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Maddox A, Oren L, Farbos de Luzan C, Howell R, Gutmark E, Khosla S. An Ex-vivo Model Examining Acoustics and Aerodynamic Effects Following Medialization With and Without Arytenoid Adduction. Laryngoscope 2023; 133:621-627. [PMID: 35655422 PMCID: PMC9715814 DOI: 10.1002/lary.30235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 05/03/2022] [Accepted: 05/07/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Quantify differences in acoustics and intraglottal flow fields between Thyroplasty Type 1 (TT1) with and without arytenoid adduction (AA) using excised canine larynx model. STUDY DESIGN Basic science experiments using excised larynges. METHODS Surgical procedures were implemented in eight excised canine larynges. Acoustics and intraglottal flow measurements were taken at low and high subglottal pressures in each experimental setup. RESULTS In all larynges, vocal efficiency (VE) and cepstrum peak prominence (CPP) were higher, and the mean phonatory flow rate was lower in TT1 with AA than without AA. The glottal asymmetry is reduced with AA and promotes the formation of stronger vortices in the glottal flow during the closing phase of the vibrating folds. CONCLUSIONS Findings suggest a clear acoustic and aerodynamic benefit to the addition of AA when performing TT1. It shows significant improvement in CPP, translating to decreased breathiness and dysphonia and increased VE, leading to easier and more sustainable phonation. Stronger intraglottal vortices are known to be correlated with the loudness of voice produced by phonation. LEVEL OF EVIDENCE N/A Laryngoscope, 133:621-627, 2023.
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Affiliation(s)
- Alexandra Maddox
- Department of Aerospace Engineering and Engineering Mechanics, University of Cincinnati, Cincinnati, Ohio, USA
| | - Liran Oren
- Department of Otolaryngology Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Charles Farbos de Luzan
- Department of Otolaryngology Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Rebecca Howell
- Department of Otolaryngology Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Ephraim Gutmark
- Department of Aerospace Engineering and Engineering Mechanics, University of Cincinnati, Cincinnati, Ohio, USA
| | - Sid Khosla
- Department of Otolaryngology Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
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Comparative Study on the Effects of Surface Neuromuscular Electrical Stimulation Between Subjects With Unilateral Vocal Fold Paralysis in the Paramedian and Median Positions. J Voice 2022. [DOI: 10.1016/j.jvoice.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Maximum vocal intensity as a primary outcome measure in unilateral vocal fold paralysis patients. The Journal of Laryngology & Otology 2020; 134:1085-1093. [PMID: 33308327 DOI: 10.1017/s0022215120002558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate voice intensity as the primary outcome measurement when treating unilateral vocal fold paralysis patients. METHODS This prospective observational study comprised 34 newly diagnosed unilateral vocal fold paralysis patients undergoing surgical interventions: injection laryngoplasty or medialisation thyroplasty. Voice assessments, including maximum vocal intensity and other acoustic parameters, were performed at baseline and at one and three months post-intervention. Maximum vocal intensity was also repeated within two weeks before any surgical interventions were performed. The results were compared between different time points and between the two intervention groups. RESULTS Maximum vocal intensity showed high internal consistency. Statistically significant improvements were seen in maximum vocal intensity, Voice Handicap Index-10 and other acoustic analyses at one and three months post-intervention. A significant moderate negative correlation was demonstrated between maximum vocal intensity and Voice Handicap Index-10, shimmer and jitter. There were no significant differences in voice outcomes between injection laryngoplasty and medialisation thyroplasty patients at any time point. CONCLUSION Maximum vocal intensity can be applied as a treatment outcome measure in unilateral vocal fold paralysis patients; it can demonstrate the effectiveness of treatment and moderately correlates with self-reported outcome measures.
