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Zhu W, Liang H, Liang F, Chen R, Zheng S, Liang W, Guan Z, Cai Q. Application of Platysma Myocutaneous Flap in Surgical Repair after T2-3 Glottic Carcinoma Resection. Laryngoscope 2024. [PMID: 38525967 DOI: 10.1002/lary.31291] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/21/2023] [Accepted: 01/03/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVE Numerous methods and materials are available for vertical partial laryngectomy. In this study, the reparative effects of the platysma myocutaneous flap (PMF) and ribbon myocutaneous flap (RMF) on the postoperative voice quality of patients were compared to provide a reference for selecting a method conducive to improving postoperative voice quality. METHODS A retrospective analysis was performed on patients with unilateral T2-3 glottic carcinoma. Following vertical partial laryngectomy, the defect was repaired with a PMF or simple RMF. Twelve months after surgery, voice quality was assessed according to voice acoustics, aerodynamics, and subjective perceptual evaluation, and glottic morphology was recorded using a laryngeal stroboscopy. RESULTS A total of 70 patients were identified, including 54 in the PMF group and 16 in the RMF group. The PMF group was superior to the RMF group in terms of voice quality assessed by voice acoustics, aerodynamics, and subjective perceptual evaluation. In the PMF group, 72.2% of patients performed phonation with their vocal cords, and approximately 27.8% of patients were affected by supraglottic compression. In the RMF group, 81.3% of patients were affected by supraglottic compression. No significant difference was found in the 5-year survival rate between the two groups. CONCLUSION For defect repair following vertical partial laryngectomy, a PMF can allow better postoperative voice quality to be achieved than an RMF because a PMF can provide more tissue (including strap muscle under the flap) for padding, which enables the glottic portion corresponding to the vocal cord to close well. LEVEL OF EVIDENCE Level 3 Laryngoscope, 2024.
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Affiliation(s)
- Wenying Zhu
- Department of Otolaryngology-Head and Neck, Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | - Haifeng Liang
- Department of Otolaryngology-Head and Neck, Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | - Faya Liang
- Department of Otolaryngology-Head and Neck, Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | - Renhui Chen
- Department of Otolaryngology-Head and Neck, Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | - Shibei Zheng
- Department of Otolaryngology-Head and Neck, Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | - Wenting Liang
- Department of Otolaryngology-Head and Neck, Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | - Zhong Guan
- Department of Otolaryngology-Head and Neck, Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | - Qian Cai
- Department of Otolaryngology-Head and Neck, Sun Yat-sen Memorial Hospital, Sun Yat-sen University
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Yan J, Hou J, Zhang H, Yang X, Sheng Y, Du X, Kong D, Wang Z, Ren X, Wu L. Immediate effect of recurrent laryngeal nerve stimulation in patients with idiopathic unilateral vocal fold paralysis. Acta Otolaryngol 2024; 144:65-70. [PMID: 38265886 DOI: 10.1080/00016489.2024.2306961] [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] [Received: 12/13/2023] [Accepted: 01/12/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND There is a lack of effective treatment for idiopathic unilateral vocal fold paralysis (IUVFP). A better phonation was reported by patients after laryngeal nerve stimulation during our clinical examination. OBJECTIVES This study aims to investigate immediate effect of recurrent laryngeal nerve (RLN) stimulation on phonation in patients with IUVFP. MATERIAL AND METHODS Sixty-two patients with clinically identified IUVFP underwent RLN stimulation with needle electrodes. Laryngoscopy, acoustic analysis, and voice perception assessment were performed for quantitative comparison of vocal function and voice quality before and after the intervention. RESULTS Laryngoscopic images showed a larger motion range of the paralyzed vocal fold (p < .01) and better glottal closure (p < .01) after RLN stimulation. Acoustic analysis revealed that the dysphonia severity index increased significantly (p < .01) while the jitter and shimmer decreased after the intervention (p < .05). According to perceptual evaluation, RLN stimulation significantly increased RBH grades in patients with IUVFP (p < .01). Furthermore, the improvement in voice perception had a moderate positive correlation with the decrease in the glottal closure. CONCLUSIONS AND SIGNIFICANCE This study shows a short-term improvement of phonation in IUVFP patients after RLN stimulation, which provides proof-of-concept for trialing a controlled delivery of RLN stimulation and assessing durability of any observed responses.
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Affiliation(s)
- Jing Yan
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, Xi'an, Shaanxi, P. R. China
| | - Jin Hou
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, Xi'an, Shaanxi, P. R. China
| | - Huihui Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, Xi'an, Shaanxi, P. R. China
| | - Xinyi Yang
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, P. R. China
| | - Ying Sheng
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, Xi'an, Shaanxi, P. R. China
| | - Xiaoying Du
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, Xi'an, Shaanxi, P. R. China
| | - Demin Kong
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, Xi'an, Shaanxi, P. R. China
| | - Zhenghui Wang
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, Xi'an, Shaanxi, P. R. China
| | - Xiaoyong Ren
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, Xi'an, Shaanxi, P. R. China
| | - Liang Wu
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, P. R. China
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Mesolella M, Motta G, Allosso S, Motta G. Effects of Adenotonsillectomy on Vocal Function. J Pers Med 2023; 13:1002. [PMID: 37373991 DOI: 10.3390/jpm13061002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
INTRODUCTION Correct breathing is a fundamental condition for adequate vocal production. Respiratory dynamics are able to modify the growth of facial mass and lingual posture, i.e., of the skull, the mandibular one. For this reason, infant mouth breathing can cause hoarseness. MATERIALS AND METHODS We evaluated the actual changes in the characteristics of the voice and articulation of language in a group of subjects affected by adenotonsillar hypertrophy (grade 3-4), with frequent episodes of pharyngo-tonsillitis who underwent adenotonsillectomy. Our study included 20 children-10 boys and 10 girls-aged 4 to 11 years who had adenotonsillar hypertrophy and pharyngotonsillitis episodes exceeding 5-6 per year in the previous 2 years. The control group (Group B) included 20 children-10 boys and 10 girls-aged 4 to 11 years (average age of 6.4 years) who had not undergone surgery and shared the same degree of adenotonsillar hypertrophy as those in Group A but who did not experience recurrent pharyngotonsillitis episodes. DISCUSSION The hypertrophy of adenoids and tonsils significantly impacted breathing, vocal function, and speech articulation. All this is responsible for a state of tension in the neck muscles, which at the level of the vocal tract causes hoarseness. The changes objectively observed in our study in the pre- and post-operative phase demonstrate how adenotonsillar hypertrophy is responsible for an increase in resistance to the passage of air at the glottic level. CONCLUSIONS For this reason, adenotonsillectomy has an impact on recurrent infections and can also lead to an improvement in speech, breathing, and posture.
