Laryngeal Dysfunction Research Articles

The use of thyroid flap for preserving laryngeal function in laryngeal cancer.

Preserving laryngeal function after partial laryngectomy for laryngeal cancer is an important consideration. Therefore, we examined the use of thyroid flaps for this purpose. We analyzed 21 patients who underwent thyroid flap reconstruction after partial laryngectomy for laryngeal cancer in the Department of Otorhinolaryngology Head and Neck Surgery, the Second Xiangya Hospital of Central South University from January 2010 to January 2020. All patients were male and aged 51-64 years. Seventeen patients underwent modified tracheocricohyoidoepiglottopexy, and the remaining four patients underwent modified cricohyoidopexy. The thyroid flap was pedicled from the superior thyroid blood vessels. In the modified tracheocricohyoidoepiglottopexy, the flap was turned to cover the area between the tracheal ring and epiglottis to reconstruct the anterior wall of the cricoid cartilage, whereas in the modified cricohyoidopexy, it was turned over between the cricoid cartilage and tongue root to reduce anastomotic tension. A total of seven patients underwent radiotherapy and chemotherapy after surgery. Thyroid flap reconstruction was successfully performed in all patients. The postoperative hospitalization time was 9-21 days, the postoperative nasal feeding time was 18-47 days, and the tracheotomy tube was removed 30-160 days after surgery. No laryngeal stenosis, flap necrosis, bleeding complication, or dysfunction of the thyroid and parathyroid glands was observed after surgery. Two patients experienced wound infections about 1 week after discharge and were admitted again for antibiotic treatment. After dressing and compressing the neck wound, the patients were discharged. Three patients experienced local tumor recurrence after surgery, two of whom did not receive radiotherapy and chemotherapy after modified tracheocricohyoidoepiglottopexy. No patients had distant metastasis after surgery. Thyroid flaps have significant application value in the reconstruction of the laryngeal cavity after partial laryngectomy for laryngeal cancer. It has high safety and feasibility, convenient surgical procedure, and satisfactory postoperative outcomes.

Vertical Partial Laryngectomy With Temporoparietal Free-Flap Reconstruction for Recurrent Laryngeal Cancer: Long-Term Study.

Treatment options for recurrent early glottic carcinoma's include conservative and radical surgical options. These options offer similar survival benefits with different impacts of patient's quality of life. We previously present our experience with vertical partial laryngectomy (VPL) and showed high locoregional control rates with high-quality voice results and normal swallowing. A long-term retrospective review. Tertiary Care Center. We analyzed all patients underwent VPL between the years 1995 to 2018. Long-term oncologic and functional outcomes were collected. A total of 40 patients were included. The majority of whom were male (n = 38, 95%) with a mean age of 64.9 years (SD ± 9.5). With a median follow up time of 12 years (range 0-24), 9 patients (22.5%) had disease recurrence; the majority of whom (8 patients), had local recurrence and all were salvaged with total laryngectomy. Eight patients (20%) developed second primaries in the head and neck region with a median time to diagnosis of 77 months (range 8-227 months). Ten-years overall survival, disease specific survival, and local disease-free survival were 80%, 90%, and 80%, respectively. Five patients had postoperative laryngeal dysfunction with a total 10-years laryngectomy free survival of 70%. VPL has a sustainable oncologic outcome with a high long-term laryngectomy free survival rate. This entity is an acceptable conservative salvage option for selected postradiated recurrent laryngeal squamous cell carcinoma patients.

The Vocal Flutter of Multiple System Atrophy: A Parkinsonian-Type Phenomenon?

Early features of multiple system atrophy (MSA) are similar to those in Parkinson's disease (PD), which can challenge differential diagnosis. Identifying clinical markers that help distinguish MSA from forms of parkinsonism is essential to promptly implement the most appropriate management plan. In the context of a thorough neurological evaluation, the presence of a vocal flutter might be considered a potential feature of MSA-parkinsonian type (MSA-P). This case series describes clinical histories of 3 individuals with MSA-P. In each case, vocal flutter was detected during neurological and motor speech evaluations. It seemed to be a concomitant feature with the constellation of other signs and symptoms that led to the clinical diagnosis. The vocal flutter may be described as pitch and loudness fluctuations during phonation. Different from a vocal tremor, the flutter phenomenon has higher oscillation frequencies. The neuropathological underpinnings of vocal flutter may be related to generalized laryngeal dysfunction that is commonly described in MSA-P. Vocal flutter may be a unique speech feature in some individuals who have MSA-P. Future studies using perceptual and acoustic measures of speech are warranted to quantify these observations and directly compare to other MSA variants, PD, and a control group.

