Membranous Vocal Fold Research Articles

Linear Measurement of Females' Vocal Fold Across Different Ages

Abstract Background One of the most complex oragns of the human body is the larynx so Understanding its morphology is an important step toward understanding the detailed laryngeal anatomy, and physiology. Different studies have described the linear measurements of the larynx in different measuring methods. but no studies have been structured to describe vocal fold length in vivo in females at different stages of their lives.The vocal instrument is comprised of the vibratory body, the respiratory power source and the oropharyngeal resonating chambers. Voice is characterized by its intensity, frequency, and harmonics. The harmonics are hormonally dependent. Aim of the Work The aim of this study is to screen the membranous vocal fold length in different ages throughout females’ life and if it is affected by hormonal changes in their lives or not. Study Design a comparative cross-sectional study. Patients and Methods This comparative cross-sectional study was carried out on 120 Egyptian Arabic speaking apparently healthy females at the outpatient clinic of the Units of Phoniatrics, ENT Department of both Ain Shams University Hospitals and Zagazig University Hospitals. Results It was obvious that female’s larynx is affected by age and sex hormones that is reflected on the laryngeal structure and function. Although the results showed non significant relation between the length of the membranous part to aging this may be due to small sample size that could not reflect that difference. Conclusion The vocal imprint is characteristic to each individual. It reveals personality and translates emotions. The voice evolves with age. It bears both the scars of life, as well as its joys and pleasures. Nevertheless, the human voice remains intangible and a fertile field for future research in the cycle of life.

A Modified Approach for Preventing Anterior Glottic Web Formation Using Mitomycin C in Bilateral Vocal Fold Lesions.

Objectives: Laryngeal keel insertion, mucosal suture, application of mitomycin-C (MMC), and staged operations are approaches to prevent the anterior glottic web, but there are limitations. Our study suggests a modified approach to prevent the formation of an anterior glottic web. Methods: This retrospective single-institution tertiary center study (N = 23) involved the simultaneous removal of bilateral vocal fold lesions with topical MMC application. If exudate was identified after 4 to 6 weeks, second laryngomicroscopic surgery (LMS) was performed to remove it with topical MMC application. Extent of anterior glottic web was measured as a percentage of the total length of the membranous vocal fold. Results: After the initial surgery, 18 patients recovered without anterior web or fibrin exudate. Thick exudate was observed in 5 patients. After the second LMS, all patients showed improvement and did not develop anterior web. Conclusion: This modified method has been developed to prevent the anterior glottic web without complications.

De Novo Granuloma of the Membranous Vocal Fold: A Marker of Occult Malignancy.

De novo occurrence of granuloma (granulation tissue) on the membranous vocal fold is not readily explained by usual causes of granuloma at the vocal process. We describe a series of patients. Case series. Single academic institution. Cases were identified over a 16-year period. All patients exhibited granulation tissue on pathology. Demographic details, presentation, treatment, histology, and clinical outcomes were recorded. Five patients (mean age: 74.0 ± 6.1 years, 40.0% male, 40.0% former smokers) underwent a biopsy. Persistent or recurrent granulation led to a second biopsy in 4 patients an average of 1423.5 days later, revealing a new diagnosis of squamous cell carcinoma (SCC) in situ in one and mild dysplasia in another. Further persistence or recurrence led to a third biopsy or excision an average of 302.3 days later in 3 patients, demonstrating SCC in situ in 1. An average of 2.5 biopsies were required with a mean time to SCC in situ diagnosis of 919.5 days from presentation. Two patients continued to demonstrate persistent granulation tissue on histology. The membranous vocal fold is an atypical location for granuloma and portends a risk of occult malignancy. The occurrence of de novo granuloma at this site should prompt close long-term clinical surveillance with a low threshold for biopsy. Consideration should be given to tissue collection in the operating room to adequately sample the lesion's base. Concern should persist even after a negative biopsy, and serial observation with repeat biopsy as needed should be pursued.

Risk factors for postoperative vocal fold fibrosis following microlaryngeal surgery.