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Affiliation(s)
- Massimo Mesolella
- Unit of Otorhinolaryngology, Department of Neuroscience, Reproductive Sciences and Dentistry, University Federico II of Naples, 80131 Naples, Italy
| | - Giovanni Motta
- Unit of Otorhinolaryngology, University Luigi Vanvitelli, 80131 Naples, Italy
| | - Salvatore Allosso
- Unit of Otorhinolaryngology, Department of Neuroscience, Reproductive Sciences and Dentistry, University Federico II of Naples, 80131 Naples, Italy
| | - Gaetano Motta
- Unit of Otorhinolaryngology, University Luigi Vanvitelli, 80131 Naples, Italy
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Miyamaru S, Murakami D, Nishimoto K, Kodama N, Tashiro J, Miyamoto Y, Saito H, Takeda H, Ise M, Orita Y. Optimal Management of the Unilateral Recurrent Laryngeal Nerve Involvement in Patients with Thyroid Cancer. Cancers (Basel) 2021; 13:cancers13092129. [PMID: 33925053 PMCID: PMC8125658 DOI: 10.3390/cancers13092129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 12/04/2022] Open
Abstract
Simple Summary Recurrent laryngeal nerve (RLN) is the second most common structure invaded by primary or metastatic thyroid cancer. However, little is known about the optimal procedure for maintaining vocal function in patients with unilateral RLN involvement in thyroid cancer. This study aimed to evaluate various parameters of vocal function to establish the optimal management of thyroid cancer patients with unilateral RLN involvement. Based on our findings, we propose that for optimal management of unilateral RLN involvement in thyroid cancer, first, sharp dissection should be performed, and if this is impossible, a simultaneous RLN reconstruction procedure should be adopted whenever possible. These findings may help improve management of RLN involvement in patients with thyroid cancer and ensure vocal function preservation. Abstract We aimed to determine the optimal management of recurrent laryngeal nerve (RLN) involvement in thyroid cancer. We enrolled 80 patients with unilateral RLN involvement in thyroid cancer between 2000 and 2016. Eleven patients with preoperatively functional vocal folds (VFs) underwent sharp tumor resection to preserve the RLN (shaving group). Thirty-three patients underwent RLN reconstruction with RLN resection (reconstruction group). We divided the reconstruction group into two subgroups based on preoperative VF mobility (normal-reconstruction and paralyzed-reconstruction subgroups). In the cases where RLN reconstruction was difficult, phonosurgeries including arytenoid adduction (AA), with or without thyroplasty type I, or nerve muscle pedicle implantation with AA were performed later (phonosurgery group). We evaluated and compared vocal function among the evaluated periods and different groups. Postoperative vocal function in the shaving and normal-reconstruction subgroups was favorable. There were no significant differences between the two groups. In the paralyzed-reconstruction and phonosurgery groups, postoperative vocal function was significantly improved, and vocal function in the paralyzed-reconstruction subgroup was significantly better than that in the phonosurgery group. For optimal management of unilateral RLN involvement in thyroid cancer, first, sharp dissection should be performed, and if this is impossible, a simultaneous RLN reconstruction procedure should be adopted whenever possible.
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Affiliation(s)
- Satoru Miyamaru
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kumamoto University, Kumamoto 860-8555, Japan; (D.M.); (K.N.); (J.T.); (Y.M.); (H.S.); (H.T.); (M.I.); (Y.O.)
- Correspondence: ; Tel.: +81-96-373-5255
| | - Daizo Murakami
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kumamoto University, Kumamoto 860-8555, Japan; (D.M.); (K.N.); (J.T.); (Y.M.); (H.S.); (H.T.); (M.I.); (Y.O.)
| | - Kohei Nishimoto
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kumamoto University, Kumamoto 860-8555, Japan; (D.M.); (K.N.); (J.T.); (Y.M.); (H.S.); (H.T.); (M.I.); (Y.O.)
| | - Narihiro Kodama
- Department of Rehabilitation, Kumamoto Health Science University, Kumamoto 860-8556, Japan;
| | - Joji Tashiro
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kumamoto University, Kumamoto 860-8555, Japan; (D.M.); (K.N.); (J.T.); (Y.M.); (H.S.); (H.T.); (M.I.); (Y.O.)
| | - Yusuke Miyamoto
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kumamoto University, Kumamoto 860-8555, Japan; (D.M.); (K.N.); (J.T.); (Y.M.); (H.S.); (H.T.); (M.I.); (Y.O.)
| | - Haruki Saito
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kumamoto University, Kumamoto 860-8555, Japan; (D.M.); (K.N.); (J.T.); (Y.M.); (H.S.); (H.T.); (M.I.); (Y.O.)
| | - Hiroki Takeda
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kumamoto University, Kumamoto 860-8555, Japan; (D.M.); (K.N.); (J.T.); (Y.M.); (H.S.); (H.T.); (M.I.); (Y.O.)
| | - Momoko Ise
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kumamoto University, Kumamoto 860-8555, Japan; (D.M.); (K.N.); (J.T.); (Y.M.); (H.S.); (H.T.); (M.I.); (Y.O.)
| | - Yorihisa Orita
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kumamoto University, Kumamoto 860-8555, Japan; (D.M.); (K.N.); (J.T.); (Y.M.); (H.S.); (H.T.); (M.I.); (Y.O.)
