Laryngeal Pathology Research Articles

The effect of two speech and language approaches on speech problems in people with Parkinson's disease: the PD COMM RCT.

Speech impairments are common with Parkinson's disease (reported prevalence 68%), increasing conversational demands, reliance on family and social withdrawal. The PD COMM trial compared the clinical and cost-effectiveness of two speech and language therapy approaches: Lee Silverman Voice Treatment LOUD and National Health Service speech and language therapy for the treatment of speech or voice problems in people with Parkinson's disease to no speech and language therapy (control) and against each other. PD COMM is a phase III, multicentre, three-arm, unblinded, randomised controlled trial. Participants were randomised in a 1 : 1 : 1 ratio to control, National Health Service speech and language therapy or Lee Silverman Voice Treatment LOUD via a central computer-generated programme, using a minimisation procedure with a random element, to ensure allocation concealment. Mixed-methods process and health economic evaluations were conducted. United Kingdom outpatient and home settings. People with idiopathic Parkinson's disease, with self-reported or carer-reported speech or voice problems. We excluded people with dementia, laryngeal pathology and those within 24 months of previous speech and language therapy. The Lee Silverman Voice Treatment LOUD intervention included maximum effort drills and high-effort speech production tasks delivered over four 50-minute therapist-led personalised sessions per week, for 4 weeks with prescribed daily home practice. National Health Service speech and language therapy content and dosage reflected local non-Lee Silverman Voice Treatment speech and language therapy practices, usually 1 hour, once weekly, for 6 weeks. Trained, experienced speech and language therapists or assistants provided interventions. The control was no speech and language therapy until the trial was completed. Primary outcome: Voice Handicap Index total score at 3 months. Secondary outcomes: Voice Handicap Index subscales, Parkinson's Disease Questionnaire-39; Questionnaire on Acquired Speech Disorders; EuroQol-5D-5L; ICEpop Capabilities Measure for Older Adults; Parkinson's Disease Questionnaire - Carers; resource utilisation; and adverse events. Assessments were completed pre-randomisation and at 3, 6 and 12 months post randomisation. Three hundred and eighty-eight participants were randomised to Lee Silverman Voice Treatment LOUD (n = 130), National Health Service speech and language therapy (n = 129) and control (n = 129). The impact of voice problems at 3 months after randomisation was lower for Lee Silverman Voice Treatment LOUD participants than control [-8.0 (99% confidence interval: -13.3, -2.6); p = 0.001]. There was no evidence of improvement for those with access to National Health Service speech and language therapy when compared to control [1.7 (99% confidence interval: -3.8, 7.1); p = 0.4]. Participants randomised to Lee Silverman Voice Treatment LOUD reported a lower impact of their voice problems than participants randomised to National Health Service speech and language therapy [99% confidence interval: -9.6 (-14.9, -4.4); p < 0.0001]. There were no reports of serious adverse events. Staff were confident with the trial interventions; a range of patient and therapist enablers of implementing Lee Silverman Voice Treatment LOUD were identified. The economic evaluation results suggested Lee Silverman Voice Treatment LOUD was more expensive and more effective than control or National Health Service speech and language therapy but was not cost-effective with incremental cost-effectiveness ratios of £197,772 per quality-adjusted life-year gained and £77,017 per quality-adjusted life-year gained, respectively. The number of participants recruited to the trial did not meet the pre-specified power. People that had access to Lee Silverman Voice Treatment LOUD described a significantly greater reduction in the impact of their Parkinson's disease-related speech problems 3 months after randomisation compared to people that had no speech and language therapy. There was no evidence of a difference between National Health Service speech and language therapy and those that received no speech and language therapy. Lee Silverman Voice Treatment LOUD resulted in a significantly lower impact of voice problems compared to National Health Service speech and language therapy 3 months after randomisation which was still present after 12 months; however, Lee Silverman Voice Treatment LOUD was not found to be cost-effective. Implementing Lee Silverman Voice Treatment LOUD in the National Health Service and identifying alternatives to Lee Silverman Voice Treatment LOUD for those who cannot tolerate it. Investigation of less costly alternative options for Lee Silverman Voice Treatment delivery require investigation, with economic evaluation using a preference-based outcome measure that captures improvement in communication. This study is registered as ISRCTN12421382. This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 10/135/02) and is published in full in Health Technology Assessment; Vol. 28, No. 58. See the NIHR Funding and Awards website for further award information.

