Laryngeal Pathology Research Articles

Primary Laryngeal Tuberculosis as a Cause of Persistent Hoarseness—A Case Report

Laryngeal tuberculosis is an uncommon disease of the larynx that can easily be missed. It is however the commonest granulomatous laryngeal pathology. Laryngeal tuberculosis and laryngeal cancer both have similar modes of clinical presentation. We present a case of isolated laryngeal tuberculosis in a 38-year-old Nigerian female, who presented with persistent hoarseness of 3 months duration with no respiratory symptoms and signs. Fiberoptic laryngoscopy showed hyperemia and oedema of the endolarynx, mucoid exudate and thickening of both false and true vocal cords. Tuberculosis was confirmed by gene Xpert. She was placed on rifampicin, isoniazid, pyrazinamide and ethambutol for two months intensive phase and rifampicin and isoniazid for four months continuation phase. There was complete resolution of hoarseness after completion of anti-tuberculous therapy.

Cardiovocal syndrom arare case of hoarseness of voice

IntroductionHoarseness of voice is a common clinical presentation in ENT practice, which may have different etiological causes. The causes may vary from local pathology of larynx to a neurogenic reason of central nervous system or recurrent laryngeal nerve pathology. Cardiovocal syndrome may cause hoarseness secondary to left recurrent laryngeal nerve palsy when left recurrent laryngeal nerve is mechanically affected due to enlarged cardiovascular structure. In this article we present a case of left recurrent laryngeal nerve palsy due to Cardiovocal syndrome or Ortner’s syndrome in a 75-year-old female. ConclusionsOrtner's syndrome may be overlooked and unless specifically looked for may be regarded as an idiopathic cause. The diagnostic methods currently used for investigation of recurrent laryngeal nerve palsy specially the CT scan of carina to skull base may have these inherited disadvantages. As the lowest plane of the scan is so proximal to inferior region of the aorto pulmonary window an interpreter may easily miss the aneurism unless specifically looked for. One effect of this would be under diagnosis and when spotted it would be highly inadequate to assess the heart and rest of the thoracic aorta as clearly demonstrated in our patient which needed further studies. It would be a more efficient to include the heart in the CT scans in patients with extra laryngeal causes of left recurrent laryngeal nerve palsy at least among cardiovascular risk factors.

Etiological Spectrum of Hoarseness of Voice in Western Regional Hospital, Pokhara, Nepal

Background: Hoarseness of voice is a common symptom presentation in the Department of ENT. The etiology ranges from benign to malignant causes. Video nasopharyngolaryngoscopy is an effective method of evaluation of the laryngeal pathologies. The aim of the study was to study the different etiological factors of hoarseness of voice presenting in the Department of ENT at Western Regional Hospital, Pokhara. 
 Materials and Methods: A retrospective observational longitudinal study was done in the Department of ENT, Western Regional Hospital after approval from IRC, Pokhara Academy of Health Science. A total of 275 patients presenting to the ENT Department with hoarseness of more than two weeks duration were examined with video nasopharyngolaryngoscopy (NPL) from April 2018 to March 2019. The data were electronically entered and analyzed with SPSS Version 21. 
 Results: Total number of cases were 275 among which 187 (68%) were females whereas 88 (32%) were males. Vocal cord nodules were observed in 107 patients (38.9%), features of laryngopharyngeal reflux were observed in 54 patients (19.6%) muscle tension dysphonia was seen in 49 (17.8 % ), vocal cord polyp in 6 patients (2.2%), left vocal cord palsy in 7 patients ( 2.5%), right sided vocal cord palsy in 2 patients (0.7%). The hemorrhagic polyp, leucoplakia and ventricular dysphonia were observed in 3 patients each. 
 Conclusion: Since causes of hoarseness of voice range from simple benign diseases to malignant diseases, it is mandatory to evaluate every cases of hoarseness of voice replace with of more than 2 weeks duration with history, videolaryngoscopic examination and investigations.