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Song W, Caffier F, Nawka T, Ermakova T, Martin A, Mürbe D, Caffier PP. T1a Glottic Cancer: Advances in Vocal Outcome Assessment after Transoral CO 2-Laser Microsurgery Using the VEM. J Clin Med 2021; 10:1250. [PMID: 33802971 DOI: 10.3390/jcm10061250] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/10/2021] [Accepted: 03/15/2021] [Indexed: 12/18/2022] Open
Abstract
Patients with unilateral vocal fold cancer (T1a) have a favorable prognosis. In addition to the oncological results of CO2 transoral laser microsurgery (TOLMS), voice function is among the outcome measures. Previous early glottic cancer studies have reported voice function in patients grouped into combined T stages (Tis, T1, T2) and merged cordectomy types (lesser- vs. larger-extent cordectomies). Some authors have questioned the value of objective vocal parameters. Therefore, the purpose of this exploratory prospective study was to investigate TOLMS-associated oncological and vocal outcomes in 60 T1a patients, applying the ELS protocols for cordectomy classification and voice assessment. Pre- and postoperative voice function analysis included: Vocal Extent Measure (VEM), Dysphonia Severity Index (DSI), auditory-perceptual assessment (GRB), and 9-item Voice Handicap Index (VHI-9i). Altogether, 51 subjects (43 male, eight female, mean age 65 years) completed the study. The 5-year recurrence-free, overall, and disease-specific survival rates (Kaplan–Meier method) were 71.4%, 94.4%, and 100.0%. Voice function was preserved; the objective parameter VEM (64 ± 33 vs. 83 ± 31; mean ± SD) and subjective vocal measures (G: 1.9 ± 0.7 vs. 1.3 ± 0.7; VHI-9i: 18 ± 8 vs. 9 ± 9) even improved significantly (p < 0.001). The VEM best reflected self-perceived voice impairment. It represents a sensitive measure of voice function for quantification of vocal performance.
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Chen L, Chen R, Guan Z, Lin P, Liang F, Han P, Yang J, Zhu W, Cai Q. Platysma skin flap: Laryngeal repair material to produce phonatory flap vibrational wave. Head Neck 2020; 42:2757-2763. [PMID: 32539190 DOI: 10.1002/hed.26294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/28/2019] [Revised: 04/12/2020] [Accepted: 05/12/2020] [Indexed: 12/30/2022] Open
Abstract
The platysma skin flap was used for laryngeal reconstruction after vertical partial laryngectomy to improve the postoperative voice quality of patients with T2 and T3 glottic laryngeal carcinoma. Sixty-nine patients with unilateral T2 and T3 glottic laryngeal carcinoma were included. Forty-six patients received vertical partial laryngectomy, and a platysma skin flap was used for laryngeal reconstruction. The other 23 patients underwent transoral laser microsurgery. Subjective and objective examinations were performed to evaluate laryngeal morphology after the surgery. Acceptable voice quality was achieved for 46 patients who underwent vertical partial laryngectomy. Flap vibrational waves occurred in 19 cases (41.3%). The platysma skin flap is an ideal tissue for the reconstruction of articulation structure in open surgery of T2 and T3 unilateral glottic laryngeal carcinoma.
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Affiliation(s)
- Ling Chen
- Department of Otolaryngology-Head and Neck, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Renhui Chen
- Department of Otolaryngology-Head and Neck, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhong Guan
- Department of Otolaryngology-Head and Neck, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Peiliang Lin
- Department of Otolaryngology-Head and Neck, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Faya Liang
- Department of Otolaryngology-Head and Neck, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ping Han
- Department of Otolaryngology-Head and Neck, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jinshan Yang
- Department of Otolaryngology-Head and Neck, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wenying Zhu
- Department of Otolaryngology-Head and Neck, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qian Cai
- Department of Otolaryngology-Head and Neck, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Yumoto E, Sanuki T, Kumai Y, Kodama N. Modified Isshiki's arytenoid adduction without separating cricothyroid and cricoarytenoid joints. ACTA ACUST UNITED AC 2020; 40:99-105. [PMID: 32469003 PMCID: PMC7256903 DOI: 10.14639/0392-100x-n0183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 09/08/2019] [Indexed: 11/23/2022]
Affiliation(s)
- Eiji Yumoto
- Department of Otolaryngology, Asahino General Hospital 12-10, Murozono-cho, Kita-ku, Kumamoto, Japan.,Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kumamoto University 1-1-1, Honjo, Chuo-ku, Kumamoto, Japan
| | - Tetsuji Sanuki
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine Nagoya City University 1, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan
| | - Yoshihiko Kumai
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kumamoto University 1-1-1, Honjo, Chuo-ku, Kumamoto, Japan
| | - Narihiro Kodama
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kumamoto University 1-1-1, Honjo, Chuo-ku, Kumamoto, Japan.,Department of Rehabilitation, Kumamoto Health Science University 325, Izumi-cho, Kita-ku, Kumamoto, Japan
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Mills M, Stoneham G, Davies S. Toward a Protocol for Transmasculine Voice: A Service Evaluation of the Voice and Communication Therapy Group Program, Including Long-Term Follow-Up for Trans Men at the London Gender Identity Clinic. Transgend Health 2019; 4:143-151. [PMID: 31119196 PMCID: PMC6528553 DOI: 10.1089/trgh.2019.0011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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] [Indexed: 11/12/2022] Open
Abstract