Imaging studies in evaluating children with stridor.

Stridor is a symptom of upper airway obstruction and may result from congenital or acquired causes. The diagnosis is usually clinical. If further investigation is necessary for differential diagnosis, endoscopy is the method of choice in most cases. Imaging studies are complementary to endoscopy. They allow evaluation of laryngeal and tracheobronchial pathology and extrinsic airway compressions due to tumors or vascular malformations and define a lesion's location, extent, and characteristics. They are helpful in cases of diagnostic doubt and when endoscopy is unavailable. It is essential to understand the anatomy and pathophysiology of the respiratory tract and to be aware of the indications and limitations of complementary examinations for proper diagnosis. The different imaging modalities available to evaluate stridor in pediatrics are described, and their advantages are discussed.

Endoscopic diagnosis of larynx pathology

Despite the large number of publications devoted to the diagnosis of laryngeal pathology, the issues of timely and early diagnosis of malignant neoplasms of this localization still remain very relevant. In 2022, the proportion of patients with laryngeal cancer in stages I-II was 40.3%, stage III - 30.3%, stage IV - 28.4%, while 13.1% were actively detected. Accordingly, stage III-IV cancer of the larynx accounts for 58.7%.

Likelihood of Laryngeal Involvement in Autoimmune Thyroid Disorder Patients: A Meta-Analysis.

The involvement of the larynx in many situations can have a substantial impact on a person's voice, breathing, and general health. Individuals with autoimmune thyroid disorders can experience a variety of conditions affecting the larynx. Autoimmune thyroid disorders, such as Hashimoto's thyroiditis [HT] and Graves' disease [GD], are prevalent conditions affecting the thyroid gland. Beyond their established impact on thyroid function, these disorders have been associated with laryngeal involvement. The current study aims to explore the likelihood of laryngeal involvement in patients with Autoimmune Thyroid Disorders [AITD]. This study involved a retrospective analysis of medical records from patients diagnosed with autoimmune thyroid disorders. Inclusion criteria were a confirmed diagnosis through laboratory investigations and clinical assessment. Patients with pre-existing laryngeal pathologies or other conditions affecting the larynx were not considered. We collected data from 4 research articles and 3 clinical trials from Embase, PubMed, and NCBI-Trials portals, focusing on reported laryngeal symptoms. The severity of laryngeal involvement was assessed and categorized based on its extent and impact on vocal function. Preliminary analysis of the collected data indicated a significant proportion of patients with autoimmune thyroid disorders reporting laryngeal symptoms. Among these patients, various manifestations of laryngeal involvement were observed, including vocal changes, hoarseness, and throat discomfort. The findings show that laryngeal symptoms may be an underappreciated feature of these diseases, potentially impacting vocal function and quality of life in affected people. Further research is also needed for more precise projections in this direction.

Integration of Dysphagia Therapy Techniques into Voice Rehabilitation: Design and Content Validation of a Cross-Therapy Protocol

BackgroundThe intricate relationship between swallowing and phonation, sharing anatomical and physiological substrates, underscores a clinical demand for integrated therapeutic approaches. Existing interventions often address these functions in isolation, overlooking their interconnected dynamics. ObjectiveTo design and validate a cross-therapy protocol incorporating dysphagia therapy techniques (maneuvers/exercises) invoice rehabilitation. This protocol aims to exploit the shared biomechanical components of swallowing and phonation to improve both functions simultaneously in patients with underlying hypofunctional laryngeal pathology. MethodsA descriptive research design was employed, consisting of three phases: a comprehensive literature review and expert discussions in a German seminar format to conceptualize the protocol; detailed analysis and categorization of swallowing maneuvers/exercises; and content validation by a panel of seven experts through a structured evaluation instrument. The process integrated motor learning and exercise physiology principles to ensure the protocol's clinical applicability and theoretical coherence. ResultsThe developed cross-therapy protocol incorporates four core swallowing therapy techniques to voice therapy procedures. Selected swallowing therapy techniques target laryngeal excursion and vocal fold closure because they are critical components of swallowing and phonation. Expert validation yielded a Content Validity Coefficient (CVC) exceeding 0.90 for most items, indicating high consensus on the protocol’s relevance, clarity, and applicability. Adjustments were made based on feedback, enhancing the protocol's precision and user-friendliness. ConclusionWe present a novel, evidence-based therapy protocol for voice and swallowing difficulties resulting from hypofunctional laryngeal pathology. Its development marks a significant step toward bridging the gap between swallowing and voice therapy. Future empirical studies are needed to assess its effectiveness in clinical settings.

