Clinical Applications of Office-Based Laryngeal Surgery With KTP Laser

The pulsed photoangiolytic 532-nm potassium-titanyl-phosphate (KTP) laser has emerged in recent years as an efficacious treatment modality for vocal fold lesions. It also has broadened the indications for other laryngeal laser surgery. Features of KTP laser that it is a fiber-based delivery system and its energy is selectively absorbed by oxyhemoglobin make it suitable for office-based laryngeal procedures. An office-based KTP laser surgery provides an alternative management option for benign laryngeal diseases and can be performed comfortably under flexible endoscopic guidance which is placed through the nose of a fully awake patient. Office-based laryngeal surgery with a KTP laser can alleviate the need for general anesthesia. However, there are some limitations to apply due to reduced visual precision and the fact that the vocal folds are moving during procedures. Clinicians should carefully weigh the advantages and disadvantages of office-based procedures before a treatment option is selected. Patient selection and standardized laser energy parameters may help in decreasing complications and improving the treatment results.

Voluntary Cough Effectiveness and Airway Clearance in Neurodegenerative Disease

Purpose: Voluntary cough dysfunction is highly prevalent across multiple patient populations. Voluntary cough has been utilized as a screening tool for swallowing safety deficits and as a target for compensatory and exercise-based dysphagia management. However, it remains unclear whether voluntary cough dysfunction is associated with the ability to effectively clear the airway. Method: Individuals with neurodegenerative disorders performed same-day voluntary cough testing and flexible endoscopic evaluations of swallowing (FEES). Participants who were cued to cough after exhibiting penetration to the vocal folds and/or aspiration with thin liquids during FEES met inclusion criteria. One-hundred and twenty-three trials were blinded, and the amount of residue before and after a cued cough on FEES was measured with a visual analog scale. Linear and binomial mixed-effects models examined the relationship between cough airflow during voluntary cough testing and the proportion of residue expelled. Results: Peak expiratory flow rate ( p = .004) and cough expired volume from the entire epoch ( p = .029) were significantly associated with the proportion of aspiration expelled from the subglottis. Peak expiratory flow rate values of 3.00 L/s, 3.50 L/s, and 5.30 L/s provided high predicted probabilities that ≥ 25%, ≥ 50%, and ≥ 80% aspirate was expelled. Accounting for depth of aspiration significantly improved model fit ( p < .001). Conclusions: These findings suggest that voluntary cough airflow is associated with cough effectiveness to clear aspiration from the subglottis, although aspiration amount and depth may play an important role in this relationship. These findings provide further support for the clinical utility of voluntary cough in the management of dysphagia.

Singing at Menopause: A Systematic Review with Pedagogical Implications

Menopause is a certainty in a female singer’s life; depletion of estrogens may lead to physical, mental, and vocal symptoms. To investigate the extent to which these symptoms affect singers, a systematic literature review was carried out using eight interdisciplinary bibliographic databases. Combinations of the following key words were used: menopause, climacterium, singing, singers, and choir. From 18 studies, including three doctoral dissertations and a master’s thesis, only 10 met the inclusion criteria. The heterogeneity of study designs and methods of data collection and analysis precluded the carrying out of a meta-analysis. Instead, descriptors of symptoms affecting the voice, and vocal characteristics associated with menopause ( menopause descriptors) were categorized, and their frequency of occurrence determined, according to six types of primary dataset: (1) self-reported symptoms, (2) acoustic characteristics, (3) observations of the larynx, (4) perceptual evaluations, (5) analysis of electrolaryngographic waveform characteristics, and (6) analysis of hormone concentrations. The descriptors that occurred most frequently in the literature concerned aspects of voice production, whereas those concerning vocal health, and vocal practice and performance, were less common. Of the three subsystems that comprise the vocal instrument, the vibrating vocal folds seem to be more affected than breathing and resonance. Changes in vocal range, timbre, endurance, and vocal fold mobility occur during menopause, affecting singers’ voice quality. Some singers reported that their ability to perform was compromised, mainly due to memory lapses and lack of confidence. Maintaining regular singing and practicing semi-occluded vocal tract exercises throughout the menopausal transition seem to help singers to overcome the negative impacts of menopause on vocal performance.

