Laryngeal Function In Patients Research Articles

Analysis of swallowing and voice-related quality of life in patients after supracricoid partial laryngectomy

ObjectiveThis study evaluated the swallowing and voice function of laryngeal cancer patients after Supracricoid Partial Laryngectomy(SCPL), and its influence on quality of life to provide a reference for the selection of surgical methods for laryngeal cancer patients.MethodsTwenty-one patients who received SCPL between April 2015 and November 2021 were included. Each patient’s swallowing function and quality of life were assessed through fiberoptic endoscopic examination of swallowing (FEES) and the M.D. Anderson Dysphagia Inventory (MDADI). Fundamental, jitter, shimmer, maximum phonation time (MPT), and voice handicap index-10 (VHI-10) were performed to assess voice function and voice-related quality of life.ResultsThe results of the FEES of the 21 patients were as follows: the rates of pharyngeal residue after swallowing solid, semiliquid, and liquid food were 0%, 28.57%, and 38.09%, respectively; the rates of laryngeal infiltration after swallowing solid, semiliquid, and liquid food were 0%, 28.57%, and 4.76%, respectively; and aspiration did not occur in any of the patients. In the evaluation of swallowing quality of life, the mean total MDADI score was 92.6 ± 6.32. The voice function evaluation showed that the mean F0, jitter, shimmer, and MPT values were 156.01 ± 120.87 (HZ), 11.57 ± 6.21 (%), 35.37 ± 14.16 (%) and 7.85 ± 6.08 (s), respectively. The mean total VHI-10 score was 7.14 ± 4.84.ConclusionSCPL provides patients with satisfactory swallowing and voice function. The patients in this study were satisfied with their quality of life in terms of swallowing and voice. SCPL can be used as a surgical method to preserve laryngeal function in patients with laryngeal cancer.

The laryngeal adductor reflex (LAR) is modulated by the serotonin 5‐HT1A agonist 8‐OH‐DPAT

Airway protection is maintained through a constellation of behaviors. The laryngeal adductor reflex (LAR) responds to mechanical or chemical stimulation of the laryngeal orifice with rapid adduction of the vocal folds. While there are abundant serotonin receptors on laryngeal motoneurons, the effects of serotonin agents on the LAR have not been investigated. To this end, a dose response protocol of 8‐OH‐DPAT (5HT1A receptor agonist) was performed on adult cats (n = 2). Animals were anesthetized using an intravenous dose of sodium pentobarbital and then tracheostomized. Electromyogram (EMG) activity of laryngeal muscles was recorded and LARs were induced by infusing water into the larynx during both normocapnia (0% CO2) and hypercapnia (10% CO2) conditions. A series of six cumulative doses (1 – 300 μg/kg) were delivered intra‐venously. 8‐OH‐DPAT is thought to activate the serotonergic raphe neuron autoreceptors at lower doses and the post‐synaptic receptors on target neurons at higher doses. LAR occurred as a response to water stimulus in 50±23% of control trials. LAR occurrence was modulated by 8‐OH‐DPAT in a dose‐dependent manner: LAR frequency at lower doses may have decreased but this was variable, and LAR frequency appeared to be increased at higher doses (LAR occurred in 13±18%, 17±23%, 50±70%, 57±9%, 84±7%, and 60±4% of stimulus trials at 1, 3, 10, 30, 100, and 300 μg/kg doses, respectively). LAR can be used as a strong clinical predictor of swallow impairment; while other airway protective behaviors require activity across multiple cranial nerves, the LAR is regulated by only laryngeal branches of the vagus nerve. Thus, the LAR is a promising biomarker for testing novel therapeutic agents. These results suggest that pharmacological interventions may be capable of facilitating laryngeal function in patients suffering from dysphagia.

Laryngeal Dysfunction in Severe Asthma: A Cross-Sectional Observational Study

Laryngeal disorders can contribute to disease burden in severe asthma yet the nature of laryngeal disorders in severe asthma is poorly understood. The aim of this study was to examine laryngeal function in patients with severe asthma. A cross-sectional observational study involving 97 participants compared laryngeal function in patients with severe asthma (n= 53) with patients with laryngeal disorders of vocal cord dysfunction/inducible laryngeal obstruction (n= 16) and muscle tension dysphonia (n= 14), and with healthy controls (n= 13). A pre-post pilot study of speech pathology intervention for laryngeal symptoms was then provided to 11 participants with severe asthma and laryngeal dysfunction. Laryngeal dysfunction was common in severe asthma. The majority of participants with severe asthma (87%) had laryngeal dysfunction, which affected respiration, phonation, or both. Three distinct patterns of laryngeal dysfunction in severe asthma were identified: (1) phonatory laryngeal dysfunction, (2) respiratory laryngeal dysfunction, and (3) combined laryngeal dysfunction. Laryngeal hypersensitivity and impaired voice measures were common in severe asthma. Patient-reported outcome measures improved after therapy, and laryngeal dysfunction improved in 7 (64%) participants. Laryngeal dysfunction affects respiration and phonation in severe asthma. It requires identification and treatment to minimize its impact on asthma symptoms.

