Laryngeal Paralysis Research Articles

Laryngeal Paralysis Recovered Two Years after a Head Trauma by Growth Hormone Treatment and Neurorehabilitation

The aim of this study was to describe the cognitive and speech results obtained after growth hormone (GH) treatment and neurorehabilitation in a man who suffered a traumatic brain injury (TBI). Seventeen months after the accident, the patient was treated with growth hormone (GH), together with neurostimulation and speech therapy. At admission, the flexible laryngoscopy revealed that the left vocal cord was paralyzed, in the paramedian position, a situation compatible with a recurrent nerve injury. Clinical and rehabilitation assessments revealed a prompt improvement in speech and cognitive functions and, following completion of treatment, endoscopic examination showed recovery of vocal cord mobility. These results, together with previous results from our group, indicate that GH treatment is safe and effective for helping neurorehabilitation in chronic speech impairment due to central laryngeal paralysis, as well as impaired cognitive functions.

Functional Evaluation of Larynx Nerve Stimulator With EMG Acquisition Capability and Wireless Connectivity.

Recently, an electrical stimulation of the paralyzed muscle, as a potential therapy for restoring function of a denervated muscle system, has been debated as an innovative treatment in the management of patients with laryngeal paralysis. Numerous studies in acute and chronic animal models have demonstrated that electrical stimulation of the paralyzed posterior cricoarytenoideus muscle (PCA) offers an approach to induce vocal fold abduction and restore ventilation through the glottis. The study aims to test applicability of the controlled opening of the rima glottides via direct electrical stimulation of the posterior cricoarytenoideus muscle. We developed for this purpose a novel instrument system for the controlled larynx nerve stimulation. An acute experiment on the 4 years old pig showed effectiveness of the engineered stimulator. The controlled opening of rima glottidis of both posterior cricoarytenoid muscles and afterwards of both PCA muscle contraction were observed as a result of the electrical stimulation with the applied current in the range of 0.1-3 mA and pulse width of 1 ms and 10 ms. Performed research indicates a large potential of the novel nerve stimulator for the human larynx stimulation.

Review of Injection Laryngoplasty for Unilateral Recurrent Laryngeal Nerve Paralysis: Transition and Features of Various Materials

Review of Injection Laryngoplasty for Unilateral Recurrent Laryngeal Nerve Paralysis: Transition and Features of Various Materials

Characteristics, natural evolution and surgical treatment outcomes of unilateral laryngeal paralysis versus ankylosis: A longitudinal cohort study.

Although unilateral laryngeal immobility (ULI) can results from paralysis or ankylosis of the cricoarytenoid joint, no comparative study exists to date. Aim of this study was to compare clinical features, aetiologies, spontaneous recovery and evolution after surgical treatment of ULI according to its mechanism. Longitudinal observational cohort study between 1992 and 2017 in a tertiary care referral centre and university teaching hospital. All adult patients with isolated ULI were included. Presenting symptoms and demographic data were recorded at baseline. During follow-up, natural recovery and, if a surgical treatment was performed, treatment failure rate were noted. 994 patients were included, 56.4% of male and with a mean age of 58 years. Overall, 91% had paralysis and 9% had ankylosis. Dysphonia was the main symptom in both groups (>96%). Dyspnoea was more frequent in patients with ankylosis (26.1% vs 4.2% in those with paralysis) whereas dysphagia was more frequent in those with paralysis (31.1% vs 20% in those with ankylosis). With a mean follow-up of 2.3 years (±5.1), spontaneous recovery did not differ according to ULI's aetiology (hazard ratio 1.43, 95% confidence interval 0.85-2.40). Overall, 37.1% underwent a surgical treatment, and paralysis was associated with a lower odd of treatment failure (hazard ratio 0.27, 95% confidence interval 0.10-0.70) over a mean follow-up of 3.1years (±4.1). ULI resulting from paralysis or ankylosis differ in their symptoms and responses to surgical treatment, whereas natural evolution was similar.

