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van den Broek EMJM, Mes SD, Heijnen BJ, Langeveld APM, van Benthem PPG, Sjögren EV. Glottic insufficiency caused by vocal fold atrophy with or without sulcus: systematic review of outcome measurements. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08751-5. [PMID: 39025974 DOI: 10.1007/s00405-024-08751-5] [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: 02/19/2024] [Accepted: 05/23/2024] [Indexed: 07/20/2024]
Abstract
PURPOSE Identifying outcome measurements instruments (OMIs) to evaluate treatment efficacy in patients with vocal fold atrophy and/or sulcus. METHODS Systematic review of records published before March 2021 by searching Pubmed and EMBASE. Included studies reported on adults (> 18 year) with dysphonia caused by glottic insufficiency due to vocal fold atrophy with or without sulcus, who were enrolled into a randomized controlled trial, a non-randomized controlled trial, a case-controlled study or a cohort study. All included studies described an intervention with at least one outcome measurement. RESULTS A total of 5456 studies were identified. After removing duplicates, screening title and abstract and full text screening of selected records, 34 publications were included in final analysis. From these 50 separate OMIs were recorded and categorized according to the ELS protocol by DeJonckere et al. (Eur Arch Otorhinolaryngol 258: 77-82, 2001). With most OMIs being used in multiple studies the total number of OMIs reported was 265. Nineteen (19) individual OMIs accounted for 80% of reports. The most frequently used OMIs according to category were: VHI and VHI-10 (subjective evaluation); G of GRBAS (perceptual evaluation); F0, Jitter and Shimmer (acoustic evaluation); MPT and MFR (aerodynamic evaluation) and glottic closure and mucosal wave (endoscopic evaluation). Of these OMIs VHI had a high percentage of significance of 90%. CONCLUSION This systematic review identifies the most used OMIs in patients with glottic incompetency due to vocal fold atrophy and/or sulcus as a step toward defining a Core Outcome Set (COS) for this population. PROSPERO REGISTRATION 238274.
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Affiliation(s)
- Emke M J M van den Broek
- Department of Otorhinolaryngology/Head and Neck Surgery, Leiden University Medical Center, Albinusdreef 2, PO-Box 9600, 2300 RC, Leiden, The Netherlands.
- Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center, Utrecht, The Netherlands.
| | - Stephanie D Mes
- Department of Otorhinolaryngology/Head and Neck Surgery, Leiden University Medical Center, Albinusdreef 2, PO-Box 9600, 2300 RC, Leiden, The Netherlands
| | - Bas J Heijnen
- Department of Otorhinolaryngology/Head and Neck Surgery, Leiden University Medical Center, Albinusdreef 2, PO-Box 9600, 2300 RC, Leiden, The Netherlands
| | - Antonius P M Langeveld
- Department of Otorhinolaryngology/Head and Neck Surgery, Leiden University Medical Center, Albinusdreef 2, PO-Box 9600, 2300 RC, Leiden, The Netherlands
| | - Peter Paul G van Benthem
- Department of Otorhinolaryngology/Head and Neck Surgery, Leiden University Medical Center, Albinusdreef 2, PO-Box 9600, 2300 RC, Leiden, The Netherlands
| | - Elisabeth V Sjögren
- Department of Otorhinolaryngology/Head and Neck Surgery, Leiden University Medical Center, Albinusdreef 2, PO-Box 9600, 2300 RC, Leiden, The Netherlands
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Hackman A, Chen CH, Chen AWG, Chen MK. Automatic Segmentation of Membranous Glottal Gap Area with U-Net-Based Architecture. Laryngoscope 2024; 134:2835-2843. [PMID: 38217455 DOI: 10.1002/lary.31266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/10/2023] [Accepted: 12/21/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND While videostroboscopy is recognized as the most popular approach for investigating vocal fold function, evaluating the numerical values, such as the membranous glottal gap area, remains too time consuming for clinical applications. METHODS We used a total of 2507 videostroboscopy images from 137 patients and developed five U-Net-based deep-learning image segmentation models for automatic masking of the membranous glottal gap area. To further validate the models, we used another 410 images from 41 different patients. RESULTS During development, all five models exhibited acceptable and similar metrics. While the VGG19 U-Net had a long inference time of 1654 ms, the other four models had more practical inference times, ranging from 16 to 138 ms. During further validation, Efficient U-Net demonstrated the highest intersection over union of 0.8455, the highest Dice coefficient of 0.9163, and the lowest Hausdorff distance of 1.5626. The normalized membranous glottal gap area index was also calculated and validated. Efficient U-Net and VGG19 U-Net exhibited the lowest mean squared errors (3.5476 and 3.3842) and the lowest mean absolute errors (1.8835 and 1.8396). CONCLUSIONS Automatic segmentation of the membranous glottal gap area can be achieved through U-net-based architecture. Considering the segmentation quality and speed, Efficient U-Net is a reasonable choice for this task, while the other four models remain valuable competitors. The models' masked area enables possible calculation of the normalized membranous glottal gap area and analysis of the glottal area waveform, revealing promising clinical applications for this model. LEVEL OF EVIDENCE NA Laryngoscope, 134:2835-2843, 2024.