Laryngeal chondrosarcoma, a 30-year series

Introduction and objectivesLaryngeal chondrosarcoma is a rare laryngeal pathology arising from cartilaginous structures and is predominantly found in the cricoid cartilage. This study investigates its presentation, treatment modalities and patient outcomes. Patients or materials and methodsRetrospective study of laryngeal chondrosarcoma cases followed from 1992 to 2022 in the Otorhinolaryngology department of a cancer center - Instituto Português de Oncologia de Lisboa. Statistical analysis was made with Microsoft Excel® and SPSS®. ResultsWe identified 16 cases, of which two-thirds were male, with an average age of 59.6 years, and only 24% of them had a history of smoking. The commonest presentation was indolent dysphonia and/or dyspnea, and the posterior arch of the cricoid cartilage was the most affected place. Although histopathological studies after biopsy were often inconclusive, surgery emerged as the first-line of treatment for all patients. Larynx microsurgery with lesion debulking was the most frequent surgical approach (47%) followed by partial laryngectomy (24%). Neither adjuvant radiotherapy (RT) nor chemotherapy was administered in any of the cases. There was residual tumor in 23% of the cases so half of these patients were in watchful waiting while the other part underwent further microsurgery or total laryngectomy. Only one patient with recurrence received RT. Disease-specific survival rate at 1 and 5 years was 97% and 91%, respectively. ConclusionLaryngeal chondrosarcoma etiology is still unknown and is effectively treated with surgery, with a generally favorable prognosis. The main concern lies in its propensity to relapse, highlighting the importance of watchful follow-up.

Unveiling the hoarseness of voice: a case report of laryngeal paraganglioma

Abstract Voice hoarseness is a common clinical symptom, often resulting from underlying laryngeal pathologies, which can be either non-neoplastic or neoplastic. Laryngeal paraganglioma, a neuroendocrine tumor with a rare occurrence, originating from the parasympathetic paraganglia of the larynx, typically presents with nonspecific symptoms such as hoarseness, making it difficult to diagnose. The authors present a case of a 19-year-old male with a 5-month history of hoarseness who visited the outpatient department. Laryngoscopy revealed a supraglottic submucosal lesion involving the right aryepiglottic fold. Histopathology suggested potential diagnoses such as a neuroendocrine tumor, carcinoid, paraganglioma, or medullary thyroid carcinoma. Immunohistochemistry ultimately confirmed the diagnosis of paraganglioma. This case report highlights the importance of considering paraganglioma as the differential diagnosis of laryngeal lesions despite its rare occurrence in the larynx. Early identification is crucial for developing an effective treatment strategy and achieving optimal patient outcomes. Our case report adds to the growing literature on the clinical presentation and diagnostic evaluation of laryngeal paragangliomas.

Anesthetic management of a child with a laryngeal mass associated with Laryngo-onycho-cutaneous syndrome

With fewer than 50 reported cases, Laryngo-onycho-cutaneous syndrome is a rare condition presenting in childhood with skin and conjunctival ulcerations and laryngeal pathology. A 4-year-old girl presented with recent onset aphonia. Airway endoscopy revealed a laryngeal mass. Tracheostomy was advised but parents denied consent. Two weeks later, she developed severe stridor warranting emergent tracheostomy. The child was diagnosed as Laryngo-onycho-cutaneous syndrome, also known as Shabbir syndrome. Subsequently, she was taken up for laser excision of the mass. Here, we describe the anesthetic management in such airway procedures. Total intravenous anesthesia and local anesthetic in the form of vocal cord spray are safe and environment-friendly alternatives to inhalational anesthesia for airway endoscopies.

Randomized Controlled Trial of Awake Transnasal Laser-Assisted Surgery for Benign Laryngeal Lesions.

