Vocal Cord Abduction Research Articles

Approaching Saber-Sheath Trachea in a Patient with Bilateral Vocal Cord Abductor Palsy and Post Tracheostomy Tracheal Stenosis.

Human trachea has variable shapes and the most common are circular and oval-shaped. Other shapes are rare to find and usually related to some diseases. Such as the Saber-sheath shaped trachea, which was commonly attributed to patients with chronic obstructive pulmonary disease (COPD). This case is about a patient who was detected to have dual pathology, bilateral vocal cord abductor palsy, and post-tracheostomy complicated with tracheal stenosis for 40 years. Symptoms worsened in the last three years until he was admitted to the ward. However, upon managing this case with multilevel airway obstruction, we have found out that this patient who did not have COPD, has a Saber-sheath trachea shape. This finding may indicate that the shape is not limited to a certain disease only.

Speech Acoustic Parameters for Predicting Presbyphagia: A Preliminary Study in the Elderly Shanghainese Population

PurposeAge is a high-risk factor for dysphagia. Speech and swallowing share the same anatomical and neurophysiological basis. Their functions are closely related; hence, speech assessment can predict the risk of dysphagia. This study aimed to investigate the factors influencing presbyphagia in a normal elderly Shanghainese population by analyzing speech acoustic parameters. MethodsRelevant speech acoustic parameters were compared between 15 people with dysphagia and 15 without dysphagia. After extracting sensitive speech acoustic parameters related to swallowing, changes in sensitive parameters were compared at different ages to analyze the relevant factors influencing presbyphagia in the normal elderly population. ResultsEight speech acoustic parameters related to swallowing, including maximum phonation time (MPT), max F0, /ʔʌ/Jitter, /ʔʌ/L-DDK, /hʌ/L-DDK, /pataka/DDK, F1/a/, and vowel space area, were extracted after comparing the relevant data between the two groups. Analyzing the changes in each of these parameters between different age groups (age 18–39, 40–64, and 65 and above), we discovered that three speech acoustic parameters, including MPT, /hʌ/L-DDK, and /pataka/DDK, had statistical differences, with a decreasing trend in their mean values with increasing age. ConclusionsThe elderly group had significantly lower MPT, /hʌ/L-DDK, and /pataka/DDK than the young and middle-aged groups. We hypothesized that reduced respiratory support and control, decreased range of mouth movements and coordination, closed control of the vocal cords, and inadequate airflow control in vocal cord abduction are risk factors for presbyphagia in the elderly Shanghainese population.

Vocal cord abductor paralysis as an early sign of multiple system atrophy

Vocal cord abductor paralysis as an early sign of multiple system atrophy

Motor neuron involvement threatens survival in spinocerebellar ataxia type 1.

Motor neuron involvement threatens survival in spinocerebellar ataxia type 1.

Bilateral Vocal Cord Abduction Paralysis after C1 Laminectomy in a Child with Type 1 Arnold Chiari Malformation.

Background: Type 1 Arnold Chiari is a neurological malformation that may be associated with vocal cord paralysis in Children. In most cases, the vocal cord paralysis is related to protrusion of medulla and cerebellum in the foramen magnum, which led to compression on the vagus nerve.Case report: A 12-year-old child underwent suboccipital decompression and C1 laminectomy for a symptomatic type 1 Arnold Chiari malformation. After the surgery, patient reported severe dyspnea, aphonia, and dysphagia. The videolaryngostroboscopy and neurological examinations reported a postoperative bilateral vocal cord abduction paralysis due to bilateral IX and X cranial nerve paralyzes and a bilateral paralysis of the tongue.Discussion: The type 1 Arnold Chiari malformation clinical picture may present with unilateral or bilateral vocal cord paralysis, which may resolve with an adequate management of the disease. However, the neurosurgical decompression and C1 laminectomy may result in bilateral lesion of the IX, X, and XII cranial nerves, and related severe swallowing, aspiration and vocal cord disorders.Conclusion: We reported the first case of bilateral vocal cord abduction paralysis occurring post-neurosurgical decompression and C1 laminectomy in a child with type 1 Arnold Chiari malformation. This case highlights the importance of surgical steps of the procedure in front of the C1 vertebrae where there are IX, X, and XII cranial nerves.

