Unilateral Laryngeal Paralysis Research Articles

Outcomes and Perioperative Complications of Surgical Resection on Canine Carotid Paragangliomas (21 Cases): A Veterinary Society of Surgical Oncology Study.

Carotid body paragangliomas represent an uncommon neoplasm in dogs. The objective of this study was to report outcomes and complications associated with surgical excision of carotid body paragangliomas in 21 dogs. Cases were recruited retrospectively via medical record review from 9 veterinary speciality centres. The perioperative complication rate was 52% (11/21). Complications encountered in this cohort related to removal of carotid body tumour included airway obstruction, aspiration pneumonia, megaesophagus, unilateral laryngeal paralysis, coughing and Horner's syndrome. The overall perioperative mortality rate was 4.7% (1/21 dogs) and median survival time was 554 days for the six patients with known dates of death. One- and two-year survival rates were 61% and 42%, respectively. This is the largest collection of carotid body paraganglioma cases reported in veterinary literature. Based on these results, surgical resection of carotid body paragangliomas was associated with low perioperative mortality and long survival times.

Vocal fold electromyography in patients with endoscopic features of unilateral laryngeal paralysis.

<b><br>Introduction:</b> Electromyography (EMG) of the larynx provides information on the electrophysiological condition of laryngeal muscles and innervation. Integration of information obtained from the EMG exams with the clinical parameters as obtained by other methods for laryngeal assessment (endoscopy, perceptual and acoustic analysis, voice self-assessment) provides a multidimensional picture of dysphonia, which is of particular importance in patients with vocal fold (VF) mobility disorders accompanied by glottic insufficiency.</br> <b><br>Aim:</b> The aim of this study was to evaluate laryngeal EMG records acquired in subjects with unilateral vocal fold immobilization with signs of atrophy and glottic insufficiency.</br> <b><br>Material and methods:</b> From the available material of 74 EMG records of patients referred for the exam due to unilateral laryngeal paralysis, records of 17 patients with endoscopic features suggestive of complete laryngeal muscle denervation were selected. The EMG study of thyroarytenoid muscles of mobile and immobile VFs was evaluated qualitatively and quantitatively at rest and during volitional activity involving free phonation of vowel /e/ [ε].</br> <b><br>Results:</b> In all patients, the EMG records from mobile VFs were significantly different from those from immobile VFs. Despite endoscopic features of paralysis, no VF activity whatsoever was observed in as few as 2 patients so as to meet the neurophysiological definition of paralysis. In 88% of cases, electromyographic activity of the thyroarytenoid muscle was observed despite immobilization and atrophy of the vocal fold. In these patients, neurogenic type of record was observed with numerous high- -amplitude mobility units. On the basis of the results, quantitative features of EMG records indicative of paralysis and residual activity of the thyroarytenoid muscle were determined.</br> <b><br>Conclusions:</b> Qualitative and quantitative analysis of laryngeal EMG records provides detailed information on the condition of vocal fold muscles and innervation. EMG records of mobile vs immobile VFs differ significantly from each other. Endoscopic evaluation does not provide sufficient basis for the diagnosis of complete laryngeal muscle denervation.</br&gt.

Can Resident Auditory-Perceptual Voice Assessments Predict Medical Urgency of Voice Disorders?

Growing reliance on telemedicine has created new triaging challenges. This study investigated how effectively otolaryngology resident auditory-perceptual voice assessments performed via telemedicine determined the need for urgent in-person clinic visits. Twelve otolaryngology resident physicians (PGY1-PGY5) performed auditory-perceptual assessments on 25 voice samples recorded during initial voice evaluations. Voice samples were balanced in severity and taken in equal numbers from patients with the following diagnoses: benign laryngeal lesions, laryngeal cancer, functional voice disorders, laryngeal edema (associated with LPR), and laryngeal paralysis/paresis. Urgent diagnoses were defined as laryngeal cancer and severe unilateral laryngeal paralysis. For each voice sample, residents were initially blinded to patient medical history. Residents rated severity of voice disorder, predicted patient diagnosis, and determined the urgency of seeing the patient in clinic. Residents then reviewed information from the patient's medical history and again rated urgency of voice disorder. On average, residents identified urgent voice disorders in 56% of cases. After reviewing medical history, this number significantly increased to 77% (P=0.001). Voice severity, smoking history, time since onset, and course of symptoms were considered most influential when determining medical urgency of voice patients. Year in residency program had no effect on rating accuracy. As expected, diagnostic accuracy of auditory-perceptual assessments was low, ranging from 40% for laryngeal paralysis/paresis to 5% for laryngeal edema. Auditory-perceptual voice assessment, combined with medical history, predicted most medically urgent voice disorders. Further work should investigate if task-specific training might improve these results and which medical history items are most critical. Until accuracy of auditory-perceptual assessment of medical urgency is improved, these data underscore the importance of laryngeal examination in identifying medical urgency and etiology of dysphonia.

