Video Stroboscopy Research Articles

Platelet Rich Plasma (PRP) Treatment in Recalcitrant, Bilateral Phono-traumatic Lesions

ObjectiveMature vocal fold nodules and fibrous phono-traumatic lesions that have failed standard voice therapy can be challenging. Autologous Platelet-rich plasma (PRP) is rich in growth factors and easily obtained from a simple blood draw. Growth factor injection into the vocal folds may reverse the scar and inflammation in recalcitrant, bilateral phono-traumatic lesions such as mature vocal fold nodules. This study reports the short-term (3 months) voice results after PRP injection in 11 subjects with recalcitrant, bilateral phono-traumatic lesions that have failed voice therapy. Materials and MethodsSerial autologous PRP injections were used to treat eleven patients with recalcitrant, bilateral phono-traumatic lesions in an office setting. All had prior conservative voice therapy or surgery and were deemed failures. Pre and post-treatment video stroboscopy, Voice Handicap Index (VHI-10), and Cepstral Spectral Index of Dysphonia (CSID) before and after treatment (3 months) were tabulated and compared. An expert rater blinded to the treatment condition rated the stroboscopy and voice results. ResultsAt three months post injection, nine of the eleven patients reported improved VHI-10 and noted sustained voice improvement after PRP injections. Median VHI-10 changed from 20 to 13 (p<.05 paired t-test). The CSID scores changed from 17 to 5 (NS p>.05, paired t-test). Nine of eleven patients reported improved vocal effort and stamina. Stroboscopy ratings were better after treatment than before treatment in 7 of the 11 subjects. ConclusionShort-term improvements in voice may occur in patients with recalcitrant, bilateral phono-traumatic lesions following PRP injection. PRP injections into the vocal folds may be a new treatment for non-surgical intervention in patients with recalcitrant, bilateral phono-traumatic lesions. Level of EvidenceII

The role of the autonomic nervous system in the development of hypotonic dysphonia

Background. Hypotonic dysphonia occupies a special place in the structure of functional dysphonia in terms of prevalence. At the same time, the autonomic nervous system has a significant impact on the course and outcome of the disease. However, data on the neurovegetative status of patients with hypotonic dysphonia in the scientific literature are extremely rare and do not fully reflect its features.Aim. To determine the neurovegetative status of laryngological patients with hypotonic dysphonia.Materials and methods. 26 patients (6 men and 20 women) with hypotonic dysphonia and hypersensitivity of the larynx (main group) and 45 patients (13 men and 32 women) with hypersensitivity of the larynx without signs of dysphonia (comparison group) were examined as a control, data on the functional state of the autonomic nervous system in 20 practically healthy people (5 men and 15 women) aged 18 to 25 years were used. The state of vegetative parameters – vegetative tone, vegetative reactivity and vegetative activity support – were evaluated using the medical diagnostic complex “Valenta”. The examination of patients included anamnestic analysis, objective examination of lororgans according to generally accepted methods and video stroboscopy of the larynx.Results. The differences between healthy and sick people regarding neurovegetative indicators are obvious, unidirectional and indicate the existence of autonomic disorders in both groups of patients. The ratios of vegetative parameters recorded during the study indicate the involvement of autonomic nervous system not only in the development of laryngeal hypersensitivity, but also in the pathogenesis of functional dysphonia of the hypotonic type.Conclusion. Thus, neurovegetative disorders – vegetative dystonia and autonomic dysfunction – are one of the factors of the pathogenesis of hypotonic dysphonia.

Modified Laryngeal Forceps for Arytenoid Cartilage Dislocation Caused by Endotracheal Intubation: A Retrospective Case-Control Pilot Study.

