Laryngeal Examination Research Articles

Recent Advances in Examination of Vocal Fold Vibration

Human vocal cords vibrate as quickly as 100–250 times per second, so it is impossible to observe them with normal endoscopic diagnostic equipment. High-speed videolaryngoscopy (HSV) allows the visualization of non-periodic vibratory motion of vocal fold beyond the limitation of videostroboscopy. New developed post-processing methods that converts HSV to two-dimensional videokymography (2D VKG) using U-medical image-processing software can provide quantitative information on vocal fold mucosa vibration. Multifunctional laryngeal examination system is composed of 3 kinds of examinations such as HSV, 2D scanning digital kymography (2D DKG) and line scanning digital kymography (DKG). Evaluation of entire vocal cord vibratory pattern in each cord is possible using 2D DKG and a faster and more reliable quantitative information can be obtained. As this system is used in clinical and research, it is expected to bring much advances to the diagnosis of voice disorders. In this review, I will introduce the principles and advantages on examination of the vocal fold vibration, which is in the spotlight recently, and proceed with the literature review. Key words: Vocal cords ㆍ Vibration ㆍ Stroboscopy ㆍ Kymography 핵심용어: 성대 ㆍ 진동 ㆍ 스트로보스코피 ㆍ 카이모그래피

Applied value of color Doppler flow imaging in diagnosis of congenital subglottic haemangioma in infant

Objective:To investigate the value of color Doppler flow imaging（CDFI） in the diagnosis of congenital subglottic hemangioma（CSH） in infants. Methods:The data of 18 children with CSH who underwent laryngeal CDFI examination were collected and analyzed retrospectively, and compared with those who underwent laryngeal ultrasound examination at the same time. The shape, size, blood flow characteristics of the tumor and its relationship with airway were observed. Eighteen cases were treated with propranolol orally. CDFI of larynx was reexamined after 1 week, 1 month and 3 months of treatment. Results:CDFI could clearly show the location, shape, size and range of CSH in 18 cases, as well as the relationship with airway and surrounding tissues. CDFI images of CSH showed that the tumor was massive or nodular with abundant or patchy blood flow signals. Hemangioma was found in 6 cases on the right side, 8 cases on the left side, and 4 cases on both sides. Conclusion:CDFI can be used in the diagnosis of subglottic hemangioma. It has advantages in displaying its size, scope and relationship with airway, especially in the later treatment and follow-up.

Development and validation of the nomogram for predicting preoperative vocal cord palsy in thyroid cancer patients.

Low incidence of preoperative vocal cord palsy (VCP) promotes a diagnosis model to eliminate patients without the necessity of preoperative laryngoscopy assessments, avoiding medical costs and discomfort. However, previous studies lacked a comprehensive strategy and external validation data to effectively detect VCP in thyroid cancer patients. This study aimed to develop a VCP scoring system that could calculate cumulative VCP risks and determine preoperative laryngeal examinations based on the clinical characteristics of VCP patients from the Union Hospital, Tongji Medical College of Huazhong University of Science and Technology. A retrospective study recruited 5,354 thyroid cancer patients was performed. Preoperative VCP incidence was recorded, and a prediction table was constructed using independent, significant risk factors for preoperative VCP. The visualized nomogram, including five parameters, was proportionally assigned 0 to 100 points. Finally, the diagnostic performance was confirmed by verifying the nomogram in the internal and external cohort. The incidence of preoperative VCP by preoperative laryngoscopy assessment was 1.57%. Age at diagnosis (OR: 1.04; P=0.006), history of neck surgery (OR: 11.57; P<0.001), voice symptoms (OR: 32.75; P<0.001), large nodule diameter (OR: 1.04; P<0.001) and suspicious neck lymph nodes (OR: 3.25; P<0.001) were identified as independent risk factors. The nomogram was proven to be acceptable discrimination in internal and external sets, and the cut-off value was 94.7. We identified clinical risk factors related to preoperative VCP and established a nomogram for VCP clinical discrimination with an excellent performance in the external cohort.

