Laryngeal Findings Research Articles

Formulation of a program for treatment of childhood dysphonia

BackgroundDysphonia is a disorder characterized by change in voice quality, pitch, loudness, or vocal effort that impairs communication or reduces voice-related quality of life. Childhood dysphonia has several adverse educational and psychosocial implications. Dysphonic children are not aware or not bothered by their voice disorder. Although dysphonia might, in some cases, improve by itself in adulthood, it can be of important value to treat the dysphonic voice already during childhood.AimThe aim of this study was to adapt and formulate a program of voice intervention for childhood dysphonia and apply it on Egyptian children to explore its effectiveness as a therapeutic tool.Patients and methodsThis study was conducted on 20 children of both sexes attending the Phoniatrics Unit in Alexandria Main University Hospital complaining of dysphonia. The remediation program aims to improve dysphonia in children using a combination of indirect and direct treatment techniques. It is a modification of The Boone Voice Program for Children combined with new technologies such as the voice games by Kay Elementrics. It is designed to provide the clinician with step-by-step procedures and materials to remediate voice disorders in school-aged children. The program was translated to Arabic and a number of modifications were done in order to adapt it to the Egyptian children.ResultsThe study showed effectiveness of the remediation program for childhood dysphonia regarding some of the auditory perceptual assessment and acoustic analysis values. Some of the laryngeal examination findings also showed improvement post-therapy. The study showed significant relation between the children’s age, sex, diagnosis, and some pretherapy and post-therapy findings.ConclusionData from the current study suggests that voice therapy may prove to be a valid alternative to just planned follow-up.

Relationship Between Laryngeal Signs and Symptoms, Acoustic Measures, and Quality of Life in Finnish Primary and Kindergarten School Teachers

This study investigated the relationship between the acoustic measure smoothed cepstral peak prominence (CPPS), teacher's quality of life as measured by the voice activity and participation profile (VAPP), laryngeal signs and symptoms, voice related health problems and laryngoscopic findings in Finnish teachers. The relationship between CPPS and sound pressure level (SPL) was also assessed. Vowel and text samples from 183 healthy Finnish teachers (99 kindergarten teachers [KT] and 84 primary school teachers [PST]) were analyzed for CPPS. Text reading was recorded in conversational loudness by PST, and KT were recorded wearing headphones, while listening to a masking noise of children talking to simulate their classroom voice and environment. CPPS values were correlated with the VAPP, self-reported laryngeal signs and symptoms, voice related health variables, and laryngoscopic findings. There was a significant difference between the two groups for CPPS text, PST showed significantly lower CPPS values (10.44) than KT (11.52). There was no difference between the two groups for CPPS vowel phonation. There was a significant correlation between SPL text and CPPS text for KT (P < 0.001, r = 0.43) but not for PST (P < 0.10, r = 0.16). There was a significant correlation between SPL vowel and CPPS vowel for both PST (P < 0.001, r = 0.47) and KT (P < 0.001, r = 0.45). CPPS did not correlate with the VAPP, laryngeal signs and symptoms, health variables or laryngeal findings. Factorial analysis of variance resulted in a significant relationship between the VAPP, laryngeal signs and symptoms, and teacher type. Teacher type and symptoms had a significant effect on VAPP scores. In the present work CPPS does not correlate with vocal health indicators of functionally healthy teachers. CPPS was significantly influenced by differences in speaking voice SPL, emphasizing the impact of recording conditions and technique. There was a significant relationship between laryngeal signs and symptoms, teacher type and the VAPP. Laryngeal signs and symptoms and teacher type are important variables and should be included in the clinical evaluation of occupational voice users, and voice problems.

Laryngeal complaints and videolaryngoscopic laryngeal alterations in rheumatoid arthritis patients and its association with disease activity and duration