Minimally Invasive Murine Laryngoscopy for Close-Up Imaging of Laryngeal Motion during Breathing and Swallowing.

The larynx is an essential organ in mammals with three primary functions - breathing, swallowing, and vocalizing. A wide range of disorders are known to impair laryngeal function, which results in difficultybreathing (dyspnea), swallowing impairment (dysphagia), and/or voice impairment (dysphonia). Dysphagia, in particular, can lead to aspiration pneumonia and associated morbidity, recurrent hospitalization, and early mortality. Despite these serious consequences, existing treatments for laryngeal dysfunction are largely aimed at surgical and behavioral interventions that unfortunately do not typically restore normal laryngeal function, thus highlighting the urgent need for innovative solutions. To bridge this gap, we have been developing an experimental endoscopic approach to investigate laryngeal dysfunction in murine (i.e., mouse and rat) models. However, endoscopy in rodents is quite challenging due to their small size relative to current endoscope technology, anatomical differences in the upper airway, and the necessity for anesthesia to optimally access the larynx. Here, we describe a novel transoral laryngoscopy approach that permits close-up, unobstructed video imaging of laryngeal motion in mice and rats. Critical steps in the protocol include precise anesthesia management (to prevent overdosing that abolishes swallowing and/or risks respiratory distress-related mortality) and micromanipulator control of the endoscope (for stable video recording of laryngeal motion by a single researcher for subsequent quantification). Importantly, the protocol can be performed over time in the same animals to study the impact of various pathological conditions specifically on laryngeal function. A novel advantage of this protocol is the ability to visualize airway protection during swallowing, which is not possible in humans due to epiglottic inversion over the laryngeal inlet that obstructs the glottis from view. Rodents therefore provide a unique opportunity to specifically investigate the mechanisms of normal versus pathological laryngeal airway protection for the ultimate purpose of discovering treatments to effectively restore normal laryngeal function.

Tout ce qui siffle n’est pas asthme chez l’adulte

Wheezing and stridor are symptoms induced by airflow obstruction. While wheezing evokes a sub-glottic origin, stridor, which consists of an inspiratory noise, can be related to an obstacle in the upper airways, larynx, or trachea. Asthma is one of the most frequent causes of wheezing. However differential diagnoses must be considered, including chronic obstructive pulmonary disease (COPD), laryngeal dysfunction, and other causes of bronchial hyperreactivity. Different aetiologies resulting in airway mechanical obstructions, such as extrinsic compressions or endobronchial obstacles, for example, foreign bodies, tumors, or mucosal injuries, can induce wheezing. The research on the cause of stridor must differentiate supra-glottic and sub-glottic obstructions, and take into account the onset and the rhythm of the stridor, whether acute, intermittent, or chronic. The diagnosis relies on a detailed clinical history, rigorous clinical examinations of the ENT and the respiratory systems, Chest X-Ray and/or CT-scan, analysis of respiratory functional tests and endoscopy.

Vocal Cord Paralysis after Repair of Esophageal Atresia.

Etiology of vocal cord paralysis (VCP) and laryngeal dysfunction may be congenital or surgical trauma of recurrent and superior laryngeal nerves. We assessed the incidence, risk factors, and morbidity of VCP after repair of esophageal atresia (EA). Medical records of 201 EA patients from 2000 to 2022 were reviewed for this retrospective study. Postrepair vocal cord examination (VCE) included awake nasolaryngeal fiberoscopy by otolaryngologist or laryngoscopy under spontaneous breathing anesthesia. Before 2017, postoperative VCE was performed in symptomatic patients only and routinely after 2017. Overall, VCE was performed on 79 (38%) patients (52 asymptomatic), whereas 122 asymptomatic patients underwent no VCE. VCP was diagnosed in 32 of 79 patients (right 12, left 10, and bilateral 10; symptomatic 25 and asymptomatic unilateral 7) corresponding with extrapolated overall VCP incidence of 16 to 24% among 201 patients including asymptomatic ones. Ten patients (bilateral VCP 8 and left VCP 2) required tracheostomy. Of 10 patients with bilateral VCP, three underwent laryngotracheal expansion surgery (left VC lateralization in one and laryngoplasty in two with acquired subglottic stenosis), three remained tracheostomy dependent, three were off tracheostomy, and one died of complications after redo esophageal reconstruction. All patients with unilateral VCP managed without tracheostomy. Cervical dissection or ostomy formation was a major risk factor of VCP. Repair of EA is associated with a considerable risk of VCP and associated morbidity. Cervical EA surgery significantly increased the risk of VCP. Bilateral VCP may eventually require laryngotracheal expansion surgery.

