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

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

Unilateral vocal cord paralysis (UVCP) is a growing area of research in pediatrics as it spans across many specialties including otolaryngology, cardiology, general surgery, respirology, and speech language pathology. Iatrogenic injury is the most common cause of UVCP, however there is a wide range of data reporting the prevalence, symptom burden, and best treatment practice for this condition. The literature included systematic reviews and meta-analyses, retrospective studies and limited prospective studies. Overall, the literature lacked consistency in the diagnosis, treatment, and long-term outcomes of patients with UVCP. Many articles conflated bilateral vocal cord paralysis (BVCP) with UVCP and had limited data on the natural history of the condition. There was no consensus on objective and subjective measurements to evaluate the condition or best indications for requiring surgical intervention. Thyroplasty, injection medialization (IM) and recurrent laryngeal nerve reinnervation (RLNR) were the reported surgical interventions used to treat UVCP, however there was limited data on short and long-term surgical outcomes in children. More research is needed to determine the true prevalence, natural history, indications for surgical intervention and long-term outcomes for pediatric patients with this condition.

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

Abstract Objective To determine whether injection laryngoplasty (IL) resolves thin liquid aspiration among children with unilateral vocal cord paralysis (UVCP) after cardiac surgery. Study Design Retrospective case‐control. Setting Tertiary children's hospital. Methods Consecutive children (

Abstract Background The study was performed to evaluate the changing trends in etiology and presenting features of vocal cord paralysis (VCP) from March 1998 to March 2020. Methods Patient’s record collected from hospital database and divided into two groups, from March 1998 to March 2009 and from April 2009 to March 2020, to evaluate the changing trends in etiology and presenting features. Results Total of 711 VCP patients, 80.3% with unilateral (UVCP) and 19.7% with bilateral vocal cord paralysis (BVCP) included. The commonest etiology was non-surgical (57.1%) for UVCP and surgical (55.7%) for BVCP. The commonest surgical etiology was thyroid and parathyroid surgery for both UVCP (16.6%) and BVCP (38.5%). The commonest non-surgical etiology was idiopathic for UVCP (23.1%) and malignancies for BVCP (13.6%). There was increase in surgical etiology for both UVCP (39.3 to 45.3%) and BVCP (51.2 to 57.7%), and decrease in non-surgical etiology for both UVCP (60.7 to 54.6%) and BVCP (48.8 to 42.3%). The change in voice was most common presenting features for both UVCP (69.2%) and BVCP (92.8%). The frequency of the presenting features was comparable, with decrease in the duration of symptom onset over the time period. Conclusion The most common etiology for UVCP was idiopathic, and for BVCP was thyroid and parathyroid surgery. For both, UVCP and BVCP there was increasing trend for surgical and decreasing trend for non-surgical etiology. The change in voice was the most common presenting complain, with decrease in duration of symptom onset over time period.

Objectives. Vocal fold injection (VFI) via the cricothyroid (CT) membrane is used to treat various diseases affecting the vocal folds. The technical challenges of this technique are mainly related to the invisibility of the needle. Real-time light-guided VFI (RL-VFI) was recently developed for injection under simultaneous light guidance in the CT approach. Herein, we present the first clinical trial of RL-VFI, in which we investigated the feasibility and safety of this new technique in unilateral vocal fold paralysis (VFP). Methods. This prospective pilot study enrolled 40 patients, who were treated with RL-VFI for unilateral VFP between September 2020 and August 2021. Adverse events were monitored during the procedure and for 4 weeks postoperatively. The Voice Handicap Index-10, the GRBAS (grade, roughness, breathiness, asthenia, and strain) scale, aerodynamic studies, and acoustic analyses were evaluated to compare the voice improvement after 4 weeks with the baseline values. Results. The needle tip was intuitively identified by the red light. The mean procedure time was 95.6±40.6 seconds for the initial injection, while the additional injection required 79.2±70.5 seconds. The injection was performed under light guidance without additional manipulation after the needle reached the intended point. No acute or delayed adverse events were reported. Among the 40 patients, 36 completed voice analyses after 4 weeks. Subjective and objective voice parameters, including the Voice Handicap Index-10, GRBAS scale, maximum phonation time, mean expiratory airflow, fundamental frequency, jitter, shimmer, and noise-to-harmonics ratio improved significantly after RL-VFI (P

