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To evaluate the anatomical and voice results of conservative management of patients diagnosed with contralateral reactive lesions (CRL) in our voice unit. A retrospective chart review was conducted of all new adult patients with benign vocal fold lesions with or without CRL, treated in the voice unit at Universidad Católica Clinical Hospital between 2015 and 2019. Patients were divided into two groups, without CRL (group A) and with CRL (group B). Analysis of preoperative and 1 month after surgery videostroboscopy, GRBASI, Voice Handicap Index-10 (VHI-10), Voice Related Quality of Life (VRQOL) surveys and management of CRL was conducted. A total of 62 patients were included, 45 (72.6%) had CRL. When compared, bivariate and multivariate analysis revealed that age was significantly associated as a mild protective factor of presenting a CRL (P < 0.05). No significative differences were found between preoperative group A and B perceptual voice analysis or voice surveys. In terms of CRL management, 30 (66.6%) were injected, conservative management with observation was performed in 12 patients (26.7%) and, three (6.7%) were surgically resected. After 1 month follow-up, 32 (71.1%) had complete CRL resolution, eight (17.8%) had CRL persistence and, five (11.1%) had CRL recurrence. Postoperative vocal outcomes, GRBASI, VHI-10 and VRQOL showed significative improvement as compared with preoperative data for each group. No differences were seen between group A and B in terms of postoperative vocal outcomes. CRL are prevalent, and their management is controversial. On our study 72.6% of BFVL presented with CRL and 93.3% of them were conservatively managed. Improvement in perceptual voice analysis and quality of life surveys were similar in both groups. [ABSTRACT FROM AUTHOR]

Vocal fold paralysis (VFP) can happen in various conditions due to mediastinal LADs, however no study has proposed anthracosis as an etiology. Here we discussed the chest CT features of anthracosis related LADs causing VFP. Among 41 cases of pulmonary anthracosis, 10 had VFP that all were presented with hoarseness. The paralysis was unilateral (left side) in all cases. Extra-nodal infiltration and conglomeration of lymph nodes were significantly higher in patients with paralysis. Left paratracheal, pre-vascular, and aortopulmonary window lymph nodes were seen in all patients. We propose that mediastinal LADs secondary to anthracosis could be a reason for left side VFP. [ABSTRACT FROM AUTHOR]

High-speed videolaryngoscopy and quantitative analysis of laryngeal images are relevant in accurately diagnosing vocal fold closure patterns. To analyze the parameters of digital videokymography obtained through high-speed videolaryngoscopy in women and men with complete and incomplete glottal closure, and posterior glottal chink. We conducted an observational, analytical, cross-sectional study with data from 65 adults, which we divided into groups according to sex and glottal closure. Digital videokymography parameters were analyzed using an image-processing program. The Anderson–Darling and Mann–Whitney U tests were used to verify sample normality and compare videokymography parameters between groups, respectively. The significance level was set at 5%. Among 65 laryngeal images, 20 each were from women with complete and incomplete glottal closure, and 20 and 5 were from men with complete and incomplete glottal closure, respectively. Considering the clinical relevance of the evaluated data, groups of 11 women and 4 men with posterior glottal chink were compared with sex-similar groups with complete glottal closure. Digital videokymography showed a lower maximum and mean vocal fold opening in women with incomplete glottal closure, and a lower dominant left vocal fold-opening amplitude and higher dominant frequency of bilateral vocal fold opening in men with incomplete glottal closure. It also showed a lower closed phase percentage in the posterior region for women and men, with higher closed phase percentage in the anterior and middle regions in women. Both groups with posterior glottal chink showed similar results. Incomplete glottal closure may interfere with the results of the digital videokymography parameters, with higher impact on the posterior vocal fold region in males and the middle and anterior vocal fold regions in females. [ABSTRACT FROM AUTHOR]

There is growing evidence that the maculae flavae of the human vocal fold are a stem cell niche, which is a microenvironment nurturing tissue stem cells. This study investigated the microenvironment, especially vascularity, in the maculae flavae of the human vocal fold. Three normal human adult, three normal newborn vocal folds obtained from autopsy cases and three surgical specimens of glottic carcinoma were investigated using light and electron microscopy. For scanning electron microscopy, a chemical digestion method (modified sodium hydroxide maceration method) was used to observe the inner 3-dimensional structure of the macula flava. Capillaries ran around the anterior and posterior maculae flavae in adults and newborns. However, there was no vascularity in the maculae flavae of the vocal fold. The inner 3-dimensional electron microscopic structure of the macula flava showed there were no blood vessels in the maculae flavae of the vocal fold. Glottic carcinoma (squamous cell carcinoma) surrounded and was in contact with the macula flava, however, the carcinoma did not invade the macula flava indicating there was no vascular supply into the macula flava from the surrounding tissue. There was no vascularity in the anterior and posterior maculae flavae in the human adult and newborn vocal folds. The present study is consistent with the hypothesis that the hypoxic microenvironment in the maculae flavae of the adult and newborn vocal fold as a stem cell niche is likely favorable to maintaining the stemness and undifferentiated states of the tissue stem cells in the stem cell system. [ABSTRACT FROM AUTHOR]

To review the authors experience in un-sedated office-based biopsies of patients with vocal fold leukoplakia and to review the literature. A retrospective review of 29 patients was conducted. A total of 41 office-based procedures were performed (eight patients had bilateral vocal fold lesions and four patients had the procedure performed twice). In 26 out of the 41 biopsies, the pathology revealed benign lesion. In eight cases, the pathology showed dysplasia (four high-grade and four low-grade). Seven biopsies revealed squamous cell carcinoma. Five patients underwent suspension micro-laryngoscopy for definitive diagnosis. Four of whom had a change in their diagnosis. Un-sedated office-based biopsy of vocal fold leukoplakia is an alternative to suspension microlaryngoscopy in case of carcinoma or nonmalignant lesions. [ABSTRACT FROM AUTHOR]

The vocal folds vibrate to produce voice, undergoing significant stress due to contact and shearing force. The epithelium operates as the primary protective layer of the tissue against stress and vibratory damage, as well as to provide a barrier against foreign organisms and toxins. Within the vocal fold epithelium, non-epithelial cells were identified that may interrupt the epithelium and compromise the epithelial barrier's protective function. Human vocal fold samples with a variety of pathologies were compared to normal vocal folds. Analysis included the number of cells in the epithelium and epithelial thickness. Vocal fold sections from 10 human tissue samples were assessed via H&E staining and immunofluorescent co-labeling. Three cell populations (vimentin expressing, CD-45 expressing, and cells expressing both) were identified within the epithelium. Statistical analysis revealed that the abnormal samples had a significantly greater number of vimentin-positive cells/area within the epithelium compared to the normal samples. Additionally, normal tissue samples had a significantly greater epithelial depth, suggesting a more robust epithelial barrier compared to tissue with pathology. Knowledge of the function of these cells could lead to a better understanding of how the local immune environment near and within vocal fold epithelium changes in the presence of different pathologies. • There are cellular differences in the epithelium of abnormal vocal folds. • Abnormal vocal fold samples had more immune cells within the epithelium. • Normal vocal folds have a thicker epithelial layer than abnormal ones. • There is a relationship between vocal fold pathology and resident immune cells. [ABSTRACT FROM AUTHOR]

