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Purpose: Volume injected for glottic insufficiency is paramount in achieving desired outcome. Factors that determine the required volume have not been thoroughly investigated and may correlate with outcome. The first objective of this investigation was to evaluate the association between injectable volume and various parameters, including lifestyle characteristics, pre-procedural factors, and voice measures, while the second aim assessed the correlation of volume to clinical outcomes in patients who underwent injection laryngoplasty. Methods: For the first objective, a one-way ANOVA and univariate linear regression were used to analyze data from 124 patients (injected material, pre-operative diagnosis, previous voice therapy, age etc.). One-sample t-tests and Pearson correlational coefficients were employed for statistical analysis of aim 2 in a subgroup of 28 patients that had pre- and post-injection voice evaluations (e.g., acoustic and aerodynamic analysis, perceptual assessment, questionnaires). Results: Average injection volume was 0.39 ± 0.062 mL (range: 0.1–1.6mL). No pre-procedural or lifestyle factor significantly affected injection volume (p > 0.05). There was no relationship between pre-procedural voice outcomes and injection volume (p > 0.05). Of the factors that were significantly improved post-injection laryngoplasty (GFI, VHI, and GRBAS), there were no significant correlations between the magnitude of improvement in these measures and injection volume (p > 0.05). Conclusion: Injection volume does not appear to be affected by pre-procedural or lifestyle factors. In addition, injection volume does not significantly impact clinical outcomes assessed through voice analysis or patient-reported questionnaires. Our results underscore the complexity of factors at play in injection laryngoplasty for glottic insufficiency. [ABSTRACT FROM AUTHOR]

Introduction: Vagal nerve stimulator (VNS) implantation is a vital therapy for epilepsy refractory to other treatments; however, it is associated with a very high rate of voice changes. Relatively few of these patients are evaluated for vocal fold motion impairments. In this series, we evaluate 5 such patients with a novel phenotype of forced abduction with VNS stimulation. Methods: Retrospective case series. Results: Five patients with a VNS implant who underwent operative direct or in-office rigid laryngoscopy and had vocal fold motion impairment associated with VNS activation are included. All 5 patients had vocal fold mobility with VNS off and a fixed with activation. All patients exhibited vocal fold abduction with VNS activation. Patient 2 has since undergone laryngeal reinnervation, which helped her intermittent dysphonia but left a small glottic gap. A type 1 thyroplasty corrected this gap and improved her voice further. Patient 3 has undergone laryngeal reinnervation for which early results show improvement in perceptual and patient reported outcomes. Patients 4 and 5 have both undergone laryngeal reinnervation with improvement in voice. Conclusion: Previous reported cases of stimulated immobility associated with VNS use describe only adduction of the vocal fold. This series expands the previous work showing the VNS activation can also cause stimulated immobility in an abducted position, for which reinnervation and other medialization procedures offer promising treatment. [ABSTRACT FROM AUTHOR]

Montgomery's medialization thyroplasty is a laryngeal frame surgery to treat patients with unilateral vocal cord paralysis. This procedure uses a silicone implant in six sizes each for male and female patients. The results of this technique are generally good; however, the results can be suboptimal in some female patients because of differences in female and male laryngeal anatomy. The angle formed by the thyroid cartilage is greater in women than in men, meaning that the posterior portion of this cartilage is further away from the midline in women. We describe our results using male prostheses to improve suboptimal results in some of our female patients. This study is a retrospective case series study. We included female patients who underwent thyroplasty reintervention from 2014 to 2021 using male Montgomery thyroplasty prostheses. Functional results were studied using maximum phonation time (MPT), the GRBAS scales, and two questionnaires: Voice-Handicap Index 30 and Eating Assessment Tool 10. The functional results for all of these women improved after secondary thyroplasty. In one case, the MPT parameter did not change but patient satisfaction improved. The use of male Montgomery implants in women can be a useful tool to achieve improvement in female thyroplasty failure. [ABSTRACT FROM AUTHOR]

Injection laryngoplasty (IL) has become a mainstay in the treatment of unilateral vocal fold paralysis due to technical ease and avoidance of open surgery. The duration of IL effect depends on the injected material and has not been defined clearly. We aimed to define the effective duration of IL and to investigate the associated factors. Fifty-nine patients who underwent IL for unilateral vocal fold paralysis were included. IL was performed using a cricothyroid membrane approach under local anesthesia. During follow-up, in cases that developed subjective hoarseness with objective glottic insufficiency, a second IL was performed, and loss of IL effect was recorded. The duration of IL was analyzed using Kaplan-Meier estimates, and the associations between duration of effect and various factors such as postinjection voice therapy, injected material, and cause of paralysis were investigated using log-rank test. Of 59 patients, 20 (33.9 %) received a second IL. The median time interval between the first and second IL was 3.3 months (95% CI, 0.4∼27.8 months). The mean duration of effect after IL was 42.5 months (95% CI, 32.1∼52.9 months), and the rate of persisting effect was 63.4% at 1-year after IL (1-year effect rate) and 59.4% at 2 years after IL. The 1-year effect rate was 80.8% in cases with postinjection voice therapy and 57.8% in those without postinjection voice therapy (P = 0.084). Injected material, DM, HTN, patient age and sex, and cause of paralysis had no effect on the 1-year effect rate. The mean duration of IL effect was 42.5 months, and the rate of persisting effect was 63.4% at 1-year after IL. There were no significant factors affecting the duration of effect, although the duration tended to be slightly longer in cases with postinjection voice therapy. Further study with a prospective, randomized design is needed. [ABSTRACT FROM AUTHOR]

Laryngeal framework surgery is a widely accepted treatment for unilateral vocal fold paralysis with good functional outcomes. Recently, with the aging of the population, opportunities to perform this procedure in elderly patients have increased; however, the safety and efficacy of this procedure in elderly patients has not been established. Therefore, this study aimed to investigate the safety and functional outcomes of laryngeal framework surgery in elderly patients. Between January 2008 and December 2017, 97 patients with unilateral vocal fold paralysis underwent laryngeal framework surgery, and 71 among them completed pre- and post-operative voice function evaluations. The clinical course of these 71 patients were retrospectively reviewed. Out of 71 patients, 35 were assigned to the younger group (< 65 years) and 36 to the elderly group (≥ 65 years). Complications included post-operative edema and submucosal hematoma that were safely managed in all cases, and no differences were identified between the groups. Significant improvements were observed in maximum phonation time (MPT), mean flow rate, alternating current/direct current ratio, pitch perturbation quotient, amplitude perturbation quotient, and noise-to-harmonic ratio in both groups, and multivariate analysis of variance revealed greater improvement in the younger group in MPT. Laryngeal framework surgeries for unilateral vocal fold paralysis are safe and effective, regardless of age. Better improvement was observed in the younger group in the MPT suggesting that the effects of laryngeal framework surgeries is more likely to be present in the younger group than in the elderly. [ABSTRACT FROM AUTHOR]

Introduction: Recurrent laryngeal nerve palsy is a rare but important complication after endarterectomy (CEA). The impact on voice quality after this procedure is also important. The aim of the study was to assess voice quality and vocal cord function after CEA. Material and Methods: 200 patients were enrolled in the study. Inclusion criteria were indications for CEA and patient consent to the procedure. Endoscopic examination of the larynx was performed before the procedure, immediately after the procedure, on the 2nd day after the procedure, then 3 month and 6 months after the procedure. Voice was assessed by maximum phonation time (MPT), GRBAS scale, Voice Handicap Index (VHI) and the Voice-Related Quality of Life (V-RQOL) questionnaire. Results: In the study group, the results on the GRBAS scale were significantly worse and the average MPT was shorter compared to the control group. In the V-RQOL assessment, patients rated their voice as fair or good, significantly more often noticed that they had difficulty speaking loudly and being heard, and that they felt short of air when speaking. In VHI-30, the total score was significantly higher in the study group compared to the control group. Voice disorders after the procedure were reported by 68 patients, while a disorder of the recurrent laryngeal nerve was observed immediately after the procedure in 32 patients. Most vocal cord disorders were transient. Ultimately, 3% of patients were diagnosed with vocal cord paralysis. Conclusion: Cranial nerves paralysis, including the recurrent laryngeal nerve, are a common complication after CEA. Majority the paralysis is transient, but requires appropriate diagnostic and therapeutic procedures. Vocal cord evaluation is a non-invasive and widely available examination and should be performed pre- and postoperatively after all neck surgeries. The incidence of voice disorders after CEA significantly affects the quality of life of patients and requires voice rehabilitation and patient care with psychological support. [ABSTRACT FROM AUTHOR]