Objective: To conduct a systematic description and meta-analysis of the treatment of unilateral vocal cord paralysis（UVCP） with recurrent laryngeal nerve reinnervation through literature search, and to analyze the therapeutic effect of recurrent laryngeal nerve reinnervation on improving vocal function in UVCP. Methods: Electronic databases Pubmed, Web of Science, EMBASE, Cochrane Library, CNKI, and Wanfang databases were searched using relevant keywords and screened in strict accordance with the inclusion and exclusion criteria, and quality evaluations were conducted. Reported treatment outcomes were measured by relevant data extracted from literature, such as auditory perception assessment（GRBAS）, voice handicap index（VHI）, maximal phonation time（MPT）, jitter, shimmer, and noise harmonic ratio（NHR）, etc. Meta-analysis was performed by Revman5.3 and heterogeneity was analyzed using fixed effects or random effects models. Results: Eight articles were included in this study, all of which showed that the postoperative maximum phonation time of patients was significantly prolonged compared to preoperative, while the postoperative GRBAS score, Jitter, Shimmer, and NHR decreased compared to preoperative with statistical significance. Conclusion: The innervation of the internal laryngeal muscle was obtained through the reinnervation of the recurrent laryngeal nerve, which effectively improved the patient's vocal function and had a good long-term therapeutic effect. Although there was no difference in the efficacy of surgical methods for reconstructing the recurrent laryngeal nerve, the anastomosis between ansa cervicalis nerve and the recurrent laryngeal nerve is more ideal. Further randomized controlled studies with longer follow-up periods and larger samples will increase the credibility of their effectiveness., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Unilateral vocal cord paralysis (UVCP) is a growing area of research in pediatrics as it spans across many specialties including otolaryngology, cardiology, general surgery, respirology, and speech language pathology. Iatrogenic injury is the most common cause of UVCP, however there is a wide range of data reporting the prevalence, symptom burden, and best treatment practice for this condition. The literature included systematic reviews and meta-analyses, retrospective studies and limited prospective studies. Overall, the literature lacked consistency in the diagnosis, treatment, and long-term outcomes of patients with UVCP. Many articles conflated bilateral vocal cord paralysis (BVCP) with UVCP and had limited data on the natural history of the condition. There was no consensus on objective and subjective measurements to evaluate the condition or best indications for requiring surgical intervention. Thyroplasty, injection medialization (IM) and recurrent laryngeal nerve reinnervation (RLNR) were the reported surgical interventions used to treat UVCP, however there was limited data on short and long-term surgical outcomes in children. More research is needed to determine the true prevalence, natural history, indications for surgical intervention and long-term outcomes for pediatric patients with this condition., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Callaghan, El-Hakim and Isaac.)

Objectives: Patients with vocal cord paralysis can experience feeding, respiratory, and vocal problems leading to disability and decreased quality of life. Current evidence suggests waiting a period of 12 months for spontaneous recovery before permanent interventions. This study aims to determine the time to recover spontaneously and vocal cord movement in a pediatric population and create a model for evidence-based patient counseling. Study Design: Retrospective longitudinal cohort study. Methods: The report is a single institution longitudinal study on vocal cord paralysis recovery. Patients were categorized based on spontaneous recovery with vocal cord movement or no recovery. Recovery rates were determined using the Kaplan-Meier method. Results: Of 158 cases of vocal cord paralysis over a 4-year period, 36 had spontaneous recovery with symptom improvement and motion return. The average recovery was 8.8 months for those who recovered, and 78% recovered within 9 months. Two groups emerged from the data: an early recovery group with spontaneous recovery before 12 months and a late recovery group after 12 months. Children with dysphonia and paralysis due to cardiac surgery were less likely to recover, and children with aspiration were more likely to recover. Children with gastrointestinal comorbidities were less likely to recover; however, those who did recover were more likely to have recovered after 12 months. Based on our model, there is about a 3% chance of recovery between 9 and 12 months. Conclusions: Patients should be counseled about earlier interventions. Waiting the conventional 12 months for only a 3% chance of spontaneous recovery without intervention or laryngeal EMG may not be the preferred option for some patients and their families. [ABSTRACT FROM AUTHOR]