Background: Rheumatoid arthritis (RA) is an autoimmune systemic disease with a wide clinical presentation. The laryngeal manifestations are often masked by the articular disability often experienced in the early and late stages of the disease. Objective: Association between different laryngeal complaints and videolaryngoscopic laryngeal alterations in patients with RA, and disease activity and duration. Patients and methods: A retrospective study was conducted on 79 patients with RA. All subjects were recruited from the out-patient clinic of physical medicine, rehabilitation, and rheumatology in Al-Menoufia University Hospitals during the period from March 2015 to March 2017. All patients were subjected to both phoniatric and rheumatological assessment. Results: Patients with phonasthenic symptoms and globus pharynges had significantly (p=0.01, 0.008 respectively) higher disease duration than patients without. No significant association found between rheumatoid arthritis duration and different videolaryngoscopic laryngeal alterations, patient’s self-assessment of the impact of laryngeal complaints on their lives, and auditory perceptual assessment (APA) of patient’s voice characters. As regards rheumatoid disease's activity no significant correlation has been established (p&gt;0.05) with different laryngeal complaints except for patients in remission who had higher prevalence of intermittent dysphonia than patients with low activities. Rheumatoid disease's activity had no significant association with different laryngeal findings except those with moderate activity; they had significantly higher prevalence of vocal folds nodules than patients with high activity and patients in remission. Conclusion: A significant association between the disease's duration and presence of laryngeal complaints, dysphonia, and its persistence has been established. Also, patients with phonasthenic symptoms and globus pharynges had significantly higher disease duration than patients without. Rheumatoid diseases activity had significant association with different laryngeal complaints in patients with remission that had higher prevalence of intermittent dysphonia than patients with low activities. No significant association between the disease activity and different laryngeal findings that has been found except for patients with DAS-28&gt;3.2, they had significantly higher prevalence of rheumatoid nodules.

An attempt at scoring laryngeal findings for cannula replacement after head and neck cancer reconstructive surgery

An attempt at scoring laryngeal findings for cannula replacement after head and neck cancer reconstructive surgery

The Efficacy of PPI in the Treatment of Laryngopharyngeal Reflux

BACKGROUND AND OBJECTIVES: Laryngopharyngeal reflux (LPR) is an inflammation affect large number of patients, it caused by the retrograde flow of gastric contents into the pharynx and larynx, causing a variety of symptoms. Therefore, the present study aimed to evaluate the efficacy of PPI in the treatment of LPR by both clinical &amp; endoscopic follow up. PATIENTS AND METHODS: This prospective observational study was conducted on 61 Consecutive patients attending the Otorhinolaryngology Clinic, Qena University Hospital from January 2018 to July 2018; patients were screened for symptoms of laryngitis. Patients were considered suitable for study if they had persistent laryngeal symptoms for at least 2 months. Laryngoscopic examination was performed using a flexible naso-pharyngoscope. The frequency and severity of patients’ laryngeal symptoms were assessed by both reflux symptoms index &amp; reflux finding score. All patients underwent an esophagogastroduodenoscopy before starting treatment, then 2 months and 6 months later (at the end of treatment). The degree of oesophagitis noted during EGD was graded according to Los Angeles classification. RESULTS: This study included 61 patients with persistent laryngeal symptoms with their mean ages were 31.62 ± 5.16; 21 females (34.43%) and 40 males (65.57%) and their mean body mass index for male and female were 20 ± 4.2 and 23 ± 3.9 respectively. sensation of lump in throat was the most common symptoms found in 54 patient (88.52%) while breathing difficulties was the least presenting symptom detected in 21 patient (34.43%). Patients treated with pantoprazole 20 mg twice daily for 6 months. There was significant post treatment improvement of all presenting symptoms 2 months of regular therapy. (p = 0.0001), with complete disappearance of symptoms by 6 months of therapy. Erythema is the most common laryngeal finding detected in 54 patients (88.52%) However, pseudosulcus was present in 12 patients (19.67%). Marked improvement in reflux signs were detected at the end of 6 months of therapy, (p = 0.0001). Endoscopic partial ventricular obliteration, mild vocal cord edema, mild laryngeal edema and persistence of granuloma were still detected 6 months post regular acid suppression therapy. Follow up esophagogastroduodenoscopy after 2 and 6 months of regular treatment reviles completely apparent healthy mucosa. CONCLUSIONS: Pantoprazole 20mg twice daily for 6 months was associated with significant improvement of laryngopharyngeal reflux symptoms and signs.

