A Synopsis of the Management of Vocal Fold Scar

2009 ◽  
Vol 19 (1) ◽  
pp. 15-23
Author(s):  
Edie R. Hapner ◽  
Adam Klein
Keyword(s):  
Lamina Propria ◽  
Vocal Fold ◽  
Wave Motion ◽  
Behavioral Treatment ◽  
Vocal Folds ◽  
Voice Therapy ◽  
Pitch Range ◽  
Glottal Closure ◽  
Vocal Fold Scar

Abstract Vocal fold scarring remains one of the greatest therapeutic challenges in laryngology and voice therapy. The loss of superior lamina propria results in a change in the pliability of the vocal folds with changes in glottal configuration, glottal closure, and reduced to absent mucosal wave motion. This results in dysphonia of varying severities including breathiness, roughness, loss of pitch range, and flexibility. The aim of this article is to present a brief review of vocal fold architecture and a discussion of the etiologies of vocal fold scarring. Methods to evaluate vocal fold scarring are presented with examples of findings in laryngoscopic, acoustic, aerodynamic, and perceptual assessments. Medical, surgical, and behavioral treatment for vocal folds scaring including sample therapy tasks are included.

scholarly journals Adipose-Derived Mesenchymal Stem Cells in the Regeneration of Vocal Folds: A Study on a Chronic Vocal Fold Scar

2016 ◽  
Vol 2016 ◽  
pp. 1-12 ◽  
Author(s):  
Angelou Valerie ◽  
Kalodimou Vassiliki ◽  
Messini Irini ◽  
Psychalakis Nikolaos ◽  
Eleftheria Karampela ◽  
...  
Keyword(s):  
Stem Cells ◽  
Hyaluronic Acid ◽  
Lamina Propria ◽  
Vocal Fold ◽  
Rabbit Model ◽  
Vocal Folds ◽  
Scar Tissue ◽  
Elastic Fibers ◽  
Adipose Derived Stem Cells ◽  
Vocal Fold Scar

Background. The aim of the study was to assess the histological effects of autologous infusion of adipose-derived stem cells (ADSC) on a chronic vocal fold scar in a rabbit model as compared to an untreated scar as well as in injection of hyaluronic acid.Study Design. Animal experiment.Method. We used 74 New Zealand rabbits. Sixteen of them were used as control/normal group. We created a bilateral vocal fold wound in the remaining 58 rabbits. After 18 months we separated our population into three groups. The first group served as control/scarred group. The second one was injected with hyaluronic acid in the vocal folds, and the third received an autologous adipose-derived stem cell infusion in the scarred vocal folds (ADSC group). We measured the variation of thickness of the lamina propria of the vocal folds and analyzed histopathologic changes in each group after three months.Results. The thickness of the lamina propria was significantly reduced in the group that received the ADSC injection, as compared to the normal/scarred group. The collagen deposition, the hyaluronic acid, the elastin levels, and the organization of elastic fibers tend to return to normal after the injection of ADSC.Conclusions. Autologous injection of adipose-derived stem cells on a vocal fold chronic scar enhanced the healing of the vocal folds and the reduction of the scar tissue, even when compared to other treatments.

Vibratory Characteristics of Teflon-Injected and Noninjected Paralyzed Vocal Folds

1990 ◽  
Vol 55 (1) ◽  
pp. 61-66 ◽  
Author(s):  
Thomas Watterson ◽  
Stephen C. McFarlane ◽  
Andrea L. Menicucci
Keyword(s):  
Vocal Fold ◽  
Vocal Folds ◽  
Vocal Fold Paralysis ◽  
Voice Therapy ◽  
Head Turning ◽  
Glottal Closure ◽  
Vocal Fold Vibration ◽  
Digital Manipulation

This study compared the vibratory characteristics of normal vocal folds, Teflon-injected paralyzed vocal folds, and noninjected paralyzed vocal folds. Laryngeal videostroboscopy under eight phonatory conditions showed that the Teflon-injected vocal folds were adynamic. The noninjected vocal folds, however, vibrated during each of the phonatory conditions although not necessarily like a normal vocal fold. In terms of vocal fold physiology, it appeared that the noninjected paralyzed vocal folds were too compliant, whereas the Teflon-injected vocal folds were too stiff. Because vocal fold paralysis is often treated in voice therapy with "digital manipulation" and "head turning," the effect of these techniques on vocal fold vibration was also studied. The results showed that digital manipulation was superior to head turning for improving glottal closure but that neither technique appeared to influence the periodicity, amplitude, or extent of vocal fold vibration for either the injected or noninjected vocal folds.