Background: It is essential and evaluates dysphagia among patients with UVCP to help the management, improves the quality of life, and prevents secondary complications. Aim of the work: This research aims to find the incidence of dysphagia in patients with unilateral vocal cord paralysis [UVCP]. Patients and Methods: This study was performed in 245 patients with UVCP; 98 males and 147 females. There were two groups of patients: the non-dysphagia group [130 patients] and the dysphagia group [115 patients]. Assessment of patients was performed by the verified 10-item Eating Assessment Tool [EAT-10] and Dysphagia Handicap Index [DHI]. Results: Performing EAT-10 questionnaire revealed average values of 18.5 ± 9.56 and 34.3 ± 11.3 in the non-dysphagia group and dysphagia groups, respectively. DHI showed mean values of 45.7 ± 18.12 and 85.42 ± 21.7 in the non-dysphagia group and dysphagia groups, respectively. All of them demonstrated a highly significant variation [P = 0.001]. Regarding the etiology of UVCP, iatrogenic was the first cause of UVCP; it was the cause of 36.9% and 36.52%, followed by idiopathic; 23.1% and 24.34 %, intubation injury; 12.6% and 11.3%, tumor; 10% and 9.56%, trauma; 8.46% and 8.69%, thyroid surgery; 4.62% and 5.22%, and neurodegenerative disease; 4.62% and 4.35% of non-dysphagia and dysphagia groups, respectively. Conclusion: The incidence of dysphagia in unilateral vocal cord paralysis depends mainly on the cause; however, vocal cord paralysis itself increases the incidence of dysphagia whatever the cause.

Objectives: To determine whether injection laryngoplasty or medialization thyroplasty is more effective in the treatment of unilateral vocal fold paralysis. Methods: A prospective study of 75 patients with unilateral vocal cord paralysis who underwent autologous fat injection laryngoplasty or medialization laryngoplasty at the First Central Hospital of Mongolia between 15th Nov 2016 and 15th Jan 2020. The data analyzed included patient characteristics and type of intervention, along with the before treatment, 1 and 6 months after treatment voice parameters of electrogIottography and patients' subjective voice assessment. Results: Seventy-five patients were evaluated. The average time from intervention to post-treatment evaluation was 1 and 6 months. Improvements were demonstrated in all voice parameters (Maximum Foniation Time, Jitter, Shimmer, and Harmonic Noise Ratio) in both the injection and the medialization groups. Conclusions: In this study, objective and subjective voice analysis confirmed that injection and medialization laryngoplasty were effective in unilateral vocal cord paralysis. Both of these methods can be used to treat unilateral vocal cord paralysis.

Unilateral vocal cord paralysis can cause a change in phonation and dyspnea and can be a cause of distress for a patient. The causes are varied and include post-surgical and post-intubation causes, malignancy, and other etiologies. Here, we present the case of a 72-year-old female who presented to the ED with a new onset of a "raspy voice" and dyspnea and had undergone an L4-L5 laminectomy with associated endotracheal intubation two weeks prior to ED presentation. Because of the complaint of a change in her voice, a nasopharyngolaryngoscopy (NPL) was performed, which demonstrated left-sided unilateral vocal cord paralysis. The patient was admitted to the hospital and was evaluated by neurology, pulmonology, and otolaryngology services. The discharge diagnosis was unilateral vocal cord paralysis, most likely caused by the patient's recent intubation. This case demonstrates the value of an NPL in the ED as part of the evaluation of a patient with dyspnea and a change in phonation., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Baluyot et al.)