Background: Arytenoid cartilage dislocation is considered as a rare laryngeal injury and closed reduction is commonly used as the first choice for the arytenoid dislocation. However, the tools of closed reduction vary, and there is no dedicated tool for closed reduction, and the treatment outcome varies from person to person. This study compared the treatment outcome of the modified laryngeal forceps and traditional laryngeal forceps. Material and Methods: This study conformed to the strengthening the reporting of observational studies in epidemiology guidelines regarding retrospective studies. From May 2021 to February 2023, the records of 28 patients with arytenoid cartilage dislocation caused by endotracheal intubation were reviewed. They were divided into the traditional group (n = 14) and the modified group (n = 14) by gender. Indirect or direct laryngoscopy, video stroboscopy, high-resolution computed tomography, and cricoarytenoid joint 3-dimensional reconstruction were used to evaluate arytenoid position and motion. Clinical characteristics, voice function, procedural skill, and treatment outcome for each case were recorded. Results: Each patient was diagnosed with arytenoid dislocation caused by endotracheal intubation. There was no significant difference in the treatment outcome between the traditional group and the modified group (P > .05). However, the median time interval between closed reduction and the return of normal voice in the traditional group was 31.08 ± 10.56 days, which was significantly longer than the median time of 17.92 ± 3.83 days in the modified group (P < .05). Conclusion: Closed reduction with the modified laryngeal forceps under local anesthesia is an effective and safe procedure. Compared with traditional laryngeal forceps, the modified laryngeal forceps can shorten the treatment duration.

An Exploration of the Risk Factors, Severity, and Sequelae of Vocal Fold Hemorrhage in a Population of Voice Patients Before and After Diagnosis

BackgroundVocal fold hemorrhage (VFH) is the rupture (usually acute) of a blood vessel within the true vocal fold. The long-term sequelae of VFH on the mucosal wave (MW) and glottic gap on video stroboscopy remain understudied. The primary objective of this study was to investigate the short-term and long-term consequences of VFH through measured and rated analysis of the mucosal wave and glottic gap. MethodsThe presence of VFH and its extent (limited/moderate vs. extensive VFH) were identified. The primary outcome of this study was mucosal wave, which was assessed on an ordinal scale by three blinded raters pre and posthemorrhage. Only patients who had undergone strobovideolaryngoscopy before sustaining VFH were included. Mucosal wave and glottic gap also were measured using image pixel analysis using the open-access tool, ImageJ (NIH, Bethesda, MD). ResultsTwenty-three subjects were included in this study (mean age 39.78 ± 15.54). Intra-rater reliability for MW ratings was 81.48% ± 6.150% (minimum 77.78%) for all evaluators (κ = 0.519 [0.267–0.772], P < 0.001). Inter-rater reliability analysis revealed 75.56% agreement between evaluators (κ = 0.524 [0.425–0.623], P < 0.001). MWMeasured extrapolated from ImageJ methodology correlated significantly with MWRated (n = 70, r = 0.448, P < 0.001). ΔMWMeasured from baseline to follow-up evaluation were compared for both the initial follow-up visit (FU1) and the second follow-up visit (FU2) [−4.135 ± 31.01 vs. 36.50 ± 39.97, P = 0.025]. Hence, ΔMWMeasured was significantly better by FU2 than FU1, with the larger positive change from baseline representing a greater improvement in the measured mucosal wave. Additionally, there were significant differences in ΔMWRated between those with limited/moderate VFH and those with extensive VFH at FU1. Duration of absolute voice rest correlated significantly with time to VFH resolution. Long-term change in mucosal wave after hemorrhage was assessed using both ΔMWMeasured and MWRated. Based on ΔMWRater, 35.0% of subjects demonstrated ongoing and worse mucosal wave restriction compared to baseline at their most recent follow-up visit. Based on ΔMWMeasured, 50.0% of the subjects showed ongoing and worse mucosal wave restriction compared to baseline at their most recent follow-up visit. ConclusionOverall long-term restrictions in MW after hemorrhage were present in 35.0% of the subjects based on ratings and 50.0% of the patients based on the measured MW using ImageJ, demonstrating the importance of ongoing study into this pathology and how to prevent it, especially in PVU and professional singers. Patients presenting with extensive hemorrhage were at risk for more prominent, detectable changes in mucosal wave compared to those with limited/moderate hemorrhage in the short-term, defined by a mean FU time of 3 months, but not long-term, characterized by a mean FU time 6 months or greater. Whether the severity of VFH is a true indicator of mucosal wave alterations requires additional study, as does the reliability and validity of ImageJ mucosal wave and glottic gap measurement techniques.

