Phonatory Function Research Articles

PREVENTION OF YATROGENIC DAMAGES OF THE LARYNGEAL NERVES IN TRADITIONAL AND MINIMALLY INVASIVE THYROID SURGERY

Objective. To assess the effectiveness of using the intraoperative neuromonitoring for conventional and minimally invasive surgical interventions on the thyroid gland for the prevention of the laryngeal nerve damage. Material and methods. For achieving this goal it was performed the retrospective analysis of surgical treatment of 310 patients with thyroid gland diseases, and 54 patients were selected, which were divided into 2 groups matched by sex and age, the nature of thyroid pathology and volume of surgical intervention: in the first (main, n = 27) operations were carried out using intraoperative neuromonitoring, in the second (control, n = 27) - visual monitoring of the laryngeal nerves was performed. The survey was performed according to the Russian and international clinical guidelines. Laryngoscopy was performed for all patients before operation and for patients with impaired phonation function - after it. «NIM-Neuro® 3.0» device with special armored endotracheal tubes preloaded with circular (detecting), as well as stimulating electrodes for searching and continuous monitoring of laryngeal nerves was used for intraoperative neuromonitoring during the operation. Results of the study. Traditional interventions were conducted on the 6 patients, minimally invasive nonendoscopic surgical - on 25, video-assisted - on 23. The exterior branch of the superior laryngeal nerve has found in 25 (92.6%) patients of the main group and 8 of the (29.6%) control group. Recurrent laryngeal nerve was identified in 27 (100%) patients of the 1st group and in 26 (96.3%) patients of the 2nd group by visual inspection. In the main group there are no cases of intraoperative fixation of the loss or signal attenuation during the laryngeal nerves monitoring, which is proved by the absence of single- and double-sided paresis of the larynx in the postoperative period. Only in 2 patients there was functional dysphonia on hypotonic type. In the control group the laryngeal dysfunction in the form of functional dysphonia (n = 1), paresis (n = 1) and paralysis (n = 1) has occurred in 3 patients. Conclusion. It has been found out that intraoperative neuromonitoring is an effective additional method of neural structures detecting, and it does not substitute the anatomic visualization of laryngeal nerves. intraoperative neuromonitoring in patients with high risk of complications (repeated operations on the thyroid gland, thyroid cancer with extrathyroidal proliferation and regional metastases) can reduce the incidence of paresis and paralysis of the larynx. All minimally invasive interventions on the thyroid gland should be accompanied by the intraoperative neuromonitoring of laryngeal nerves (8 figs, 1 table, bibliography: 15 refs).

Correlations Between Deaf-Muteness and Cephalometric Characteristics in Adults

Objective: The purpose of this study was to assess any existing correlations between the phonatory function obviously affected in deaf-mute patients and dento-maxillary and/or facial anomalies. Material and Methods: The study comprised 55 deaf-mute patients (28 males and 27 females) aged between 23 and 76 from 2 cities of Romania, belonging to the Hearing Deficiency Persons’ Association. 13 were edentulous. Each patient was clinically and radiographically assessed. We applied computer assisted interpretetation of the profile teleradiographies using AudaxCeph and Scanora Lite 3.2.6 software for the following parameters: SNA, SNB, ANB, SN/ML, FH/ML, NL/ML, NL/+1 and ML/-1 angles, Ls-ELine, Li-ELine, UP and LP distances.The data was compared to normal values as referred to in the mentioned computer programs by using Student’s t-tests and the Bland Altman plot. Results: The following characteristics were identified as being statistically different from the normal values: SN/ML with a mean of -5,5°, FH/ML by 6,2°, NL/ML with -5,2°, Ls-ELine by -4,2 mm and Li-ELine with a mean of -3,7 mm. Conclusions: Deaf-mute patients tend to present hypodivergent vertical skeletal patterns, anterior mandibular growth/rotation and skeletal deep bite and also protruded lips, aspects which must be taken into consideration when commencing an orthodontic treatment.