Outcomes of Vocal Hygiene Program in Facilitating Vocal Health in Female School Teachers With Voice Problems

Teachers suffer greater impacts of voice problems due inappropriate voice use and other contributing factors such as physiological, environmental, and individual & work related issues. Structured vocal hygiene programs (VHP) prevent/reduce the risk of vocal trauma and promote vocal health in teachers. This study aimed to estimate the outcome of instituting a sociocultural relevant vocal hygiene program in facilitating vocal health among female school teachers using a comprehensive voice assessment protocol. VHP was developed emphasizing adequate hydration, healthy vocal diet, posture and alignment, vocal practices while teaching, and ideal speaking environment. This was administered via a face to face session to seventeen female teachers with voice concerns. All underwent a comprehensive voice assessment (subjective, objective, and self-perceptual vocal measures) before and four weeks after the VHP. Inter-rater reliability for perceptual and visual examination was estimated using Intra-Class Coefficient. Wilcoxon signed ranks test was used to compare the pre- and post-treatment measures of continuous variables (acoustic, Maximum phonation time, s/z ratio, Vocal Fatigue Index [VFI] & Voice Disorder Outcome Profile [V-DOP]), and McNemar test was used for categorical variables (vocal health questionnaire, visual examination of larynx and perceptual evaluation of voice). Teachers reported reduction of unhealthy vocal & nonvocal practices after VHP. Improvements in vocal and related symptoms such as sensation of heart burn (P=0.031), discomfort around the throat (P=0.008), inadequate breath control while speaking (P=0.016) were noticed. Perceptually, minimal improvement was seen in voice quality (overall grade). However, MPT & s/z ratio showed no significant difference. Improvement was observed in frequency range (P=0.004), low I0 (P=0.044), shimmer (P=0.017), and DSI (P=0.013). Changes were evident in all parameters of stroboscopic evaluation (except nonvibratory portion & ventricular fold hyper-adduction). V-DOP scores indicated positive change in the overall severity (P=0.002), physical (P=0.003) and functional domain (P=0.034). VFI indicated improvement in teachers voice after a period of voice rest (P=0.048). Though VHP facilitated in improving the teachers' awareness of at risk phono-traumatic behaviors and vocal health, its efficiency was limited in producing physiological improvement in teachers' voice. The comparison of vocal metrics before & after the treatment provides information on changes that can be expected in teachers after guiding them through a systematic VHP.

Hypertrophic Cardiomyopathy as an Unexpected Mimic of Inducible Laryngeal Obstruction: The Case for Cardiopulmonary Exercise Testing in Otolaryngology

Inducible laryngeal obstruction is a common and challenging cause of exertional dyspnea. We report a case of an unanticipated cardiac condition that presented with symptoms suggestive of inducible laryngeal obstruction. A 55-year-old man was evaluated for progressive exertional dyspnea and throat tightness, unexplained after multiple medical evaluations. Resting laryngeal examination was suspicious for laryngopharyngeal reflux and mild vocal fold adduction during quiet expiration. Given progressive and refractory symptoms, maximal cardiopulmonary exercise testing with intermittent laryngeal examination was performed. This study excluded laryngeal causes of exercise limitation and led to an unexpected diagnosis of persistent atrial flutter and hypertrophic cardiomyopathy. Cardiopulmonary exercise testing with laryngeal examination can identify unexpected and life-threatening mimics of inducible laryngeal obstruction that may be missed by unmonitored exercise challenges. Suspicion for inducible laryngeal obstruction at rest may not predict the true nature of exercise limitation on cardiopulmonary exercise testing.