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Ryu CH, Kwon TK, Kim H, Kim HS, Park IS, Woo JH, Lee SH, Lee SW, Lim JY, Kim ST, Jin SM, Choi SH. Guidelines for the Management of Unilateral Vocal Fold Paralysis From the Korean Society of Laryngology, Phoniatrics and Logopedics. Clin Exp Otorhinolaryngol 2020; 13:340-360. [PMID: 32877965 PMCID: PMC7669319 DOI: 10.21053/ceo.2020.00409] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 04/13/2020] [Indexed: 01/08/2023] Open
Abstract
The Korean Society of Laryngology, Phoniatrics and Logopedics appointed a task force to establish clinical practice guidelines for the management of unilateral vocal fold paralysis (UVFP). These guidelines cover a comprehensive range of management-related factors, including the diagnosis and treatment of UVFP, and provide in-depth information based on current, up-to-date knowledge. Detailed evidence profiles are provided for each recommendation. The CORE databases, including OVID Medline, Embase, the Cochrane Library, and KoreaMed, were searched to identify all relevant papers, using a predefined search strategy. When insufficient evidence existed, expert opinions and Delphi questionnaires were used to fill the evidence gap. The committee developed 16 evidence-based recommendations in six categories: initial evaluation (R1–4), spontaneous recovery (R5), medical treatment (R6), surgical treatment (R7–14), voice therapy (R15), and aspiration prevention (R16). The goal of these guidelines is to assist general otolaryngologists and speech-language pathologists who are primarily responsible for treating patients with UVFP. These guidelines are also intended to facilitate understanding of the condition among other health-care providers, including primary care physicians, nurses, and policy-makers.
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Affiliation(s)
| | | | - Chang Hwan Ryu
- Department of Otorhinolaryngology-Head Neck Surgery, National Cancer Center, Goyang, Korea
| | - Tack-Kyun Kwon
- Department of Otorhinolaryngology-Head Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Heejin Kim
- Department of Otorhinolaryngology-Head Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Han Su Kim
- Department of Otorhinolaryngology-Head Neck Surgery, Ewha Womans University College of Medcine, Seoul, Korea
| | - Il-Seok Park
- Department of Otorhinolaryngology-Head Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Joo Hyun Woo
- Department of Otorhinolaryngology-Head Neck Surgery, Gachon University College of Medicine, Incheon, Korea
| | - Sang-Hyuk Lee
- Department of Otorhinolaryngology-Head Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Won Lee
- Department of Otorhinolaryngology-Head Neck Surgery, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jae-Yol Lim
- Department of Otorhinolaryngology-Head Neck Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seong-Tae Kim
- Department of Speech-Language Pathology, Dongshin University, Naju, Korea
| | - Sung-Min Jin
- Department of Otorhinolaryngology-Head Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Ho Choi
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Evaluation of upper oesophageal sphincter in unilateral vocal fold paralysis. The Journal of Laryngology & Otology 2019; 133:149-154. [PMID: 30706840 DOI: 10.1017/s0022215119000045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To evaluate dysphagia and manometric changes in the upper oesophageal sphincter in patients with unilateral vocal fold paralysis. METHODS Thirty patients with unilateral vocal fold paralysis due to vagal nerve paralysis scheduled for evaluation were enrolled in the study group; 24 healthy subjects were included in the control group. Upper oesophageal sphincter basal and residual pressure, relaxation time, and pharyngeal pressure values were evaluated by manometry. All patients completed the Turkish Eating Assessment Tool 10 questionnaire, the MD Anderson dysphagia questionnaire and the reflux symptom index form. RESULTS Swallowing assessment questionnaires and reflux symptom index results were significantly higher in the study group. Upper oesophageal sphincter basal and relaxation pressures were lower in the study group. Upper oesophageal sphincter relaxation time was shorter in the study group, but pressure values recorded from the pharynx were higher. CONCLUSION Upper oesophageal sphincter manometric pressure was lower in patients with unilateral vocal fold paralysis. A hypotonic sphincter likely contributes to dysphagia and aspiration.