To compare functional and cost-effectiveness of awake transnasal laser assisted-surgery versus microlaryngeal surgery for benign laryngeal lesions. This was a prospective non-inferiority randomized controlled trial conducted from May 2021 to December 2022 at two tertiary referral hospitals in Hong Kong. Patients were block-randomized to receive either awake transnasal laser-assisted surgery or microlaryngeal surgery, with post-operative follow-up in a multidisciplinary voice clinic for 1-year. Primary outcome was Voice Handicap Index (VHI-30). Secondary outcomes included operation time, complications, length of stay, peri-operative discomfort, recurrence, and medical costs. Sixty-one patients were randomized to either awake transnasal laser-assisted surgery (n = 30) and microlaryngeal surgery (n = 31). Both groups had comparable demographics and laryngeal pathologies. Both groups showed significant improvement of VHI-30 score over time and had comparable post-operative VHI-30. Awake transnasal laser-assisted surgery group had a significantly shorter length of stay (0.5 vs. 1 day) and less throat discomfort (2 vs. 4) compared to microlaryngeal surgery group. Intraoperative complications were more common in microlaryngeal surgery group (14.3% vs. 0%). Otherwise, both groups had similar operative time and recurrence rate. Cost-analysis showed a significantly lower hospital cost for awake transnasal laser-assisted surgery (USD 3090) compared to microlaryngeal surgery group (USD 5120). Awake transnasal laser-assisted surgery was safe, functionally non-inferior, as measured by VHI-30, to microlaryngeal surgery in managing benign laryngeal lesions, while superior to microlaryngeal surgery in peri-operative discomfort and medical costs. 2 Laryngoscope, 134:3732-3740, 2024.

Rearranging Voice Disorders: Refining the New Two-Dimensional Continuous Model

BackgroundVoice and laryngeal pathologies are traditionally arranged in categories. A recent study has suggested an alternative approach, using two continuous scales, Organicity and Tonicity, which form a two-dimensional plane on which all pathologies/conditions can be arranged. ObjectivesThis study was designed to examine the validity and reliability of the new continuous 2D model and to learn how it is affected by experts' background characteristics. MethodsNinety-three international experts from 16 countries participated in the study and rated a comprehensive list of 35 laryngeal and voice pathologies/conditions on two continuous scales. On the Organicity scale, 0 represented 'non-organic', and 10 defined 'organic.' Similarly, on the Tonicity scale, 0 described 'hypotonic' and 10 represented 'hypertonic'. ResultsCronbach's alphas were high for Organicity and Tonicity (.99), with varied inter-expert agreement scores. Pathologies/conditions populated all four quadrants of the constructed two-dimensional plane, with a majority of 21 of the 35 located in the first quadrant (high-Tonicity, high-Organicity). Results showed strong replicability when compared to the preliminary study. In addition, ratings on the two scales were found consistent and statistically unaffected by the experts' background characteristics. ConclusionsThe new two-dimensional model is valid and reliable, and it provides a simple yet comprehensive approach for arranging voice disorders using a continuous perspective rather than a categorical one. Furthermore, the new model offers a framework that facilitates examination of the differences in how professional experts view different laryngeal pathologies and conditions.

Transoral robotic surgery for supraglottic cancer. A review of oncological and functional outcomes compared to open surgery.

Supraglottic squamous cell carcinoma (SCC) represents a major surgical challenge in organ-preserving treatment. Type I open partial horizontal laryngectomy (OPHL I) is considered the most popular. To date, minimally-invasive approaches such as laser microsurgery and transoral robotic surgery (TORS) have gained increasing relevance. The aim of this narrative review is to obtain a descriptive comparison of functional and oncological outcomes from studies on patients with supraglottic SCC treated with OPHL I and TORS, respectively. A computerised search was performed using the Pubmed database for articles published from 2000 to 2023. A comparative analysis on functional and oncological outcomes of patients treated by TORS and OPHL I was performed. The present narrative review shows a superiority of TORS compared to open surgery for supraglottic SCC in terms of functional outcomes, while maintaining comparable oncological outcomes. Although recently introduced in the treatment of laryngeal pathology, TORS has been shown to be a reliable technique not only for functional but also for oncological outcomes, ensuring good overall survival, disease-free survival, and disease control rates comparable to OPHL I.

Prediction of a Difficult Airway Using the ARNE Score and Flexible Laryngoscopy in Patients with Laryngeal Pathology.