Psychological Distress in a Sample of Adult Italian Patients Affected by Vocal Nodules and Muscle-Tension Dysphonia: Preliminary Results

To evaluate the correlation between voice disorders and psychological distress, in terms of anxiety, stress, and depression, in a sample of adult Italian patients and to compare our results with those obtained in a group of adult healthy controls matched by age, sex, geographic distribution, and occupation. This prospective-controlled study included 100 adults with Vocal nodules (VN) and Muscle Tension Dysphonia (MTD1), aged between 18 and 65 years, as Experimental Group (EG) and 100 age-matched subjects without any voice disorders as a Control Group (CG). All patients in the EG underwent a phoniatric evaluation, including the administration of the Voice Handicap Index (VHI) and laryngeal examination. Both patients of EG and CG underwent a Psychological evaluation by means of standardized tests; Beck's Depression Inventory, State Anxiety Inventory (STAI 1-State Anxiety), Trait Anxiety Inventory (STAI 2- Trait Anxiety), and Perceived Stress Scale (PSS-10) were completed by patients. Fisher's exact test and chi-squared test were used to compare all categorical variables, whereas numerical variables were compared either with the nonparametric Mann-Whitney-Wilcoxon or with Kruskal Wallis test. General linear models were used to study continuous variables between patients and controls and between different groups within the sample. In the study group, the Physical domain (P score) of the VHI was more affected than the Emotional (E score) and Functional ones (F score) both in patients with MTD1 and VN; patients with VN presented a significant difference in P score, E score and VHI total score than patients with isolated MTD 1 (P < 0.005). Psychological assessment showed a significant difference (P < 0.005) between VN and MTD 1 regarding PSS-10 and STAI-1 scores. Low Beck's Depression Inventory scores were present in our sample without significant differences between patients with VN and those with MTD 1. Scores related to psychological distress in the EG were far superior to those obtained by the healthy CG, with markedly significant values especially for PSS-10 (P < 0.0001) and STAI 2 (P < 0.01). Finally, younger patients (18-35 years) with VN showed a highest risk of psychosocial distress. the present study identified a high prevalence of psychological distress among patients with vocal disorders without any prior specific psychiatric diagnosis, especially in terms of anxiety and perceived stress. For this reason both these symptoms should be taken into consideration in the diagnostic, therapeutic, and follow-up process of patients with MTD1 and VN.

Laryngeal Injury and Upper Airway Symptoms After Endotracheal Intubation During Surgery: A Systematic Review and Meta-analysis.

Laryngeal injury from intubation can substantially impact airway, voice, and swallowing, thus necessitating multidisciplinary interventions. The goals of this systematic review were (1) to review the types of laryngeal injuries and their patient-reported symptoms and clinical signs resulting from endotracheal intubation in patients intubated for surgeries and (2) to better understand the overall the frequency at which these injuries occur. We conducted a search of 4 online bibliographic databases (ie, PubMed, Embase, Cumulative Index of Nursing and Allied Health Literature [CINAHL], and The Cochrane Library) and ProQuest and Open Access Thesis Dissertations (OPTD) from database inception to September 2019 without restrictions for language. Studies that completed postextubation laryngeal examinations with visualization in adult patients who were endotracheally intubated for surgeries were included. We excluded (1) retrospective studies, (2) case studies, (3) preexisting laryngeal injury/disease, (4) patients with histories of or surgical interventions that risk injury to the recurrent laryngeal nerve, (5) conference abstracts, and (6) patient populations with nonfocal, neurological impairments that may impact voice and swallowing function, thus making it difficult to identify isolated postextubation laryngeal injury. Independent, double-data extraction, and risk of bias assessment followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Cochrane Collaboration's criteria. Twenty-one articles (1 cross-sectional, 3 cohort, 5 case series, 12 randomized controlled trials) representing 21 surgical studies containing 6140 patients met eligibility criteria. The mean patient age across studies reporting age was 49 (95% confidence interval [CI], 45-53) years with a mean intubation duration of 132 (95% CI, 106-159) minutes. Studies reported no injuries in 80% (95% CI, 69-88) of patients. All 21 studies presented on type of injury. Edema was the most frequently reported mild injury, with a prevalence of 9%-84%. Vocal fold hematomas were the most frequently reported moderate injury, with a prevalence of 4% (95% CI, 2-10). Severe injuries that include subluxation of the arytenoids and vocal fold paralysis are rare (<1%) outcomes. The most prevalent patient complaints postextubation were dysphagia (43%), pain (38%), coughing (32%), a sore throat (27%), and hoarseness (27%). Overall, laryngeal injury from short-duration surgical intubation is common and is most often mild. No uniform guidelines for laryngeal assessment postextubation from surgery are available and hoarseness is neither a good indicator of laryngeal injury or dysphagia. Protocolized screening for dysphonia and dysphagia postextubation may lead to improved identification of injury and, therefore, improved patient outcomes and reduced health care utilization.