Local recurrence of iodine refractory thyroid cancers. Surgicaltherapy options for larynx and trachea infiltration

Local recurrence of thyroid carcinomas can result in tumor infiltration in the lower region of the larynx. Since these tumors typically no longer store iodine, treatment options are greatly limited. The present study describes our experience with laryngo-tracheal resection of such cases of local recurrence. From July 2019 to November 2020, we treated five patients with malignant infiltration of the trachea and larynx due to local recurrence of a thyroid carcinoma. We performed laryngo-tracheal resection with end-to-end anastomosis in four patients and frontolateral partial laryngectomy in one patient. The median length of hospital stay was 6 days (5-14). An R0 resection was performed in two patients. Problems with the anastomosis or bilateral recurrent laryngeal nerve paralysis was not seen in any of the patients. One patient had to be reintubated on the second postoperative day due to lung failure. He was able to be extubated after five days. High tracheal resection with partial resection of the larynx was able to be performed with minimal risk. Although radical resections are rare, they expand oncological treatment options in the case of local recurrence of thyroid carcinomas that are iodine-refractory. High tracheal resection could be part of the oncological treatment spectrum in the case of local recurrence of thyroid carcinomas that no longer store iodine.

Tiroidectomía y paratiroidectomía endoscópica transoral con abordaje vestibular (TOETVA TOEPVA): Experiencia inicial en el Hospital Universitario Austral

Background:Kocher’s cervicotomy has been the classic approach for thyroid and parathyroid surgery. The greater concern about neck scarring has generated an increasing interest in reducing scar size or leaving the scar in less visible places. In 2016 Anuwong published 60 cases of TOETVA/TOEPVA with optimal outcomes.Objectives: The aim of this study is to report the initial experience with transoral endoscopic thyroidectomy and parathyroidectomy vestibular approach in Hospital Universitario Austral.Material and methods: We conducted a retrospective analysis of 18 prospective procedures performed between May 2019 and March 2020. The procedures performed were 2 parathyroidectomies, 13 lobectomies, 4 total thyroidectomies, 1 with central lymph node dissection; one patient presented a parathyroid adenoma and a benign thyroid nodule. Cytology report according to the Bethesda system: category II in 7 cases, VI in 9 and indeterminate in 1.Results: 18 female patients. Median age: 41 years. Mean nodule size: 30 mm. Mean gland volume: 24 mL. Conversion. 1 case. Mean operative time: lobectomy, 260 minutes; total thyroidectomy, 262 minutes. Definite histology: papillary thyroid carcinoma,11; benign nodular goiter, 6; parathyroid adenoma, 2. Complications: mild ecchymosis, 12 patients; temporary hyperparathyroidism, 1 case; temporary recurrent laryngeal palsy, 1 case; temporary numbness of the mental region in 1 case.In the two cases undergoing total thyroidectomy due to cancer, thyroglobulin level 6 weeks after surgery was < 0.1 μIU/mL.Conclusions: 1) The transoral approach is a safe and feasible procedure that offers excellent cosmeticresults. 2) It can be implemented using conventional endoscopic equipment,

Effect of doxepin on quality of life in Labradors with laryngeal paralysis: A double-blinded, randomized, placebo-controlled trial.

BackgroundLaryngeal paralysis commonly affects older Labrador retrievers. Currently, dogs with severe disease require surgical intervention, most commonly arytenoid lateralization. Anecdotally, doxepin has been proposed to help dogs with laryngeal paralysis.HypothesisDoxepin will improve quality of life measures assessed by owners of Labrador retrievers with laryngeal paralysis not requiring emergency surgery.AnimalsTwenty‐two Labrador retrievers with laryngeal paralysis.MethodsDogs were randomized to receive doxepin (3‐5 mg/kg q12h PO) or placebo for 28 days. Owners completed quality‐of‐life assessments before and after completing the study. Data were compared between groups using Rank‐Sum tests or Fisher's exact tests.ResultsThe 2 groups of dogs did not differ at baseline except for owner‐perceived degree of ataxia (owners of dogs receiving doxepin considered them more ataxic than owners of dogs receiving placebo). After 28 days, owner‐assessed quality of life measures did not differ between dogs receiving doxepin or placebo (dogs worsening: doxepin = 2, placebo = 1; dogs unchanged: doxepin = 6, placebo = 7; dogs improved: doxepin = 4, placebo = 2; P = .84). Dogs receiving placebo had a greater improvement in client‐assessed overall health than dogs receiving doxepin (mean ranks: doxepin = 4.36, placebo = 6.64; P = .04). The study was terminated at this interim analysis.Conclusions and Clinical ImportanceDoxepin did not appear to improve any measures of owner‐assessed quality of life in Labrador retrievers with laryngeal paralysis.