Purpose: Since new evidence regarding the impact of Wendler glottoplasty (WG) on the voice in transgender women became available in the literature in recent years, we aimed to perform an updated systematic review and meta-analysis to determine the actual safety and efficacy of WG in the process of vocal feminization. Methods: PubMed, Embase, and Cochrane were searched for English-language articles published until July 4, 2023. Studies were found eligible if they evaluated the impact of WG on the acoustic-aerodynamic measures and quality of voice in transgender women. Results: Twenty-three studies were identified. After exclusion of three studies due to incomplete data, 20 studies including 656 patients were included in the meta-analysis. After WG, there was a significant increase of fundamental frequency, speaking fundamental frequency, and lower limit of the frequency range (p < 0.001). Concurrently, a significant reduction of frequency range and maximum phonation time was observed (p < 0.001). No significant differences were found between the pre- and postoperative values regarding the Grade, Roughness, Breathiness, Asthenia, and Strain scale score (p = 0.339). The overall score in the Trans Woman Voice Questionnaire (TWVQ) significantly improved after WG (p < 0.001). Conclusions: WG is an effective voice feminization method in transgender women, associated with a high procedural success and low risk of postoperative complications. Significantly improved TWVQ score after surgery suggests its positive impact on the voice-related quality of life. Postoperative decrease of maximum phonation time and frequency range does not seem to significantly impact the effectiveness of voice production. [ABSTRACT FROM AUTHOR]

ObjectiveTo evaluate the safety and biocompatibility of bone wax as an implant material for medialisation laryngoplasty in a large animal model.MethodsThree Dorper-cross ewes underwent type I thyroplasty of the right vocal fold with bone wax. The animals were monitored for four weeks for general wellbeing. The animals were euthanised and the larynges harvested. Histological evaluation was performed to assess for adverse tissue reaction and biocompatibility.ResultsThe mean (± standard deviation) amount of bone wax implanted was 0.49 g (± 0.12 g). No adverse events were reported. Ex vivo vibration was present on high-speed imaging for all medialised vocal folds. Histology demonstrated implanted paraffin embedded within the thyroarytenoid muscle with no evidence of resorption, a minimal inflammatory infiltrate, and a thin fibrotic capsule.ConclusionThe results of this investigation suggest that bone wax may be a safe and efficacious implant material for medialisation laryngoplasty. Further studies are necessary to assess its long-term safety and efficacy.

Objective: This study was conducted to present the long-term functional outcomes of injection laryngoplasty (IL) with hyaluronic acid/dextranomer (HA/D) in unilateral vocal fold paralysis (UVFP). Methods: A total of 40 patients who underwent HA/D injection for UVFP were enrolled. The acoustic analysis of the voice was evaluated with jitter percentage, shimmer percentage, maximum phonation time, harmonics-to-noise ratio, and fundamental frequency. The psychosocial effect of the voice was determined using the Voice Handicap Index-10. Fiberoptic endoscopic evaluation of swallowing was performed and 2 scales were used for quantification: a modified penetration-aspiration scale and a dysphagia score. All measurements were performed at preoperative day and postoperative months 1, 6, and 24. Results: A statistically significant improvement was observed for all of the evaluated parameters except the maximum phonation time for postoperative months 1, 6, and 24 (P <.05). In the evaluation of the maximum phonation time, although there was a significant improvement for the postoperative months 1 and 6, no significant difference was observed between the postoperative 24th month and the preoperative value. Conclusions: HA/D injection laryngoplasty is an effective method both in the short- and long-term to improve voice and swallowing functions in patients with UVFP. [ABSTRACT FROM AUTHOR]

Background: Limited information is available on the long-term impact of active surveillance (AS) and immediate surgery (IS) on the quality of life (QoL) and psychological status of patients with highly suspicious subcentimeter thyroid nodules. Methods: A prospective study was conducted on 752 patients showing highly suspicious subcentimeter thyroid nodules, among whom 584 chose AS and 168 chose IS. All patients underwent at least two assessments regarding their QoL and psychological status, using three questionnaires: Thyroid Cancer-Specific Quality of Life (THYCA-QoL), Hospital Anxiety and Depression Scale (HADS), and European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire (QLQ-C30). Propensity-score matching (PSM) at a ratio of 3:1 was utilized on patients in the AS and IS groups to mitigate selection bias (504 patients in the AS group and 168 in the IS group). Subsequently, the mixed linear model was used to analyze the QoL data. Results: The median time from the initial evaluation to the last follow-up in the AS and IS groups was 24.0 and 14.2 months, respectively. The AS group showed superior QoL outcomes compared to the IS group, mainly manifested in voice (p < 0.001), sympathetic (p = 0.008), throat/mouth (p < 0.001), and problems with scar (p < 0.001) domains, as per the THYCA-QoL questionnaire. Further, the EORTC QLQ-C30 questionnaire highlighted better outcomes in physical function (p = 0.029), role function (p < 0.001), social function (p < 0.001), global health status (p < 0.001), fatigue (p = 0.012), pain (p = 0.028), appetite loss (p = 0.017), and financial difficulties (p < 0.001). Compared to the initial assessment (1 week after surgery), the IS group showed progressive improvements in QoL, especially in voice (p = 0.024), throat/mouth (p < 0.001), physical function (p = 0.004), social function (p = 0.014), nausea and vomiting (p < 0.001), pain (p = 0.006), and appetite loss (p = 0.048) domains as per both questionnaires. Conclusion: Patients with highly suspicious subcentimeter thyroid nodules who choose IS tend to experience a poorer long-term QoL compared to those who choose AS. Although the situation may improve over time, certain issues might persist, making AS a favorable option for these patients. [ABSTRACT FROM AUTHOR]

Purpose: Arytenoid adduction as an addition to medialisation thyroplasty is highly advocated by some surgeons in selected cases but deemed less necessary by others in patients with unilateral vocal fold paralysis. This study aims to evaluate the additional benefits on voice outcome of arytenoid adduction in patients with unilateral vocal fold paralysis undergoing medialisation thyroplasty using intra-operative voice measurements. Design/methods: A prospective study was conducted. Voice audio recordings were obtained at 4 moments; 1. direct prior to the start of surgery, 2. during surgery after medialisation thyroplasty, 3. during surgery after medialisation and arytenoid adduction, 3 months postoperative. At these same timepoints patients rated their own voice on a numeric rating scale between 0 and 10. The blinded recordings were rated by consensus in a team of experienced listeners, using the Grade of the GRBAS scale. Furthermore, the Voice Handicap Index was administered before and at 3 months after surgery. Results: Ten patients who underwent medialisation and arytenoid adduction at our tertiary referral hospital between 2021 and 2022, were included. One patient was excluded after surgery. The intraoperative measurements showed a Grade score of 1.4 preoperatively, improving to 1.2 after medialisation, 1.2 after medialisation and arytenoid adduction, and further improving to 0.4 at 3 months postoperative, which was a not statistically significant improvement (p = 0.2). The intraoperative subjective numeric rating scale showed a statistically significant improvement from 3.9 preoperatively, to 6.1 after medialisation, 7.1 after medialisation and arytenoid adduction and a 7.6 at 3 months postoperative (p = 0.001). The Voice Handicap Index total score showed a statistically significant improvement from 71 points before surgery to 13 at 3 months after surgery (p = 0.008). Conclusions: Our study using intraoperative voice measurements indicate that the addition of arytenoid adduction to medialisation thyroplasty is a benefit in selected patients although more studies are needed due to the many limitations inherent to this field of investigation. [ABSTRACT FROM AUTHOR]

Objective: Evaluate long-term voice outcome after bilateral medialisation thyroplasty in glottic insufficiency due to vocal fold atrophy with or without sulcus. Methods: Patients after medialisation thyroplasty for vocal fold atrophy with or without sulcus were identified. Long-term post-operative subjective voice outcomes (> 1 year) using Voice Handicap Index-30, subjective ratings on voice aspects and study-specific questionnaire were compared to pre-operative and shorter-term (1 year) values. Results: Thirty-six patients were identified, of which 26 were included (16 atrophy, 10 sulcus) with median follow up of 6.7 years. Mean Voice Handicap Index score at > 1 year (40.0) showed clinically relevant (≥ 15 for groups) and statistically significant improvement compared to pre-operative score (58.1) and remained stable compared to post-operative score (35.7) at one year. Ten patients (56 per cent) reported clinically relevant improvement (≥ 10) after more than five years. Conclusion: Long-term improvement in subjective voice outcomes is attainable in a significant proportion of patients undergoing bilateral medialisation thyroplasty for atrophy with or without sulcus. [ABSTRACT FROM AUTHOR]