Objective Measures of Stroboscopy and High-Speed Video.

Videostroboscopy and high-speed imaging is now an accepted way to evaluate laryngeal function in patients with voice disorders. In patients with neurolaryngological diseases such as tremor, laryngeal spasm, and paralysis, having an objective way to evaluate vocal function is desirable. Using digital imaging and analysis, both the videostroboscopy and the high-speed video can be analyzed to obtain relevant measures of vocal function. From the videostroboscopy, the montage of the glottal cycle derived from steady of vocal vibration can be analyzed by using edge tracking software to obtain the glottal area waveform. The waveform is an indication of the efficiency of the vocal folds in acting as an oscillator and gives direct information as to the open and closed phase, the symmetry of vocal fold vibration and the degree of amplitude contribution from each fold. High-speed video overcomes the deficiencies of stroboscopy by allowing for all voice gestures to be studies. Using digital kymography and analysis of the vibrogram, analysis of the onset of vocal fold oscillation, evaluation of diplophonia, tremor, and voice breaks becomes possible. Furthermore, analysis of the high-speed video kymograph tracing using signal analysis allow the investigator to evaluate the frequency and power relationships of vocal fold vibratory function in the normal and disordered state.

Laryngeal Transplantation.

Laryngeal transplantation offers the hope of replacing voice and laryngeal function in patients with debilitating laryngeal injuries or loss of the larynx from trauma or oncologic reasons. Our group at UC Davis performed a laryngotracheal transplantation, and our experience is reviewed in this chapter. The indications, challenges, and limitations of this procedure are highlighted, and the world's other published cases are reviewed.

Treatment results of 99 patients undergoing open partial hypopharyngectomy with larynx preservation.

Hypopharyngeal cancers frequently go undetected until advanced stages. However, recent advances in endoscopic technology have enabled earlier detection of hypopharyngeal cancer. We evaluated the effectiveness of larynx-preserving surgery for hypopharyngeal cancer. We retrospectively analyzed 99 patients with hypopharyngeal squamous cell carcinoma who underwent partial hypopharyngectomy with larynx preservation between September 1992 and December 2009 at the National Cancer Center Hospital East. Of these, 91 patients underwent larynx-preserving surgery as initial treatment; eight patients underwent salvage surgery for recurrent disease after previous radiotherapy. Also, 9 of our patients had undergone previous radiotherapy in the head and neck for a different cancer. Before surgery, the TNM stage and tumor location was recorded. Free-flap reconstruction was performed in 60 patients, while the hypopharyngeal mucosa was closed without a free flap in 39 patients. The 5-year overall survival rate in our cohort was 66.9%, and 59 patients are currently alive without recurrence. Thirty-three patients died due to primary recurrence (n = 5), regional recurrence (n = 10), distant metastasis (n = 9), postoperative death (n = 1), and unrelated disease (n = 8). Laryngeal function could not be preserved in 19 patients, 2 of whom had undergone previous radiotherapy, and 7 of whom had undergone both previous radiotherapy and other salvage surgeries. Partial hypopharyngectomy can preserve laryngeal function in patients with pharyngeal cancer with careful patient selection.

Improved adductor function after canine recurrent laryngeal nerve injury and repair using muscle progenitor cells.

Muscle progenitor cells (MPCs) can be isolated from muscle samples and grown to a critical mass in culture. They have been shown to survive and integrate when implanted into rat laryngeal muscles. In this study, the ability of MPC implants to enhance adductor function of reinnervated thyroarytenoid muscles was tested in a canine model. Animal study. Sternocleidomastoid muscle samples were harvested from three canines. Muscle progenitor cells were isolated and cultured to 107 cells over 4 to 5 weeks, then implanted into right thyroarytenoid muscles after ipsilateral recurrent laryngeal nerve transection and repair. The left sides underwent the same nerve injury, but no cells were implanted. Laryngeal adductor force was measured pretreatment and again 6 months later, and the muscles were harvested for histology. Muscle progenitor cells were successfully cultured from all dogs. Laryngeal adductor force measurements averaged 60% of their baseline pretreatment values in nonimplanted controls, 98% after implantation with MPCs, and 128% after implantation with motor endplate-enhanced MPCs. Histology confirmed that the implanted MPCs survived, became integrated into thyroarytenoid muscle fibers, and were in close contact with nerve endings, suggesting functional innervation. Muscle progenitor cells were shown to significantly enhance adductor function in this pilot canine study. Patient-specific MPC implantation could potentially be used to improve laryngeal function in patients with vocal fold paresis/paralysis, atrophy, and other conditions. Further experiments are planned. NA. Laryngoscope, 2017.