Relationship between swallowing function and breathing/phonation

ObjectiveClarification of the association between the swallowing function and respiratory and phonatory functions. MethodsThe subjects were 30 patients with a chief complaint of swallowing disorder with clear consciousness capable of retaining a sitting position. Patients with organic and functional diseases of the larynx were excluded. Twenty-two and eight patients were male and female, respectively, and the mean age was 77.0±14.6years old. The chest expansion score was measured as an index of the respiratory function, and the maximum phonation time (MPT) was measured as an index of the phonatory function. The presence or absence of aspiration was judged using videoendoscopic swallowing study (VESS) and videofluoroscopic swallow studies (VFSS). The patients were divided into those with and without aspiration, and the chest expansion score and MPT were compared. In addition, the distance of laryngeal elevation was measured in the lateral view of VFSS, and its correlations with the chest expansion score and MPT were closely analyzed. To evaluate reliability of the test, the distance of laryngeal elevation and videoendoscopic score were compared between the presence and absence of aspiration. ResultsThe distance of laryngeal elevation was significantly shortened and the videoendoscopic score was significantly higher in the group with aspiration, as previously reported. On comparison of the chest expansion score between the groups with and without aspiration, no significant difference was noted at the axillary or xiphoid process level, and shortening was significant only at the 10th rib level in the group with aspiration. On comparison of MPT, it was significantly shortened in the group with aspiration. In addition, a significant positive correlation with the distance of laryngeal elevation was noted in both chest expansion score and MPT. ConclusionIt was suggested that declines of the respiratory and phonatory functions are risk factors of aspiration through limiting laryngeal elevation, and the chest expansion score at the 10th rib level and MPT are useful for screening of aspiration.

Biomechanical Description of Phonation in Children Affected by Williams Syndrome

The voice of persons with Williams syndrome (WS) is described as hoarse with a deep and unstable fundamental frequency (f0). These observations may be justified by the deficit of elastin due to a haplo-insufficiency in the ELN gene characteristic of the syndrome. In view of the possible relationship between elastin deficit and dysphonia, a study of the dynamic function of WS phonation was conducted by means of biomechanical analysis. In order to assess the presence of dysphonic symptoms and their degree of severity, the biomechanical description of WS phonation has been evaluated in terms of dynamic mass and viscoelasticity estimates. Glottal biomechanical features such as vocal fold dynamic mass, stiffness, unbalances, and laryngeal tremor of 12 children with WS aged 3 to 8 years (five girls and seven boys) have been estimated and compared with the normative phonation of 97 children with typical development (53 girls and 44 boys). The results show that WS children show differences in f0, vocal fold mass and stiffness, phonation stability, glottal contact defects, and laryngeal tremor. The conclusions may help to make a more complete view of the connection between WS and dysphonia based on objective assessments.

A pilot study on the evaluation of normal phonating function based on high-density sEMG topographic maps.

Phonation is controlled by complex synergism of muscles over the front neck region. Proper evaluation of the muscular activities in this region would not only help to estimate phonation function, but may also provide characteristics to diagnose dysphonia. While surface electromyography (sEMG) technique has been used to study the physiological aspects of phonation in previous studies, it remains unclear if the phonating function could be dynamically characterized by the sEMG signals of the neck muscles associated with phonation. In this study, almost 80 channels of high-density (HD) sEMG signals were acquired from four healthy subjects when the vowel /a/ was phonated across different pitches by them. The root mean square (RMS) of the HD sEMG signals was computed within a series of segmented analysis windows and used to construct dynamic sEMG topographic maps. And the RMS maps represented the energy distribution of the front neck muscles, which would provide both the temporal and spatial information in accordance with the physiological and biomechanical principles of phonation. Our pilot results from the sEMG topographic maps across different pitch levels showed that the muscular activities consistently increased with the enhancement of the pitch levels. This pilot study suggests that HD sEMG might be a potential tool to visualize the distribution of the muscular activities and observe the coordination of muscular contractions during phonation. Also, it might pave way for proper screening and diagnosis of dysphonia as well as its associated pathologies.