Scarless Neck Feminization by Transoral Endoscopic Vestibular Approach Chondrolaryngoplasty: A Prospective Cohort.

Chondrolaryngoplasty (laryngeal-prominence reduction) is a gender affirmation surgery for transgender women, or for cisgender people desiring an esthetic correction. Up until recently, chondrolaryngoplasty required a visible neck scar. The transoral endoscopic vestibular approach (TOEVA) is gaining widespread use as a scarless alternative for thyroid/parathyroid surgeries. This study aims to describe the feasibility, safety, and outcomes of TOEVA-chondrolaryngoplasty, based on the first-ever performed cases. A prospective cohort. An academic referral center. Adult patients interested in chondrolaryngoplasty underwent scarless TOEVA-chondrolaryngoplasty between 2019 and 2022, according to the described protocol. Video stroboscopy was recorded pre-and postoperatively. Surgical data, adverse events, and complications were recorded. Patients' satisfaction was measured using an outcome instrument for esthetic chondrolaryngoplasty. Twelve patients (10 transgender women, a cisgender man, and a woman) were included. The mean age was 26.7 ± 6.5 years, ranging from 19 to 37. The average operative time was 3:01 ± 0:51hours. The thyroid cartilage and laryngeal prominence were easily and safely approached and reduced, with no adverse events or major complications. All patients were discharged on postoperative day 1. A single patient had a temporary mental nerve hypoesthesia that resolved spontaneously. Otherwise, no other complications were encountered. Vocal folds' function remained unchanged in all patients. Patients were very much to completely satisfied with the surgical results as measured by the outcome instrument; median (interquartile range), 25 (21-27.75). In this first reported cohort of scarless TOEVA-chondrolaryngoplasty, this approach was proven to be safe and feasible, with no adverse events or major complications, and with high patient satisfaction.

A STUDY OF CONVENTIONAL METHOD AND MICROFLAP BASED TECHNIQUE FOR EXCISION OF NON MALIGNANT VOCAL FOLD NODULAR LESIONS

Introduction: Management of benign vocal fold nodular lesion provides a particularly good window into the revolution of voice surgery. The changes in approach to surgical management have resulted largely because of advancement in knowledge of anatomy and physiology of the vocal fold layered structures &amp; technological developments that have improved our ability to examine and quantify voice function and the availability of better surgical instruments. Aims: Comparison of Microap technique with conventional method for benign vocal fold nodular lesion and Comparison of Intropertive and post-operative parameters like operative time, primary bleeding, operative procedures, residual tissue, collateral damage, postoperative complication, recovery time and so on between two methods. Materials and Methods: This study was Prospective Randomised single blind trial study. This study was conducted at Patna Medical College &amp; Hospital, Department of ENT from Feb 2020-August 2022. Result: We found in Conventional Group, the mean Total Score of Pre-op Video Stroboscopy (Individual) (mean± s.d.) of patients was 9.2632± 1.9268. In Micro Flap Group, the mean Total Score of Pre-op Video Stroboscopy (Individual) (mean± s.d.) of patients was 8.7857± 1.6898. Difference of mean Total Score of Pre-op Video Stroboscopy (Individual) with both Group was not statistically signicant (p=0.2413). In Conventional Group, the mean Total Score of Post-op Video Stroboscopy (mean± s.d.) of patients was 2.2895 ± 3.3684. Conclusion:We found that Mean Total Score of Post-op Video Stroboscopy was higher in Conventional compared to Micro Flap group which was statistically signicant. It was showed that Mean Video Stroboscopy Outcome Difference (Pre-Post) was less in Conventional compared to Micro Flap group which was statistically signicant

Etiopathogenetic grounding of the treatment of voice-speech professions with functional dysphonia on the background of subclinical psycho-emotional disorders during the COVID-2019 pandemic