Purpose: A service evaluation was undertaken with 10 participants identifying as trans men who received voice and communication group therapy and 12-month follow-up at the London Gender Identity Clinic between February 2017 and March 2018, to investigate levels of satisfaction, how helpful they found the program in facilitating vocal change and skill development, and whether they would recommend it to others. Methods: Participant evaluations of overall and ideal rating of masculinity of voice, and level of feeling comfortable with voice, evaluations of voice skills and changes in speaking and reading fundamental frequency were retrospectively reviewed and analyzed. Results: Six participants reported being very satisfied with the service; four were satisfied. Eight participants found the program very helpful in achieving voice and communication change; two found it helpful. Eight strongly agreed and two agreed with recommending the service. Participants' overall and comfort ratings of voice significantly increased (p<0.01), while there was no significant change in ideal ratings (p=0.063), and a significant decrease in the difference between overall and ideal ratings (p<0.01). Participants achieved a significant decrease in fundamental frequency for reading and speaking (p<0.01), a significant decrease in voice fatigue (p=0.039) and restriction in voice adaptability (p<0.01), a significant increase in confidence in public speaking (p<0.01), but no significant change in vocal projection (p=0.07). Conclusion: Ten trans men reported high levels of satisfaction with the voice group program and long-term follow-up, making significant positive shifts in voice skills and vocal self-perception. These findings apply locally but suggest appropriate interventions toward a transmasculine voice modification protocol.
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Affiliation(s)
- Matthew Mills
- London Gender Identity Clinic, Tavistock and Portman NHS Foundation Trust, London, United Kingdom
| | - Gillie Stoneham
- London Gender Identity Clinic, Tavistock and Portman NHS Foundation Trust, London, United Kingdom
| | - Skye Davies
- London Gender Identity Clinic, Tavistock and Portman NHS Foundation Trust, London, United Kingdom
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Abstract
The change of vocal function after vocal fold dehydration due to dryness was discussed along with the treatment effect of different atomizing agents. Forty-eight staffs from The Central Hospital of Wuhan were recruited. All volunteers breathed dry air for vocal fold dehydration. After dry air inhalation, the subjects were randomly divided into four groups, with 12 cases each. Three groups were treatment groups, receiving 0.9% normal saline (IS), 5% hypertonic saline (HS) and double-distilled water (SW) atomizing inhalation therapy, respectively, and the last group was the control group without treatment. Voice data were collected for all subjects before and immediately after dry air inhalation using the Multi-Dimensional Voice Program (MDVP) system. Atomizing inhalation therapy was given 10 min after dry air inhalation, and voice data were collected using MDVP system at the following time points after atomizing inhalation treatment: 5 min, 20 min, 35 min, 50 min, 65 min, 80 min, 95 min, 110 min. In the control group, voice data were collected at the same time points and compared with those of treatment groups. The vocal function parameters collected before and after dry air inhalation as well as after treatment were subjected to test using SPSS 16.0 software. In the four groups, jitter (fundamental frequency perturbation), shimmer (amplitude perturbation), and amplitude perturbation quotient (APQ) were significantly increased after dry air inhalation (P<0.05). In IS, HS and SW groups, after atomizing inhalation treatment, there was an obvious reduction in jitter, shimmer and APQ, showing significant differences as compared with those after dry air inhalation (P<0.05). Moreover, these parameters were significantly lower than those in the control group (P<0.05). The jitter, shimmer and APQ in the IS group were significantly lower than those in the HS and SW groups (P<0.05). We are led to a conclusion: Vocal fold dehydration induced by dryness can reduce the stability of voice; such decreased voice stability can be improved by atomizing inhalation therapy; without proper treatment, voice stability caused by vocal fold dehydration cannot heal spontaneously; of three atomizing agents namely, IS, HS and SW, IS had the best treatment effect for decreased voice stability caused by vocal fold dehydration.
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Affiliation(s)
- Zhe-Fei Zou
- Department of Otolaryngology-Head and Neck Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Wei Chen
- Department of Otolaryngology-Head and Neck Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Wei Li
- Hubei Cancer Hospital, Wuhan, 430014, China
| | - Kun Yuan
- Department of Otolaryngology-Head and Neck Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China.
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Lazio MS, Vallin A, Giannini C, Taverna C, Maggiore G, Saraceno MS, Gallo O. Phonosurgical Resection Using Submucosal Infusion Technique for Early Glottic Lesions: Diagnostic and Therapeutic Procedure? Ann Otol Rhinol Laryngol 2018; 128:277-285. [PMID: 30547680 DOI: 10.1177/0003489418819544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/17/2022]
Abstract
OBJECTIVES: The aim of this study was to assess the feasibility of the submucosal infusion combined with microflap dissection via laser CO2 as both a diagnostic and therapeutic procedure for superficial glottic lesions. To define a safe surgical procedure in terms of local control, a morphometric study of surgical margins was performed. METHODS: From January 2011 to January 2016, we treated 122 patients with early glottic lesions with phonomicrosurgery. Patients with effective hydrodissection underwent a microflap and type I-II diagnostic cordectomy. In the others, a biopsy was carried out, and in the case of a malignant lesion, a type III to VI cordectomy was performed. Disease-free survival (DFS) for all the lesions was also determined according to comparative assessments of surgical margins. The Voice Handicap Index was used to evaluate functional outcomes. RESULTS: In 27 cases (32%), hydrodissection was effective; specifically, 24 (88.8%) were premalignant lesions, and 3 (11.2%) had a carcinoma. In 56 patients (68%), hydrodissection was not adequate, and a biopsy was performed: 9 (16%) were premalignant and 47 (84%) malignant lesions. The DFS analysis suggests that margins >0.7 mm resulted in a cutoff that can guarantee a safe procedure in the case of effective hydrodissection ( P < .05). CONCLUSION: Phonomicrosurgery may be both a diagnostic and therapeutic option with oncological efficacy for superficial glottic lesions of undetermined nature when surgical margins exceed 0.7 mm. In case of inadequate hydrodissection, the hypothesis of an infiltrative carcinoma warrants a wider cordectomy.