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Irace AL, Dombrowski ND, Kawai K, Dodrill P, Perez J, Hernandez K, Davidson K, Hseu A, Nuss R, Rahbar R. Aspiration in children with unilateral vocal fold paralysis. Laryngoscope 2018; 129:569-573. [DOI: 10.1002/lary.27410] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Alexandria L. Irace
- Department of Otolaryngology and Communication Enhancement; Boston Children's Hospital; Boston Massachusetts
| | - Natasha D. Dombrowski
- Department of Otolaryngology and Communication Enhancement; Boston Children's Hospital; Boston Massachusetts
| | - Kosuke Kawai
- Department of Otolaryngology and Communication Enhancement; Boston Children's Hospital; Boston Massachusetts
- Department of Otolaryngology; Harvard Medical School; Boston Massachusetts U.S.A
| | - Pamela Dodrill
- Department of Otolaryngology and Communication Enhancement; Boston Children's Hospital; Boston Massachusetts
| | - Jennifer Perez
- Department of Otolaryngology and Communication Enhancement; Boston Children's Hospital; Boston Massachusetts
| | - Kayla Hernandez
- Department of Otolaryngology and Communication Enhancement; Boston Children's Hospital; Boston Massachusetts
| | - Kathryn Davidson
- Department of Otolaryngology and Communication Enhancement; Boston Children's Hospital; Boston Massachusetts
| | - Anne Hseu
- Department of Otolaryngology and Communication Enhancement; Boston Children's Hospital; Boston Massachusetts
- Department of Otolaryngology; Harvard Medical School; Boston Massachusetts U.S.A
| | - Roger Nuss
- Department of Otolaryngology; Harvard Medical School; Boston Massachusetts U.S.A
| | - Reza Rahbar
- Department of Otolaryngology and Communication Enhancement; Boston Children's Hospital; Boston Massachusetts
- Department of Otolaryngology; Harvard Medical School; Boston Massachusetts U.S.A
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Misono S, Marmor S, Roy N, Mau T, Cohen SM. Multi-institutional Study of Voice Disorders and Voice Therapy Referral: Report from the CHEER Network. Otolaryngol Head Neck Surg 2017; 155:33-41. [PMID: 27371624 DOI: 10.1177/0194599816639244] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 02/25/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To assess perspectives of patients with voice problems and identify factors associated with the likelihood of referral to voice therapy via the CHEER (Creating Healthcare Excellence through Education and Research) practice-based research network infrastructure. STUDY DESIGN Prospectively enrolled cross-sectional study of CHEER patients seen for a voice problem (dysphonia). SETTING The CHEER network of community and academic sites. METHODS Patient-reported demographic information, nature and severity of voice problems, clinical diagnoses, and proposed treatment plans were collected. The relationship between patient factors and voice therapy referral was investigated. RESULTS Patients (N = 249) were identified over 12 months from 10 sites comprising 30 otolaryngology physicians. The majority were women (68%) and white (82%). Most patients reported a recurrent voice problem (72%) and symptom duration >4 weeks (89%). The most commonly reported voice-related diagnoses were vocal strain, reflux, and benign vocal fold lesions. Sixty-seven percent of enrolled patients reported receiving a recommendation for voice therapy. After adjusting for sociodemographic and other factors, diagnoses including vocal strain/excessive tension and vocal fold paralysis and academic practice type were associated with increased likelihood of reporting a referral for voice therapy. CONCLUSIONS The CHEER network successfully enrolled a representative sample of patients with dysphonia. Common diagnoses were vocal strain, reflux, and benign vocal fold lesions; commonly reported treatment recommendations included speech/voice therapy and antireflux medication. Recommendation for speech/voice therapy was associated with academic practice type.