Hypopharynx and larynx defect repair after resection for pyriform fossa cancer with a platysma skin flap.

We used a platysma skin flap to repair larynx and hypopharynx defects to improve postoperative laryngeal function in patients with pyriform fossa cancer. Larynx-sparing surgery and postoperative radiotherapy were used in 10 patients with pyriform fossa cancer. The surgical approaches of lymph node dissection of the neck, vertical partial laryngectomy, and pyriform fossa resection were adopted, and a platysma skin flap was used to repair the resulting defects. In this group, the overall 3-year survival rate was 75% according to the Kaplan-Meier analysis, and the local control rate was 90%. Additionally, all patients were able to speak fluently with mild-to-moderate hoarseness. The tracheal tube was removed in all cases. Laryngeal fistulas were observed in 1 patient during radiotherapy. In conclusion, a platysma skin flap can be used to rebuild the larynx and hypopharynx in larynx-sparing resection for pyriform fossa cancer. These patients can obtain good postoperative function in swallowing, breathing, and pronunciation.

Modified frontolateral partial laryngectomy operation: combined muscle-pedicle hyoid bone and thyrohyoid membrane flap in laryngeal reconstruction.

ObjectiveLaryngeal reconstruction is needed to preserve laryngeal function in patients who have undergone extensive vertical or frontal partial laryngectomy. However, the procedure remains a difficult challenge. Several reconstruction techniques have been described, but these techniques pose risks of complications such as laryngeal stenosis. This study aimed to evaluate the postoperative course and functional outcomes of a new technique that combined a muscle-pedicle hyoid bone and a thyrohyoid flap during laryngeal reconstruction after tumor resection.MethodsFour patients underwent extensive vertical partial or frontal partial laryngectomy for cancer. After tumor resection, laryngeal reconstruction was performed using the proposed technique. Postoperative recovery time, complications, and oncologic results were evaluated.ResultsThe four patients were successfully treated with the proposed technique. No dyspnea, dysphagia, or death occurred during the postoperative course. Decannulation was performed after a median of 3 days. The average postoperative hospital stay was 7 days. Short-term postoperative functional recovery was normal. No laryngeal stenosis or tumor recurrence was observed in any of the four patients after a follow-up period of more than 24 months.ConclusionThe combination of the muscle-pedicle hyoid bone and the thyrohyoid flap is a reliable procedure for laryngeal reconstruction after extensive vertical partial or frontal partial laryngectomy.

The S/Z ratio: A simple and reliable clinical method of evaluating laryngeal function in patients after intubation

Objectives 1. To determine the consequences of prolonged intubation on laryngeal function. 2. To evaluate simple clinical criteria or tests that could alert the clinician to potential laryngeal pathology requiring ear, nose, and throat/otolaryngology (ENT) referral. Design A prospective case series. Setting A surgical intensive care unit in a tertiary academic hospital in Cape Town, South Africa. Participants Thirty-two patients who had undergone a period of translaryngeal intubation for a period greater than 12 hours. Main outcome measures 1. Patient subjective voice change rating. 2. Clinician assessment of laryngeal function. 3. S/Z ratio. 4. Presence of laryngeal pathology on endoscopic assessment of the larynx. Results Upon initial evaluation within 6 hours of extubation, 26 (81%) of patients exhibited symptomatic laryngeal dysfunction. At this stage, 13 (40%) had S/Z ratios greater than 1.4. The degree of dysfunction as described by subjective scoring and the S/Z ratio was proportional to the duration of intubation. After 24 hours, 23 (72%) patients' voices had improved subjectively; and the S/Z ratio exceeded 1.4 in just 6 patients (19%). Of these 6 patients, 4 exhibited laryngeal pathology on flexible nasoendoscopy. These 4 patients were followed up over 1 year, and 1 patient was ultimately offered a vocal cord medialization procedure. The S/Z ratio is 100% sensitive and 93% specific, with an accuracy of 93.75%, in diagnosing laryngeal pathology requiring ENT referral. Conclusions 1. A period of laryngeal intubation carries signification risk of laryngeal dysfunction. Most, but not all, dysfunction resolves within 24 hours. 2. Residual laryngeal pathology can be reliably and simply screened for by the use of the S/Z ratio. We recommend that patients with an S/Z ratio greater than 1.4 more than 24 hours after extubation require ENT referral for laryngoscopy.