Early Complications after Thyroid Surgery

Background: In this study we shall deal with the early complications after thyroid surgery and compare the complication rate with the extent of resection (subtotal, near total and total thyroidectomy). Patients and Methods: Early complications after thyroid surgery were studied in A prospective study in One hundred patients. Data was collected in the pre-designed proforma. And they are classified according to age and sex of the patients, clinical conditions and training state of the surgeon. Descriptive statistics was used to calculate frequency of each complication in the early post-thyroidectomy period. Results: Most of the patients were females and lie at the (30-39) age group. Clinically, most of them are presented with simple multinodular goitre. Subtotal thyroidectomy is the most commonly used type of resection. The frequency of complications after total thyroidectomy is more than other types. And identification of the (RLN) will minimize the incidence of injury. These complications were (4%) tension haematoma, (11%) hypocalcaemia, (4%) respiratory obstruction, (8%) developed recurrent laryngeal nerve paralysis, (2%) superior laryngeal nerve paralysis, and (1%) wound infection. Surgeon’s experience is so important, in which there is less complications when the operation is performed by a consultant surgeon. Conclusions: Surgery may be associated with significant numbers of post-operative complications according to the type of surgery. Total thyroidectomy confers certain advantages over less extended procedures, but it is associated with higher morbidity. Due to the risk of an unsuspected malignancy and goiter relapse following conservative surgery and increased risk of complications following reoperation, total thyroidectomy is emerging as an attractive surgical option.

Management of patients with bilateral recurrent laryngeal nerve paralysis following esophagectomy.

BackgroundRecurrent laryngeal nerve paralysis (RLNP) is a common complication after esophagectomy which can cause severe pulmonary complications. However, bilateral RLNP has been rarely reported in esophagectomy patients. The objective of our study is to investigate the clinical significance of patients who had bilateral RLNP following esophagectomy.MethodsWe retrospectively reviewed patients who underwent esophagectomy at a single center from 1994 to 2018. Among these, patients with bilateral vocal cord paralysis were included in this study.ResultsA total of 3217 patients were reviewed and 400 (12.4%) patients had RLNP, including 56 patients with bilateral RLNP identified by laryngoscopic examination. During the postoperative managements, 10 of the 56 patients (17.9%) required tracheostomy. Among them, two died of acute respiratory distress syndrome and the other eight patients were discharged after removing the tracheostomy tube. The median lengths of hospital and intensive care unit stay were 19.5 (range 8–157) and 2 (range 1–46) days, respectively. Forty‐six patients (83.6%) were discharged with oral feeding after swallowing therapy including tongue holding maneuver and head tilt exercise. The other five patients (8.9%) were discharged with alternative enteral feeding via jejunostomy, but they were able to achieve oral diet 2–3 months after surgery.ConclusionBilateral RLNP following esophagectomy was rare, but it required great attention to prevent severe respiratory complications. However, only a few patients required tracheostomy and the majority achieved oral ingestion after intensive rehabilitation. Feeding education and respiratory rehabilitation are critical during the management of patients with bilateral RLNP.

Diagnosis of recurrent laryngeal nerve paralysis following esophagectomy by evaluating movement of the vocal cords and arytenoid cartilages using ultrasonography.

Advancements in thoracoscopic surgery have provided us with a deeper anatomical understanding of recurrent laryngeal nerve paralysis (RLNP), which is likely to occur after lymph node dissection. Taking a novel approach to researching the diagnosis of RLNP, we evaluated movement of the vocal cords and arytenoid cartilages using ultrasonography in patients who underwent thoracoscopic esophagectomy. RLNP occurred in six of the 24 patient cohort. The rate of hoarseness and difficulty in discharging sputum was significantly higher in the paralyzed group than in the non-paralyzed group. The diagnostic accuracy of RLNP by ultrasonography had a sensitivity of 83.3% (5/6), a specificity of 88.8% (16/18), a false positive rate of 5.6% (1/18), and a false negative rate of 0% (0/6). Although it is not completely accurate, our findings indicate that ultrasonography is quite effective for diagnosing RLNP, more so in combination with clinical symptoms. Ultrasonography may also be effective for identifying patients who are amenable to laryngoscopy for diagnosing RLNP, or for evaluating the recovery status of nerve paralysis.