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Affiliation(s)
- Acquah Hackman
- Artificial Intelligence Development Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Chih-Hua Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Andy Wei-Ge Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, Changhua Christian Hospital, Changhua, Taiwan
- Doctoral Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan
- Rong Hsing Translational Medicine Research Center, National Chung Hsing University, Taichung, Taiwan
| | - Mu-Kuan Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, Changhua Christian Hospital, Changhua, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
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Rameau A, Andreadis K, German A, Lachs MS, Rosen TE, Pitzrick MS, Symes LB, Klinck H. Changes in Cough Airflow and Acoustics After Injection Laryngoplasty. Laryngoscope 2023; 133 Suppl 3:S1-S14. [PMID: 35723533 PMCID: PMC9763552 DOI: 10.1002/lary.30255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/05/2022] [Accepted: 06/01/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE/HYPOTHESIS We explored the following hypotheses in a cohort of patients undergoing injection laryngoplasty: (1) glottic insufficiency affects voluntary cough airflow dynamics and restoring glottic competence may improve parameters of cough strength, (2) cough strength can be inferred from cough acoustic signal, and (3) glottic competence changes cough sounds and correlates with spectrogram morphology. STUDY TYPE/DESIGN Prospective interventional study. METHODS Subjects with glottic insufficiency secondary to unilateral vocal fold paresis, paralysis, or atrophy, and scheduled for injection laryngoplasty completed an instrumental assessment of voluntary cough airflow using a pneumotachometer and a protocolized voluntary cough sound recording. A Wilcoxon signed-rank test was used to compare the differences between pre- and post-injection laryngoplasty in airflow and acoustic measures. A Spearman rank-order correlation was used to evaluate the association between airflow and acoustic cough measures. RESULTS Twenty-five patients (13F:12M, mean age 68.8) completed voluntary cough airflow measurements and 22 completed cough sound recordings. Following injection laryngoplasty, patients had a statistically significant decreased peak expiratory flow rise time (PEFRT) (mean change: -0.03 s, SD: 0.06, p = 0.04) and increased cough volume acceleration (mean change: 13.1 L/s2 , SD: 33.9, p = 0.03), suggesting improved cough effectiveness. Correlation of cough acoustic measures with airflow measures showed a weak relationship between PEFRT and acoustic energy (coefficient: -0.31, p = 0.04) and peak power density (coefficient: -0.35, p = 0.02). CONCLUSIONS Our study thus indicates that injection laryngoplasty may help avert aspiration in patients with glottic insufficiency by improving cough effectiveness and that improved cough airflow measures may be tracked with cough sounds. LEVEL OF EVIDENCE 3 Laryngoscope, 133:S1-S14, 2023.