Treatment of bilateral vocal cord paralysis by hemi-phrenic nerve transfer

Objective: To investigate the surgical effect of reinnervation of bilateral posterior cricoarytenoid muscles(PCA) with left hemi-phrenic nerve and endoscopic laser arytenoid resection in bilateral vocal cord fold paralysis(BVFP) and to analyze the pros and cons of the two methods. Methods: One hundred and seventeen BVFP patients who underwent reinnervation of bilateral PCA using the left hemi-phrenic nerve approach (nerve group, n=52) or laser arytenoidectomy(laser group, n=65) were enrolled in this study from Jan.2009 to Dec.2015.Vocal perception evaluation, video stroboscopy, pulmonary function test and laryngeal electromyography were preformed in all patients both preoperatively and postoperative1y.Extubution rate was calculated postoperative1y. Results: Most of the vocal function parameters in nerve group were improved postoperatively compared with preoperative parameters, albeit without a significant difference(P>0.05), while laser group showed a significant deterioration in voice quality postoperative1y(P<0.05). The two groups showed significant difference in voice quality postoperative1y(P<0.05). Videostroboscopy showed that vocal fold on the operated side in both groups could abduct to various extent postoperatively, which showed significant difference when compared with preoperative abductive movements (P<0.05). But the amplitude in nerve group was larger than that in laser group (P<0.05). 89% of the patients in nerve group were inhale physiological vocal cord abductions. Postoperative glottal closure showed no significant difference in nerve group (P>0.05), while showed various increment in laser group(P<0.05). Differences between the two groups were statistically significant(P<0.05). The pulmonary function in both groups was better after operation, reaching the reference value. Postoperative laryngeal electromyography confirmed successful reinnervation of the bilateral PCA muscles. The decannulation rate were 88.5% and 81.5% in nerve group and laser group respectively. In both groups, patients presented aspiration symptoms postoperatively, and rdieved soon, except 2 patients in laser group suffered repeated aspiration. Conclusions: Reinnervation of bilateral PCA muscles using left hemi-phrenic nerve can restore inspiratory vocal fold abduction to a satisfactory extent while preserving phonatory function at the preoperative level without evident morbidity, and do not affect swallowing function, greatly improving the quality of life of the patients.

A quantitative method for the assessment of dysarthrophonia in myasthenia gravis

Speech and voice symptomatology (dysarthrophonia) are often reported by patients with myasthenia gravis (MG). However, they have been poorly investigated despite their significant impact on quality of life. Quantitative methods for the assessment of dysarthrοphonia could facilitate the evaluation of these common MG symptoms. The goal of this study was to investigate the phonatory (sustained phonation and reading) and speech (diadochokinesis) function in MG patients using quantitative measures. The voice/speech of 12 MG patients (7 with anti-AchR and 5 with anti-MuSK antibodies) and 24 age-matched healthy controls was recorded and analyzed using electroglottography (EGG) and speech acoustics. For the analysis of voice, the variables that were found to distinguish MG patients compared to healthy controls were a higher average fundamental frequency (P<0.05), a higher standard deviation of the average fundamental frequency (P<0.001), a higher mean fundamental frequency of the vibrating vocal folds (P<0.005) and a higher fundamental frequency range (P<0.005). The analysis of diadochokinesis showed that MG patients had a higher mean duration of the silent interval between a series of repetitive /pa/ syllables (P<0.05), of the sound /t/ (P=0.05) and of the silent interval between a series of repetitive /ka/syllables (P<0.05). No statistical differences were found in any of these variables between the MG subgroups with anti-AchR or anti-MuSK antibodies. This study demonstrates that non-invasive physiological methods (EGG and speech acoustics) offer essential tools for the assessment of dysarthrophonia in MG patients.

Transcricothyroid Endoscopic Subglottic Surgery for Posterior Glottic Stenosis: A Case Report

Posterior glottic stenosis (PGS) is a rare but life-threatening condition mostly caused by damage to the interarytenoid mucosa by an endotracheal tube. In surgical treatment of PGS, airway patency is prioritized, and the laryngeal functions involved in swallowing and phonation are considerably sacrificed. In the majority of cases, lateralization of a vocal fold or partial excision of a vocal fold and arytenoid cartilage results in glottal closure insufficiency and deterioration of phonatory function. We present the first report of transcricothyroid endoscopic subglottic surgery to treat a 46-year-old man with PGS who was intubated for 10 days. Postoperative hypofunction was not observed in the aerodynamic examination and acoustic analysis, and phonatory function has been maintained within normal limits.