A preliminary study on nasalization and phonation

Although it is widely acknowledged that different speech processes may interact with each other, the way that nasalization affects phonation remains poorly understood. This paper explores the relationship between nasalization and phonation, by analyzing the phonetic cues of the tense/lax distinction both in nasalization and non-nasalization in the Bai language. The data for discussion is from two Bai dialects, Chengbei and Jinhua, which have a tense/lax distinction in both nasalized and non-nasalized syllables. Three phonation parameters – fundamental frequency (F0), open quotient (OQ), and speed quotient (SQ) – are extracted from EGG signals for analysis. It is found that the influence of nasalization on phonation varies with the tone contours. As for the level tones, the role of phonation manner in tone distinction is not evident in nasalization in that tense tones can be distinguished from lax tones only by pitch. However, in non-nasalization, phonation manner plays an indispensable role in tone distinction, in that the contrast between tense and lax tones are reflected not only on F0 but also on OQ and SQ. Moreover, non-nasalized tense tones are more likely to be accompanied by non-modal phonation that is characterized by a significantly higher SQ. In terms of articulatory explanation, high SQ in non-modal phonation is the result of the vibration of tightened vocal folds, and the tension of vocal folds is caused by raising the soft palate in non-nasalization. As for the falling tones, the role of phonation manner in tone distinction is more salient in nasalization than in non-nasalization in Chengbei Bai, but it is not attested in Jinhua Bai. This study shows that the interaction between nasalization and phonation in Bai can be revealed in the analysis of phonation parameters, i.e. F0, OQ, and SQ.

Leukoplakia: An Invasive Cancer Hidden within the Vocal Folds. A Multivariate Analysis of Risk Factors

IntroductionDiscerning the preoperative nature of vocal fold leukoplakia (VFL) with a substantial degree of certainty is fundamental, seeing that the histological diagnosis of VFL includes a wide spectrum of pathology and there is no consensus on an appropriate treatment strategy or frequency of surveillance. The goal of our study was to establish a clear schedule of the diagnostics and decision-making in which the timing and necessity of surgical intervention are crucial to not miss this cancer hidden underneath the white plaque.Material and MethodsWe define a schedule as a combination of procedures (white light and Narrow Band Imaging diagnostic tools), methods of evaluating the results (a combination of multiple image classifications in white light and Narrow Band Imaging), and taking into account patient-related risk factors, precise lesion location, and morphology. A total number of 259 patients with 296 vocal folds affected by leukoplakia were enrolled in the study. All patients were assessed for three classifications, in detail according to Ni 2019 and ELS 2015 for Narrow Band Imaging and according to Chen 2019 for white light. In 41 of the 296 folds (13.9%), the VFL specimens in the final histology revealed invasive cancer. We compared the results from the classifications to the final histology results.ResultsThe results showed that the classifications and evaluations of the involvement of anterior commissure improve the clinical utility of these classifications and showed improved diagnostic performance. The AUC of this model was the highest (0.973) with the highest sensitivity, specificity, PPV, and NPV (90.2%, 89%, 56.9%, and 98.3%, respectively).ConclusionThe schedule that combines white light and Narrow Band Imaging, with a combination of the two classifications, improves the specificity and predictive value, especially of anterior commissure involvement.

Methods of sparing surgical treatment of chronic edematous-polypous laryngitis, edema Reinke