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Affiliation(s)
- Anaïs Rameau
- Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York, U.S.A
| | - Katerina Andreadis
- Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York, U.S.A
| | - Alexander German
- Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York, U.S.A
| | - Mark S Lachs
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, U.S.A
| | - Tony E Rosen
- Department of Emergency Medicine, Weill Cornell Medicine, New York, New York, U.S.A
| | - Michael S. Pitzrick
- K. Lisa Yang Center for Conservation Bioacoustics, Cornell University, Ithaca, New York, U.S.A
| | - Laurel Braden Symes
- K. Lisa Yang Center for Conservation Bioacoustics, Cornell University, Ithaca, New York, U.S.A
| | - Holger Klinck
- K. Lisa Yang Center for Conservation Bioacoustics, Cornell University, Ithaca, New York, U.S.A
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Dwyer CD, Devore E, Kridgen S, Roth D, Winston J, Carroll TL. Preliminary Results on the Safety and Efficacy of Silk-Hyaluronic Acid for Treatment of Glottic Insufficiency. J Voice 2022:S0892-1997(22)00362-9. [PMID: 36529565 DOI: 10.1016/j.jvoice.2022.11.009] [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: 09/22/2022] [Revised: 11/06/2022] [Accepted: 11/07/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Silk-Hyaluronic Acid (Silk-HA) is a novel vocal fold augmentation material that has been used in humans since July 2020. There is a paucity of published data on Silk-HA and its longevity remains a question. This study aimed to evaluate a single surgeon's initial experience performing Silk-HA injection laryngoplasty for the treatment of glottic insufficiency. METHODS Retrospective chart review of Silk-HA injections between July 2020 and December 2021. Subject demographics, diagnoses, volume of material injected, VHI-10 data, and complications were collected. A blinded perceptual voice analysis of voice samples was performed by two voice-specialized speech-language pathologists (SLP) for a subset of unilateral vocal fold paralysis patients before and 3-months following silk-HA injection. Univariate assessment of the change in VHI-10 and perceptual voice analyses at 3-month follow up was determined. RESULTS 58 patients (43.1% female) underwent Silk-HA injection with a mean age of 64 (range 21-88). 38 subjects had unilateral paralysis (65.6%), and the remaining had scar, atrophy, paresis or a combination thereof. 49 injections were unilateral (84.5%). Mean volume of silk injected was 0.26 mL. Complications were rare, most notable though for 2 admissions for dyspnea and laryngoscopic evidence of hemi-laryngeal edema (3.4%). Mean change in CAPE-V overall severity rating was -32.9 (P<0.0001), and VHI-10 was -14.6 ± 10 (P=0.0013). 14 patients underwent a repeat silk-HA injection for ongoing glottic insufficiency (loss of augmentation vs under-augmentation). CONCLUSIONS Preliminary results for Silk-HA show potential for ongoing improvement of glottic insufficiency at 3 months from date of augmentation. Clinician and patient perception of voice outcomes showed overall improvement at three months, though longevity remains to be determined. While overall well tolerated and without serious complications in 96% of the cohort, patients should be counseled on the potential for airway edema and symptomatic dyspnea requiring steroid management and observation.
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Affiliation(s)
- Christopher D Dwyer
- Department of Surgery, Division of Otolaryngology, Brigham & Women's Hospital, Boston, Massachusetts.
| | - Elliana Devore
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Samantha Kridgen
- Department of Surgery, Division of Otolaryngology, Brigham & Women's Hospital, Boston, Massachusetts
| | - Douglas Roth
- Department of Surgery, Division of Otolaryngology, Brigham & Women's Hospital, Boston, Massachusetts
| | - Jennifer Winston
- Department of Surgery, Division of Otolaryngology, Brigham & Women's Hospital, Boston, Massachusetts
| | - Thomas L Carroll
- Department of Surgery, Division of Otolaryngology, Brigham & Women's Hospital, Boston, Massachusetts
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González-Herranz R, Navarro-Mediano A, Hernández-García E, Plaza G. Autologous Adipose Tissue Injection of Vocal Cords in Presbyphonia. Otolaryngol Head Neck Surg 2021; 167:118-124. [PMID: 34546813 DOI: 10.1177/01945998211045292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This series evaluates the long-term results of autologous adipose injection (AAI) in patients older than 65 years with presbyphonia. STUDY DESIGN Retrospective cohort study. SETTING Academic secondary medical center. METHODS This was a retrospective study with a minimum follow-up of 12 months. All patients underwent AAI for atrophy of both vocal folds due to presbyphonia. We measured subjective parameters as Voice Handicap Index-10 (VHI-10) or GRBAS scale (grade, roughness, breathiness, asthenia, strain) and objective measures such as maximum phonation time (MPT) or square pixel closure defect. We reviewed the medical records of patients undergoing AAI during the 2011-2018 period. An analysis of the demographic variables of the group was performed, as well as the values of VHI-10, GRBAS, and MPT, and the minimum closure defect measured in square pixels and the number of closed frames in the glottal cycle before and after the intervention. RESULTS At 12 months, 17 of 18 patients reported subjective and VHI-10 improvement. The mean preoperative VHI-10 (26.7) was significantly higher than the postoperative value (14.4), and the GRBAS scale had a preoperative mean of 8.7 and a postoperative mean of 4.3, both with statistical significance. MPT increased from 7.7 to 12.4 seconds (P < .0001). The minimum closure defect measurements obtained in square pixels changed from 305 to 124, achieving complete closure in 3 patients. The closed phase of the glottal cycle change from 14.3% to 38.2% after the AAI. CONCLUSIONS AAI improves long-term vocal fold closure, demonstrating utility in patients with presbyphonia.