Background and Objectives: The ARNE score was developed for the prediction of a difficult airway for both general and ear, nose and throat (ENT) surgery with a universal cut-off value. We tested the accuracy of this score in the case of laryngeal surgery and provided an insight into its effects in combination with flexible laryngoscopy. Materials and Methods: This prospective pilot clinical study included 100 patients who were being scheduled for microscopic laryngeal surgery. We calculated the ARNE score for every patient, and flexible laryngoscopy was provided preoperative. Difficult intubation was assessed according to the intubation difficulty score (IDS). Results: A total of 33% patients had difficult intubation according to the IDS. The ARNE score showed limited accuracy for the prediction of difficult intubation in laryngology with p < 0.0001 and an AUC of 0.784. Flexible laryngoscopy also showed limitations when used as an independent parameter with p < 0.0001 and an AUC of 0.766. We defined a new cut-off value of 15.50 for laryngology, according to the AUC. After the patients were divided into two groups, according to the new cut-off value and provided cut-off value, the AUC improved to 0.707 from 0.619, respectively. Flexible laryngoscopy improved the prediction model of the ARNE score to an AUC of 0.882 and of the new cut-off value to an AUC of 0.833. Conclusions: It is recommended to use flexible laryngoscopy together with the ARNE score in difficult airway prediction in patients with laryngeal pathology. Also, the universally recommended cut-off value of 11 cannot be effectively used in laryngology, and a new cut-off value of 15.50 is recommended.

Nonlinear Dynamic Analysis and Perturbation Measurement Used for Discriminating Pathological Voices and Their Correlations With Perceptual Evaluation

1. To investigate the discriminatory and diagnostic power of nonlinear dynamic analysis measures concerning voices from normal, benign, and malignant voice disorders. 2. To study the correlations of nonlinear dynamic analysis measures with perceptual ratings to evaluate the reliability of the objective acoustic analysis in predicting severity of voice. The perturbation analysis metrics used were Jitter%, Shimmer%, and signal-to-noise ratio. The nonlinear dynamic analysis metrics used were spectrum convergence ratio (SCR), nonlinear energy difference ratio (NEDR), and rate of divergence (ROD). Subjects were enrolled and divided into three groups based on laryngeal pathology: normal, benign, and malignant. Vowel sound and reading samples were recorded. Perceptual evaluation was applied to these voice samples to investigate correlations between metrics and auditory perception. Each metric was capable of discriminating laryngeal pathology, except for SCR in the case of distinguishing between benign and malignant pathologies. Perturbation analysis parameters had a moderate ability to differentiate between normal and benign pathologies, but were unable to characterize malignant pathologies for certain diseases, such as Reinke's edema. All metrics significantly correlated with perceptual G scores. Nonlinear dynamic analysis was superior when applied to cases of severe dysphonia, where linear metrics such as Jitter% and Shimmer% tended to lose utility. NEDR and ROD were successful at differentiating between the different pathologies, whereas SCR could not discriminate between the benign and malignant groups. Perturbation and nonlinear dynamic analyses are comparable in their discriminating power with respect to normal and benign voices, and normal and malignant voices. The nonlinear dynamic analysis metrics NEDR and ROD may be superior in clinical settings with respect to discriminating voice pathology ranging from mild pathological voice to severe dysphonia, and with respect to discriminating benign and malignant voice. SCR was found unable to discriminate pathological voices.

Diagnosis of benign laryngeal tumors using neural network

The article describes our experience in developing and training an artificial neural network based on artificial intelligence algorithms for recognizing the characteristic features of benign laryngeal tumors and variants of the norm of the larynx based on the analysis of laryngoscopy pictures obtained during the examination of patients. During the preparation of data for training the neural network, a dataset was collected, labeled and loaded, consisting of 1471 images of the larynx in digital formats (jpg, bmp). Next, the neural network was trained and tested in order to recognize images of the norm and neoplasms of the larynx. The developed and trained artificial neural network demonstrated an accuracy of 86% in recognizing of benign laryngeal tumors and variants of the norm of the larynx. The proposed technology can be further used in practical healthcare to control and improve the quality of diagnosis of laryngeal pathologies.