Idiopathic ulcerative laryngitis (IUL) is a rare disorder characterized by ulceration in the mid-membranous portions of the vocal folds. The etiology and optimal management of this condition are poorly understood. We aimed to survey laryngologists on their experiences with managing IUL in order to better understand the diagnosis and treatment of this unusual condition. An online survey was sent to 149 laryngologists practicing at academic institutions in the United States. Survey questions assessed respondents' professional backgrounds and clinical experiences with IUL. Individual responses were tallied and calculated as percentages of total responses. A total of 96 out of 149 academic laryngologists completed the survey, leading to an overall response rate of 64.4%. All respondents reported that they had encountered IUL in practice, including 56.3% who reported having seen 1–10 cases, 22.9% reporting 11–20 cases, and 20.8% reporting greater than 20 cases over their careers. Dysphonia (99.0%) and cough (84.4%) were the two co-occurring primary presenting symptoms reported. Most base diagnosis on laryngeal videostroboscopy (93.8%). Fungal/bacterial cultures and operative biopsy had been performed by approximately 30% of respondents with occasional candidiasis reported but otherwise negative or nonspecific results. Common therapies used were empiric: antireflux therapy (91.7%), modified voice rest (91.7%), and oral steroids (80.2%). Among survey respondents with experience managing more than 10 cases of IUL, many found complete voice rest (60.0%), oral steroids (55.9%), behavioral cough suppression (46.7%), and modified voice rest (46.3%) to be at least moderately effective treatment options. Resolution of symptoms was most commonly reported to occur over the course of 1–3 months (59.4%) and recurrences were seen not very often or never (85.4%). However, permanent sequelae were common, including vocal fold stiffness (89.6%) and dysphonia (81.3%). IUL is a rare disorder of unknown etiology. Diagnosis is typically made with laryngeal videostroboscopy and spontaneous resolution occurs over 1–3 months. Laryngologists commonly treat empirically with antireflux therapy, voice rest, antimicrobials, and oral steroids. While no empiric treatment appears to be highly effective for the management of IUL, complete or modified voice rest, oral steroids, and behavioral cough suppression may be the most effective of the currently available options. Further research is necessary to improve the understanding and optimal management of IUL. [ABSTRACT FROM AUTHOR]

Objectives: The human adult vocal fold mucosa, especially, superficial layer of the lamina propria (Reinke's space) has attracted notice as an important vibrating structure. However, fine structures of the stratified squamous epithelium of the human adult vocal fold, which is another histological component of the mucosa, remain enigmatic.Methods: Three normal human adult vocal folds and epiglottises and three newborn vocal folds were investigated. Observations using transmission electron microscopy and light microscopy including immunohistochemistry were performed.Results: The most obvious feature of the epithelium of the human adult vocal folds was that the intercellular spaces between adjacent epithelial cells were large (984 ± 186 nm) compared with the stratified squamous epithelium of the human adult epiglottis and the human newborn vocal fold. Even though intercellular spaces between adjacent epithelial cells of the human adult vocal fold were large, desmosomes at the junctions of two adjacent epithelial cells made firm intercellular adhesion. Tonofilaments composed of the bundles of intermediate filaments anchored to the desmosomes. Desmosomes formed a continuous cytoskeletal network throughout the epithelial cells and epithelium of the human adult vocal fold. In addition, a great deal of E-cadherin (adhesive glycoprotein) was present between epithelial cells especially the lower half of the stratified squamous epithelium of the human adult vocal fold.Conclusions: From the functional morphological point of view, stratified squamous epithelium of the human adult vocal fold seems to form a structural framework of tensile strength with pliability suitable structure for vibration. [ABSTRACT FROM AUTHOR]

Superficial laryngeal hydration, obtained through nebulization, is related to the moisture level on the epithelial surfaces of the vocal folds, modifying their biomechanical and aerodynamic properties. Through high-speed videolaryngoscopy it is possible to obtain objective data for laryngeal analysis after nebulization and a better understanding of this phenomenon To verify the effects of nebulization with saline solution on laryngeal parameters of digital videokymography obtained by high-speed videolaryngoscopy examination in women and men with and without laryngeal alterations This is a clinical, comparative intra-subject study. Fifty-nine adults were selected, with and without laryngeal alterations, 30 females and 29 males. Digital videokymographs in the anterior, middle and posterior thirds of the vocal folds of the participants were analyzed before and after nebulization with 0.9% saline solution. Women without laryngeal alterations showed more parameters changes after nebulization, in which there was a decrease in maximum and medium opening, amplitude of opening of the left and right vocal fold in the anterior glottal third, and an increase of the percentage of closure of the vocal folds. These results indicate a minor extent of lateral excursion of the vocal folds during phonation. In women with laryngeal alterations, the parameters that changed after nebulization were the increased frequency of opening of the left and right vocal folds in the topography of the posterior third. In men, nebulization did not change the variables studied, except for the amplitude of the right vocal fold in men with laryngeal alterations, in the analysis of the posterior glottic third. The results suggest that surface hydration modifies laryngeal dynamics differently between genders. After nebulization with saline solution, women without laryngeal alterations showed a decrease in the lateralization of the vocal folds during phonation, suggesting a better phonatory efficiency. [ABSTRACT FROM AUTHOR]

In this study, we aimed to assess whether remnant vocal fold nodules (VFN) influence immediate and long-term voice outcomes after voice therapy. This is a retrospective cohort study evaluating immediate and long-term voice outcomes. Twenty-five adult patients with VFN who completed voice therapy were included in this study. Patients were classified into remnant (n = 18) and nonremnant (n = 7) groups according to the presence of remnant nodules immediately after completion of voice therapy. Acoustic and perceptual parameters, as well as voice handicap index (VHI), were compared between groups immediately (immediate outcome) and more than 3 months (long-term outcome) after completion of voice therapy. Immediately after voice therapy, there were no significant differences between groups in grade-roughness-breathiness-asthenia-strain (GRBAS) score, jitter, shimmer, noise-to-harmonics ratio, voice range profile, or s/z ratio. Postvoice therapy VHI scores did not significantly differ between the two groups (9.29 ± 8.94 in the nonremnant group vs. 12.78 ± 9.01 in the remnant group, P = 0.392). The overall GRBAS grade of all patients was maintained at 0 or 1 during long-term follow-up. There was no significant difference between the long-term VHI scores of the remnant group (10.00 ± 8.58) and the nonremnant group (5.67 ± 8.71) (P = 0.306). Immediately after voice therapy, perceptual scores, acoustic parameters, and VHI scores all significantly improved regardless of presence of remnant nodules. Favorable outcomes of voice therapy were maintained during long-term follow-up regardless of presence of remnant nodules after voice therapy. [ABSTRACT FROM AUTHOR]

This study compared the voice outcomes of selected patients with unilateral vocal fold palsy (UVFP) who underwent either nonselective laryngeal reinnervation (LR) or Type 1 thyroplasty (thyroplasty) in a Malaysian tertiary centre using multidimensional voice assessments. The study included 16 patients with UVFP who underwent either LR (9 patients) or thyroplasty (7 patients) between 2015 and 2018 who fulfilled the inclusion criteria. The outcomes were measured subjectively and objectively with: (1) voice handicap index-10 (VHI-10- Malay version); (2) auditory perceptual evaluation using the breathiness component of Grade, Roughness, Breathiness, Asthenia, Strain scale; (3) maximum phonation time (MPT); and (4) acoustic analysis (jitter%, shimmer%, and NHR) using OperaVOXTM. The outcomes were measured at baseline, 6 and 12-months postoperative. The comparison of outcomes between pre and postoperative of each group was evaluated using one-way ANOVA test. Mann-Whitney test was used to compare the outcomes between the two groups. Comparison of each group at different time points showed significant improvement of VHI-10 and MPT of LR group between baseline and 12 months (P ≤ 0.05) whereas, the improvement in thyroplasty group was observed at all time points (P ≤ 0.05). When comparing between the two groups at 12 months, the VHI-10 and MPT was significantly better in the LR group than thyroplasty group with P = 0.004 and P = 0.001 respectively. Other outcome measures did not reveal significant difference between the two groups. This observational study showed that LR may be better than thyroplasty in improving VHI-10 and MPT in selected patients with UVFP. [ABSTRACT FROM AUTHOR]

E-cigarettes heat a solution into an aerosol that is inhaled. This paper demonstrates that vaping can cause vocal fold injury such as the mucosal burn seen in the case presented. [ABSTRACT FROM AUTHOR]