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Affiliation(s)
- Stephanie Misono
- Lions Voice Clinic, Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Schelomo Marmor
- Lions Voice Clinic, Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Nelson Roy
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City, Utah, USA
| | - Ted Mau
- Clinical Center for Voice Care, Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Seth M Cohen
- Duke Voice Care Center, Division of Otolaryngology-Head and Neck Surgery, Duke University Medical Center, Durham, North Carolina, USA
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Cates DJ, Venkatesan NN, Strong B, Kuhn MA, Belafsky PC. Effect of Vocal Fold Medialization on Dysphagia in Patients with Unilateral Vocal Fold Immobility. Otolaryngol Head Neck Surg 2016; 155:454-7. [PMID: 27165683 DOI: 10.1177/0194599816645765] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 04/01/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The effect of vocal fold medialization (VFM) on vocal improvement in persons with unilateral vocal fold immobility (UVFI) is well established. The effect of VFM on the symptom of dysphagia is uncertain. The purpose of this study is to evaluate dysphagia symptoms in patients with UVFI pre- and post-VFM. STUDY DESIGN Case series with chart review. SETTING Academic tertiary care medical center. SUBJECTS AND METHODS The charts of 44 persons with UVFI who underwent VFM between June 1, 2013, and December 31, 2014, were abstracted from a prospectively maintained database at the University of California, Davis, Voice and Swallowing Center. Patient demographics, indications, and type of surgical procedure were recorded. Self-reported swallowing impairment was assessed with the validated 10-item Eating Assessment Tool (EAT-10) before and after surgery. A paired samples t test was used to compare pre- and postmedialization EAT-10 scores. RESULTS Forty-four patients met criteria and underwent either vocal fold injection (73%) or thyroplasty (27%). Etiologies of vocal fold paralysis were iatrogenic (55%), idiopathic (29%), benign or malignant neoplastic (9%), traumatic (5%), or related to the late effects of radiation (2%). EAT-10 (mean ± SD) scores improved from 12.2 ± 11.1 to 7.7 ± 7.2 after medialization (P < .01) with a follow-up of 119 ± 65 days. CONCLUSION Patients with UVFI suffer from dysphagia and report significant improvement in swallowing symptoms following VFM. The symptomatic improvement appears to be durable over time.
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Affiliation(s)
- Daniel J Cates
- Department of Otolaryngology Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Naren N Venkatesan
- Department of Otolaryngology Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Brandon Strong
- Department of Otolaryngology Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Maggie A Kuhn
- Department of Otolaryngology Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Peter C Belafsky
- Department of Otolaryngology Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
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Oren L, Khosla S, Gutmark E. Effect of vocal fold asymmetries on glottal flow. Laryngoscope 2016; 126:2534-2538. [PMID: 26972976 DOI: 10.1002/lary.25948] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 01/29/2016] [Accepted: 02/04/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Voice disorders, such as unilateral vocal fold paralysis or paresis, and vocal fold scarring feature structural asymmetries of the vocal folds. Studies on how structural asymmetries affect voice has mostly been limited to computational simulations and experiments on mechanical models. The purpose of the current study is to examine the effects of asymmetries in left-right position, height, and length of the vocal folds on the intraglottal flow characteristics, as well as acoustics in the canine larynx model. STUDY DESIGN Basic science. METHODS Measurements of intraglottal flow velocity fields were taken in excised canine larynges using particle image velocimetry. Asymmetries of the vocal folds are induced by translating the vocal processes in space using a prong apparatus connected to a micrometer. RESULTS Asymmetries in length height and abduction produced a reduction in the intraglottal vortices strength and subsequently the glottal efficiency. CONCLUSION Current findings can affect future recommendations for surgical interventions that are used to treat unilateral vocal fold paralysis. LEVEL OF EVIDENCE NA Laryngoscope, 126:2534-2538, 2016.