The aim of the research: Improvement of the traditional complex treatment of voice-speaking professions during the COVID-2019 pandemic with functional dysphonia on the background of subclinical psycho-emotional disorders by appointment neurotransmitter drugs. Materials and methods: The study involved 49 people of voice-speech professions with functional disorders of the voice function of the hypotonic type, who were diagnosed with subclinical disorders of the psychoemotional state by questioning on the hospital anxiety and depression scale (HADS). Before and after treatment, voice disorders were diagnosed using perceptual evaluation of the GRBAS voice scale and video stroboscopy of the larynx. The impact of voice disorders on quality of life during the pandemic was assessed using the Voice COVID-19 (VC-19) questionnaire. All patients received standardized treatment, which consisted of the use of metabolic, stimulant drugs, physiotherapy and instillation of drugs into the larynx. In 26 patients of the main group (MG), in addition to treatment, a neurotransmitterotropic drug ("Beresh Magnesium plus B6") was prescribed. The comparison group (CG) consisted of 23 people who received traditional therapy. Descriptive statistics were used for statistical analysis of the effectiveness of treatment, comparison of the difference in quantitative indicators by the method of nonparametric statistics using the Mann-Whitney-U-test. Results: The use of the neurotransmitter correction agent "Beresh Magnesium plus B6" by the patients with MG contributed to the suppression of their susceptibility to anxiety, stress and, as a result of these processes, made it possible to obtain, in comparison with the control group, a significant improvement in such indicators of acoustic parameters as voice strength by 5.78%, integral stroboscopy index - 13.34% and improvement of the quality of life by 34.03%, which indicates the effectiveness of the use of magnesium compounds with vitamin B6 in the complex treatment of patients with hypotonic dysphonia against the background of subclinical psychoemotional disorders. Conclusions: Addit ional appointment of magnesium citrate and magnesium oxide compounds with vitamin B6, which has a modulating effect on neurotransmitters that affect depression and anxiety, to basic therapy for patients of main group, made it possible to obtain a significant improvement in the main perceptual and functional indicators of the voice and quality of life.

Результаты хирургического лечения с использованием СО2-лазера у больных с двусторонним параличом гортани

Introduction. Despite advances in modern surgery, the percentage of patients with bilateral paralysis of the larynx is not decreasing. There are many author’s methods of treatment, but there is no single algorithm. This problem remains relevant, especially among people of working age. Research objective: Optimization of surgical treatment of patients with bilateral paralysis of the larynx using a CO2-laser. Materials and methods. For 2014–2018, 143 patients diagnosed with bilateral paralysis of the larynx were treated. The patients underwent a general clinical examination, video endolaryngoscopy, video stroboscopy, spirometry, acoustic voice analysis. For a subjective assessment of the condition, patients filled out the VOICE HANDICAP INDEX (VHI) voice questionnaire, the 36-Item Short Form Survey (SF-36) quality of life questionnaire. Depending on the degree of stenosis, age, body mass index, the presence of a tracheostomy, comorbidities, the following operations were performed using a CO2-laser: posterior partial chordotomy, posterior vestibulo-chordotomy, posterior chordotomy with wound defect plasty. Results and discussion: The patients followed up for 6 to 12 months in the postoperative period. A positive outcome achieved in 128 patients (90%). 15 patients needed a second operation. Tracheostomy patients were decannulated on days 3 to 5. Conclusion. Restoration of respiratory function was achieved by expanding the lumen of the glottis in the posterior parts of the larynx, while maintaining a socially adapted voice was achieved due to intact anterior two-thirds of the vocal folds. These methods are among the most effective and minimally invasive methods for the treatment of bilateral paralysis of the larynx.