Reinke's Edema: Phonatory Mechanisms and Management Strategies

1997 ◽  
Vol 106 (7) ◽  
pp. 533-543 ◽  
Author(s):  
Steven M. Zeitels ◽  
Glenn W. Bunting ◽  
Robert E. Hillman ◽  
Traci Vaughn
Keyword(s):  
Lamina Propria ◽  
Fundamental Frequency ◽  
Vocal Fold ◽  
Management Strategies ◽  
Vocal Folds ◽  
Vocal Fold Vibration ◽  
Reinke’S Edema ◽  
Subglottal Pressure ◽  
Almost All ◽  
Superficial Lamina

Reinke's edema (RE) has been associated typically with smoking and sometimes with vocal abuse, but aspects of the pathophysiology of RE remain unclear. To gain new insights into phonatory mechanisms associated with RE pathophysiology, weused an integrated battery of objective vocal function tests to analyze 20 patients (19 women) who underwent phonomicrosurgical resection. Preoperative stroboscopic examinations demonstrated that the superficial lamina propria is distended primarily on the superior vocal fold surface. Acoustically, these individuals have an abnormally low average speaking fundamental frequency (123 Hz), and they generate abnormally high average subglottal pressures (9.7 cm H20). The presence of elevated aerodynamic driving pressures reflects difficulties in producing vocal fold vibration that are most likely the result of mass loading associated with RE, and possibly vocal hyperfunction. Furthermore, it is hypothesized that in the environment of chronic glottal mucositis secondary to smoking and reflux, the cephalad force on the vocal folds by the subglottal driving pressure contributes to the superior distention of the superficial lamina propria. Surgical reduction of the volume of the superficial lamina propria resulted in a significant elevation in fundamental frequency (154 Hz) and improvement in perturbation measures. In almost all instances, both the clinician and the patient perceived the voice as improved. However, these patients continued to generate elevated subglottal pressure (probably a sign of persistent hyperfunction) that was accompanied by visually observed supraglottal strain despite the normalsized vocal folds. This finding suggests that persistent hyperfunctional vocal behaviors may contribute to postsurgical RE recurrence if therapeutic strategies are not instituted to modify such behavior.

Effects of Voice Therapy as Objectively Evaluated by Digitized Laryngeal Stroboscopic Imaging

2002 ◽  
Vol 111 (10) ◽  
pp. 902-908 ◽  
Author(s):  
Renée Speyer ◽  
Pieter A. Kempen ◽  
George Wieneke ◽  
Willem Kersing ◽  
Elham Ghazi Hosseini ◽  
...  
Keyword(s):  
Vocal Fold ◽  
Vocal Folds ◽  
Lesion Size ◽  
Voice Therapy ◽  
Benign Lesions ◽  
Objective Measurements ◽  
Significant Parameter ◽  
Surface Areas ◽  
Vocal Fold Vibration ◽  
Maximal Opening

Objective measurements derived from digitized laryngeal stroboscopic images were used to demonstrate changes in vocal fold vibration and in the size of benign lesions after 3 months of voice therapy. Forty chronically dysphonic patients were studied. By means of a rigid stroboscope, pretreatment and posttreatment recordings were made of the vocal folds at rest and under stroboscopic light during phonation. From each recording, images of the positions at rest and during vibration at maximal opening and at maximal closure were digitized. The surface areas of any lesions and of the glottal gap were independently measured in the digitized images by 2 experienced laryngologists. Referential distances were determined in order to compensate for discrepancies in magnification in the various recordings. After 3 months of voice therapy, significant improvement in lesion size and degree of maximal closure during vibration could be demonstrated in about 50% of the patients. The degree of maximal opening did not prove to be a significant parameter.