To analyze the values of the fundamental frequency obtained through acoustic, electroglottographic, and accelerometer assessments on the skin of the neck in individuals with and without vocal alterations. This was an observational cross-sectional study carried out at the Voice and Biomechanical Outpatient Clinic of the Federal University of Minas Gerais, approved by the Research Ethics Committee (study number 1,229,521). The nonprobabilistic sample consisted of 30 women (normal vocal quality, 15 and dysphonia, 15) aged 18–36 years (mean, 26.1 years) and 20 men (normal vocal quality, 15 and dysphonia, 5) aged 19–48 years (mean, 28.6 years). Subjects sustained a comfortable /ɑ/ with data captured by microphone, with electrodes on thyroid cartilage, and from accelerometer above the thyroid cartilage. Results of fundamental frequency extraction were compared between acoustic microphone vs electrodes vs accelerometer for each subject. Regarding the fundamental frequency, we observed a difference in the values estimated using the microphone and accelerometer, when compared to the values estimated by the electrodes, in the dysphonic and nondysphonic female groups and among nondysphonic men. The mean fundamental frequency found for normal voices was 195.8 Hz for female voices and 112.0 Hz for male voices obtained through the microphone and accelerometer. The values estimated using the electrodes were 209.6 Hz for female voices and 160.5 Hz for male voices. For dysphonic voices, the values were 187.7 Hz for female voices and 126.8 Hz for male voices obtained through the microphone and accelerometer. The values estimated using the electrodes were 226.8 Hz for female voices and 173.8 Hz for male voices. The fundamental frequency values estimated using the microphone and accelerometer showed perfect correlation; however, the values estimated by the electrodes differ from them. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this prospective study was to identify preoperative predictors of unstable exposure of vocal folds with focus on the anterior commissure (AC) prior to Laryngeal Microscopic Surgery.Methods and Materials: Patients were classified into four groups based on the degree of AC exposure during Laryngeal Microscopic Surgery, and for the analysis, these groups were subdivided into unstable exposure and stable exposure subgroups depending on whether external manipulation was required to achieve AC exposure. Correlation of the degree of AC exposure with demographics, physical measurements, and anatomical measurements taken using landmarks in simple radiograph were evaluated. Receiver operating characteristic curve analysis was used to determine optimal cutoff values to predict unstable AC exposure.Results: Fifty-nine patients were included in the analyses. Thyroid-mandible angle (TMA) in the extended position, thyroid-mental distance (TMD) ratio, and TMA difference in the neutral and extended positions were significantly correlated with the degree of AC exposure. However, only a TMD ratio of <1.25 reliably predicted unstable AC exposure.Conclusions: TMD ratio of <1.25 reliably predicted unstable AC exposure. If there is no increase of the distance between the thyroid notch and the mental prominence (TMD) more than 25% on neck extension, the probability of getting stable exposure of the anterior commissure is low. [ABSTRACT FROM AUTHOR]

Vocal folds are widely assumed to only elongate to raise vocal pitch. However, the mechanisms seem to be more complex and involve both elongation and tensioning of the vocal folds in series. The aim of the present study was to show that changes in vocal fold morphology depend on vocal fold elongation and tensioning during singing. This was a prospective study. Forty-nine professional female singers (25 sopranos, 24 altos) were recruited and three-dimensional laryngeal images analyzed in a coronal view derived from high-resolution computed tomography scans obtained at the mean speaking fundamental frequency (ƒ 0) and one (2ƒ 0) and two octaves (4ƒ 0) above ƒ 0. The vocal fold angle, defined by a tangent above and below the vocal folds, was 58° at ƒ 0 , 47° at 2ƒ 0 , and 59° at 4ƒ 0. The decreased caudomedial angle of the vocal fold from ƒ 0 to 2ƒ 0 (change in muscle belly from ";fat" to "thin") and increased angle from 2ƒ 0 to 4ƒ 0 (from "thin" to "fat") strongly supports the hypothesis that the vocal folds elongate and then tension when singing from ƒ 0 to 4ƒ 0. This is the first study to show this relationship in vivo. [ABSTRACT FROM AUTHOR]

We analyzed the results of 10 patients treated by unilateral autologous temporal fascia graft, comparing the pre and post surgery results, as well as the appearance of the wave and the intervals until the re-appearance of it. Retrospective, clinical case series. Subjective and objective evaluation was preoperatively and postoperatively performed, using laryngovideostroboscopy, the Voice Handicap Index-10, GRBAS (grade, roughness, breathiness, asthenia, and strain), harmonics to noise ratio, Jitter, Shimmer, phonatory range, maximum phonation time, and S/Z ratio in all patients. Postoperative visits were scheduled after 1 week, 1 month, at 3 months, and at 6 months after the surgery. After surgery, we found significant differences in the maximum phonation time and the S/Z ratio (P <0.05). Most parameters of GRBAS also improved significantly, both in general and in the subscales, except for Breathiness and Asthenia (P <0.05). There was an average decrease in Voice Handicap Index-10 of 11.2 (P <0.05). At laryngovideostroboscopy, the mucous wave reappeared in all patients treated 1 month after surgery, and increased in amplitude until 6 months postoperative. [ABSTRACT FROM AUTHOR]

Although laryngeal videostroboscopy is widely utilized in the analysis of vocal fold vibrations, it is often difficult to identify patterns of vocal fold vibrations in patients with aperiodic voice signals due to failure of synchronization during laryngeal videostroboscopy examination. Therefore, the present study aimed to compare the usefulness of simultaneous two-dimensional digital kymography (2D DKG) and traditional DKG for the detection of changes in the pattern of vocal fold vibrations in patients with vocal fold scarring (VFS). Seven patients with VFS and one normal subject underwent high-speed videoendoscopy (HSV). DKG and 2D DKG evaluations of vocal fold vibrations were performed simultaneously, following which both qualitative and quantitative analyses were performed. Simultaneous DKG and 2D DKG enabled observation of vibratory patterns as well as amplitude and phase symmetry. DKG revealed and provided temporal information regarding the pattern of vocal fold vibrations at sites of VFS. In contrast, 2D DKG provided real-time information regarding the pattern of vibrations for the whole vocal fold region and regions of increased stiffness, as well as spatial information regarding changes in this pattern. Our findings indicate that 2D DKG enables the assessment of overall vocal fold vibrations, regardless of periodicity, and that simultaneous DKG and 2D DKG can be used to confirm abnormal patterns of vocal fold vibrations in patients with impaired flexibility and elasticity of the vocal folds. [ABSTRACT FROM AUTHOR]

To examine the prevalence of dysphagia in patients presenting with dysphonia and diagnosed with non-neoplastic vocal fold pathology. A total of 45 patients presenting with dysphonia and diagnosed with non-neoplastic vocal fold pathology and a control group matched according to age and gender were included. Patients with recent history of respiratory tract infection, laryngeal surgery or manipulation, neurologic disorders, head and neck tumors, or history of chemotherapy/radiotherapy were excluded. The primary outcome measure for dysphagia was Eating Assessment Tool-10. Patients with a score above three were considered to have dysphagia. The 45 patients were stratified as 18 males and 27 females, with an overall mean age of 48.23 ± 14.65 years. The most common vocal fold pathology was Reinke edema (28.8%), followed by laryngitis (24.4%), and vocal fold nodules (17.7%) and polyps (13.33%). Out of 45 patients with dysphonia, 37.7% had dysphagia and out of 25 controls, 8% had dysphagia as evidenced by an Eating Assessment Tool-10 score of above three. This prevalence is higher than normative values reported in the literature (16%–22%). The high prevalence of dysphagia in patients with non-neoplastic vocal fold pathology alludes to the pathogenic role of laryngeal behavior in the development of obstructive swallowing symptoms. The potential benefit of voice and swallowing therapy in the treatment of these patients should be considered. [ABSTRACT FROM AUTHOR]