Impact of subclinical mental disorders of voice function and quality of life in voice-speaking professions during the COVID-2019 pandemic

Objective: To investigate the risk of mental distress during the COVID-19 pandemic in individuals of the voice-speech professions and the possibility of its impact on voice function and quality of life. Materials and Methods: The study involved 33 people of voice-speech professions who were treated at the University Clinic of Zaporizhzhia State Medical University in 2020. The presence of mental disorders was determined by questionnaires using the hospital anxiety and depression scale (HADS). The patients were divided into 2 groups, depending on the absence and presence of significantly expressed symptoms. A specialized phoniatric examination using functional loads (measuring the time of maximum phonation (PMF), perceptual assessment of the voice according to the GRBAS scale), videostroboscopy of the larynx were carried out. The assessment of the mental impact of voice disorders on the quality of life was carried out according to the Voice Handicap Index (VHI) questionnaire. The statistical significance of the comparative indicators and the connection of their changes were established using the Spearman's rank correlation coefficient. Results: It was found that among the surveyed 33 people, 22 patients (group 1) had subclinical anxiety and depression, and 11 (group 2) had no significant symptoms. Patients with subclinically severe mental disorders (n = 22) showed a significant increase in the emotional indicator by 85.37% (p≤0.01). A high positive relationship was found between subclinical levels of anxiety and depression and disturbances in the phonatory cycle of the larynx. When conducting a Spearman correlation analysis between the data of perceptual assessment of the voice according to the GRBAS system, data of video stroboscopy of the larynx, indicators of anxiety and depression, and the results of the VHI questionnaire, a positive relationship of a high degree was established between the level of anxiety and vibratory insufficiency of the vocal folds (rs=0.95; p≤0.05), negative with the Navy (rs=-0.59; p≤0.05), as well as physical (rs=0.75; p≤0.05) and emotional (rs=0.79; p≤0.05) components of average quality of life. The data obtained indicate a significant effect of subclinical disorders of the mental state on impaired voice function and the emotional component of the quality of life in persons of vocal-speech professions. Conclusions: Screening of mental health in persons of voice-speech professions together with a baseline assessment of voice function and quality of life are important steps for monitoring potential voice disorders and the formation of risk groups in order to carry out preventive and therapeutic measures for voice disorders.

Vocal Fold Fat Augmentation for Atrophy, Scarring, and Unilateral Paralysis: Long-term Functional Outcomes.

There is a debate regarding the durability of fat implants. Our experience and recent publications suggest fat implantation may deliver a long-lasting improvement. This study aims to present the long-term outcomes for vocal fold fat augmentation using strict harvesting, preparing, and implantation protocols. A prospective cohort conducted between 2014 and 2020 (recruitment 2014-2017). An academic tertiary referral center. Twenty-two patients with glottic insufficiency were enrolled: 11 had unilateral vocal fold paralysis (UVFP), and 11 had atrophy or scar. Harvested fat was injected unilaterally or bilaterally into multiple sites. Six of these patients also had simultaneous microlaryngoscopic removal of other benign glottic lesions. Outcome measurements included video stroboscopy; Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS) score; Voice Handicap Index (VHI); and acoustic analysis, performed preoperatively, 3, 12, 24, and 36 months after surgery. Ten augmentations were unilateral and 12 bilateral. Comparing the preoperative and 36-month postoperative periods, the mean VHI score improved from 73.45 (±22.78) to 44.88 (±28.93), P = .001, and the mean GRBAS decreased from 8.64 (±3.89) to 2.82 (±2.3), P = .001; 24 months postoperatively, the mean fundamental frequency decreased from 163.88 Hz (±41.61) to 150.44 Hz (±41.47), P = .012. Stroboscopic analysis revealed statistically significant improvement in mucosal wave propagation, phase closure, and phase symmetry. Best results were achieved in the UVFP subgroup. Computed tomography scans demonstrated long-term viability of the implanted adipose tissue. Fat is an excellent source of autologous graft. With careful patient selection and proper surgical technique, fat is suitable for long-term correction of glottic insufficiency. Fat augmentation should be considered as a long-lasting or even permanent solution, rather than temporary.

Subjective and Objective Assessment of Effect of Allergic Rhinitis on Voice in Indian Patients.

