Persistent Dysphonia Research Articles

Machine Learning Models for Predicting Dysphonia Following Anterior Cervical Discectomy and Fusion – A Swedish Registry Study

BACKGROUNDDysphonia is one of the more common complications following anterior cervical discectomy and fusion (ACDF). ACDF is the gold standard for treating degenerative cervical spine disorders, and identifying high-risk patients is therefore crucial. PURPOSEThis study aimed to evaluate different machine learning models to predict persistent dysphonia after ACDF. STUDY DESIGNA retrospective review of the nationwide Swedish spine registry (Swespine) PATIENT SAMPLEAll adults in the Swespine registry who underwent elective ACDF between 2006 and 2020. OUTCOME MEASURESThe primary outcome was self-reported dysphonia lasting at least one month after surgery. Predictive performance was assessed using discrimination and calibration metrics. METHODS: Patients with missing dysphonia data at the one-year follow-up were excluded. Data preprocessing involved one-hot encoding categorical variables, scaling continuous variables, and imputing missing values. Four machine learning models (logistic regression, random forest (RF), gradient boosting, K-nearest neighbor) were employed. The models were trained and tested using an 80:20 data split and 5-fold cross-validation, with performance metrics guiding the selection of the best model for predicting persistent dysphonia. RESULTSIn total, 2,708 were included in the study. Twelve key predictors were identified. Four machine learning models were tested, with the RF model achieving the best performance (AUC = 0.794). The most significant predictors across models included preoperative NDI, EQ5Dindex, preoperative neurology, number of operated levels, and use of a fusion cage. The RF model, chosen for its superior performance, showed high sensitivity and consistent accuracy, but a low specificity and positive predictive value. CONCLUSIONSIn this study, machine learning models were employed to identify predictors of persistent dysphonia following ACDF. Among the models tested, the RF classifier demonstrated superior performance, with an AUC value of 0.790. The RF model identified NDI, EQ5Dindex, and number of fused vertebrae as key variables. These findings underscore the potential of machine learning models in identifying patients at increased risk for dysphonia persisting for more than one month after surgery.

Pediatric Unilateral Vocal Fold Paralysis

Purpose: The aim of this case study was to provide a review of a pediatric patient diagnosed with unilateral vocal fold paralysis. Method: The case history, voice samples, laryngeal examinations, and diagnostic probes were reviewed in a 10-year-old girl with the chief complaint of persistent dysphonia, characterized by use of both a breathy and a typical voice. Perceptual ratings were completed using both Consensus Auditory-Perceptual Evaluation of Voice and Grade, Roughness, Breathiness, Asthenia, and Strain scales. Cepstral peak prominence was determined and compared for the same file segment using both Praat and Analysis of Dysphonia in Speech and Voice analysis programs. Treatment probes during the initial preoperative visit are described. Results: The patient was able to compensate for short phonation tasks, but longer conversations were judged to have increased dysphonia and increased vocal fatigue. Because noted compensation was unable to be stabilized or sustained, both a reinnervation of the ansa cervicalis to the recurrent laryngeal nerve and voice therapy techniques were recommended as part of the multidisciplinary team plan. Conclusion: Pediatric patients with unilateral vocal fold paralysis may present with complex phonatory behaviors. This case study paired with supplemental acoustic and videostroboscopy files provides an opportunity to practice both an auditory-perceptual and acoustic assessment and to rate a laryngeal examination. Supplemental Material: https://doi.org/10.23641/asha.24163926

Salvage Treatments for Poor Voice Outcomes Following Autologous Fat Injection Laryngoplasty.