Metachronous Malingnancy, 27 Years After Teflon Cordal Injection

We report a rare case of a patient known for a long-time history of iatrogenic VC paralysis, with unusual PET-CT findings. Due to a bilateral paragangliomas (PGLs), 27 years before the patient underwent a left jugulo-petrosectomy. After admission for contralateral sudden hearing loss, MRI and PET-CT scans were acquired. We tried to critically analyze the clinical relevance of multimodal imaging in an unusual condition of comorbities. Moreover, we suggested a physiopathological interpretation of collecting imagings and clinical otorhinolaryngological aspects. We could determine that high SUV in paralyzed left VC was related to a foreign-body reaction after laryngeal injection by polytetrafluoroethylene fluoropolymer resin (Teflon) performed 27 years before. Moreover, an asymptomatic pT1c mixed lung adenocarcinoma was serendipitously detected in the left lung. The SUVs of these two lesions were both compatible with neoplasms. A further possible lesion in the right lung highlighted by MRI was not confirmed by PET-CT imaging (MRI artifact). Although Teflon is no longer in use for laryngeal injection, clinicians should be aware of the potential misinterpretation laryngeal findings in patients with such a clinical history, even long time after the procedure.

A specific laryngeal finding in dogs with bronchial vegetal foreign bodies: a retrospective study of 63 cases.

Grass awns commonly cause respiratory disease in dogs; when located in the trachea or bronchi, they cause severe bronchial inflammation and sepsis. The interplay of cough, bronchoconstriction, and mucus secretion can result in a less effective expulsive cough phase, especially when the causal factor persists. The bronchial exudate could consequently become trapped in the upper respiratory tracts of dogs with bronchial vegetal foreign bodies. We retrospectively reviewed endoscopic findings of the upper respiratory tract in dogs that underwent bronchoscopy in our hospital and correlated these findings with the presence of bronchial grass awns. Muco-purulent exudate in the ventral larynx region, between the vocal cords and laryngeal ventricles, was frequently associated with the presence of bronchial grass awns. This laryngeal finding could be secondary to an altered response to grass awn localization in the bronchi. These results should be carefully considered, particularly in countries where grass awns are commonly found.

Influence Disease Activity on Voice and Laryngeal Findings of Rheumatoid Arthritis Patients

To reveal and to compare the voice pathologies and the detectable laryngeal findings in different phases of rheumatoid arthritis (RA). Prospective clinical study. Sixty-seven consecutive patients with RA, followed up at our Physical Therapy and Rehabilitation Clinic, were included in the study. Disease activity indices of patients were calculated with Disease Activity Score-28 Index. With Voice Handicap Index (VHI), patients answered 30 questions of functional, physical, and emotional aspects. Videolaryngostroboscopy was performed by the same physician for all patients with a 70° rigid telescope (Karl Storz, Tuttlingen, Germany), and then acoustic voice analysis (PRAAT program) was performed. Reflux Finding Score was used in evaluating the laryngopharyngeal reflux. Posterior comissure hypertrophy (25.3%) and hyperemia/edema in arytenoid mucosa (22.3%) were detected as the most frequent findings. Other common findings were thick endolaryngeal mucus, vocal cord varices. Twenty-two patients had reflux findings (32.8%). Fundamental frequency, shimmer, maximum phonation time and VHI value were not significantly different between active and remission phases of the disease (P > 0.05). In remission phase, the jitter value and the noise to harmonic ratio value were significantly higher (P < 0.05) than active phase of the disease (P < 0.05). Abnormal laryngeal findings are higher in active phase (28% in remission phase, 54% in active phase). The mean VHI score of patients in remission phase was lower than that in active phase. RA should be included in the differential diagnosis of patients with voice disorders. Nonspecific pathologies are more prevalent in the picture. There are more objective findings and subjective complaints of patients in active phase of the disease than in the remission phase.