To analyze the risk factors for postoperative vocal fold fibrosis (PVF) in patients undergoing microlaryngeal surgery (MLS) for benign vocal fold lesions. Retrospective study. We retrospectively included patients who had undergone MLS for vocal polyps, nodules, mucus retention cysts, fibrous mass, or Reinke's edema. Data on the patients' clinicodemographic characteristics and intraoperative findings were obtained by reviewing their clinical records. PVF was defined by the presence of an adynamic segment of membranous vocal folds or a marked reduction in mucosal wave amplitude on post-MLS (6 weeks) videolaryngostroboscopy. The risk factors for PVF were analyzed through univariate and multivariate logistic regressions. This study included 89 patients, of whom 16 (18%) were given a diagnosis of PVF. A significantly increased incidence of PVF was noted in patients with fibrous mass (p < .01). The univariate analysis indicated that lesion attachment to the vocal ligament, prolonged surgical duration (>60 min), and symptom duration (>12 months) were significantly correlated with PVF (p < .05). The multivariate analysis confirmed that diagnosis of fibrous masses, lesion attachment to the vocal ligament and symptom duration are significant risk factors for PVF. PVF is more common in patients with fibrous masses. Lesions attachment to the vocal ligament and prolonged symptom duration appear to be other significant risk factors for PVF. 4.

Subtotal Submucosal Arytenoidectomy with Lateralization Sutures (SMALS) Covered by a Mucosal Flap.

Glottic airway stenosis (GAWS) may result from bilateral paralysis (BVFP) or posterior glottic stenosis (PGS). Since the glottis is the principal airway sphincter, surgeons shift on the balance between airway, aspirations, and voice. We aim to describe our surgical technique and outcome of the SMALS procedure for GAWS correction. A retrospective cohort of patients who underwent SMALS for PGS between 2018 and 2021. SMALS involves: endoscopic submucosal subtotal arytenoidectmy (preserving medial mucosal flap) and lateralization sutures. The sutures lateralize the mucosal flap to cover the arytenoidectomy bed without lateralization of the membranous vocal fold; expanding the posterior glottis, while preserving a relatively good voice. Covering the arytenoidectomy bed enhances healing. Medical and surgical data, airway, voice, and swallowing symptoms were collected. Relative glottic opening area (RGOA) and relative glottic insufficiency area (RGIA) were calculated. Eleven PGS patients who underwent 15 SMALS were included (4 bilateral), all patients had post-intubation PGS, 1 patient also had prior radiation to the larynx. All patients were tracheostomy-dependent. There were no major complications. No granulation or retracting scar was observed at follow-up. None had a persistent voice or swallowing disability. Successful outcome (decannulation) was achieved in 8 (73%); RGOA increased in all (Δ = 0.37; p = 0.003), while RGIA remained relatively stable (Δ = 0.02; p = 0.055). SMALS is a safe and effective, novel modification of the classic arytenoidectomy, for GAWS correction that can be easily applied and may expand the airway without significant glottic insufficiency symptoms. 4 Laryngoscope, 134:353-360, 2024.

