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Abstract Objectives The success of type 2 thyroplasty (TP2) for adductor spasmodic dysphonia (AdSD) depends on the selection of optimally sized titanium bridges, which requires accurate assessment of intraoperative vocal changes. While this procedure has traditionally been performed according to the laryngologist's experience, the most appropriate method for voice monitoring and selection of titanium bridge size remains to be determined. This study aimed to investigate evaluation parameters useful for voice monitoring, as these may allow less experienced surgeons to perform TP2 properly. Methods In this prospective study, voice monitoring was performed in 18 patients with AdSD patients undergoing TP2. Evaluations were performed preoperatively, intraoperatively, 13 weeks postoperatively, and 52 weeks postoperatively using GRBAS (grade, roughness, breathiness, asthenia, and strain), as well as perceptual judgment and acoustic analyses. Results Preoperative and intraoperative assessments of the G, R, B, and S parameters, perceptual judgment, and harmonic‐to‐noise ratio (HNR) were in moderate or better agreement. Intraoperative and 13‐ or 52‐week postoperative measurements of the R, B, and G parameters and strangulation, tremor, and HNR were also in high agreement. When two different sizes of titanium bridges were compared (unselected vs. selected), ratings for G, R, S, strangulation, tremor, jitter, shimmer, HNR, standard deviation of F0, and degree of voice breaks were better for the selected width than the unselected width. Conclusion The candidate items for intraoperative voice monitoring during TP2 for AdSD are G, R, strangulation, tremor, and HNR. The use of these items may help to ensure successful TP2 and contribute to the advancement of laryngeal framework surgery. Level of evidence Level 4.

Objectives: To propose a simple technique to preserve, medialize and stabilize the middle turbinate through a planned medial synechiae formation using a nasal septal flap Methods: • Study Design: Case series, surgical innovation • Setting: Tertiary hospital (Kumamoto University Hospital, Japan) • Participants, Patients or Population: Six patients suffering from chronic sinusitis unresponsive to medication. The indication for doing this technique was unstable turbinates after removal of diseased mucosa. Results: Twelve weeks after surgery, the patients reported significant resolution of symptoms (headache, nasal congestion, rhinorrhea, post-nasal drip and loss of smell). CT and endoscopic findings likewise revealed clear ostio-meatal complex, drained sinuses, and complete removal of polypoid mucosa. No major side effects were noted. Conclusions: This technique is especially encouraged when surgeons encounter an unstable middle turbinate after removing massive pathologic mucosal lesions. This is a preliminary report and further investigations are being carried out to validate the technique. Keywords: medial synechiae, nasal septal flap, ostio-meatal complex

Objective: To evaluate the long-term efficacy of arytenoid adduction (AA) combined with ansa cervicalis-recurrent laryngeal nerve anastomosis (ACN-RLN) in the treatment of unilateral vocal fold paralysis. Design: Retrospective review of clinical records. Setting: Institutional practice. Patients: Nine patients with severe paralytic dysphonia with large glottal gap were included. Voice outcome was followed up over 24 months postoperatively. One patient did not attend the 24-month evaluation. Interventions: All patients underwent AA + ACN-RLN. The ansa cervicalis nerve to the sternohyoid muscle was used as the donor nerve. Main Outcome Measures: Maximum phonation time (MPT), pitch range, harmonics-to-noise ratio (HNR), and perceptual voice quality were evaluated preoperatively and postoperatively at 1 to 3 months, 6 to 8 months, 12 to 14 months, and 24 months. Results: All parameters improved significantly after surgery and continued to improve over the 24-month period. The MPT continued to improve over time (P=.01,P=.006, and P=.001 when comparing the 1- to 3-month evaluation with the 6- to 8-month, 12-to 14-month, and 24-month evaluations, respectively). Also, pitch rangeand HNR showed significant, steady improvement over the 24-month duration of the study. Perceptual voice quality markedly improved at 24 months compared with the 1- to 3-month, 6- to 8-month, and 12- to 14-month follow-ups (P=.004, P=.005, and P=.02, respectively, for grade overall, and P=.004, P=.008, and P=.02, respectively, for breathiness grade). Conclusions: Treatment with AA + ACN-RLN provides near-normal vocal function in the 24-month followup. Therefore, this method could be a successful surgical treatment for severe paralytic dysphonia. [ABSTRACT FROM AUTHOR]

Objectives: To describe a new technique of nerve-muscle pedicle (NMP) flap implantation combined with arytenoid adduction (AA) to treat dysphonia due to unilateral vocal fold paralysis and to examine postoperative vocal function. Study Design: Retrospective review of clinical records. Setting: Tertiary academic center. Patients: Twenty-two consecutive patients underwent NMP flap implantation with AA and were followed up short term over a period of 1 to 6 months (mean, 2.9 months) and long term over a period of 7 to 36 months (mean, 21.4 months). Interventions: An NMP flap was made using an ansa cervicalis branch and a piece of the sternohyoid muscle. A window was opened in the thyroid ala at the level of the vocal fold. Then, AA was performed and the NMP flap was securely implanted onto the thyroarytenoid muscle through the window under microscopic guidance. Main Outcome Measures: The maximum phonation time, mean airflow rate, pitch range, and acoustic parameters (jitter, shimmer, and harmonics to noise ratio) were evaluated before surgery and twice after surgery. Results: All parameters improved significantly after surgery (P<.01).The measurements for maximum phonation time, mean airflow rate, and harmonics to noise ratio were with innormalranges after surgery. Furthermore, the maximum phonation time and jitter were significantly improved after long-term follow-up compared with early postoperative measurements (P<.01 and P<.05, respectively). Conclusions: Precise harvest of an NMP flap and its placement directly onto the thyroarytenoid muscle combined with AA provided excellent vocal function. The NMP method may have played a certain role in the improvement of postoperative vocal function, although further study with electromyographic examination is required to clarify the innervation status of the thyroarytenoid muscle. [ABSTRACT FROM AUTHOR]