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Affiliation(s)
- Maria Silvia Lazio
- 1 Clinic of Otolaryngology, Head and Neck Surgery, Department of Translational Surgery and Medicine, Careggi University Hospital, Florence, Italy
| | - Alberto Vallin
- 1 Clinic of Otolaryngology, Head and Neck Surgery, Department of Translational Surgery and Medicine, Careggi University Hospital, Florence, Italy
| | - Costanza Giannini
- 1 Clinic of Otolaryngology, Head and Neck Surgery, Department of Translational Surgery and Medicine, Careggi University Hospital, Florence, Italy
| | - Cecilia Taverna
- 2 Section of Anatomic Pathology, Department of Surgery and Translational Medicine, Careggi University Hospital, Florence, Italy
| | - Giandomenico Maggiore
- 1 Clinic of Otolaryngology, Head and Neck Surgery, Department of Translational Surgery and Medicine, Careggi University Hospital, Florence, Italy
| | - Massimo Squadrelli Saraceno
- 1 Clinic of Otolaryngology, Head and Neck Surgery, Department of Translational Surgery and Medicine, Careggi University Hospital, Florence, Italy
| | - Oreste Gallo
- 1 Clinic of Otolaryngology, Head and Neck Surgery, Department of Translational Surgery and Medicine, Careggi University Hospital, Florence, Italy
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Tanaka S, Tomifuji M, Araki K, Uno K, Tanaka Y, Mizokami D, Suzuki H, Miyagawa Y, Taniai S, Shiotani A. Vocal function after transoral videolaryngoscopic surgery (TOVS) for hypopharyngeal and supraglottic cancer. Acta Otolaryngol 2017; 137:403-410. [PMID: 27976979 DOI: 10.1080/00016489.2016.1266509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 10/20/2022]
Abstract
CONCLUSION The resection of the medial and lateral pyriform sinus was associated with post-operative voice impairment after TOVS. Scar contracture around the cricoarytenoid joint lead to arytenoid fixation toward lateral position, and this wound healing process caused insufficient glottis closure. Although oncological and functional outcomes of TOVS was satisfactory, surgeons should mention the risk of post-operative voice impairment in pre-operative counseling. OBJECTIVES Transoral surgery is a minimally invasive treatment option for hypopharyngeal and supraglottic cancer. Post-operative vocal function was satisfactory in most cases, but in some cases vocal cord was fixed and occasionally voice impairment persists. METHODS Vocal function of 55 patients who underwent transoral videolaryngoscopic surgery (TOVS) for hypopharyngeal and supraglottic cancers was evaluated by the GRBAS perceptive scale, aerodynamic tests and acoustic analyses, and the Voice Handicap Index questionnaire. The risk factors for voice impairment were identified. RESULTS Voice impairment (G score ≧2) was found in 16 cases (29.1%). Univariate analysis revealed that the resection of medial and lateral pyriform sinus (p = .0018) and neck dissection (p = .0421) were associated with post-operative voice impairment. Multivariate analysis revealed that the resection of medial and lateral pyriform sinus (p = .0021) was associated with post-operative voice impairment.
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Affiliation(s)
- Shingo Tanaka
- Department of Otolaryngology-Head and Neck Surgery, National Defense Medical College, Saitama, Japan
| | - Masayuki Tomifuji
- Department of Otolaryngology-Head and Neck Surgery, National Defense Medical College, Saitama, Japan
| | - Koji Araki
- Department of Otolaryngology-Head and Neck Surgery, National Defense Medical College, Saitama, Japan
| | - Kosuke Uno
- Department of Otolaryngology-Head and Neck Surgery, National Defense Medical College, Saitama, Japan
| | - Yuya Tanaka
- Department of Otolaryngology-Head and Neck Surgery, National Defense Medical College, Saitama, Japan
| | - Daisuke Mizokami
- Department of Otolaryngology-Head and Neck Surgery, National Defense Medical College, Saitama, Japan
| | - Hiroshi Suzuki
- Department of Otolaryngology-Head and Neck Surgery, National Defense Medical College, Saitama, Japan
| | - Yoshihiro Miyagawa
- Department of Otolaryngology-Head and Neck Surgery, National Defense Medical College, Saitama, Japan
| | - Shinichi Taniai
- Department of Otolaryngology-Head and Neck Surgery, National Defense Medical College, Saitama, Japan
| | - Akihiro Shiotani
- Department of Otolaryngology-Head and Neck Surgery, National Defense Medical College, Saitama, Japan
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Huang GJ, Luo MS, Zhang JX, Zhu CM, Liu YH, Liu HB. [The impact of laser treatment for postoperative different vocal functions in early laryngeal cancer: network Meta-analysis]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2017; 31:382-387. [PMID: 29871267 DOI: 10.13201/j.issn.1001-1781.2017.05.013] [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] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Indexed: 11/12/2022]
Abstract
Objective:To evaluate the impact of postoperative vocal different functional characteristics with laser treatment for early laryngeal cancer.Method:Computer searching the major medical-related databases: PubMed, Web of Science and Embase, searching and screening by two staff members at the same time to read the relevant literatures, extraction of data and research related to the purpose from the selected literature. Using Stata 14.0 software analysis the extracted data with Bayesian network Metaanalysis, get the laser surgery of early laryngeal cancer effects of different voice characteristics of vocal cord.Result:A total of nine articles was included finally according through the necessary conditions, statistical analysis results showed that early laryngeal laser surgery can significantly reduce GRABS and VHI assessment score.Conclusion:Laser treatment of early laryngeal cancer could reduce VHI and the GRABS assessment score postoperatively, improve overall postoperative vocal cord function and the quality of life of patients after surgery, but not in the early post-operative function and physiology in vocal function.