Experimental Injury Rodent Models for Oropharyngeal Dysphagia.

Simple SummaryDysphagia is a symptom of difficulty in carrying food safely from the mouth to the stomach. Recently, the number of people complaining of discomfort in swallowing due to various causes increased. In order to develop an appropriate treatment for them, experimentally induced dysphagia rodent models that mimic human dysphagia have recently been developed. Therefore, in this study, the rodent models of oropharyngeal dysphagia reported so far was summarized. The article search was conducted using Medline, Embase, and Cochrane Library. For this study, 13 articles that reported an experimentally induced oropharyngeal dysphagia in rodents were selected. The following information was collected: injury type, animal type, induction protocol of dysphagia, main defects, and dysphagia screening. Advances in basic research using animal studies are paving the way for intensive research and active therapeutic strategies for patients with swallowing disorders. The information would be the basis for pre-clinical trials to overcome oropharyngeal dysphagia.Oropharyngeal dysphagia is a disorder that can make swallowing difficult and reduce the quality of life. Recently, the number of patients with swallowing difficulty has been increasing; however, no comprehensive treatment for such patients has been developed. Various experimental animal models that mimic oropharyngeal dysphagia have been developed to identify appropriate treatments. This review aims to summarize the experimentally induced oropharyngeal dysphagia rodent models that can be used to provide a pathological basis for dysphagia. The selected studies were classified into those reporting dysphagia rodent models showing lingual paralysis by hypoglossal nerve injury, facial muscle paralysis by facial nerve injury, laryngeal paralysis by laryngeal and vagus nerve injury, and tongue dysfunction by irradiation of the head and neck regions. The animals used in each injury model, the injury method that induced dysphagia, the screening method for dysphagia, and the results are summarized. The use of appropriate animal models of dysphagia may provide adequate answers to biological questions. This review can help in selecting a dysphagia animal system tailored for the purpose of providing a possible solution to overcome dysphagia.

Evaluation of synchronous multiple primary superficial laryngo-pharyngeal cancers that were treated by endoscopic laryngo-pharyngeal surgery

Objectivendoscopic laryngopharyngeal surgery (ELPS) is a useful surgery for superficial cancers of the head and neck region, but it has not yet been well evaluated for synchronous multiple primary cancers (multiple primaries). The purpose of this study was to clarify the safety and usefulness of ELPS for patients with multiple superficial primary cancers in the head and neck region. Methodsrom December 2009 to December 2016, 145patients with superficial head and neck cancers underwent ELPS. The patients were divided into two groups; a group consisting of patients with a single primary cancer (single primary) and another group consisting of patients with synchronous multiple primaries, and the incidences of postoperative complications and lymph node metastasis were retrospectively compared between the two groups. Resultsf the 145 patients, 107 had a single primary cancer and 38 had multiple primaries. There was no significant difference in the age, sex, or rate of intraepithelial cancer between the two groups. Postoperative complications included dysphagia in 6 (5.6%) patients with a single primary and 2 (5.3%) patients with multiple primaries. One patient with multiple primaries required gastrostomy because of aspiration pneumonia. In addition, the following complications were also observed. Laryngeal paralysis occurred in 2 (1.9%) patients with a single primary, and 1 (2.6%) patient with multiple primaries; tracheostomy because of postoperative bleeding in 1 (0.9%) patient with a single primary; infection occurred in 2 (5.3%) patients with multiple primaries. Postoperative lymph node metastasis was found in 7 (6.5%) patients with a single primary and 6 (15.8%) patients with multiple primaries. Lymphatic invasion of the primary cancer was noted in 3 (2.8%) patients with a single primary and 5 (13.2%) patients with multiple primaries, being significantly higher in the latter group. ConclusionELPS is also a safe surgery for patients with multiple primaries. However, the incidence of lymphatic invasion of the primary cancer was significantly higher in patients with multiple primaries.