Fat injection laryngoplasty (FIL) is a common procedure used to correct glottic insufficiency. Nevertheless, few studies have discussed potential treatments for cases with poor voice recovery after FIL. Eighteen patients with unfavorable vocal outcomes from FIL were analyzed. Each of these patients presented persistent dysphonia for more than 2 months following FIL, together with bulging vocal folds and poor mucosal wave. We applied microsurgery as the standard treatment to remove excessive fat. Vocal fold steroid injection (VFSI) was administered to patients that were hesitant or declined to undergo microsurgery. Voice outcomes were evaluated using the Voice Handicap Index-10 (VHI-10), grade-roughness-breathiness (GRB) scores, and smoothed cepstral peak prominence (CPPs). Six patients underwent microsurgery directly, 6 patients received only VFSIs as a salvage treatment, and the remaining 6 patients received 1 to 3 courses of VFSIs before the decision to undergo microsurgery. Pathology reports were available for 10 patients, and contained 5 instances of adipose tissues, 3 of fat necrosis, 1 of chronic inflammation, and 1 of fibrosis. Seventeen patients reported satisfactory or improved outcomes. We found remarkable improvements in VHI-10, GRB, and CPPs (all P < .05) after salvage treatments for FIL. Subgroup analyses showed comparable voice outcomes for patients undergoing direct microsurgery, VFSI alone, and VFSI followed by microsurgery (P > .05). This study demonstrated that fat overinjection and/or fibrotic change in the injected vocal folds may cause poor voice outcomes after FIL. Both microsurgery and VFSI could be applied as salvage treatments with good voice recovery profiles. Level 4.

The Feasibility of Outpatient Type I Thyroplasty with Laryngeal Reinnervation.

Type I thyroplasty has increasingly been performed on an outpatient basis. Laryngeal reinnervation is recognized for its long-term and functional benefits but is typically performed inpatient under general anesthesia. Herein we report the first published outpatient type I thyroplasty with laryngeal reinnervation performed under monitored anesthesia care (MAC). Three adults underwent type I thyroplasty with ansa cervicalis to recurrent laryngeal nerve (RLN) reinnervation. A 23-year-old female with a history of generalized idiopathic epilepsy s/p vagal nerve stimulator implantation presented with persistent dysphonia. She developed longstanding left vocal fold paralysis. She underwent left type I thyroplasty with silastic implant and ansa cervicalis to RLN neurorrhaphy under MAC-local anesthesia. The patient was discharged home on the day of surgery. Two additional patients underwent the same procedure, including a 58-year-old male with postsurgical dysphonia who was admitted for overnight observation due to a small amount of incisional crepitus and a 23-year-old female with postsurgical vocal cord paralysis who was admitted overnight due to multiple comorbidities. Both were discharged on post-operative day one without issue and demonstrated improvement in voice at follow up. Outpatient type I thyroplasty with laryngeal reinnervation under MAC is feasible with proper patient selection.

Impact of Voice Therapy on Pediatric Patients With Dysphonia and Vocal Nodules: A Systematic Review

One of the most prevalent pediatric ailments around the world is voice disorders. Around 5-million children suffer from voice disorders, and three out of five of them suffer from vocal nodule-induced persistent dysphonia. Nineteen out of 20 otolaryngologists recommend voice therapies for the treatment of pediatric vocal fold nodules. However, the benefits of these therapies still remain to be assessed systematically. The objective of this study is to systematically review the impact of voice therapy (direct and indirect) on pediatric patients with vocal nodules.In this systematic review of randomized control trials (RCTs), four electronic databases, PubMed, CENTRAL (Cochrane), Science Direct, and Lancet, were explored for the literature survey. The impact of direct and indirect voice therapies on pediatric cases with vocal nodules was reviewed based on the results of the selected articles.Based on stringent inclusion and exclusion criteria, six articles were selected. All these studies examined the effects of direct and indirect voice therapies on two types of voice disorders, that is, dysphonia and vocal nodules. Only one of the six studies reported significant alleviation of the patient condition post-intervention. However, none of the studies discussed the clinical significance of the interventions.Three of the six included studies used both direct and indirect voice therapies and reported substantial differences in the data collected before and after the interventions. However, overall, the studies reported more significant improvements in patient conditions. More studies in this domain are still warranted, especially to help understand and define the meaning of the term “effectiveness” with respect to voice therapies.