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Affiliation(s)
- G J Huang
- Department of Otolaryngology-Head and Neck Surgery, the Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - M S Luo
- Department of Anesthesiology, the Second Affiliated Hospital of Nanchang University
| | - J X Zhang
- Department of Otolaryngology-Head and Neck Surgery, the Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - C M Zhu
- Department of Otolaryngology-Head and Neck Surgery, the Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Y H Liu
- Department of Otolaryngology-Head and Neck Surgery, the Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - H B Liu
- Department of Otolaryngology-Head and Neck Surgery, the Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
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Caffier PP, I Nasr A, Weikert S, Rummich J, Gross M, Nawka T. The use of injectable calcium hydroxylapatite in the surgically pretreated larynx with glottal insufficiency. Laryngoscope 2016; 127:1125-1130. [PMID: 27578371 DOI: 10.1002/lary.26261] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 03/20/2016] [Revised: 07/09/2016] [Accepted: 07/29/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate the efficacy of vocal fold (VF) augmentation with calcium hydroxylapatite (CaHA) microspheres in the surgically pretreated larynx with glottal insufficiency. STUDY DESIGN Prospective clinical pilot study. METHODS After several prior reconstructive attempts (following tumor resection, VF paralysis, in sulcus vocalis, and VF scarring), CaHA was injected under general anaesthesia using a transoral microlaryngoscopic approach in 10 patients with residual glottal insufficiency ≤1.5 mm. The postinterventional result was assessed after 1 day, and 1 and 3 months. Evaluation of augmentation comprised intraoperative video/photo documentation, pre-/postoperative videolaryngostroboscopy, as well as established subjective and objective voice function diagnostics (Grade, Roughness, Breathiness [GRB] Scale; Voice Handicap Index; voice range profile; and acoustic-aerodynamic analysis). RESULTS In the pretreated VF with no or minimal lamina propria remaining, the exact placement of CaHA was not possible due to unpredictable propagation into the scarred tissue. The results showed an insufficient postoperative augmentation. Accordingly, the voice function did not improve. However, a significant increase of the vocal range from 6.2 ± 3.2 to 8.7 ± 3.9 semitones was observed in the speaking voice profile (P =.02). All other acoustic and aerodynamic parameters remained on the whole unchanged; the slight differences between pre- and postoperative findings were not significant. CONCLUSIONS The application of CaHA in the surgically pretreated scarred larynx is not reliable to achieve a sufficient glottal closure and a satisfactory improvement of voice. Though CaHA is a welcome addition to our armamentarium against glottal insufficiency, the suitability for augmentation of scar tissue in the larynx must be considered carefully in each individual case. LEVEL OF EVIDENCE 4 Laryngoscope, 127:1125-1130, 2017.
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Affiliation(s)
- Philipp P Caffier
- Department of Audiology and Phoniatrics, Charité- University Medicine Berlin, Berlin, Germany
| | - Ahmed I Nasr
- Department of Audiology and Phoniatrics, Charité- University Medicine Berlin, Berlin, Germany
| | - Sebastian Weikert
- Department of Audiology and Phoniatrics, Charité- University Medicine Berlin, Berlin, Germany
| | - Julius Rummich
- Department of Audiology and Phoniatrics, Charité- University Medicine Berlin, Berlin, Germany
| | - Manfred Gross
- Department of Audiology and Phoniatrics, Charité- University Medicine Berlin, Berlin, Germany
| | - Tadeus Nawka
- Department of Audiology and Phoniatrics, Charité- University Medicine Berlin, Berlin, Germany
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Kono T, Yabe H, Uno K, Saito K, Ogawa K. Multidimensional vocal assessment after laser treatment for recurrent respiratory papillomatosis. Laryngoscope 2016; 127:679-684. [PMID: 27515839 DOI: 10.1002/lary.26210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 04/19/2016] [Revised: 05/29/2016] [Accepted: 06/29/2016] [Indexed: 11/05/2022]
Abstract
OBJECTIVES/HYPOTHESIS Recurrent respiratory papillomatosis (RRP) is a benign epithelial tumor that exhibits a high frequency of recurrence. This study assesses the vocal function after laser treatment for RRP, particularly in relation to the frequency of surgery. STUDY DESIGN Retrospective study. METHODS Thirty RRP patients who underwent laser surgery that controlled the tumor were included. Preoperative and postoperative Grade, Roughness, Breathiness, Asthenia, and Strain Scale, videostroboscopic findings, aerodynamic and acoustic parameters, and self-assessment questionnaires were measured and compared with an age- and sex-matched control group. Subsequently, to evaluate the association between postoperative voice quality and the number of surgeries, the patients were divided into three groups (group 1: single surgery, group 2: 2-5 surgeries, group3: >6 surgeries), and comparative multidimensional vocal assessments were performed. RESULTS The mean number of surgeries was 3.4 (range, 1-8). Although all patients exhibited poorer vocal function than the control group preoperatively, they showed improvement in postoperative subjective and objective parameters. However, four patients who underwent one surgery with relatively aggressive ablation exhibited vocal cord scarring and deteriorated objective parameters. All remaining patients showed voice quality that was on par with the control group. Subgroup analysis proved no association between post-therapeutic voice quality and the patient characteristics, including preoperative staging and the number of surgical treatments performed. CONCLUSIONS RRP patients can achieve a close to normal voice with high satisfaction even after recurrent surgical treatment when ablation of a subepithelial lesion using sufficient laser energy is adequate. LEVEL OF EVIDENCE 3b Laryngoscope, 127:679-684, 2017.