Recurrent Respiratory Papilloma of the Larynx

Recurrent respiratory papilloma (RRP) is a common benign neoplasm that most commonly affects the larynx. Caused primarily by human papilloma virus (HPV) types 6 and 11, RRP affects both children and adults; juvenile-onset RRP is thought to be related to HPV exposure during childbirth, whereas adult-onset disease has been hypothesized to be related to sexual contact.1Aaltonen L.M. Rihkanen H. Vaheri A. Human papillomavirus in larynx.Laryngoscope. 2002; 112: 700-707https://doi.org/10.1097/00005537-200204000-00020Crossref PubMed Scopus (83) Google Scholar Symptoms of RRP are typically voice or airway related. Adults tend to experience voice changes, primarily because of impairment of vocal fold vibration in the setting of papilloma along the membranous vocal folds. In children, in whom lesions tend to grow more quickly, airway narrowing may present with stridor in addition to voice changes. Direct or indirect laryngoscopy is standard work-up. Flexible fiberoptic or distal chip scopes may reveal heaped, irregular lesions of the glottis (Figure 1A) or supraglottis, and filters (eg, narrow-band imaging) (Figure 1B) may help to reveal intraepithelial capillary loops. Biopsy remains the criterion standard for diagnosis. Figure 2 illustrates typical findings, including a higher-power image of a cellular papillary frond with viral cytopathic effects and corresponding chromogenic in situ hybridization for low-risk HPV type 6/11.2Venkatesan N.N. Pine H.S. Underbrink M.P. Recurrent respiratory papillomatosis.Otolaryngol Clin North Am. 2012; 45 (671-94, viii-ix. https://doi.org/10.1016/j.otc.2012.03.006)Abstract Full Text Full Text PDF Scopus (89) Google Scholar Treatment includes excision or ablation with cold technique, photoangiolytic lasers, or microdebriders, with maximal conservation of the subepithelial vocal fold tissue. Recurrent respiratory papilloma routinely recurs, and so adjunct treatments with cidofovir and bevacizumab are advocated for recalcitrant cases.3Pogoda L. Ziylan F. Smeeing D.P.J. Dikkers F.G. Rinkel R.N.P.M. Bevacizumab as treatment option for recurrent respiratory papillomatosis: a systematic review.Eur Arch Otorhinolaryngol. 2022; 279: 4229-4240https://doi.org/10.1007/s00405-022-07388-6Crossref Scopus (3) Google Scholar Emerging evidence suggests that HPV vaccination, even in those already affected, may be beneficial in reducing the severity of disease.4Ponduri A, Azmy MC, Axler E, et al. The efficacy of human papillomavirus vaccination as an adjuvant therapy in recurrent respiratory papillomatosis. Laryngoscope. Published online January 18, 2023. https://doi.org/10.1002/lary.30560.Google Scholar The authors report no competing interests.

Membranous Vocal Fold Lesions in Patients With Chronic Cough: A Case Series

Trauma related to chronic cough and forceful glottal closure has been associated with lesions of the vocal process; however, there is limited description of cough leading to membranous vocal fold lesions. We present a series of mid-membranous vocal fold lesions in a cohort of patients with chronic cough, with a proposed mechanism of lesion formation. Patients treated for chronic cough with membranous vocal fold lesions affecting phonation were identified. Presentation, diagnosis, treatment strategies (behavioral, medical, and surgical), patient-reported outcome measures (PROMs), and videostroboscopy were reviewed. Five patients are included (four females, one male, aged 56±16 years). Mean cough duration was 2.6±3.5 years. All patients were on acid suppressive medications for existing gastroesophageal reflux disease (GERD) prior to referral. All lesions were identified at the mid-membranous vocal folds and morphologically encompassed a wound healing spectrum between ulceration and/or granulation tissue (granuloma) formation. Patients were treated in an interdisciplinary fashion with behavioral cough suppression therapy, superior laryngeal nerve block, and neuromodulators. Three had persistent lesions requiring procedural intervention (one office-based steroid injection and two surgical excisions). At the completion of treatment, all five patients had improvement in Cough Severity Index with an average decrease of 15.2±4.8. All but one patient had improvement in their Voice Handicap Index-10 with an average decrease of 13.2±11.1. One patient undergoing surgical intervention was noted to have a persistent lesion on follow-up. Mid-membranous vocal fold lesions in patients with chronic cough are uncommon. When they do occur, they represent epithelial change arising in context of shear injury and are distinct from phonotraumatic lesions in the lamina propria. An interdisciplinary approach including behavioral cough suppression therapy, neuromodulators, superior laryngeal nerve block, and acid suppression are reasonable for initial management, reserving surgical intervention for refractory lesions once the inciting source of injury has been controlled.

