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Niermeyer W, Diao G, Bielamowicz SA, Stager SV. Predicting Airflow from Measures Sensitive to Mid-cord Glottal Gap During the COVID-19 Pandemic. Ann Otol Rhinol Laryngol 2023; 132:1543-1549. [PMID: 37096374 DOI: 10.1177/00034894231170937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
OBJECTIVES To determine if trans-laryngeal airflow, important in assessing vocal function in paresis/paralysis and presbylarynges patients with mid-cord glottal gaps, could be predicted by other measures sensitive to mid-cord glottal gap size but with smaller risks of spreading COVID-19, and if any patient factors need consideration. METHODS Four populations were: unilateral vocal fold paresis/paralysis (UVFP, 148), aging and UVFP (UVFP plus aging, 22), bilateral vocal fold paresis/paralysis without airway obstruction (BVFP, 49), and presbylarynges (66). Five measures were selected from the initial clinic visit: mean airflow from repeated /pi/ syllables, longer of 2 /s/ and 2 /z/ productions, higher of 2 cepstral peak prominence smoothed for vowel /a/ (CPPSa), and Glottal Function Index (GFI). S/Z ratios were computed. Stepwise regression models used 3 measures and 5 patient factors (age, sex, etiology, diagnosis, and potentially impaired power source for voicing) to predict airflow. RESULTS Log-transformations were required to normalize distributions of airflow and S/Z ratio. The final model revealed age, sex, impaired power source, log-transformed S/Z ratio, and GFI predicted log-transformed airflow (R2 = .275, F[5,278] = 21.1; P < .001). CONCLUSIONS The amount of variance explained by the model was not high, suggesting adding other predictive variables to the model might increase the variance explained.
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Affiliation(s)
- Weston Niermeyer
- Division of Otolaryngology, The George Washington University, Washington, DC, USA
| | - Guoqing Diao
- Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Steven A Bielamowicz
- Division of Otolaryngology, The George Washington University, Washington, DC, USA
| | - Sheila V Stager
- Division of Otolaryngology, The George Washington University, Washington, DC, USA
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Medeiros N, Castro MEM, van Lith-Bijl JT, Desuter GRR. A Systematic Review on Surgical Treatments for Sulcus Vocalis and Vocal Fold Scar. Laryngoscope 2021; 132:822-830. [PMID: 34057225 DOI: 10.1002/lary.29665] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/29/2021] [Accepted: 05/05/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVES/HYPOTHESIS Vocal fold sulcus and scars are benign vocal fold lesions that present as a challenge to the laryngologist. A number of different surgical techniques have been proposed, aiming at restoring the lamina propria (LP), closing the glottal gap, or both. This study aimed to provide a systematic review of surgical treatment for sulcus and scar and to propose a new classification for these techniques. STUDY DESIGN A literature search using MEDLINE and Google Scholar through August 2020. METHODS Data on study design were retrieved and outcomes were classified as acoustic, aerodynamic, self-reported, perceptual, and stroboscopic. Methodological quality was assessed using the MINORs criteria. Each technique was classified as direct, indirect, or combined. RESULTS Our search included 31 studies with a total of 617 patients. Direct techniques included dissection, graft interposition, or LP regeneration/scar degradation while indirect techniques aimed for glottal gap closure. Only one article performed a comparison between different types of techniques and only eight studied the five types of outcomes. No superiority of any technique was noted in our analysis. Self-reported outcomes were the most frequently improved. CONCLUSIONS There seems to not exist a one-fits-all treatment for this clinical picture and no clear decision-making pattern. A recent trend toward sequential approaches, starting with less invasive procedures, can be observed. Laryngoscope, 2021.
