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Background: Inducible laryngeal obstruction causes narrowing of the laryngeal aperture in response to external triggers. Outcomes are measured in inducible laryngeal obstruction to monitor changes in health status over time., Methods: This study is a scoping review based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. The review will be guided by the following research question: 'What health outcomes are measured in studies including people with inducible laryngeal obstruction?' The research question was validated using the Population-Concept-Context framework according to the methodology for Joanna Briggs Institution Scoping Reviews. Relevant peer-reviewed studies and grey literature conducted over the last 40 years will be identified from electronic databases including AMED, CINAHL, Embase, EMCARE, MEDLINE, OVID, PubMed and PsycINFO. The search strings 'inducible laryngeal obstruction', 'ILO', 'vocal cord dysfunction', 'VCD', 'paradoxical vocal fold motion', 'PVFM', 'outcome', 'measure', 'measurement instrument', 'assessment', 'scale', 'questionnaire' will be combined using Boolean logic. An independent reviewer will conduct title screening; two independent reviewers will conduct abstract and full article screening, followed by data extraction by two reviewers. Analyses will be conducted appropriate to the findings., Discussion: The review will document evidence of health outcomes measured in inducible laryngeal obstruction, identifying measurement characteristics and potential utility. Collating studies may identify gaps in coverage, the need for novel tools, and for standardisation for clinical and research purposes., What This Paper Adds: What is already known on the subject Inducible laryngeal obstruction causes narrowing of the laryngeal aperture in response to external triggers. Outcomes are measured in inducible laryngeal obstruction to monitor changes in health status over time. Currently, there are no standardised outcome measures for measuring the effects of interventions in inducible laryngeal obstruction (ILO). What this paper adds to existing knowledge Assessment of health can be measured in a variety of ways. Physiological, radiological and biochemical measurements of impairment are more common historically but there are a lot of outcomes of other factors now including subjective measures of functional status and health-related quality of life, with data collected directly from patients. This study will allow us to scope the literature to see the health outcomes being measured in ILO to attempt to standardise and develop future health outcomes. What are the potential or actual clinical implications of this work? The review will document evidence of health outcomes measured in inducible laryngeal obstruction, identifying measurement characteristics and potential utility. Collating studies may identify gaps in coverage, the need for novel tools and for standardisation for clinical and research purposes., (© 2024 The Authors. International Journal of Language & Communication Disorders published by John Wiley & Sons Ltd on behalf of Royal College of Speech and Language Therapists.)

Objective To identify occupational groups' use of specialty voice clinic evaluation. Study Design Retrospective cohort study. Setting Tertiary subspecialty clinic. Subjects and Methods We analyzed data collected on patients presenting to the Massachusetts Eye and Ear Infirmary Voice and Speech Laboratory over a 20-year period (1993-2013). The relative risk (RR) and 99% confidence interval (CI) of presentation were calculated for each occupational category in the greater Boston population using year-matched data from the Bureau of Labor Statistics (BLS). Results The records of 12,120 new patients were reviewed. Using year- and occupation-matched BLS data from 2005 to 2013, 2726 patients were included in the cohort analysis. Several occupations had significantly higher risk of presentation. These included arts and entertainment (RR 4.98, CI 4.18-5.95), law (RR 3.24, CI 2.48-4.23), education (RR 3.08, CI 2.70-3.52), and social services (RR 2.07, CI 1.57-2.73). In contrast, many occupations had significantly reduced risk of presentation for laryngological disorders, for example, maintenance (RR 0.25, CI 0.15-0.42), food preparation (RR 0.35, CI 0.26-0.48), and administrative support (RR 0.49, CI 0.41-0.57). Conclusion Certain occupations are associated with higher use of laryngological services presumably because of their vocational voice needs. In addition to confirming findings from other studies, we identified several new occupation groups with increased or decreased risk for laryngologic disorders. Understanding what factors predispose to requiring specialty voice evaluation may help in targeting preventative efforts.