Dysphonia of exceptional origin: lichen planus of the vocal fold \u2014 a case report of a very uncommon area affected by lichen planus

BackgroundLichen planus is an immune-mediated chronic inflammatory condition of unknown origin that affects the skin and the mucosa. Lichen planus in the larynx is not common, and there are few cases reported in literature. We report an unusual case of lichen planus in the vocal fold.Case presentationWe present a case of a 62-year-old Caucasian male with a 2-month history of persistent dysphonia and a smoking habit of about 10 cigarettes per day. He has no previous history of systemic disease, and he was not taking any drug for treatment. Fiber-optic laryngoscopy showed a single white rough lesion in the middle third of the right vocal fold. The diagnosis was performed with direct laryngoscopy. Complete excisional biopsy was used as a treatment method. Chest X-ray and blood test were normal. The biopsy reported lichen planus and mild dysplasia. The voice quality improved after the laryngeal microsurgery, and a close follow-up was advised.ConclusionsThere are few cases of lichen planus in the vocal fold reported in the literature, presenting as a unilateral and isolated lesion or concomitant with oral and genital lesions. Other cases mainly report lesions that affect more than one area of the larynx, with undefined margins or with marked cicatrization. Oral or topical corticosteroids, in this case, were not required because of total extirpation of the lesion but may be necessary in case of recurrence. Although lichen planus of vocal fold is very uncommon, it should be consider in differential diagnosis of leukoplakia of the larynx and once diagnosed could be manage with corticosteroid drugs avoiding aggressive treatment.

Prolonged persistence of hyaluronic acid after suboptimal vocal fold injection.

Hyaluronic acid (HA) is a commonly used injectable material in temporary vocal fold injections (VFI) in patients with unilateral vocal fold paralysis (UVFP). Hyaluronic acid has generally been known for its three-six months of longevity following VFI. Owing to recent advances in cross-linking technologies, the longevity of HA-based materials, including deep-volumizing cross-linked HA used in VFI, has been improved. However, persisting injectable material in the subepithelial space poses undesirable complications following VFI. Herein, we report 2 cases of unexpected persistence of superficially injected cross-linked HA. In the first case, a 70-year-old man with iatrogenic UVFP received VFI with cross-linked HA three years ago and was referred for persistent dysphonia. Previously injected HA spilled out from the vocal fold (VF) when an epithelial incision was made in the subepithelial cystic lesion. In the second case, a 72-year-old woman with iatrogenic UVFP received VFI with cross-linked HA that migrated into the subepithelial space. Diffuse swelling of the injected VF caused dysphonia that lasted for a year. The previously injected HA spilled out when an epithelial incision was made in the swollen VF. Since superficially injected deep-volumizing cross-linked HA can persist for up to three years, laryngologists should be aware of possible sequelae upon suboptimal VFI with cross-linked HA.

Long-Term Voice Outcomes Following Cricotracheal Resection for Subglottic Stenosis: A Retrospective Analysis.

Cricotracheal resection (CTR) is an effective treatment for refractory idiopathic subglottic stenosis (iSGS) but is associated with persistent dysphonia. Outcomes were measured longitudinally to characterize how patients' voices and self-perceived voice handicaps changed after CTR. Retrospective case-series. We conducted a retrospective cohort study of patients with refractory iSGS treated by CTR from 2006 to 2017. Voice Handicap Index (VHI), Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V), and acoustic analysis were prospectively collected preoperatively and postoperatively at 1, 3, 6, 12, and 24-month intervals. A linear mixed model was used to evaluate temporal change. Thirty-three patients (97% female) were included. VHI scores increased significantly from baseline preoperative score (27.2 ± 22.7) to a mean value of 44.3 ± 25.6 (P< .001) 1-month postoperatively but decreased below preoperative scores after 2 years (18.8 ± 11.9, P= .795). Mean fundamental frequency (F0) values in speech decreased significantly from 192.0 ± 24.9 Hz preoperatively to 167.1 ± 19.8 Hz at a 2-year follow-up (P= .002), with a nadir value at 1-month postoperatively (148.4 ± 20.5, P< .001). CAPE-V scores increased significantly from preoperative to 1-month postoperative (3.0 ± 2.3 vs. 21.9 ± 17.3, P< .001) but returned toward baseline values at 24 months after CTR (6.9 ± 4.8, P= .027). CAPE-V measurements postoperatively were correlated with VHI and F0 (Pearson coefficient=0.54 (VHI), -0.46 (F0), P< .001). Following CTR, mean F0 values were significantly and consistently lower but did increase over time, correlating with patients' improving VHI and CAPE-V scores. VHI values indicate that patient's perception of their voice is not significantly impacted in long term. These results provide a framework to counsel patients about long term voice expectations. 4 Laryngoscope, 132:1054-1060, 2022.