Feasibility and Associated Limitations of Office-Based Laryngeal Surgery Using Carbon Dioxide Lasers

There are few reports evaluating awake, office-based carbon dioxide (CO2) laser surgery for laryngeal lesions. To date, this study was the largest reported case series of office-based laryngeal surgery by fiber delivery CO2 laser. Office-based laryngeal surgical procedures have become increasingly popular. Technical problems and treatment outcomes associated with the use of a CO2 laser for office-based laryngeal surgery have yet to be fully addressed. To discuss a single institution's clinical experience with office-based CO2 laser laryngeal surgery and the feasibility and limitations associated with this procedure. This retrospective study evaluated 49 laryngeal surgical procedures performed using a CO2 laser in 40 consecutive adult patients at a single institution in Taiwan from July 1, 2014, through September 30, 2015. Laryngeal lesions treated included vocal fold leukoplakia (n = 13), benign vocal fold lesions (n = 10), Reinke edema (n = 4), recurrent respiratory papillomatosis (n = 6), and lesions outside the vocal folds (n = 7). Office-based laryngeal surgery performed using a CO2 laser under topical anesthesia. Videolaryngoscopy was performed on all patients at each follow-up point. Among patients with benign vocal lesions and Reinke edema, videolaryngostroboscopy, voice laboratory measurements, perceptual measurements of vocal quality, and subjective evaluations were conducted before and after surgery. Among the 40 patients included in this study (28 men [70%] and 12 women [30%]; median [range] age, 56 [29-83] years), median follow-up time was 6.5 months (range, 1-21 months). Among the 49 procedures, 2 (4%) could not be tolerated by patients owing to severe gag reflex and laryngeal hypersensitivity, 6 (12%) could not completely evaporate lesions owing to an inadequate surgical field or laryngeal instability, and 1 (2%) led to a complication (ie, mild vocal fold wound stiffness). In addition, 2 patients with premalignant vocal fold leukoplakia showed lesion recurrence in the subglottic area. Among patients with benign vocal lesions and Reinke edema, postoperative phonatory function showed large improvements in jitter (effect size, 0.61; median difference, -0.98%; 95% CI, -1.57% to -0.11%), noise to harmonic ratio (effect size, 0.63; median difference, -0.02; 95% CI, -0.07 to -0.01), maximal phonation time (effect size, 0.61; median difference, 3.6 seconds; 95% CI, 1.9 to 8.8 seconds), and Voice Handicap Index-10 score (effect size, 0.60; median difference, -7; 95% CI, -12 to -2). Office-based laryngeal surgery performed using a CO2 laser was shown to be a feasible treatment option for various types of vocal lesions. However, patients should not undergo this procedure if they have multiple bulky lesions or lesions involving the subglottic area, the laryngeal ventricle, or (in cases of inadequate laryngeal stability) the free edge of a vocal fold.

Cognitive Dysfunction and Malnutrition Are Independent Predictor of Dysphagia in Patients with Acute Exacerbation of Congestive Heart Failure.

Early detection and intervention for dysphagia is important in patients with congestive heart failure (CHF). However, previous studies have focused on how many patients with dysphagia develop CHF. Studies focusing on the comorbidity of dysphagia in patients with CHF are rare. Additionally, risk factors for dysphagia in patients with CHF are unclear. Thus, the aim of this study was to clarify risk factors for dysphagia in patients with acute exacerbation of CHF. A total of 105 patients, who were admitted with acute exacerbation of CHF, were enrolled. Clinical interviews, blood chemistry analysis, electrocardiography, echocardiography, Mini-Mental State Examination (MMSE), exercise tolerance tests, phonatory function tests, and evaluation of activities of daily living (ADL) and nutrition were conducted on admission. After attending physicians permitted the drinking of water, swallowing screening tests were performed. Patients were divided into a dysphagia group (DG) or a non-dysphagia group (non-DG) based on Functional Oral Intake Scale level. Among the 105 patients, 38 had dysphagia. A greater number of patients had history of aspiration pneumonia and dementia, and there was a higher age, N-terminal pro-B-type natriuretic peptide level in the DG compared with the non-DG. MMSE scores, exercise tolerance, phonatory function, status of ADL, nutrition, albumin, and transthyretin were lower in the DG compared with the non-DG. In multivariate analysis, after adjusting for age and sex, MMSE, BI score, and transthyretin was independently associated with dysphagia. Comorbidity of dysphagia was 36.1% in patients with acute exacerbation of CHF, and cognitive dysfunction and malnutrition may be an independent predictor of dysphagia.