Electromyographic Evaluation of Vocal Folds in Patients With Laryngeal Paralysis Referred for Injection Laryngoplasty.

According to the literature, almost 80% of the patients diagnosed with permanent unilateral laryngeal paralysis experience vocal disability. Laryngeal electromyography (LEMG) provides information on the characteristics and progression of the disease process, allowing for optimal treatment. The aim of this study was to evaluate LEMG recordings in patients with unilateral vocal fold (VF) immobility referred for injection laryngoplasty (IL). 17 patients with unilateral laryngeal immobilisation as an iatrogenic complication after neck surgery. The patients were referred for IL surgery due to glottic insufficiency. All patients underwent a preoperative otolaryngologic-phoniatric evaluation with perceptual and acoustic voice assessment and LEMG. Patients with unilateral VF immobilisation referred for injection laryngoplasty for glottal insufficiency show significant differences on LEMG between the mobile and immobile folds. In these patients, electromyography (EMG) features of the thyroarytenoid (TA) muscle correlate with the severity of breathiness in the voice and pathological variation in the fundamental frequency. Despite the lack of mobility and features of VF atrophy, only 12% meet the electromyographic criterion for vocal fold paralysis. The immobile VF has a poorer recording from the TA muscle, the more material needs to be injected to surgically model the glottis during IL. This study demonstrated that LEMG is a valuable criterion for qualifying patients for injection laryngoplasty in unilateral vocal fold paralysis.

Objective Evaluation of the Pathological Voice Based on Deep Learning Neural Networks in an Algerian hospital environment

In this study, we propose a method based on Recurrent Neural Networks, to objectively evaluate the process of rehabilitation of the pathological voice, in an Algerian clinical environment. We choose Unilateral Laryngeal Paralysis as the pathology of the voice. In this paper, we used a Deep Learning system of pathological voice detection by Long Short Term Memory neural model (LSTM). As the dysphony studied in our work concerns essentially the laryngeal vibration, we choose the acoustic parameters based on the instability of the frequency and the amplitude of the laryngeal vibration: Jitter and Shimmer, Noise parameters and Cepstraux MFCC coefficients (Mel Frequency Cepstral Coefficients). A pathological voice detection rate of 88.65% shows important results brought by the rehabilitation technique adopted in Algerian clinical setting. The exclusive and abusive use of hearing to evaluate the effect of speech rehabilitation in the Algerian hospital environment remains insufficient. It is important to correlate perceptual data with objective methods based on detection and classification methods by introducing relevant acoustic parameters, for an effective and objective management of vocal pathology assessment.

A model of transient laryngeal hemiplegia in dogs through conduction blockade of the recurrent laryngeal nerve.

To create a model of transient unilateral laryngeal paralysis (LP) that will allow the study of cricoarytenoideus dorsalis dysfunction and a method for quantification of varying degrees of LP in dogs. 5 castrated male research Beagles. Between January and February 2018, dogs were anesthetized and instrumented with a laryngeal mask airway and a flexible endoscope to record the rima glottidis. The left or right recurrent laryngeal nerve (RLn) was localized using ultrasonography and electrical stimulation, then conduction blockade was induced with perineural lidocaine. The normalized glottal gap area (NGGA) was measured before and every 15 minutes after the block. Inspired 10% carbon dioxide (CO2) was administered for 1 minute at each sampling time. The inspiratory increase in NGGA (total and each side) was measured at peak inspiration. The change in hemi-NGGA for the control side versus the anesthetized side was evaluated with a mixed-effect model. During CO2 stimulation, the increase in inspiratory hemi-NGGA was consistently less (P < .001) for the treated side (-8% to 13%) versus the control side (49% to 82%). A compensatory increase (larger than at baseline) in the control hemi-NGGA was observed. The total NGGA remained unaffected. Unilateral local anesthesia of the RLn produced transient unilateral LP with a compensatory increase in the hemi-NGGA for the contralateral side. This model could facilitate the evaluation of respiratory dynamics, establishment of a grading system, and collection of other important information that is otherwise difficult to obtain in dogs with LP.