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Affiliation(s)
- Liran Oren
- Department of Otolaryngology Head and Neck Surgery, University of Cincinnati College of Medicine and Neurosensory Disorder Center at UC Neuroscience Institute, Cincinnati, Ohio, U.S.A..
| | - Sid Khosla
- Department of Otolaryngology Head and Neck Surgery, University of Cincinnati College of Medicine and Neurosensory Disorder Center at UC Neuroscience Institute, Cincinnati, Ohio, U.S.A
| | - Ephraim Gutmark
- Department of Aerospace Engineering and Engineering Mechanics, University of Cincinnati, Cincinnati, Ohio, U.S.A
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El-Banna M, Youssef G. Early Voice Therapy in Patients with Unilateral Vocal Fold Paralysis. Folia Phoniatr Logop 2015; 66:237-43. [DOI: 10.1159/000369167] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Medialization thyroplasty using autologous nasal septal cartilage for treating unilateral vocal fold paralysis. Clin Exp Otorhinolaryngol 2011; 4:142-8. [PMID: 21949581 PMCID: PMC3173706 DOI: 10.3342/ceo.2011.4.3.142] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Accepted: 07/22/2011] [Indexed: 11/24/2022] Open
Abstract
Objectives A persistent insufficiency of glottal closure is mostly a consequence of impaired unilateral vocal fold movement. Functional surgical treatment is required because of the consequential voice, breathing and swallowing impairments. The goal of the study was to determine the functional voice outcomes after medialization thyroplasty with using autologous septal cartilage from the nose. Methods External vocal fold medialization using autologous nasal septal cartilage was performed on 15 patients (6 females and 9 males; age range, 30 to 57 years). Detailed functional examinations were performed for all the patients before and after the surgery and this included perceptual voice assessment, laryngostroboscopic examination and acoustic voice analysis. Results All the patients reported improvement of voice quality post-operatively. Laryngostroboscopy revealed almost complete glottal closure after surgery in the majority of patients. Acoustic and perceptual voice assessment showed significant improvement post-operatively. Conclusion Medialization thyroplasty using an autologous nasal septal cartilage implant offers good tissue tolerability and significant improvement of the subjective and objective functional voice outcomes.
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Hamdan AL, Ashkar J, Sibai A, Oubari D, Husseini ST. Effect of fasting on voice in males. Am J Otolaryngol 2011; 32:124-9. [PMID: 20392525 DOI: 10.1016/j.amjoto.2009.12.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Revised: 11/09/2009] [Accepted: 12/29/2009] [Indexed: 11/28/2022]
Abstract
PURPOSE OF THE STUDY The aim of the study was to study how fasting between 12 and 14 hours affects voice production. STUDY DESIGN This is a prospective study of male subjects. MATERIAL AND METHOD A total of 26 healthy male subjects were recruited for the study. The age varied between 22 and 50 years with a mean of 28 years. Exclusion criteria included hoarseness at the time of presentation, history of recent upper respiratory tract infection, or microlaryngeal surgery. Subjects were evaluated while fasting and nonfasting. Each subject was asked about vocal fatigue and ease of phonation. This was followed by acoustic analyses and laryngeal videostroboscopy. RESULTS The incidence of vocal fatigue was not higher while fasting compared to nonfasting (P = 1.00). Phonatory effort was significantly greater during fasting (P < .001). Fifty percent of the subjects had an increase in their phonatory effort. There was a significant decrease in the habitual pitch, voice turbulence index, and noise-to-harmonic ratio (P = .018, .045, and .001, respectively). There were no laryngeal videostroboscopic changes. CONCLUSION Fasting in males results in an increase in phonatory effort. These phonatory changes may be secondary to dehydration as well as overall neuromuscular fatigability.
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Affiliation(s)
- Abdul-Latif Hamdan
- Department of Otolaryngology, American University of Beirut Medical Center, Lebanon.