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Affiliation(s)
- Ramón González-Herranz
- Department of Otolaryngology, Hospital Universitario de Fuenlabrada, Madrid, Spain.,Department of Otolaryngology, Hospital Universitario La Zarzuela, Madrid, Spain
| | | | - Estefanía Hernández-García
- Department of Otolaryngology, Hospital Universitario de Fuenlabrada, Madrid, Spain.,Department of Otolaryngology, Hospital Universitario La Zarzuela, Madrid, Spain
| | - Guillermo Plaza
- Department of Otolaryngology, Hospital Universitario de Fuenlabrada, Madrid, Spain.,Department of Otolaryngology, Hospital Universitario La Zarzuela, Madrid, Spain
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Mohd Khairuddin KA, Ahmad K, Mohd Ibrahim H, Yan Y. Description of the Features and Vibratory Behaviors of the Nyquist Plot Analyzed From Laryngeal High-Speed Videoendoscopy Images. J Voice 2020; 36:582.e11-582.e22. [PMID: 32861565 DOI: 10.1016/j.jvoice.2020.07.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/25/2020] [Accepted: 07/27/2020] [Indexed: 11/17/2022]
Abstract
Facilitative playback-based subjective measures offer a more reliable evaluation of the vocal fold vibration than those derived from direct inspection of video playback. One of the measures is a Nyquist plot, which presents the analyzed cycle-to-cycle vibratory information in a graphical form. While the potential is evident, the information of the features of the Nyquist plot, which the evaluation is based on, is still incomplete. The current identified features and their vibratory behaviors may be inadequate to guarantee accurate interpretation of the findings. The present study aims to address this issue by examining the features of the Nyquist plot and their vibratory behaviors. A total of 56 young normophonic speakers, that is, 20 males and 36 females were recruited as the participants. Each of them underwent laryngeal high-speed videoendoscopy to record the images of the vocal fold vibration, which were then analyzed to generate the Nyquist plots. The features were identified by inspecting the properties of the plot points forming the Nyquist plots. For each identified feature, its vibratory behaviors were examined. The results revealed four features: rim contour depicting the longitudinal phase difference; left edge shape signifying the glottal configuration, phase closure, and closed phase duration; rim width and rim pattern visualizing the regularity of glottal areas and the regularity of the intracycle variations, respectively. The findings present a more complete reference of the features and their vibratory behaviors that is pertinent for the Nyquist plot interpretation.
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Affiliation(s)
- Khairy Anuar Mohd Khairuddin
- Speech Sciences Program, Centre for Rehabilitation and Special Needs, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia; Speech Pathology Program, School of Health Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.
| | - Kartini Ahmad
- Speech Sciences Program, Centre for Rehabilitation and Special Needs, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Hasherah Mohd Ibrahim
- Speech Sciences Program, Centre for Rehabilitation and Special Needs, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Yuling Yan
- Department of Bioengineering, School of Engineering, Santa Clara University, California, USA
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Van Doren M, Faudoa E, Carroll TL. Treatment of Patients with Vocal Fold Atrophy and Comorbid Essential Voice Tremor: Long-Term Injection Augmentation Outcomes After Successful Diagnostic Vocal Fold Injection Augmentation. J Voice 2020; 34:471-476. [DOI: 10.1016/j.jvoice.2018.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 10/12/2018] [Accepted: 11/05/2018] [Indexed: 11/29/2022]
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van den Broek EMJM, Heijnen BJ, Hendriksma M, Langeveld APM, van Benthem PPG, Sjögren EV. Bilateral trial vocal fold injection with hyaluronic acid in patients with vocal fold atrophy with or without sulcus. Eur Arch Otorhinolaryngol 2019; 276:1413-1422. [PMID: 30859293 PMCID: PMC6458982 DOI: 10.1007/s00405-019-05347-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 02/13/2019] [Indexed: 11/28/2022]
Abstract
Purpose To evaluate the outcome of bilateral trial vocal fold injection (VFI) with hyaluronic acid in patients with vocal fold atrophy ± sulcus and to assess the predictive value of trial VFI on the outcome of durable medialization procedure. Methods Voice data collected according to a standardized protocol before and one month after trial VFI of 68 patients with vocal fold atrophy (30) and atrophy with sulcus (38) were analyzed. Voice Handicap Index (VHI)-30 was compared to the outcome of a durable medialization at 3 and 12 months. Results The overall VHI-30 improvement was 16.8 points (from 49.9 to 33.1), which was statistically significant and clinically relevant. 57.8% of the patients experienced enough subjective benefit after trial VFI to undergo durable medialization. Of the patients that experienced subjective benefit 62% had a clinically relevant improvement in VHI-30. There was no relevant change in other parameters and no difference between ± sulcus. After durable medialization 90–94% of the patients had VHI-30 scores similar to or better than post-trial VFI. Conclusion The majority of patients experience subjective improvement after bilateral trial VFI indicating that medialization is a valid treatment option for patients with vocal fold atrophy ± sulcus. The VHI-30 only partially overlaps with patients’ subjective evaluation and does not predict which patients will experience subjective improvement. It is, however, predictive for VHI-30 outcome after durable medialization. The aerodynamic and acoustic parameters showed no relevant change. Further identification of voice assessment parameters accurately reflecting the subjective experience of these patients is warranted.