Purpose: Treating an infiltration of the recurrent laryngeal nerve (RLN) by thyroid carcinoma remains a subject of ongoing debate. Therefore, this study aims to provide a novel strategy for intraoperative phenosurgical management of RLN infiltrated by thyroid carcinoma. Methods: Forty-two patients with thyroid carcinoma infiltrating the RLN were recruited for this study and divided into three groups. Group A comprised six individuals with medullary thyroid cancer who underwent RLN resection and arytenoid adduction. Group B consisted of 29 differentiated thyroid cancer (DTC)patients who underwent RLN resection and ansa cervicalis (ACN)-to-RLN anastomosis. Group C included seven patients whose RLN was preserved. Results: The videostroboscopic analysis and voice assessment collectively indicated substantial improvements in voice quality for patients in Groups A and B one year post-surgery. Additionally, the shaving technique maintained a normal or near-normal voice in Group C one year post-surgery. Conclusion: The new intraoperative phonosurgical strategy is as follows: Resection of the affected RLN and arytenoid adduction is required in cases of medullary or anaplastic carcinoma, regardless of preoperative RLN function. Suppose RLN is found infiltrated by well-differentiated thyroid cancer (WDTC) during surgery, and the RLN is preoperatively paralyzed, we recommend performing resection the involved RLN and ACN-to-RLN anastomosis immediately during surgery. If vocal folds exhibit normal mobility preoperatively, the MACIS scoring system is used to assess patient risk stratification. When the MACIS score > 6.99, resection of the involved RLN and immediate ACN-to-RLN anastomosis were performed. RLN preservation was limited to patients with MACIS scores ≤ 6.99. [ABSTRACT FROM AUTHOR]

Benign laryngeal lesions like vocal nodules, vocal polyp, vocal fold cysts are mostly found in patients complaining of change in voice. S/Z ratio has become the most frequently used clinical tool to assess phonatory mechanics. This study shows the pre-treatment and post-treatment comparison of S/Z ratios in patients with benign laryngeal lesions. To evaluate the outcome of microlaryngeal surgery in patients with benign laryngeal lesions using S/Z ratio as an outcome parameter. During this study, 65 patients with complaints of change in voice, with clinical evidence of benign laryngeal lesions underwent microlaryngeal surgery. Improvement in symptoms were measured preoperatively and postoperatively using S/Z ratio. This ratio was calculated by asking the patient to to maximally sustain 'S' and 'Z', repeated thrice. S/Z ratio was calculated by dividing the maximum duration for which /S/ was sustained by the maximum duration for which /Z/ was sustained. A ratio of more than 1.4 suggested a vocal cord disorder. There was statistically significant difference observed in S/Z ratio values, from pre-treatment to 6 months post-treatment, with P value 0.001. Pre and post treatment assessment of patients with benign vocal fold lesions showed significant improvement in S/Z ratio postoperatively. It is the simplest and a reliable objective method of voice assessment and can also be used in assessing the outcome of the treatment. [ABSTRACT FROM AUTHOR]

Objective: Laryngoplasty requires the manipulation of the vocal folds, which are not visible during the operation. The widespread use of this technique is limited by the need for adequate knowledge of anatomy, the small surgical field, and the high level of skill required for the procedure. An exoscope has been developed to provide a stereoscopic view similar to that of a microscope while using the same compact endoscopic tool. This study aimed to determine whether the three‐dimensional (3D) exoscopic surgical technique could be applied to laryngoplasty and explore its possibility to ultimately replace the current approach. Methods: This was a retrospective case series analysis, which included 28 patients with hoarseness who underwent surgery with (Exoscope; n = 12) or without (Macrosurgery; n = 16) a 3D exoscope between July 2018 and February 2021. The feasibility of performing all surgical steps with the 3D exoscope was evaluated. The Exoscope and Macrosurgery groups were compared for surgical time, vocal function outcomes, and complications. Questionnaires were completed by medical staff regarding the usefulness of medical education. Results: No intraoperative or postoperative complications occurred in either procedure. The operative time was similar in both groups. The vocal function outcomes were also comparable between the groups. Questionnaires revealed that the exoscope was useful in terms of sharing information on surgical procedures and anatomy, as well as functioning as an educational tool. Conclusion: While this was a preliminary study, our results indicated that the exclusive use of the 3D exoscope was feasible for open approaches. Level of Evidence: 4 Laryngoscope, 134:1813–1819, 2024 [ABSTRACT FROM AUTHOR]

Objectives: Medialization thyroplasty (MT) using various implants has been employed as a corrective procedure for unilateral vocal fold paralysis (UVFP). A newly developed APrevent® vocal implant system (VOIS) offers an innovative solution with a finely adjustable design. This study aimed to investigate the long-term functional voice outcomes and benefits of postoperative adjustments in patients receiving MT using the VOIS-implant. Methods: This is a prospective case series study at single tertiary medical center. Fourteen adult patients diagnosed with UVFP received MT with the VOIS implant and were followed up for more than 1 year. Implant adjustment procedure by injecting 0.9% physiological saline solution was performed both during and after the surgery to optimize glottal closure and voice quality. Objective voice outcomes and acoustic parameters were assessed preoperatively and postoperatively at various timepoints. Results: Thirteen patients (93%) received intraoperative balloon adjustment, ranging from 0.05to 0.12 ml. Four patients underwent adjustments postoperatively and exhibited a positive trend towards immediately improving acoustic voice quality. Our long-term results demonstrated a notable improvement after the surgery in voice quality, with significant decreases in VHI-30 and improvements in perceptual parameters of GRBAS scale, acoustic measures such as jitter and signal-to-noise ratio (p < 0.001) and cepstral peak prominence smoothed in sustained vowel and short sentences. The voice outcomes remained stable more than 1 year follow-up. Conclusions: Overall, MT with VOIS implantation provides a favorable long-term outcomes and stability in voice quality for patients with UVFP and also an effective tool for postoperative adjustment without major revision surgeries. [ABSTRACT FROM AUTHOR]

Arytenoid edema is not a well-described complication of thyroplasty. We report a case of exuberant arytenoid edema following thyroplasty in a 33-year-old female. The diagnosis was made post-operative day 1, the patient was immediately started on a 6-day course of methylprednisone with voice rest. The arytenoid edema completely resolved within 1 week. [ABSTRACT FROM AUTHOR]

Study post treatment improvement of Laryngopharyngeal Reflux Disease (LPRD) using non-invasive tools of Reflux symptom index (RSI), Reflux finding score (RFS) grading of videolaryngostroboscopy (VLS) and voice analysis. This study from December 2020 to April 2022 enrolled 100 adults with complaints suggestive of reflux symptoms and having Reflux Symptom Index (RSI) more than 13. All patients underwent VLS along with voice analysis. VLS findings were graded using Reflux Finding Score (RFS). Patients were advised for lifestyle modifications and proton pump inhibitors for 8 weeks when post treatment RSI, VLS and voice analyses were again documented. The age range was from 18 to 75 years. Males predominated. Lifestyle modification compliance was seen in 85% of the patients. We found a significant association (P = 0.001) for difference in pretreatment and posttreatment for both Reflux Symptom Index (RSI) parameters & Reflux Finding Score Index (RFS) parameters. Voice analysis pre and post treatment showed a significant association (P = 0.001) for fundamental frequency, jitter, shimmer, harmonic-to-noise ratio and maximum phonation time. The gold standard of diagnosis of LPRD is 24 h pH monitoring but has many false negatives and false positives due to intermittent reflux and inaccurate probe placement. This costly, time consuming and invasive procedure is not widely available amongst our speciality. Excellent visualisation of VLS allowed accurate RFS calculation. Voice analysis permitted early diagnosis of LPRD induced hoarseness before it became clinically significant. It also documented the treatment outcome. We conclude that an 8-weeks proton pump inhibitor treatment combined with lifestyle modification resulted in a significant improvement in the parameters of the non-invasive tools of RSI and RFS and voice analysis. [ABSTRACT FROM AUTHOR]