Voice Disorders in Lower Primary School Teachers: An Observational Study

Voice problems are very common among teachers, and etiology-based methods are used in the diagnosis and treatment process. Our study aims to reveal the changes in subjective voice analysis during the diagnosis and treatment process of dysphonia in lower primary school teachers. The nature of the study is a prospective observational one designed for lower primary school teachers in Kahramanmaraş conducted between the year 2015 and 2019 and evaluations for parameters including sociodemographic characteristics, laryngeal lesions and pre- and post-treatment scales such as Voice Handicap Index-10 (VHI-10), Reflux Symptom Index (RSI) and Hospital-Anxiety Depression Scale (HADS) for treatment subgroups were made. Statistical analysis was analyzed using SPSS. Three hundred and fifty-one lower primary school teachers were included in the study. A statistically significant difference was found for the development of dysphonia in terms of sociodemographic features such as smoking, professional experience and crowdedness of classroom. Changes in RSI, VHI-10 and HADS values after treatment were clinically significant in all treatment groups. While there was a significant post-treatment improvement in terms of RSI in patients with granuloma and laryngopharyngeal reflux disorders, the VHI-10, and HADS assessments revealed a significant difference in clinical recovery compared to laryngeal lesions. The RSI, VHI-10 and HADS values for various laryngeal pathologies were found to be high in dysphonic teachers. An improvement was observed in the scale scores upon the application of treatment modalities. This situation emphasizes the importance of questionnaire survey in the diagnosis, treatment, and follow-up process of dysphonia.

Efecto Preventivo de Ejercicios con Tubos de Resonancia en un Grupo Docente.

En múltiples estudios se ha determinado la importancia de la voz en aquellos profesionales que la utilizan como su herramienta principal de trabajo. Dentro de este grupo se encuentran locutores, agentes de call center, profesores, entre otros; la población objeto de estudio en esta investigación son los profesores universitarios, ellos trabajan durante varias horas al día usando su voz para transmitir el conocimiento dentro del aula de clase, muchas veces en condiciones poco óptimas para un desempeño laboral efectivo. Además, están expuestos a diversos factores de riesgos ambientales y organizacionales lo cual los predispone y genera diversidad de patologías laríngeas propias de su ocupación. Los participantes pertenecen a un programa de conservación de la voz. El diseño de investigación pre experimental, cuantitativo, utilizando pre-test y pos-test en una misma población, descriptivo transversal, bajo un enfoque epidemiológico. Se aplicó una encuesta de autopercepción vocal como pre-test, con el fin de identificar la percepción que tenían estos profesionales acerca de sus características vocales. Posterior a esto, se les realizó una serie de ejercicios con tubos de resonancia basados en la técnica de Tracto Vocal Semi Ocluido (TVSO) y finalmente, se le reaplicó la encuesta de autopercepción vocal como post-test para determinar los efectos y cambios fisiológicos de estos ejercicios sobre los parámetros acústicos de la voz y las características del habla tales como: inteligibilidad, naturalidad y audibilidad; logrando un efecto fisiológico terapéutico inmediato y una percepción subjetiva de mejoría posterior a la terapia, generando un cambio en el patrón vibratorio de sus pliegues vocales, minimizando el abuso y mal uso vocal, creando conciencia del cuidado que se debe tener con la voz cuando se utiliza de manera profesional por ser la herramienta principal de su trabajo.

Correlation Between Subjective and Objective Parameters of Voice in Elderly Male Speakers

Literature review suggests that the analysis of acoustic, cepstral, and spectral parameters of voice offers excellent discrimination between the normal and pathological voices and strongly correlates with the perception of voice quality. Although the correlation between the subjective and objective voice measures can facilitate the clinician to distinguish pathological voices from normal voices, only a handful of investigations have examined the relationship between these measures in aging voices. To investigate the differences in the subjective and objective parameters (acoustic, spectral, and cepstral parameters) of the voice in elderly male speakers with and without symptoms of dysphonia, and to document the correlation between the subjective and objective parameters in the voice of elderly male speakers. Retrospective standard group comparison study. Phonation and speech samples were collected from 30 elderly male participants having no vocal symptoms related to dysphonia and 30 elderly male participants with the self-reported presence of vocal symptoms related to dysphonia. The subjective, acoustic, spectral, and cepstral parameters were analyzed from all the voice samples. Results revealed significant differences in subjective, acoustic, cepstral, and spectral parameters of voice between the voice samples of the elderly individuals with and without dysphonic symptoms. Perceptual parameters showed a weak and moderate correlation with acoustic parameters and a strong correlation with spectral and cepstral parameters of voice. Further studies on the correlation between the subjective and objective parameters of voice in elderly male speakers with various types of laryngeal pathologies would throw light on distinguishing the voice of normal aging from the impact of any associated laryngeal pathology to make diagnostic distinctions.

Dysphonia and dysphagia as early manifestations of autoimmune inflammatory myopathy.