Iatrogenic bilateral recurrent laryngeal nerve injury: a retrospective study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Bilateral recurrent laryngeal nerve injury is mostly iatrogenic following thyroidectomy. Our study aims at defining need for tracheostomy, timing of intervention and best method to achieve permanent treatment in cases of iatrogenic bilateral recurrent laryngeal nerve.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; In past four years we did 34 total thyroidectomy surgeries, all patients were female between 21-65 years of age. Common indications were multi nodular goiter 25 cases, papillary carcinoma thyroid 7 cases and follicular neoplasm 2 cases. 5 patients developed bilateral recurrent laryngeal nerve injury, of which 3 were multi nodular goiter cases and papillary carcinoma thyroid 2 cases. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 5 out of 34 (14.7%) patients developed bilateral recurrent laryngeal nerve injury. 3 patients had complete bilateral abductor paralysis. 1 patient had bilateral abductor paresis and 1 patient had all bilateral recurrent laryngeal nerve and superior laryngeal nerve injury causing combined paralysis of vocal cord. Other 3 patients with bilateral abductor paralysis, 1 patient was not willing for tracheostomy and 2 patients underwent tracheostomy. Of those with tracheostomy, one had partial recovery after one year and tracheostomy was removed. The other patient had coblation arytenoidectomy.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; In bilateral recurrent laryngeal nerve injury, Tracheostomy to be done if airway is compromised. Patients with pathological laryngeal electromyographic findings at least two months after the paresis need laryngeal framework surgery. Endoscopic cordotomy is the preferred intervention for long-term management.&lt;/p&gt;

Prevalence of Minor Larynx Structural Alterations: Influence on the Concept of a Normal Vocal Fold.

To determine the prevalence of minor structural alterations (MSA) in the vocal fold cover in a population submitted to extralaryngeal site surgery and to characterize them according to morphological and epidemiological parameters. This was a cross-sectional and observational study. Tertiary referral medical center. A total of 147 patients underwent general anesthesia for extralaryngeal site surgery indicated for a procedure extraneous to the study and irrespective of the presence of vocal complaint. Next, detection and morphological characterization of MSAs in the vocal fold cover were performed by means of suspension microlaryngoscopy with laryngeal inspection and palpation without surgical intervention related to this procedure. The laryngeal findings were compared with variables from a clinical and demographic characteristics questionnaire given to these individuals. A 21.1% prevalence of MSAs was identified in the sample, which included a majority of individuals without vocal complaint (95.9%). Of these, 5.4% of individuals had laryngeal microdiaphragms, 16.3% sulcus vocalis, and 4.1% epidermoid cysts. No pouch sulcus or mucosal bridges were found. The identification of these alterations occurred mainly after 10 years of age, without effects of sex, vocal abuse, or upper airway conditions. The most common combination of MSAs was bilateral sulcus vocalis. The prevalence of MSAs in laryngeal coverage in this predominantly vocally asymptomatic population was 21.1%, with identification of sulcus vocalis, epidermoid cyst, and laryngeal microdiaphragm. Age was the only clinical or demographic characteristic associated with these alterations.

Role of Proton Pump Inhibitors in Laryngopharyngeal Reflux: Clinical Evaluation in a North Indian Population.

There has been an escalation of patients presenting with symptoms of Laryngopharyngeal reflux disease (LPRD) in the otorhinolaryngology clinics due to life style and dietary changes. This study was undertaken to evaluate the effect of various proton pump inhibitors in the treatment of LPRD using Reflux symptom index (RSI) and Reflux finding score (RFS). This was a prospective study conducted from June 2016 to February 2017 with a total of 240 patients with symptoms and signs of LPR. The patients were divided into 5 groups. Each group was subjected to particular proton pump inhibitor. There were 124 males 116 females with a mean age 34.3 and rural to urban ratio being 11. After 3months, RFS and RSI score within each group, improved significantly with Proton pump inhibitor therapy. In our study patients who were treated with omeprazole 20mg twice daily had the highest improvement in laryngeal symptoms and laryngeal findings. We conclude emphasizing the effectiveness of proton pump inhibitors with incorporation of lifestyle modification in the successful management of LPRD.

Vocal fold paresis: Medical specialists' opinions on standard diagnostics and laryngeal findings.

There is still no clear consensus on the diagnostic value of specific laryngeal findings in patients with suspected vocal fold paresis (VFP). The aim of the study was to establish expert opinion on criteria for the diagnosis of VFP in Europe. A cross-sectional survey using the questionnaire introduced by Wu and Sulica for US American experts was addressed to laryngeal experts in Germany, Austria, and Switzerland and in a second survey wave to members of the European Laryngological Society. 100 respondents returned survey 1 (response rate 47.2%). 26% worked at a university department. 28% regularly used laryngeal electromyography (LEMG). A pathologic test results in LEMG was considered to have the strongest positive predictive value for VFP (79 ± 23%), followed by a decreased vocal fold abduction (70 ± 29%), decreased vocal fold adduction (61 ± 34%), and atrophy of the hemilarynx (61 ± 31%). The multivariate analysis showed the predictive value of LEMG was estimated lower by respondents from non-university hospital (β = - 16.33; confidence interval (CI) = - 25.63 to - 7.02; p = 0.001) and higher in hospitals with higher frequency of VFP patients per months (β = 1.57; CI = - 0.98 to 2.16; p < 0.0001). 30 ELS members returned survey 2 (response rate, 8.4%). Their answers were not significantly different to survey 1. The laryngology experts in Europe rely on LEMG for diagnosis of VFP like the US American experts, but paradoxically only a minority uses LEMG frequently. Next to LEMG, motion abnormities were considered to have the best predictive value for the diagnosis of VFP.