Laryngological Complaint Prevalence in Hypermobile Ehlers-Danlos or Hypermobility Spectrum Disorders.

The aim was to study laryngological complaints in patients with hypermobile Ehlers-Danlos syndrome (hEDS) or hypermobility spectrum disorders (HSD). A total of 363 patients met inclusion for the study by completing questions related to voice, upper airway, and swallowing between July 7, 2020 and July 13, 2022. Demographic data, voice-related questions, and hypermobility diagnosis were analyzed retrospectively. From those, 289 patients were diagnosed with hEDS or HSD with 74 that did not meet the diagnostic criteria for either diagnosis serving as controls. There were no statistically significant differences between patients with hEDS and HSD regarding Voice Handicap Index (VHI-10) scores, voice, upper airway, or swallow complaints. However, more hEDS/HSD patients answered positively to the laryngeal dysfunction question versus controls (p = 0.031). 22.5% of hEDS/HSD patients (n = 65) reported hoarseness, of which 52.3% reported hoarseness >2 days/month. 33.9% (n = 98) with hEDS/HSD reported symptoms of dysphagia, and 27.0% (n = 78) reported laryngeal dysfunction symptoms. Controls demonstrated 20.3% prevalence of hoarseness, of which 46.7% reported hoarseness >2 days/month. 24.3% of controls had dysphagia and 14.9% laryngeal dysfunction symptoms. Of the 363 patients, VHI-10 scores >11 were more likely in patients reporting >2 days of hoarseness/month (p = 0.001) versus those with <2 days of hoarseness/month. There was an increased prevalence of voice, upper airway, and dysphagia symptoms in hEDS/HSD patients compared with previously reported prevalence data in the general population. A significant proportion of patients diagnosed with hypermobility due to hEDS or HSD were found to have voice, upper airway, and dysphagia symptoms. These rates are higher than those previously reported in the general population. 3 Laryngoscope, 134:773-778, 2024.

Late laryngeal dysfunction in head and neck cancer survivors.

Head and neck cancer (HNC) survivorship issues are areas of increasing research interest. Laryngeal dysfunction in HNC patients is particularly important given the importance of the larynx in voice, swallowing, and airway protection. The objective of our study is to characterize late laryngeal dysfunction in a cohort of long-term HNC survivors. HNC survivors who were at least 2 years post-treatment were recruited prospectively for standard collection of videolaryngoscopy findings, videofluoroscopic swallowing studies, and assessment of clinical outcomes. Descriptive statistics were performed and clinical presentation and outcomes were compared between survivors >10 years and <10 years post-treatment. Additional factor analysis to correlate clinical outcomes with clinical variables was performed. Thirty participants were analyzed with a mean age of 66 years. The majority were male (80%) patients treated for oropharyngeal squamous cell carcinoma (67%). Within the cohort, 43% underwent primary chemoradiation therapy and had 13% radiation alone. Common presenting symptoms included swallowing dysfunction (83%), voice change (67%), and chronic cough (17%). Laryngeal findings on video laryngoscopy include vocal fold motion abnormalities (VFMA) in over half of participants (61%) and mucosal changes in 20%. A weak correlation was found between time since treatment and laryngeal dysfunction (r = .182, p = .34), and no correlation was found between age, sex, time since treatment, or primary site and the presence or absence of VFMA, G-tube status, or tracheostomy-tube status. Late laryngeal dysfunction in HNC survivors contributes to significant morbidity, is difficult to treat, and remains static decades after treatment for their original cancer. The voice-box, or the larynx, plays an important role in voice, swallowing and airway protection. It is particularly vulnerable to radiation-related damage and changes. This study demonstrates the sequelae of long-term damage of the larynx in head and cancer survivors. IV.

