Vocal Cord Atrophy Research Articles

Laryngeal office-based procedures: A safe approach

PurposeLaryngeal surgeries using a flexible nasopharyngoscope equipped with an operative channel has gained popularity, with gradual increase in the variety of interventional office-based procedures, under local anesthesia. The purpose of this study is to analyze the tolerance of such procedures. Materials and methodsRetrospective cohort study. 337 cases were performed during 2 years. We collected the following data: type of pathology, type of procedure and modalities of anesthesia, adverse events. Results19 % of the visits were for the purpose of Biopsy, 65 % for an injection, and Trublue Laser was utilized in 12 % of the procedures. Regarding the pathologies, 27 % were vocal fold paralysis, 18 % leukoplakia or another suspicious lesion, 15 % recurrent respiratory papillomatosis, 13 % neuromuscular disorder, 9 % vocal fold scarring, 7 % vocal cord atrophy and 6 % had an inflammatory presentation. Side effects were documented in 26 visits (7.7 %) and were minor in almost all the encounters: they included strong reflexive cough, deep throat pain, discomfort, gag reflex, anxiety, vagal discomfort, malaise, hypersalivation, nose pain, labile hypertension. More severe side effects were very rare and included septal wound and epistaxis, erythematous rash, dyspnea, and transient dysarthria. 13 procedures were either aborted, or canceled at initial steps, due to inability of the patient to tolerate the procedure and were rescheduled for general anesthesia. 97 % of the cases were released home after 1 h of surveillance. ConclusionOffice-based flexible interventional laryngoscopy under local anesthesia is a safe and well-tolerated procedure, with abundance of various interventions feasible on ambulatory, office-based setup.

Artificial Nerve Conduit for Recurrent Laryngeal Nerve Reconstruction in Thyroid Surgery.

Oncological reconstruction of the recurrent laryngeal nerve (RLN) is sometimes necessary for RLN invaded by thyroid cancer. There have been no case reports of RLN reconstruction using artificial nerve conduits, which are often used for peripheral nerves. In this study, we retrospectively evaluate the feasibility, safety, and efficacy of a collagen conduit with collagen filaments for RLN reconstruction cases at our hospital. Artificial nerve conduits were used in seven cases of RLN reconstruction. Two patients had preoperative unilateral vocal cord paralysis with severe vocal cord atrophy, and two had vocal cord paresis without atrophy. The remaining three patients had functional vocal cords before surgery that had to be resected via surgery due to thyroid cancer infiltration of the RLN. Reconstruction was performed using RENERVE®, which is a collagen conduit. Voice examination and laryngeal endoscopy were performed 1, 3, and 12 months after surgery. There was no improvement in the phonetics of the two patients with vocal cord atrophy before surgery. In the remaining five cases, three with functional vocal cords improved to preoperative values, and two with vocal cord paresis improved to greater than preoperative values. We report the first case series using an artificial nerve conduit for human RLN reconstruction. In cases of RLN resection when the patient has good voice quality pre-operatively, reconstruction of the RLN using an artificial nerve may be a favorable option in cases where direct anastomosis or ansa cervicalis to RLN anastomosis cannot be performed. 4 Laryngoscope, 133:1773-1779, 2023.

The role of imaging in the evaluation of hoarseness: A review.

Hoarseness is a common symptom indicating an abnormal change in the quality of voice and has a lifetime prevalence of around 30%. There are multiple causes of hoarseness, ranging from acute laryngitis, chronic laryngitis, laryngopharyngeal reflux, functional dysphonia due to vocal overuse or abuse, vocal cord paralysis (VCP), to various pathologies and masses in the larynx. A detailed history and thorough physical examination, and in many cases, laryngoscopy by a clinician are the initial steps in its management. Laryngoscopy should be considered if hoarseness persists for more than 2 weeks without a known benign cause. An Ear Nose and Throat surgeon performs direct visualization by laryngoscopy to rule out VCP or a lesion in the larynx, and it should be performed before ordering any imaging. CT with contrast is the imaging of choice to evaluate the laryngeal tumors and find the etiology of VCP. Typical findings of VCP are ipsilateral dilatation of the pyriform sinus and laryngeal ventricle, thickening and medialization of the ipsilateral aryepiglottic fold, medialization of the arytenoid cartilage and posterior aspect of the true vocal cord (TVC) atrophy of the TVC, and loss of the subglottic arch. The lesions causing the VCP may extend from the medulla, jugular foramen, carotid space, and upper mediastinum. CT neck must cover the aorticopulmonary window when evaluating the left VCP to cover the left recurrent laryngeal nerve's origin.

Patient-defined duration of benefit from juvederm (hyaluronic acid) used in injection laryngoplasty.