While dysphagia is a recognized manifestation of autoimmune inflammatory myopathy, a relationship between myositis and dysphonia or laryngeal pathology is not well-documented. We therefore sought to describe the spectrum of laryngeal disorders present in myositis patients, evaluate whether any specific conditions are overrepresented among these patients compared to a large treatment-seeking population, and examine the clinical course and outcomes of these symptoms. This was a retrospective chart review, including all patients seen at the Johns Hopkins Voice Center between January 2016 and December 2017. Demographic data, comorbidities, and laryngeal diagnoses were extracted from the electronic medical record. The charts of patients with myositis were reviewed further to ascertain details of their laryngeal symptoms and myositis disease course. Associations between myositis and dysphonia/dysphagia were evaluated using binary regression and multinomial logistic regression models to adjust for age, sex, race, and smoking status. Of 4252 patients, sixteen had myositis. Compared to 4236 controls, these patients had significantly higher odds of presenting with muscular voice disorders (adjusted odds ratio (OR*)=4.503, p*=0.005) and dysphagia (OR*=6.823, p*<0.001). A majority (64.3%, CI:35.6-93.0%) of myositis patients had laryngeal pathology among the presenting symptoms of their myositis. Across all diagnostic categories, there was a non-significant trend towards better outcomes in patients receiving specific interventions for their laryngeal symptoms. Muscular voice disorders and dysphagia are significantly overrepresented in myositis patients presenting to a laryngology clinic, and in these patients, both are frequently among the presenting symptoms of myositis.

CHARACTERIZATION OF LARYNGEAL DISORDERS IN PATIENTS WITH EXCESSIVE CENTRAL AIRWAY COLLAPSE

SESSION TITLE: Procedures Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Tracheobronchomalacia and excessive dynamic airway collapse are conditions affecting the trachea and mainstem bronchi leading to respiratory symptoms through excessive central airway collapse (ECAC) during expiration. Patients with this condition often present with laryngeal pathology resulting in hoarseness, shortness of breath, dysphagia, or cough. Despite previous descriptions of the incidence of paradoxical vocal fold motion in this population, the various possible laryngeal abnormalities have not been characterized. METHODS: We performed a retrospective review of our prospectively collected institutional tracheobronchomalacia database. The most recent patients seen at the chest disease center during the previous and current year (2019-2020) were evaluated. Demographics, comorbidities, previous airway surgeries, and laryngoscopy results were included. Continuous outcomes are presented as means or medians based on the assessment of normality (Shapiro-Wilk test). Dichotomic outcomes are presented as proportions. RESULTS: A total of seventy patients were included in the study. The median age was 57 (49 – 64) and 55 patients were female (78.6%). The most common comorbidities were asthma in 46 (66.7%), gastroesophageal reflux in 41 (59.4%), and obstructive sleep apnea in 32 (46.4%) patients. Only 4 (5.8%) patients had a previous tracheostomy, while 7 (10.1%) had had a previous airway surgery. Out of 70 patients, 64 (91.4%) were evaluated by the laryngology service. Of the patients that were evaluated, 53 (82.8%) had at least one abnormality in their larynx. The most common findings were laryngeal hyperfunction/muscle tension dysphonia in 34 (53.1%), signs of laryngopharyngeal reflux in 27 (42.2%), and vocal fold hypomobility/paresis in 25 (39.1%) patients. More severe conditions like paradoxical vocal fold motion, laryngospasm, and vocal fold paralysis were present in 13 (20.3%), 2 (3.1%), and 2 (3.1%) patients respectively. CONCLUSIONS: ECAC patients have a high incidence of laryngeal disorders that may contribute to their respiratory symptomatology and deteriorate their health-related quality of life. For this reason, it is important to have a baseline laryngeal evaluation before any airway intervention, especially when respiratory symptoms are out of proportion to the degree of dynamic central airway collapse. CLINICAL IMPLICATIONS: Laryngeal pathology may be an additional cause of symptoms in patients with ECAC that can be overlooked if a detailed laryngoscopy evaluation is not conducted. Early identification and opportune intervention could lead to improved patient-centered outcomes. DISCLOSURES: No relevant relationships by Alex Chee, source=Web Response No relevant relationships by Sidhu Gangadharan, source=Web Response No relevant relationships by Fayez Kheir, source=Web Response Consultant relationship with Boston Scientific Please note: $1001 - $5000 by Adnan Majid, source=Web Response, value=Consulting fee Consultant relationship with olympus Please note: $5001 - $20000 by Adnan Majid, source=Web Response, value=Consulting fee Consultant relationship with pinacle biologics Please note: $1001 - $5000 by Adnan Majid, source=Web Response, value=Consulting fee Consultant relationship with cook medical Please note: $1001 - $5000 by Adnan Majid, source=Web Response, value=Consulting fee No relevant relationships by Pavan Mallur, source=Web Response No relevant relationships by Daniel Ospina-Delgado, source=Web Response No relevant relationships by Mihir Parikh, source=Web Response No relevant relationships by Jennifer Wilson, source=Web Response