Surgical treatment of unilateral laryngeal paralysis by selective reinnervation in thyroid surgery

State of the problem: One of the complications in thyroid surgery is a lesion of RLN which can be bilateral with a violation of respiratory function of the larynx and unilateral, in which the first priority is a violation of vocal function of the larynx. The most effective treatment for paralysis of the larynx is the method of laryngeal reinnervation, which can be non-selective, which is usually used in unilateral laryngeal paralysis and promotes reinnervation of both abductors and laryngeal adductors. Selective reinnervation is selectively focuses on the reinnervation of individual target muscles, so it is more often used in bilateral laryngeal paralysis. But despite this, it was used in unilateral laryngeal paralysis during surgery on the thyroid gland during intentional resection of the anterior branch of RLN with partial invasion of its tumour process. Aim: evaluation of the results of surgical treatment unilateral laryngeal paralysis by the method selective reinnervation in thyroidectomy. Materials and Methods: clinical case results of patient A. 15 years old with papillary thyroid cancer and metastases to regional lymph nodes of the neck (T4aN1M0) with absence disorders of laryngeal motility before surgery were analyzed. Examination of the larynx and voice examination were performed before surgery, 2-3 days and 6,12 months after surgery. Changes of laryngoscopic images and evaluation of the Indicators: maximum pho- nation time, fundamental frequency, noise to harmonic ratio, Jitter (loc), Shimmer (loc), Voice Handicap Index-30 (VHI-30), completed version of Jacobcon B. Results: Considering extralaryngeal bifurcation of the recurrent laryngeal nerve (RLN) and invasion of the tumor into the adductive branch of RLN on the left, its dissection was performed and end-to-end neuroanastomosis was formed, completed is selective laryngeal reinnervation. In the immediate postoperative period, patients complained of voice disorders. Study of voice parameters corresponded to severe voice disorders. Partial resumption of the mobility of the larynx and voice function was after 6 months. The signs of the laryngoscopic picture and the spectral analysis of the voice corresponded to the indicators before the operation after 12 months Сonclusions 1. Primary selective reinnervation of the larynx can be used to treat unilateral laryngeal paralysis under the following conditions: extralaryngeal branching of the recurrent laryngeal nerve (bifurcation), lesion of only one of its branches, which will provide sufficient coaxiality to perform anastomosis "end-to-end" and preservation electrical integrity of another branch. 2. This method allows you to restore the motility of the denervated vocal folds and the main indicators of the voice. 3. Given only one clinical case of treatment of unilateral laryngeal paralysis by selective reinnervation, this technique needs further study and refinement.

Assessment of the effectiveness of laryngeal protection mechanisms in patients with iatrogenic, unilateral laryngeal paralysis

Introduction: Postoperative paresis of the laryngeal nerves may disrupt the protection function of the larynx during swallowing. Material and method: Stage 1: Retrospective analysis of FEES reports in patients with unilateral laryngeal paralysis (n = 99) in terms of the occurrence of penetration or aspiration of saliva and liquid and solid food. Stage 2: Prospective analysis of the results of the EAT-10 screening questionnaire and reports (n = 12) of FEES examination performed in the early postoperative period (up to 7 days after the surgery) in patients with iatrogenic palsy of the X cranial nerve. Assessment of: sensory of the larynx, effectiveness for cough and pressure tests, presence of "white out", PAS scale for a regular diet according to IDDSI (ST 0; ST 7). Results: Stage 1: Penetration or aspiration was found in 65% of patients, in 29% of patients it were silent symptoms. Salivary penetration or aspiration concerned 60.60% of patients. Among people who developed silent disorders, 20 had isolated n. X paralysis, and 79% - polyneuric palsy. The PAS level between 2-8 was found in 65% of patients. Stage 2: 11/12 patients obtained the result of the EAT 10 questionnaire &gt; = 3. "White out" elongation and sensory loss were found in 75% of patients, ineffective cough in 33%. In oral trials, residue (50% ST0), premature swallowing (8% ST0), penetration (33% ST0, 8% ST7) and aspiration (16% ST0, 8% ST7) were found. Adaptive and compensatory techniques were the most frequently combined (66%), and the dominant technique was turning the head towards the affected side. Conclusions: In every sixth patient with iatrogenic laryngeal paralysis, aspiration of non-condensed fluids occurs early after the surgery, and the penetration of these contents into the larynx occurs in every third patient. It is therefore advisable to improve the comfort associated with the quality of life dependent on swallowing and to prevent complications of dysphagia in the study group. Therefore, it is justified to extend diagnostics to include clinical assessment of swallowing and qualify patients for FEES assessment. Key words: dysphagia, penetration, aspiration, laryngeal paralysis, FEES, vocal fold paresis, oropharyngeal dysphagia