Motor neuron involvement threatens survival in spinocerebellar ataxia type 1.

Motor neuron involvement threatens survival in spinocerebellar ataxia type 1.

Tension-free thyroidectomy (TFT, medial thyroidectomy) — a prospective study: surgical technique and results of 259 operations

BACKGROUND: One of the most important tasks in thyroid surgery is to prevent the development of specific complications — laryngeal nerve dysfunction and hypoparathyroidism. A significant number of technical solutions introduced into clinical practice in recent years are aimed at solving this problem.AIM: Тo evaluate the results of an alternative technique of thyroid surgery — medial thyroidectomy.MATERIALS AND METHODS: 270 patients with thyroid diseases were operated on using tension free thyroidectomy technique in the volume of hemi- or thyroidectomy with or without cervical lymphadenectomy. The selection of patients was continuous. All patients underwent ultrasound or videolaryngoscopy before the operation and on the 1st postoperative day. Patients who underwent thyroidectomy underwent blood analysis for parathormone and blood analysis for ionized calcium.RESULTS: For hemithyroidectomy the duration of surgery did not change. In the group of patients with nodes up to 30 mm the duration of surgery increased. An increase in the operation time was also noted for thyroidectomy. Unilateral laryngeal paresis was registered in 6 (2.3%) patients or 1.7% of the number of recurrent laryngeal nerves in the risk area. The risk of parathyroid gland (PTG) removal was 0.39% of the number of operations and 0.14% of the number of PTG in the risk area. Decrease in the level of parathormone in the first day after surgery was noted in 11.5% of patients. The development of postoperative hematoma was noted in 1 patient (0.39%).CONCLUSION: The technique of thyroid surgery with medial access to the recurrent laryngeal nerve and parathyroid glands is feasible in the vast majority of patients with thyroid diseases requiring surgical treatment and shows high safety and a number of advantages over the traditional method of thyroid surgery.

Complications of Thyroidectomy and Learning Curve for Thyroid Surgeons: An Institutional Experience.

To study the complications of thyroidectomy and the various methods to be followed in the intra and post-operative period to prevent complications. It is a prospective study of 5years and 9months duration from 1/1/2015 to 31/9/2020 done in a tertiary care hospital. A total of 268 patients were included in this study. Adequate measures were taken intraoperatively to prevent any complications and the patients were observed post-operatively for development and management of any complications. The patients were followed up regularly. Out of the 268 thyroidectomies performed in our study following which 5 patients had hemorrhage, 19 patients had temporary recurrent laryngeal nerve dysfunction, 3 patients developed respiratory obstruction, 12 patients developed transient parathyroid insufficiency, 62 patients developed thyroid insufficiency,1 patient had permanent parathyroid insufficiency, permanent recurrent laryngeal nerve dysfunction was seen in 7 patients, 3 patients developed seroma formation, 7 patients developed post-operative hypertrophic scar and 3 developed keloid. Sound anatomical knowledge, meticulous surgical technique and effective protocol for the management of complication can reduce the postoperative morbidity of the patient.

Standardized Behavioral Treatment Improves Chronic Cough

ObjectivesNeurogenic Laryngeal Hypersensitivity (NLH) refers to a constellation of upper airway symptoms thought to be caused by a disturbance in afferent and/or efferent neural pathways creating an exaggerated hypersensitive laryngeal response. There is evidence to support behavioral therapy as treatment for improving symptoms from laryngeal motor dysfunction to sensory disturbance. This study aims to determine if there is significant symptomatic improvement in patients with NLH who received non-pharmacologic behavioral treatment performed by trained SLPs. Study designA retrospective review. MethodsA review of all patients with NLH from 2017 to 2020 was performed at a tertiary care voice and swallowing center. Subjects with persistent symptoms despite maximal medical management were considered for inclusion. Newcastle Laryngeal Hypersensitivity Questionnaire (NLHQ) was completed by patients before and after undergoing therapy by one of three trained SLPs. Posttherapy improvement was determined by utilizing the NLHQ's minimal clinically important difference of 1.7 points. ResultsA total of 81 patients were included in this study. Study participants included 61 women and 20 men with an average age of 60.64±14.05 years. There was a statistically significant difference between the pre and post therapy scores amongst all patients when treated by each individual SLP and all three SLPs combined (P < 0.008). There was a clinically significant change in 66% of all patients, 76% of which presented with abnormal NLHQ scores, and 14% who presented with normal NLHQ scores. ConclusionsA standardized behavioral treatment protocol for patients with symptoms consistent with NLH is effective in improving symptoms in a large majority of patients. When following a standardized protocol SLPs can obtain similar results for their patients.