Purpose: We hypothesized that using a 3D-exoscope (3Dex) in microlaryngoscopic phonosurgery is non-inferior to using a standard operating microscope (OM). To compare the above, we utilized a 3Dex and an OM for microlaryngoscopic vocal fold augmentation with autologous fat in patients with glottic insufficiency and compared the procedure itself and the long-term impact of vocal fold augmentation on subjective and objective voice parameters in both groups. Methods: 36 patients with glottic insufficiency received microlaryngoscopic laryngeal augmentation with autologous fat. A 3Dex was utilized in 24 cases for visualization and compared to twelve cases in which an OM was used. Voice parameters were evaluated over a period of twelve months. Results: Comparison of operation time and voice parameters between the 3Dex and OM groups did not reveal significant differences. Significant improvement of mean voice quality in all parameters excluding roughness was observed at 3 and 6 months followed then by a slight decrease of voice quality parameters between the 6 and 12 months interval in both groups. Conclusion: Our findings indicate no difference concerning operation time and outcome between the use of a 3Dex and an OM in phonosurgery. Our results highlight a significant voice improvement after vocal fold augmentation with autologous fat in glottic insufficiency mediated dysphonia. The smaller viewing system, better ergonomics for the primary surgeon and the assistant and a direct view for the entire surgical team make a 3Dex an interesting alternative for visualization in microlaryngoscopic phonosurgery. [ABSTRACT FROM AUTHOR]

Objective Etiology of vocal cord paralysis (VCP) and laryngeal dysfunction may be congenital or surgical trauma of recurrent and superior laryngeal nerves. We assessed the incidence, risk factors, and morbidity of VCP after repair of esophageal atresia (EA). Methods Medical records of 201 EA patients from 2000 to 2022 were reviewed for this retrospective study. Postrepair vocal cord examination (VCE) included awake nasolaryngeal fiberoscopy by otolaryngologist or laryngoscopy under spontaneous breathing anesthesia. Before 2017, postoperative VCE was performed in symptomatic patients only and routinely after 2017. Main Results Overall, VCE was performed on 79 (38%) patients (52 asymptomatic), whereas 122 asymptomatic patients underwent no VCE. VCP was diagnosed in 32 of 79 patients (right 12, left 10, and bilateral 10; symptomatic 25 and asymptomatic unilateral 7) corresponding with extrapolated overall VCP incidence of 16 to 24% among 201 patients including asymptomatic ones. Ten patients (bilateral VCP 8 and left VCP 2) required tracheostomy. Of 10 patients with bilateral VCP, three underwent laryngotracheal expansion surgery (left VC lateralization in one and laryngoplasty in two with acquired subglottic stenosis), three remained tracheostomy dependent, three were off tracheostomy, and one died of complications after redo esophageal reconstruction. All patients with unilateral VCP managed without tracheostomy. Cervical dissection or ostomy formation was a major risk factor of VCP. Conclusion Repair of EA is associated with a considerable risk of VCP and associated morbidity. Cervical EA surgery significantly increased the risk of VCP. Bilateral VCP may eventually require laryngotracheal expansion surgery. [ABSTRACT FROM AUTHOR]

Objectives: Laryngeal dystonia (LD) is characterized by irregular and involuntary task-specific spasms of the intrinsic laryngeal muscles. There is no curative treatment for it, however, laryngeal botulinum neurotoxin injections (BoNT-I) are considered the standard of care therapy. This study aims to characterize the population of LD patients and to assess the results of laryngeal BoNT-I. Methods: A Retrospective cohort study was conducted. Medical records were reviewed for all the patients with LD diagnosis seen in the Voice Unit of the Red de Salud UC Christus between January 2013 and October 2021. Biodemographic, clinical and treatment data were collected. Additionally, a telephonic survey was completed by the patients that underwent laryngeal BoNT-I, including self-reported voice outcomes and Voice Handicap Index 10 (VHI-10). Results: Of the 34 patients with LD included in the study, 23 received a total of 93 laryngeal BoNT-I and 19 completed the telephone survey. The majority (97%) of the injections corresponded to patients with adductor LD and 3% to abductor LD. Patients received a median of 3 (1–17) injections, with a more frequent cricothyroid approach (94.4%), while the thyrohyoid approach accounted for 5.6% of cases. Most injections were bilateral (96.8%). A significant improvement in the vocal quality and effort was noted after the last injection and the overall BoNT-I treatment (P < 0.001). Similarly, the VHI-10 score improved from a median of 31 (7–40) to 2 (0–19) (P < 0.001) after the last injection. A post-treatment breathy voice was reported in 95% of patients, and dysphagia to liquids and solids in 68% and 21%, respectively. Conclusions: Laryngeal BoNT-I is an effective treatment for LD, achieving an improvement in self-reported vocal quality and VHI-10 scores, and a reduction of the self-reported vocal effort. Adverse effects are mild in the majority of cases, constituting a safe and effective therapy for these patients. [ABSTRACT FROM AUTHOR]

The benefit of injection laryngoplasty (IL) on voice for unilateral vocal fold paralysis (UVFP) is supported increasingly in literatures, yet less is known for swallowing. Also, prevalence of patient-reported dysphagia is substantially higher than instrumental studies. This prospective study focused on swallowing outcomes, with predetermined flexible endoscopic evaluation of swallowing (FEES) protocol that simulates daily life situation. Adult patients with UVFP and aspiration receiving IL were recruited. Voice outcome measurements, as well as swallowing outcomes including Eating Assessment Tool (EAT-10) and FEES, which challenged patients with different fluid volumes: 10 mL, 20 mL, and 90 mL cup sipping were evaluated. Significant improvements were demonstrated in all voice outcomes. Significant changes were also presented inEAT-10 (P < 0.01). Pre-operatively, penetration–aspiration scale (PAS) was 1.5 ± 1.3, 1.9 ± 1.7 and 2.3 ± 1.8 for 10 mL, 20 mL and 90 mL serial sipping, and improved to 1.1 ± 0.3, 1.1 ± 0.4 and 1.4 ± 0.7 post-operatively (P < 0.01). Safe swallowing (PAS ≤ 2) was achieved in all, except for one patient, who presented with a post-injection PAS of 4 (material enters the airway, contacts the vocal folds, and is ejected from the airway) on 90 mL cup sipping, whose pre-injection PAS was 7 (residue in trachea). Maintaining swallowing function suitable for social environment is important. Our results demonstrated the feasibility of the predetermined FEES protocol, and positive effects of IL on both voice and swallowing outcomes. [ABSTRACT FROM AUTHOR]

Introduction Deep interarytenoid groove (DIG) may cause swallowing dysfunction in children; however, the management of DIG has not been established. Objective We evaluated the subjective and objective outcomes of interarytenoid augmentation with injection in children with DIG. Methods Consecutive children under 18 years of age who underwent injection laryngoplasty for DIG were reviewed. Data pertaining to demographics, past medical history, past surgical history, and results of pre and postoperative video fluoroscopic swallow study (VFSS) were obtained. The primary outcome measure was the presence of thin liquid aspiration or penetration on postoperative VFSS. The secondary outcome measure was caregiver-reported improvement of symptoms. Results Twenty-seven patients had VFSS before and after interarytenoid augmentation with injection (IA). Twenty (70%) had thin liquid penetration and 12 (44%) had thin liquid aspiration before the IA. Thin liquid aspiration resolved in 9 children (45%) and persisted in 11 (55%). Of the 12 children who had thin liquid aspiration prior to IA, 6 (50%) had resolution of thin liquid aspiration after IA. Conclusions Injection laryngoplasty is a safe tool to improve swallowing function in children with DIG. Further studies are needed to assess the long-term outcomes of IA and identify predictors of successful IA in children with DIG. [ABSTRACT FROM AUTHOR]