Introduction. Laryngeal pathology occupies a leading place in the general structure of diseases of the upper respiratory tract, chronic edematous-polypous laryngitis, Reinke-Gayek edema accounts for 5.5% of all benign diseases of the vocal folds. The main method of treating Reinke-Gayek's disease is surgical treatment, which consists in removing excess mucosa, or “stripping” - tearing a strip of mucosa with forceps from the vocal fold. One of the main principles of laryngeal surgery is the maximum preservation of the structures of the vocal fold, obtaining a flexible vibration of the muscular-membranous part and the mucous membrane of the vocal fold.Purpose. The purpose of our work is to improve the effectiveness of treatment of chronic edematous-polypous laryngitis using a CO2 laser.Tasks. To develop a differentiated approach to the surgical treatment of chronic edematous-polypous laryngitis using a carbon dioxide laser.Materials and Methods. We treated 46 patients with Reinke-Gayek disease, including 35 women and 11 men. The age of the patients ranged from 40 to 67 years. Preoperative examination included endoscopic examination, laryngostroboscopy. The type was determined according to the classification of H. Yonekawa, for the choice of further surgical tactics. In type II, an incision of the mucosa, aspiration of gelatinous matter from the Reinke space, and laying of the mucosa were performed. With type III, it is made by forming M-shaped flap to close the defect.Results. All patients in the preoperative period were surveyed with the VOICE HANDICAP INDEX(VHI-30) questionnaire, laryn-gostroboscopy, and maximum phonation time. In the postoperative period, the examination was performed twice, 1 month after the operation and 3 months after the operation. There is a significant increase in indicators, an increase in the maximum phonation time, a decrease in VHI-30 points.Conclusion. The use of this technique allowed to significantly accelerate the recovery of the voice, reduce the time spent in the hospital, minimally damaging the structure of the mucous membrane of the vocal folds.

Study to assess proper timing of laryngoscopy in post-thyroid surgery patients to detect recurrent laryngeal nerve injury

Background: Thyroid surgeries are commonly done nowadays for benign and malignant conditions. Recurrent laryngeal nerve palsy (RLNP) is an important and potentially catastrophic complication of thyroid surgery. The purpose of the study was to determine the impact of rigid endoscopy (Hopkins rod-lens telescope) performed at different time intervals on the diagnosis of RLNP in post-thyroid surgery patients. Aims and Objectives: To assess Proper Timing of Laryngoscopy in Post-thyroid Surgery patients to Detect RLN Injury. Materials and Methods: Rigid endoscopy was performed postoperatively at day 0 (T0), at 2nd day post-op (T1), and day 14 (T2). For patients with RLNP, repeated examinations were performed at 2 months (T3), 6 months (T4), and 12 months (T5). Results: The study included 50 patients of thyroid swelling with different diagnoses. Overall, 35 patients appeared for postoperative laryngoscopic examination of the vocal folds at our center, providing 61 nerves at risk. RLNP rate was 8.1% at T0, 11.5% at T1, 9.8% at T2, 8.1% at T3, 4.9% at T4, and 3.3% at T5. T1 was significantly superior to all other time intervals in terms of diagnosis of RLNP but statistically not significant. Conclusion: Rigid endoscopy is essential for the detection of vocal cord paralysis after thyroidectomy. We report different time evaluation criteria of vocal cord morbidity with great and significant variability of results. Second day post-op inspection of the larynx (T1) is suggested.

Recurring exposure to low humidity induces transcriptional and protein level changes in the vocal folds of rabbits

Voice disorders are an important human health condition. Hydration is a commonly recommended preventive measure for voice disorders though it is unclear how vocal fold dehydration is harmful at the cellular level. Airway surface dehydration can result from exposure to low humidity air. Here we have induced airway surface dehydration in New Zealand White rabbits exposed to a recurring 8-h low humidity environment over 15 days. This model mimics an occupational exposure to a low humidity environment. Exposure to moderate humidity was the control condition. Full thickness soft-tissue samples, including the vocal folds and surrounding laryngeal tissue, were collected for molecular analysis. RT-qPCR demonstrated a significant upregulation of MUC4 (mucin 4) and SCL26A9 (chloride channel) and a large fold-change though statistically non-significant upregulation of SCNNA1 (epithelial sodium channel). Proteomic analysis demonstrated differential regulation of proteins clustering into prospective functional groups of muscle structure and function, oxidative stress response, and protein chaperonin stress response. Together, the data demonstrate that recurring exposure to low humidity is sufficient to induce both transcriptional and translational level changes in laryngeal tissue and suggest that low humidity exposure induces cellular stress at the level of the vocal folds.