Montgomery® implant extrusion after type I thyroplasty. A CARE case report

To document the first case of Montgomery® implant extrusion after type I thyroplasty for unilateral laryngeal nerve paralysis in adults. Three years after onset of right idiopathic unilateral laryngeal nerve paralysis resulting in severe dysphonia not improved by speech therapy, a 45-year-old Caucasian woman consulted to improve her voice. Maximum phonation time (MPT) was 5seconds. Voice Handicap Index (VHI) was 64. Type I thyroplasty with n°10 Montgomery® implant was performed without difficulties. Immediate postoperative course was uneventful. One month after thyroplasty, the patient considered her voice normal, with 8sec MPT and VHI of 23. At 4 months, there was implant extrusion through the cervical skin, with 9sec MPT and VHI of 18. When performing type I thyroplasty with Montgomery® implant, the otorhinolaryngologist must not only take care to position the implant properly within the thyroid lamina but also ensure that the inner flanges of the implant are well deployed, to achieve proper retention.

Unilateral Laryngeal Paralysis Secondary to Otitis Media/Interna in Two Cats

ABSTRACT Two adult cats were presented for coughing, gagging, dysphonia, exaggerated swallowing attempts, unilateral vestibular dysfunction, and/or Horner syndrome. In both cats, unilateral laryngeal paralysis was identified on the side ipsilateral to other neurological deficits. Cross-sectional imaging was consistent with otitis media/interna. In both cats, there also was extensive cellulitis surrounding the tympanic bulla and dissecting through tissue planes to involve the opening of the tympano-occipital fissure on the side ipsilateral to the laryngeal paralysis. Laryngeal paralysis was presumed secondary to involvement of the vagus nerve as it emerged from the tympano-occipital fissure. Antibiotic therapy resulted in resolution of clinical signs in both cats and restored laryngeal function as evidenced by visual examination of the larynx in one cat.

Tracheostomy in COVID-19 acute respiratory distress syndrome patients and follow-up: A parisian bicentric retrospective cohort.

Tracheostomy has been proposed as an option to help organize the healthcare system to face the unprecedented number of patients hospitalized for a COVID-19-related acute respiratory distress syndrome (ARDS) in intensive care units (ICU). It is, however, considered a particularly high-risk procedure for contamination. This paper aims to provide our experience in performing tracheostomies on COVID-19 critically ill patients during the pandemic and its long-term local complications. We performed a retrospective analysis of prospectively collected data of patients tracheostomized for a COVID-19-related ARDS in two university hospitals in the Paris region between January 27th (date of first COVID-19 admission) and May 18th, 2020 (date of last tracheostomy performed). We focused on tracheostomy technique (percutaneous versus surgical), timing (early versus late) and late complications. Forty-eight tracheostomies were performed with an equal division between surgical and percutaneous techniques. There was no difference in patients' characteristics between surgical and percutaneous groups. Tracheostomy was performed after a median of 17 [12-22] days of mechanical ventilation (MV), with 10 patients in the "early" group (≤ day 10) and 38 patients in the "late" group (> day 10). Survivors required MV for a median of 32 [22-41] days and were ultimately decannulated with a median of 21 [15-34] days spent on cannula. Patients in the early group had shorter ICU and hospital stays (respectively 15 [12-19] versus 35 [25-47] days; p = 0.002, and 21 [16-28] versus 54 [35-72] days; p = 0.002) and spent less time on MV (respectively 17 [14-20] and 35 [27-43] days; p<0.001). Interestingly, patients in the percutaneous group had shorter hospital and rehabilitation center stays (respectively 44 [34-81] versus 92 [61-118] days; p = 0.012, and 24 [11-38] versus 45 [22-71] days; p = 0.045). Of the 30 (67%) patients examined by a head and neck surgeon, 17 (57%) had complications with unilateral laryngeal palsy (n = 5) being the most prevalent. Tracheostomy seems to be a safe procedure that could help ICU organization by delegating work to a separate team and favoring patient turnover by allowing faster transfer to step-down units. Following guidelines alone was found sufficient to prevent the risk of aerosolization and contamination of healthcare professionals.