Surgical Method for Glottic Web and Vocal Fold Adhesion

Laryngeal web most frequently occurs due to acquired rather than congenital factors. It can cause dysphonia and airway disorder depending on the extent of the area or thickness of the web. The prevention of relapse after web resection is the most important aspect of surgery for laryngeal web. A local mucosal flap can be developed using the superior and inferior surface of the web. This flap can cover at least one side of the wound on the vocal fold after web resection, and consequently leads to primary healing. The other technique for preventing web relapse is to place a stent (also called a “keel”) at the anterior commissure after removing the web. A slim silicone tube can be used as a stent to prevent web relapse. A membrane like plate can also be adopted. The round-shaped silicone tube has an advantage in softness for the vocal fold in comparison to a flat-shaped plate. One of the disadvantages of the silicone tube is that it cannot cover the wound that develops after the resection of a broad web affecting the posterior membranous vocal fold. To resolve this problem, we developed a new type of silicone stent that includes both a tube and a plate component. An appropriate surgical method and stent should be chosen based on the condition of the web.

Voice After Cordectomy Type I or Type II or Radiation Therapy for Large T1a Glottic Cancer.

T1a glottic cancer can be treated with transoral laser microsurgery (TLM) or radiation therapy (RT). Dysphonia is the major disadvantage of TLM, and preservation of voice appears to be the best advantage of RT compared to TLM. Studies on voice outcomes of both options gave conflicting results, but there is a tendency toward better voice outcome after TLM compared to the past. Nonrandomized retrospective cohort study. Tertiary referral center. In total, 172 patients with a cancer lesion involving more than two-thirds of 1 membranous vocal fold underwent cordectomy type I (n = 56) (C1 group) or type II (n = 59) (C2 group) or RT (n = 57) (RT group). GRBASI (grade, roughness, breathiness, asthenia, strain, instability), videolaryngostroboscopy, Voice Handicap Index-30, acoustic analysis including F0, jitter, shimmer, noise to harmonic ratio, cepstral peak prominence, and cepstral spectral index of dysphonia using running speech, and aerodynamic analysis were performed before treatment and 6 and 24 months after treatment. Study groups did not differ significantly on pretreatment voice outcomes (P > .05). The RT group had significantly better voice outcomes at 6 months posttreatment compared to the C1 and C2 groups (P < .05). The C1 group had significantly better voice outcomes at 6 months posttreatment compared to the C2 group (P < .05). The C1 group had significantly better voice outcomes at 24 months posttreatment compared to the RT and C2 groups (P < .05). The RT and C2 groups did not differ significantly at 24 months posttreatment (P > .05). Voice outcomes after C2 are equal to RT. C1 has better voice outcomes than RT. C1 and C2 can be the treatment of choice for large T1a glottic cancers.

Endoscopic Posterior Rotation Flap for Posterior Glottic Insufficiency.

Endoscopic Posterior Rotation Flap for Posterior Glottic Insufficiency.

Inflammatory Myofibroblastic Tumor of the Larynx: Report of a Case

PurposeInflammatory myofibroblastic tumor (IMT) is a rare tumor composed of mesenchymal myofibroblastic spindle cells enveloped by an inflammatory infiltrate. Historically, this tumor sparked debate regarding whether it was a true malignancy with metastatic potential or merely a locally destructive physiologic inflammatory response. Few reports of IMT exist in the recent literature, with the majority of cases occurring in the pediatric population and favoring the lungs. Here we present an exceedingly rare case of IMT involving the larynx of a 22-year-old female. ResultsA hemorrhagic and solid mass of the right true membranous vocal fold was excised and sent for histopathological assessment. Features of the surgical specimens were diagnostic for IMT. Intralesional steroid therapy was selected for additional treatment. Panendoscopy facilitated surveillance for any additional or recurrent lesions, of which there were none. At 11 months post-excision, follow-up MRI revealed symmetric vocal cords without evidence of any masses. ConclusionsAlthough rare, laryngeal IMT should be considered in any patient presenting with hoarseness due to a vocal fold mass. Based on the successful treatment of our patient, we suggest that our approach of surgical excision followed by intralesional corticosteroid injection may be an efficacious treatment approach for this rare tumor. However, more research is warranted to elucidate the most effective, safe, and cost-effective treatment approach.

The Effect of the Mother's Participation in Therapy on Children with Vocal Fold Nodules.