Study of spatiotemporal liquid dynamics in a vibrating vocal fold by using a self-oscillating poroelastic model.

The main purpose of this study is to investigate the spatiotemporal interstitial fluid dynamics in a vibrating vocal fold. A self-oscillating poroelastic model is proposed to study the liquid dynamics in the vibrating vocal folds by treating the vocal fold tissue as a transversally isotropic, fluid-saturated, porous material. Rich spatiotemporal liquid dynamics have been found. Specifically, in the vertical direction, the liquid is transported from the inferior side to the superior side due to the propagation of the mucosal wave. In the longitudinal direction, the liquid accumulates at the anterior-posterior midpoint. However, the contact between the two vocal folds forces the accumulated liquid out laterally in a very short time span. These findings could be helpful for exploring etiology of some laryngeal pathologies, optimizing laryngeal disease treatment, and understanding hemodynamics in the vocal folds.

Correlation of Glottic Gap and Voice Impairment in Presbyphonia.

The objective of this study was to investigate the glottic gap area as a significant marker for the severity of presbyphonia as it relates to patient-reported outcome measures (Voice Handicap Index-10 [VHI-10]) and stroboscopic findings. Retrospective case-control study conducted in an academic tertiary voice center. Patients seen at a tertiary voice clinic who were diagnosed with presbyphonia without other organic laryngeal pathology from January 2014 to December 2017 were included. Clinical data and laryngeal videostroboscopy videos were collected. Still images at the point of vocal process approximation during adduction were captured, and the glottic gap area was measured using ImageJ. These were compared to a control cohort. Correlations were made using Wilcoxon rank sum test, Mann-Whitney U test, and Pearson correlation coefficients. Thirty-three patients were included. Inter-rater reliability of glottic area measurement was strong (intraclass correlation coefficient= 0.73, P< .001). Compared to controls, presbyphonia patients had a larger glottic gap area (P< .001) and greater open-phase quotient on laryngeal videostroboscopy (P< .001). Larger glottic gap area did not correlate with patient-reported vocal function as measured by VHI-10 (P= .79) and did not correlate with presence of secondary muscle tension dysphonia (P= .99). In the presbyphonia cohort, the glottic gap area did not correlate with age (P= .29). Glottic gap area at the point of vocal process approximation during phonation can be reliably measured. Patients with presbyphonia have a larger glottic gap area and greater open-phase quotient on stroboscopy, but these do not correlate with patient-reported voice impairment or the presence of secondary muscle tension dysphonia (MTD). These data suggest that dysphonia severity in presbyphonia is not fully explained by a glottic gap or secondary MTD alone. 4 Laryngoscope, 131:1594-1598, 2021.

Twenty Eight Days in the Life of a Vocal Pathology: A Case Study of Videolaryngostroboscopy, Acoustic, and Perceptual Variability

The purpose of this investigation was to observe laryngeal tissue and vocal function changes over the course of 28 days in a single participant diagnosed by a laryngologist with bilateral nodules. Laryngeal imaging, acoustic variables and perceptual assessments of voice quality, and perceived vocal effort were obtained every morning for 28 consecutive days. A daily journal of occupational and recreational voice use as well as menstruation and alcohol consumption was maintained each day. It was hypothesized that the laryngeal pathology would appear more extensive and the vocal function measures obtained would be worse following extensive voice use. Laryngeal imaging, acoustic variables, and perceptual measures quantified provided evidence to support the study hypotheses. The size, extent, and asymmetry of the bilateral vocal pathologies observed were more extensive on days following occupational and recreational vocal loading. Acoustic and perceptual measures obtained correlated with the laryngeal tissue changes observed. Study findings support a more holistic approach to laryngeal pathology diagnosis that is based on a more thorough understanding of vocal loading considerations up to 48 hours prior to laryngeal endoscopy to better understand the pathophysiology of the observed lesion(s) for most accurate clinical diagnosis.