Quantitative assessment of progressive laryngeal hemiplegia in a 4-year-old beagle.

Progression of unilateral laryngeal paralysis (LP) was quantified in an asymptomatic 4-year-old beagle during spontaneous breathing stimulated with inhaled 10% CO2. Laryngeal evaluation was performed sequentially to track progression of LP over an 18-month period. Videos of the larynx during CO2-stimulated breathing were obtained under propofol anaesthesia. Maximal inspiratory normalised glottal gap area (NGGA) was determined on each occasion for left and right hemiglottis. Left NGGA was smaller than the right side throughout the period of follow-up. After 18 months, LP had progressed to such a degree that the left arytenoid was completely paralysed with no movement during inspiration. This case report demonstrates the possibility of early detection of LP, and quantification of progression. Early detection may allow regenerative surgical strategies for LP to maintain glottic area and reduce postoperative complication rates.

Acoustic Analysis of Voice Signal of Patients with Unilateral Laryngeal Paralysis a View to Objective Evaluation after Rehabilitation

We propose in this study an acoustic analysis called objective, based on physical measurements, to extract the acoustic characteristics of the voice of patients with Unilateral Laryngeal Paralysis. Our experiments were made at the Otorhinolaryngology service of the hospital of Bab El Oued. Algiers. (Algeria). In this work, an acoustic analysis of the vocal signal is based on measurements of the instability of the amplitude and frequency of the vibrations of the vocal cords. The results obtained are compared with those of a group of reference of subjects who normally speak. The study of the results obtained by the acoustic analysis of the pathological voice during the rehabilitation phase shows a strong correlation of the acoustic parameters between the pathological voice and the reference one. The exclusive use of hearing to evaluate the effect of voice rehabilitation in the Algerian hospital environment remains insufficient. It is important to correlate the perceptual information with the interpreted acoustic measurements, in a manner to be able to develop a therapeutic project appropriate to the patient’s expectations and difficulties.

Effect of Fascia Implantation and Controlled Release of Basic Fibroblast Growth Factor for Muscle Atrophy in Rat Laryngeal Paralysis.

To improve lateral thyroarytenoid (TA) muscle atrophy after laryngeal paralysis, reconstruction of the vascular network of the atrophied muscle is necessary. We therefore evaluated whether the controlled release of basic fibroblast growth factor (bFGF) with autologous fascia implantation could affect vascular reconstruction in the lateral TA muscle. Animal experiment. Laboratory. Unilateral laryngeal paralysis was induced in 20 rats. The rats were implanted with autologous fascia and a gelatin hydrogel sheet with or without 1 µg of bFGF (fascia and bFGF + fascia groups; n = 5 each) and with only a gelatin hydrogel sheet with bFGF (bFGF group: n = 5). Another group remained untreated (n = 5) at 4 months after paralysis. At 3 months since transplantation, intra- and intergroup comparisons of the muscle volumes and total area of blood vessels in the lateral TA muscle were performed. When compared with the untreated group, the bFGF + fascia group showed a significant increase in muscle volume (P =.0008) and vascular area (P =.0002) in the lateral TA muscle, whereas the other 2 treated groups demonstrated an insufficient effect. bFGF + fascia implantation showed histologic improvement in severe laryngeal paralysis. We demonstrated that the decrease in lateral TA muscle mass after paralysis might be countered by the reconstruction of the vascular network. Our findings indicate that hypovascular and denervated areas of the laryngeal muscle can be regenerated by the implantation of growth factors and scaffolds with surgical stress. 5.

Determining Medical Urgency of Voice Disorders Using Auditory-Perceptual Voice Assessments Performed by Speech-Language Pathologists.