Ultrasonography diagnostic validity in structural and functional laryngeal disorders

BackgroundThe diagnostic approach for patients with laryngeal lesions differs among otolaryngologists. Indirect laryngoscopy, flexible fibrooptic laryngoscopy, CT, and MRI are all modalities used for diagnosis. Ultrasonography is noninvasive, non-irradiating, and safe. The availability, affordability, and usability of portable ultrasound units have undergone dramatic improvements. It is well tolerated by patients, dynamic technique that can be performed easily in phonation, quickly performed, and allows for photo-documentation. Our objective is to evaluate the laryngeal ultrasound as a diagnostic tool to evaluate different laryngeal structure as regard laryngeal dynamics (range and abnormality), and anatomic structures. This prospective study was carried out on individuals in “blinded for peer review” hospitals. They were divided into group I (healthy volunteers), group II (unilateral vocal fold paralysis), and group III (patients underwent vertical hemilaryngectomies). All patients were subjected to full history taking, detailed head and neck examination, and fibrooptic nasopharyngolaryngoscopy then all patients underwent laryngeal sonographic examination. The photos were analyzed to identify various laryngeal structures and to measure glottic areas and inter-arytenoid distances.ResultsAfter recognition of laryngeal anatomic details and different measurements, we found that the percent of change in length and area were much less in group III than group I or II. Another important finding is that glottic area during respiration is related significantly to interarytenoid length during respiration with a statistically significant regression coefficient.ConclusionLaryngeal ultrasound is a valid diagnostic tool for imaging laryngeal structures and measuring various distances and areas inside the larynx. It is recommended to consider ultrasonography as a reliable imaging modality, and at least a useful adjunct to endoscopy when identification of airway patency, vocal fold mobility, or structural alterations is suspected. To our best knowledge, this study may contain a hitherto undescribed correlation between inter-arytenoid length and glottic area.

Investigation of the serum vitamin D level in infants followed up with the diagnosis of laryngomalacia: a case-control study.

The possible etiological relationship of the vitamin D with laryngomalacia is unclear. The aim of the study was to demonstrate the relationship between laryngomalacia and vitamin D levels. Twenty-three non-syndromic babies under the age of 1year who were diagnosed with laryngomalacia were included in the study group. Forty healthy babies were included in the control group. The detailed anamnesis was obtained and a complete systemic physical examination, a flexible endoscopic laryngeal examination, and laboratory tests [calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), parathormone (PTH), alanine transaminase (ALT), aspartate transaminase (AST), blood urea nitrogen (BUN), creatinine (Cre), and 25-hydroxy vitamin D (25-OH D)] were performed in all patients. All laboratory tests of the groups were compared. It was observed that there was no significant difference in the parameters that could affect vitamin D levels, namely type of feeding, vitamin D supplement intake, and the season when the serum sample was taken (p > 0.05). The vitamin D level was significantly lower (p = 0.003, p < 0.05) and the P and ALP levels were significantly higher (p = 0.016 and p = 0.001, respectively; p < 0.05) in the laryngomalacia group. Although the correlation between vitamin D and PTH was not statistically significant according to the Pearson correlation analysis, it was lower in the laryngomalacia group compared to the control group (p = 0.381, p > 0.05). In this study, it was observed that the vitamin D levels were lower in infants with laryngomalacia compared to the control group. We consider that vitamin D deficiency may be a factor in the etiology of laryngomalacia with a yet-to-be-clarified etiology.

The Role of Nutritional and Dietary Habits in Etiology in Pediatric Vocal Fold Nodule

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.

Evaluating the utility of pre-operative airway assessment for intubation management in difficult airway patients.