Immunocytochemical Study of Proteoglycans in Vocal Folds

1996 ◽  
Vol 105 (1) ◽  
pp. 6-11 ◽  
Author(s):  
Agnieszka S. Pawlak ◽  
Elizabeth Hammond ◽  
Thomas Hammond ◽  
Steven D. Gray
Keyword(s):  
Chondroitin Sulfate ◽  
Lamina Propria ◽  
Vocal Fold ◽  
Keratan Sulfate ◽  
Vocal Folds ◽  
Basement Membrane Zone ◽  
Immunocytochemical Study ◽  
Frozen Sections ◽  
Intense Staining ◽  
Immunocytochemical Techniques

We evaluated the proteoglycan composition of normal vocal folds using immunocytochemical techniques. Frozen sections of 14 normal cadaveric vocal folds were obtained within 12 hours of death and sectioned immediately. Vocal fold sections were stained with antibodies against keratan sulfate, chondroitin sulfate, heparan sulfate proteoglycan (HSPG), decorin, and hyaluronate receptor. We found that the lamina propria has diffuse staining of fibrillar components with keratan sulfate and decorin. Intense staining was observed in the vocal ligament area with keratan sulfate. The HSPG was localized to the basement membrane zone. Chondroitin sulfate, HSPG, and hyaluronate receptor were detected in the cytoplasm of interstitial cells with immunocytochemical characteristics of macrophages. The keratan sulfate distribution suggests that fibromodulin may be significant in normal vocal folds. Production of HSPG and probably versican occurs in macrophages and fibroblasts in the lamina propria.

Hepatocyte Growth Factor and its Receptor C-Met in Rat and Rabbit Vocal Folds

2002 ◽  
Vol 111 (8) ◽  
pp. 661-666 ◽  
Author(s):  
Shigeru Hirano ◽  
Susan Thibeault ◽  
Charles N. Ford ◽  
Diane M. Bless ◽  
Shin-Ichi Kanemaru
Keyword(s):  
Wound Healing ◽  
Growth Factor ◽  
Hepatocyte Growth Factor ◽  
Lamina Propria ◽  
Vocal Fold ◽  
Vocal Folds ◽  
Enzyme Linked Immunosorbent Assay ◽  
Alternative Approach ◽  
Fibrotic Scar ◽  
Hepatocyte Growth

Vocal fold fibrotic scar is characterized by fibrosis of the lamina propria and epithelium, and is difficult to treat. Hepatocyte growth factor (HGF) has antifibrotic activity and has received attention as a possible therapeutic alternative to treat fibrosis. In this study, in order to clarify whether HGF can be involved in vocal fold scarring, we examined the existence of HGF and its receptor, c-Met, in rat vocal folds, and then the activity of HGF in rabbit injured vocal folds, using immunohistochemistry and enzyme-linked immunosorbent assay. We found HGF and c-Met on epithelial cells and gland cells of the rat vocal folds. On the injured vocal folds of rabbits, little HGF was observed immediately after injury, but prominent activity occurred simultaneously with reepithelialization of the vocal fold mucosa on days 10 to 15. The activity of HGF was observed on fibroblasts in the lamina propria, as well as the epithelium. It is suggested that HGF in the vocal folds is produced by the fibroblasts and delivered to the epithelium. The implication of these findings is that HGF is involved in wound healing of the vocal fold, and may provide an alternative approach in preventing and treating vocal fold scarring.

scholarly journals Does Voice Therapy Cure All Vocal Fold Nodules?

2014 ◽  
Vol 4 (2) ◽  
pp. 55-59 ◽  
Author(s):  
Baisakhi Bakat ◽  
Arunima Roy ◽  
Amitabha Roychoudhury ◽  
Barin Kumar Raychaudhuri
Keyword(s):  
Vocal Fold ◽  
Tertiary Care ◽  
Vocal Folds ◽  
Voice Therapy ◽  
Care Hospital ◽  
Laryngeal Surgery ◽  
Voice Outcome ◽  
Vocal Nodules ◽  
A Prospective Study ◽  
Vocal Fold Nodules

ABSTRACT Introduction Vocal nodules are known to be one of the most common benign lesions, commonly situated at the junction of anterior one third and posterior two third of vocal folds. Voice therapy is considered to be the gold standard of treatment of vocal fold nodule. Objectives To determine the efficacy of voice therapy in the treatment of vocal fold nodules and to identify any possible reason for failure to voice therapy in managing vocal fold nodules. Materials and methods A prospective study, conducted over a period of 6 months. Eighteen adult patients diagnosed with vocal fold nodules at a tertiary care hospital were subjected to 6 weeks of voice therapy. Pre and post therapy subjective (Voice Handicap Index-10) and objective (Rigid fiber optic laryngoscopy) evaluation was done. Patients with no improvement after 6 weeks of voice therapy underwent micro laryngeal surgery. All patients were followed up at 3 months and 6 months. Results In majority of patients, objective and subjective voice outcome parameters were significantly improved after voice therapy. Although a few cases showed no significant improvement after therapy, they recovered completely after microlaryngoscopic surgery. It was found that patients who required surgery even after voice therapy had hard nodules. How to cite this article Bakat B, Gupta A, Roy A, Roychoudhury A, Raychaudhuri BK. Does Voice Therapy Cure All Vocal Fold Nodules? Int J Phonosurg Laryngol 2014;4(2):55-59.