This study examined whether speech-language pathologist auditory-perceptual voice assessments can predict the medical urgency of voice disorders. Twenty speech-language pathologists (SLPs) evaluated 25 voice samples recorded during initial voice evaluations. Voice samples represented a range of dysphonia severity (mild-severe) balanced across patient diagnoses. Diagnoses included: benign lesions, laryngeal cancer, non-organic voice disorders, laryngeal edema (associated with LPR), and laryngeal paralysis or paresis. Laryngeal cancer and severe unilateral laryngeal paralysis were considered urgent disorders. While blinded to patient information, SLPs rated severity of voice quality, predicted patient diagnosis, and determined whether the patient should be seen urgently by a laryngologist. SLPs were then given basic medical history information and rated medical urgency of voice disorder a second time. On average, SLPs correctly identified 65% of urgent voices and 87% of nonurgent voices when blinded to patient information. Accuracy improved significantly to 86% for urgent voices with medical history information (P < .001) and decreased to 77% for nonurgent voices. Accuracy was better when severity of voice quality was severe for urgent voices and mild for nonurgent voices (P < .001). SLPs indicated that patient smoking history and severity of dysphonia were most influential in their decision making. Diagnostic accuracy of auditory-perceptual assessments was poor. SLPs identified 86% of medically urgent voice disorders when auditory perceptual assessments were combined with medical history information. Further work is needed to determine what medical history information is most crucial to rating accuracy and what speech tasks might best separate urgent and nonurgent patients.

Laryngeal paralysis secondary to cervical bite injuries in five dogs

Case histories : Medical records of a veterinary hospital in Belgium were reviewed for dogs (n=5) that presented between 2016 and 2019 with laryngeal paralysis secondary to bite wounds to the cervical region received while fighting with other dogs . The time elapsed between the trauma and presentation was from a few hours up to 5 days. Clinical findings and treatment Bilateral laryngeal paralysis was identified in three dogs and unilateral laryngeal paralysis in two dogs via endoscopic assessment of laryngeal function. The primary concomitant lesions included tracheal injury in 3/5 dogs and oesophageal injury in 1/5 dogs. One dog with bilateral laryngeal paralysis was treated medically as no signs of dyspnoea were present. Surgical management was elected in 4/5 dogs based on evaluation of their clinical status and lesions revealed by endoscopic examination of upper gastrointestinal and respiratory tracts. Dogs underwent surgical procedures as were determined to be appropriate for treatment of the lesions identified on clinical examination, diagnostic imaging, and endoscopy. The cervical region was explored through a ventral midline approach in 2/4 cases to close tracheal perforations. Temporary tracheostomy was performed in 2/4 cases. Procedures to correct brachycephalic airway obstructive syndrome were performed in 2/4 cases. Cricoarytenoid lateralisation was performed in 2/4 dogs. Dogs were hospitalised for 2–10 days and received antimicrobial therapy before surgery and for 2–3 weeks after surgery. Physical examination and respiratory function were normal in 3/5 dogs 4–6 months after discharge. Information regarding outcomes for two cases was obtained from the owners by telephone assessment 1–6 months after surgery. The owner of each dog reported the respiratory function to be excellent. Diagnosis: Uni- or bilateral, transient or permanent laryngeal paralysis with concomitant oesophageal, tracheal, or laryngeal lesions following cervical dog bite injuries diagnosed by endoscopic examination of upper gastrointestinal and respiratory tracts. Clinical relevance: This case series describes the diagnosis and management of dogs with laryngeal paralysis secondary to cervical dog bite injuries. To the authors’ knowledge, this is the first published report documenting bilateral laryngeal paralysis secondary to cervical dog bite injuries. Clinicians should be aware of this pathology and the importance of investigating laryngeal function in dogs presenting with cervical bites, particularly those with inspiratory dyspnoea. Upper airway and digestive endoscopy are recommended for complete assessment of cervical traumatic injuries.

Characteristics, natural evolution and surgical treatment outcomes of unilateral laryngeal paralysis versus ankylosis: A longitudinal cohort study.