Purpose: This study prospectively assessed the efficacy and safety of 532-nm diode laser glottoplasty in patients with sulcus vocalis. Methods: A prospective human trial was performed from August 2016 to September 2021. 532-nm diode laser glottoplasty was performed in 30 consecutive patients with sulcus vocalis who suffered from voice problems. Patients underwent acoustic aerodynamic, perceptual, stroboscopic, and Voice Handicap Index-10 (VHI-10) evaluations before and 1, 6, and 12 months after laser glottoplasty. Results: Most subjective parameters showed significant improvement (P < 0.05) at 6 months after laser glottoplasty and remained stable at 12 months. Most objective parameters showed significant improvement (P < 0.05) at 12 months after laser glottoplasty. Complications during follow-up included mild vocal fold vibration reduction in 3.3% of patients (1/30) and persistent vocal fold edema in 3.3% of patients (1/30). Conclusions: Statistically significant voice improvement at 12 months after 532-nm diode laser glottoplasty was achieved without serious complications. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study was to measure the efficacy of injection thyroplasty by liquid paraffin in the medialization of vocal cords in permanent post-traumatic or idiopathic hoarseness. Methodology: A total of 37 patients were enrolled in the study after obtaining approval from the ethical review board. The sample size was calculated using the WHO sample size calculator. All the patients in the study presented with hoarseness of voice due to either traumatic injury, idiopathic aetiology, or post-thyroidectomy. Samples were selected by simple random sampling. It was a Quasi-experimental study. All patients underwent an injection thyroplasty procedure using liquid paraffin to medialize the vocal cords. All the procedures were done under local anaesthesia. The patients were kept in follow-up for 1 year at an interval of 3 months. All the data was entered and analyzed by using SPSS version 24. Paired sample t-test was applied to measure pre-procedure and post-procedure scores. Results: The mean age of the participants was 38 years. Out of 37 patients 23 (62%) patients presented within 6 months of hoarseness of voice. 14 (38%) patients presented after 6 months of hoarseness of voice. 19 out of 23 patients (83%) underwent only a single dose of liquid paraffin via injection thyroplasty to resolve hoarseness of voice. However, out of 14 patients, 7 patients (50%) reportedly had to undergo 2 doses of liquid paraffin via injection thyroplasty. The p-value calculated was <0.005 which was statistically significant. Out of patients presenting after 6 months, 11 patients (79%) underwent transcervical phonation surgery. The p-value calculated was <0.05 which is statistically significant. Conclusion: Our study concludes that liquid paraffin is a safe and cost-effective solution for vocal cord paralysis. Liquid paraffin is not expensive and easily available which can be implied to yield excellent results to improve hoarseness of voice. Patients with late presentation are less likely to get the benefit of this procedure and may have to go for invasive transcervical phonation surgeries. It is recommended that this procedure should be done within 6 months of the development of hoarseness of voice. [ABSTRACT FROM AUTHOR]

Objectives: To assess novel morphometric measurement strategies and observer perception ratings as potential metrics for evaluating gender-affirming transvestibular chondrolaryngoplasty in reducing contour protrusion of the neck. Methods: High-resolution preoperative and 3-month postoperative photographs of a pilot series of 10 patients (n = 10) who underwent endoscopic transvestibular chondrolaryngoplasty were collected. Morphometric measurements of "light reflex" and lateral view thyroid protrusion angles of the neck contours were analyzed. Pre- and postoperative photographs were presented in random order in a survey to 17 untrained judges and rated on perceived masculinity/femininity and thyroid notch protrusion on a 7-point scale. A pre- to postoperative change in morphometric angles and subjective ratings was assessed using paired t -tests and Wilcoxon signed-rank tests. Results: Mean light reflex angles were reduced after surgery from 78.6° to 40.5° in the anterior neutral view (P =.0003), from 45.2° to 24.4° in the anterior extended view (P =.003), and from 7.03° to 4.32° in the lateral view (P =.006). Median survey ratings of neck photographs were improved after surgery, from 4 to 3 in gender perception toward more feminine perception (P <.0001) and from 4 to 2 in thyroid protrusion toward less protrusive perception (P <.0001). Conclusions: Morphometric analysis in anterior and lateral views as well as subjective gender perception and contour protrusion measures following feminization chondrolaryngoplasty by endoscopic transvestibular scarless approach demonstrate encouraging possibilities as outcome evaluation measures for chondrolaryngoplasty. [ABSTRACT FROM AUTHOR]

Health related quality of life (HRQOL) is a multidimensional concept that encompasses the patient's perceptions of his or her physical, emotional, social, and cognitive functions. Despite DTC patients' long survival, HRQOL has been shown to be lower than in the general population. There is a scarcity of data on HRQOL in thyroid cancer in the Indian population and especially goiter endemic area. As a result, the authors conducted a health-related quality of life survey in patients managed at their center in Northern India's Sub-Himalayan region using two widely accepted questionnaires. Adults with differentiated thyroid cancer who had surgery with or without radio-iodine ablation and had recovered for at least 6 months were assessed using health quality of life surveys, the QLQ-C30 and QLQ-THY34 of the European Organization for Research and Treatment of Cancer Quality of Life Group. The survey was completed by 57 adults with a mean age of 45.64 ± 15.64 years. The average time between the survey and treatment was 13.3 ± 10.8 months. After surgery, the QLQ-C30 found a significant reduction in insomnia, appetite loss, constipation, diarrhea, and financial difficulties, whereas radio-iodine ablation significantly improved global health status. The QLQ-THY34 found a significant increase in symptoms such as voice concerns, hair problems, dry mouth, shoulder functioning, tingling, and worrying after surgery, with a significant improvement in swallowing and job impact symptoms. The surgical extent had no impact. The quality of life for people with differentiated thyroid cancer in goiter-endemic areas is similar to that of other areas. However, the limited number of subjects in the study warrants further large sample size longitudinal study to understand the exact Health-related quality of life in thyroid cancer in endemic area. [ABSTRACT FROM AUTHOR]

Voice assessment before and after treatment helps the clinician to assess the effectiveness of the treatment given and facilitates comparison between different treatment modalities. Voice handicap index -10(VHI-10) questionnaire is a tool which allows the voice to be evaluated subjectively from the patient's perspective. PRAAT is a freely available, software programme that acoustically analyse voice signals. Smart phones are widely used and the high quality of the embedded microphone in it makes it a suitable and easily available voice recording device. This study aims at using PRAAT and VHI-10 questionnaire in evaluating voice before and after treatment. The utility of smart phones as a voice acquisition device is also explored in the study. Prospective, observational study, carried out from 1st November 2019 to 30th September 2021in the ENT out- patient department at a tertiary hospital in Punjab. 58 patients complaining of dysphonia were enrolled consecutively in the study. All patients underwent detailed history, examination of the larynx using 70-degree rigid laryngoscope. The voice handicap was scored by (VHI-10) questionnaire and acoustic evaluation of voice was done using the PRAAT software. Patients' voice was further evaluated 3 months post-therapy with VHI 10 questionnaire and acoustic analysis. The parameters measured on PRAAT were mean pitch, jitter (local), shimmer (local), and mean harmonics to noise ratio (HNR). The voice was recorded using a smart phone and later transferred onto a laptop for analysis. The pre and post treatment acoustic parameters and VHI-10 scores were compared and correlated. There was significant difference (p < 0.001) between the pre and post treatment VHI-10 scores and all the acoustic parameters measured except for median pitch (p = 0.995). A poor positive correlation was found between the pre treatment VHI-10 scores and jitter(r = 0.188, p = 0.157) and shimmer (r = 0.288, p = 0.028) values. A negative correlation was observed between pre treatment VHI-10 scores and pitch (r = − 0.151, p = 0.259) and HNR(r = − 0.424, p = 0.001). Post treatment VHI-10 scores showed positive correlation with jitter (r = 0.302, p = 0.021) and shimmer (0.162, p = 0.225) values and negative correlation with pitch (r = − 0.10, p = 0.457) and HNR (r = − 0.356, p = 0.006) values. We found significant differences in the VHI-10 scores and PRAAT voice analysis results before and after treatment in patients complaining with voice change (dysphonia). VHI-10 questionnaire and PRAAT are good and convenient tools for assessing the voice subjectively and objectively. Only a poor to fair correlation was found between VHI-10 scores and PRAAT analysis results. More studies must be done to confirm the utility of smart phones as a voice acquisition device and PRAAT software in voice analysis. [ABSTRACT FROM AUTHOR]

Objective: To discuss the presentation, evaluation, and management of congenital laryngeal webs with subglottic stenosis. Methods: The clinical data of six children were retrospectively analyzed. Results: The median age of these children who came to our hospital was 14 months (range 1–26 months). A tracheotomy was performed in all these six children. The median age of the patients who underwent tracheotomy was 4 months (range 1–11 months). The surgical method was T-tube implantation combined with cricoid cartilage reconstruction. The median age of these patients at the time of operation was 22 months (range 13–35 months). The T-tube remained in place for 3–8 months, with a median time of 6 months. The tracheal tubes in all these children were successfully removed. All patients were followed up for more than 2 years without recurrence. Conclusions: Children who have congenital laryngeal webs with subglottic stenosis required early tracheotomy. Open laryngoplasty combined with T-tube implantation and cricoid cartilage reconstruction may play a crucial role in the treatment of these children. [ABSTRACT FROM AUTHOR]