To perform a subjective and objective assessment of vocal complaints in patients of allergic rhinitis (AR) using voice handicap index and video-stroboscopy respectively and find the association of their parameters with severity of the disease. Cross-sectional-observational study design. Outpatient department of Otorhinolaryngology of a tertiary centre. Seventy-five adult patients diagnosed with AR and classified according to 'Allergic Rhinitis and its Impact on Asthma' guidelines were compared with same number of normal subjects as controls, with the same age and sex, to ensure uniformity. Both the groups were asked to fill a self-answered questionnaire called Voice Handicap Index (VHI) and underwent laryngeal examination with Video-Stroboscopy (VS). The mean VHI score of the AR group (29.45 ± 32.11) was significantly higher (p < 0.05) than that of controls (12.07 ± 16.62). VS parameters including amplitude, supraglottic activity, vocal edge and phase closure also showed significant difference between cases and controls (p < 0.05). VHI scores increased, but the VS findings did not change significantly with the severity of the disease. AR patients show subjective and objective derangements of voice quality. VHI scores show increase, while VS parameters do not change with the severity of AR.

Value of pre- and intraoperative diagnostic methods in suspected glottic neoplasia.

To evaluate the individual and combined ability of videostroboscopy (VS), high-speed digital imaging (HSDI), enhanced endoscopy (EE) and saline infusion (SI) to predict neoplasia, defined as glottic precursor lesion (GPL) or T1a glottic cancer, in patients suspected for glottic neoplasia. A nationwide prospective cohort study of patients treated by cordectomy for suspected GPL or T1a glottic cancer from August 1st 2016 to October 31st 2018 was conducted in the five Danish University Departments of Head and Neck surgery. Sensitivity, specificity, negative and positive predictive values, and area under Receiver Operating Curves (AUC-ROC) were calculated with 95% confidence intervals with respect to the histological diagnosis. Logistic regression with an imputation model for missing data was applied. 261 patients aged 34-91years participated; 79 (30.3%) with non-neoplasia (i.e., inflammation, papilloma, hyperkeratosis) and 182 (69.7%) neoplasia, hereof 95 (36.4%) with GPL and 87 (33.3%) with T1a glottic cancer. Data from 188 VS, 60 HSDI, 100 preoperative EE, 209 intraoperative EE, and 234 SI were analyzed. In the complete case analysis the AUC-ROC of each diagnostic test was low, but increased when the tests were combined and especially if the combination included EE. However, multinomial logistic regression with imputation showed significant association (p < 0.05) only between age, male gender, and perpendicular vasculature in intraoperative EE, and the endpoint neoplasia. Intraoperative EE was the most accurate diagnostic method in detecting neoplasia. The prediction ability of methods applied preoperatively was more limited, but improved when test modalities were combined.

Efficacy of Videostroboscopy and High-Speed Videoendoscopy to Obtain Functional Outcomes From Perioperative Ratings in Patients With Vocal Fold Mass Lesions

A major limitation of comparing the efficacy of videostroboscopy (VS) and high-speed videoendoscopy (HSV) is the lack of an objective reference by which to compare the functional assessment ratings of the two techniques. For patients with vocal fold mass lesions, intraoperative measures of lesion size and depth may serve as this objective reference. This study compared the relationships between the pre- to postoperative change in VS and HSV visual-perceptual ratings to intraoperative measures of lesion size and depth. Prospective visual-perceptual study with intraoperative measures of lesion size and depth. VS and HSV samples were obtained preoperatively and postoperatively from 28 patients with vocal fold lesions and from 17 vocally healthy controls. Two experienced clinicians rated amplitude, mucosal wave, vertical phase difference, left-right phase asymmetry, and vocal fold edge on a visual-analog scale using both imaging techniques. The change in perioperative ratings from VS and HSV was compared between groups and correlated to intraoperative measures of lesion size and depth. HSV was as reliable as VS for ratings of amplitude and edge, and substantially more reliable for ratings of mucosal wave and left-right phase asymmetry. Both VS and HSV had mild-moderate correlations between change in perioperative ratings and intraoperative measures of lesion area. Change in function could be obtained in more patients and for more parameters using HSV than VS. Group differences were noted for postoperative ratings of amplitude and edge; however, these differences were within one level of the visual-perceptual rating scale. The presence of asynchronicity in VS recordings renders vibratory features either uninterpretable or potentially distorted and thus should not be rated. Amplitude and edge are robust vibratory measures for perioperative functional assessment, regardless of imaging modality. HSV is indicated for evaluation of subepithelial lesions or if asynchronicity is present in the VS image sequence.