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Affiliation(s)
- Emke M J M van den Broek
- Department of Otorhinolaryngology/Head and Neck Surgery, Leiden University Medical Centre, Albinusdreef 2, PO-Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Bas J Heijnen
- Department of Otorhinolaryngology/Head and Neck Surgery, Leiden University Medical Centre, Albinusdreef 2, PO-Box 9600, 2300 RC, Leiden, The Netherlands
| | - Martine Hendriksma
- Department of Otorhinolaryngology/Head and Neck Surgery, Leiden University Medical Centre, Albinusdreef 2, PO-Box 9600, 2300 RC, Leiden, The Netherlands
| | - Antonius P M Langeveld
- Department of Otorhinolaryngology/Head and Neck Surgery, Leiden University Medical Centre, Albinusdreef 2, PO-Box 9600, 2300 RC, Leiden, The Netherlands
| | - Peter Paul G van Benthem
- Department of Otorhinolaryngology/Head and Neck Surgery, Leiden University Medical Centre, Albinusdreef 2, PO-Box 9600, 2300 RC, Leiden, The Netherlands
| | - Elisabeth V Sjögren
- Department of Otorhinolaryngology/Head and Neck Surgery, Leiden University Medical Centre, Albinusdreef 2, PO-Box 9600, 2300 RC, Leiden, The Netherlands
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Voice outcome measures after flexible endoscopic injection laryngoplasty. World J Otorhinolaryngol Head Neck Surg 2018; 4:130-134. [PMID: 30101223 PMCID: PMC6074013 DOI: 10.1016/j.wjorl.2018.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 04/17/2018] [Indexed: 11/22/2022] Open
Abstract
Objective To report voice outcome measures after injection laryngoplasty using the transnasal or transoral flexible endoscopic technique. Methods A retrospective review of all patients who underwent flexible endoscopic injection laryngoplasty between June 2010 and August 2016 was carried out. Only those patients who had pre- and post-injection voice outcome measures recorded were included. Voice outcome measures recorded included perceptual voice evaluation using GRBAS, Voice Handicap Index-10 (VHI-10), maximum phonation time (MPT) and closed quotient (CQ) before and after treatment. Results Forty-six patients were identified, of which 32 had pre- and post-injection voice outcome measures recorded. There were 19 males and 13 females. The mean age was 56.97 years (range 20-86 years) and the most common indication was unilateral vocal fold paralysis. Thirteen patients had a transnasal flexible endoscopic injection), while 19 patients were injected transorally. Following injection laryngoplasty, there was significant improvement in the mean grade of dysphonia (2.81 vs. 1.22, P < 0.01, roughness (2.44 vs. 1.34, P < 0.01), breathiness (2.72 vs. 1.13, P < 0.01), asthenia (2.78 vs. 1.06, P < 0.01), and strain (2.44 vs. 1.19, P < 0.01), MPT (3.85 s vs. 9.85 s, P < 0.01) and mean CQ (0.19 vs. 0.46, P < 0.01). There was also a decrease in the mean VHI-10 score (33.31 vs. 7.94, P < 0.01). Conclusion s: Patients achieved significant improvement in both subjective and objective voice measures after flexible endoscopic injection laryngoplasty via the nasal or transoral route. Voice outcomes were comparable to those reported for other approaches. This technique provides an alternative approach for the management of patients with vocal fold paralysis or glottal insufficiency.