Vocal fold scar formation due to vocal fold injury (VFI) is a common cause of surgery or trauma-induced voice disorders. Severe scar formation can lead to reduced voice quality or even be life-threatening. Here, we investigated the role of autophagy in VFI, focusing on fibrosis as a consequence of autophagy in inducing VFI. A VFI model was constructed in rats by dissecting the lamina propria tissue from the thyroarytenoid muscle. Real-time PCR and Western blot were used to analyze expressions of autophagy markers, including Beclin1 and Atg7, in VFI. Tgfb1 and Col1a1 were assessed to determine the correlation of fibrosis with VFI progression and autophagy levels. Rat vocal fold fibroblasts were also treated with TGF-β1 or rapamycin, which activates and suppresses autophagy respectively, to explore how autophagy regulates fibrosis in VFI. Initially, we observed that autophagy was downregulated in vocal fold mucosa after VFI in rats. This was particularly evident by the time-dependent downregulation of Beclin1 and Atg7 following VFI. Concurrently, levels of Tgfb1 and Col1a1 also surged, hinting at elevated fibrosis levels. Furthermore, our experiments with TGF-β1 stimulation revealed that it inhibited autophagy in rat vocal fold fibroblasts. Interestingly, when we introduced rapamycin, this effect was reversed. Our data suggest that autophagy is a suppressor of VFI by alleviating fibrosis, making targeting autophagy a potential therapeutic route in VFI. NEW & NOTEWORTHY The study has demonstrated that autophagy is a suppressor of VFI by alleviating fibrosis, making autophagy a potential therapeutic target in VFI. [ABSTRACT FROM AUTHOR]

Purpose: Laryngeal framework surgery, including medialization laryngoplasty and arytenoid adduction (AA), is expected to have a lasting or permanent effect in patients with unilateral vocal fold paralysis (UVFP); however, there are few reports about the long-term outcomes of AA. This study aimed to evaluate the long-term postoperative effects of AA surgery and examine its stability and reliability. Methods: This study collected the voice handicap index (VHI) questionnaire from patients with UVFP who underwent AA more than 2 years previously. The VHI values preoperatively and 3 months postoperatively (early postoperative evaluation) were retrospectively calculated, and VHI values more than 2 years after surgery (late postoperative evaluation) were collected by mailing a sheet to the patients and asking to fill and return it. Possible influenced subscales such as age, sex, causes of UVFP, affected side, and surgeons were also analyzed. Results: A total of 77 patients with UVFP who underwent AA had significantly lower early and late postoperative evaluations than preoperative evaluations. In 38 patients with no missing values, there were no significant differences between early and late postoperative evaluations, measured at a median of approximately 5 years. There were also no significant differences between early and late postoperative evaluations in any of the subscale groups. Conclusion: Patients with UVFP who underwent AA surgery achieved stable voice improvement in the long term after surgery. [ABSTRACT FROM AUTHOR]

Objective: Fat injection laryngoplasty (FIL) is a common procedure used to correct glottic insufficiency. Nevertheless, few studies have discussed potential treatments for cases with poor voice recovery after FIL. Methods: Eighteen patients with unfavorable vocal outcomes from FIL were analyzed. Each of these patients presented persistent dysphonia for more than 2 months following FIL, together with bulging vocal folds and poor mucosal wave. We applied microsurgery as the standard treatment to remove excessive fat. Vocal fold steroid injection (VFSI) was administered to patients that were hesitant or declined to undergo microsurgery. Voice outcomes were evaluated using the Voice Handicap Index-10 (VHI-10), grade-roughness-breathiness (GRB) scores, and smoothed cepstral peak prominence (CPPs). Results: Six patients underwent microsurgery directly, 6 patients received only VFSIs as a salvage treatment, and the remaining 6 patients received 1 to 3 courses of VFSIs before the decision to undergo microsurgery. Pathology reports were available for 10 patients, and contained 5 instances of adipose tissues, 3 of fat necrosis, 1 of chronic inflammation, and 1 of fibrosis. Seventeen patients reported satisfactory or improved outcomes. We found remarkable improvements in VHI-10, GRB, and CPPs (all P <.05) after salvage treatments for FIL. Subgroup analyses showed comparable voice outcomes for patients undergoing direct microsurgery, VFSI alone, and VFSI followed by microsurgery (P >.05). Conclusions: This study demonstrated that fat overinjection and/or fibrotic change in the injected vocal folds may cause poor voice outcomes after FIL. Both microsurgery and VFSI could be applied as salvage treatments with good voice recovery profiles. Level of evidence: Level 4. [ABSTRACT FROM AUTHOR]

The aim of this paper was to provide a concise review of modern standards in the management of unilateral vocal fold paralysis (UVFP). This article can be used as a proposal for unilateral vocal fold paralysis treatment and as a possible indication for referral to a tertiary laryngology center. Unilateral vocal fold paralysis is a common condition, mainly caused by iatrogenic, neoplastic, or idiopathic causes. The initial treatment consists of vocal therapy with or without injection laryngoplasty. If voice impairment persists, a permanent reconstruction is usually proposed, mainly consisting of an adduction thyroplasty with or without arytenoid adduction or, to a lesser extent, laryngeal reinnervation, according to the patient's wishes. [ABSTRACT FROM AUTHOR]

Transcutaneous injection laryngoplasty (TIL) is a commonly used method to treat vocal fold paresis, where the affected vocal folds are augmented through injection. Determining the injection site and route is a major step during the preprocedural planning of TIL. In this communication, we propose and investigate an automatic method for needle route computation in preoperative neck CT. Recently, deep reinforcement learning (RL) agents showed noteworthy results for localizing the vocal folds. In this work, we focus on finding the optimal needle trajectory from the neck skin to the vocal folds localized by such RL agents. Identifying critical structures and constraints in the medical routine, we propose a minimal cost-based search to find the optimal path. Furthermore, we evaluate the proposed method with neck CT volumes from 136 patients, where it is shown that our computed needle paths have high accuracy. [ABSTRACT FROM AUTHOR]

Introduction: Benign laryngeal lesions usually disrupt the microstructure in the vocal cords causing hoarseness of voice. This study analyses the success rate of voice therapy and factors contributing to better outcomes in surgical treatment of benign vocal fold lesions. Methods: Forty consecutive patients with benign vocal cord lesions complying with the inclusion and exclusion criteria were enrolled and divided into two groups A and B, such that one received speech therapy post surgery for 6 weeks and the other received speech therapy for 12 weeks respectively. Preoperatively all the patients were evaluated by voice fatigue index, GRBAS scale and videolaryngoscopy. Vocal fold relaxation exercises were given preoperatively for patients of both groups. After undergoing conventional microlaryngeal excision surgery, both groups of patients underwent subjective analysis by voice fatigue index, perceptual analysis by GRBAS scale and videolaryngoscopy in regular intervals. Speech therapy was started after 1 week of complete voice rest post operatively and patients were followed up at the end of 1 week, 2 months and 4 months from the date of surgery. Results: There is no statistical difference in characteristics of patients between the two groups. Improvement in the Voice fatigue index and GRBAS scale score is statistically the same in groups A and B. Conclusion: Speech therapy is an important part of voice rehabilitation following microlaryngeal surgery. The misconception that longer speech therapy duration leads to better outcomes did not hold true in this study. Speech therapy postoperatively with proper voice hygiene practices is sufficient to obtain a near normal voice. [ABSTRACT FROM AUTHOR]