Maximum Phonation Time Normative Values Among Malaysians and Its Relation to Body Mass Index

Maximum phonation time (MPT) is a test to measure glottic efficiency for laryngeal pathology screening and treatment monitoring. The normative value of MPT for South East Asia population has yet to be reported. It is postulated that MPT may be affected by body mass index (BMI) despite the paucity of evidence. Therefore, this study was designed to establish the normative value of MPT for a South East Asia population and investigate its relation to BMI. This cross-sectional study was conducted in Universiti Kebangsaan Malaysia Medical Center between May and September 2017. Three hundred males and females with mean age of 30.23 (±11.04) years were recruited in equal number for each gender (n=150) and divided into 3 groups of 50 according to their BMI (n=50). The three groups are non-obese (BMI≤22.9kg/m2); obese (BMI between 23 and 34.9 kg/m2); and morbidly obese (BMI >35kg/m2). BMI and Voice Handicap Index-10 (VHI-10) were obtained. The average of three readings of MPT was measured using a stopwatch while the participants phonate /a/, /i/ and /u/. Unpaired t-test and ANOVA were used to compare means between and across groups. Spearman correlation assessed the correlation between MPT and BMI. The normative values of MPT of both genders and correlation with BMI were analyzed. The MPT normative values for males and females in the non-obese group were of 21.41 (±6.85) seconds and 18.05 (±5.06)seconds respectively for /a/. The MPT for all vowels were significantly higher in males across the BMI groups (P ≤ 0.05). There was low negative correlation between MPT and BMI in both genders. This pioneering study documented the normative values of MPT among Malaysians showed that males had longer MPT than females across the BMI groups. Obesity affects the MPT in that as BMI increases, the MPT decreases.

Study of maximum phonation time and S/Z ratio in laryngeal paralysis

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Alterations in human voice occur frequently and patients usually complain of hoarseness of voice. Laryngeal paralysis is an important differential diagnosis in patients complaining change of voice. Because of simplicity and ease, maximum phonation time (MPT) and S/Z ratio have become the most frequently used clinical tools to assess phonatory mechanics. Published research studying analysis of MPT and S/Z ratio in patients with vocal cord paralysis (VCP) is scanty. Hence this study was taken up to study MPT and S/Z ratios in patients with laryngeal paralysis.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;62 patients with VCP were included in our study. Complete history was taken and examination was done in all patients. VCP was confirmed by indirect laryngoscopic examination. The MPT and S/Z ratios were evaluated in a quiet room. Data was analyzed using IBM SPSS Version 22.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Mean MPT in males with VCP was 6.71±0.54 and in females it was 6.80±2. Mean S/Z ratio in males was 1.69±0.54, in females 1.59±0.35. The difference between laterality of VCP and MPT was statistically highly significant and the difference between laterality of VCP and S/Z ratio was also statistically highly significant. Our study shows no statistically significant difference in MPT and S/Z ratio with respect to age and gender. There was a significant negative correlation between MPT and S/Z ratio. &lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Irrespective of age and gender MPT and S/Z ratio are simple and effective objective clinical tests to diagnose paralytic laryngeal pathologies. As laryngeal pathology heals on treatment MPT and S/Z ratio are expected to normalize indicating therapeutic progress.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;

The Association Between Endotracheal Tube Size and Aspiration (During Flexible Endoscopic Evaluation of Swallowing) in Acute Respiratory Failure Survivors.

