Otorhinolaryngology, Weill Medical College of Cornell University, NYC, NY
| | - Susan L. Thibeault
- Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | - Peak Woo
- Department of Otolaryngology, Mt Sinai School of Medicine, New York, NY
| | - Gayle E. Woodson
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University, Springfield, IL
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Quantitative Assessment of Laryngeal Muscle Morphology After Recurrent Laryngeal Nerve Injury: Right vs. Left Differences. Laryngoscope 2008; 118:1768-70. [DOI: 10.1097/mlg.0b013e31817f1940] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
PURPOSE OF REVIEW To present and assess the current state of knowledge regarding vocal fold paresis. RECENT FINDINGS Neurogenic compromise of vocal fold function exists along a continuum encompassing partial denervation (paresis), complete denervation (paralysis), and variable degrees and patterns of reinnervation. Not abundantly recognized clinically until recently, paresis typically presents with symptoms of glottic insufficiency. As a result of preserved vocal fold mobility, paresis can be difficult to diagnose and to distinguish from innocent vocal fold asymmetry. Laryngoscopy alone has proved an unreliable means of diagnosis, and laryngeal electromyography, although not immune to error itself, is often helpful. Treatment consists of medialization procedures that do not compromise remaining nerve function. Significant disagreement exists regarding the incidence, causes and relationship to other pathologies. In the absence of evidence, natural history must be inferred. SUMMARY Vocal fold paresis is probably a significant source of vocal disability, especially among cases that have eluded straightforward diagnosis. An accurate assessment of its clinical impact, patterns of dysfunction, natural history and relationship to other pathologies depends on diagnostic rigor and accuracy and is still evolving.
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Affiliation(s)
- Lucian Sulica
- Department of Otorhinolaryngology, Weill Medical College of Cornell University, New York, New York, USA.
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Merati AL, Halum SL, Smith TL. Diagnostic Testing for Vocal Fold Paralysis: Survey of Practice and Evidence-Based Medicine Review. Laryngoscope 2006; 116:1539-52. [PMID: 16954976 DOI: 10.1097/01.mlg.0000234937.46306.c2] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES/HYPOTHESIS Vocal fold paralysis continues to be a dominant topic in laryngology. Although the majority of cases can be attributed to a known etiology, a significant number of patients present without a clear precipitating event. Over 1,500 studies regarding vocal fold paralysis exist in the medical literature, although only a small percentage report on the use of serum or radiographic testing for the evaluation of idiopathic paralysis. Despite this, patients are routinely subjected to diagnostic evaluation to investigate the underlying cause. To characterize contemporary practice, a national survey of the American Broncho-Esophagological Association (ABEA) membership was undertaken. It is hypothesized that the current practice of diagnostic testing for idiopathic vocal fold paralysis is not well supported by an evidence-based medicine (EBM) review of the available medical literature. STUDY DESIGN The authors conducted a national survey, systematic EBM review of existing literature. METHODS Surveys were mailed to all active ABEA members; responses regarding practice specialization as well as serum/radiographic diagnostic preferences for idiopathic vocal fold paralysis were tabulated and subjected to statistical analysis. To compare contemporary practice with evidence in the available literature, an EBM review was first performed. Articles for evaluation were selected from a Medline search of English-language abstracts related to adult vocal fold paralysis. The publications were individually reviewed and an EBM level and grade were assigned and compared with the survey results. RESULTS Eighty-four of 249 active members responded with 76 (31%) replies submitted for analysis. Specific serum tests were advocated by 41 of 76 (54%) respondents, although the majority (52 of 65 [80%]) felt that they were only "occasionally" or "never" necessary. The most common tests were rheumatoid factor (38%), Lyme titer (36%), erythrocyte sedimentation rate (34%), and antinuclear antibody (33%). Fifty-one of 71(72%) felt that computed tomography (CT) was "always" or "often" necessary and 50 of 72 (69%) replied that chest radiography (CXR) was "always" or "often" necessary. There was no significant difference between CT and CXR ordering (P < .51). In contrast, magnetic resonance imaging (MRI) was described as "always" or "often" necessary in 28 of 71 (39%) of the surveys, significantly less than CT (P < .0001). There was no statistical impact of practice specialization on ordering of serum tests (P = .25) or imaging (P = .50 for CT; P = .46 for CXR; P = .45 for MRI). Following analysis of 1,510 vocal fold paralysis abstracts, 19 publications were found to be appropriate for an EBM review of serum testing with 15 available for review of radiographic imaging. Only one study presented level III evidence; the remainder were levels IV and V comprised of retrospective series and case reports. The evidence supporting serum or radiographic testing toward the evaluation of idiopathic vocal fold paralysis is given an overall grade of "C." CONCLUSIONS Serum and radiographic testing for the evaluation of vocal fold paralysis is supported by grade "C" evidence only. There are no existing prospective studies estimating the clinical impact of testing on diagnosis or patient outcome. Current practice, as estimated by a survey of the ABEA membership, is not well founded for serum testing and only by retrospective case series with regard to imaging. Further study into the nature of idiopathic vocal fold paralysis and outcomes assessment of diagnostic paradigms may improve clinical practice.
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Affiliation(s)
- Albert L Merati
- Division of Laryngology, Department of Otolaryngology and Communication Sciences and Zablocki VAMC, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
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