Vocal fold nodules (VFN) are a bilateral epithelial thickening of the membranous vocal folds. In this study, children with VFN and their mothers took part in voice therapy. We then compared acoustic analyzes and subjective evaluations to those in previous literature to determine whether voice therapy is more effective for children with VFN when their mothers also take part in therapy. Children aged eight to 12 years who were diagnosed with bilateral VFN between January 2018 and January 2020 were included in this study. Participating children diagnosed with bilateral VFN were divided into two groups based on the wishes and cooperation of their families. Group 1 consisted of 16 patients; Group 2 included 17 patients. The children in Group 1 received voice therapy alone; children in Group 2 took part in therapy with their mothers. For all participants, the average fundemental frequency (F0), jitter percentages, shimmer percentages, maximum phonation time (MPT) and s/z ratios were measured. Pediatric voice handicap index (p-VHI) values were calculated as well. The two groups' measures pre-treatment and post-treatment were compared. Except for p-VHI, no significant difference was observed between the two groups. However, p-VHI post-treatment was significantly lower in Group 2 than in Group 1. Involving the families and even teachers of children with VFN in voice therapy can increase the effectiveness of therapy. The family's involvement increases the child's motivation in therapy. The mother's presence during therapy, supporting the child or even doing the work with the child, can be a very important source of motivation for the child, who may already be tired from school and other activities. Thus, the mother's involvement increases the child's compliance with and interest in therapy.

A COMPARATIVE STUDY OF SURGICAL TREATMENT VERSUS CONSERVATIVE TREATMENT OF VOCAL CORD NODULES IN TERTIARY CARE HOSPITAL.

Background: Vocal cord nodules are bilateral, benign, and callous like growths of the mid portion of the membranous vocal folds. They are of variable size and characterised histologically by thickening of epithelium with a variable degree of inflammation in the underlying superficial lamina propria1. They characteristically produced hoarseness, discomfort and an unstable voice when speaking or singing. AIMS: Comparison between post treatment (surgical and conservative treatment groups) voice quality of the two groups and post treatment status of nodules in both the groups. MATERIAL AND METHODS: Outpatient department and Indoor wards of Department of ENT and Head Neck surgery, R. G Kar Medical College. Patients attending ENT OPD of R G Kar Medical College during the Study period were the study population. Sample size was atleast 50 Patients. RESULT: In group-A, 4(23.5%) patients were regressing and 13(76.5%) patients had resolve. In group-B, 4(12.1%) patients were persisting and 29(87.9%) patients were regressing. Association of post Rx VCN vs. group was statistically significant (p&lt;0.001). CONCLUSION: Vocal fold nodule is one of the most frequent benign laryngeal lesions, influencing the quality of life of those affected by them, primarily the vocal production. Despite being a well-established therapy in conjunction with surgery, speech therapy alone may also be effective in treating these lesions.

Vocal Tradeoffs in Anterior Glottoplasty for Voice Feminization.

Anterior (Wendler) glottoplasty has become a popular surgery for voice feminization. However, there has been some discrepancy between its theoretical pitch-raising potential and what is actually achievable, and downsides to shortening the glottis have not been fully explored. In addition, descriptions of the surgery are inconsistent in their treatment of the vocal ligament. This study aimed to determine 1) how fundamental frequency (fo ) is expected to vary with length of anterior glottic fixation, 2) the impact of glottic shortening on sound pressure level (SPL), and 3) the effect of including the ligament in fixation. Computational simulation. Voice production was simulated in a fiber-gel finite element computational model using canonical male vocal fold geometry incorporating a three-layer vocal fold composition (superficial lamina propria, vocal ligament, and thyroarytenoid muscle). Progressive anterior glottic fixation (0, 1/8, 2/8, 3/8, etc. up to 7/8 of membranous vocal fold length) was simulated. Outcome measures were fo , SPL, and glottal flow waveforms. fo increased from 110 Hz to 164 Hz when the anterior one-half vocal fold was fixed and continued to progressively rise with further fixation. SPL progressively decreased beyond 1/8 to 1/4 fixation. Inclusion of the vocal ligament in fixation did not further increase fo . Any fixation increased aperiodicity in the acoustic signal. The optimal length of fixation is a compromise between pitch elevation and reduction in output acoustic power. The simulation also provided a potential explanation for vocal roughness that is sometimes noted after anterior glottoplasty. NA Laryngoscope, 131:1081-1087, 2021.