Polypositional transcutaneous ultrasound assessment of vocal folds mobility. Ultrasonographic sign of laryngeal dysfunction

To increase the effectiveness of the diagnosis of laryngeal dysfunction using transcutaneous laryngeal ultrasonography. Patients underwent laryngeal ultrasonography and videolaryngoscopy before and after thyroid or parathyroid surgery. Ultrasound was performed polypositionally in the transverse and oblique planes. Functional tests with breathing and breath holding were used. Qualitative (the smile or flying bird signs, the vertical closing line of the vocal folds, synchronicity and symmetry movement of the arytenoid cartilages) and quantitative (the length contraction of the vocal cord, the rotation angle of the arytenoid cartilage) ultrasonic parameters determin the normal vocal folds mobility. 996 patients were included in the study. Vocal folds paresis was detected in 106 (10.6%) patients. In 72 (7.2%) cases partial impaired mobility of the vocal folds (laryngeal dyskinesia) were detected. The echographic patterns of these patients were analyzed. Qualitative ultrasound signs of laryngeal dysfunction were identified: a crooked smile or falling bird signs, a closing line deformation of the vocal folds, an arytenoid immobility. Quantitative ultrasound signs included: a decrease in the length contraction of the vocal cord and a reduction of rotation angle of the arytenoid cartilage. Unilateral laryngeal paresis was diagnosed in 101 (10.1%) patients. In unilateral disorders the rotation angle of the arytenoid on the affected side was 0-14° and the length contraction of the vocal cord was 0-1.8 mm. A crooked smile or falling bird signs, a closing line deformation of the vocal folds and immobility of the arytenoid cartilages were also determined. In 5 (0.5%) cases bilateral laryngeal paresis was revealed, in which on both sides the rotation angles of the arytenoid were 0-14°, and the length contraction of the vocal cords was 0-1.8 mm. At the same time there was no a smile or flying bird signs and a closing line of the vocal folds. Laryngeal dyskinesia was characterized by a crooked smile or falling bird signs and a closing line deformation of the vocal folds. At the same time, partial mobility of the arytenoid cartilage was noted in comparison with the contralateral side (there was a difference in the rotation angle of the arytenoid between the right and left sides of 15 ° or more degrees). The sensitivity and specificity polypositional ultrasound of the vocal folds in women were 100% and 99.8%, in men - 85.7% and 99.2%, respectively.

Early assessment of laryngeal dysfunction after thyroid surgery: a narrative review on detection and treatment considerations and the role of speech language pathology

Background and Objectives: Laryngeal function is an important quality of life (QOL) aspect after thyroid and parathyroid surgery that focuses on the functions of voice, swallow and breathing. These important functions may be altered secondary to nerve injury to the recurrent laryngeal nerve (RLN) and the superior laryngeal nerve (SLN), two branches of the vagus nerve, which traverse the surgical field during dissection. The dysfunction arising from injury to these branches can lead to a spectrum of voice, swallow and breathing disorders, that lead to increased morbidity for patients as well as poor QOL after surgery.

Long-term laryngological sequelae and patient-reported outcomes after COVID-19 infection