Anterior Cervical Corpectomy with Cage Fixation for Cervical Spondylotic Myelopathy

Objective: This study aimed to report the clinical outcome of anterior cervical corpectomy with cage fixation in patients with cervical spondylotic myelopathy.&#x0D; Material and Methods: This observational retrospective study included 36 patients from the Neurosurgery department of Lady Ready Hospital MTI, Peshawar from 2014 January to 2015 December. After performing surgery, the patients were followed up for six months for neurological outcome and various post-operative complications such as infection, transient recurrent laryngeal palsy, screw displacement and improvements in paresthesias and gait ataxia.&#x0D; Results: Most of the patients have no post-operative complications. Seventy-five percent (n = 27) of patients reported an immediate improvement in paresthesia and fine hand movements and gait. The major reported complications were implant failure (5.55%) and recurrent laryngeal nerve transient palsy in two patients (5.55%) each.&#x0D; Conclusion: In patients with cervical spondylotic myelopathy, with anterior compression, cervical corpectomy with cage fixation is less invasive and an effective procedure with acceptable outcomes.

Management of benign paediatric thyroid nodules: experience from paediatric ENT services of a tertiary care hospital

&lt;p class="abstract"&gt;Thyroid nodules are a common occurrence in adults but are rarely seen in children. We present here four cases of paediatric thyroid nodules. Patients were subjected to a thorough clinical evaluation, blood thyroid level testing, ultrasonography (USG) and fine needle aspiration cytology (FNAC). The size of the nodules ranged from 2 cm to 7.5 cm. All four nodules were reported as “benign” on FNAC, of which three under-went total thyroidectomy owing to the bi-laterality and large size of the nodules. None of the cases had post-operative complications of hypocalcemia or recurrent laryngeal nerve paralysis. Of the 3 patients taken up for surgery one patient was found to have papillary thyroid carcinoma. Subsequent radiological investigation showed no residual disease. All three operated cases were followed-up in the ENT outpatient department for at least 2 years and showed no signs of recurrence. One patient with a small thyroid nodule (2 cm) was managed non – surgically and has been kept on follow up since 12 months. In our experience, total thyroidectomy, even in a benign disease, in expert hands, is a safe procedure and the best management option in children with large goiter, to avoid recurrence and thereby a redo surgery. &lt;/p&gt;

長期集中治療を要した続発性喉頭麻痺を伴う重度嚥下障害症例に対する誤嚥防止術：症例報告(Surgery aimed for prevention of aspiration in patient with severe dysphagia due to laryngeal palsy after long–term intensive care: A case report)

要旨 喉頭麻痺による喉頭感覚低下や声帯の運動障害は，長期にわたる嚥下障害の原因となりうる。頭蓋内・外の種々の器質性病変によって発症するが，原因は多岐にわたり定かではない。集中治療患者におけるICU–acquired swallowing dysfunctionなどによる嚥下障害は遷延することが稀ではなく，誤嚥性肺炎の反復による入院の長期化，高い死亡率が報告されている。今回，遷延する重度嚥下障害に対する治療として誤嚥防止術を選択し，患者のactivities of daily life，ならびに患者と家族のquality of life（以下QOL）の改善が得られた症例を経験したので報告する。症例は80歳代の男性。重症急性膵炎に対して気管挿管を要することなく急性期治療を行い，膵炎の病態は改善した。しかし，続発する喉頭麻痺による両側声帯運動障害と嚥下反射惹起不全が生じ，その後半年以上にわたる難治性誤嚥と繰り返す敗血症性ショックによる多臓器不全に対し，誤嚥防止術を実施したことで経口摂取が可能となり，QOL向上に寄与することができた。集中治療分野において周知に乏しい誤嚥防止術は，音声機能を犠牲にするため慎重な判断を要するが，リハビリテーションや代替栄養法の治療で対処できない重度嚥下障害に対する治療の重要な選択肢となりうる。