Tissue engineering-based therapeutic strategies for vocal fold repair and regeneration.

Vocal folds are soft laryngeal connective tissues with distinct layered structures and complex multicomponent matrix compositions that endow phonatory and respiratory functions. This delicate tissue is easily damaged by various environmental factors and pathological conditions, altering vocal biomechanics and causing debilitating vocal disorders that detrimentally affect the daily lives of suffering individuals. Modern techniques and advanced knowledge of regenerative medicine have led to a deeper understanding of the microstructure, microphysiology, and micropathophysiology of vocal fold tissues. State-of-the-art materials ranging from extracecullar-matrix (ECM)-derived biomaterials to synthetic polymer scaffolds have been proposed for the prevention and treatment of voice disorders including vocal fold scarring and fibrosis. This review intends to provide a thorough overview of current achievements in the field of vocal fold tissue engineering, including the fabrication of injectable biomaterials to mimic invitro cell microenvironments, novel designs of bioreactors that capture invivo tissue biomechanics, and establishment of various animal models to characterize the invivo biocompatibility of these materials. The combination of polymeric scaffolds, cell transplantation, biomechanical stimulation, and delivery of antifibrotic growth factors will lead to successful restoration of functional vocal folds and improved vocal recovery in animal models, facilitating the application of these materials and related methodologies in clinical practice.

Etiology and long-term functional swallow outcomes in pediatric unilateral vocal fold immobility

ObjectiveUnilateral vocal fold immobility (UVFI) results in deficits in phonatory, respiratory, and swallow function of the pediatric patient. Little is known about long-term functional swallow outcomes. MethodsMedical records of children diagnosed with UVFI between 2005 and 2014 at a tertiary children's hospital were retrospectively reviewed. Etiology, laryngoscopy findings, and swallow status at diagnosis and follow-up were recorded. Swallow outcomes were compared by etiology using Fisher's exact test. McNemar's test was used to identify correlations between return of mobility and swallow recovery. Rates of pneumonia were compared with initial swallow evaluation results using a two-tailed t-test. ResultsEighty-eight patients with UVFI were identified and 73 patients (47% female, mean age 14.4 months, standard deviation (SD) 26.7 months) had complete medical records. Mean follow up time was 52.7 months (SD 36.8 months). Etiologies included cardiothoracic surgery (68.5%), idiopathic (12.3%), prolonged intubation (11.0%), central nervous system (CNS) abnormality (5.5%), and non-cardiac iatrogenic injury to the recurrent laryngeal nerve (2.7%). Forty-seven patients underwent a follow up laryngoscopy, and recovery of vocal fold (VF) mobility was documented in 42.6% (20/47). At diagnosis, 31.5% fed orally, compared with 79.5% at follow-up. Direct correlation between recovery of VF mobility and swallow recovery was not demonstrated. Cardiac etiologies demonstrated higher rates of swallow recovery than CNS abnormalities (p = 0.0393). Twenty-five children aspirated on initial modified barium swallow (MBS) and 10 children developed pneumonias at some point during the follow up period. There was no significant difference in rates of pneumonia in patients with and without aspiration on MBS. ConclusionRecovery of swallow in children with UVFI does not directly parallel return of VF mobility. Long-term swallow outcome is favorable in this population. Initial MBS does not indicate ultimate swallow outcome.

