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Summary Background The aim of our study was to determine the presence and pattern of ventricular hyperadduction (VH) following unilateral vocal fold (VF) paralysis/paresis and that following unilateral cordectomy (UC). Methods The authors independently reviewed charts and flexible videostroboscopic recordings of 214 patients diagnosed with unilateral VF paralysis/paresis and those who had undergone UC from 2015 to 2018. The presence and pattern of VH was noted. VH was considered to be present when the false vocal fold (FVF) obliterated 50% or more of the true vocal fold width during phonation, with or without FVF vibration. The true vocal fold width was considered to be that which was visible on abduction of the VFs. Categorical variables were presented in numbers and percentages and qualitative variables were correlated using Chi-Square test. Odds ratio with 95% Confidence Interval was calculated. Results In 154 patients diagnosed as unilateral VF paralysis/paresis 85 patients had a VH pattern (55.19%) with contralateral VH observed in 74 (87.05%), ipsilateral VH observed in 6 (7.05%) and bilateral VH observed in five patients (5.88 %). The total number of patients of UC was 60 with 36 of these patients developing a VH (60%). Ipsilateral VH was observed in 28 of these 36 patients (77.77%), three patients developed contralateral VH (8.33%) and five patients developed bilateral VH (13.88%). Conclusion Ipsilateral ventricular hyper-adduction following unilateral cordectomy in the group of patients that develop hyperadduction is a significant finding in our study suggesting possibility of unilateral central phonatory control of the FVF. Contralateral ventricular hyper-adduction following unilateral paralysis and paresis, in the group of patients that develop hyperadduction is a significant finding in our study and this finding resonates with previously published papers. A finding of unilateral VH may serve as a possible indicator of the occasionally challenging diagnosis of vocal fold paresis. Study type : Retrospective, Observational

Adequate visualization of the vocal folds is essential for optimal phonosurgery. Pre-operative knowledge of a difficult laryngeal exposure (DLE) can alert the surgeon regarding the need for alternative measures. Our study is based on the hypothesis that a patient who has difficult intubation (DI) is likely to have DLE, thus scales anticipating DI should also anticipate DLE. Our aims were to correlate patients of actual DI on table with patients who had DLE, secondly to assess the ability of grading scales of DI to predict DLE and finally to obtain a cut-off value of neck circumference and length for predicting DLE. This is a prospective, observational study wherein four grading scales; Modified Mallampati Classification (MMC), 3-3-2, Upper lip bite test (ULBT) and Neck Mobility (NM) were used for anticipating DI and correlated with DLE during MLS. Occurrence of actual DI and DLE was correlated. Neck circumference and neck length was correlated with incidence of DLE. Out of 42 patients, 22 were anticipated to have DI (52.38%). Actual incidence of DI was 6 (14.28%) and DLE was 10 (23.80%). Correlation between actual DI and DLE was statistically significant. Of the 4 grading scales, ULBT was significant in predicting DLE. Neck circumference more than 37.5 cm and neck length less than 15.3 cm was significant in anticipating DLE. There is a significant correlation between DI and DLE. A positive ULBT, neck circumference more than 37.5 cms and neck length less than 15.3 cms are independently suggestive of a DLE.

Isolated Fungal Laryngitis (FL) has recently shown an increased incidence globally and is now being reported even in immunocompetent individuals. In our Voice Clinic we have documented an increasing number of cases of FL, specifically laryngeal candidiasis, with the lesion over the striking zone (anterior 1/3rd posterior—2/3rd) of vocal folds. Our objective was to study the sites of involvement of FL within the glottis along with a review of literature. A 4 year retrospective study was performed by reviewing clinical and stroboscopic recordings of all patients diagnosed as FL at our Voice clinic. Age, gender, presenting complaints, co-morbidities, history of steroid intake orally or via inhalation and stroboscopic findings were noted as was response to antifungals and duration of treatment. A total of 55 cases were diagnosed with FL (all laryngeal candidiasis) between 2016 and 2019. Majority of them were immunocompetent, middle aged (41–60 years) males. Hoarseness was the most common presenting complaint. On stroboscopy, the striking zone involvement was seen in 89.1% cases. On comparing site of involvement a chi-square value of 115.58; p

Unilateral vocal fold paralysis is a common finding with a variety of underlying causes. The six main etiologic groups include neoplastic, traumatic (iatrogenic, accidental) neurological, inflammatory, congenital, and idiopathic. Various unusual causes have been described including foreign body ingestion, mediastinal lymph nodes, large pleural blebs, tracheal diverticulum, etc. It is therefore essential, that a thorough evaluation and methodical approach be undertaken to ascertain the etiology, before labelling it as idiopathic and offering any treatment. This review article focuses on the uncommon and rare causes of unilateral vocal fold paralysis that are presented through 3 representative case reports; a cardio-vocal (Ortner’s) syndrome, Zenker’s diverticulum and diffuse idiopathic skeletal hyperostosis. These examples are discussed with radiological findings in the context of current literature.