Objectives: Injection laryngoplasty (IL) has been widely used as an initial treatment option for unilateral vocal fold paralysis (UVFP). An additional (second) IL is considered a salvage treatment for unsatisfactory outcomes of initial IL resulting from inadequate injection or early resorption of the injection material. This study aims to evaluate the efficacy of additional IL, distinguishing between "salvage" (within 4 months) and "repeated" injections (beyond 4 months), and to analyze prognostic factors for successful outcomes., Methods: This retrospective study involved patients who received IL at Asan Medical Center from January 2014 to December 2020. Voice parameters were collected after each procedure, and those who conducted the statistical analysis were blinded to the study subjects. Among the 65 patients who underwent additional IL, 51 patients were enrolled in this study. Postinjection grade, roughness, breathiness, asthenia, strain (GRBAS) scales were used to determine satisfactory treatment outcomes. Success of the additional IL was defined as a postinjection grade of dysphonia score of 0 or 1, with a reduction in grade compared with the preinjection grade., Results: The mean age of the patients was 61.6 years. Out of a total of 51 patients, 37 were men participating in the study. The odds ratio represents the likelihood of success in the second IL. Improved voice outcome after the additional IL was maintained in 23 (45%) patients. Compared with the failure group, the success group had a longer injection time interval between the initial and additional injection (9.1 vs. 7.4 months, respectively, p = 0.010). The success group had a higher proportion of patients with injection intervals >6 months (73.9% vs. 42.9%, p = 0.026). Logistic regression analysis revealed an injection interval >6 months had an odds ratio of 0.265 (confidence interval: 0.080-0.874, p = 0.029)., Conclusions: Additional injections would benefit the patients whose voice outcomes are maintained for a longer period (>6 months) after the first injection., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: To describe surgical management of calcium hydroxylapatite (CaHA) inappropriately located within the superficial lamina propria (SLP) in patients undergoing injection laryngoplasty (IL) for unilateral vocal fold paralysis (UVFP). Methods: Retrospective chart review. Results: Three patients with persistent or worsening dysphonia after previous CaHA IL underwent attempted endolaryngeal excision of superficially located CaHA. In the patient with the least CaHA duration, a subepithelial CaHA mass was partially debulked via microlaryngoscopic cordotomy. However, in two patients with extended CaHA dwell time, residual CaHA took of the form of microspheres, which were either easily removed (if encapsulated) or diffusely scattered throughout the SLP, making extirpation impossible. Conclusions: CaHA can persist in the SLP for years following IL. Microlaryngoscopic explantation can improve voice in patients with malpositioned superficial injections; however, this may not be achievable, depending on the CaHA distribution, which may be a function of time elapsed since the initial IL.

Objectives/Hypothesis: Injection laryngoplasty of materials for unilateral vocal‐fold paralysis has shown various results regarding the long‐term stability of the injected material. We evaluated a fibrin‐gel based cell suspension with autologous chondrocytes in‐vitro and in‐vivo as long‐term‐stable vocal‐fold augmentation material in an animal model. Study Design: This study compises an in vitro cell‐culture part as well as an in vivo animal study with New Zealand White Rabbits. Methods: In in‐vitro experiments, auricular chondrocytes harvested from 24 New Zealand White Rabbits cadavers were cultivated in pellet cultures to evaluate cartilage formation for 4 weeks using long‐term‐stable fibrin gel as carrier. Injectability and injection volume for the laryngoplasty was determined in‐vitro using harvested cadaveric larynxes. In‐vivo 24 Rabbits were biopsied for elastic cartilage of the ear and autologous P1 cells were injected lateral of one vocal cord into the paraglottic space suspended in a long‐term‐stable fibrin gel. Histologic evaluation was performed after 2, 4, 12, and 24 weeks. Results: During 12‐week pellet culture, we found extracellular matrix formation and weight‐stable cartilage of mature appearance. In‐vivo, mature cartilage was found in two larynxes (n = 6) at 4 weeks, in four (n = 6) at 12 weeks, and in five (n = 6) at 24 weeks mostly located in the paraglottic space and sometimes with spurs into the vocalis muscle. Surrounding tissue was often infiltrated with inflammatory cells. Material tended to dislocate through the cricothyroid space into the extraglottic surrounding tissue. Conclusions: A cell‐based approach with chondrocytes for permanent vocal‐fold augmentation has not previously been reported. We have achieved the formation of structurally mature cartilage in the paraglottic space, but this is accompanied by difficulties with dislocated material, deformation of the augmentation, and inflammation. Level of Evidence: N/A Laryngoscope, 131:E1624–E1632, 2021 [ABSTRACT FROM AUTHOR]

Background: There is a paucity of Asian-based data regarding the diagnostic yield of computed tomography imaging in the initial assessment of idiopathic unilateral vocal fold palsy. Objectives: To investigate the diagnostic yield of computed tomography in idiopathic unilateral vocal fold palsy cases in an Asian tertiary hospital, and to determine the causative pathologies and positive predictive factors. Method: A retrospective chart review was conducted of patients (between 2010 and 2018) with a clinical diagnosis of idiopathic unilateral vocal fold palsy who underwent contrast-enhanced computed tomography of the neck and chest at Tan Tock Seng Hospital, Singapore. Results: The overall computed tomography diagnostic yield was 21 per cent, with malignancy accounting for 63.6 per cent of diagnoses. Degree of vocal fold weakness was the only significant predictor of positive computed tomography findings (11.5 per cent in vocal fold paresis vs 29.1 per cent in vocal fold paralysis, p = 0.025). None of the patients with negative computed tomography findings went on to develop disease after a mean follow up of 14.3 months. Conclusion: Computed tomography is a useful initial investigation for idiopathic unilateral vocal fold palsy, particularly in cases with vocal fold paralysis. [ABSTRACT FROM AUTHOR]