Vocal fold nodules (VFNs) are benign disorders affecting the superficial lamina propria of the true vocal folds. The etiology of VFNs still remains unclear but laryngeal trauma caused by vocal abuse, tobacco, alcohol, and laryngopharyngeal reflux (LPR) plays a crucial role on the pathogenesis. The aim of this study was to assess the presence of pepsin in formalin-fixed, paraffin-embedded (FEPE) specimens of VFNs to evaluate the role of LPR as a risk factor for VFNs. A total of 28 pathology specimens of patients suffering from VFNs who had undergone laser microsurgery under general anesthesia were evaluated. The specimens were maintained in paraffin blocks in the pathology department. Western blot (WB) and enzyme-linked immunosorbent assay (ELISA) analyses were used to measure pepsin enzyme levels in the VFNs tissue specimens. Signs of LPR were assessed according to the reflux finding score. The mean reflux finding score of the patients was 13.6 ± 2.89 (8–21). According to WB and ELISA analyses, pepsin was detected with both the WB the ELISA tests in positive controls, but there was no pepsin enzyme in any of the 28 laryngeal FEPE VFNs specimens. The pepsin enzyme was not detected in any of the FEPE VFNs specimens, and it is concluded that further studies are needed to reveal the role of pepsin in the etiology of VFNs. [ABSTRACT FROM AUTHOR]

The objective of this study was to quantitatively measure the three-dimensional (3D) structure of the vocal folds in normal subjects and in patients with different types of cricoarytenoid dislocation. We will analyze differences in parameters between the groups and also determine if any morphologic parameters possess utility in distinguishing the type and the degree of cricoarytenoid dislocation. This retrospective study was conducted using university hospital data. Subjects' larynges were scanned using dual-source computed tomography (CT). The normal subjects were divided into deep-inhalation and phonation groups, and patients with cricoarytenoid joint dislocation were divided into anterior-dislocation and posterior-dislocation groups. Membranous vocal fold length and width were measured directly on the thin-section CT images. Vocal fold and airway 3D models were constructed using Mimics software and used in combination to measure vocal fold thickness, subglottal convergence angle, and oblique angle of the vocal folds. The phonation group displayed a greater vocal fold width, greater oblique angle, thinner vocal folds, and a smaller subglottal convergence angle than those of the deep-inhalation group (P < 0.05). The anterior-dislocation group displayed a smaller oblique angle and subglottal convergence angle than the posterior-dislocation group (P < 0.05). The 3D structure of the vocal folds during deep inhalation and phonation can be accurately measured using dual-source CT and laryngeal 3D reconstruction. As the anterior-dislocation group yielded negative values for the oblique angle and the posterior-dislocation group yielded positive values, the oblique angle of the vocal folds may possess utility for distinguishing the type and for quantitatively determining the degree of cricoarytenoid dislocation. [ABSTRACT FROM AUTHOR]

A novel, silk protein-based injectable filler was engineered with the intention of vocal fold augmentation as its eventual intended use. This injectable filler leverages the unique properties of silk protein's superior biocompatibility, mechanical tunability, and slow in vivo degradation to one day better serve the needs of otolaryngologists. This paper intends to demonstrate the mechanical properties of the proposed novel injectable and to evaluate its longevity in animal models. Experimental. The mechanical properties of silk bulking agents were determined to characterize deformation resistance and recovery compared with commercially available calcium hydroxylapatite through rheologic testing. Fresh porcine vocal fold tissue was used for injectable placement to simulate the mechanical outcomes of native tissue after bulking procedures. In vivo subcutaneous rodent implantation examined immune response, particle migration, and volume retention. Porous, elastomeric silk microparticles demonstrate high recovery (>90% original volume) from compressive strain and mimic the native storage modulus of soft tissues (1–3 kPa). Injectable silk causes only a slight increase in porcine vocal fold stiffness immediately after injection (20%), preserving the native mechanics of bulked tissue. In the subcutaneous rat model, silk demonstrated biocompatibility and slow degradation, thus enabling host cell integration and tissue deposition. The presented novel silk injectable material demonstrates favorable qualities for a vocal fold injection augmentation material. An in vivo long-term canine study is planned. [ABSTRACT FROM AUTHOR]

Dysphonia is a known consequence of premature birth, and is usually associated with endotracheal intubation in the neonatal period or surgical ligation of persistent patent ductus arteriosus. Recently, cases of dysphonia, in the absence of these causative factors, have been reported. This review seeks to identify literature pertaining to those aspects of laryngeal development that may potentially be disrupted by premature birth. The purpose of the review is to determine whether there is any possible anatomical or physiological explanation for dysphonia to arose solely from premature birth. This scoping review was conducted in accordance with the guidelines prescribed by Arskey and O'Malley (2005). Fifteen relevant papers were identified. Results were categorized into age-related categories, to identify changes in the developmental trajectory. Based on the results of the literature search, a further category of unphonated larynges was added. Potential differences in the laryngeal framework (e.g., the development of the cricoid cartilage and the shape of the glottis) and vocal fold histology, depending on gestational age and post-natal phonation were identified. Much literature focused on the macula flavae, however, the layers of the lamina propria were also discussed. It is unclear whether the process of differentiation of the layers of the lamina propria, which commences in the second to third months of life in term-born infants, is disrupted by prematurity. Further, development of the macula flavae continues until at least 28 weeks' gestation. Preterm children may not phonate immediately after birth, which may also affect laryngeal development. [ABSTRACT FROM AUTHOR]

Summary Objective The study aimed (1) to evaluate the prevalence of sulcus vocalis (SV) coexisting with vocal fold polyp (SV-VFP), and (2) to determine the effect of their coexistence on voice quality. Study Design This is a retrospective cohort study in a tertiary referral center. Methods The medical records of all patients who underwent micro direct laryngoscopy due to VFPs between January 2013 and April 2015 were reviewed. Patients with SV-VFP were identified and data of their demographics, medical history, habits, preoperative and intraoperative laryngeal findings, and pre- and postoperative GRBAS (Grade, Roughness, Breathiness, Asthenia, Strain) score, and compared with the data of patients with solitary VFPs (S-VFPs). Results Eighty-nine patients were diagnosed with VFPs, 14 (15.7%) of whom were diagnosed with SV-VFPs. Patients with SV-VFPs had significantly lower incidence of concurrent leukoplakia ( P  = 0.01), higher incidence of contralateral vocal fold lesions ( P  = 0.04), increased voice roughness score postoperatively ( P  = 0.01) on the GRBAS score, and had a lower rate of cigarette smoking ( P  = 0.02) compared with patients with S-VFPs. Conclusions The possibility of a hidden SV should be considered when detecting VFPs, particularly in patients with contralateral vocal fold lesions and without cigarette smoking history. Because the group of patients with SV-VFP presented with unique features, we suspect that the coexistence of VFPs and SVs is not incidental and that SVs may contribute to the formation of VFPs, possibly by alternating glottic airflow. [ABSTRACT FROM AUTHOR]

For many real speech applications such as speech synthesis, speech conversion it is essential to reproduce the voice source waveforms as close as possible to the real ones in order to synthesize a natural speech. In the literature, voice source waveform models such as Liljencrants-Fant (LF) synthesize the voice source waveform using mathematical expressions. Such parametrization produces a poor approximation of real voice source waveforms of the human voice. This paper presents a frequency study of the LF-model. Based on this study, we propose to enrich the spectrum and the phase of the LF-model. An analysis/synthesis scheme was set up to demonstrate the effectiveness of the proposed method. Subjective and objective measures show that the synthesized speech using the proposed method performs better when using the simple LF model. [ABSTRACT FROM AUTHOR]