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Hu HC, Hung YT, Lin SY, Tung TH, Chang SY. Office-Based Autologous Fat Injection Laryngoplasty for Glottic Insufficiency in Patients Under 50 Years Old. J Voice 2018; 33:747-750. [PMID: 29678440 DOI: 10.1016/j.jvoice.2018.03.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 03/13/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We sought to determine the outcomes of office-based autologous fat injection laryngoplasty in the treatment of patients under 50 years old with glottic insufficiency but without neurological problems or acquired organic lesions in the vocal fold. METHODS We conducted a retrospective chart review of consecutive patients under 50 years of age who underwent office-based autologous fat injection laryngoplasty for glottic insufficiency. None of the patients presented neurological problems or acquired organic lesions in the vocal fold. Videolaryngostroboscopic data, objective voice assessment, perceptual measurements of vocal quality, and subjective ratings of voice quality were evaluated before and after treatment. RESULTS The 23 patients (7 men and 16 women) in this study presented significant improvements in phonatory function in terms of maximum phonation time, jitter, grade, asthenia, and Voice Handicap Index-10 (VHI-10) values at 3 months. Significant improvements in terms of jitter, noise-to-harmonic ratio, grade, roughness, breathiness, asthenia, and the VHI-10 values were also observed at 6 months. CONCLUSIONS Glottic insufficiency in younger patients without neurological problems or acquired organic lesions in the vocal fold can be treated effectively using office-based autologous fat injection laryngoplasty. Significant improvements in phonatory function were observed even 6 months after surgery.
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Affiliation(s)
- Hao-Chun Hu
- Department of Otorhinolaryngology-Head and Neck Surgery, Fu Jen Catholic University Hospital, New Taipei, Taiwan; Voice Center, Department of Otolaryngology, Cheng Hsin General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan
| | - Yi-Ting Hung
- Voice Center, Department of Otolaryngology, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Shu-Yi Lin
- Voice Center, Department of Otolaryngology, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Tao-Hsin Tung
- Department of Medical Research and Education, Cheng Hsin General Hospital, Taipei, Taiwan; Department of Public Health, Fu Jen Catholic University, New Taipei, Taiwan
| | - Shyue-Yih Chang
- Voice Center, Department of Otolaryngology, Cheng Hsin General Hospital, Taipei, Taiwan; Department of Otolaryngology, National Yang-Ming University, Taipei, Taiwan.
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Carroll TL, Faudoa E, Van Doren M. Evaluation of a Shorter Follow-up Time to Capture Benefit of a Trial Vocal Fold Augmentation. J Voice 2018; 33:169-175. [PMID: 29373176 DOI: 10.1016/j.jvoice.2017.10.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/18/2017] [Accepted: 10/19/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Trial vocal fold injection (TVFI) is employed diagnostically for patients with subtle glottic insufficiency to explore potential for improvement. Clinical experience demonstrates the time to and length of peak benefit of the TVFI is variable. Previous studies collected data 4 weeks or more after TVFI. The aim of this study was to compare subjectively successful and unsuccessful TVFI patient groups. It is hypothesized that patients with subjectively reported success will also have significant improvements in Voice Handicap Index-10 (VHI-10), phase closure percentage, and aerodynamic measures 2 weeks after trial augmentation. METHODS/DESIGN Subjects with glottic insufficiency were included in this retrospective review if they underwent office-based, per-oral vocal fold injection augmentation specifically for trial purposes. Patients were divided into "successful" and "unsuccessful" groups based on their subjective experience during the 2-week post-TVFI period. VHI-10, subjective report, phase closure evaluation using frame-by-frame analysis, and aerodynamic data were collected pre- and 2 weeks post-TVFI. RESULTS Of the subjects, 15 of 23 (65%) reported a successful subjective improvement of their symptom, whereas 8 (35%) were unsuccessful (only partial improvement or no improvement). The number of subjects with an improvement in VHI-10 by 5 or more points was not significantly different between groups. The number of subjects that demonstrated complete, long phase closure was significantly higher in the successful group (P = 0.021). CONCLUSIONS The understanding of how to more precisely determine the success of TVFI remains incomplete. Subjective improvement of successful TVFI was captured with basic clinical questioning, yet the VHI-10 was unable to confidently demonstrate this reported success 2 weeks after TVFI.