To determine whether a modifiable risk factor, endotracheal tube size, is associated with the diagnosis of postextubation aspiration in survivors of acute respiratory failure. Prospective cohort study. ICUs at four academic tertiary care medical centers. Two hundred ten patients who were at least 18 years old, admitted to an ICU, and mechanically ventilated with an endotracheal tube for longer than 48 hours were enrolled. Within 72 hours of extubation, all patients received a flexible endoscopic evaluation of swallowing examination that entailed administration of ice, thin liquid, thick liquid, puree, and cracker boluses. Patient demographics, treatment variables, and hospital outcomes were abstracted from the patient's medical records. Endotracheal tube size was independently selected by the patient's treating physicians. For each flexible endoscopic evaluation of swallowing examination, laryngeal pathology was evaluated, and for each bolus, a Penetration Aspiration Scale score was assigned. Aspiration (Penetration Aspiration Scale score ≥ 6) was further categorized into nonsilent aspiration (Penetration Aspiration Scale score = 6 or 7) and silent aspiration (Penetration Aspiration Scale score = 8). One third of patients (n = 68) aspirated (Penetration Aspiration Scale score ≥ 6) on at least one bolus, 13.6% (n = 29) exhibited silent aspiration, and 23.8% (n = 50) exhibited nonsilent aspiration. In a multivariable analysis, endotracheal tube size (≤ 7.5 vs ≥ 8.0) was significantly associated with patients exhibiting any aspiration (Penetration Aspiration Scale score ≥ 6) (p = 0.016; odds ratio = 2.17; 95% CI 1.14-4.13) and with risk of developing laryngeal granulation tissue (p = 0.02). Larger endotracheal tube size was associated with increased risk of aspiration and laryngeal granulation tissue. Using smaller endotracheal tubes may reduce the risk of postextubation aspiration.

The Impact of Laryngeal pathology on sleep disorders patients

Sleep disorders are a common disorder the most frequent being obstructive sleep apnea characterized by repetitive episodes of upper airway collapse and respiratory pause. It is associated with a significant cardiovascular morbidity and mortality and severely alters the quality of life .In many cases it can remain undiagnosed because of its symptoms that can be underestimated by both the patient and the doctor. Tobacco, alcohol abuse and obesity are amongst the most common risk factors but the most important ones are related to different anatomical structures that can stop the airflow.Treating this disorder sometime requires multilevel surgery depending on the structures involved the most common of them being palatal, oropharyngeal and tongue base. The development and increased usage of sleep endoscopy has somewhat changed the treatment options due to the fact that laryngeal collapse is almost always seen only on sleep endoscopy. The role of laryngeal pathology has to be taken into account especially in cases where CPAP and surgery have failed.

Flock health survey of Irish Texel society breeders and larynx examination in Texel sheep

BackgroundLaryngeal chondritis is a disease of undetermined aetiology, characterised by oedema, ulceration, abscessation and necrosis of the laryngeal mucosa and cartilage. The initial aim of the study was to document flock health issues identified by Irish pedigree Texel breeders using a questionnaire survey. Additionally, given the reports of breed predisposition for laryngeal chondritis in Texels, a further aim was to identify if laryngeal problems were perceived as an issue. Work was then conducted to identify if pre-clinical laryngeal mucosal pathology was identifiable in Texel sheep showing no overt clinical signs of respiratory disease and if associations existed between laryngeal measurements and laryngeal pathology.Thirty one larynges were collected from a Texel flock that previously had laryngeal chondritis diagnosed in fallen stock. Gross visual inspection was performed to identify and grade (0–5) laryngeal pathology. A series of measurements were then performed on larynges that had been formalin fixed. Associations between independent variables (larynx measurements) and the dependent variable (laryngeal pathology score) were examined.ResultsRespiratory disease was the most frequently identified health issue. Farmer-diagnosed ‘throat problems’ were reported by over 80% of respondents.Laryngeal pathology was noted in Texels showing no overt clinical signs of respiratory disease. Associations between laryngeal measurements and laryngeal pathology were identified relating to the angle between the cranial point of the cricoid cartilage and the vocal process of the arytenoid cartilage.ConclusionsMild laryngeal pathology was noted in animals with no overt clinical signs of respiratory disease. Future research should examine whether significant associations between laryngeal measurements and laryngeal pathology identified in the current study can be measured ante mortem, and whether such ante mortem measurements will allow early identification of sheep at risk of developing laryngeal chondritis.

Endoscopic Findings in Male Prepubertal Choir Singers.