To assess intubation management in difficult airway patients by performing a multidisciplinary pre-operative examination of the airway using a flexible fibre-optic laryngoscope. Patients with a known but stable difficult airway were evaluated prior to surgery in the pre-operative holding suite by both an ENT surgeon and an anaesthesiologist via a fibre-optic laryngeal examination. Performing a pre-operative fibre-optic examination of the difficult airway led to a change in intubation strategy in 6 out of 12 cases. Intubation 'first-pass' success occurred in 9 out of 12 (75 per cent) of our patients. By performing a multidisciplinary airway examination immediately prior to surgery, a safe plan to intubate on the initial attempt was developed. This resulted in improved first-pass success at intubation compared to historical data.

Does the Combination of Glottal and Supraglottic Acoustic Measures Improve Discrimination Between Women With and Without Voice Disorders?

To analyze the accuracy of traditional acoustic measurements (F0, perturbation, and noise) and formant measurements in discriminating between women with and without voice disorders, and with different laryngeal disorders. A descriptive, cross-sectional, and retrospective. Two hundred and sixty women participated. All participants recorded the spoken vowel /Ɛ/ and underwent laryngeal visual examination. Acoustic measures of the mean and standard deviation of the fundamental frequency (F0), jitter, shimmer, glottal-to-noise excitation ratio, and the values of the first three formants (F1, F2, and F3) were obtained. Individual acoustic measurements did not demonstrate adequate (<70%) performance when discriminating between women with and without voice disorders. The combination of the standard deviation of the F0, shimmer, glottal-to-noise excitation ratio, F1, F2, and F3 showed acceptable (>70%) performance in classifying women with and without voice disorders. Individual measures of jitter as well as F1 and F3 demonstrated acceptable (>70%) performance when distinguishing women with different laryngeal diagnoses, including without voice disorders (healthy larynges), Reinke's edema, unilateral vocal fold paralysis, and sulcus vocalis. The combination of acoustic measurements showed excellent (>80%) performance when discriminating women without voice disorder from those with Reinke's edema (mean of F0, F1, and F3) and with sulcus vocalis (mean of F0, F1, and F2). Individual formant and traditional acoustic measurements do not demonstrate adequate performance when discriminating between women with and without voice disorders. However, the combination of traditional and formant measurements improves the discrimination between the presence and absence of voice disorders and differentiates several laryngeal diagnoses.

Two Cases of Parkinson's Disease Accompanied with Nasogastric Tube Syndrome

We report 2 cases of patients with Parkinson's disease who exhibited bilateral vocal cord paralysis induced by an indwelling nasogastric tube (N-G tube). Both patients showed abrupt inspiratory stridor after N-G tube placement. A fiberoptic laryngeal examination revealed bilateral vocal cord abductor paralysis (VCAP). After N-G tube removal, patient symptoms improved. Nasogastric tube syndrome (NGTS) is an uncommon but life-threatening syndrome that causes sore throat and bilateral VCAP following N-G tube insertion. Throat pain is considered an important early manifestation of NGTS. However, in cases of advanced Parkinson's disease, subjective symptoms of NGTS, such as throat pain, may be difficult to recognize. We here report 2 patients with parkinson's disease accompanied by NGTS with literature review and proposed that inspiratory strider is a useful objective symptom in early diagnosing of NGTS. (Received March 25, 2020; Accepted May 18, 2020; Published September 1, 2020).

Vocal Outcomes in Vagus Nerve Stimulation: A Laryngeal Pattern-Based Objective Analysis