Initial outcomes at a nascent tertiary pediatric thyroid surgical center

ObjectivesPrevious studies on pediatric thyroid surgical complications suggest that high-volume centers achieve improved outcomes. We hypothesize that initial outcomes from a nascent pediatric surgical practice may be comparable to higher volume centers. Furthermore, we determine whether a low-volume center can safely transition to an intermediate or high-volume center. MethodsA retrospective chart review was performed for all pediatric patients undergoing thyroid surgery at a single institution from 2014 to 2020. Surgeries were performed by two pediatric otolaryngologists. All patients were managed postoperatively by a multidisciplinary team of physicians that included pediatric otolaryngologists and endocrinologists. Data collection focused on patient demographics and postoperative complications, including rates of recurrent laryngeal nerve injury and permanent hypoparathyroidism. ResultsFrom 2014 to 2020, a total of 31 patients underwent thyroid surgery at our pediatric thyroid surgery center, 9 of whom underwent neck dissection. The mean age of our cohort was 14.4 ± 3.9 years (range 8 months–20 years). Postoperative pathology results revealed that 15 patients (46.9%) were diagnosed with PTC, 6 (18.8%) with follicular adenoma, and 4 (15.6%) with benign thyroid tissue. One (2.0%) patient had permanent unilateral recurrent laryngeal nerve paralysis and one patient experienced permanent hypoparathyroidism (2.7%). ConclusionsOur initial low complication rate as a nascent pediatric thyroid surgery center suggests that favorable outcomes can be achieved at lower volume surgery centers. In order to increase patient access to high-volume pediatric thyroid surgery centers, new centers must start with lower volumes before ultimately becoming high-volume centers. Our study shows that this can be safely achieved. Level of evidenceIV.

Is total endoscopic parathyroidectomy an acceptable treatment for patients with primary hyperparathyroidism due to a presumed solitary adenoma?-comparison of minimally invasive total endoscopic parathyroidectomy and open minimally invasive parathyroidectomy.

Remote-access thyroidectomy and its cosmetic merit have been widely accepted, but remote-access parathyroidectomy has not become common. There are few reports about the risks and effectiveness of a remote-access endoscopic parathyroidectomy. Herein, we evaluated the risks and benefits of total endoscopic parathyroidectomy (TEP) for patients with primary hyperparathyroidism (PHPT). We retrospectively compared the surgical outcomes of TEP and open minimally invasive parathyroidectomy (MIP). We analyzed the cases of 28 patients with PHPT who were scheduled to undergo a MIP at Mita Hospital (Tokyo) during the period from April 2015 to March 2019, all of whom were presumed preoperatively to have a single adenoma. Eleven of the patients underwent a TEP (10 females, one male; mean age 54.2 years). The other 17 patients underwent an open MIP (11 females, 6 males; mean age 63.5 years). The younger patients and the females tended to select endoscopic surgery as their treatment. The operation time was significantly longer in the TEP group compared to the open MIP group (106 vs. 50 min; P<0.001). Common postoperative complications (such as recurrent laryngeal nerve paralysis and seroma) did not occur in this series. For the TEP patients who did not undergo a partial thyroidectomy, the mean amount of drainage on the first postoperative day was only 19±10 mL. The operative cure rate of the minimally invasive parathyroidectomies was 96.4%. TEP is a good surgical procedure for hyperparathyroidism caused by a single adenoma, and it achieves superior cosmetic results without increasing the rate of complications.

Case report of a patient with recurrence after endoscopic submucosal dissection for superficial esophageal cancer, diagnosed with mediastinal lymph node endoscopic ultrasound-fine needle aspiration based on the symptom of hoarseness

The patient was an 81-year-old man who presented with a complaint of hoarseness. When he was 80 years old, he had developed superficial esophageal cancer and had undergone endoscopic submucosal dissection (ESD) at our hospital. Two months after the ESD, he developed hoarseness. Computed tomography (CT) scan showed no abnormal findings at that time;therefore, he was diagnosed with idiopathic vocal cord paralysis, and followed up with symptom treatment in the Gastroenterology and Otolaryngology Departments. Ten months after the ESD, a CT scan revealed mediastinal lymph node swelling. He was admitted to our hospital for histopathological examination of the lymph node using endoscopic ultrasound-fine needle aspiration (EUS-FNA). The histopathological examination revealed squamous cell carcinoma of the lymph node, similar to the primary esophageal tumor. This result suggests that laryngeal nerve paralysis involving hoarseness is caused by lymph node metastasis of superficial esophageal cancer. We report that histopathological examination with EUS-FNA helps in determining the cause of hoarseness that develops after ESD.