Laringectomias supracricóides: revisão de literatura em protocolos de qualidade de vida

RESUMO: A Laringectomia Parcial Supracricóide (LPSC) é indicada para tratamento de tumores com estadiamento1 e 2 e certos casos de tumores avançados. É considerada pela literatura como apresentando resultados satisfatórios em ambas situações, preservação da laringe e funcionalidade. Este estudo tem como objetivo rever de forma sistemática a literatura voltada para qualidade de vida em voz de pacientes submetidos a LPSC, identificando-se os protocolos de qualidade de vida em câncer de cabeça e pescoço. Para a revisão de literatura sistemática exploratória foram considerados os seguintes bancos de dados: MEDLINE, SciELO, LILACS; PubMed. Utilizados descritores em português, inglês e espanhol. A seleção dos artigos seguiu critérios de inclusão, para aplicação de teste de Relevância. Esta revisão de literatura revelou que os protocolos específicos para pacientes oncológicos de cabeça e pescoço mais utilizados são o EORTC-C30/H&amp;N35, UW-QOL e HNQOL. A LPSC embora seja considerada uma cirurgia que vise à preservação das funções de deglutição e fonação é apontada como tendo possibilidade de permanência de queixas em tais funções. A literatura afirma que os pacientes se declaram satisfeitos com a própria voz, tendo pouca dificuldade para se comunicar de forma inteligível. Estudos relacionam pacientes com dificuldades respiratórias após LPSC, inclusive com apneia obstrutiva do sono. Conclui-se que há necessidade de mais pesquisas que visem pontuar as dificuldades resultantes da LPSC e que utilizem protocolos específicos em cabeça e pescoço, para melhor mostrar o impacto da LPSC na qualidade de vida.

The assessment of the impact of anorexia nervosa on the vocal apparatus in adolescent girls – A preliminary report

BackgroundChronic undernourishment in the course of anorexia nervosa leads to various metabolic and hormonal changes, which translates to the impaired functioning of the majority of systems and internal organs. The impact of eating disorders on the condition of the vocal apparatus has been described in the literature; nevertheless, it concerns mainly bulimia nervosa. Objectivesassessment of the vocal apparatus in adolescent girls diagnosed with anorexia nervosa from the point of view of possible influence on the function and structure of the larynx, low body mass accompanying anorexia, as well as energy deficiency, hormonal and emotional disturbances. Materials and methodsThe research included 41 girls aged 12–19 years, diagnosed with anorexia, who were assessed for the condition of the vocal apparatus, using the perceptual assessment of voice according to GRBAS scale, videolarynostroboscopy, acoustic assessment, and voice self-assessment in Jacobson's VHI scale (voice handicap index). ResultsThe perceptual assessment of voice using the GRBAS scale revealed that changes in voice were mainly weak, asthenic in nature (70.73%) and there was also the feature of puffing perceived in voice (41.46%). In voice self-assessment with the use of VHI, most subjects seemed to point to changes of voice self-perception in emotional subscale (68%). Videolaryngostroboscopy revealed some features of functional disturbances of voice in more than half of subjects, mainly in the form of hyperfunctional dysphonia (31.78%). The maximal phonation time was significantly shorter, in proportion to duration of the primary disease. In the acoustic analysis, the decrease in the basic frequency F0 and narrowing of the voice scale were observed. 55% of older, post-adolescent patients presented with the structure of the larynx that was inappropriate for their age. ConclusionsThese results might indicate that anorexia nervosa could have led to the structural and functional changes in the vocal apparatus. Such disturbances may be explained by the hormonal dysfunctions as well as starvation. Hormonal substitution at the appropriate time might be beneficial for the structure and phonation function of the larynx in girls with AN.

Tissue-Engineered Vocal Fold Mucosa Implantation in Rabbits.

To assess phonatory function and wound healing of a tissue-engineered vocal fold mucosa (TE-VFM) in rabbits. An "artificial" vocal fold would be valuable for reconstructing refractory scars and resection defects, particularly one that uses readily available autologous cells and scaffold. This work implants a candidate TE-VFM after resecting native epithelium and lamina propria in rabbits. Prospective animal study. Research laboratory. Rabbit adipose-derived stem cells were isolated and cultured in three-dimensional fibrin scaffolds to form TE-VFM. Eight rabbits underwent laryngofissure, unilateral European Laryngologic Society type 2 cordectomy, and immediate reconstruction with TE-VFM. After 4 weeks, larynges were excised, phonated, and examined by histology. Uniform TE-VFM implants were created, with rabbit mesenchymal cells populated throughout fibrin hydrogels. Rabbits recovered uneventfully after implantation. Phonation was achieved in all, with mucosal waves evident at the implant site. Histology after 4 weeks showed resorbed fibrin matrix, continuous epithelium, and mildly increased collagen relative to contralateral unoperated vocal folds. Elastic fiber appearance was highly variable. Inflammatory cell infiltrate was limited to animals receiving sex-mismatched implants. TE-VFMs were successfully implanted into 8 rabbits, with minor evidence of scar formation and immune reaction. Vibration was preserved 4 weeks after resecting and reconstructing the complete vocal fold cover layer. Further studies will investigate the mechanism and durability of improvement. TE-VFM with autologous cells is a promising new approach for vocal fold reconstruction.