Endoscopic examinations were performed on 1005 thoroughbred racehorses in South Africa a mean (sd) 24 (12.3) minutes after racing, to determine the prevalence of pharyngeal, laryngeal and tracheal disorders, and to determine the relationship of these disorders with performance (number of wins and placed finishes). Overall, there was a low prevalence of grade 2 and 3 laryngeal function (LF) (2.2 per cent), grade 4 LF (0.6 per cent), epiglottic entrapment (1.3 per cent), subepiglottic cyst (0.2 per cent) and epiglottic deformity (0.6 per cent), while a higher prevalence of grade 2 to 4 pharyngeal lymphoid hyperplasia (PLH) (63 per cent), laryngeal debris (43.5 per cent), tracheal debris (21.9 per cent), tracheal mucus (99.5 per cent) and tracheal cartilaginous nodules (TCNs) (6.8 per cent) was observed. Performance was not affected by the presence of epiglottic deformity, grade 2 and 3 LF, grade 4 LF, debris within the trachea or larynx, or epiglottic entrapment. Grade 3 PLH occurred in younger racehorses; performance was impaired in horses with grade 2 and 3 PLH. Furthermore, TCNs were more prevalent in male racehorses and were associated with better performance.

The Neurolaryngology Study Group convened a multidisciplinary panel of experts in neuromuscular physiology, electromyography, physical medicine and rehabilitation, neurology, and laryngology to meet with interested members from the American Academy of Otolaryngology Head and Neck Surgery, the Neurolaryngology Subcommittee and the Neurolaryngology Study Group to address the use of laryngeal electromyography (LEMG) for electrodiagnosis of laryngeal disorders. The panel addressed the use of LEMG for: 1) diagnosis of vocal fold paresis, 2) best practice application of equipment and techniques for LEMG, 3) estimation of time of injury and prediction of recovery of neural injuries, 4) diagnosis of neuromuscular diseases of the laryngeal muscles, and, 5) differentiation between central nervous system and behaviorally based laryngeal disorders. The panel also addressed establishing standardized techniques and methods for future assessment of LEMG sensitivity, specificity and reliability for identification, assessment and prognosis of neurolaryngeal disorders. Previously an evidence-based review of the clinical utility of LEMG published in 2004 only found evidence supported that LEMG was possibly useful for guiding injections of botulinum toxin into the laryngeal muscles. An updated traditional/narrative literature review and expert opinions were used to direct discussion and format conclusions. In current clinical practice, LEMG is a qualitative and not a quantitative examination. Specific recommendations were made to standardize electrode types, muscles to be sampled, sampling techniques, and reporting requirements. Prospective studies are needed to determine the clinical utility of LEMG. Use of the standardized methods and reporting will support future studies correlating electro-diagnostic findings with voice and upper airway function.

Reason for Performing Study: Dynamic laryngeal collapse (DLC) associated with poll flexion is a newly diagnosed upper respiratory tract obstructive disorder that causes poor racing performance., Objectives: To determine if Norwegian Coldblooded Trotters (NCTs) affected with DLC associated with poll flexion differ from normal, elite NCTs based on simple airway mechanics measurements., Methods: Five normal elite NCTs and 6 NCTs diagnosed previously with DLC underwent treadmill videoendoscopy while tracheal pressures were measured continuously. Alternating head positions were used such that horses were exercised with free head carriage and induced poll flexion at heart rates >200 beats/min., Results: Peak inspiratory tracheal pressures were significantly more negative for horses with DLC compared to the elite horses. This difference was only significant during the exercise phases when the poll region was flexed, P = 0.0015. Head position significantly affected peak inspiratory pressure for both elite and affected horses, P < 0.0001., Conclusions and Clinical Relevance: Induced poll flexion significantly affected peak inspiratory pressure (PIP) in all horses; however, PIPs were significantly more negative in those affected with DLC. Based upon the tracheal pressure measurements recorded in this study, DLC in NCTs is a severe obstructive upper respiratory tract disorder that is induced by poll flexion.