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Mattioli F, Bergamini G, Alicandri-Ciufelli M, Molteni G, Luppi MP, Nizzoli F, Grammatica A, Presutti L. The role of early voice therapy in the incidence of motility recovery in unilateral vocal fold paralysis. LOGOP PHONIATR VOCO 2011; 36:40-7. [DOI: 10.3109/14015439.2011.554433] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Van Daele DJ. Quantitative PCR analysis of laryngeal muscle fiber types. JOURNAL OF COMMUNICATION DISORDERS 2010; 43:327-334. [PMID: 20430402 PMCID: PMC4530018 DOI: 10.1016/j.jcomdis.2010.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2010] [Revised: 03/21/2010] [Accepted: 03/23/2010] [Indexed: 05/29/2023]
Abstract
UNLABELLED Voice and swallowing dysfunction as a result of recurrent laryngeal nerve paralysis can be improved with vocal fold injections or laryngeal framework surgery. However, denervation atrophy can cause late-term clinical failure. A major determinant of skeletal muscle physiology is myosin heavy chain (MyHC) expression, and previous protein analyses have shown changes in laryngeal muscle fiber MyHC isoform with denervation. RNA analyses in this setting have not been performed, and understanding RNA levels will allow interventions better designed to reverse processes such as denervation in the future. Total RNA was extracted from bilateral rat thyroarytenoid (TA), posterior cricoarytenoid (PCA), and cricothyroid (CT) muscles in rats. Primers were designed using published MyHC isoform sequences. SYBR Green real-time reverse transcription-polymerase chain reaction (SYBR-RT-PCR) was used for quantification. The electropherogram showed a clear separation of total RNA to 28S and 18S subunits. Melting curves illustrated single peaks for all type MyHC primers. All MyHC isoforms were identified in all muscles with various degrees of expression. Quantitative PCR is a sensitive method to detect MyHC isoforms in laryngeal muscle. Isoform expression using mRNA analysis was similar to previous analyses but showed some important differences. This technique can be used to quantitatively assess response to interventions targeted to maintain muscle bulk after denervation. LEARNING OUTCOMES (1) Readers will be able to describe the relationship between myosin heavy chain expression and muscle contractile properties. (2) Readers will be able to separate myosin heavy chain isoforms into slow and fast twitch phenotypes. (3) Readers will be able to describe differential muscle isoform expression between different laryngeal muscles. (4) Readers will be able to compare this study to other modalities of determining muscle fiber type.
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Affiliation(s)
- Douglas J Van Daele
- Department of Otolaryngology - Head and Neck Surgery, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
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Idiopathic vocal fold paralysis: clinical course and outcomes. J Neurol Sci 2009; 284:56-62. [PMID: 19411079 DOI: 10.1016/j.jns.2009.04.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Revised: 03/26/2009] [Accepted: 04/02/2009] [Indexed: 11/20/2022]
Abstract
This investigation details the results of a retrospective chart review of 35 patients with idiopathic vocal fold paralysis. Clinical findings at presentation, as well as patient outcomes in both the short and long-term duration are comprehensively reported. Spontaneous improvement of vocal fold function was observed in 25% of patients with long-term follow up. Of those with unilateral paralysis, 27% elected to undergo surgical intervention for improvement of symptoms. Four out of the five (80%) patients with bilateral paralysis required surgical intervention, including tracheotomy to relieve severe dyspnea and stridor. Discussions regarding possible underlying, occult etiologies of idiopathic vocal fold paralysis are presented, and suggested sequential behavioral and surgical treatment strategies are introduced.
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Reliability of perceptions of voice quality: evidence from a problem asthma clinic population. The Journal of Laryngology & Otology 2009; 123:755-63. [PMID: 19250586 DOI: 10.1017/s0022215109004605] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Methods of perceptual voice evaluation have yet to achieve satisfactory consistency; complete acceptance of a recognised clinical protocol is still some way off. MATERIALS AND METHODS Three speech and language therapists rated the voices of 43 patients attending the problem asthma clinic of a teaching hospital, according to the grade-roughness-breathiness-asthenicity-strain (GRBAS) scale and other perceptual categories. RESULTS AND ANALYSIS Use of the GRBAS scale achieved only a 64.7 per cent inter-rater reliability and a 69.6 per cent intra-rater reliability for the grade component. One rater achieved a higher degree of consistency. Improved concordance on the GRBAS scale was observed for subjects with laryngeal abnormalities. Raters failed to reach any useful level of agreement in the other categories employed, except for perceived gender. DISCUSSION These results should sound a note of caution regarding routine adoption of the GRBAS scale for characterising voice quality for clinical purposes. The importance of training and the use of perceptual anchors for reliable perceptual rating need to be further investigated.