The purpose of this paper is to describe a series of patients who have undergone medialisation thyroplasty (with or without arytenoid adduction) at our centre with respect to demographics, aetiology for unilateral vocal fold paralysis, pre- and postoperative maximum phonation time, amount of anterior and posterior medialisation required and complications. A comparative analysis with international studies was also performed. A retrospective analysis was performed on 67 patients, who underwent medialisation thyroplasty at our centre from August 2008 to August 2014. All the medialisation thyroplasty were performed using Netterville's technique. The average anterior medialisation needed was 2.25 mm (SD 1.05 mm) while the average posterior medialisation needed was 6.75 mm (SD 1.79 mm). Our study is the first to determine the amount of anterior and posterior medialisation needed in the Indian population. Mean anterior and posterior medialisation required was found to be the same, regardless of the age, gender of the patient and side of surgery.

Korman et al (Laryngoscope.1973;83:683-690) first reported arytenoid dislocation as a rare and unusual complication of intubation. Since then, the terms arytenoid dislocation and arytenoid subluxation (AS) have been used interchangeably to describe disruption of the cricoarytenoid joint. Only 74 cases of AS have been reported in the literature to date. The most common cause of AS is intubation trauma and external neck injury. Only 1 case of AS due to coughing has been documented. Arytenoid subluxation cases are often misdiagnosed as vocal fold paralysis. A high index of suspicion based on the history, examination findings, and objective tests helps in early diagnosis and, thus, early surgical intervention. We present a rare etiology of AS due to a bout of coughing, which was diagnosed early and reduced under general anesthesia with complete reversibility of vocal fold motion, thus restoring normal voice function.

Objective Subepithelial vocal fold cyst (SEVFC) is an epithelium lined sac within the lamina propria. These cysts are of two histologic types: Mucous retention cyst and epidermoid cyst. Rupture of the cyst during surgical excision and incomplete cyst wall removal with consequent recurrence of the cyst is not an infrequent problem. While performing cold-steel blunt microflap surgery for SEVFC, the first author observed thick fibrotic bands at the 12 and 6 o'clock position in all the cases, giving the appearance of a ‘pearl (cyst) on a string (fibrotic bands)’. In most cases of cyst rupture, it took place during dissection of these bands. The aim of our study was to see if there was any significant difference in rupture and recurrence rate by sharp versus blunt dissection of these fibrotic bands. Study design Retrospective nonrandomized cohort comparison. Materials and methods Fifty-nine subepithelial cysts were operated by microflap technique. The first 26 cysts were taken in alternation for blunt vs sharp dissection of the fibrotic bands. As the results of sharp dissection were better, the subsequent 33 cysts were operated with sharp dissection of the anterior and posterior bands. Results Sharp dissection of the anterior and posterior bands during microflap dissection reduced the incidence of cyst rupture (p = 0.006) and recurrence (p = 0.007) of cyst formation. Conclusion SEVFC are anchored by thick fibrotic bands at the 12 and 6 o'clock position giving it the appearance of a ‘pearl (cyst) on a string (fibrotic bands)’. Sharp dissection of these bands during microflap dissection reduces the incidence of cyst rupture and recurrence. How to cite this article Nerurkar NK, Shukla SC. Subepithelial Vocal Fold Cyst: A Pearl on a String? Int J Phonosurg and Laryngol 2012;2(2):53-56.

Background Spinal muscular atrophy is a rare autosomal recessive neurodegenerative disorder. We report a case of 62-year-old female of spinal muscular atrophy presenting with bilateral vocal fold paralysis, her diagnosis and management. Objective Case report of a case of spinal muscular atrophy presenting with bilateral vocal fold paralysis. Conclusion Spinomuscular atrophy though rarely associated with laryngeal symptoms should be kept in mind as a possible etiology of bilateral vocal fold paralysis. The surgical decision and the postoperative sequeale will be affected due to the presence of this disease and thus a high index of suspicion is required. How to cite this article Nerurkar NK, Deshmukh S, Agrawal P, Kulkarni P. An Unusual Presentation of Bilateral Vocal Fold Paralysis due to Spinal Muscular Atrophy. Int J Phonosurg Laryngol 2014;4(1):27-29.

A tracheocele is a rarely encountered entity that may be congenital or acquired. This tracheal lesion is characterized by the presence of a single cystic pouch filled with air or a mixture of liquid and air. We recently managed a case of a large voluminous acquired tracheocele originating from the right posterolateral tracheal wall. A 39-year-old male patient presented with chronic cough and breathy voice. Rigid laryngoscopy revealed a right immobile vocal fold. Computed tomography scan revealed a tracheocele that was excised externally with recurrent laryngeal nerve preservation.