Summary: Prosthetic laryngoplasty is a recognised treatment option for recurrent laryngeal neuropathy (RLN) in horses; however, there is no report of the use of laryngoplasty alone or in combination, as a successful treatment of equine laryngeal dysplasia. A 6‐year‐old Warmblood gelding was referred to the hospital for investigation of respiratory noise and exercise intolerance. Grade 4 recurrent laryngeal neuropathy and bilateral vocal fold collapse were diagnosed with overground endoscopy. Ultrasonography revealed laryngeal dysplasia. The horse underwent standing laser bilateral ventriculectomy, left vocal cordectomy, right vocal cordotomy and left‐sided laryngoplasty. Abnormal structural anatomy of the left aspect of the larynx consistent with laryngeal dysplasia was identified during surgery. Post‐operatively, the horse showed substantial clinical improvement with decreased respiratory noise and improved exercise capacity. Follow‐up overground endoscopy at 6 months post‐operative revealed Dixon grade 4 abduction of the left arytenoid cartilage. Follow‐up information via telephone conversation with the owner confirmed that the horse continued in active exercise with clinical improvement. This case report highlights the value of combined clinical, endoscopic and ultrasonographic examinations of the larynx in a horse with laryngeal dysplasia and concurrent grade 4 RLN and the successful surgical treatment achieved with combined bilateral ventriculectomy, left vocal cordectomy, right vocal cordotomy and prosthetic laryngoplasty. [ABSTRACT FROM AUTHOR]

Objective: Conventional injection medialisation laryngoplasty techniques may be compromised by patient-specific factors such as marked kyphosis, an anteriorly positioned larynx or intolerance to nasendoscopy. This paper describes a technique for successful injection medialisation laryngoplasty where conventional methods are precluded, in an 88-year-old man with presbyphonia on a background of Parkinson's disease. Methods: After induction of general anaesthesia, a transoral introducing needle, shaped by tactile manipulation to match the curvature of a 'C-MAC' intubating video-laryngoscope 'D-blade' attachment, was introduced until visible above the glottis. The implant material was then injected into the paraglottic space as normal until satisfactory medialisation of the vocal fold was achieved. Results: When reviewed in the out-patient clinic four weeks later, the patient's post-operative Voice Handicap Index score fell to 6, from a pre-operative score of 21. Conclusion: By utilising commonly available equipment and anaesthetic support to recreate the views and access conventional nasendoscopy and laryngoscopy facilitate, this novel procedure provides a viable and proven alternative in uncommon but challenging cases. [ABSTRACT FROM AUTHOR]

Objective: To compare voice-related outcomes of type 1 thyroplasty using Gore-Tex® between patients with and without augmentation injection laryngoplasty (IL) prior to surgery. Methods: Forty-five patients who underwent Gore-Tex® thyroplasty at a single institution by a single surgeon between November 2016 and February 2019 were identified as those who previously had IL (n = 20) and those without IL (n = 25). Pre- and post-operative voice-related primary outcomes were evaluated using the GRBAS, and CAPE-V auditory-perceptual rating scales and secondary outcome were evaluated using the VRQOL. Pre- and post-operative voice samples were blinded, randomized, and analyzed by 3 voice-specialized speech pathologists to obtain CAPE-V scores. The VRQOL and GRBAS scores were obtained from retrospective chart review. Student's t test with a paired one-tailed distribution was used for comparisons within groups and 2-sample equal variance for comparisons between groups. Intraclass correlation coefficient determined interrater agreement. Results: GRBAS, and VRQOL significantly improved post Gore-Tex® thyroplasty. There was no difference in improvement between patients who received pre-surgery IL and those who did not in either GRBAS or VRQOL scores, but CAPE-V showed significant improvement in the IL group. A strongly positive correlation was demonstrated between the severity of CAPE-V pre-op score and the overall improvement following surgery for both groups combined. Conclusion: Patients with vocal fold paralysis have a significantly better voice after Gore-Tex® thyroplasty by self-report (VRQOL) and assessment by trained voice professionals (GRBAS). Having IL prior to surgery does not adversely affect later surgical outcomes. This paper represents one of the largest analyses of voice quality outcomes of Gore-Tex® thyroplasty using validated patient scales and randomized blinded analyses. [ABSTRACT FROM AUTHOR]

Objectives: Vocal fold medialization surgery is generally considered a phonosurgical procedure for improvement of vocal function in patients with glottic insufficiency. However, the literature describing this procedure for the management of dysphagia is limited. This study aims to assess the effects of medialization surgery on swallowing function in patients with unilateral vocal fold paralysis (UVFP). Methods: We enrolled 32 patients with UVFP undergoing vocal fold medialization surgery (medialization laryngoplasty combined with arytenoid adduction [ML + AA], 12 cases; injection laryngoplasty [IL], 20 cases). We assessed the aerodynamic vocal function including maximum phonation time and mean flow rate to evaluate glottal closure status. The Hyodo score determined by flexible endoscopic evaluation and Functional Oral Intake Scale (FOIS) were evaluated pre‐ and postoperatively. Results: Almost 60% of patients with UVFP had dysphagia, and one‐third were at high risk for aspiration. Aerodynamic parameters effectively improved after IL and ML + AA. With regard to swallowing, both the FOIS and total Hyodo score were significantly improved postoperatively. We found a particularly significant improvement in pharyngeal clearance. However, patients with high vagal nerve paralysis and postoperative insufficient glottal closure showed poor swallowing benefits after the interventions. In patients with recurrent laryngeal nerve palsy, there were no significant differences in postoperative swallowing function between the ML + AA and IL groups. Conclusion: Vocal fold medialization surgery was effective in improving swallowing function in most cases with UVFP, except for those with high vagal paralysis and insufficient postoperative glottal closure. Both IL and ML + AA showed an equivalent effect on swallowing improvement. Level of evidence: 3b. [ABSTRACT FROM AUTHOR]

Supracricoid hemilaryngopharyngectomy (SCHLP) is a laryngeal preservation surgery for hypopharyngeal carcinoma confined to the pyriform sinus or laryngeal carcinoma with arytenoid infiltration. Postoperative dysphagia is inevitable, but both voice and swallowing functions can be preserved. Here, we present a case of severe dysphagia secondary to unexpected postoperative tissue loss and scarring. A 67-year-old man underwent left SCHLP for hypopharyngeal cancer, and on the third postoperative day, he developed necrotizing fasciitis of the left neck. He was unable to swallow and was transferred to a rehabilitation hospital 90 days after the surgery. Six months after surgery, the patient had significant glottic insufficiency due to laryngeal deformity, constant massive salivary aspiration, and difficulty releasing the cuffed cannula. Severe dysphagia due to glottic insufficiency and laryngeal elevation insufficiency due to scar formation were considered, and laryngoplasty and laryngeal suspension surgery using costal cartilage were performed on the 221st postoperative day. After the reoperation, he was able to wear a speech valve and could speak and spit out, although his glottis was still closed. On the 70th day after the reoperation, he was able to consume three meals of an oral dysphagia diet and was discharged home. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the effect of transoral CO2 laser‐modified posterior cordotomy combined with plasma ablation subtotal arytenoidectomy for bilateral vocal fold paralysis (BVFP). Design: A retrospective study with medical records from 2017 to 2021 in our hospital. Setting: A single‐centre study. Participants: This retrospective study included 22 patients with BVFP. They underwent transoral CO2 laser‐modified posterior cordotomy combined with plasma ablation subtotal arytenoidectomy in our hospital from 2017 to 2021. Main Outcome Measures: Preoperative and postoperative swallowing and phonation functions were evaluated in all patients. Results: All 22 patients with a tracheostomy were successfully decannulated within 6 months after surgery without subsequent revision operations, and the width of the posterior glottis was more than 3.9 mm in all patients when they inspired. The statistical analysis showed that there was no difference in vocal function and swallowing function in all patients compared to preoperative (p >.05). Conclusion: Transoral CO2 laser‐modified posterior cordotomy combined with plasma ablation subtotal arytenoidectomy enlarges the posterior glottis in patients with BVFP, which maintains airway patency without significant worsening in voice and swallowing function. [ABSTRACT FROM AUTHOR]

The Third Asia Pacific Laryngology Association Congress and Sixth National Conference of Laryngology and Voice Association of Bangladesh were held in Dhaka, Bangladesh from March 2-4, 2024. The conference aimed to promote collaboration and the study of laryngology, with a focus on the theme of "SAVE (Swallowing, Airway & Voice Evaluation) LIVES." The event attracted renowned international faculties and 700 national delegates, making it a highly regarded academic congress. Participants had access to educational opportunities, including instructional courses and live procedures, supervised by experts in the field. The conference also included keynote speeches, panel discussions, and cultural events. Plans were made for the next APLA Congress in Egypt. [Extracted from the article]