The aim of our study is to evaluate objective and subjective vocal outcomes in patients undergoing vagus nerve stimulation (VNS) therapy for drug-resistant epilepsy and to assess the vocal outcome in the known laryngeal dysmotility patterns induced by VNS. We enrolled 16 adult patients without cognitive impairment who had undergone VNS implant for drug-resistant epilepsy at least 1 year prior. They were evaluated by flexible fibreoptic laryngeal examination and Voice Handicap Index questionnaire administration; acoustic and perceptual voice analysis was performed both at rest and during VNS activation. All recruited patients were admitted to the study. The VNS implant systematically determined laryngeal motility alterations, which were in turn mirrored by perceptual, subjective, and/or acoustic analysis voice alterations in all patients. Patients with intact vocal fold function at rest performed worse during acoustic voice analysis in terms of jitter during VNS activation and shimmer at rest when compared to other laryngeal patterns (P= 0.027 and P=0.034, respectively, Kruskal-Wallis test). Furthermore, VNS activation determined an overall worsening of the perceptual and acoustically analysed voice quality: the grade of hoarseness, instability and breathiness parameters of the GRBASI (grade, roughness, breathiness, asthenia, strain, instability) scale and the jitter, shimmer and noise-to-harmonic ratio of the acoustic analysis worsened significantly during VNS activation (P=0.001, P=0.021, P=0.012, P < .001, P=00.002, P=0.039, respectively, Wilcoxon test). According to our results, the VNS implant determines a significantly impaired vocal outcome that has a surprisingly mild impact on Voice Handicap Index scores. Such impairment is significantly greater in patients with intact vocal fold function at rest.

Performance of Different Acoustic Measures to Discriminate Individuals With and Without Voice Disorders

The goal of this study is to compare and combine different acoustic features in discriminating subjects with and without voice disorders. A database of 484 adult patients participated in the research. All subjects recorded a sustained vowel /Ɛ/ and underwent a laryngoscopic examination of the larynx. From the results of the laryngeal examination performed by a physician and the auditory-perceptual judgment performed by a Speech-Language Pathologist, the subjects were allocated to the group with (n=52) and without (n=432) voice disorder. Four types of acoustic features were used: traditional measures, cepstral measures, nonlinear measures, and recurrence quantification measures. Recordings comprised the emission of the vowel /ε/. Quadratic discriminant analysis was used as classifier. Individual features in the context of traditional, cepstral, and recurrence quantification measures achieved an acceptable performance of ≥70%. Combination of measures improved the classifier performance. The best classification result (86.43% accuracy) was obtained by combining traditional linear and recurrence quantification measures. Results shown that Traditional, Cepstral, and recurrence quantification measures are promising features that capture meaningful information about voice production, which provides good classification performances. The findings of this study can be used to develop a computational tool for voice disorders diagnosis and monitoring.

Which one is favorable in the elderly? Transoral rigid laryngoscopy or transnasal flexible fiberoptic laryngoscopy.

To determine whether transoral rigid laryngeal endoscopy (TORLE) or transnasal flexible fiberoptic laryngoscopy (TNFFL) is more favorable for laryngeal endoscopic examination in the elderly population. This randomized prospective study carried out in a tertiary reference center. TORLE or TNFFL were performed to patients who were over 65years at their first visit according to randomization list. At their second visit, other method was performed. Patients' physiological parameters (Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and oxygen (O2) saturation before and immediately after laryngeal examination were recorded. Patients' pain-irritation, gag reflex, and dyspnea status were evaluated using visual analog scale after first and second endoscopic examinations. Further patient preferences for TORLE and TNFFL were recorded. Of 96 patients included in the study, 69.8% (n=67) preferred TORLE while 30.2% (n=29) preferred TNFFL. Major factor influencing patient preferences was pain-irritation in TNFFL. Pain-irritation scores were significantly higher in TNFFL than those in TORLE (p<0.001). However, no significant difference was found between two methods with respect to gag reflex and dyspnea scores (p=0.194, p=0.327, respectively). In TORLE, there was no statistically significant difference between the values measured before and after examination in terms of SBP, DBP, HR, and O2 saturation (p=0.641, p=0.134, p=0.119, p=0.414, respectively). However, in TNFFL, statistically significant decrease was observed after examination in HR and O2 saturation (p<0.001, p<0.001, respectively). TORLE is more suitable for laryngeal examination in elderly patients since it is more comfortable for patient and does not change physiological parameters.