Purpose: Preventive detection of premalignant lesions of vocal fold can play an important role for earlier detection of larynx cancer. In this paper, an automatic detection of premalignant lesions based on human voice production theory is designed. More specifically, premalignant lesions such as leukoplakia, Erythroplakia, Keratosis, etc are directly related to the vocal fold, features extracted from glottal fold waveform can be pertinent and critical. The proposed method performs as non-intrusive technique based on the extraction of vocal fold waveform from the recorded utterances. Method: The basic idea is to extract pertinent features from the source signal (glottal waveform). However, such signal is not directly accessible. Hence, we perform a first treatment of recorded speech using Iterative Adaptive Inverse Filtering (IAIF) to extract the glottal waveform. IAIF is applied on two databases: Massachusetts Eye and Ear Inrmary (MEEI) database and Saarbrucken Voice Database (SVD) with sustained vowel samples. From the glottal flow impulses, pertinent instances are used to build pertinent features. A deep exploration of extracted features, using statistical tools such as boxplot and Principal Component Analysis (PCA), leads to select the most critical and pertinent features. By using Support Vector Machine Technique as classification technique, a discrimination between normal and premalignant tumor is achieved. Results: Preliminary results show that some features are not discriminant. Those features are discarded and only pertinent ones are used in learning and testing processing using SVM. The performances are assessed using four criteria, sensitivity, specificity, precision and accuracy. When selected features are combined according to PCA analysis, an accuracy of about 92% is accomplished. Conclusion: It is shown in this study that is possible to detect the premalignant lesions with acceptable and fairly sensitivity, specificity, precision and accuracy. Such algorithm can help detect at earlier stage laryngeal cancer. [ABSTRACT FROM AUTHOR]

A mixed-effects model approach was introduced in this study for the statistical analysis of rheological data of vocal fold tissues, in order to account for the data correlation caused by multiple measurements of each tissue sample across the test frequency range. Such data correlation had often been overlooked in previous studies in the past decades. The viscoelastic shear properties of the vocal fold lamina propria of two commonly used laryngeal research animal species (i.e. rabbit, porcine) were measured by a linear, controlled-strain simple-shear rheometer. Along with published canine and human rheological data, the vocal fold viscoelastic shear moduli of these animal species were compared to those of human over a frequency range of 1–250 Hz using the mixed-effects models. Our results indicated that tissues of the rabbit, canine and porcine vocal fold lamina propria were significantly stiffer and more viscous than those of human. Mixed-effects models were shown to be able to more accurately analyze rheological data generated from repeated measurements. [ABSTRACT FROM AUTHOR]

Vocal fold microstructure is complex and can be affected by laryngeal microsurgery, inducing scarring that prevents mechanical uncoupling of epithelium and muscle, leading to vibration disorder and disabling dysphonia. Treatment options presently are few, and often without efficacy for vibration, having only an impact on volume to reduce glottal closure defect. The present review of the literature had two aims: (i) to report the current state of the literature on cell therapy in vocal fold scarring; and (ii) to analyze the therapeutic interest of the adipose-derived stromal vascular fraction in the existing therapeutic armamentarium. A PubMed ® search conducted in September 2016 retrieved English or French-language original articles on the use of stem cells to treat vocal fold scarring. Twenty-seven articles published between 2003 and 2016 met the study selection criteria. Mesenchymal stem cells were most widely used, mainly derived from bone marrow or adipose tissue. Four studies were performed in vitro on fibroblasts, and 18 in vivo on animals. End-points comprised: (i) scar analysis (macro- and micro-scopic morphology, viscoelastic properties, extracellular matrix, fibroblasts); and (ii) assessment of stem cell survival and differentiation. The studies testified to the benefit of mesenchymal stem cells, and especially those of adipose derivation. The stromal vascular fraction exhibits properties that might improve results by facilitating production logistics. [ABSTRACT FROM AUTHOR]

Summary As one of the key fibrous proteins in the extracellular matrix, collagen plays a significant role in the structural and biomechanical characteristics of the vocal fold. Anchored fibrils of collagen create secure structural regions within the vocal folds and are strong enough to sustain vibratory impact and stretch during phonation. This contributes tensile strength, density, and organization to the vocal folds and influences health and pathogenesis. This review offers a comprehensive summary for a current understanding of collagen within normal vocal fold tissues throughout the life span as well as vocal pathology and wound repair. Further, collagen's molecular structure and biosynthesis are discussed. Finally, collagen alterations in tissue injury and repair and the incorporation of collagen-based biomaterials as a method of treating voice disorders are reviewed. [ABSTRACT FROM AUTHOR]

Objective To describe a novel methodology for intraoperative neuro-monitoring of laryngeal and vagus nerves by utilizing the laryngeal adductor reflex (LAR). Methods Case series of 15 patients undergoing thyroid and cervical spine surgeries under total intravenous general anesthesia. Vocal fold mucosa was electrically stimulated to elicit a LAR using endotracheal tube based electrodes. Contralateral R1 (cR1) and R2 (cR2) responses were recorded using the endotracheal tube electrode contralateral to the simulating electrode. Results The LAR was reliably elicited in 100% of patients for the duration of each surgical procedure. Mean onset latency of cR1 response was 22.4 ± 2.5 ms (right) and 22.2 ± 2.4 ms (left). cR2 responses were noted in 10 patients (66.7%). No peri-operative complications or adverse outcomes were observed. Conclusions The LAR is a novel neuro-monitoring technique for the vagus nerve. Advantages over current monitoring techniques including simplicity, ability to continuously monitor neural function without placement of additional neural probes and ability to assess integrity of both sensory and motor pathways. Significance The LAR represents a novel method for intraoperatively monitoring laryngeal and vagus nerves. The LAR monitors the entire vagus nerve reflex arc and is thus applicable to all surgeries where vagal nerve integrity may be compromised. [ABSTRACT FROM AUTHOR]

Summary Objectives/Hypothesis To examine the changes in the larynx, as well as self-reported voice and throat symptoms, among patients undergoing a histamine challenge test. Thus, to understand the possible clinical effects of histamine on the larynx. Study design Controlled, open prospective study. Methods Thirty adult patients with prolonged cough and suspicion of bronchial asthma underwent a histamine challenge test. Videolaryngostroboscopy was performed immediately before and after the challenge. Voice and throat symptoms immediately before and after the challenge test were assessed using a visual analog scale. Results Videolaryngostroboscopy after exposure showed significant increases in edema ( P  < 0.001) as well as redness ( P  < 0.001) of the vocal folds after the exposure. Self-reported voice complaints increased significantly for 8 of 11 symptoms. A moderate positive correlation was found between the increase in edema of the vocal folds and reported heartburn/regurgitation symptoms ( r  = 0.42, P  < 0.05). Atopy, asthma, nasal symptoms, or bronchial hyperreactivity during the histamine challenge test were not associated with laryngeal reactions. Conclusions According to the results, the laryngeal mucosal reaction during a histamine challenge test can be objectively visualized. Videolaryngostroboscopy findings, together with an increase in self-reported voice and throat symptoms, show that histamine has potential effects on vocal folds. The mucosal reaction seems to be pronounced among patients with reflux symptoms, probably reflecting the permeability features of the vocal folds. [ABSTRACT FROM AUTHOR]

Summary Vocal fold scarring is a common cause of dysphonia. Current treatments involving vocal fold augmentation do not yield satisfactory outcomes in the long term. Tissue engineering and regenerative medicine offer an attractive treatment option for vocal fold scarring, with the aim to restore the native extracellular matrix microenvironment and biomechanical properties of the vocal folds by inhibiting progression of scarring and thus leading to restoration of normal vocal function. Hyaluronic acid is a bioactive glycosaminoglycan responsible for maintaining optimum viscoelastic properties of the vocal folds and hence is widely targeted in tissue engineering applications. This review covers advances in hyaluronic acid-based vocal fold tissue engineering and regeneration strategies. [ABSTRACT FROM AUTHOR]