A Comprehensive Voice Analysis in Benign Vocal Fold Lesions Treated by Cold Knife Endolaryngeal Surgery Using Subjective, Objective and Video-Stroboscopic Parameters.

In the era of globalisation, numerous technical methods have emerged in the management of benign laryngeal lesions. Still cold knife endolaryngeal surgery holds the basic and effective position in providing excellent voice outcome. The aim of this study is to assess the cold knife as a tool for excision of benign laryngeal lesions by protocol of voice assessment. Fifty-five patients with benign vocal fold lesions were included (26 women and 29 men), with age ranging from 22 to 56years. Each patient was subjected to endoscopic microlaryngeal surgery with cold instruments. Voice assessment was done preoperatively and 3weeks postoperatively and 3month post-operatively. The patients were assessed subjectively by Voice Problem Self-Assessment Scale and objectively by laryngoscopy, stroboscopy, and acoustic analysis. Outcome was measured by comparing preoperative and postoperative groups. Significant improvement (< 0.05) was observed in the voice handicap index, acoustic parameters and video stroboscopy parameters between the preoperative and the postoperative groups. The cold knife endo-laryngoscopic surgery still stands out to be a simple, cost effective yet efficient way in treating majority of benign vocal fold lesions causing hoarseness of voice.

Современный подход к диагностике хронического ларингита

The timely detection and treatment of chronic hypertrophic laryngitis is a task of particular importance, it is the main link in the prevention of malignant diseases of the larynx. The traditional diagnostic methods do not always provide proper assessment of the state of the larynx in chronic laryngitis and the dynamics of recovery processes during therapeutic activities. Therefore, the combined use of modern methods of examination of the larynx condition is getting more and more important. Based on examination of 15 men and 5 women aged from 24 to 72 years previously treated for chronic hypertrophic laryngitis, it has been shown that video stroboscopy, autofluorescence diagnostics, NBI endoscopy, and cytological examination of swabs from the affected vocal fold areas are methods of early diagnostics of chronic hyperplastic laryngitis, they can complement each other not only in the event of diagnostic difficulties, but in the assessment of efficacy of treatment and rehabilitation measures aimed at restoration of laryngeal functions and prevention of the development of tumors. The data obtained made it possible to clarify the nature of the hypertrophic changes in the mucous membrane of the vocal folds and thereby confidently interpret the clinical picture of the disease in the examined patients as a manifestation of chronic hyperplastic laryngitis with leukokeratosis and leukoplakia.

Study of Pre and Post Operative Videostroboscopic Evaluation of Benign Vocal Cord Lesions.

To determine pre and postoperative vocal fold vibratory changes using videostroboscopy (VS) and effect of surgery on functional, physical and emotional levels of voice using voice handicap index (VHI). To determine correlation between VHI and VS in patients with benign vocal fold pathology. This is aprospective study doneat Pushpagiri Medical College. 40 patients in the age group of 14-75years who presented with complaints of voice change were included. VS and VHI of patients done preoperatively in 40 patients. Patients were re-evaluated postoperatively at 1month by VHI and VS. All patients underwent microlaryngoscopic excision of the benign vocal cord lesion with biopsy under GA in the conventional manner. One month postoperatively, these patients were evaluated by VS and VHI and the findings noted. There was statistically significant improvement in the stroboscopy ratings and VHI scores post operatively (p < 0.0001). The mucosal wave was diminished or absent in 100% of the studied TVC cysts and present in approximately 60% of vocal polyps. There was no significant correlation found between preoperative VHI scores and stroboscopy ratings except for mucosal waves. Whereas there was significant correlation noted between the VHI subscales and total scores with stroboscopic scores postoperatively except for symmetry. All but 6 patients in this study benefitted from surgery and 85% had a normal voice post-operatively. Pre and post operative assessment of patients with benign vocal fold lesions by stroboscopy and VHI is a useful way to determine the degree of improvement following surgery.