Although unilateral laryngeal immobility (ULI) can results from paralysis or ankylosis of the cricoarytenoid joint, no comparative study exists to date. Aim of this study was to compare clinical features, aetiologies, spontaneous recovery and evolution after surgical treatment of ULI according to its mechanism. Longitudinal observational cohort study between 1992 and 2017 in a tertiary care referral centre and university teaching hospital. All adult patients with isolated ULI were included. Presenting symptoms and demographic data were recorded at baseline. During follow-up, natural recovery and, if a surgical treatment was performed, treatment failure rate were noted. 994 patients were included, 56.4% of male and with a mean age of 58 years. Overall, 91% had paralysis and 9% had ankylosis. Dysphonia was the main symptom in both groups (>96%). Dyspnoea was more frequent in patients with ankylosis (26.1% vs 4.2% in those with paralysis) whereas dysphagia was more frequent in those with paralysis (31.1% vs 20% in those with ankylosis). With a mean follow-up of 2.3 years (±5.1), spontaneous recovery did not differ according to ULI's aetiology (hazard ratio 1.43, 95% confidence interval 0.85-2.40). Overall, 37.1% underwent a surgical treatment, and paralysis was associated with a lower odd of treatment failure (hazard ratio 0.27, 95% confidence interval 0.10-0.70) over a mean follow-up of 3.1years (±4.1). ULI resulting from paralysis or ankylosis differ in their symptoms and responses to surgical treatment, whereas natural evolution was similar.

Linguistic adaptation and validation of the voice handicap index (VHI)-30 in patients with dysphonia into Russian

It is prospective observational study. The original English version of the VHI-30 questionnaire was translated into Russian by two independent researchers (professional translators). The final Russian version (VHI-30rus) was formulated by a third researcher (otorhinolaryngologist) on the basis of these two translations, and then translated back into English. The 181 participants were included in this study. The main group patients (n=91) were additionally divided into subgroups in accordance with the form of dysphonia: 65 (71.4%) patients had functional and organic dysphonia, 8 (8.8%) had chronic inflammatory diseases of the larynx, 7 (7.7%) - benign neoplasms of the larynx (singing nodules, polyps, cysts), 11 (12.1%) - unilateral laryngeal paralysis. The control group consisted of 90 people without voice disorders. Internal consistency (Cronbach's α coefficient), retest reliability (intraclass correlation coefficient (ICC) VHI-30, comparison of VHI-30 indicators of patients and studied control group (Mann-Whitney U-test, Kruskal-Wallis test) and correlation with the overall severity of dysphonia (Spearman's ρ rank correlation coefficient) were determined. In the patient group, we observed excellent internal consistency for VHI-30rus (α=0.95) and good internal consistency for all VHI-30rus subscales: physical (α=0.88), functional (α=0.88), and emotional (α=0.88). The intraclass correlation coefficient (ICC) indicated high retest reliability for patients (0.99) and control group subjects (0.84). The 30-item mean total values for patients with dysphonia were statistically significantly higher than for control group participants (p<0.001). A correlation was found between the overall VHI-30rus value and the overall severity of dysphonia (ρ=0.748, p<0.001). In the patient's group, female and male participants showed a statistically insignificant difference in the total value of VHI-30rus (Mann-Whitney U-test, p<0.001). There was a correlation in terms of VHI-30rus indicators in different subgroups of the patient group and the control group (Spearman's correlation coefficient: functional dysphonia - 0.942; chronic laryngitis - 0.756; unilateral laryngeal paralysis - 0.888; benign neoplasms - 0.982; control group studied - 0.882). As a result of this study, the VHI-30 questionnaire was translated from English into Russian for use in the Russian-speaking environment. The study showed good internal consistency, retest reliability, and clinical validity for the Russian version of the VHI-30rus questionnaire. The VHI-30rus questionnaire can be recommended for use in clinical practice for patients with dysphonia.

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.

Precision treatment of post pneumonectomy unilateral laryngeal paralysis due to cancer.

Aim: The aim of this study is to assess the efficacy of external laryngeal medialization acquired through a Gore-Tex implant in a 45 patients affected by unilateral vocal fold paralysis in abduction after pneumonectomy. Method: The cohort of patients was made up of 30 male (73.1%) and 11 female patients (26.9%) with an average age of 66.7 years in a range between 46 and 78 years. Results: The results were analyzed with the objective and subjective analysis of voicing and swallowing. In 95.2% of cases, voice and swallow improvement with statistically significant evidences. Conclusion: We can conclude that Gore-Tex implantation is a simple, reproducible and minimally invasive procedure for management of selected cases of vocal fold unilateral paralysis in the abductory position.