In this paper, we describe a method for primary culture of a well differentiated electrically tight rabbit vocal fold epithelial cell multilayer and the measurement of transepithelial electrical resistance (TEER) for the evaluation of epithelial barrier function in vitro . Rabbit larynges were harvested and enzymatically treated to isolate vocal fold epithelial cells and to establish primary culture. Vocal fold epithelial cells were co-cultured with mitomycin C-treated feeder cells on collagen-coated plates. After 10–14 days in primary culture, cells were passaged and cultured until they achieved 70–90% confluence on collagen-coated plates. Epithelial cells were then passaged onto collagen-coated cell culture inserts using 4.5 cm 2 membrane filters (1.0 μm pore size) with 10% fetal bovine serum or 30 μg/mL bovine pituitary extract to investigate the effects of growth-promoting additives on TEER. Additional experiments were performed to investigate optimal seeding density (1.1, 2.2, 4.4, or 8.9 × 10 5 cells/cm 2 ), the effect of co-culture with feeder cells, and the effect of passage number on epithelial barrier function. Characterization of in vitro cultures was performed using hematoxylin and eosin staining and immunostaining for vocal fold epithelial cell markers and tight junctions. Results revealed higher TEER in cells supplemented with fetal bovine serum compared to bovine pituitary extract. TEER was highest in cells passaged at a seeding density of 2.2 × 10 4 cells/cm 2 , and TEER was higher in cells at passage two than passage three. Ultrastructural experiments revealed a well-differentiated epithelial cell multilayer, expressing the epithelial cell markers CK13, CK14 and the tight junction proteins occludin and ZO-1. [ABSTRACT FROM AUTHOR]

Summary Objectives Professional voice users, such as singers and teachers, are at greater risk of developing vocal fold injury from excessive use of voice; thus, protection of the vocal fold is essential. One of the most important factors that aggravates injury is the production of reactive oxygen species at the wound site. The purpose of the current study was to assess the effect of astaxanthin, a strong antioxidant, on the protection of the vocal fold from injury and inflammation due to vocal loading. Study Design This study is an institutional review board-approved human clinical trial. Methods Ten male subjects underwent a 60-minute vocal loading session and received vocal assessments prior to, immediately after, and 30 minutes postvocal loading (AST(−) status). All subjects were then prescribed 24 mg/day of astaxanthin for 28 days, after which they received the same vocal task and assessments (AST(+) status). Phonatory parameters were compared between both groups. Results Aerodynamic assessment, acoustic analysis, and GRBAS scale (grade, roughness, breathiness, asthenia, and strain) were significantly worse in the AST(−) status immediately after vocal loading, but improved by 30 minutes after loading. In contrast, none of the phonatory parameters in the AST(+) status were statistically worse, even when measured immediately after vocal loading. No allergic responses or adverse effects were observed after administration of astaxanthin. Conclusions The current results suggest that astaxanthin can protect the vocal fold from injury and inflammation caused by vocal loading possibly through the regulation of oxidative stress. [ABSTRACT FROM AUTHOR]

Summary Objectives The goal of this study was to quantify the viscoelastic parameters of the vocal fold mucosa at varying dehydration levels. Study Design and Methods Healthy canine larynges were obtained postmortem, and the samples were separated from the subglottal wall. The samples were dehydrated in a vacuum dryer. According to the total dehydration time per sample, dehydration levels were divided into four degrees: 0%, 40%, 60%, and 80%. The stepper was set to stretch the sample to a level of 35% strain at the same rate (0.5 mm/s). Data collection was repeated five times under each dehydration condition. The compression resilience, RC%  =  S′/S*100% , and the hysteresis area were measured according to the stress-strain curves. The varying properties of the samples under different dehydration levels were investigated by fitting the curves. Results The area of the hysteresis loops observed in the stress-strain curves increased exponentially with dehydration levels, whereas the RC% decreased linearly. For all curves, low-strain stages can be explained by Hooke's law ( σ  =  E 0 *ε ). With increasing levels of dehydration, E 0 was shown to increase, whereas the linear range was shortened. High-strain stages resembled exponential rather than the linear curves. And the nonlinear stage of the curve became increasingly apparent in the stress-strain curves of increased dehydration levels. Conclusions The quantitative results in this study not only provide a numerical reference for future experimental measurements, but also can be used to verify the biphasic model in future studies. [ABSTRACT FROM AUTHOR]

Summary Objective The study aims to evaluate the changes in volume and dimensions of the thyroarytenoid (TA) muscle in the elderly using magnetic resonance imaging (MRI). Study Design This is a retrospective study. Methods The neck MRIs of 40 adult patients aged less than 65 years old and 40 patients aged 65 years old and above were compared. Demographic data included age and gender. The length, width, and height of the TA muscle as well as its volume were measured on each side, right and left, in both groups. Results The differences in the mean length, width, and height of TA muscle were not statistically significant between the two groups on either right or left side. Similarly, there was no statistically significant difference in the mean volume of the TA muscles between the two groups on either side as well. The mean volume of the right and left TA muscles in those aged less than 65 years was 0.65 ± 0.26 mL and 0.69 ± 0.30 mL, respectively. The mean volume of the right and left TA muscles in the elderly group was 0.72 ± 0.31 mL and 0.72 ± 0.32 mL, respectively. Conclusion Using MRI, there are no dimensional or volumetric changes in TA muscles with aging. [ABSTRACT FROM AUTHOR]

Objective: Currently, various tools have been introduced for the assessment of vocal fold vibration: laryngeal videolaryngoscopy (LV), videokymography (VKG), high speed videoendoscopy (HSV), digital videokymography (DKG), and 2D scanning videokymography (2D VKG). Among these, the authors have recently designed a dual modality examination system using LV and 2D VKG for more detailed information regarding the vibrations of the vocal folds. The clinical availability of this hybrid system offers medical imaging departments a range of potential advantages in the evaluation of vocal fold vibration. The obvious benefit of simultaneous acquisition is the improved integration of information that allows not only optimal anatomic localization, but also physical movement patterns. Other advantages include the lessened inconvenience to patients due to no longer requiring repeated examinations and shortening the examination time, and increased profitability. The purpose of study was to identify the efficacy of real-time dual examination of two different modalities for the evaluation of vocal fold vibration in human subjects and vocal fold vibration simulator.Methods: One vocally healthy subject and three patients with vocal fold nodules, a vocal cyst, and vocal fold paralysis took part in this study. The vibratory patterns of the vocal folds were visualized using simultaneous real-time examination of two different modalities. Additionally, qualitative and quantitative analyses of the dual LV and 2D VKG images were performed.Results: Real-time dual examination using a two modality system provided high definition images of the vibratory movements of the vocal folds. By assessing the obtained images, we confirmed that the dual modality examination method was useful in the evaluation of pathologic vibratory patterns, even in non-periodic phonation.Conclusion: The present system might improve the understanding of the processes of vocal fold vibration and make a contribution to pathologic voice research, as well as clinical practice. [ABSTRACT FROM AUTHOR]

To verify the effect of nebulization on the voice of dysphonic and non-dysphonic individuals on acoustic, perceptual-auditory, aerodynamic, electroglottographic, laryngeal parameters and on the self-perception of vocal discomfort. All the research subjects were submitted to vocal evaluation, laryngeal and voice self-perception. Then, the participants remained in vocal rest for a period of 10 minutes and the analysis mentioned above were again performed. After this first stage, the participants were submitted to the nebulization for a period of 10 minutes and the all analysis above were again performed. Descriptive analysis of the variables was carried. In the comparison of the pre- and post-nebulization groups, the Paired T-Student Test was used for variables with non-dysphonic distribution and the Wilcoxon Test for variables with asymmetric distribution. When categorical variables were evaluated (perceptual-auditory evaluation and laryngeal assessment), the Pearson's Chi-square test was used. In all analysis, a significance level of 5% was considered. The intra-rater agreement in the auditory-perceptual and perceptual-visual assessment was assessed using the AC1 statistic, using the R program. For this purpose, 20% of the voice samples and laryngeal images were replicated blindly and interpreted by the evaluators at the time evaluations. The results of this research show that non-dysphonic individuals have more positive vocal and laryngeal effects after nebulization than dysphonic ones. It is also observed that the EGG measurement was the most sensitive to the effect of nebulization, with an increase in the Closed quotient (CQ) in all groups evaluated. Regarding acoustic measurements, it is noted that the effect of nebulization in men is more evident than in women. After nebulization, there was an increase in fundamental frequency in the group of non-dysphonic women and dysphonic and non-dysphonic men. A decrease in the amplitude perturbation quotient values is observed in all groups, besides a reduction in the pitch perturbation quotient values after nebulization in non-dysphonic men groups. There was improves aerodynamic efficiency in groups of dysphonic and non-dysphonic men and in the self-perception of vocal discomfort in all groups studied after the hydration procedure. The results of this study demonstrate a significant improvement in the mucosal wave after nebulization in the groups of women and men who are not dysphonic. The nebulization procedure with saline solution improves acoustic measurements, the electroglottographic closed quotient and vocal self-perception of dysphonic and non-dysphonic women and men. Nebulization increases the mucosal wave of the vocal folds in non-dysphonic women and men and improves the aerodynamic efficiency of men. [ABSTRACT FROM AUTHOR]