Variability of Maximum Glottal Angle on Clinical Sniff Task Differs in Patients With Functional and Organic Laryngeal Pathologies Compared to Healthy Controls

ObjectivesPractitioners rely heavily on flexible endoscopic visualization of the true vocal folds during a repeated “sniff-ee” maneuver to assess vocal fold mobility. However, the human eye lacks the temporal and spatial precision required to accurately gauge fine differences in maximal glottal angle. This study compared differences in maximal glottal angle variables during “sniff-ee” maneuvers across patients with various voice and laryngeal breathing disorders. MethodsWe retrospectively measured glottal angle from flexible laryngoscopy exams in six groups of patients with voice and upper airway disorders: laryngeal dystonia/essential tremor (LD/ET), vocal fold lesions, vocal fold atrophy, paradoxical vocal fold motion disorder (PVFMD), muscle tension dysphonia (MTD), and healthy controls. Maximum glottal angle (GAMAX) and average glottal angle (GAAVG) were calculated during three serial “sniff-ee” maneuvers for all participants. Individual disorder groups (MTD, PVFMD, LD/ET, atrophy, lesion) and broader disorder types (functional and organic) were compared to healthy controls using simple linear regression analyses. ResultsNo significant difference in either GAMAX or GAAVG was found between controls and the disorder subgroups or broader disorder type (function and organic). However, there were statistically significant differences in the variability of GAMAX in both PVFMD (6.2° more variability; p<0.001) and LD/ET (5.8° more variability; p<0.001) compared to healthy controls. ConclusionPatients diagnosed with LD/ET and PVFMD both demonstrated significantly more variability in their GAMAX compared to healthy controls, suggesting that movement consistency or coordination may be relatively compromised in these patient groups. Further research is warranted to investigate the sensitivity and specificity of glottal angle variability in diagnosing PVFMD and LD in clinical or research settings. Level of Evidence4 Short SummaryLaryngeal exams from five patient groups were compared to those from healthy controls. Patients with paradoxical vocal fold motion disorder and laryngeal movement disorders exhibited significantly greater variability of glottal angle during sniff maneuver compared to healthy controls.

Clinical manifestations of autoimmune rheumatic diseases in the larynx

Introduction. Autoimmune rheumatic diseases are attributed to a systemic process that develops in many organs, including the larynx. Complaints of impaired vocal function in patients with this pathology require a thorough clinical and endoscopic analysis.The purpose of the study. To determine the clinical-endoscopic changes of the larynx in patients with impaired vocal function in autoimmune rheumatic diseases..Materials and methods. 31 (100%) patients aged 25 to 84 (41 ± 15) years with autoimmune rheumatic diseases applied to the phoniatric department of the St. Petersburg Research Institute of ENT. There were 3 men (10%), 28 women (90%). All patients complained of impaired vocal function, 5 of the examined (16%) were also concerned about breathing disorders during exercise or at rest.Patients were grouped into three groups: systemic lupus erythematosus 4 (13%) people, systemic vasculitis 10 (32%) people, rheumatoid arthritis 17 (55%) people.Videolaryngoscopy, videolaryngostroboscopy, autofluorescence endoscopy, NBI – endoscopy (according to indications) were used to make the diagnosis.Results. The distribution of laryngeal pathology by nosological forms in patients with аutoimmune rheumatic diseases was as follows. The most numerous were groups with functional dysphonia of the hypotonic type 10 (32%) and bamboo nodules of 8 (26%) patients. Chronic laryngeal stenosis was diagnosed in 5 (16%), and chronic catarrhal laryngitis and soft nodules of the vocal folds in 3 (9.5%) people in each group (respectively). The smallest number of patients suffered from ulcerative necrotic changes of the larynx and pharynx – 2 (7%).Conclusion. Thus, laryngeal changes in аutoimmune rheumatic diseases had both specific manifestations and non-specific ones. The latter include functional dysphonia of the hypotonic type, chronic catarrhal laryngitis, soft nodules of the vocal folds. Bamboo nodules of the vocal folds, ulcerative necrotic diseases, chronic laryngeal stenosis (infiltrative and scarring) were specific for patients with аutoimmune rheumatic diseases.

Outcomes of a first point of contact speech language therapy clinic for patients requiring vocal cord check pre and post thyroid/parathyroid surgery.