Indications, reconstructive techniques, and results for total glossectomy.

The best treatment for advanced tongue tumors remains controversial. Total glossectomy with laryngeal preservation is considered a feasible option, despite its morbidity. A retrospective analysis of 12 total glossectomies with laryngeal preservation was performed in order to assess the available reconstruction techniques and analyze survival and functional outcomes. One-year overall survival (OS) and disease-free survival (DFS) rates were 58.3% and 33.3%, respectively, both dropping to 25% after 3 years. Permanent gastrostomy was necessary in 10 patients, although videofluoroscopy revealed adequate tolerance to liquids. Speech intelligibility was satisfactory in 50% of the patients and severely impaired in the remaining 50%. Laryngeal preservation in the context of advanced tumors of the tongue without supraglottic invasion carried similar oncologic results to total glossectomy with laryngectomy, but offers a better phonatory function. However, it is usually associated with a higher gastrostomy dependency ratio. A scrupulous selection of candidates is mandatory. © 2016 Wiley Periodicals, Inc. Head Neck 38: E2004-E2010, 2016.

Andreas Vesalius' 500th Anniversary: Initial Integral Understanding of Voice Production

Voice production relies on the integrated functioning of a three-part system: respiration, phonation and resonance, and articulation. To commemorate the 500th anniversary of the great anatomist Andreas Vesalius (1515-1564), we report on his understanding of this integral system. The text of Vesalius' masterpiece De Humani Corporis Fabrica Libri Septum and an eyewitness report of the public dissection of three corpses by Vesalius in Bologna, Italy, in 1540, were searched for references to the voice-producing anatomical structures and their function. We clustered the traced, separate parts for the first time. We found that Vesalius recognized the importance for voice production of many details of the respiratory system, the voice box, and various structures of resonance and articulation. He stressed that voice production was a cerebral function and extensively recorded the innervation of the voice-producing organs by the cranial nerves. Vesalius was the first to publicly record the concept of voice production as an integrated and cerebrally directed function of respiration, phonation and resonance, and articulation. In doing so nearly 500 years ago, he laid a firm basis for the understanding of the physiology of voice production and speech and its management as we know it today.

Biofeedback eletromiográfico no tratamento das disfunções orofaciais neurogênicas: revisão sistemática de literatura

RESUMO Objetivo Investigar se o uso do biofeedback eletromiográfico na terapia voltada às funções orofaciais (expressão facial, mastigação, deglutição, fonação e fala) produz efeitos benéficos para os indivíduos com doenças neurológicas. Estratégia de pesquisa Foi realizada busca nas bases de dados MEDLINE, LILACS e SciELO, por meio dos descritores “electromyographic biofeedback”, “swallowing”, “speech” “chewing”, “phonation”, e “facial expression”. A busca nas bases de dados e a seleção dos artigos foram realizadas independentemente, por duas pesquisadoras e, nos casos de não concordância, houve discussão fundamentada nos critérios de inclusão e exclusão para que chegassem a um consenso. Critérios de seleção Foram incluídos estudos experimentais em seres humanos, em inglês e português, que descreveram e discutiram a utilização do biofeedback eletromiográfico no tratamento das alterações das funções orofaciais provenientes de doenças neurológicas. Resultados Foram encontrados 175 artigos, sendo que somente 10 se adequaram aos critérios de inclusão. A maioria dos trabalhos relacionou-se a estudo de caso, seguido por estudos de série de casos, caso controle e ensaio clínico randomizado. A maior parte dos artigos abordou a aplicação da terapia com biofeedback eletromiográfico na função da deglutição, seguida da função da fala e apenas um artigo utilizou esta modalidade de tratamento na terapia para melhora da expressão facial. Não foram encontrados estudos que abordassem o tratamento fonoaudiológico utilizando o biofeedback eletromiográfico em pacientes com doenças neurológicas, nas funções de fonação e mastigação. Conclusão O uso do biofeedback eletromiográfico na terapia voltada às funções orofaciais pode produzir efeitos benéficos para os indivíduos com doenças neurológicas, nas funções de deglutição, fala e expressão facial.