Puberphonia is a common vocal disorder characterized by the persistence of high vocal pitch postpuberty. Affected individuals may suffer from social impediments that can markedly affect their quality of life. Voice therapy is invariably offered as a main treatment modality with a successful outcome. Other treatment modalities include laryngeal framework surgery, cricothyroid muscle chemodenervation, and injection laryngoplasty. The authors of this manuscript report the impact of injection laryngoplasty on the average fundamental frequency in three cases of puberphonia. [ABSTRACT FROM AUTHOR]

Summary Objectives Platelet-rich plasma (PRP) is a reliable and has low side-effect profile and has beneficial effects on wound healing. Its investigatory effects on wound-healing process were shown on various tissues. The aim of the present study was to evaluate effectiveness of PRP application on scar tissue of acute vocal fold injury. Materials and methods Twenty-four Wistar rats were used in the study. The entire layer of the lamina propria down to the thyroarytenoid muscle of 10 subjects was unilaterally injured by with a microscissor. Gelfoam-absorbed PRP was applied on the injured area for 10 minutes. Control group consisted of rats unilaterally injured using a microscissor, and gelfoam with normal saline was applied on the injured area. Following sacrifice, the larynxes were carefully dissected and removed for histopathologic examination. After excised larynx experiments, serial sections were prepared from vocal fold. Hematoxylin eosin and immunohistochemical staining were done for epithelial growth factor receptor (EGFR), fibroblast growth factor receptor (FGFR1), and vascular endothelial growth factor (VEGF) staining for histopathologic examinations. Results There was not a significant difference between the two groups for lymphocyte. Although collagen and VEGF were higher in the study group, there was not a significant difference between the groups ( P > 0.05). There was a significant difference between control and study groups for EGFR and FGFR1( P < 0.05). Conclusions PRP has beneficial effects on wound healing. PRP accelerates epithelization of injured rat vocal folds by inducing EGFR secretion. PRP is an autogenous, reliable, low side-effect profile, easily harvested material. PRP may be useful to prevent scar formation. [ABSTRACT FROM AUTHOR]

Clinical voice disorders pose significant communication-related challenges to patients. The purpose of this study was to quantify the rate of apoptosis and tumor necrosis factor‐alpha (TNF‐α) signaling in vocal fold epithelial cells in response to increasing time‐doses and cycle‐doses of vibration. 20 New Zealand white breeder rabbits were randomized to three groups of time‐doses of vibration exposure (30, 60, 120 min) or a control group (120 min of vocal fold adduction and abduction). Estimated cycle-doses of vocal fold vibration were extrapolated based on mean fundamental frequency. Laryngeal tissue specimens were evaluated for apoptosis and gene transcript and protein levels of TNF-α. Results revealed that terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining was significantly higher after 120 min of vibration compared to the control. Transmission electron microscopy (TEM) revealed no significant effect of time‐dose on the mean area of epithelial cell nuclei. Extrapolated cycle‐doses of vibration exposure were closely related to experimental time‐dose conditions, although no significant correlations were observed with TUNEL staining or mean area of epithelial cell nuclei. TUNEL staining was positively correlated with TNF-α protein expression. Our findings suggest that apoptosis can be induced in the vocal fold epithelium after 120 min of modal intensity phonation. In contrast, shorter durations of vibration exposure do not result in apoptosis signaling. However, morphological features of apoptosis are not observed using TEM. Future studies are necessary to examine the contribution of abnormal apoptosis to vocal fold diseases. [ABSTRACT FROM AUTHOR]

Summary Objectives The cricoarytenoid joint has a loose capsule and large cavity and may allow the arytenoid distanced from the cricoid cartilage. The objective was to quantify vertical motion of the arytenoid cartilage in the living subject. Study Design This is a prospective study. Methods Axial computed tomography images from 35 healthy subjects and seven patients with unilateral vocal fold paralysis were collected at inspiration and phonation. The perpendicular distance from the arytenoid vocal process (VP) or muscular process (MP) to the cricoid plane was measured and analyzed. Results During phonation, the range of the vertical movement of the VP was significantly wider than that of the MP. The vertical motion varies in sides, sexes, and ages. The vertical gaps of the VP and MP between the paralyzed and contralateral sides were about 0.8 mm and 1.5 mm, respectively. Conclusions This study confirms a visor-like downward vertical motion of the arytenoid cartilage during phonation. [ABSTRACT FROM AUTHOR]

Summary Objectives To quantitatively analyze the vibratory characteristics of vocal folds before and after conservative treatments to evaluate the outcomes of conservative treatments for vocal fold leukoplakia using videostrobokymography (VSK). Study Design This is a prospective study. Methods Twenty patients and 20 controls were enrolled into the study. All patients received conservative treatments for 3 weeks and received VSK examination before and 3 weeks after the treatments. All controls only received VSK examination once. Vocal fold lengths of 25%, 50%, and 75% were chosen as the line-scan positions to evaluate the vocal fold vibration. Open quotient (OQ) and asymmetry index (AI) were obtained using VSK. Results Significant improvements in the main symptoms including voice hoarseness were found. Videostroboscopic findings showed that the white lesions on the vocal folds almost completely disappeared in all patients, and the vocal fold flexibility returned to normal. All OQs and AIs at each line-scan position in patients before the treatments were larger than those in controls ( P < 0.017), whereas all OQs and AIs at each line-scan position decreased 3 weeks after conservative treatments ( P < 0.017). No significant differences in OQs and AIs at each line-scan position were detected between patients after the treatments and controls ( P > 0.017). Conclusions VSK could quantitatively evaluate the vibratory characteristics of vocal folds before and after the treatments, and conservative treatment could improve VSK measurements to normal control values, suggesting that VSK is a tool to assess the outcomes of the conservative treatments for vocal fold leukoplakia. [ABSTRACT FROM AUTHOR]

Control of laryngeal muscles is required to manipulate pitch, volume, and voice quality. False vocal fold activity (FVFA) refers to the constriction and release of constriction of the false vocal folds. True vocal fold mass (TVFM) represents the cross-sectional thickness of the vocal folds. Larynx height (LH) refers to the vertical position of the larynx in the neck. To date, studies of voice control have examined the effects of these parameters separately. No study has investigated the impact of instructed systematic manipulation of these parameters on acoustic voice measures in vocally healthy trained subjects. This study examined the effects of systematically manipulating FVFA, TVFM, and LH on several acoustic voice measures. Twelve vocally trained speakers were instructed to use specific techniques to achieve experimental conditions of constriction and release of constriction of FVFA, thicker and thinner TVFM, and normal and low LH. Each condition was implemented in combination with manipulating the other parameters. Voice recordings of sustained vowel /a/ and Rainbow Passage were obtained for all laryngeal manipulation conditions and underwent acoustic analyses for fundamental frequency (F0), signal typing, harmonics-to-noise ratio (HNR), cepstral peak prominence (CPP), and vocal relative intensity. Constricted FVFA caused more aperiodicity in the signals, lower CPP, and lower vocal relative intensity than release of constriction. Thicker TVFM resulted in significantly higher CPP and vocal relative intensity than thinner TVFM. Modifying TVFM did not affect F0 and HNR. Low LH had significantly lower F0 but did not impact on HNR, CPP, and intensity. The effects of systematic manipulation of each laryngeal parameter resulted in independent acoustic effects without measurable interaction. Release of constriction of FVFA, thicker TVFM, and low LH were configurations that resulted in more optimal acoustic signals. [ABSTRACT FROM AUTHOR]