Objective: To determine whether injection laryngoplasty (IL) resolves thin liquid aspiration among children with unilateral vocal cord paralysis (UVCP) after cardiac surgery., Study Design: Retrospective case-control., Setting: Tertiary children's hospital., Methods: Consecutive children (<5 years) between 2012 and 2022 with UVCP after cardiac surgery were included. Resolution of thin liquid aspiration after IL versus observation was determined for children obtaining videofluoroscopic swallow studies (VFSS)., Results: A total of 32 children with left UVCP after cardiac surgery met inclusion. Initial surgeries were N = 9 (28%) patent ductus arteriosus ligations, N = 7 (22%) aortic arch surgeries, N = 9 (28%) surgeries for hypoplastic left heart syndrome, and N = 7 (22%) other cardiac surgeries. The mean age at initial surgery was 1.8 months (SD: 3.7). All children had a VFSS obtained after surgery that confirmed aspiration. There were 17 children that obtained an IL at 33.6 months (SD: 20.9) after cardiac surgery and 15 children observed without IL procedure. No surgical complications after IL were noted. The rate of aspiration resolution based on postoperative VFSS was N = 14 (82%) for the IL group and N = 9 (60%) for the control group P  = .24. Documented VFSS aspiration resolution after cardiac surgery occurred by 9.6 months (SD: 10.0) in the observation group and 47.4 months (SD: 24.1) in the IL group ( P  < .001)., Conclusion: IL can help treat aspiration in children with UVCP after cardiac surgery but the benefit beyond observation remains unclear. Future studies should continue to explore the utility for IL in managing dysphagia in this pediatric population., Competing Interests: None., (© 2024 The Authors. OTO Open published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

Objective: To evaluate voice intensity as the primary outcome measurement when treating unilateral vocal fold paralysis patients. Methods: This prospective observational study comprised 34 newly diagnosed unilateral vocal fold paralysis patients undergoing surgical interventions: injection laryngoplasty or medialisation thyroplasty. Voice assessments, including maximum vocal intensity and other acoustic parameters, were performed at baseline and at one and three months post-intervention. Maximum vocal intensity was also repeated within two weeks before any surgical interventions were performed. The results were compared between different time points and between the two intervention groups. Results: Maximum vocal intensity showed high internal consistency. Statistically significant improvements were seen in maximum vocal intensity, Voice Handicap Index-10 and other acoustic analyses at one and three months post-intervention. A significant moderate negative correlation was demonstrated between maximum vocal intensity and Voice Handicap Index-10, shimmer and jitter. There were no significant differences in voice outcomes between injection laryngoplasty and medialisation thyroplasty patients at any time point. Conclusion: Maximum vocal intensity can be applied as a treatment outcome measure in unilateral vocal fold paralysis patients; it can demonstrate the effectiveness of treatment and moderately correlates with self-reported outcome measures. [ABSTRACT FROM AUTHOR]

Background: Foreign body (FB) aspiration in children is a frequent condition managed by ENT pediatric surgeons and pediatric pulmonologists.Methods: We present the case of a 20-months-old child who presented with three recurrent episodes of FB aspiration.Results: At the time of FB removal, an initial dynamic examination of the larynx revealed a unilateral vocal cord palsy (UVCP).Conclusion: For recurrent tracheobronchial FB inhalation, we recommend a systematic dynamic airway endoscopy.