Differentiating between adductor and abductor spasmodic dysphonia using airflow interruption

To measure the laryngeal resistance (R(L)), subglottal pressure (P(s)), and mean flow rate (MFR) of adductor (ADSD) and abductor (ABSD) spasmodic dysphonia patients using the airflow interrupter. The R(L) of six ABSD and seven ADSD patients was measured using the airflow interrupter, a noninvasive device designed to measure MFR and P(s) via mechanical balloon valve interruption. Subjects performed 10 trials at each of two intensity levels, with each trial consisting of a sustained /a/ during which phonation was interrupted for 500 ms. Laryngeal resistance was calculated as subglottal pressure divided by airflow. Mean R(L) for the ADSD and ABSD subtypes at 65 dB were 24.78 cmH(2)O/L/s and 14.51 cmH(2)O/L/s, respectively (P = .04). Mean R(L) at 70 dB were 40.02 cmH(2)O/L/s and 15.84 cmH(2)O/L/s (P = .014). P(s) for the ADSD and ABSD subtypes at 65 dB were 10.23 cmH(2)O and 8.32 cmH(2)O, respectively (P = .582). At the 70 dB level, P(s) were 12.39 cmH(2)O and 11.78 cmH(2)O (P = .886). MFR for the ADSD and ABSD subtypes at 65 dB were 435 mL/s and 746 mL/s (P = .205). Mean MFR at 70 dB were 518 mL/s and 848 mL/s (P = .198). Noninvasive measurements of R(L) may be useful for differentiating between ADSD and ABSD. This simple objective test, which produces a quantitative output, could be used to evaluate laryngeal function in patients with spasmodic dysphonia.

Diagnosis of Unilateral Recurrent Laryngeal Nerve Paralysis: Laryngeal Electromyography, Subjective Rating Scales, Acoustic and Aerodynamic Measures

To determine whether specific laryngeal electromyography (LEMG) patterns in patients with unilateral vocal fold paralysis/paresis (UVFP) are related to etiology of injury, time from onset of injury, patient perception of symptom severity, acoustic measures, and laryngeal aerodynamic measures. This is a retrospective review of 75 patients. Each patient received LEMG, acoustic and aerodynamic testing, and a subjective rating scale assessment (the Glottal Closure Index). Statistical analysis by groups were performed using both chi and single-factor analysis of variance testing. An iatrogenic etiology was associated with poor tone on LEMG (P = .05). Those individuals evaluated after 3 months after onset demonstrated more nascent units, a sign of reinnervation, compared with individuals evaluated before 3 months (P < .02). Individuals with fewer normal motor units on LEMG had significantly higher mean translaryngeal air flows (P = .044). Individuals with poor recruitment had significantly shorter maximum phonation times (P = .034) and higher mean flows (P = .044). Individuals with better laryngeal tone as noted on LEMG had significantly lower mean flows (P = .06). Specific LEMG patterns are related to the etiology of the UVFP and time course since recurrent laryngeal nerve injury. LEMG appears to reflect vocal fold muscle tone as seen on laryngeal function studies. In combination, these studies provide a cohesive assessment of laryngeal function in patients with UVFP.

Instrumental Assessment of Respiratory and Laryngeal Function in Patients With Neurological Disorders

Instrumental Assessment of Respiratory and Laryngeal Function in Patients With Neurological Disorders

Análise funcional da laringe pós-cordectomia, reconstruída com retalho de prega vestibular