In pediatric pediatric vocal fold nodule (VFN) patients, different causes have been suggested in the development of the vocal cord nodule, including laryngopharyngeal reflux (LPR). It is known that the content of consumed foods, obesity, and other dietary behaviors are among the risk factors for the development of reflux. The aim of this study was to evaluate dietary and food consumption habits in pediatric VFN patients. This prospective-controlled study included 50 children with VFNs (age range 5–14 years) and 50 age-matched children without any voice disorders as a control group. BMI values of each participant were evaluated according to age-percentile range. The voice usage habits and personality structure of all the children were questioned. All patients underwent laryngeal examination and voice analysis. The Turkish Pediatric Voice Handicap Index (t-PVHI) and Child Voice Handicap Index-10 (t-CVHI) were completed by patients or their parents. The examination findings of all patients were evaluated with the reflux finding score (RFS), and their complaints were questioned with the reflux symptom index (RSI). In addition, eating and drinking at night, fast eating and excessive food consumption habits and the frequency of consumption of packaged foods defined as junk food, carbonated beverage were questioned. The data obtained were compared statistically between the two groups. There was no significant difference between the study and control groups in terms of age, gender distribution, median BMI value, voice usage habits, and personality structure. In the study group, t-PVHI, t-CVHI, jitter, schimmer values, the mean RFS, and RSI scores were significantly higher than those of the control group. The number of children with high consumption of junk food and carbonated drinks was higher in the study group. There was no significant difference between the two groups in terms of dietary habits. Food consumption habits may play a role in childhood voice problems in this population. [ABSTRACT FROM AUTHOR]

Objective. Evaluation of the vibratory pattern of vocal folds is of paramount importance to diagnose vocal fold disorders. Currently, laryngeal videokymography (VKG) and digital kymography from high-speed videolaryngoscopy are the available techniques for studying aperiodic vibrations of vocal folds. But VKG has the fundamental limitation that only linear portion of the vocal fold mucosa can be visualized. Digital kymography has the disadvantages of no immediate feedback during examination, considerable waiting time before kymographic visualization, recoding duration limited to seconds, and extreme demands on storage space. We developed a new system-two-dimensional (2D) scanning VKG-for evaluation of the vibratory pattern of vocal folds, and the method provided a possible alternative with its advantages and disadvantages. Thus, we aimed to evaluate the feasibility of the new device for the vocal fold vibration in excised canine larynx model. Methods. The vibrating pattern for vocal folds was evaluated using high-speed videolaryngoscopic and 2D scanning videokymographic system in the excised canine larynx model. Results. The images of canine vocal folds were captured with high-speed videolaryngoscopic system and converted to the kymographic images using the software. The kymographic image acquired by 2D scanning VKG was comparable with multi-line digital kymography at multiple locations. Conclusions. The vocal fold vibration could be evaluated in the excised canine larynx model using 2D scanning VKG. And this new device is expected to be a promising tool to evaluate the vocal fold vibration for clinical practice and voice research. [ABSTRACT FROM AUTHOR]

Summary Objective CO 2 laser cordectomy for glottic carcinoma offers excellent oncologic control on a per stage basis as compared with primary radiotherapy. We aim to further investigate the fluctuations of postoperative vocal outcomes following extended laser cordectomy for glottic cancer. Design Single center retrospective cohort study. Methods Eleven patients with glottic squamous cell carcinoma (SCC) who received CO 2 laser cordectomy European Laryngological Society type III-IV with complete datasets at preoperative, immediate postoperative (within 4 months), and delayed (greater than 6 months) time points were included. Results All patients (n = 11) received cordectomy as their primary treatment. Tumor stage was divided evenly between T1 and T2. One patient was referred for post-cordectomy thyroplasty. Mean Voice Handicap Index (VHI) scores increased in the immediate postoperative period (43.3–46.2) but did not reach significance ( P > 0.05). Delayed postoperative VHI (23.3) demonstrated substantial improvement from both pre- and immediate postoperative levels ( P = 0.047). Objective voice rating significantly declined initially ( P = 0.03; Grade, P = 0.01; Breathiness) and recovered to similar preoperative levels. Maximum phonation time (MPT) showed substantial decreases at the initial postoperative period ( P = 0.007). Although significant improvement was made at the delayed postoperative point ( P = 0.009), MPT remained below the preoperative level ( P = 0.028). No significant changes were seen in phonatory subglottic pressures. Conclusions Patients undergoing extended CO 2 laser cordectomy for glottic cancers can experience initial decline in voice quality; however, vocal function routinely returns to preoperative levels following the initial healing period. A small percentage of extended cordectomy patients may require further vocal interventions. [ABSTRACT FROM AUTHOR]

Objective To provide detailed information about recurrent laryngeal nerve (RLN) reinnervation outcomes in children using objective measures. Methods The records of three pediatric patients with unilateral vocal cord paralysis that underwent RLN reinnervation were retrospectively reviewed. Fundamental frequency ( F 0 ), jitter, shimmer, noise-to-harmonic ratio (NHR), and voice phonation (sustained / s /, / z /, / a /) were measured preoperatively and post-operatively at 13, 9, and 33 months (each time period corresponding to one of the three patients). Results Mean preoperative and post-operative variables were as follows: shimmer, 9.65 ± 1.02% vs. 4.46 ± 0.71% ( p = 0.01); NHR, 0.296 ± 0.063 vs. 0.127 ± 0.011 ( p = 0.04); jitter, 3.57 ± 0.89% vs. 1.46 ± 0.54% ( p = 0.08); F 0 , 274.6 ± 35.4 Hz vs. 282.2 ± 70.6 Hz ( p = 0.44); maximum phonation time, 7.46 ± 1.40 s vs. 9.79 ± 1.84 s ( p = 0.22); / s : z / ratio, 1.28 ± 0.22 vs.1.07 ± 0.09 ( p = 0.26). Conclusions There was statistically significant improvement in shimmer and NHR. Jitter improvement approached statistical significance. All other variables failed to show significant improvement among this small sample size. RLN reinnervation for pediatric patients is an option for the treatment of vocal cord paralysis. Further studies with larger cohorts are needed to show the full benefits. [ABSTRACT FROM AUTHOR]

The goal of this study was to characterize the vocal folds microstructure and elasticity using nonlinear laser scanning microscopy and atomic force microscopy-based indentation, respectively. As a pilot study, the vocal folds of fourteen rats were unilaterally injured by full removal of lamina propria; the uninjured folds of the same animals served as controls. The area fraction of collagen fibrils was found to be greater in scarred tissues two months after injury than the uninjured controls. A novel mathematical model was also proposed to relate collagen concentration and tissue bulk modulus. This work presents a first step towards systematic investigation of microstructural and mechanical characteristics in scarred vocal fold tissue. [ABSTRACT FROM AUTHOR]

The aim of this study is to elucidate the relationship of laryngeal electromyography (LEMG) and computed tomographic (CT) parameters to improve the prognosis of recurrent laryngeal nerve injury. 22 patients clinically suspected of having recurrent laryngeal nerve injury were examined with LEMG and CT studies. Bilateral thyroarytenoid (TA) muscles were examined and findings were interpreted by a single blind technique. Laryngeal CT image analysis of the ventricle dilation symmetry determined TA muscle atrophy. Finally, a follow-up laryngoscopic examination determined improvement of vocal fold movement. Ventricle dilation symmetry and the dichotomized TA muscle atrophy parameter significantly relate to the improvement of vocal fold movement ( χ 2 = 4.029, P = 0.039, and χ 2 = 3.912, P = 0.048, respectively). When the severity of vocal fold impairment was classified as severe TA muscle atrophy or none/discrete MUAP recruitment, it was found to significantly relate with the improvement of vocal fold movement ( χ 2 = 6.712, P = .010). From this study, image analysis of the ventricle dilation symmetry to determine the severity of TA muscle atrophy shows promise for the improved prognosis of vocal fold immobility. [ABSTRACT FROM AUTHOR]