Objective: To measure the upper-airway resistance in patients with tracheostomies and determine the value representing decannulation readiness., Subjects and Methods: Fifty-six patients with tracheostomies resultant to laryngeal disease participated in this study. Forty patients met clinical criteria for decannulation; 16 did not. Subglottal pressure was measured with a tube connected to the tracheostomy tube, and airflow was monitored simultaneously using a facemask. Upper-airway resistance measurements were recorded during shallow and deep breathing., Results: During both shallow and deep breathing, the inspiratory and expiratory resistances were significantly higher for the group unsuitable for decannulation (P < .0001). The areas under the receiver operating characteristic curves were 0.938 or greater for the four curves, indicating a high sensitivity and specificity of resistance measures for diagnosis., Conclusions: Objective measurement of upper-airway resistance during shallow and deep breathing may be a useful parameter in determining decannulation readiness of tracheostomized patients.

This paper reports on an evidence-based review of laryngeal electromyography (EMG) as a technique for use in the diagnosis, prognosis, and treatment of laryngeal movement disorders including the laryngeal dystonias, vocal fold paralysis, and other neurolaryngological disorders. The authors performed a systematic review of the medical literature from 1944 through 2001 on the clinical application of EMG to laryngeal disorders. The review yielded 584 articles of which 33 met the predefined inclusion criteria. The evidence demonstrated that in a double-blind treatment trial of botulinum toxin versus saline, laryngeal EMG used to guide injections into the thyroarytenoid muscle in persons with adductor spasmodic dysphonia was beneficial. A cross-over comparison between laryngeal EMG-guided injection and endoscopic injection of botulinum toxin into the posterior cricoarytenoid muscle in abductor spasmodic dysphonia found no significant difference between the 2 techniques and no significant treatment benefit. Based on the evidence, laryngeal EMG is possibly useful for the injection of botulinum toxin into the thyroarytenoid muscle in the treatment of adductor spasmodic dysphonia. There were no evidence-based data sufficient to support or refute the value of laryngeal EMG for the other uses investigated, although there is extensive anecdotal literature suggesting that it is useful for each of them. There is an urgent need for evidence-based research addressing other applications in the use of laryngeal EMG for other applications.

Objective: Our goal was to investigate the presence of laryngeal abnormalities is patients with paradoxical vocal fold dysfunction (PVFD)., Study Design and Setting: A retrospective chart review was performed of patients referred for evaluation of paradoxical vocal fold dysfunction between July 2002 and December 2002. The patients completed questionnaires at the time of the office visit. Data collected from the medical record included age, gender, duration of symptoms before evaluation, asthma, gastroesophageal reflux symptoms, and laryngoscopic findings. Exercise stress test was performed when suitable. The diagnosis of PVFD was made based on patient history and laryngoscopy., Results: Thirty patients were identified. There was a 27:3 (90%) female predominance, and mean age of presentation at was 28 years (range, 12 to 67 years). The median time from the onset of respiratory symptoms to diagnosis was 4.5 years (range, 0.5 to 30 years). Of the 30 patients, 17 (56%) had asthma, 16 had laryngeal findings suggestive of gastroesophageal reflex disease, 4 (12%) had laryngoscopic findings of chronic laryngitis, and 10 (33%) had additional findings, including laryngomalacia, vocal fold motion impairment, sulcus vocalis, nodules, and subglottic stenosis, mostly in the exercise-induced group., Conclusions: Concomitant laryngeal abnormalities are present in a many patients with PVFD, particularly in those with exercise-induced symptoms. Laryngoscopy is important in the management of these patients.