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.

Comparison of Videostroboscopy to Stroboscopy Derived From High-Speed Videoendoscopy for Evaluating Patients With Vocal Fold Mass Lesions.

Videostroboscopy (VS) uses an indirect physiological signal to predict the phase of the vocal fold vibratory cycle for sampling. Simulated stroboscopy (SS) extracts the phase of the glottal cycle directly from the changing glottal area in the high-speed videoendoscopy (HSV) image sequence. The purpose of this study is to determine the reliability of SS relative to VS for clinical assessment of vocal fold vibratory function in patients with mass lesions. VS and SS recordings were obtained from 28 patients with vocal fold mass lesions before and after phonomicrosurgery and 17 controls who were vocally healthy. Two clinicians rated clinically relevant vocal fold vibratory features using both imaging techniques, indicated their internal level of confidence in the accuracy of their ratings, and provided reasons for low or no confidence. SS had fewer asynchronous image sequences than VS. Vibratory outcomes were able to be computed for more patients using SS. In addition, raters demonstrated better interrater reliability and reported equal or higher levels of confidence using SS than VS. Stroboscopic techniques on the basis of extracting the phase directly from the HSV image sequence are more reliable than acoustic-based VS. Findings suggest that SS derived from high-speed videoendoscopy is a promising improvement over current VS systems.

Minimally invasive technologies in the treatment of closed fractures of the intercondylar elevation of the knee: a clinical case

Тhis article presents a clinical case of the surgical treatment of a fracture in the intercondylar eminences of the knee joint in a 7-year-old child. Closed fractures of the intercondylar exaltation are mainly a characteristic of childhood. This type of damage occurs by dysfunction of the knee resulting from instability. Because the fracture of the intercondylar eminences of the knee joint in children is similar to the damage of the anterior cruciate ligament in adults, the current course of knee surgery is a minimally invasive technique. These include fixation of the intercondylar exaltation using video stroboscopy as well as the assistance of various implants (e.g., screw, wire, and Dacron). In the children's Department of Traumatology and Orthopedics of the Federal Center of Traumatology, Orthopedics and Endoprosthesis Replacement in Barnaul, various surgeries are performed, including arthroscopy of the right knee joint, intercondylar exaltation reposition, and fixation of the intercondylar exaltation latch Lupine (De PuyMitek).

Can videostroboscopy predict early glottic cancer? A systematic review and meta-analysis.

Correct assessment of patients with a glottic lesion is crucial for ensuring proper treatment in cases of cancer or premalignancy and for avoiding unnecessary surgery. For years, videostroboscopy (VS) has been the gold standard for assessing such lesions, but diagnostic difficulties have been described. We aim to estimate the diagnostic accuracy of VS in differentiating early glottic cancer from noninvasive lesions by conducting a systematic review and meta-analysis of published studies. PubMed and Embase databases were searched without restrictions on publication date. A systematic review and subsequent meta-analysis were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. We systematically searched the literature for publications on stroboscopic diagnosis of cancer or premalignant lesions on the vocal cords. All retrieved studies were reviewed and qualitatively assessed. The pooled sensitivity and specificity of VS were calculated, and bubble and summary receiver operating characteristics plots were created. A meta-analysis was conducted on five studies with a total of 307 patients. The sensitivities of VS within the single studies ranged from 86% to 100% and specificities ranged from 7% to 93%. The meta-analysis showed that the sensitivity of the combined results was 0.96 (95% confidence interval [CI]: 0.89-0.98), and the specificity was 0.65 (95% CI: 0.21-0.93). VS is able to identify almost all patients with cancer, but only approximately two-thirds of patients with noninvasive lesions are correctly identified as not having cancer. Further research concerning assessment of patients with vocal cord lesions is needed. NA Laryngoscope, 126:2079-2084, 2016.