Pharyngolaryngeal semiology and prognostic factors in multiple system atrophy

IntroductionMultiple system atrophy (MSA) is a rare degenerative neurological disorder in adults. It induces parkinsonian and/or cerebellar syndrome associated with dysautonomia. Pharyngolaryngeal symptoms are common. Our aim is to describe the Pharyngolaryngeal semiology on one hand, and to ascertain whether the presence of these symptoms represents a prognostic factor for MSA on the other.MethodsThus, we carried out a retrospective, single-centre study, on a cohort receiving care at the centre of reference for MSA. The patients were referred for otorhinolaryngology assessment. The data was collected over the year 2020 with the help of computer software from the university hospital centre (UHC). Firstly, we described the Pharyngolaryngeal semiology specific to MSA by questioning patients, and by the results of nasofibroscopic examinations and swallowing tests. We then used multivariate analysis of variance to describe the prognostic factors of MSA progression (in UMSARS I and II points per month of progression) and survival (number of years between the first symptoms and death).ResultsThis study included a hundred and one patients and made it possible to define a Pharyngolaryngeal semiology profile of MSA, which is: a reduction in laryngeal mobility (primarily vocal cord abduction defects), abnormal movements (particularly at rest or when initiating a movement) and a defect in the protection mechanisms of the upper airways. The swallowing difficulties are moderate and the main mechanisms are delayed pharyngeal swallow and/or an oro-pharyngeal transport defect. In the multivariate analyses, the contributing factors are laryngeal anomalies, modification of solid food to fluid food and nutritional complication.ConclusionENT specialists should pay close attention to problems in the Pharyngolaryngeal dynamic and then consider a neurological cause. They can also itemize the clinical factors that could have a negative effect on the prognosis of the patient with MSA. Indeed, early detection makes it possible to provide care for respiratory and nutritional complications.

The Clinical Analysis of Patients with Bilateral Vocal Cord Abductor Paralysis as an Early Manifestation of Multiple System Atrophy

Multiple system atrophy (MSA) is a neurodegenerative disease that is associated with cerebellar symptoms, autonomic symptoms and parkinsonism as three significant signs. The prevalence of MSA is 7-10 per 100,000 population, thus, among neurodegenerative diseases, it is not a rare condition.

MRI of the upper airways in children and young adults: the MUSIC study

RationalePaediatric laryngotracheal stenosis (LTS) is often successfully corrected with open airway surgery. However, respiratory and vocal sequelae frequently remain. Clinical care and surgical interventions could be improved with better understanding...

Stridor during sleep: description of 81 consecutive cases diagnosed in a tertiary sleep disorders center.

To describe the characteristics of stridor during sleep (SDS) in a series of adults identified by video-polysomnography (V-PSG). Retrospective clinical, V-PSG, laryngoscopic, and therapeutic data of patients diagnosed with SDS in a tertiary referral sleep disorders center between 1997 and 2017. A total of 81 patients were identified (56.8% males, age 61.8 ± 11.2 years). Related etiologies were multiple system atrophy (MSA), amyotrophic lateral sclerosis, spinocerebellar ataxia type 1, anti-IgLON5 disease, fatal familial insomnia, brainstem structural lesions, vagus nerve stimulation, recurrent laryngeal nerve injury, the effect of radiotherapy on the vocal cords, cervical osteophytes, and others. Stridor during wakefulness coexisted in 13 (16%) patients and in MSA was only seen in the parkinsonian form. Laryngoscopy during wakefulness in 72 (88.9%) subjects documented vocal cord abductor impairment in 65 (90.3%) and extrinsic lesions narrowing the glottis in 2 (2.4%). The mean apnea-hypopnea index (AHI) was 21.4 ± 18.6 and CT90 was 11.5 ± 19.1. Obstructive AHI > 10 occurred in 52 (64.2%) patients and central apnea index >10 in 2 (2.4%). CPAP abolished SDS, obstructive apneic events and oxyhemoglobin desaturations in 58 of 60 (96.7%) titrated patients with optimal pressure of 9.0 ± 2.3 cm H20. Tracheostomy in 19 (23.4%) and cordotomy in 3 (3.7%) subjects also eliminated SDS. SDS in adults is linked to conditions that damage the brainstem, recurrent laryngeal nerve, and vocal cords. V-PSG frequently detects obstructive sleep apnea and laryngoscopy usually shows vocal cord abductor dysfunction. CPAP, tracheostomy, and laryngeal surgery abolish SDS.

Two Cases of Parkinson's Disease Accompanied with Nasogastric Tube Syndrome

We report 2 cases of patients with Parkinson's disease who exhibited bilateral vocal cord paralysis induced by an indwelling nasogastric tube (N-G tube). Both patients showed abrupt inspiratory stridor after N-G tube placement. A fiberoptic laryngeal examination revealed bilateral vocal cord abductor paralysis (VCAP). After N-G tube removal, patient symptoms improved. Nasogastric tube syndrome (NGTS) is an uncommon but life-threatening syndrome that causes sore throat and bilateral VCAP following N-G tube insertion. Throat pain is considered an important early manifestation of NGTS. However, in cases of advanced Parkinson's disease, subjective symptoms of NGTS, such as throat pain, may be difficult to recognize. We here report 2 patients with parkinson's disease accompanied by NGTS with literature review and proposed that inspiratory strider is a useful objective symptom in early diagnosing of NGTS. (Received March 25, 2020; Accepted May 18, 2020; Published September 1, 2020).