Relationship between extralaryngeal endoscopic findings, proton pump inhibitor (PPI) response, and pH measures in suspected laryngopharyngeal reflux.

Laryngopharyngeal reflux (LPR) is a clinical entity diagnosed by history laryngoscopic findings that has a variable response to empiric proton-pump inhibitor (PPI) therapy. While the reflux finding score (RFS), an endoscopic scoring scheme, has been advanced as a measure of LPR, it has not been externally validated against symptom severity in practice. Extralaryngeal pharyngeal endoscopic findings may have diagnostic utility but remain underexplored. This study assesses the correlation between extralaryngeal findings and (1) 24-hour oropharyngeal pH & (2) PPI response in patients with suspected LPR. Subjects presented to a tertiary care center with laryngeal symptoms ≥1 month and reflux symptom index (RSI) ≥13. Following baseline questionnaires, laryngoscopy, and a 24-hour oropharyngeal pH probe study, subjects were prescribed 8-12 week omeprazole trials. Baseline endoscopic findings were scored in a blinded fashion using the RFS and extralaryngeal score criteria, summatively the 'ELS.' PPI response was defined as ≥50% improvement in RSI. Thirty-three subjects with flexible endoscopic recordings completed baseline and follow-up questionnaires. The cohort's baseline mean RSI was 23.0±7.2 with a ΔRSI=9.8 after PPI therapy. The baseline RFS score averaged 5.3±2.7. 45% of our subjects was found to be PPI responsive. The Cohen's kappa for the ELS but not the RFS was significant. There were no significant differences between the RFS (P=0.10) or ELS (P=0.07) for PPI responders & nonresponders. Oropharyngeal pH measures did not correlate with the RFS or ELS. In conclusion, endoscopic scores of laryngeal and extralaryngeal findings did not predict PPI response or oropharyngeal acid exposure in suspected LPR.

Uzun süreli entübasyon yapılmış hastalarda laringofaringeal etkilerin değerlendirilmesi

Aim: Open cardiovascular surgery involves prolonged intubation, postoperatively in the intensive care unit monitoring. The purpose of this study was to investigate the effects of long-term intubation after coronary artery surgery on laryngeal and pharyngeal structures and the probable underlying causes for such effects.Material and Methods: Forty two patients undergoing cardiovascular surgery were included in the study. All patients underwent endoscopic examination in the preoperative period and approximately 7th postoperative day. Results: Mean age of the patients was 61±9.98 years, mean duration of intubation was 14.80±3.41 hours (h) and mean size of intubation tube used was 8.02±0.45 mm. The number of preoperative smokers was 25(59.52%), and number of patients with preoperative gastroesophageal reflux disease symptoms were 8(19.04%). The level of postoperative laryngeal and pharyngeal pathological findings were 38.09%. Postoperative laryngeal and pharyngeal pathological findings were correlated with age, length of intubation and preoperative presence of the gastroesophageal reflux disease symptoms (p˂0.05). However, no statistically significant correlation was determined between postoperative pathological finding and sex, tube type, tube diameter, smoking status. Conclusion: Age, presence of gastroesophageal reflux disease, length of intubation were identified as risk factors for the development of postoperative pathological laryngopharyngeal findings.