Speech Language Therapy First Point of Contact Clinic (SLT-FPOCC) models can assist assessment of low-risk patient populations referred to ear, nose and throat (ENT) services. To further improve ENT waitlist management and compliance with best-practice care, consideration of other low-risk populations that could be safely managed through this service model is needed. The aims of this paper are to evaluate the clinical and service outcomes of completing vocal cord check (VCC) assessments for patients' pre and post thyroid/parathyroid surgery within an SLT-FPOCC model and examine consumer perceptions. The service followed existing SLT-FPOCC procedures, with ENT triaging referrals, then SLT completing pre- and postoperative VCC assessment (interview, perceptual assessment, flexible nasendoscopy), with assessment data later reviewed by ENT to diagnose laryngeal pathology. Clinical and service outcomes were collected prospectively. Patients completed an anonymous post-service satisfaction survey. Of the first 100 patients referred for preoperative VCCs, SLT assessment identified 42 with dysphonia and 30 reporting dysphagia, while ENT confirmed 9 with significant preoperative anatomical findings. Eighty-three underwent surgery, with 63 (95 nerves at surgical risk) returning for a postoperative VCC. Postoperative VCC identified three temporary neuropraxias (3.2%) and three unilateral vocal fold paresis (3.2%). Patients were highly satisfied with the service. All 163 pre-/postoperative VCCs were completed with no adverse events. The current data support SLT-FPOCC service expansion to include pre and post thyroid/parathyroid surgery VCC checks, with positive consumer perception. The model supports delivery of best practice management (i.e., pre- and postoperative VCC) for patients receiving surgery for thyroid/parathyroid dysfunction, and associated efficiencies for ENT services. What is already known Assessment of laryngeal function via flexible nasoendoscopy is recommended best practice for patients pre and postthyroid/parathyroid surgery, as recurrent laryngeal nerve injury is a low incidence (<10%), yet well-recognised risk of these surgeries. Traditionally, general surgeons refer presurgical patients to ear, nose and throat (ENT) for vocal cord check (VCC) assessment. However, with access to specialist outpatient services under increasing pressure, there is growing support for utilisation of other health professionals, such as speech-language therapists working in first point of contact (FPOCC) models, to assist with the administration of pre- and postsurgical assessments of such low-risk populations. What this study adds This work expands on the emerging body of evidence for speech language therapy (SLT) led FPOCC models within ENT outpatient services, providing clinical and service outcomes to support the safety of a new model designed to administer VCCs for patients pre and post thyroid/parathyroid surgery. Adopting a similar model to a prior published SLT-led FPOCC model, the trained SLT completes the pre- and postsurgical VCC including flexible nasoendoscopy and videostroboscopy, with images and clinical information then presented to ENT for diagnosis and management planning. This study also provides the first data on consumer perceptions of this type of service model. Clinical implications of this study Data on 100 consecutive presurgical patients revealed positive service findings, supporting the safety of this model. Nature and incidence of clinical findings pre and post surgery were consistent with previously published studies using traditional models of care (i.e., ENT completing the flexible nasendoscopy). Consumer perception was positive. This model enables delivery of pre-and postsurgical assessments for patients receiving thyroid/parathyroid surgery, consistent with best practice care, and reduces burden on ENT services. In total 163 ENT appointments were avoided with this model, with positive implications for ENT waitlist management.

Indications, Efficacy, Safety, and Clinical Outcomes of 585 nm Pulsed Dye Laser in Non-Malignant Laryngeal Lesions: A Systematic Review.

The objective of this manuscript was to review the indications, efficacy, and safety of a 585 nm pulsed dye laser (PDL) in non-malignant laryngeal lesions. Following the PRISMA statement recommendations, three independent authors searched for articles published in PubMed/MEDLINE, the Cochrane Library, Google Scholar, Scielo, and Web of Science. A bias analysis was performed following NICE guidance tools. From the 506 identified publications, 19 observational studies met the inclusion criteria. The PDL improves vocal quality objectively and subjectively in vascular lesions (p < 0.005) and improves vocal quality in patients with dysplasia/leukoplasia without changing the natural history of the disease compared to other treatments. Reinke's edema and granulomas require an average of 1.5 PDL sessions for resolution. Treatment of recurrent respiratory papillomatosis requires multiple sessions, with complete remission achieved in 50-70% of patients. Regardless of the lesion, the tolerance of the procedure under local anesthesia is exceptional (84-97%), and the results in terms of regression and vocal quality are promising. The complication rate is minimal, and the procedure does not interfere with other treatment alternatives. There is no consensus on laser settings. The lack of consistent use in evaluating vocal outcomes, whether objective or subjective, prevents the comparability between studies. The 585 nm pulsed dye laser appears to be an effective and safe therapeutic option in patients with non-malignant laryngeal pathology. Future controlled studies are needed to compare the 585 nm pulsed dye laser with other lasers or cold instrument procedures.