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Affiliation(s)
- Takeyuki Kono
- Department of Otolaryngology-Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Haruna Yabe
- Department of Otolaryngology-Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kosuke Uno
- Department of Otolaryngology-Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Koichiro Saito
- Department of Otolaryngology-Head and Neck Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Kaoru Ogawa
- Department of Otolaryngology-Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
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Kono T, Saito K, Yabe H, Ogawa K. Phonosurgical resection using submucosal infusion technique for precancerous laryngeal leukoplakia. Laryngoscope 2016; 127:153-158. [PMID: 27107249 DOI: 10.1002/lary.26028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 11/26/2015] [Revised: 03/08/2016] [Accepted: 03/18/2016] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS This study was designed to assess the feasibility of the submucosal infusion technique combined with microflap dissection as a radical therapeutic and diagnostic option for precancerous laryngeal leukoplakia. STUDY DESIGN Retrospective study. METHODS Severe dysplasia or carcinoma in situ was diagnosed after phonomicrosurgical dissections in 25 patients with unilateral laryngeal leukoplakia. Of these, 15 patients preferred no additional surgery (observation group), whereas 10 patients underwent further laser subligamental cordectomy (additional surgery group). The relationship between the initial surgical margin and histopathological characteristics of additionally excised tissues was assessed to evaluate diagnostic reliability. Disease control was assessed to determine the oncologic efficacy of the therapeutic procedure. Comparative multidimensional vocal assessments were performed in both groups to evaluate functional advantages of one-stage excision. RESULTS After the initial phonomicrosurgical resection, three patients had residual dysplastic lesions near the vocal process and anterior commissure, whereas three other patients had lesions suspicious for recurrence. No postoperative malignant transformation was observed in any patient. Although well-preserved vocal function was observed in the observation group, vocal quality deteriorated shortly after laser surgery in the additional surgery group. Regarding acoustics, aerodynamics, and quality-of-life evaluations, statistically equivalent scores were observed between the observation and control groups, whereas scores were inferior in the additional surgery group than in the control group. CONCLUSIONS Phonomicrosurgical resection may be a therapeutic option with oncologic efficacy against precancerous laryngeal leukoplakia. This radical management might achieve more satisfactory postoperative vocal function. LEVEL OF EVIDENCE NA Laryngoscope, 127:153-158, 2017.
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Affiliation(s)
- Takeyuki Kono
- Department of Otolaryngology-Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Koichiro Saito
- Department of Otolaryngology-Head and Neck Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Haruna Yabe
- Department of Otolaryngology-Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kaoru Ogawa
- Department of Otolaryngology-Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
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Kono T, Saito K, Yabe H, Uno K, Ogawa K. Comparative multidimensional assessment of laryngeal function and quality of life after radiotherapy and laser surgery for early glottic cancer. Head Neck 2016; 38:1085-90. [PMID: 26969802 DOI: 10.1002/hed.24412] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND This study was designed to comparatively assess laryngeal function and quality of life (QOL) of patients after laser surgery (LS) or radiotherapy (RT) for early glottic cancer. METHODS Sixty-four patients with T1 glottic cancer treated with RT or type II cordectomy underwent both subjective and objective vocal assessments. The LS group was divided into the following: (1) vaporization with defocused mode (laser surgery [LS]-Vap); and (2) excision with focused mode using lower power (LS-Ex). RESULTS Auditory-perceptual evaluation and videostroboscopic images in the LS-Ex group worsened shortly after treatment and time-dependent recovery was quicker than in the LS-Vap group. The LS-Ex group showed equivalent posttherapeutic vocal function with the RT group by acoustics, aerodynamics, and self-assessment questionnaire analysis, whereas the LS-Vap group showed statistically significant worse function. CONCLUSION The multidimensional assessment showed that early glottic cancer could be successfully treated by either RT or LS-Ex with equivalent posttherapeutic laryngeal function and QOL. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1085-1090, 2016.
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Affiliation(s)
- Takeyuki Kono
- Department of Otolaryngology-Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Koichiro Saito
- Department of Otolaryngology-Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Haruna Yabe
- Department of Otolaryngology-Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kosuke Uno
- Department of Otolaryngology-Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kaoru Ogawa
- Department of Otolaryngology-Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
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Mehta DD, Van Stan JH, Zañartu M, Ghassemi M, Guttag JV, Espinoza VM, Cortés JP, Cheyne HA, Hillman RE. Using Ambulatory Voice Monitoring to Investigate Common Voice Disorders: Research Update. Front Bioeng Biotechnol 2015; 3:155. [PMID: 26528472 PMCID: PMC4607864 DOI: 10.3389/fbioe.2015.00155] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [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] [Received: 06/17/2015] [Accepted: 09/23/2015] [Indexed: 11/28/2022] Open
Abstract
Many common voice disorders are chronic or recurring conditions that are likely to result from inefficient and/or abusive patterns of vocal behavior, referred to as vocal hyperfunction. The clinical management of hyperfunctional voice disorders would be greatly enhanced by the ability to monitor and quantify detrimental vocal behaviors during an individual’s activities of daily life. This paper provides an update on ongoing work that uses a miniature accelerometer on the neck surface below the larynx to collect a large set of ambulatory data on patients with hyperfunctional voice disorders (before and after treatment) and matched-control subjects. Three types of analysis approaches are being employed in an effort to identify the best set of measures for differentiating among hyperfunctional and normal patterns of vocal behavior: (1) ambulatory measures of voice use that include vocal dose and voice quality correlates, (2) aerodynamic measures based on glottal airflow estimates extracted from the accelerometer signal using subject-specific vocal system models, and (3) classification based on machine learning and pattern recognition approaches that have been used successfully in analyzing long-term recordings of other physiological signals. Preliminary results demonstrate the potential for ambulatory voice monitoring to improve the diagnosis and treatment of common hyperfunctional voice disorders.