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Affiliation(s)
- Nuno Medeiros
- Voice and Swallowing Clinic, Department of Otolaryngology Head and Neck Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium.,Department of Otolaryngology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | | | - Julie Titske van Lith-Bijl
- Voice and Swallowing Clinic, Department of Otolaryngology Head and Neck Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium.,Department of Otolaryngology, Flevoziekenhuis, Almere, The Netherlands
| | - Gauthier René Raymond Desuter
- Voice and Swallowing Clinic, Department of Otolaryngology Head and Neck Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Cielo CA, Schwarz K, Finger LS, Lima JM, Christmann MK. Glottal Closure in Women with No Voice Complaints or Laryngeal Disorders. Int Arch Otorhinolaryngol 2019; 23:e384-e388. [PMID: 31649756 PMCID: PMC6805197 DOI: 10.1055/s-0038-1676108] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 10/12/2018] [Indexed: 10/26/2022] Open
Abstract
Introduction The understanding of normal vocal production is essential to guide any voice professional as it is fundamental to understand the effects of the posterior glottal gap on the vocal quality. Objective The aim of the present study was to verify the association between glottic closure, acoustic parameters, and some characteristics of the videolaryngostroboscopy of young women without vocal complaints nor laryngeal disorders. Methods This is a cross-sectional study with 56 women between 20 and 30 years old who underwent videolaryngostroboscopy. The acoustic parameters of the vowel /a:/ were analyzed using the Praat software, Release 4.6.10 (Paul Boersman and David Weenik, Amsterdam, Netherlands). Statistical Analysis The chi-squared, Fischer, and Kruskall-Wallis tests were applied, with 5% significance. Results Significant occurrence of posterior glottal gap (85.71%, p < 0.001), of normal vocal folds vibration amplitude (82.14%, p < 0.001), and of absence of significant constriction of the laryngeal vestibule (98.21%, p < 0.001); no significant association of the glottic closure with the vocal acoustic parameters; no significant association of glottic closure, vocal folds vibration amplitude, and constriction of the laryngeal vestibule. Conclusion There was a predominance of posterior glottal gap, normal vocal folds vibration amplitude, and absence of laryngeal vestibule constriction, and no relation with the acoustic parameters, suggesting that the posterior glottal gap did not generate impact on the vocal production of the young adult women studied.
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Affiliation(s)
- Carla Aparecida Cielo
- Department of Phonoaudiology, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
| | - Karine Schwarz
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Leila Susana Finger
- Postgraduation Program in Human Communication, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
| | - Joziane Moraes Lima
- Department of Phonoaudiology, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
| | - Mara Keli Christmann
- Department of Phonoaudiology, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
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Gugatschka M, Jarvis JC, Perkins JD, Bubalo V, Wiederstein-Grasser I, Lanmüller H, Gerstenberger C, Karbiener M. Functional Electrical Stimulation Leads to Increased Volume of the Aged Thyroarytenoid Muscle. Laryngoscope 2018; 128:2852-2857. [PMID: 30284246 PMCID: PMC6586045 DOI: 10.1002/lary.27342] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2018] [Indexed: 12/14/2022]
Abstract
Objectives/Hypothesis To reverse sarcopenia and increase the volumes of atrophied laryngeal muscles by functional electrical stimulation (FES) using a minimal invasive surgical procedure in an aged ovine model. Study Design Prospective animal study. Methods A stimulation electrode was placed unilaterally near the terminal adduction branch of the recurrent laryngeal nerve (RLN) adjacent to the right cricothyroid joint. The electrode was connected to an implant located subcutaneously at the neck region. Predesigned training patterns were automatically delivered by a bidirectional radio frequency link using a programming device and were repeated automatically by the implant every other day over 11 weeks in the awake animal. Outcome parameters comprised volumetric measurements based on three‐dimensional reconstructions of the entire thyroarytenoid muscle (TAM), as well as gene expression analyses. Results We found significant increases of the volumes of the stimulated TAM of 11% and the TAM diameter at the midmembranous parts of the vocal folds of nearly 40%. Based on gene expression, we did not detect a shift of muscle fiber composition. Conclusions FES of the terminal branches of the RLN is a secure and effective way to reverse the effects of age‐related TAM atrophy and to increase volumes of atrophied muscles. Level of Evidence NA Laryngoscope, 128:2852–2857, 2018
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Affiliation(s)
| | - Jonathan C Jarvis
- School of Sport and Exercise Sciences , Liverpool John Moores University, Liverpool, United Kingdom
| | - Justin D Perkins
- Department of Veterinary Clinical Sciences , Royal Veterinary College, London, United Kingdom
| | - Vladimir Bubalo
- Center of Biomedical Research , Medical University Graz, Graz, Austria
| | | | - Hermann Lanmüller
- Center of Medical Physics and Biomedical Engineering , Medical University of Vienna, Vienna, Austria
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Pei YC, Fang TJ, Hsin LJ, Li HY, Wong AM. Early hyaluronate injection improves quality of life but not neural recovery in unilateral vocal fold paralysis: an open-label randomized controlled study. Restor Neurol Neurosci 2015; 33:121-30. [PMID: 25588457 DOI: 10.3233/rnn-140439] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To investigate the neurologic and functional effect of intracordal hyaluronate injections in acute unilateral vocal fold paralysis (UVFP) in a randomized controlled trial. METHODS In this open-label, randomized controlled study, 29 patients with UVFP were recruited within 6 months of their first outpatient visit and were randomized to receive either single hyaluronate injection (HI group) or conservative management (CM group). Quantitative laryngeal electromyography, videolaryngostroboscopy, UVFP-related quality of life (Voice Outcomes Survey, VOS), laboratory voice analysis, and health-related quality of life (SF-36) were evaluated at baseline, and at 1, 3 and 6 months post-injection in the HI group, and at baseline and 6 months in the CM group. RESULTS Improvements in most quality of life domains and other assessments were comparable between the HI and CM groups; however, the HI group had a greater improvement in the mental health domain of quality of life at the end of follow-up. CONCLUSIONS Early hyaluronate injection cannot improve nerve regeneration but can result in long-lasting improvements in patients' psychosocial well-being, thus highlighting the importance of early intervention for patients with UVFP.