Flock health survey of Irish Texel society breeders and larynx examination in Texel sheep

BackgroundLaryngeal chondritis is a disease of undetermined aetiology, characterised by oedema, ulceration, abscessation and necrosis of the laryngeal mucosa and cartilage. The initial aim of the study was to document flock health issues identified by Irish pedigree Texel breeders using a questionnaire survey. Additionally, given the reports of breed predisposition for laryngeal chondritis in Texels, a further aim was to identify if laryngeal problems were perceived as an issue. Work was then conducted to identify if pre-clinical laryngeal mucosal pathology was identifiable in Texel sheep showing no overt clinical signs of respiratory disease and if associations existed between laryngeal measurements and laryngeal pathology.Thirty one larynges were collected from a Texel flock that previously had laryngeal chondritis diagnosed in fallen stock. Gross visual inspection was performed to identify and grade (0–5) laryngeal pathology. A series of measurements were then performed on larynges that had been formalin fixed. Associations between independent variables (larynx measurements) and the dependent variable (laryngeal pathology score) were examined.ResultsRespiratory disease was the most frequently identified health issue. Farmer-diagnosed ‘throat problems’ were reported by over 80% of respondents.Laryngeal pathology was noted in Texels showing no overt clinical signs of respiratory disease. Associations between laryngeal measurements and laryngeal pathology were identified relating to the angle between the cranial point of the cricoid cartilage and the vocal process of the arytenoid cartilage.ConclusionsMild laryngeal pathology was noted in animals with no overt clinical signs of respiratory disease. Future research should examine whether significant associations between laryngeal measurements and laryngeal pathology identified in the current study can be measured ante mortem, and whether such ante mortem measurements will allow early identification of sheep at risk of developing laryngeal chondritis.

Subjective and Objective Assessment of Effect of Allergic Rhinitis on Voice in Indian Patients.

To perform a subjective and objective assessment of vocal complaints in patients of allergic rhinitis (AR) using voice handicap index and video-stroboscopy respectively and find the association of their parameters with severity of the disease. Cross-sectional-observational study design. Outpatient department of Otorhinolaryngology of a tertiary centre. Seventy-five adult patients diagnosed with AR and classified according to 'Allergic Rhinitis and its Impact on Asthma' guidelines were compared with same number of normal subjects as controls, with the same age and sex, to ensure uniformity. Both the groups were asked to fill a self-answered questionnaire called Voice Handicap Index (VHI) and underwent laryngeal examination with Video-Stroboscopy (VS). The mean VHI score of the AR group (29.45 ± 32.11) was significantly higher (p < 0.05) than that of controls (12.07 ± 16.62). VS parameters including amplitude, supraglottic activity, vocal edge and phase closure also showed significant difference between cases and controls (p < 0.05). VHI scores increased, but the VS findings did not change significantly with the severity of the disease. AR patients show subjective and objective derangements of voice quality. VHI scores show increase, while VS parameters do not change with the severity of AR.

Prognostic indicators of short-term outcome in dogs undergoing surgery for brachycephalic obstructive airway syndrome

BackgroundThe aims of this study were to assess the impact of epidemiological variables, severity of presurgical respiratory signs, diagnostic findings from pharyngeal and laryngeal examination using a new grading scheme...

Voice-related complaints and vocal and nonvocal habits of Hindustani classical singers: a questionnaire-based study

Objective This study aimed to profile voice-related complaints, as well as vocal and nonvocal habits among Hindustani classical singers. Method Cross-sectional study design was used to profile voice-related complaints and vocal and nonvocal habits among Hindustani classical singers. Phase I involved developing a questionnaire for exploring vocal and nonvocal habits. Phase II involved the administration of the survey to 61 Hindustani classical singers. Results Based on the overall findings, 41% of singers reported of at least three vocal symptoms. The most common vocal symptoms included out of breath while singing, felling tired after singing and experiencing tension or tightness in neck/shoulder. The commonly reported vocal habits included excessive phone use, loud coughing/sneezing, throat clearing and excessive speaking. A high consumption of caffeinated beverages and spicy food were also reported. Conclusion This study helps to highlight the voice-related complaints and vocal and nonvocal habits of Hindustani classical singers. Further studies, need to explore the prevalence of voice problems incorporating other dimensions of voice evaluation such as acoustic, auditory perceptual, self-reported and laryngeal examination.