Persistent Dysphonia in Hospitalized COVID-19 Patients

IntroductionThe main objective of this study is to estimate the prevalence of persistent dysphonia in hospitalised COVID-19 patients.MethodsData were collected from those COVID-19 patients who, during the months of March to April 2020, were hospitalised in ward or intensive care unit at the University Hospital of Fuenlabrada. Patients with dysphonia prior to SARS-CoV-2 were excluded. Informed consent was obtained orally by a telephone call, as well as clinical and epidemiological data. Patients who reported persistent dysphonia were assessed using the Voice Handicap Index 10, the maximum phonation time, the s/z ratio and a fibrolaryngoscope examination. Patients who reported persistent dysphagia were assessed with the Eating Assessment Tool 10.ResultsA total of 79 patients were included in the study (48 men and 31 women). 10 ICU patients (25%) and 4 ward patients (10,3%) had dysphonia at least 3 months after hospital discharge, but no association was found between ICU admission and the presence of persistent dysphonia (P = 0.139). Persistent dysphonia in patients admitted to the ICU is associated with persistent dysphagia (P = 0.002), also the age of patients with persistent dysphonia is significantly higher than the age of non-dysphonic patients (P = 0.046). The most frequent exploratory finding was vocal cord paresis/paralysis (60.4%).ConclusionThis is one of the first studies to show that persistence of dysphonia may be a consequence of COVID-19, so further studies are needed to assess the evolution and prognosis of these patients and the possible association of dysphonia with the severity of the disease.

Sudden and persistent dysphonia within the framework of COVID-19: The case report of a nurse

In December 2019, clusters of atypical pneumonia with unknown etiology emerged in the city of Wuhan in China. In early January 2020, the Center for Disease Control in China announced that it was identified a new coronavirus, first tentatively named 2019-nCoV and officially named SARS-CoV-2 by the International Committee on Taxonomy of Viruses. On February 11, 2020 the WHO identified the disease caused by SARS-CoV-2 as COVID-19 (COronaVIrus Disease-19 based on the year of appearance). Although only a few months have passed since the beginning of this pandemic, numerous studies, case reports, reviews by leading international scientific and medical journals have been published. However, given the unpredictability of virus behaviour and the still limited knowledge about it, many aspects of the infection are still little known. A recent epidemiological study has shown the presence of dysphonia in some patients with COVID-19, with a minority reporting aphonia during the clinical course of the disease. This case study draws attention on a 50-year-old female nurse presented with a history of fatigue resulting from minor exertion and persistent dysphonia at the Occupational Health Department of a major University Hospital in central Italy. The patient had a history of COVID-19 infection, which lasted about two months with pulmonary and extrapulmonary symptoms. After two RT-PCR negativities for SARS-CoV-2, dysphonia and fatigue due to minor exertionpersisted. The patient, following the persistence of the symptomatology, was subject to numerous specialist examinations, which showed no organic alterations. Based on her clinical and instrumental history, we hypothesized a psychogenetic dysphonia related to COVID-19. This case report highlights the importance of personalized medicine with long-term follow-up and rubustpsychological support in patients who tested positive for COVID-19 and in particular in the categories at greatest risk of both contagion and adverse physical and mental outcomes like health care workers.

Risk factors and prognosis of voice disorders after surgical treatment of thyroid and parathyroid diseases.