PurposeWe examine prevalence, characteristics, quality of life (QOL) assessments, and long-term effects of interventions for laryngeal dysfunction after recovery from COVID-19 infection. Materials and methods653 patients presenting to Yale's COVID clinic from April 2020 to August 2021 were identified retrospectively. Patients with PCR-positive COVID-19 who underwent evaluation by fellowship-trained laryngologists were included. Patient demographics, comorbidities, intubation/tracheostomy, strobolaryngoscopy, voice metrics, and management data were collected. Patient-reported QOL indices were Dyspnea Index (DI), Cough Severity Index (CSI), Voice Handicap Index-10 (VHI-10), Eating Assessment Tool-10 (EAT-10), and Reflux Symptom Index (RSI). Results57 patients met inclusion criteria: 37 (64.9 %) were hospitalized for COVID-19 infection and 24 (42.1 %) required intubation. Mean duration between COVID-19 diagnosis and presentation to laryngology was significantly shorter for patients who were intubated compared to non-intubated (175 ± 98 days versus 256 ± 150 days, respectively, p = 0.025). Dysphonia was diagnosed in 40 (70.2 %) patients, dysphagia in 14 (25.0 %) patients, COVID-related laryngeal hypersensitivity in 13 (22.8 %), and laryngotracheal stenosis (LTS) in 10 (17.5 %) patients. Of the 17 patients who underwent voice therapy, 11 (64.7 %) reported improvement in their symptoms and 2 (11.8 %) patients reported resolution. VHI scores decreased for patients who reported symptom improvement. 7 (70 %) patients with LTS required >1 procedural intervention before symptom improvement. Improvement across QOL indices was seen in patients with LTS. ConclusionsLaryngeal dysfunction commonly presents and is persistent for months after recovery from COVID-19 in non-hospitalized and non-intubated patients. Voice therapy and procedural interventions have the potential to address post-COVID laryngeal dysfunction.

2022 Year in Review: Mechanical Insufflation-Exsufflation

Manual and mechanical cough augmentation techniques are used for airway clearance when cough effort is ineffective. Mechanical insufflation-exsufflation (MI-E) has been a mainstay for respiratory complications of neuromuscular disorders, but its use has expanded to other conditions that result in respiratory muscle weakness and impaired cough, such as intubation and mechanical ventilation. Mechanical in-exsufflation has been used for cough augmentation in both adults and children but has been more widely evaluated in adults. Optimal settings for pressure and time are unknown. Newer MI-E devices have the option for oscillatory vibrations during therapy to facilitate secretion clearance. However, use of oscillations is not supported by the available evidence. Pressure settings and the interface used to administer MI-E influence peak expiratory flow generated during therapy. Laryngeal dysfunction can impact successful MI-E treatment in individuals with neuromuscular disorders and bulbar involvement. Transnasal fiberoptic laryngoscopy and videofluoroscopy may be helpful in assessing the laryngeal response and in customizing pressure settings to decrease the incidence of upper airway collapse during therapy. Electrical impedance tomography has been used for monitoring during mechanical ventilation and may have a role in assessing the effectiveness of MI-E. Much of the literature that supports MI-E is derived from small, single-center studies of adult populations. Future study is warranted for efficacy and optimization of MI-E therapy in various clinical applications.

Laryngeal dysfunction is prominent in asthmatic women treated by inhaled corticosteroids.

Dysphonia is a frequent comorbidity of asthma and has been suggested to be a local side effect of inhaled corticosteroids due to laryngeal candidiasis. We hypothesized that dysphonia in asthmatics was not due to laryngeal organic lesions but to laryngeal dysfunction during phonation (LDP). We compared the frequency of LDP in female asthmatic patients treated with inhaled corticosteroids to female controls. We compared 68 asthmatic female patients to 53 female control subjects. Pulmonary function tests were performed and the asthmatic patients classified according to the level of inhaled corticosteroids. Dysphonia was defined as a Vocal Handicap Index ≥18 or GRBAS score ≥2. All patients underwent video laryngo-strobe examination, analyzed blindly and separately by two otolaryngologists, describing mucosal changes, LDP, or Organic lesions linked to Laryngeal Dysfunction during Phonation (OLDP). 66.2% of the asthmatic patients exhibited dysphonia and 11.3% of controls (p<0.001). No laryngeal candidiasis was found, only 3 patients presented laryngeal mucosa inflammation. LDP was observed in 60.3% of asthmatic patients and 18.9% of controls (p<0.001), and no difference was found for OLDP (11.8% vs. 13.2%). No association was made between LDP, the dosage of inhaled corticosteroid, and bronchial obstruction. Asthmatic patients were more dysphonic than control subjects. This phenomenon was not explained by mucosal inflammation, laryngeal candidiasis or OLDP. Asthmatic patients had more LDP than controls. There was no relation between LDP, inhaled corticosteroids dosage or bronchial obstruction. These results change our view of inhaled corticosteroid side effects in female asthmatic patients.