MuSK Antibody Positive Myasthenia Gravis Presenting with Bilateral Vocal Cord Abduction Paralysis: A Case Report and Literature Review (1418)

MuSK Antibody Positive Myasthenia Gravis Presenting with Bilateral Vocal Cord Abduction Paralysis: A Case Report and Literature Review (1418)

A Case of Bilateral Vocal Cord Abductor Paralysis Caused by Idiopathic Non-inflammatory Myopathy Localized in the Posterior Cricoarytenoid Muscle

A Case of Bilateral Vocal Cord Abductor Paralysis Caused by Idiopathic Non-inflammatory Myopathy Localized in the Posterior Cricoarytenoid Muscle

Efficacy of NPPV for vocal cord abductor paralysis with floppy epiglottis in multiple system atrophy

Background: Multiple system atrophy (MSA) often presents as obstructive breathing disorder, vocal cord abductor paralysis (VCAP) and floppy epiglottis (FE) in an advanced stage. Noninvasive positive-pressure ventilation (NPPV) is known to be effective for VCAP. On the other hand, some reports insist that in the presence of FE, NPPV may worsen obstructive respiratory disorder.

Vocal cord assessment with transnasal endoscopy in intubated patients after esophagectomy.

Vocal cord paralysis (VCP) is one of the postoperative complications after radical esophagectomy. VCP may also lead to serious morbidities such as respiratory distress and aspiration pneumonia. Therefore, an early diagnosis of VCP is meaningful in the postoperative management of patients undergoing esophagectomy. We evaluated a new practical method for diagnosing postoperative VCP. The laryngeal assessment of 30 patients was performed, and the presence of VCP was inferred while the following 15 patients by endoscopy before extubation after performing consecutive radical esophagectomy in 45 esophageal cancer patients. The vocal cord mobility, including adduction and abduction, were assessed by inserting the tip of a transnasal endoscope near the vocal cord in the awake patients with orotracheal intubation on the first postoperative day. The presence of VCP was reevaluated after extubation. Eleven of the 30 patients assessed after radical esophagectomy had unilateral VCP and one patient had bilateral VCP. The abduction findings were useful for assessing VCP and the sensitivity, specificity, positive and negative predictive values and accuracy were 97.9%, 100%, 100%, 92.9% and 98.3%, respectively. The results of the following 15 patients were closely similar. The VCP during orotracheal intubation is assessable by transnasal endoscopy.

The Posterior Cricoarytenoid Muscle Is Spared from MuRF1-Mediated Muscle Atrophy in Mice with Acute Lung Injury

BackgroundSkeletal muscle wasting in acute lung injury (ALI) patients increases the morbidity and mortality associated with this critical illness. The contribution of laryngeal muscle wasting to these outcomes is unknown, though voice impairments and aspiration are common in intensive care unit (ICU) survivors. We evaluated the intrinsic laryngeal abductor (PCA, posterior cricoarytenoid), adductor (CT, cricothyroid) and limb (EDL, extensor digitorum longus) muscles in a mouse model of ALI.MethodsEscherichia coli lipopolysaccharides were instilled into the lungs of adult male C57Bl6J mice (ALI mice). Limb and intrinsic laryngeal muscles were analyzed for fiber size, type, protein expression and myosin heavy chain (MyHC) composition by SDS-PAGE and mass spectroscopy.ResultsMarked muscle atrophy occurred in the CT and EDL muscles, while the PCA was spared. The E3 ubiquitin ligase muscle ring finger-1 protein (MuRF1), a known mediator of limb muscle atrophy in this model, was upregulated in the CT and EDL, but not in the PCA. Genetic inhibition of MuRF1 protected the CT and EDL from ALI-induced muscle atrophy. MyHC-Extraocular (MyHC-EO) comprised 27% of the total MyHC in the PCA, distributed as hybrid fibers throughout 72% of PCA muscle fibers.ConclusionThe vocal cord abductor (PCA) contains a large proportion of fibers expressing MyHC-EO and is spared from muscle atrophy in ALI mice. The lack of MuRF1 expression in the PCA suggests a previously unrecognized mechanism whereby this muscle is spared from atrophy. Atrophy of the vocal cord adductor (CT) may contribute to the impaired voice and increased aspiration observed in ICU survivors. Further evaluation of the sparing of muscles involved in systemic wasting diseases may lead to potential therapeutic targets for these illnesses.