Várias técnicas para a reconstrução da laringe, pós laringectomias parciais verticais, são citadas na literatura, algumas utilizando estruturas da própria laringe, como a prega vestibular, porém, poucas dão destaque à análise das funções laríngeas após estas reconstruções. Este estudo teve como objetivo avaliar as funções laríngeas em pacientes submetidos à cordectomia completa (tipo IV), reconstruídos com retalho de prega vestibular. FORMA DE ESTUDO: Estudo de coorte transversal. MATERIAL E MÉTODO: Dez pacientes, nove do sexo masculino e um do sexo feminino, com idades entre 45 e 75 anos, e média de 64,5, com carcinomas glóticos tratados por cordectomias totais ou completas (tipo IV) e reconstruídos com retalho de prega vestibular, foram submetidos a videolaringoestroboscopia, onde se avaliou a permeabilidade laríngea, o posicionamento do retalho, o fechamento laríngeo, a movimentação das aritenóides e a característica da fonte sonora: vibrátil ou friccional, e quando vibrátil, a localização e as estruturas que a compunham. A qualidade vocal foi analisada por avaliação perceptiva auditiva e objetiva computadorizada. A função de proteção das vias aéreas durante a deglutição foi realizada pela avaliação endoscópica da deglutição. RESULTADOS: Os resultados evidenciaram que não houve necessidade de manter a traqueostomia no pós-operatório tardio, pois a luz laríngea reconstruída mantinha-se pérvia. A função de proteção estava mantida em todos os casos, a coaptação completa em 30% e somente um paciente teve a movimentação da aritenóide limitada devido à imobilidade do lado operado. Evidenciaram, também, que havia fonte sonora vibrátil em 90% dos casos e que em todos a prega vestibular participava da sua composição. Em sete pacientes a fonte sonora vibrátil se localizava na região glótica. A análise computadorizada revelou freqüência fundamental média de 177,5 Hz, jitter médio de 1,11% e shimmer de 7,04%. Pela escala GRBAS, um paciente apresentou voz normal e 4 tiveram disfonia discreta. CONCLUSÕES: A reconstrução laríngea pós-cordectomia realizada com o retalho da prega vestibular tornou possível emissão de voz normal (freqüência fundamental 205 Hz, jitter 0,13%, shimmer 1,16%), proporcionando coaptação completa em 30% dos casos, fonte sonora vibrátil na região glótica em 70% e participação do retalho como estrutura vibrátil em 90%, além de preservar as funções laríngeas de respiração e proteção das vias aéreas durante a deglutição.

Bilateral Vocal Cord Paralysis After Radical Cystectomy in a Patient with a History of Bulbar Polio

Bilateral Vocal Cord Paralysis After Radical Cystectomy in a Patient with a History of Bulbar Polio

Vocal Cord Paralysis: Treatment with Teflon Paste Injections

The immediate restoration of laryngeal function in patients suffering unilateral vocal cord paralysis after major thoracic vascular procedures makes the use of Teflon paste injection a desirable treatment. It is safe, effective, and simple when performed by an experienced surgeon and OR team.

Preservation of Laryngeal Function in Patients With Carcinoma of the Larynx

In an effort to preserve laryngeal function in patients with carcinoma of the larynx, Wolf et al reported on a new strategy in treatment at the recent Second International Head and Neck Oncology Research Conference held in Arlington, Va. In 1985, the Veterans Administration cooperative study program initiated a prospective, randomized multi-institutional study of the effectiveness of induction chemotherapy (CT) and radiation therapy (RT) compared with surgery and postoperative RT in patients with stage III/IV laryngeal squamous carcinoma. Induction CT (cisplatin, 100 mg/m²administered intravenously on day 1, and fluorouracil, 1000 mg/m²in a 24-hour infusion on days 1 through 5) was repeated on days 1, 22, and 43. Tumor response was assessed after two cycles; responders received a third cycle followed by tumor biopsy and RT (66 to 76 Gy [6600 to 7600 rad]). Patients having less than a partial response (PR) had salvage laryngectomy and RT.

再建手術を行ったこう頭外傷症例のこう頭機能の検討

Laryngeal function was evaluated in six patients after treatment of laryngeal trauma. The patients were all male, aged 18 to 61 years (average age 41.0 years). The injury in three patients was caused by automobile accidents, in two patients by industrial accidents, and in one patient by contusion due to being kicked in the neck. Treatment included tracheostomy, repositioning of fragments, grafting, arytenoidectomy, trough method, cricopharyngeal myotomy, upward fixation of the hyoid bone and thyroid cartilage, and introduction of silicon rubber T-tubes.The six patients answered questionnaires concerning their laryngeal symptoms: hoarseness, dyspnea, and dysphagia. Five patients were examined by phonation analyzer (PS-77, Nagashima Co.) and automatic analyzable system for pulmonary function (autospiror HI-498, Chest Co.)Two patients still complained of severe hoarseness, and four of moderate or slight hoarseness. Two patients still complained of slight dyspnea and four of slight dysphagia.The curve of the phonation analyzer in all patients demonstrated by fundamental frequency and intensity a disappearance of normal vocal cord vibration.The flow-volume curve of the autospiror showed decreased peak expiratory flow plateau formation in three patients.All patients except one with a gait disturbance, returned to work with only slight laryngeal symptoms.In the follow-up of laryngeal function in patients with laryngeal injury and in advising them about rehabilitation, the newly developed phonation analyzer and respirometer are very useful.