Sectorial Analysis of the Fibrous Matrix of Vocal Folds in the Elderly

to determine the sectorial concentration of fibrous matrix along the vocal folds of the elderly. Thirteen fresh vocal folds were removed from 13 cadavers. The subjects were divided into two groups: control group (CG) - age range 25-40 years (n=5), and elderly group (EG), aged ≥70 years (n-8). The vocal folds were separated according to regions in: anterior macula flava (AMF), posterior macula flava (PMF), medial region (M) and lateral region of the membranous vocal fold (L). The material was examined using a scanning electron microscope and 10 pictures per region were obtained at 1200x magnification. The area of fibrous matrix was quantified in both groups using the AVSOFT Biovew Program. Percentage (%) of fibrous matrix per region (%): AMF (EG=86.78%; CG=81.63%); PMF (EG=88.19%; CG=81.52%); M (EG=84.92%; CG=77.96%); L (EG=83.93%; CG=78.91%). Irregular distribution of a dense fibrous matrix was also more evident in the elderly's larynges in a qualitative assessments. A higher concentration of fibrous matrix was observed in the vocal folds of the elderly when compared to the control at all the studied regions. The greatest increase in the concentration of fibers in the medial portion of the body of the vocal folds is probably due to the phonatory stimulation. The macula flava remains functional even in the senile larynx.

Modified Isshiki's arytenoid adduction without separating cricothyroid and cricoarytenoid joints.

SUMMARYModified methods of arytenoid adduction (AA) have been reported to keep the cricothyroid (CT) joint intact. However, postoperative laryngeal oedema and long-term vocal function have not been compared with those after AA with CT joint separation. We refined AA to combine it with nerve-muscle pedicle (NMP) flap transfer for preservation of the CT joint. Eight patients with unilateral laryngeal paralysis underwent the procedure (Group 1). Postoperative oedema at membranous vocal fold (MVF), arytenoid mound (AM) and pyriform sinus (PS) was assessed using a 4-point ordinal scale: none (0) to severe (3). Laryngeal oedema in Group 1 was compared with that of 19 patients who had AA with CT joint separation (Group 2). Maximum phonation time (MPT), jitter and voice handicap index-10 (VHI-10) were measured before surgery and one year postoperatively. Vocal function in Group 1 was compared with 58 patients who underwent AA + NMP flap transfer with CT joint separation (Group 3). The degree of oedema from postoperative days 1 to 6 in Group 1 was relatively invariable: 1.2~1.6 at MVF, 1.3~1.7 at AM, and 1.4~1.7 at PS. The scores at 3 and 4 days postoperatively at MVF and PS in Group 1 were significantly lower than in Group 2 (P = 0.0032 and 0.0317 at day 3, and 0.0224 and 0.0182, at day 4, respectively). The degree of oedema at day 3 at AM in Group 1 was significantly less than in Group 2 (P = 0.0260). One year after surgery, there were no significant differences in MPT, jitter and VHI-10 between Groups 1 and 3 (P = 0.660, 0.111 and 0.556, respectively). Preservation of the CT joint might be beneficial in reducing the maximum degree of laryngeal oedema after AA. Vocal function after AA + NMP flap transfer with CT joint preservation is comparable to that after AA + NMP flap transfer with CT joint separation.