scholarly journals Corrigendum to “Adipose-Derived Mesenchymal Stem Cells in the Regeneration of Vocal Folds: A Study on a Chronic Vocal Fold Scar”

2016 ◽  
Vol 2016 ◽  
pp. 1-1 ◽  
Author(s):  
Valerie Angelou ◽  
Vassiliki Kalodimou ◽  
Irini Messini ◽  
Nikolaos Psychalakis ◽  
Eleftheria Karampela ◽  
...  
Keyword(s):  
Stem Cells ◽  
Mesenchymal Stem Cells ◽  
Vocal Fold ◽  
Vocal Folds ◽  
Vocal Fold Scar

scholarly journals Ayurvedic Management of Subepithelial Vocal Cord Cyst: A Case Study

2020 ◽  
Author(s):  
Sundara Raman ◽  
S Aswathy Krishna ◽  
BN Ashwini ◽  
K Sivabalaji
Keyword(s):  
Vocal Cord ◽  
Vocal Fold ◽  
Single Case ◽  
Medical Science ◽  
Surgical Excision ◽  
Vocal Folds ◽  
Voice Therapy ◽  
High Pitch ◽  
Repeat Endoscopy

Vocal fold cysts, otherwise called as vocal cord cyst, are benign masses formed on the membranous vocal folds. Present line of treatment in contemporary medical science is surgery followed by supplementary voice therapy. There are high chances of recurrence of the cyst after surgical excision. This report deals with a single case which was effectively managed with ayurvedic intervention. A 38-year-old female patient presented with hoarseness of voice, difficulty to produce high pitch notes, variations in pitch while talking. Rigid endoscopy was done and there was presence of solitary subepithelial vocal fold cyst in the middle of larynx. Treatment was done with Amapachana with Swasamrutam capsule and gorochanadi, two tablets twice daily after food. Snehapana with Varanadighrita + Guggulutikthaka ghrita in arohana matra for 4 days; Abhyanga and bashpasweda for 1 day; Virechana with TrivrtChurna 20 gm given at 7 am; Nasya with Anuthaila for 7 days; Matravasti with Sahacharadi Mezhukupakam 60 mL for 5 days. The hoarseness of voice and voice clarity improved on completion of the treatment. A repeat endoscopy showed that the cyst was no longer present. Subepithelial vocal cord cyst can be effectively managed with ayurvedic intervention principles of amapachana, agnideepana and ojovardhana.

Suspension microlaryngoscopic surgery and indirect microlaryngostroboscopic surgery for benign lesions of the vocal folds

1994 ◽  
Vol 108 (12) ◽  
pp. 1064-1067 ◽  
Author(s):  
F. G. Dikkers ◽  
A. M. Sulter
Keyword(s):  
Vocal Fold ◽  
Functional Result ◽  
Benign Lesion ◽  
Vocal Folds ◽  
Benign Lesions ◽  
Intensity Maximum ◽  
Pitch Range ◽  
Intensity Range ◽  
A Prospective Study

AbstractA prospective study was designed to compare the effects on voice capacities after either suspension microlaryngoscopic surgery or indirect microlaryngostroboscopic surgery. Patients where the clinical diagnosis 'dysphonia due to a benign lesion of the vocal fold' was made, and who could be operated in either way, entered the study. Post-operative voice evaluation was performed on 21 patients after suspension microlaryngoscopic or indirect microlaryngostroboscopic surgery. The long-term voice results following indirect microlaryngostroboscopic surgery and suspension microlaryngoscopic surgery demonstrate a statistically significant improvement for the maximum intensity, maximum dynamic intensity range, dynamic intensity range at habitual speaking pitch, and melodic pitch range. In selected cases indirect microlaryngostroboscopic surgery offers a very good functional result.

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