To analyze risk factors and prognosis of voice disorders after surgical treatment of thyroid and parathyroid diseases. There were 1272 patients who were operated in the endocrine surgery department for the period from January 1, 2016 to April 30, 2017. We studied the incidence of VF paresis, VF paralysis, and persistent dysphonia as clinical outcomes. Potential risk factors have to be analyzed were sex and age of patients, BMI, diagnosis, surgical technique, thyroid volume, experience of the surgeon and assistant, use of intraoperative neuromonitoring, etc. RESULTS: Significant relationships of risk factors with various complications of thyroid surgery were found. In logistic regression analysis, the independent predictors of complications were the following: 1) for VF paresis - extent of surgery and thyroid volume; 2) for VF paralysis - sex, extent of surgery and thyroid volume; 3) for persistent postoperative dysphonia - age and thyroid volume. The correlation of various risk factors with development of VF paresis, VF paralysis and persistent dysphonia were identified in patients undergoing thyroid and parathyroid surgery.

Voice Disorders after Intubation: The Importance of Intra-Operative Monitoring and Controlling of Endo-Tracheal Tube Cuff Pressure in Reducing Intubation-Related Complications

AbstractBackground: The importance of monitoring and controlling endotracheal tube cuff (ETTc) pressure in reducing larynge-otracheal injuries and intubation-related respiratory compli-cations has been previously investigated by several authors. However, little is known about the role of controlling ETT cuff pressure in minimizing transient voice changes following endotracheal intubation.Aim of the Study: The aim of this study was to investigate the importance of monitoring and controlling ETTc pressure in reducing voice disorders after endotracheal intubation.Patients and Methods: Fifty patients in the age between 18-50 years, undergoing middle ear surgery were enrolled into the study. Patients were randomized by means of individ-ually prepared envelopes to either the control group (n=25), without measuring ETTc pressure, or the study group (n=25), with ETTc pressure measurement. All patients were examined pre-operatively to determine baseline values, 24 hours after surgery and 1 week post-operatively. Phoniatric examination included auditory perceptual assessment, videolaryngoscopy and acoustic analysis of voice. Statistical analysis included the arithmetic mean, Standard Deviation (SD), standard error, hypothesis student's t and Spearman's rank-order correlation tests. p-values <0.05 were chosen as the level of significance.Results: Auditory perceptual assessment of voice per-formed one day after extubation indicated the presence of post-intubation dysphonia which was of a mild to moderate grade, an irregular quality, a low pitch and fluctuating loudness. These changes were more pronounced and occurred more frequently in patients of the control group in whom the cuff pressure was adjusted by pilot balloon palpation according to the experience of the anaesthesiologist. One week after surgery, all patients belonging to the study group, in whom a hand-held cuff pressure monitor was used to adjust the cuff pressure, showed improvement in all the perceived parameters, whereas persistent dysphonia was still perceived in two patients of the control group. Videolaryngoscopy performed before intubation showed that all patients were free from any laryngeal lesions. One day after extubation, there was evidence of traumatic laryngeal lesions in the form of vocal fold congestion in 5 patients (20%) of the control group and 3 patients (12%) of the study group. One week after extubation, residual lesions were still present in 3 patients (12%) of the control group in the form of mild vocal fold edema in one patient and vocal fold congestion in two other patients. Acoustic analysis of voice performed 24 hours after extubation showed a highly significant increase in fundamental frequency F0 in both male and female patients of the control group. These changes were accompanied by a significant increase in jitter in only the female patients. By contrast, acoustic analysis of voice recorded both 24 hours and one week after extubation in patients belonging to the study group did not show any significant changes in any of the measured parameters when compared to their corresponding baseline values. An inter-group com-parison of the post-operative parameters recorded by acoustic analysis of voice one day after extubation showed a statistically highly significant (p=0.013) reduction in fundamental fre-quency F0 by 75% among male patients, and a statistically significant (p=0.05) reduction in jitter by 74% in females belonging to the study group when compared to those of the control group. Shimmer and NHR increased to 78% and 47%, respectively, in male patients belonging to the study group, and decreased in females, but these changes were statistically not significant.Correlation performed between the changes in parameters obtained by acoustic analysis of voice and the duration of intubation showed a statistically significant (p-value=0.023) positive correlation between the changes in fundamental frequency F0 and the duration of intubation. Likewise, a significant (p-value=0.016) positive correlation was found between the changes in jitter and the duration of intubation.Conclusion and Future Recommendations: General an-aesthesia has multisystem effects, some of which can disturb the fine harmony necessary for voice production. Even short-term intubation is usually followed by a period of dysphonia that may extend after extubation anywhere from 12 hours to more than five days. Proper control of endotracheal tube cuff (ETTc) pressure by a manometer helps reduce ETT-related postprocedural complications. Acoustic analysis may be used to identify and monitor even minor laryngeal trauma resulting from the procedure. Jitter and shimmer are the best indicators of post-intubation phonation changes. For medicolegal reasons, patients scheduled for general anesthesia should be informed about the possible post-operative voice changes that could last longer than one day. We further recommend routine intraoperative monitoring of endotracheal tube cuff pressure, in additition to post-operative phoniatric assessment and follow-up of the patients for early post-operative diagnosis and treatment of dysphonia.