The issues of pharmacotherapy of larynx chronic diseases in patients with chronic obstructive pulmonary disease (COPD)

The paper deals with the issues of pharmacotherapy of larynx chronic diseases in patients with COPD, the use of the acoustic voice characteristics for assessment of the functional state of larynx using a software package SpectaPLUS. Complex treatment of chronic laryngitis, different from the traditional drug therapy, involves voice rest and phonopedic training containing the rational psychotherapy, breath correction, strengthening of voice recovery skills. In addition to indirect laryngoscopy, visualization techniques included inspection with rigid and flexible endoscopes, stroboscope inspection. The identified changes had the form of diffuse hyperemia of the mucous larynx and (or) of the true vocal cords, thickening thereof, rounded medial edge of the true vocal cords. The front third of the folds often featured with the typical «mucous bridges» or the mucus was located diffusely in all parts of the larynx, in some patients phonation process involved false vocal folds. Stroboscopic signs included low amplitude of the vocal folds fluctuation, phase asymmetry, a small symptom of mucosal wave, with the most intense manifestation of these symptoms in hyperplastic laryngitises. Re­examination of the patients was conducted 1.5 months after the end of treatment. Most of the patients indicated the positive trend in the treatment, both in terms of endoscopic pattern and phonatory function. It was found that such factors as maximum phonation time, voice­noise areas dynamically reflect the improved phonation function of larynx on the background of complex therapeutic correction of the upper respiratory tract diseases. In contrast, the frequency of the pitch is a more stable parameter; it is not subject to statistically significant changes. The authors established the relationship between the efficiency of chronic laryngitis treatment and the frequency of COPD aggravation.

Laser-assisted posterior cordotomy for bilateral vocal fold paralysis: Our experience

Introduction: Bilateral vocal fold paralysis (BVFP) is a relatively uncommon cause of respiratory distress. The goals of surgical treatment are an improvement in airway size by enlarging the glottis, thus, eliminating the need for tracheostomy, while at the same time avoiding a breathy voice and aspiration. Striking this balance is extremely important. Unilateral laser-assisted posterior cordotomy provides sufficient airway at posterior glottis while preserving phonatory and protective functions of the larynx. Aims: To evaluate long-term acoustic, aerodynamic and functional results of laser-assisted unilateral posterior cordotomy in BVFP. Materials and Methods: The prospective study includes seven patients of BVFP who underwent unilateral laser-assisted posterior cordotomy. Surgical success was evaluated regarding decannulation rate, time to decannulation and need for the second procedure. Voice assessment was done using voice handicap index (VHI), grade, roughness, breathiness, asthenia, strain and measurement of maximum phonation time (MPT). Effect of deglutition was assessed by the presence or absence and duration of aspiration. Observations and Results: Of seven patients, four had been tracheostomized at some time during their treatment. They were successfully decannulated within an average of 1 week after the surgery. The postoperative respiratory function was adequate for more than routine activity in all patients. None of the patients required a second procedure. VHI values demonstrated that while four patients had no/mild degree of voice handicap, two had moderate and one had a severe degree of handicap. While five patients had a normal MPT, two had a reduced MPT. Perceptual rating by a speech pathologist revealed that while two patients had mild dysphonia, four had moderate dysphonia. None of the patients complained of aspiration postoperatively. Conclusion: Unilateral CO2laser posterior cordotomy is a simple, safe and short surgical technique that creates a satisfactory glottic airway to improve respiration while avoiding aspiration and having minimal to the mild effect on the voice.