The male singing voice through puberty undergoes many changes that present challenges for the singer and choral director. The purpose of this study was to discuss the endoscopic findings seen in prepubescent choir singers. Single-institution prospective study. Subjects were recruited from the Cincinnati Boychoir and were described as Cooksey stage unchanged or mid-voice I, as described by the Boychoir artistic director. Vocal history was obtained via questionnaire at the initial visit. Subjects with known laryngeal pathologies were excluded. Endoscopic laryngeal examinations were performed using videoendoscopy. During examination, each subject sang four discrete frequencies. Findings of the endoscopic exam were judged by a board-certified pediatric otolaryngologist specializing in pediatric voice. We evaluated 28 subjects prior to vocal maturation. Their age range was 8 to 13 years old (mean = 10.2 ± 1.2 years). The singing voice category of all 28 subjects was described as soprano vocal range by the Boychoir artistic director. The subjects had a mean of 1.7 ± 1.1 years in the Boychoir (0-5 years). None reported history of vocal issues or voice problems in the past; seven (25%) subjects had vocal fold lesions seen at one or more frequencies; 24 (85%) subjects had a posterior gap seen at one or more frequencies. Two subjects (7%) had a posterior gap at one frequency, C3 and G3, respectively. Five subjects (18%) had a posterior gap at two frequencies, seven subjects (25%) at three frequencies, and 10 subjects (36%) in all four frequencies. Our study aimed to describe the laryngeal examination of dedicated Boychoir singers prior to undergoing pubertal development and vocal maturation. In elite pediatric singers we found that vocal nodules are common (25%) and are not correlated with vocal symptoms. These findings may suggest that asymptomatic lesions may be more prevalent than previously thought. In these individuals, posterior glottic gap is common and can be considered a normal glottal configuration. 4 Laryngoscope, 131:592-597, 2021.

Volumetric Analysis of the Vocal Folds Using Computed Tomography: Effects of Age, Height, and Gender.

The goal of this study was to use computed tomography (CT) volumetric analysis to assess the effect of age, gender, height, body mass index (BMI), and ethnicity on vocal fold volume in patients with normal larynges. Retrospective cross-sectional study. Vocal fold length, width, and height were measured in a total of 105 patients without a history of laryngeal or thyroid pathology on thin-section soft-tissue neck CTs. The product of the three dimensions was used to calculate vocal fold volume. Simple and multiple linear regression analyses were used to assess for an association between vocal fold volume and age, gender, height, BMI, and ethnicity. Intraclass correlation coefficients (ICCs) were estimated to evaluate the degree interobserver and intraobserver agreement. Vocal fold volume was not associated with age, BMI, or ethnicity. Gender-adjusted height (P = .002) and height-adjusted gender (P = .016) were significantly associated with volume. Height remained significantly associated with volume after stratifying by gender (P < 0.001). There was moderate-to-good correlation in both interobserver (ICC = 0.690 to 0.761) and intraobserver (ICC = 0.733 to 0.873) agreement. Age was not associated with vocal fold volume, which is in accordance with several prior negative studies. Age-related vocal fold atrophy may not substantially contribute to presbyphonia symptoms, but other processes such as changes in the extracellular matrix may play a larger role. However, both gender and height were independently associated with vocal fold volume. 4 Laryngoscope, 131:E240-E247, 2021.

Diode Laser for Laryngeal Cancer: "980 nm" and Beyond the Classic CO2.

Lasers have been used in otolaryngology for more than 40 years and are widely considered an established way of addressing laryngeal pathology, benign and malignant. Carbon dioxide (CO2) laser is considered a gold standard, but over the last 2 decades, a new technology has been developed and established in other medical specialties, not so much in Ear Nose and Throat (ENT), the diode laser. It consists of a flexible fiber that passes through a hollow guidance system and is capable of reaching certain angled spots easier than straight beam systems. Portability, lower cost, easier setup, and improved photocoagulation are just some of the many features rendering it an excellent choice for the surgeon and the patient. The few studies published worldwide for the usage and efficacy of this system show no major differences related to the oncologic outcome and survival rate of patients having an early glottic tumor between diode laser microsurgery and CO2 laser cordectomy. Nevertheless, the advantages offered by fiber-optic laser surgery render it a worthy and perhaps equal alternative for treating this kind of pathology.

Office Laser Laryngology: A Paradigm Shift.

To present the value of office-based laryngological procedures as an effective alternative method to the treatment of benign and malignant laryngeal pathologies. We have reviewed the technological advancements of fiber-guided laser systems, fiberoptic endoscopes, and high-definition imaging systems that have enabled office-based laryngological procedures. We describe the importance of case and patient selection, the available laser systems, and the technique applied. Several benign and malignant pathologies can be now treated in the office under local anesthesia with angiolytic or thermocoagulative lasers and with success rate comparable to that of general anesthesia. Safety guidelines and laser precautions must be implemented invariably to protect the patient and caregivers from the untoward effects of laser. Although there is considerable reduction of cost with office procedures, there are risks of undertreatment, increased repeatability, as well as tissue edema from the burning effect. The low learning curve, high patient satisfaction rate, and excellent results indicate that in-office laser procedures have become an effective weapon in our armamentarium.