Background Factors and Subjective Voice Symptoms in Patients with Acquired Vocal Fold Scarring and Sulcus Vocalis

Objective: Vocal fold scarring (VFS) and sulcus vocalis (SV) often result in severe and chronic voice disorders. This study compares subjective voice complaints as rated with the Voice Handicap Index and etiological factors for patients with VFS and SV. Patients and Methods: Data were collected from the medical records at the Department of Otorhinolaryngology, Karolinska University Hospital, for 27 VFS patients and 27 SV patients. Descriptive background factors were compared between the groups and data were compared from the Swedish Voice Handicap Index (Sw-VHI) questionnaires. Results: Previous laryngeal surgery/trauma was significantly more common for the patients with VFS. The SV group had significantly more persistent dysphonia since childhood. It was significantly more common to have a non-Germanic language origin among the SV patients. VFS and SV rated high for the total median Sw-VHI scores. The VFS group’s total Sw-VHI and the three domain scores were significantly higher compared to the SV group. The physical domain showed a significantly higher score when compared to the functional and emotional domains in the SV cohort and when compared to the emotional domain in the VFS cohort. Conclusion: There are significant differences between the VFS group and SV group regarding etiological factors as well as the Sw-VHI. The degree and profile of VHI should be considered when selecting patients and evaluating the result of new treatments for this group of patients.

The Role of Occupational Voice Demand and Patient-Rated Impairment in Predicting Voice Therapy Adherence

Examine the relationship among the severity of patient-perceived voice impairment, perceptual dysphonia severity, occupational voice demand, and voice therapy adherence. Identify clinical predictors of increased risk for therapy nonadherence. A retrospective cohort study of patients presenting with a chief complaint of persistent dysphonia at an interdisciplinary voice center was done. The Voice Handicap Index-10 (VHI-10) and the Voice-Related Quality of Life (V-RQOL) survey scores, clinician rating of dysphonia severity using the Grade score from the Grade, Roughness Breathiness, Asthenia, and Strain scale, occupational voice demand, and patient demographics were tested for associations with therapy adherence, defined as completion of the treatment plan. Classification and Regression Tree (CART) analysis was performed to establish thresholds for nonadherence risk. Of 166 patients evaluated, 111 were recommended for voice therapy. The therapy nonadherence rate was 56%. Occupational voice demand category, VHI-10, and V-RQOL scores were the only factors significantly correlated with therapy adherence (P < 0.0001, P = 0.018, and P = 0.008, respectively). CART analysis found that patients with low or no occupational voice demand are significantly more likely to be nonadherent with therapy than those with high occupational voice demand (P < 0.001). Furthermore, a VHI-10 score of ≤29 or a V-RQOL score of >40 is a significant cutoff point for predicting therapy nonadherence (P < 0.011 and P < 0.004, respectively). Occupational voice demand and patient perception of impairment are significantly and independently correlated with therapy adherence. A VHI-10 score of ≤9 or a V-RQOL score of >40 is a significant cutoff point for predicting nonadherence risk.