Objective: To identify dysphagia prevalence and characteristics among patients with unilateral vocal fold immobility (UVFI) through a systematic review of current literature.Data Sources: Embase, PubMed, ScienceDirect, Wiley Online Library.Review Methods: Four electronic databases were reviewed according to the PRISMA criteria. Original English-language studies examining dysphagia among adult patients with UVFI met eligibility. Two researchers independently analyzed qualified articles.Results: Of 227 studies discovered through the literature search, 17 satisfied eligibility criteria. The prevalence of symptomatic dysphagia ranged from 55.6% to 69.0%, and the aspiration rate was 20.0% to 50.0%. Self-reporting and clinical evaluation were used to identify symptomatic dysphagia, while videofluoroscopic swallowing study and functional endoscopic evaluation of swallowing evaluated aspiration. Left-sided UVFI predominated. The most common causes of UVFI were iatrogenic and idiopathic. Central lesions and acute-onset UVFI were each associated with more severe dysphagia. Patients were more likely to aspirate on liquids versus purées and pastes. Benefits of medialization thyroplasty and vocal cord injection were equivocal.Conclusion: A significant portion of patients with UVFI present with dysphagia due to anatomic and physiologic disruptions during the swallow. Study population heterogeneity and small sample sizes in the reviewed studies may have compromised reliability, calling for large-scale studies with rigorous methodology. Future studies should not only strive to identify the mechanics of the disordered swallow but also explore patients' quality of life and the effectiveness of current treatments for dysphagia with underlying UVFI. [ABSTRACT FROM AUTHOR]

Introduction: The presentation, course, and management of a rare laryngeal manifestation of neurosarcoidosis due to central nervous system (as opposed to peripheral nervous system) injury are described. Methods: The authors present 3 cases of vocal cord paralysis as the initial symptom of isolated neurosarcoidosis at a tertiary care laryngology clinic. Results: Laryngoscopy diagnosed unilateral vocal cord paralysis. Laryngeal electromyography revealed high vagal injury, prompting workup on brain magnetic resonance imaging. On magnetic resonance imaging, 2 cases showed basilar leptomeningeal inflammation and 1 case showed a brainstem mass. Patients were found at follow-up to have severe, progressive vagal injury, with patients developing severe quality of life impairments and medical complications. Conclusions: Neurosarcoidosis is not usually considered in the differential diagnosis of vocal cord paralysis. At initial presentation, all patients lacked other cranial neuropathies and systemic sarcoidosis manifestations, making diagnosis difficult. Otolaryngologists should be aware of this rare presentation, as prompt diagnosis by brain magnetic resonance imaging with or without central nervous system biopsy, as opposed to traditional chest radiography or computed tomography for the workup of peripheral nerve injury, is necessary. Serial laryngeal examinations are recommended for close monitoring of progressive disease and recommending treatment. Injection or medialization laryngoplasty can provide improvements in voicing but not swallow. [ABSTRACT FROM AUTHOR]

Objective: To evaluate dysphagia and manometric changes in the upper oesophageal sphincter in patients with unilateral vocal fold paralysis. Methods: Thirty patients with unilateral vocal fold paralysis due to vagal nerve paralysis scheduled for evaluation were enrolled in the study group; 24 healthy subjects were included in the control group. Upper oesophageal sphincter basal and residual pressure, relaxation time, and pharyngeal pressure values were evaluated by manometry. All patients completed the Turkish Eating Assessment Tool 10 questionnaire, the MD Anderson dysphagia questionnaire and the reflux symptom index form. Results: Swallowing assessment questionnaires and reflux symptom index results were significantly higher in the study group. Upper oesophageal sphincter basal and relaxation pressures were lower in the study group. Upper oesophageal sphincter relaxation time was shorter in the study group, but pressure values recorded from the pharynx were higher. Conclusion: Upper oesophageal sphincter manometric pressure was lower in patients with unilateral vocal fold paralysis. A hypotonic sphincter likely contributes to dysphagia and aspiration. [ABSTRACT FROM AUTHOR]