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Affiliation(s)
- Daryush D Mehta
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital , Boston, MA , USA ; Department of Surgery, Harvard Medical School , Boston, MA , USA ; MGH Institute of Health Professions, Massachusetts General Hospital , Boston, MA , USA
| | - Jarrad H Van Stan
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital , Boston, MA , USA ; MGH Institute of Health Professions, Massachusetts General Hospital , Boston, MA , USA
| | - Matías Zañartu
- Department of Electronic Engineering, Universidad Técnica Federico Santa María , Valparaíso , Chile
| | - Marzyeh Ghassemi
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology , Cambridge, MA , USA
| | - John V Guttag
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology , Cambridge, MA , USA
| | - Víctor M Espinoza
- Department of Electronic Engineering, Universidad Técnica Federico Santa María , Valparaíso , Chile ; Department of Music and Sonology, Faculty of Arts, Universidad de Chile , Santiago , Chile
| | - Juan P Cortés
- Department of Electronic Engineering, Universidad Técnica Federico Santa María , Valparaíso , Chile
| | - Harold A Cheyne
- Bioacoustics Research Laboratory, Laboratory of Ornithology, Cornell University , Ithaca, NY , USA
| | - Robert E Hillman
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital , Boston, MA , USA ; Department of Surgery, Harvard Medical School , Boston, MA , USA ; MGH Institute of Health Professions, Massachusetts General Hospital , Boston, MA , USA
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Yumoto E, Sanuki T, Minoda R, Kumai Y, Nishimoto K, Kodama N. Over-adduction of the unaffected vocal fold during phonation in the unilaterally paralyzed larynx. Acta Otolaryngol 2014; 134:744-52. [PMID: 24834940 DOI: 10.3109/00016489.2014.886020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 11/13/2022]
Abstract
CONCLUSIONS Over-adduction of the unaffected vocal fold may not compensate vocal function in unilateral vocal fold paralysis (UVFP). OBJECTIVE To determine whether over-adduction of the unaffected vocal fold has any impact on vocal function in patients with UVFP. METHODS A total of 101 patients with UVFP who underwent three-dimensional computed tomographic (CT) examination of the larynx served as subjects. Three-dimensional endoscopic images together with coronal images during phonation were produced to evaluate over-adduction of the unaffected fold, posterior glottal gap, and differences in the vertical position and thickness between the vocal folds. Maximum phonation time (MPT) and mean airflow rate (MFR) were measured. RESULTS In all, 47 patients showed over-adduction. Their MPT and MFR were 4.9 ± 2.9 s and 653 ± 504 ml/s, respectively. The remaining 54 did not show over-adduction. Their MPT and MFR were 4.7 ± 2.7 s and 574 ± 384 ml/s, respectively. There were no significant differences in MPT or MFR between the two groups. Of the 47 patients with over-adduction, 9 showed no posterior glottal gap. However, their vocal function was not significantly different from that of 38 patients with posterior glottal gap or from that of 43 patients without over-adduction and having a posterior glottal gap.
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Affiliation(s)
- Eiji Yumoto
- Department of Otolaryngology - Head and Neck Surgery, Graduate School of Medicine, Kumamoto University , Kumamoto , Japan
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Li M, Lorenz RR, Khan MJ, Burkey BB, Adelstein DJ, Greskovich JF, Koyfman SA, Scharpf J. Salvage laryngectomy in patients with recurrent laryngeal cancer in the setting of nonoperative treatment failure. Otolaryngol Head Neck Surg 2013; 149:245-51. [PMID: 23585149 DOI: 10.1177/0194599813486257] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [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: 11/16/2022]
Abstract
OBJECTIVE To investigate the effectiveness of salvage partial and total laryngectomy in the treatment of recurrent laryngeal cancer in the setting of initial nonoperative treatment failure and to identify factors influencing long-term survival. STUDY DESIGN Case series with planned chart review. SETTING Tertiary medical center. SUBJECTS AND METHODS Patients with recurrent squamous cell carcinoma of the larynx initially treated with either radiation or chemoradiation, who underwent salvage laryngectomy at the Cleveland Clinic Foundation from 1997 to 2011, were identified. The cohort was divided into an early-stage group and an advanced-stage group based on initial tumor staging. Survival outcome was evaluated separately in each group against tumor staging, methods of treatment, and nodal status. Secondary endpoints of speech and swallowing were also evaluated. RESULTS A total of 100 patients were identified, with 72 patients in the early-stage group and 28 patients in the advanced-stage group. The overall postsalvage locoregional control rate was 70%, and the 5-year disease-specific survival was 70% and 55.2% in the early and advanced group, respectively (P = .39). The 5-year disease-specific survival was not significant in either group when compared with recurrent staging, initial treatment, salvage treatment, or nodal disease (P = ns). Using voice prostheses, good to excellent speech function was achieved postoperatively in most patients. CONCLUSION Tumor staging, methods of initial and salvage treatment, and nodal disease were not significant predictors of survival. Both salvage partial and total laryngectomy were effective methods in the treatment of recurrent laryngeal cancer in carefully selected patients.
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Affiliation(s)
- Mingsi Li
- Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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