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Affiliation(s)
- Thomas L Carroll
- Department of Surgery, Division of Otolaryngology, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Elizabeth Faudoa
- Department of Surgery, Division of Otolaryngology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Maxine Van Doren
- Department of Surgery, Division of Otolaryngology, Brigham and Women's Hospital, Boston, Massachusetts
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Litts JK, Fink DS, Clary MS. The effect of vocal fold augmentation on cough symptoms in the presence of glottic insufficiency. Laryngoscope 2017; 128:1316-1319. [DOI: 10.1002/lary.26914] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 07/24/2017] [Accepted: 08/19/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Juliana K. Litts
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Colorado School of MedicineAurora Colorado U.S.A
| | - Daniel S. Fink
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Colorado School of MedicineAurora Colorado U.S.A
| | - Matthew S. Clary
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Colorado School of MedicineAurora Colorado U.S.A
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Estes C, Sadoughi B, Mauer E, Christos P, Sulica L. Laryngoscopic and stroboscopic signs in the diagnosis of vocal fold paresis. Laryngoscope 2017; 127:2100-2105. [DOI: 10.1002/lary.26570] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 01/20/2017] [Accepted: 02/13/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Christine Estes
- Department of Otolaryngology-Head and Neck Surgery; Sean Parker Institute for the Voice; New York New York U.S.A
| | - Babak Sadoughi
- Department of Otolaryngology-Head and Neck Surgery; Sean Parker Institute for the Voice; New York New York U.S.A
| | - Elizabeth Mauer
- Department of Biostatistics and Epidemiology; Weill Cornell Medical College; New York New York U.S.A
| | - Paul Christos
- Department of Biostatistics and Epidemiology; Weill Cornell Medical College; New York New York U.S.A
| | - Lucian Sulica
- Department of Otolaryngology-Head and Neck Surgery; Sean Parker Institute for the Voice; New York New York U.S.A
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Hu HC, Hung YT, Lin SY, Chang SY. Office-based Autologous Fat Injection Laryngoplasty for Vocal Process Granuloma. J Voice 2015; 30:758.e7-758.e11. [PMID: 26454769 DOI: 10.1016/j.jvoice.2015.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 09/03/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To present the outcomes of office-based autologous fat injection laryngoplasty for the treatment of vocal process granuloma in conjunction with glottic insufficiency. STUDY DESIGN Retrospective chart review. METHODS This study included nine patients with vocal process granuloma in conjunction with glottic insufficiency who received autologous fat injection laryngoplasty. Videolaryngostroboscopic data, objective voice assessment, perceptual measurements of vocal quality, and subjective ratings of voice quality were examined before and after treatment. RESULTS Of the nine patients, seven (78%) exhibited complete remission. The other two patients (22%) exhibited a partial response following the injection. In a subgroup of five patients who were refractory to antireflux and voice therapies, the resolution rate was 60%. Phonatory function presented significant improvements in jitter, noise-to-harmonic ratio, maximal phonation time, and asthenia. Videolaryngostroboscopic rating revealed significant improvements in closure phase ratio in the vibratory cycle. CONCLUSIONS Autologous fat injection laryngoplasty can ameliorate glottic insufficiency and the resulting hyperfunctional behavior of the larynx. This therapy also encourages remission of vocal process granuloma and may represent an alternative treatment strategy.
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Affiliation(s)
- Hao-Chun Hu
- Voice Clinic, Department of Otolaryngology, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Yi-Ting Hung
- Voice Clinic, Department of Otolaryngology, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Shu-Yi Lin
- Voice Clinic, Department of Otolaryngology, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Shyue-Yih Chang
- Voice Clinic, Department of Otolaryngology, Cheng Hsin General Hospital, Taipei, Taiwan; Department of Otolaryngology, National Yang-Ming University, Taipei, Taiwan..
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Abstract
OBJECTIVES The objective of this study was to evaluate the role of transnasal fiber-optic injection laryngoplasty in the treatment of glottic insufficiency. METHODS Video recordings of 16 patients who underwent fiber-optic injection laryngoplasty for the treatment of glottic insufficiency were reviewed. Outcome measures included perceptual evaluation using the GRBAS (grading, roughness, breathiness, asthenia, straining) classification, laryngeal videostroboscopy, and frame-by-frame analysis to assess the extent, shape, and duration of glottic closure. RESULTS Nine patients were ultimately included in this study. Their mean age was 66.2 years, with 7 men and 2 women. The most common symptoms were dysphonia and aspiration, and the most common diagnosis was vocal fold paralysis. Patients underwent transnasal fiber-optic injection laryngoplasty with hyaluronic acid as a filling material (0.2-0.8 mL). The procedure was well tolerated by all patients, with improvement in the phonatory symptoms and aspiration in 66.66% and 50% of patients, respectively. There were significant decreases in the mean scores of all perceptual parameters (P<.05 for all). All subjects had glottal gap preoperatively that was closed completely in 66.66% and reduced to <2 mm in 33.33%. The mean closed quotient significantly increased from 0.10 to 0.51 (P<.05). CONCLUSIONS Transnasal fiber-optic injection laryngoplasty is a safe procedure well tolerated by patients with good results.