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Introduction: Video-assisted mediastinal lymphadenectomy (VAMLA) is a valuable tool for invasive staging of the mediastinum. Unilateral vocal cord paralysis (UVCP) may occur in patients following VAMLA and may result in secretion retention within the lungs, atelectasis and associated infectious situations such as pneumonia. Minimally invasive injection laryngoplasty (ILP) is the treatment of choice in UVCP. Aim: To evaluate the efficacy and success of acute minimally invasive injection laryngoplasty for patients with UVCP following VAMLA. Material and methods: Patients with the symptom of dysphonia following VAMLA were reviewed. All of the patients had UVCP according to the video laryngoscopy examination and had symptoms of aspiration and ineffective coughing. The Voice Handicap Index (VHI) questionnaire and maximum phonation time (MPT) were measured. Minimally invasive ILP was performed under general anesthesia with 1 cm of hyaluronic acid. Results: There were 525 consecutive non-small cell lung cancer (NSCLC) patients who underwent VAMLA. Five (0.95%) of the patients had UVCP and were suffering from aspiration during oral intake and ineffective coughing reflex. Maximum phonation time (MFT) was measured before and after ILP, and the results were 7.1 ±1.6 and 11.1 ±2.3 s, respectively (p < 001). The Voice Handicap Index-10 (VHI-10) score was 30.4 ±4.7 and 13.4 ±3.5 (p < 0.01), respectively. Patients underwent surgical lung resection. There was no morbidity or mortality. Conclusions: Unilateral vocal cord paralysis may occur as a complication of VAMLA. ILP may be an active tool for treating UVCP before anatomical lung resection to avoid potential morbidities. Successful management of this complication with multidisciplinary team work may encourage the use of VAMLA more frequently. [ABSTRACT FROM AUTHOR]

Background: Medialisation thyroplasty is considered the ‘gold standard’ treatment for unilateral vocal fold paralysis, enabling improvement of voice and swallowing function, and preventing life-threatening aspiration events. The most commonly used laryngeal implants induce some degree of local tissue inflammatory response, and carry the risk of immediate or delayed implant extrusion. Methods: This paper describes a novel approach for medialisation thyroplasty. Specifically, it utilises a ribbon of autologous tensor fascia lata harvested at the time of surgery. This is layered within the paraglottic space in a manner similar to Gore-Tex thyroplasty. Results: Thus far, this method has been accomplished in two patients with unilateral vocal fold paralysis, who also received prior radiotherapy to the head and neck. Conclusion: Given the increased risk of post-operative wound breakdown and infection in irradiated patients, it is suggested that this new approach will lead to improved outcomes, and a decrease in complications such as extrusion or wound infection, particularly in this patient population. [ABSTRACT FROM AUTHOR]

The article discusses a study focusing on the use of botulinum toxin in managing laryngeal synkinesis, a movement disorder, in patients with unilateral and bilateral vocal fold paralysis. Topics discussed include the treatments for dyspnea and stridor caused by laryngeal synkinesis, the use of laryngeal electromyography (LEMG) in the study, and the lack of effectiveness of botulinum toxin therapy.

Purpose: The outcome of voice surgery on unilateral vocal cord paralysis (UVCP) by medialization laryngoplasty (ML) was various although the series of reports consistently claimed that the phonation ability restored well after their reconstructive surgery. We revised several unsatisfactory subjects and proposed a correct concept to facilitate a successful surgery. Patients and Methods: One hundred and forty subjects suffering from UVCP and undergoing ML procedure were reviewed. Eight of the 140 subjects underwent revised thyroplasty to improve their unsatisfactory voice. The time elapse from UVCP onset to first ML procedure and between first and second ML procedure was recorded and analyzed. Maximal phonation time (MPT) was used to evaluate the improvement of phonation ability. Result: Inappropriate size or location of the implant material were defined in two subjects, inappropriate management of the inner perichondrium of thyroid lamina (IPTL) were defined in 5, and cricoarytenoid joint (CAJ) fixation in one. MPT was increased from 3 s to 11 s in average after revised surgery. MPT more than 10 s was obtained in 7 subjects in their followup at mean 15 months. Conclusion: The management of IPTL actually determined the voice surgical outcome significantly. Preoperative evaluation of the CAJ mobility was still an important factor to determine the use of corrective methods.