Background: Hyperkinetic vocal function (muscle tension dysphonia) may be an indication of underlying glottal insufficiency. In the face of an organic voice disorder such as presbylaryngis or vocal fold paresis. Hyperkinetic laryngeal behaviors may be used to achieve glottal closure. Such compensatory laryngeal behaviors may mask the correct underlying diagnosis., Objective: We sought to evaluate the association between vocal fold bowing due to presbylaryngis and abnormal muscle tension patterns (MTPs)., Methods: One hundred consecutive volunteers >40 years old were prospectively evaluated. All underwent a comprehensive head and neck examination that included transnasal fiberoptic laryngoscopy with videostroboscopy. Abnormal MTPs were compared in subjects with and without vocal fold bowing., Results: The mean age of the cohort was 61 years. Eighty-four percent (42 of 50) of the male subjects and 60% (30 of 50) of female subjects had evidence of vocal fold bowing. Of the 72 patients with bowing, 94% (68 of 72) had abnormal MTPs. Compared with subjects without vocal fold bowing, persons with bowing were 17 times more likely to exhibit abnormal MTPs (P < 0.001)., Conclusions: Abnormal MTPs are common in persons with underlying glottal insufficiency. Patients with vocal fold bowing are 17 times more likely to exhibit abnormal MTPs (95% confidence interval, 4.9 to 59.4). Clinicians should be aware that compensatory hyperkinetic laryngeal behaviors may mask an underlying organic condition.

The electrodiagnostic measurement of the thoracolaryngeal reflex (TLR) ('slap test') latency was compared to 5 other diagnostic techniques used for evaluation of laryngeal function, namely laryngeal muscle palpation, resting and immediately postexercise endoscopic examinations, and palpable and endoscopic responses to the TLR. Compared to resting endoscopy, the electrodiagnostic measurement of TLR latency was not found to be an accurate test for the evaluation of recurrent laryngeal neuropathy (RLN), nor was laryngeal muscle palpation or the endoscopic response to the TLR. Twenty-five (71%) of 35 Clydesdale horses examined were affected by RLN; 16 (46%) had mild, 5 (14%) moderate, 3 (9%) severe hemiparesis and 1 (3%) had total laryngeal paralysis. Within these 35 horses, physical traits such as height or neck length did not correlate with the incidence or severity of RLN. Ten control ponies showed no evidence of abnormal laryngeal function.

Background: Laryngeal electromyography (LEMG) is a valuable diagnostic/prognostic test for patients with suspected laryngeal neuromuscular disorders., Objective: To report our experience with diagnostic LEMG at the Center for Voice Disorders of Wake Forest University and to evaluate the impact of LEMG on clinical management., Methods: Retrospective chart review of 415 patients who underwent diagnostic LEMG over a 5-year period (1995-1999)., Results: Of 415 studies, 83% (346 of 415) were abnormal, indicating a neuropathic process. LEMG results altered the diagnostic evaluation (eg, the type of radiographic imaging) in 11% (46 of 415) of the patients. Unexpected LEMG findings (eg, contralateral neuropathy) were found in 26% (107 of 415) of the patients, and LEMG results differentiated vocal fold paralysis from fixation in 12% (49 of 415). Finally, LEMG results altered the clinical management (eg, changed the timing and/or type of surgical procedure) in 40% (166 of 415) of the patients., Conclusions: LEMG is a valuable diagnostic test that aids the clinician in the diagnosis and management of laryngeal neuromuscular disorders.

It is conceivable that the subjects who have phonatory disorders, in comparison with normal individuals, exert a greater expiratory effort when phonating loudly. Furthermore, we presume that the extent and pattern of the changes in the expiratory effort for increasing vocal intensity may vary according to the types of laryngeal lesions. To prove these hypotheses, we investigated the changes in expiratory effort for increments of the vocal intensity by measuring the expiratory lung pressure. The subjects included 10 each of normal controls, patients with Reinke's edema, and those with recurrent laryngeal nerve paralysis. For the normal controls, the increase in vocal intensity was achieved by slightly increasing the expiratory lung pressure. The patients with Reinke's edema showed a greater increase in expiratory lung pressure, as compared with the normal group. The patients with recurrent laryngeal nerve paralysis exhibited greater expiratory effort with extreme increases in airflow than normal group for louder phonation. It was concluded that the subjects who have phonatory disorders, in comparison with normal individuals, require a greater expiratory effort. This phonatory function test with an increase in voice intensity made the aerodynamic pathologic condition clearer.