One of the main issues in early-stage glottic carcinoma management is the voice quality following different types of treatment modalities. In type 3 and 4 transoral laser cordectomies, the voice outcomes can show significant differences due to the extent of the vocal muscle resection. This study aims to compare the voice quality in patients who underwent type 3 and 4 laser cordectomy for early-stage glottic carcinoma. A total of 30 patients who underwent type 3 (15 patients) and type 4 (15 patients) laser cordectomy for T1a glottic carcinoma between May 2018 and 2020 were included in this retrospective comparative study. Electroacoustic voice analysis and Voice Handicap Index-10 were performed in the postoperative twelfth month and the outcomes were compared between two laser cordectomy groups. The mean age of all patients was 48.6 ± 4.2 years. Noise-to-harmonic ratio, jitter, shimmer, pitch perturbation quotient and amplitude perturbation quotient values were significantly different between two groups (p < 0.05). Fundamental frequency and Voice Handicap Index-10 scores showed no statistically significant difference (p > 0.05). This study reports significantly better results for type 3 against type 4 laser cordectomy by means of objective voice analysis outcomes, except fundamental frequency. On the other hand, self-reported subjective analysis showed very similar results for both groups. Further studies combining data with multiple objective and subjective analyses with larger patient series and longer follow-up are warranted. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to describe the epidemiology of laryngotracheal stenosis within a resource-constrained setting, whilst exploring the outcome correlates unique to Montgomery Safe-T-Tube stented laryngotracheoplasty. Methods: A retrospective cross-sectional study of patients who underwent Montgomery Safe-T-Tube stented laryngotracheoplasty between January 2000 and December 2019 was performed. Results: Amongst 75 patients, most lesions were iatrogenic (78.7 per cent) and high-grade in severity (84 per cent). Following 101 laryngotracheoplasties, 57 patients (76 per cent) were successfully decannulated. Young age (84.6 per cent; p = 0.009), low-grade stenosis (100 per cent; p = 0.034) and airway-framework structural integrity (79.3 per cent; p = 0.004) were significant correlates of success. Restenosis (n = 43; 57.3 per cent), occurring at a median of 9.37 weeks following decannulation, was predominantly associated with antecedent dilatation (96.3 per cent; p < 0.001). Conclusion: Demographic and clinical profiles play a pivotal role in the outcomes and complications of Montgomery Safe-T-Tube stented laryngotracheoplasty. The success rate validates the procedure within a resource-limited setting. There exist critical periods following both surgery and decannulation when the occurrence of adverse events is most likely. [ABSTRACT FROM AUTHOR]

Background: Glottic insufficiency, or glottic gap as it is commonly called, is a common cause of dysphonia, producing symptoms of soft voice, decreased projection, and vocal fatigue. The etiology of glottic gap can occur from issues related to muscle atrophy, neurologic impairment, structural abnormalities, and trauma related causes. Treatment of glottic gap can include surgical and behavioral therapies or a combination of the two. When surgery is chosen, closure of the glottic gap is the primary goal. Options for surgical management include injection medialization, thyroplasty, and other methods of medializing the vocal folds. Methods: This manuscript reviews the current literature regarding the options for treatment of glottic gap. Discussion: This manuscript discusses options for treatment of glottic gap, including the indications for temporary and permanent treatment modalities; the differences between the available materials for injection medialization laryngoplasty and how they affect the vibratory function of the vocal folds and vocal outcome; and the evidence that supports an algorithm for treatment of glottic gap. Level of Evidence: 3a—Systematic review of case–control studies. [ABSTRACT FROM AUTHOR]

Anterior commissure (AC) involvement is an unfavorable factor for transoral laser microsurgery (TLM) treatment of early glottic carcinoma (EGC). This study aimed to evaluate the therapeutic efficacy of TLM treatment for EGC with AC involvement. From 2008 to 2017, 177 patients with T1-T2 EGC with AC involvement were retrospectively included and divided into the TLM group (n=115) receiving CO 2 laser TLM and the control group undergoing open surgery (n=62). The survival outcomes, postoperative complications, laryngeal preservation rate, recurrence and the phonological results were compared between groups. The TLM group had significantly reduced hospital stay, hospitalization costs, and intraoperative blood loss as compared with the control group. The tracheotomy rate was significantly higher in the control group (96.8% vs. 0%). The 5-year overall survival (OS) was 89.6% and 85.5% in the TLM group and control group, respectively. Log-rank test showed no difference in survival rate between the two groups. There was no significant difference in laryngeal preservation rate and overall recurrence rate between groups. In postoperative vocal function evaluation, there were significant differences in the overall grade (G), the roughness (R), the breathiness (B), Voice Handicap Index-10 (VHI-10), Jitter, Shimmer, noise/harmonic ratio (NHR), maximum phonation time (MPT), phonation threshold pressure (PTP) between the two groups. For EGC with AC involvement, TLM has similar survival outcomes with the open surgery, but has better postoperative voice outcomes. Meanwhile, TLM can effectively reduce intraoperative blood loss, hospitalization time, hospitalization costs and postoperative complications. [ABSTRACT FROM AUTHOR]

Objective: To assess the effect of maternal audiotaped voice on clinical parameters of sedated children. Methods: A randomized controlled trial was conducted on 25 sedated critically ill children admitted to the pediatric intensive care unit. An audiotaped maternal voice was played to the children in the experimental group (n=13) via a headphone for 15 minutes, twice a day for 3 days. Children in the control group (n=12) received routine care without any additional auditory stimulation. Clinical and hemodynamic variables were recorded at 5 minutes interval three times. Results: Significant changes were observed in the mean (SD) heart rate (per minute) at 10 minutes [129.83 (19.14) vs 124.29 (14.90), P=0.051], respiratory rate at 5 minutes [44.38 (17.79) vs 34.65 (7.64), P=<0.001] and 10 minutes [42.79 (13.89) vs 35.44 (7.65) P=<0.001], systolic blood pressure at 5 minutes [95.24 (15.01) vs 101.02 (19.83) P=0.045], and mean blood pressure at 15 minutes [68.66 (13.61) vs 73.61 (17.59) P=0.051] mmHg between the experimental and the control group, respectively. Conclusion: Listening to recorded maternal voice had a positive effect on clinical parameters of sedated critically ill children. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to investigate the feasibility of flexible endoscopy‐guided tracer injection for sentinel lymph node (SLN) identification in patients with laryngeal and pharyngeal carcinoma. Methods: Sixteen cT1‐4N0‐2M0 patients with laryngeal or pharyngeal carcinoma underwent intra‐ and peritumoral [99mTc]Tc‐nanocolloid injections after topical anesthesia under endoscopic guidance. SPECT–CT scans were performed at two time points. Results: Tracer injection and visualization of SLNs was successful in 15/16 (94%) patients. Median number of tracer injections was 1 intratumoral and 3 peritumoral. The median duration of the endoscopic procedure including tracer injection after biopsy taking was 7 min (range 4–16 min). A total of 28 SLNs were identified which were all visualized on the early and late SPECT–CT. Most SLNs were visualized in neck levels II and III. Conclusions: Flexible endoscopy‐guided tracer injection for SLN identification is a feasible and fast procedure in laryngeal and pharyngeal carcinoma patients. [ABSTRACT FROM AUTHOR]

Glottal insufficiency due to vocal fold paralysis, paresis, or atrophy often leads to degraded voice quality. One of the primary surgical intervention procedures to treat glottal insufficiency is medialization laryngoplasty, in which an implant is inserted through a lateral window on the thyroid cartilage to medialize the vocal folds. While the goal of medialization is to modify the vocal fold structure to restore normal phonation, few studies have attempted to quantify such structural changes of the vocal folds. The goal of this study is to quantify the three-dimensional structural changes of the vocal folds due to implant insertion in medialization laryngoplasty, and evaluate its potential effect on voice production. Medialization laryngoplasty were performed in excised human larynges using implants of different stiffness. Magnetic resonance images of the larynges were obtained with and without implant insertion. The results showed that implant insertion significantly changed the original body-cover structure of the vocal folds, with the implant taking over the large space used to be occupied by the original body layer and the vocal fold being stretched into a thin layer wrapped around the implant. The medial-lateral dimension of the vocal fold was significantly reduced from about 4 mm to 1 mm, and the vocal fold was stretched in the coronal plane by about 70%. It is hypothesized that use of implants with stiffness comparable to that of the vocal folds is beneficial because the degree of medialization can be adjusted without much negative effects on phonation frequency, phonation threshold pressure, or vibration amplitude.