기계학습에 의한 후두 장애음성 식별기의 성능 비교*

This paper studies how to improve the identification rate of laryngeal disability speech data by convolutional neural network (CNN) and machine learning ensemble learning methods. In general, the number of laryngeal dysfunction speech data is small, so even if identifiers are constructed by statistical methods, the phenomenon caused by overfitting depending on the training method can lead to a decrease the identification rate when exposed to external data. In this work, we try to combine results derived from CNN models and machine learning models with various accuracy in a multi-voting manner to ensure improved classification efficiency compared to the original trained models. The Pusan National University Hospital (PNUH) dataset was used to train and validate algorithms. The dataset contains normal voice and voice data of benign and malignant tumors. In the experiment, an attempt was made to distinguish between normal and benign tumors and malignant tumors. As a result of the experiment, the random forest method was found to be the best ensemble method and showed an identification rate of 85%.

MUSCLE TENSION DYSPHONIA MASQUERADING AS ASTHMA

<h3>Introduction</h3> Muscle Tension Dysphonia is a laryngeal disorder characterized as an imbalance of coordination of the laryngeal muscles. Any form of laryngeal dysfunction may masquerade as an asthma exacerbation. <h3>Case Description</h3> A 44-year-old chemistry teacher with a past medical history of well controlled asthma on budesonide/formoterol and seasonal allergic rhinitis presented with shortness of breath and "wheezing." Episodes of her dyspnea were triggered by strong scents such as hand sanitizers and household chemicals or chemical exposures in the chemistry classroom. Spirometry preformed before the episodes of dyspnea as well as during exacerbations were both reproducible and normal with no signs of bronchial obstruction or reversibility. Similarly, exhaled nitric oxide testing before exacerbation and during exacerbation, were also within normal limits on multiple readings. Despite escalating therapy in her asthma regimen, including initiating allergy immunotherapy and different rounds of biologic therapy, her symptoms persisted. Only after an ENT evaluation with a flexible laryngoscopy, was it discovered that the etiology of the patient's symptoms was due to muscle tension dysphonia—not asthma. Patient was subsequently treated with speech therapy and botulinum injections into the vocal cords with improvement of symptoms. <h3>Discussion</h3> When a patient presents with shortness of breath, providers are quick to attribute symptoms to related comorbidities when the etiology may be something else. This case highlights the importance of including muscle tension dysphonia and other laryngeal pathologies in a differential diagnosis for patients with with a history of asthma presenting with symptoms of shortness of breath resistant to escalating asthma therapy.

Utility of Intraoperative Neurophysiologic Monitoring in Routine Anterior Cervical Spine Surgery

Introduction: Intraoperative neurophysiologic monitoring (IOM) is commonly used in spine surgery; advantages include identification of intraoperative neurologic decline that may be related to a remediable cause. Disadvantages include increased time and cost, morbidity associated with the monitoring procedure, and the potential for false positive alerts prompting unnecessary action. The study’s goal was to assess whether use of IOM in routine, uncomplicated cases of anterior cervical discectomy and fusion (ACDF) surgery was of demonstrable benefit. Methods: 50 consecutive patients were identified who underwent one-level ACDF with anterior instrumentation for cervical disc herniation with radiculopathy without myelopathy. For all cases, a NIMS tube was used to monitor laryngeal nerve function, and EMG, SSEP, and MEP modalities were monitored. Hospital and postoperative records were investigated for the presence of IOM alerts, whether corrective action was taken during surgery, and the presence of any postoperative neurologic deficits. Results: In all cases, there were no alerts of laryngeal nerve dysfunction, or SSEP/ MEP abnormality. In 12 cases, transient EMG irritation activity was documented; in no cases was there any change to the surgical procedure, such as abandonment of surgery, removal of implant, etc. There were no instances of new or worsened postoperative neurologic deficit, and clinical findings of vocal cord dysfunction. Conclusion: In ACDF with anterior instrumentation for cervical disc herniation with radiculopathy without myelopathy, IOM use did not convey any identifiable advantage. Therefore, the data does not support considering IOM to be required or standard of care for routine, uncomplicated ACDF surgery.