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Abstract
OBJECTIVES/HYPOTHESIS To identify clinical evidence regarding outcome and duration of unilateral idiopathic vocal fold paralysis (IVFP). STUDY DESIGN Literature review. METHODS Medline search using the terms "vocal fold paralysis," "laryngeal paralysis," "vagal paralysis," and "recurrent nerve paralysis" was performed. Results were cross-checked by substituting "palsy" and "paresis" in place of "paralysis," "cord" in place of "fold," and adding "idiopathic" to each term. Furthermore, papers antedating the period of time covered by Medline were identified in references of publications. Case series identified by means of these searches were examined for information regarding duration and outcome of IVFP. RESULTS Seven hundred seventeen cases are reported. Complete recovery of motion occurred in 36 +/- 22% (range, 13-83%) of individuals. Some recovery of motion (complete and partial) occurred in 39 +/- 20% (range, 19-83%). Complete recovery of voice occurred in 52 +/- 17% (range, 25-87%) of cases, some degree of recovery in 61 +/- 22% (range, 25-87%). Most cases appear to recover in well under a year, with rare instances of markedly delayed recovery. CONCLUSIONS Review of available evidence reveals a highly variable rate of return of motion in IVFP. The rate of return of normal voice is consistently higher, although similarly variable. The marked differences in rates of recovery among reports appears to be the result of variable definitions of recovery, oversimplified all-or-none notions of paralysis and recovery, and inconsistent reporting of time elapsed from onset of paralysis to evaluation. All of these factors should be addressed in future prospective studies to shed further light on the natural history of vocal fold paralysis.
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Schindler A, Bottero A, Capaccio P, Ginocchio D, Adorni F, Ottaviani F. Vocal Improvement After Voice Therapy in Unilateral Vocal Fold Paralysis. J Voice 2008; 22:113-8. [PMID: 17014987 DOI: 10.1016/j.jvoice.2006.08.004] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2006] [Accepted: 08/04/2006] [Indexed: 11/15/2022]
Abstract
Unilateral vocal fold paralysis (UVFP) is associated with changes in acoustic and aerodynamic voice measurements and can have a significant impact on a patient's quality of life. Few objective data regarding the efficacy of voice therapy for UVFP exist. The aim of this study was to retrospectively analyze voice modifications in a group of patients with UVFP before and after voice therapy. Forty patients with UVFP of different etiology were included in the study. Each subject had voice therapy with an experienced speech/language pathologist twice a week; the mean number of sessions was 12.6. A multidimensional assessment protocol was used; it included videoendoscopy, the maximum phonation time (MPT), the GIRBAS scale, spectrograms and a perturbation analysis, and the Voice Handicap Index (VHI). Pre- and posttreatment data were compared by means of the Wilcoxon and Student's t tests. A complete glottal closure was seen in 8 patients before voice therapy and in 14 afterward. Mean MPT increased significantly. In the perceptual assessment, the difference was significant for five out of six parameters. A significant improvement was found on spectrographic analysis; as for perturbation analysis, the differences in jitter, shimmer, and noise-to-harmonic ratio values were significant. VHI values showed a clear and significant improvement. A significant improvement of voice quality and quality of life after voice therapy is an often reached and reasonable goal in patients with UVFP.
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Affiliation(s)
- Antonio Schindler
- Dipartimento di Scienze Cliniche L. Sacco, L. Sacco Hospital, University of Milan, Milan, Italy.