Linguistic adaptation and validation of the voice handicap index (VHI)-30 in patients with dysphonia into Russian

It is prospective observational study. The original English version of the VHI-30 questionnaire was translated into Russian by two independent researchers (professional translators). The final Russian version (VHI-30rus) was formulated by a third researcher (otorhinolaryngologist) on the basis of these two translations, and then translated back into English. The 181 participants were included in this study. The main group patients (n=91) were additionally divided into subgroups in accordance with the form of dysphonia: 65 (71.4%) patients had functional and organic dysphonia, 8 (8.8%) had chronic inflammatory diseases of the larynx, 7 (7.7%) - benign neoplasms of the larynx (singing nodules, polyps, cysts), 11 (12.1%) - unilateral laryngeal paralysis. The control group consisted of 90 people without voice disorders. Internal consistency (Cronbach's α coefficient), retest reliability (intraclass correlation coefficient (ICC) VHI-30, comparison of VHI-30 indicators of patients and studied control group (Mann-Whitney U-test, Kruskal-Wallis test) and correlation with the overall severity of dysphonia (Spearman's ρ rank correlation coefficient) were determined. In the patient group, we observed excellent internal consistency for VHI-30rus (α=0.95) and good internal consistency for all VHI-30rus subscales: physical (α=0.88), functional (α=0.88), and emotional (α=0.88). The intraclass correlation coefficient (ICC) indicated high retest reliability for patients (0.99) and control group subjects (0.84). The 30-item mean total values for patients with dysphonia were statistically significantly higher than for control group participants (p<0.001). A correlation was found between the overall VHI-30rus value and the overall severity of dysphonia (ρ=0.748, p<0.001). In the patient's group, female and male participants showed a statistically insignificant difference in the total value of VHI-30rus (Mann-Whitney U-test, p<0.001). There was a correlation in terms of VHI-30rus indicators in different subgroups of the patient group and the control group (Spearman's correlation coefficient: functional dysphonia - 0.942; chronic laryngitis - 0.756; unilateral laryngeal paralysis - 0.888; benign neoplasms - 0.982; control group studied - 0.882). As a result of this study, the VHI-30 questionnaire was translated from English into Russian for use in the Russian-speaking environment. The study showed good internal consistency, retest reliability, and clinical validity for the Russian version of the VHI-30rus questionnaire. The VHI-30rus questionnaire can be recommended for use in clinical practice for patients with dysphonia.

TransOral Endoscopic Thyroidectomy via Submental and Vestibular Approach: A Preliminary Report.

Purpose: Transoral endoscopic thyroidectomy via vestibular approach (TOETVA), with its excellent cosmetic effect, has become increasingly popular worldwide. Nonetheless, anatomic obstacles have limited its development to a certain extent. Here, we present our preliminary outcomes of transoral endoscopic thyroidectomy via submental and vestibular approach (TOETSMVA), which can overcome those limitations.Methods: From November 2019 to March 2020, we performed TOETSMVA in 21 consecutive patients with thyroid carcinoma at Zhongshan Hospital, Xiamen University. A 1.5-cm lateral incision was made at two fingers below the mandible; two 5-mm incisions were made in the vestibule near the first molars; TOETSMVA was completed through these incisions. The demographic data and surgical outcomes of the patients were retrospectively reviewed.Results: Twenty-one patients with a mean age of 37.5 ± 10.4 years were incorporated into this study. Fourteen patients had papillary thyroid micro-carcinomas, two had papillary thyroid carcinomas, and five had benign nodules. Eight patients had lymph node metastases. All surgeries were performed successfully without conversion to open thyroidectomy. The mean operation time was 138.8 ± 33.2 min; the average hospital stay was 3.3 ± 0.8 days. No patients developed cutaneous paralysis in the midline chin region. Transient recurrent laryngeal nerve paralysis was observed in one patient. There was no evidence of postoperative bleeding, infection, tetany, or other complications.Conclusion: TOETSMVA was shown to be a safe and advisable alternative for selected patients. This approach can overcome the limitations of TOETVA without sacrificing cosmetic results.