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Affiliation(s)
- Abdul-Latif Hamdan
- Department of Otolaryngology - Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Georges Ziade
- Department of Otolaryngology - Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hussein Jaffal
- Department of Otolaryngology - Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ghassan Skaff
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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Patel AK, Mildenhall NR, Kim W, Carroll TL. Symptom overlap between laryngopharyngeal reflux and glottic insufficiency in vocal fold atrophy patients. Ann Otol Rhinol Laryngol 2014; 123:265-70. [PMID: 24671482 DOI: 10.1177/0003489414525021] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine in true vocal fold (TVF) atrophy patients if symptoms of throat clearing and mucus sensation, attributed to laryngopharyngeal reflux (LPR), are due to glottic insufficiency. Is the TVF atrophy population being prescribed proton pump inhibitors unnecessarily? METHODS A retrospective review of patients with TVF atrophy but no other underlying laryngeal pathology seen at a tertiary voice center from July 2009 to May 2012 was conducted. Patient demographics, symptoms, LPR diagnosis, interventions, and pre-intervention and post-intervention Voice Handicap Index-10 (VHI) and Reflux Symptom Index (RSI) scores were recorded. RESULTS Twenty-six patients met inclusion criteria, and 85% were treated for LPR. Throat clearing and mucus sensation (85%), dysphonia (54%), and globus sensation (46%) were recorded. Interventions included LPR medical management (65%), vocal fold augmentation (23%), and voice therapy (12%). Reflux Symptom Index scores improved in all groups. Voice Handicap Index-10 and RSI scores normalized in patients treated with augmentation. Globus was never present in patients who received augmentation. CONCLUSION Throat clearing and mucus sensation may be due to underlying glottic insufficiency and changes of the aging larynx rather than LPR. High VHI and RSI scores normalized with TVF augmentation. Further work is needed to evaluate symptom presentation and risk versus benefit of treatment options, especially if it avoids unnecessary proton pump inhibitor trials.
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Affiliation(s)
- Anju K Patel
- Department of Otolaryngology, Tufts Medical Center, Boston, Massachusetts, USA
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Cohen SM, Thomas S, Roy N, Kim J, Courey M. Frequency and factors associated with use of videolaryngostroboscopy in voice disorder assessment. Laryngoscope 2014; 124:2118-24. [PMID: 24659429 DOI: 10.1002/lary.24688] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 03/19/2014] [Accepted: 03/21/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Videolaryngostroboscopy (VLS) is considered an important diagnostic tool in the evaluation of patients with laryngeal/voice disorders. We evaluated the frequency of, diagnoses associated with, and factors related to VLS use in the evaluation of outpatients with laryngeal/voice disorders. STUDY DESIGN Retrospective analysis of a large, national administrative U.S. claims database. METHODS Patients with a laryngeal disorder based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes from January 1, 2004, to December 31, 2008, seen by an otolaryngologist were included. Patient age, gender, geographic region, laryngeal diagnosis, comorbid conditions, and whether laryngoscopy or VLS was performed during the outpatient otolaryngology visit were collected. RESULTS A total of 168,444 unique patients saw an otolaryngologist for 272,112 outpatient visits. Of those, 6.2% of outpatient otolaryngology visits had a VLS performed. Patient age was related to VLS use, with lower odds in the elderly (≥ 65 years of age) and those 0 to 17 years of age. Geographic variation was noted, with higher odds of VLS use in urban versus rural areas and greater odds in the Northeast versus the South. Laryngeal diagnosis was associated with VLS use with greatest odds for patients with multiple diagnoses, vocal fold paralysis, and paresis-followed by nonspecific dysphonia and benign vocal fold/laryngeal pathology and followed by acute and chronic laryngitis and laryngeal cancer. Patients with gastro-esophageal reflux (GER) had greater odds of VLS use than patients without GER. CONCLUSIONS VLS was used in 6.2% of outpatient otolaryngology outpatient visits; and its use was influenced by multiple factors.
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Affiliation(s)
- Seth M Cohen
- Duke Voice Care Center, Division of Otolaryngology-Head & Neck Surgery, Duke University Medical Center, Durham, North Carolina
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