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Role of early voice therapy in patients affected by unilateral vocal fold paralysis. The Journal of Laryngology & Otology 2007; 122:936-41. [DOI: 10.1017/s0022215107000679] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:To evaluate the functional results obtained after voice therapy in patients with unilateral vocal fold paralysis caused by different aetiologies.Design:Prospective analysis of the outcome of unilateral vocal fold paralysis cases treated at our speech and language rehabilitation service from November 2003 to January 2006. Thirty cases underwent behavioural treatment, between two and six weeks after unilateral vocal fold paralysis onset. A multi-dimensional assessment was carried out before, immediately after and six months after treatment.Results:After behavioural therapy, the prevalence of complete glottal closure increased significantly (p < 0.05). Subjects' pre-therapy mean values for jitter, shimmer and noise-to-harmonic ratio were statistically significantly different from those taken both immediately and six months after treatment (p < 0.05). The mean values for voice turbulence index significantly improved only six months after therapy (0.08 vs 0.04). At both post-treatment assessments, voice range profile analysis showed a significant decrease of lowest voice frequency and a significant increase of the number of semitones (p < 0.05). Mean values for grade, instability, breathiness, asthenia and voice handicap index scores were significantly decreased both immediately and six months after treatment, compared with pre-treatment values (p < 0.05).Conclusions:Early voice therapy may enable significant improvement in vocal function, allowing the patient to avoid surgery.
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Hamdan AL, Sibai A, Rameh C. Effect of Fasting on Voice in Women. J Voice 2007; 21:495-501. [PMID: 16630706 DOI: 10.1016/j.jvoice.2006.01.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2005] [Accepted: 01/24/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE/HYPOTHESIS To study the effect of fasting on voice in women: abstinence from food and water intake between 14 and 18 hours. STUDY DESIGN A prospective study on female subjects. MATERIAL AND METHOD A total of 28 female subjects were included in this study. Their age ranged between 21 and 45 years. Subjects with vocal symptoms or vocal fold lesions were excluded. The subjects were tested when they were not fasting and while fasting after the first week of intermittent fasting during Ramadan. Each subject was first asked about her vocal symptoms and the ease of phonation or phonatory effort. Then each underwent acoustic analysis and laryngeal video-endostroboscopy. RESULTS Vocal fatigue was the most common reported complaint (53.6%) followed by deepening of the voice (21.4%) and harshness (10.2%). Self-reported phonatory effort was significantly affected by fasting (P value < 0.001). Out of the 28 subjects, 23 had an increase in their phonatory effort. Vocal acoustic parameters did not change markedly except for the maximum phonation time, which decreased significantly. Laryngeal video-endostroboscopy did not reveal any significant changes during fasting. All stroboscopic parameters were the same except for a decrease in the amplitude of the mucosal waves in one subject and the presence of a posterior chink in three subjects. CONCLUSION Fasting affects voice. There is an increase in the phonatory effort, and vocal fatigue is the most common symptom.
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Affiliation(s)
- Abdul-Latif Hamdan
- Department of Otolaryngology Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
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Abstract
PURPOSE OF REVIEW A number of technological advancements in recent years have spurred renewed interest in vocal fold injection augmentation. The present review discusses the characteristics of currently available short-term and long-term injection materials, and the advantages and disadvantages of each. RECENT FINDINGS Many of the newer laryngeal injectable substances were originally used as dermal fillers born out of the plastic surgery and dermatologic literature. Clinical outcomes have improved as a result of exciting advancements in vocal fold injection material availability and design. New substances now closely mimic the native viscoelastic properties of the vocal folds, but the search for the ideal material is ongoing. SUMMARY The wide array of injectable materials available is both daunting and exciting. Many variables must be considered in choosing the best temporary or long-term injectable material to meet each patient's needs. Surgeons will be better able to optimize patient outcomes by understanding the advantages and disadvantages each has to offer.
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Affiliation(s)
- J Michael King
- Department of Otolaryngology, Head and Neck Surgery, University of Texas Health Science Center, San Antonio, Texas 78229, USA
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Affiliation(s)
- Miriam A O'Leary
- Department of Otolaryngology-Head and Neck Surgery, Boston University Medical Center, 88 East Newton Street, D-608, Boston, MA 02118, USA
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