Efficacy and Safety of Adjunctive Steroid Injection After Microsurgical Removal of Benign Vocal Fold Lesions

This study aims to investigate the clinical efficacy and safety of immediate intralesional steroid injection in patients undergoing laryngeal microsurgery (LMS) for benign vocal fold lesions (BVFLs). This is a single-institution, retrospective cohort study. Patients were divided into two groups according to whether or not they received adjunctive steroid injection after LMS. We evaluated the outcomes using objective, perceptual voice analysis and videostroboscopy. We also analyzed clinical parameters and identified risk factors associated with persistent dysphonia after LMS. The study included a total of 211 patients with BVFLs (82 men and 129 women), which comprised 136 vocal polyps (64.5%), 49 nodules (23.2%), and 30 cysts (14.2%); 84 patients (39.8 %) had intralesional steroid administration combined with LMS. The overall results for postoperative voice parameters in both groups were significantly improved. On videostroboscopic examination, the rate of recurrent lesions was lower in the group that received adjunctive steroid injection than in the group with only LMS (P = 0.014). In the multivariate analysis, older age (compared to <50 years of age; odds ratio [OR] = 2.697, 95% confidence interval [CI]: 1.300-5.595, P = 0.008) and duration of hoarseness longer than 6 months (compared to <3 months; OR = 2.729, 95% CI: 1.193-6.242, P = 0.017) were identified as independent risk factors associated with persistent dysphonia. Nevertheless, adjunctive steroid injection was associated with a 0.3-fold (OR = 0.345, 95% CI: 0.152-0.784, P = 0.011) lower risk of persistent dysphonia. Steroid injection combined with LMS in the treatment of BVFLs was safe and associated with improved voice quality.

Factors Associated With Infectious Laryngitis: A Retrospective Review of 15 Cases.

To identify the culturable microbes associated with infectious laryngitis and outline effective treatment strategies. This is a retrospective chart review of adult patients with persistent dysphonia plus evidence of laryngeal inflammation who underwent biopsy for culture at a tertiary care medical center. Demographic factors, symptoms as reported on validated patient assessment tools, past medical history, social history, culture results, and treatment duration and response were reviewed. Fifteen patients with infectious laryngitis were included in this study. Culture results demonstrated Methicillin-sensitive Staphylococcus aureus (MSSA), Methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, Serratia marcescens, and "normal respiratory flora." In most patients, multiple courses of prolonged antibiotics were needed to treat MSSA or MRSA. Infections associated with other microbes resolved with a single course of antibiotics. In this population, infectious laryngitis is defined as colonization with bacteria not found in the previously characterized laryngeal microbiome of benign vocal fold lesions. In suspected cases of infectious laryngitis, culture is recommended, by biopsy if needed. For MSSA- and MRSA-associated laryngitis, an extended course of antibiotics may be necessary for symptom improvement and resolution of laryngeal inflammation. However, the optimal treatment regimen has yet to be defined and will require larger, prospective studies.

Case Report of Lewis and Sumner Syndrome with Bilateral Vagus Nerves Paralysis for 16 Years

This report describes a patient with dysphonia for 16 years in combination with asymmetric and progressive decrease in sense and power of both upper and lower extremities for the past 3 years. Electrophysiological study revealed asymmetric conduction block and abnormal sensory action potential in 4 limbs. The vagus nerves palsy and abnormal electrodiagnosis of the limbs led us to diagnose the disease as Lewis and Sumner syndrome, also called multifocal acquired demyelinating sensory and motor neuropathy diagnosis, which improved by corticosteroid consumption to some extent. This case is uncommon by its long time presentation and progression. To the best of the authors' knowledge, this is the first report of simultaneous bilateral vagus nerve palsy in combination with upper and lower limbs' demyelinating neuropathy. In conclusion, persistent dysphonia can be a part of the presentation of demyelinating neuropathy.