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Affiliation(s)
- Yu-Cheng Pei
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan School of Medicine, Chang Gung University, Taoyuan, Taiwan Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Tuan-Jen Fang
- School of Medicine, Chang Gung University, Taoyuan, Taiwan Department of Otolaryngology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Li-Jen Hsin
- School of Medicine, Chang Gung University, Taoyuan, Taiwan Department of Otolaryngology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Hsueh-Yu Li
- School of Medicine, Chang Gung University, Taoyuan, Taiwan Department of Otolaryngology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Alice Mk Wong
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan School of Medicine, Chang Gung University, Taoyuan, Taiwan Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
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Andrade-Miranda G, Godino-Llorente JI, Moro-Velázquez L, Gómez-García JA. An automatic method to detect and track the glottal gap from high speed videoendoscopic images. Biomed Eng Online 2015; 14:100. [PMID: 26510707 PMCID: PMC4625946 DOI: 10.1186/s12938-015-0096-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 10/20/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The image-based analysis of the vocal folds vibration plays an important role in the diagnosis of voice disorders. The analysis is based not only on the direct observation of the video sequences, but also in an objective characterization of the phonation process by means of features extracted from the recorded images. However, such analysis is based on a previous accurate identification of the glottal gap, which is the most challenging step for a further automatic assessment of the vocal folds vibration. METHODS In this work, a complete framework to automatically segment and track the glottal area (or glottal gap) is proposed. The algorithm identifies a region of interest that is adapted along time, and combine active contours and watershed transform for the final delineation of the glottis and also an automatic procedure for synthesize different videokymograms is proposed. RESULTS Thanks to the ROI implementation, our technique is robust to the camera shifting and also the objective test proved the effectiveness and performance of the approach in the most challenging scenarios that it is when exist an inappropriate closure of the vocal folds. CONCLUSIONS The novelties of the proposed algorithm relies on the used of temporal information for identify an adaptive ROI and the use of watershed merging combined with active contours for the glottis delimitation. Additionally, an automatic procedure for synthesize multiline VKG by the identification of the glottal main axis is developed.
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Affiliation(s)
- Gustavo Andrade-Miranda
- Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, Campus de Montegancedo, Crta. M40 km, 38, Madrid, Spain.
| | - Juan I Godino-Llorente
- Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, Campus de Montegancedo, Crta. M40 km, 38, Madrid, Spain.
| | - Laureano Moro-Velázquez
- Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, Campus de Montegancedo, Crta. M40 km, 38, Madrid, Spain.
| | - Jorge Andrés Gómez-García
- Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, Campus de Montegancedo, Crta. M40 km, 38, Madrid, Spain.
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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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Abstract
In the human larynx, implants a primarily used for the correction of glottis insufficiency. In a broader sense laryngeal stents may be considered as implants as well. Laryngeal implants can be differentiated into injectable and solid. The most important representatives of both groups are discussed in detail along with the respective technique of application. Laryngeal stents are primarily used perioperatively. Different types and their use are presented.
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Affiliation(s)
- Christian Sittel
- Klinik für Hals-, Nasen-, Ohrenkrankheiten, Plastische Operationen, Klinikum Stuttgart – Katharinenhospital, Stuttgart, Germany
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