The Effect of Low-Dose Tacrolimus on Recurrent Laryngeal Nerve Regeneration in Pigs: A Pilot Study

Objective: The functional neurotrophic effects of systemic tacrolimus in a sub-immunosuppressive regimen in the minipig model of laryngeal reinnervation were investigated. Methods: Right recurrent laryngeal nerve transection and phrenic-abductor branch of recurrent laryngeal nerve anastomosis were performed in two minipigs that were administered low-dose oral tacrolimus (0.125 mg/kg) for one month. Vocal cord abduction at four months was rated by two blinded expert assessors on a four-point Likert scale from poor (1) to complete (4), and compared with five fully matched historical control animals that received the same surgery but no other interventions. Results: Right vocal cord abduction was more complete in tacrolimus-treated animals than controls (mean abduction score 2.3 vs. 1.5, p=0.019). Conclusion: Tacrolimus may have an important role in laryngeal reinnervation following allograft transplantation, and low-dose regimens may have applications in cranial and peripheral nerve injuries or in the reinnervation of tissue-engineered laryngeal constructs, but further studies are required.

Sleep and autonomic function: sleep related breathing disorders in Parkinson's disease and related disorders

In patients with multiple system atrophy (MSA), sleep related breathing disorders (SRBD), including obstructive and central sleep apnea, vocal cord abductor paralysis and dysrhythmic breathing pattern, are frequently observed. SRBD may have a considerable impact on variation of autonomic nervous activity during sleep. The previous studies correlated upper airway muscle dysfunction related parkinsonism with increased prevalence of SRBD in patients with Parkinson's disease (PD). However, recently, the clinical significance of SRBD and its impact on sleepiness and disease severity have been debated. In this review, we discuss sleep and autonomic function, especially, SRBD in PD and related disorders, including the previous studies from our department.

Critical vocal cord abductor paralysis as an emergency in myasthenia gravis

A 78-year-old woman was admitted for sudden-onset dyspnea, presenting with hypoxemia, stridor and pooling of saliva in the pharynx. One month earlier, she had complained of dysphagia and had been diagnosed with myasthenia gravis (MG) based on weakness of the proximal muscles, decremental response in repetitive nerve stimulation and positive anti-acetylcholine receptor antibodies (Myasthenia Gravis Foundation of America [MGFA] class IIb). Laryngoscopy disclosed severe bilateral vocal cord abductor paralysis (VCAP), which was improved to one-third of the maximum abduction by edrophonium injection (Fig. 1a, b). An emergency tracheostomy was required to avoid suffocation (MGFA class V). Immunosuppressive treatment improved symptoms including VCAP (Fig. 1c). A thymectomy was carried out and the involuted thymus was found. VCAP, a rare complication of MG, can be the first and sole manifestation of the disease.1 VCAP also occurs in patients with anti-muscle-specific receptor tyrosine kinase antibodies.2 When neurologists encounter dyspnea in MG, not only respiratory muscle weakness, but also VCAP should be considered, and indications of tracheostomy must be assessed immediately by laryngoscopy using edrophonium. The authors declare no conflicts of interests with respect to this article.

Laryngo-pharyngeal findings and sleep-related breathing disorders in patients with multiple system atrophy

Patients with multiple system atrophy (MSA) manifest a variety of sleep-related breathing disorders (SRBD). Vocal cord abductor paralysis (VCAP) is associated with respiratory failure and sudden death during sleep. To evaluate the relation between SRBD and clinical symptoms in patients with MSA, 11 patients with MSA admitted to our hospital were recruited for this study. All patients underwent detailed neurological examinations and brain imaging studies. Laryngoscopic examination and polysomnography were performed to detect SRBD and abnormal movements of the vocal cords and larynx. Ten patients (91%) showed SRBD, defined as five or more episodes of apnea and/or hypopnea per hour, with hypopnea predominant. Among the nine patients who underwent laryngoscopic examination, six (67%) showed VCAP, of whom two exhibited it only during sleep. Four patients had abnormal laryngeal movements, of whom two (33%) showed floppy arytenoid, one showed omega type, according to the classification of sleep-induced laryngomalacia in MSA, and the fourth one showed an unclassified pattern. Patients with VCAP tended to be older and have more frequent dysphagia, neurogenic bladder and severe SRBD, compared with those without VCAP. Physicians should be aware that SRBD is frequently observed in patients with MSA, and that VCAP and laryngo-pharyngeal abnormalities may be the initial or early signs of MSA.

S93 Laryngeal obstruction during exercise is prevalent in severe asthma

IntroductionReduced exercise capacity is a common problem for patients with severe asthma, yet the reason for this remains unclear. Exercise induced laryngeal obstruction (EILO) is now recognised to cause dyspnoea...