Contact Pressure Between the Vocal Folds in Reinke's Edema: Experimental Observations on an Excised Human Larynx

To analyze the range of values of the contact pressure between the membranous vocal folds with Reinke's edema and to compare it to those observed in the absence of such a lesion. Two human larynges were separately tested on the experimental bench, one of them with a bilateral loose swelling of the vocal folds. Once in a glottal prephonatory configuration, airflow was increased until achievement of self-sustained oscillations while recording aerodynamic, acoustic, electroglottographic data, and contact pressure between the folds. We observed well-documented variations in acoustical parameters, as the decrease of the fundamental frequency and the increase of the phonation threshold pressure. The results of the study also point to a significant increase in the amplitude of the contact pressure in presence of the Reinke's edema, and a lower degree of harmonicity of the produced sounds. This is the first report of ex vivo study of a larynx with Reinke's edema. It highlights the increase in the contact pressure during phonation, which possibly contributes to sustain the lesion once it appeared.

Ayurvedic Management of Subepithelial Vocal Cord Cyst: A Case Study

Vocal fold cysts, otherwise called as vocal cord cyst, are benign masses formed on the membranous vocal folds. Present line of treatment in contemporary medical science is surgery followed by supplementary voice therapy. There are high chances of recurrence of the cyst after surgical excision. This report deals with a single case which was effectively managed with ayurvedic intervention. A 38-year-old female patient presented with hoarseness of voice, difficulty to produce high pitch notes, variations in pitch while talking. Rigid endoscopy was done and there was presence of solitary subepithelial vocal fold cyst in the middle of larynx. Treatment was done with Amapachana with Swasamrutam capsule and gorochanadi, two tablets twice daily after food. Snehapana with Varanadighrita + Guggulutikthaka ghrita in arohana matra for 4 days; Abhyanga and bashpasweda for 1 day; Virechana with TrivrtChurna 20 gm given at 7 am; Nasya with Anuthaila for 7 days; Matravasti with Sahacharadi Mezhukupakam 60 mL for 5 days. The hoarseness of voice and voice clarity improved on completion of the treatment. A repeat endoscopy showed that the cyst was no longer present. Subepithelial vocal cord cyst can be effectively managed with ayurvedic intervention principles of amapachana, agnideepana and ojovardhana.

An ex vivo porcine model of the anterior glottoplasty for voice feminization surgery.

Perceived gender identity is correctly assigned when a combination of physical and vocal attributes become congruent. Several voice feminization procedures have gained popularity, but current evidence of their impact on vocal feminization is limited to case series. This study establishes an ex vivo porcine phonatory model to evaluate the ideal extent of anterior glottic web formation in relation to frequency elevation and airway patency. Six fresh porcine larynges were obtained and fitted with arytenoid adduction sutures. Compressed air was passed through the larynges, and the vocal folds were adducted to induce phonation. Vocal fold length, posterior glottic width, fundamental frequency, and sound pressure intensity were measured as the vocal folds were progressively shortened as per the anterior glottic web surgical technique. The average fundamental frequency prior to web formation was 109.7 Hz. The maximum frequency achieved after web formation was 403.7 Hz, and the web proportions varied from 11.8% to 61.0% of the length of the membranous vocal folds. The glottic cross-sectional area showed an expected inverse linear relationship to the length of the glottic web. Creation of an anterior glottic web caused consistent elevation of pitch, but there was a gradual plateau of effect with increased length of the web. The ex vivo porcine larynx is demonstrated as an effective, available, and low-cost model for further study of vocal pitch elevation surgical techniques. We demonstrate that in addition to progressively reducing the cross-sectional area of the airway, additional benefit from increased web length is limited. NA Laryngoscope, 130:E206-E212, 2020.

Carcinoma presenting as idiopathic anterior glottic webs: A case series

An anterior glottic web is an abnormal fusion of the anterior aspect of the membranous vocal folds. Noncongenital glottic webs are usually iatrogenic from intubation or laryngeal surgery. We present six adult patients whose initial in-office diagnoses were consistent with "idiopathic" benign anterior glottic webs as determined by three laryngologists (a.m.k., j.m.b., m.j.p.). Further evaluation revealed the diagnoses of laryngeal squamous cell carcinoma in all cases. The high risk of malignancy in cases of idiopathic anterior glottic web necessitates biopsy for tissue diagnosis of all such lesions. Laryngoscope, 129:2118-2120, 2019.