Vocal Fold Paresis: Incidence, and the Relationship between Voice Handicap Index and Laryngeal EMG Findings

To determine whether there is a correlation between Voice Handicap Index 10 (VHI-10) and degree of vocal fold paresis as determined by laryngeal EMG. Secondary objective was to determine the incidence of vocal fold paresis in a tertiary laryngology practice. A retrospective chart review of all new voice patients seen by the senior author (RTS) from January 1, 2016 to December 31, 2017. Subjects completed VHI at their initial visit. Patients were examined with flexible and rigid laryngoscopy and videostroboscopy and referred for laryngeal electromyography (LEMG) if neuromuscular weakness was suspected. LEMG was used to identify the affected nerves and to quantify subjectively the degree of paresis. Patients who did not complete LEMG and or handicap index were excluded from the correlation analysis. The prevalence of vocal fold paresis was determined by reviewing the records of each subject. The number of patients diagnosed clinically with paresis or paralysis and referred for LEMG was documented. The subjects, who had paresis confirmed on LEMG (n = 210) were grouped according to the nerves involved and by the degree of paresis. The unilateral superior laryngeal nerve and ipsilateral recurrent laryngeal nerve paresis group (n = 29) had a reasonably even distribution of patients in each sub-group (n = 11; 12; 6) and was analyzed for correlation. There was a strong positive correlation between the degree of paresis and the VHI score (r = 0.59, P < 0.001). Other groups did not have an even distribution among sub-groups and could not be to be analyzed for correlation. The senior author examined 344 new voice patients during years of 2016 and 2017. Based on laryngoscopy, 335 patients were referred for LEMG (97.4%). Two hundred thirty-seven patients had LEMG performed, and 234 patients confirmed to have vocal fold paresis were confirmed (98.7%.). The incidence of vocal fold paresis in subjects who underwent LEMG or who had normal motion during laryngoscopy was 95.1% (234 out of 246). The incidence in the 98 subjects who did not complete the recommended LEMG is unknown. The unilateral superior laryngeal nerve with ipsilateral recurrent laryngeal nerve paresis was the only group that allowed for analysis whether patient's perception of their voice problem as measured VHI-10 correlated with increasing degree of vocal fold paresis. A strong significant positive correlation in this group was identified. Additional studies with a larger patient cohort are recommended.

A Clinical Study of Patients with Acute Epiglottitis

AbstractAcute epiglottitis is an acute inflammation of the upper respiratory airway that rarely causes airway obstruction. A retrospective study was conducted on 115 patients with acute epiglottitis from April 2007 to December 2017 (65 males and 50 females; aged 12–85 years old, median age of 45 years). When counting the number of patients according to the month, from April to September more than 10 patients were treated. Median duration from symptom onset to first visit was 3 days (1–14 days). Eight (7%) of 115 patients had diabetes, and 16 (13.9%) had epiglottic cyst. We divided all the patients into six groups by laryngeal findings according to the classification of Katori and Tsukuda. Number of patients classified as IA, IB, IIA, IIB, IIIA, and IIIB was 41 (35.7%), 21 (18.3%), 22 (19.1%), 15 (13%), 8 (7%), and 8 (7%), respectively. Median duration of hospitalization was 5 days (2–26 days). In the blood test on the first day of hospitalization, the number of white blood cells (WBC) ranged from 3,400 to 25,350/μL (median 10,350/μL) and the C-reactive protein (CRP) ranged from 0.01 to 23.3 mg/dL (median, 2.5 mg/dL). The number of WBC and CRP at the fourth day after the hospitalization was significantly lower than those at the first day. Eight (7%) patients required the airway management such as tracheotomy or cricothyroidotomy. Age, laryngeal finding (severe epiglottis swelling and arytenoid edema; Katori and Tsukuda's classification IIIB), and high inflammatory reaction in blood test (WBC ≥ 20,000/μL and CRP ≥ 20 mg/dL) were the factors that significantly correlated with the airway management.

Reflux symptom index and reflux finding score in 91 asymptomatic volunteers

Background: The primary goal of this study was to investigating the symptoms, in addition to the reflux-related laryngopharynx inflammation performance of asymptomatic, volunteers, and verified the ‘normal point’.Methods: A total of 91 asymptomatic subjects were recruited for this cross-sectional study between March 2016 and September 2016. Participants completed the reflux symptom index (RSI) assessment and underwent laryngostroboscopic examination using a rigid endoscope. Their RFS were graded according to the laryngeal findings. The distribution and the relationship of the RSI and the RFS were analyzed.Results: The mean RSI of individuals was 2.24 ± 2.34 [95% confidence interval (CI) = 1.75, 2.72], and the mean RFS of individuals was 5.78 ± 1.74 (95% CI = 5.42, 6.15). The Pearson product–moment correlation coefficient of the RSI and RFS scores was –0.084 (n = 91, p = .428).Conclusions: Asymptomatic people could present relatively high RFS scores, and no linear relationship existed between RSI and RFS.