C2-C3 Anterior Cervical Fusion: Technical Report.

Retrospective review of patients at a university hospital. To describe the anterior approach for cervical discectomy and fusion (ACDF) at C2-C3 level and evaluate its suitability for treatment of instability and degenerative disease in this region. The anterior approach is commonly used for ACDF in the lower cervical spine but is used less often in the high cervical spine. We retrospectively reviewed a database of consecutive cervical spine surgeries performed at our institution to identify patients who underwent ACDF at the C2-C3 level during a 10-year period. Demographic data, clinical indications, surgical technique, complications, and immediate results were evaluated. Of the 11 patients (7 female, 4 male; mean age 46 y) identified, 7 were treated for traumatic fractures and 4 for degenerative disk disease. Three patients treated for myelopathy showed improvement in mean Nurick grade from 3.6 to 1.3. Pain was significantly improved in all patients who had preoperative pain. Solid bony fusion was achieved in 5 of 7 patients at 3-month follow-up. Complications included dysphagia in 4 patients (which resolved in 3), aspiration pneumonia, mild persistent dysphonia, and construct failure at C2 requiring posterior fusion. One patient died of a pulmonary embolism 2 weeks postoperatively. ACDF at the C2-C3 level is an option for the treatment of high cervical disease or trauma but is associated with a higher rate of approach-related morbidity. Familiarity with local anatomy may help to reduce complications. ACDF at C2-C3 appears to have a fusion rate similar to ACDF performed at other levels.

Voice Outcomes following a Single Office-Based Steroid Injection for Vocal Fold Scar.

Persistent dysphonia from vocal fold scar remains a clinical challenge, with current therapies providing inconsistent outcomes. We evaluated voice outcomes after a single office-based steroid injection. Case series with chart review. Academic medical center. This study was based on pre- and postoperative analysis of patient-reported, perceptual, acoustic, aerodynamic, and videostroboscopic parameters. The sample comprised 25 patients undergoing office-based dexamethasone injection into the superficial lamina propria for mild/moderate vocal fold scar. Average follow-up was 13.7 ± 4.4 weeks; patients completed 3.5 ± 2.3 sessions of voice therapy between assessments. Complete data sets were not available for each parameter; sample size is noted with results. Voice handicap index (n = 24; P < .001) and glottal function index (n = 22; P < .001) decreased after injection. Total GRBAS score (grade, roughness, breathiness, asthenia, strain) decreased (n = 25; P < .001). Fundamental frequency range increased (n = 24; P = .024). Phonation threshold pressure decreased (n = 14; P = .017). Videostroboscopic parameters of vocal fold edge (P = .004), glottic closure (P = .003), and right mucosal wave (P = .016) improved after injection. Office-based steroid injection combined with voice therapy for mild/moderate vocal fold scar is associated with improved patient-reported and functional voice measures. These findings provide preliminary support for this approach. Importantly, the procedure is low risk and can be performed in the office, thus offering a simple treatment alternative to patients with a disorder that has traditionally been difficult to manage. Prospective studies evaluating the effects of multiple injections are warranted.

The Possibilities of Cell Technologies in the Treatment of Cicatricial Lesions of the Vocal Folds

The article is a brief review of publications devoted to the problem of persistent dysphonia. The main cause of voice disorders is the scarring of the vocal folds resulting from trauma, surgical manipulation, inflammatory process. Treatment of cicatricial lesions of the vocal folds remains a challenge, as far as existing methods do not ensure the recovery of the ultrastructure of the vocal folds. The authors present modern data on the structure of the vocal folds at the cellular level. Considered pathologic processes occur in different stages of scarring. Applied technologies of phonosurgery and conservative treatment, their effectiveness and shortcomings are covered. Analysis of experimental research conducted in the world demonstrates the promise of using the methods of tissue engineering to treat scarring of the vocal folds and to restore the microstructure of the latter. Identified current issues remain unresolved, which leads to the need for further experimental and clinical studies in the treatment of this pathology.