Accurate diagnosis of upper airway abnormalities by flexible laryngoscopy in infants is hampered by rapid laryngeal motion and lack of patient cooperation. This study evaluates the added role of videorecorded flexible laryngoscopy and the objective measurement of vocal fold abduction in improving the diagnosis of upper airway abnormalities in infants. Seventy-eight infants had videorecorded flexible laryngoscopy performed as part of their evaluation of a suspected airway disorder. These recordings were reviewed by three otolaryngologists for confirmation of the clinical diagnosis. From the video image, the maximum angle of vocal fold abduction was measured with image analysis software. Of 78 patients 40 had supraglottic or glottic abnormalities, 9 had nasal or nasopharyngeal obstruction, 9 had subglottic abnormalities (diagnosed subsequent to videolaryngoscopy), and 15 patients had normal findings on examination. Of those with laryngeal abnormalities, laryngomalacia was the most common diagnosis (23 of 78). Vocal fold paralysis was present in 4 patients. A separate group (9 of 78) of patients was identified as having symmetric bilateral limitation of vocal fold abduction. Laryngeal dyskinesia was diagnosed in these 9 patients. The mean values of maximal vocal fold abduction were as follows: (1) normals, 59.5 degrees; (2) laryngomalacia, 57.0 degrees; (3) paralysis, 26.6 degrees; and (4) incomplete abduction with laryngeal dyskinesia, 27.6 degrees. Videolaryngoscopy is a valuable tool for documentation, parent education, and analysis of infant laryngeal abnormalities. Repeat viewing of the video examination and frame-by-frame analysis improve the diagnostic accuracy. Using this approach, we have calculated the anterior glottic abduction angle in the normal and abnormal infant larynx. In addition, we have identified a group of infants with incomplete abduction of the vocal folds that appears to be different from that found in vocal cord paralysis.

The health care team caring for the child with stridor must be familiar with congenital abnormalities of the airway and airway problems resulting from infections and foreign bodies and their typical presentation and endoscopic findings. Teamwork and communication are the keys to safe diagnosis and management of these children.

The paper describes the assessment and practical implications of a laryngeal adductory reflex in a series of 30 ataxic and 64 non-ataxic horses. The reflex was evoked by slapping the saddle region just caudal to the withers. In normal horses this produced a flickering adductory movement of the contralateral arytenoid cartilage which was observed endoscopically. Abolition of the laryngeal response was encountered in in 3 situations:--(1) Disruption of the afferent impulse occurred in those horses in which there was significant spinal cord pathology affecting the pathway from the cranial thoracic region to the medulla. (2) Disruption of the efferent impulse was manifest when damage to the adductory component of the recurrrent laryngeal nerve prevented normal adduction. (3) The reflex was abolished in tense or frightened horses, possibly due to interference from higher centres. The laryngeal adductory reflex was considered to be a useful diagnostic and prognostic aid in the assessment of ataxia and spinal cord lesions in the horse.

An automated computer system was used to measure changes in vocal quality resulting from laryngeal surgery. Five acoustic parameters were computed and seven listeners made judgments on vowel samples recorded before and after surgery from 37 patients. Presurgery and postsurgery changes in the five acoustic measures were compared with the perception of change in vocal harshness. A multiple regression analysis showed that four of the five acoustic measures accounted for a large amount of the variance in the judgment of change of voice quality following surgery. The measures may provide a quick and relatively sensitive method that may be clinically useful in measuring change in vocal quality.

The normal respiratory function of the larynx has been described in detailed reports in both the otolaryngology and the respiratory physiology literature. The role of the posterior cricoarytenoid muscle in vocal cord abduction has been shown to be paramount in laryngeal respiratory function. However, only in recent reports has attention been directed toward disordered laryngeal function as evidenced in pulmonary disorders, such as asthma, or in association with underlying pulmonary disorders, such as asthma (ROAD) or emphysema (COPD). In this article, cases will be presented to demonstrate the role of disordered laryngeal function appearing as pulmonary disease and associated with various degrees of underlying pulmonary disease. The effect on pulmonary function tests and the role of treatment will be discussed.