The Effect of Deep Brain Stimulation (DBS) for Voice Tremor in a Case of Essential Tremor

Patients with voice tremor present with shaking voice which has a frequency of 4-5 Hz in their vocal tract. In most of cases, voice tremor is refractory to conservative treatment such as medication or voice therapy and the symptoms may affect a patient’s quality of life. We experienced a case of voice tremor accompanied by essential tremor of the upper extremities who was treated with bilateral thalamic deep brain stimulation (DBS). The results of an acoustic analysis and laryngeal endoscopic findings showed a partial improvement following unilateral DBS and complete improvement following bilateral DBS. FTRI, Fatr, ATRI, Jitter, Shimmer, vF0, vAm, NHR, sPPQ and sAPQ seemed to be useful parameters of voice tremor. The results suggest that the indication of DBS should be discussed for patients severely affected by voice tremor after considering the patient’s age, accompanying symptoms, backgrounds, occupation and needs.

Injury of the external branch of the superior laryngeal nerve in thyroid surgery.

The external branch of the superior laryngeal nerve (EBSLN) innervates the cricothyroid muscle (CTM) to promote lengthening and thinning of the vocal fold, thus increasing voice pitch. The close relation with the superior thyroid vessels (STV) puts the EBSLN in risk every time the superior pole of the thyroid is dissected. It travels downward to innervate the CTM, lateral to the thyroid cartilage and to the inferior pharyngeal constrictor muscle (IPCM), being eventually covered by this muscle fibers as it approaches its entry point. During its descending course, the EBSLN curves and crosses the STV posteriorly. The lower this crossing occurs in the neck, the higher the risk of surgical damage to the nerve by transection, traction, entrapment, thermal damage or disrupted blood supply. The chances of surgical trauma are also increased by size and weight of the specimen, shorter neck length and non-white ethnicity. Voice changes following thyroid surgery are common and multifactorial. The actual rate of vocal impairment due to EBSLN injury is unclear, since changes to the everyday speaking voice can be minimal and laryngeal findings are usually subtle and controversial. CTM electroneuromyography (EMG) is the most accurate tool to diagnose abnormal EBSLN conductivity, but it is technically difficult and barely applicable in routine practice. Recommended approaches to prevent injury include: (I) individual distal ligature of the STV by the thyroid capsule; (II) visual identification of the nerve and its trajectory and (III) electrostimulation with either observation of CTM twitch or intraoperative nerve monitoring (IONM) via dedicated endotracheal tube electrodes. There is accumulating evidence that a combination of visual and standardized electrophysiological EBSLN identification with meticulous division of the STV improves preservation rates. IONM bears the additional benefits of prognostication, quantification and documentation of neural function once it allows intraoperative laryngeal EMG.

Overground endoscopy in 311 Thoroughbred racehorses: findings and correlation to resting laryngeal function.

To review a large number of equine overground endoscopy (OGE) examinations to determine the incidence of dynamic upper airway obstructions (DUAO); correlations were explored with laryngeal endoscopy findings at rest and abnormal exercising respiratory noise. Retrospective analysis of horses presenting for OGE because of perceived poor performance and/or history of abnormal exercising respiratory noise between 2010 and 2014. Signalment, history and examination findings during resting laryngeal endoscopy and OGE were reviewed. Of the total examinations, 311 were reviewed. One or more DUAO were found in 249/311 horses. From 210 males (colts and geldings), 121 had arytenoid cartilage collapse (ACC) and 111 had vocal fold collapse (VFC). From 101 females, 25 had intermittent dorsal displacement of the soft palate (DDSP). Resting laryngeal function grade 4 was found in 121/311 of the study population and 92/210 of males. An association was found between horses with lower resting arytenoid abduction ability to dynamic ACC and higher resting arytenoid abduction ability with DDSP. Abnormal exercising respiratory noise was positively associated with the presence of DUAO. Multiple DUAO in association with abnormal exercising respiratory noise was a common finding in horses examined for poor performance. This study highlights the importance of OGE in accurately diagnosing the nature of DUAO associated with poor performance.