Introduction In today's world of rapid technological advances, the medical field is developing at a rapid speed. Various sophisticated tools are available for the diagnostic work-up of patients with voice disorders. These are stroboscopy, optical coherence tomography (OCT), contact endoscopy and laryngeal USG, which gives sophisticated details of the larynx. However, at present most of these modalities are expensive and available only at few research centers. Rigid laryngoscopy is a noninvasive, easily available and fairly accurate diagnostic tool in patients with voice disorders. Aims and objectives The aim of our study was to assess the diagnostic potential of rigid laryngoscopy in different laryngeal lesions and its correlation with histopathology. This is a one year retrospective study at our voice clinic at Bombay Hospital, Mumbai. Patients and methods We examined 720 patients at our voice clinic from January 2008 to December 2008. Microlaryngeal surgery was performed on 59 of these. The clinical diagnosis was made after detailed history taking and clinical examination by a 70 degree Hopkins rod telescope. Results In our study, clinical diagnosis was 100% accurate in vocal fold subepithelial cyst, vocal fold nodules, laryngeal papilloma and contact granuloma. The clinical diagnosis had a reliability of 30% for Vocal fold polyps, 50% for leukoplakia, and 66% for malignant lesion. In suspected laryngeal polyps, leukoplakia and malignancy, our study indicates that we need to excise the lesion surgically and prove the histopathology. Conclusion Every tissue removed during laryngeal surgery should be sent for histopathology. Rigid Laryngoscopy is a safe and accurate tool to diagnose nodules and cysts.

Virtual bronchoscopy is one of the many new radiological scanning techniques that have been recently introduced. Virtual endoscopy, according to Ahlquist (Ahlquist and Johnson CD, Gastroenterology, 112, 1997, 2150) is a technique for visualizing interior cavities using computer graphic techniques. Virtual bronchoscopy generates 3D reconstructions of the human airway from high-resolution CT data sets of the chest and performs a simulated bronchoscopy. This method uses perspective surface or volume rendering to produce endoscope-like visualizations of the airway. Our early experience with this new investigative modality in cases of laryngeal and subglottic stenosis and intratracheal tumors is discussed.

Mucoceles of the sphenoid sinus are rare and may frequently remain undiagnosed until symptoms due to compression of surrounding structures set in. In such cases, the optic nerve, because of its close proximity to the sphenoid sinus, is at risk, and pressure exerted by the mucocele may result in visual impairment. A case of a sphenoid sinus mucocele with sudden-onset unilateral blindness as the only presenting symptom has been described. Early diagnosis and prompt surgical intervention enabled the vision to be restored completely.

Endoscopie excision of Juvenile Nasopharyngeal Angiofibroma (JNA) was carried out with (he objective of minimizing blood loss and attempting a complete excision of the tumor under direct vision with the help of Hopkins telescopes.A prospective 4 year study of 23 cases of JNA treated by endoscopie excision is presented. Of these, 18 were treated by endoscopie excision alone. The remaining 5 were treated with a two staged approach either by mid-facial degloving followed by endoscopy or by 2 endoscopie procedures.The tumor was excised completely in 17 out of the total 18 cases that were treated exclusively by endoscopy. One case has shown a recurrence. The 5 cases treated by the staged approach represented very large tumours or tumours with intra-cranial extensions. In I of these cases, inoperable tumor remnant engulfing the internal carotid artery was treated by radiotherapy post-operatively.With successful excision of JNA in all but one case, we could reasonably conclude, that endoscopie excision of JNA could become a safer and a more precise alternative to open surgery provided it is practiced judiciously by surgeons who have considerable experience in endoscopie surgery and the necessary backup to convert to open surgery should the need arise.

To evaluate the role of CT scan prior to approximation laryngoplasty (AL). Occasionally, postoperative results in AL are unsatisfactory. The reasons for failure may be an incomplete closure of the phonatory gap or improper size of the implant or implant migration. The role of CT scan in planning the steps of surgery in cases of AL especially in revision cases is discussed in three cases of unilateral vocal fold paralysis. Preoperative CT larynx, especially in revision AL cases, helps plan steps of surgery by deciphering implant material, size, shape and position used in previous surgery.

Understanding of the anatomy and physiology of the vocal folds, availability of better diagnostic tools and precise instruments has spurred the development of newer techniques for the management of benign lesions arising in the vocal folds. As the propensity of the superficial lamina propria to regenerate is minimal, it is of paramount importance to maximally preserve it. Microflap surgery of the vocal folds is based on this principle.There exists a dichotomy in opinion regarding the role of subepithelial infiltration in microflap surgery; the disadvantages cited being possible confusion of the surgical plane following infiltration and hydrodissection of the normal basement membrane from the superficial layer of the lamina propria. A prospective study was therefore carried out in 30 cases of benign glottic lesions and microflap surgery was performed with and without infiltration in similar pathologic lesions. The vocal outcomes i.e. fundamental frequency, jitter, shimmer and maximum phonation time were audited. The advantages of this technique with a review of the literature are discussed.

Blunt laryngeal injuries are rare and are not typically seen in isolation; they are usually associated with multiple traumas. 1 Such injuries account for less then 1% of all the cases seen at major trauma centers.