Prevalence and recovery of dysphonia in COVID-19 patients requiring intensive care treatment

BackgroundDysphonia and laryngeal pathology are considerable issues in patients hospitalised with COVID-19 with prevalence rates cited between 29% and 79%. Most studies currently are limited to reporting single-institution data with many retrospective. ObjectivesThe aims of this study were to prospectively explore the following: (i) prevalence; (ii) treatment; and (iii) recovery pattern and outcomes for dysphonia, in patients with COVID-19 requiring intensive care unit (ICU) treatment. MethodsPatients admitted to 26 ICUs over 12 months, diagnosed with COVID-19, treated for survival, and seen by speech–language pathology for clinical voice assessment were considered. Demographic, medical, speech–language pathology treatment, and voice outcome data (grade, roughness, breathiness, asthenia, strain [GRBAS]) were collected on initial consultation and continuously monitored throughout the hospital admission. FindingsTwo-hundred and thirty five participants (63% male, median age = 58 yrs) were recruited. Median mechanical ventilation duration and ICU and hospital lengths of stay (LOSs) were 16, 20, and 42 days, respectively. Dysphonia prevalence was 72% (170/235), with 22% (38/170) exhibiting profound impairment (GRBAS score = 3). Of those with dysphonia, rehabilitation was provided in 32% (54/170) cases, with dysphonia recovery by hospital discharge observed in 66% (112/170, median duration = 35 days [interquartile range = 21–61 days]). Twenty-five percent (n = 42) of patients underwent nasendoscopy: oedema (40%, 17/42), granuloma (31%, 13/42), and vocal fold palsy/paresis (26%, 11/42). Presence of dysphonia was inversely associated with the number of intubations (p = 0.002), intubation duration (p = 0.037), ICU LOS (p = 0.003), and hospital LOS (p = 0.009). Conversely, duration of dysphonia was positively associated with the number of intubations (p = 0.012), durations of intubation (p = 0.000), tracheostomy (p = 0.004), mechanical ventilation (p = 0.000), ICU LOS (p = 0.000), and hospital LOS (p = 0.000). More severe dysphonia was associated with younger age (p = 0.045). Proning was not associated with presence (p = 0.075), severity (p = 0.164), or duration (p = 0.738) of dysphonia. ConclusionsDysphonia and laryngeal pathology are common in critically ill patients with COVID-19 and are associated with younger age and protracted recovery in those with longer critical care interventions.

Dysphonia Outperforms Voice Change as a Clinical Predictor of Dysphagia.

Changes in voice quality after consuming food or drink have been used as a clinical indicator of dysphagia during the clinical swallowing evaluation (CSE); however, there is conflicting evidence of its efficacy. This study investigated if dysphonia and/or voice change after swallowing are valid predictors of penetration, aspiration, or pharyngeal residue. Our approach aimed to improve current methodologies by collecting voice samples in the fluoroscopy suite, implementing rater training to improve interrater reliability and utilizing continuous measurement scales, allowing for regression analyses. In this prospective study, 30 adults (aged 49-97 years) referred for a videofluoroscopic swallowing study (VFSS) were audio-recorded completing a sustained /i/ prior to VFSS and again after swallowing each bolus during the VFSS. Swallowing function was measured using the reorganized Penetration-Aspiration Scale and the Normalized Residue Ratio Scale. Following listener training, 84 voice samples were perceptually rated using the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V). Ordinal and logistic regression were used to determine whether voice quality and voice quality change after swallowing were predictors of airway invasion and pharyngeal clearance. Results indicated that the presence of dysphonia at baseline during a sustained /i/ task as measured by the CAPE-V predicted airway invasion but not pharyngeal residue. Voice change after swallowing associated with vowel /i/ production as measured by the CAPE-V did not predict either dysphagia measure. These results indicate that voice change during a sustained /i/ after swallowing appears unrelated to airway invasion or pharyngeal residue; however, in the absence of known laryngeal pathology, dysphonia prior to a CSE should alert speech-language pathologists of a possible comorbid dysphagia.