In unilateral vocal cord paralysis (UVCP), hoarseness is usually the leading symptom; however, the diminished airway might lead to breathing problems as well, especially with exertion. The application of the classic resection glottis enlarging or medialization procedures might shift the breathing and/or the voice to a worse condition. The non-destructive endoscopic arytenoid abduction lateropexy (EAAL) might be a solution for this problem. The aim of our study was to analyze the phonatory and respiratory outcomes of this treatment concept. The first year phoniatric [Jitter, Shimmer, harmonics-to-noise ratio (HNR), maximum phonation time (MPT), fundamental frequency ( F ), Voice Handicap Index (VHI), Dysphonia Severity Index (DSI), Global-Roughness-Breathiness scale (GRB)], peak inspiratory flow (PIF), and quality of life (QoL) were evaluated in ten UVCP patients treated by EAAL for dyspnea generally presented on exertion. PIF, Jitter, QoL, GRB, and VHI significantly improved. DSI, HNR, and MPT got non-significantly better. F slightly increased in all patients, a mild deterioration of shimmer was observed. These results prove that improving respiratory function is not necessarily associated with a deterioration in voice quality. The EAAL provides a significant improvement in breathing and the vibratory parameters of the postoperative, more tensed and straightened vocal cords proved to be more advantageous than the original (para) median 'loose' position. The over-adduction of the contralateral side more or less compensates for the disadvantageous, more lateral position of the operated side. EAAL might be an alternative treatment for unilateral vocal cord paralysis associated with breathing problems. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: To evaluate the cost-effectiveness of routine computed tomography (CT) in individuals with unilateral vocal fold paralysis (UVFP) STUDY DESIGN: Health Economics Decision Tree Analysis METHODS: A decision tree was constructed to determine the incremental cost-effectiveness ratio (ICER) of CT imaging in UVFP patients. Univariate sensitivity analysis was utilized to calculate what the probability of having an etiology of the paralysis discovered would have to be to make CT with contrast more cost-effective than no imaging. We used two studies examining findings in UVFP patients. The decision pathways were utilizing CT neck with intravenous contrast after diagnostic laryngoscopy versus laryngoscopy alone. The probability of detecting an etiology for UVFP and associated costs were extracted to construct the decision tree. The only incorrect diagnosis was missing a mass in the no-imaging decision branch, which rendered an effectiveness of 0.Results: The ICER of using CT was $3,306, below most acceptable willingness-to-pay (WTP) thresholds. Additionally, univariate sensitivity analysis indicated that at the WTP threshold of $30,000, obtaining CT imaging was the most cost-effective choice when the probability of having a lesion was above 1.7%. Multivariate probabilistic sensitivity analysis with Monte Carlo simulations also showed that at the WTP of $30,000, CT scanning is more cost-effective, with 99.5% certainty.Conclusions: Particularly in the current healthcare environment characterized by increasing consciousness of utilization defensive medicine, economic evaluations represent evidence-based findings that can be employed to facilitate appropriate decision making and enhance physician-patient communication. This economic evaluation strongly supports obtaining CT imaging in patients with newly diagnosed UVFP.Level Of Evidence: 2c. Laryngoscope, 2016 127:440-444, 2017. [ABSTRACT FROM AUTHOR]

Objective: To describe a new method of medialization thyroplasty using a modified preformed nasal silicone implant. Methods: Design: Surgical Innovation Setting: Tertiary Private Hospital Participants: Four patients underwent medialization thyroplasty using a pocket and nasal implant technique performed by the senior co-author. The indication for medialization thyroplasty for these patients was hoarseness secondary to unilateral vocal fold paralysis of more than 6 months duration, and documented by flexible fiberoptic laryngoscopy. The outcomes were described with comparison of pre- and post-operative subjective voice assessment. Results: Operative time was 15–30 minutes. Post-operative subjective improvement of voice quality was evident. Scars were minimal and aesthetically acceptable. The procedure could be done on an outpatient basis. Conclusion: Medialization thyroplasty via a pocket and silicone implant technique is initially effective and may be a worthwhile alternative to the usual window technique. Keywords: unilateral vocal cord paralysis; medialization thyroplasty; Isshiki thyroplasty; silicone implant

Conclusion: The volume of fat tissue loss after vocal fold augmentation can be decreased when augmentation is performed with addition of basic fibroblast growth factor (b-FGF). Objectives: The effectiveness of augmentation is easily decreased due to absorption. Canine experiments have confirmed that the decreased effectiveness caused by absorption after augmentation can be reduced by administering low-concentration b-FGF. Clinical application was trialed after acquiring approval from the institutional clinical review committee. Method: Autologous fat tissue with b-FGF was injected into the vocal folds in cases of unilateral vocal cord paralysis. This study compared fat tissue survival after injection by assessing images from computed tomography (CT). Results: Assessments using CT revealed that the decrease in volume of injected fat tissue was smaller in cases treated using b-FGF than in cases using the conventional method. No severe complications were encountered using this method. [ABSTRACT FROM AUTHOR]