Injection laryngoplasty has become valuable in treating laryngologic disorders including vocal cord atrophy, paralysis, and paresis. Although materials such as carboxymethylcellulose and calcium hydroxylapatite are Food and Drug Administration (FDA) approved, they are not without limitations. Juvederm (hyaluronic acid) is an alternative treatment that is not FDA approved. Although studies have examined Juvederm's longevity in cutaneous injections, there are limited data examining durability of Juvederm used in laryngoplasty. We aimed to determine the longevity and effectiveness of Juvederm used in injection laryngoplasty. Retrospective cohort study. Subjects who underwent injection laryngoplasty using Juvederm were reviewed. Longevity was defined as the time between injection and the date that a patient first noted subjective deterioration of their voice. All subjects were subsequently followed using videostroboscopy to evaluate for Juvederm resorption. Longevity was analyzed using a Kaplan-Meier survival model, and effectiveness of laryngoplasty was determined using the Voice-Related Quality of Life index scores and analyzed using a Wilcoxon signed ranks test. Fifty-nine subjects met inclusion criteria and underwent Juvederm injection laryngoplasty. Kaplan-Meier survival analysis revealed a mean longevity of 10.6 months (95% confidence interval: 9.1-12.0 months). Wilcoxon signed ranks analysis of the pre- and postinjection Voice Related Quality of Life (VRQOL) scores revealed improvement, with a mean preinjection VRQOL of 49.2 (standard deviation [SD] = 25.8) and mean postinjection VRQOL of 68.2 (SD = 27.5) (P < .001). Injection laryngoplasty using Juvederm is an effective treatment for vocal cord atrophy, paralysis, and paresis. Knowledge of the patient-defined duration of benefit following laryngoplasty using Juvederm plays an important role in counseling patients as well as in the planning of future interventions. 4 Laryngoscope, 129:2744-2747, 2019.

Efficacy of Two-dimensional Scanning Digital Kymography in Evaluation of Atrophic Vocal Folds

The purpose of this study was to evaluate the clinical feasibility and diagnostic accuracy of two-dimensional scanning digital kymography (2D DKG) in patients with vocal cord atrophy before and after treatment. We analyzed the characteristics of vocal fold vibration in five patients with unilateral vocal fold paralysis and five patients with presbyphonia. In patients with vocal cord paralysis, the status before and after intracordal injection was compared. Furthermore, in patients with presbyphonia, we compared the status before and after voice therapy (Seong-Tae Kim's laryngeal calibration technique). Quantitative parameters such as amplitude and phase symmetry indices, jitter, shimmer, noise-to-harmonic ratio, and maximum phonation time and qualitative parameters such as Voice Handicap Index, glottal gap, amplitude, and phase difference were used to evaluate the pre- and post-treatment status. In cases of vocal cord paralysis, vibratory changes of the vocal folds before and after intracordal injection could be identified immediately using 2D DKG. In overcorrection cases, all of the measured parameters were poor except for improvement of the glottal gap. In addition, 2D DKG showed appropriately the changes in vocal cord vibration before and after voice therapy in patients with presbyphonia. Two-dimensional DKG may be a useful diagnostic tool in evaluation of the vibratory characteristics of entire vocal cords. In addition, it may also play a role in providing a decision for treatment modalities.

Independent exercise for glottal incompetence to improve vocal problems and prevent aspiration pneumonia in the elderly: a randomized controlled trial

Objectives: To evaluate the effect of a self-controlled vocal exercise in elderly people with glottal closure insufficiency. Design: Parallel-arm, individual randomized controlled trial. Methods: Patients who visited one of 10 medical centers under the National Hospital Organization group in Japan for the first time, aged 60 years or older, complaining of aspiration or hoarseness, and endoscopically confirmed to have glottal closure insufficiency owing to vocal cord atrophy, were enrolled in this study. They were randomly assigned to an intervention or a control group. The patients of the intervention group were given guidance and a DVD about a self-controlled vocal exercise. The maximum phonation time which is a measure of glottal closure was evaluated, and the number of patients who developed pneumonia during the six months was compared between the two groups. Results: Of the 543 patients enrolled in this trial, 259 were allocated into the intervention group and 284 into the control; 60 of the intervention group and 75 of the control were not able to continue the trial. A total of 199 patients (age 73.9 ±7.25 years) in the intervention group and 209 (73.3 ±6.68 years) in the control completed the six-month trial. Intervention of the self-controlled vocal exercise extended the maximum phonation time significantly (p < 0.001). There were two hospitalizations for pneumonia in the intervention group and 18 in the control group, representing a significant difference (p < 0.001). Conclusion: The self-controlled vocal exercise allowed patients to achieve vocal cord adduction and improve glottal closure insufficiency, which reduced the rate of hospitalization for pneumonia significantly. Clinical Trial.gov Identifier-UMIN000015567

G.P.8: Dramatic improvement after injection augmentation in oculopharyngodistal myopathy

Oculopharyngodistal myopathy (OPDM) is a rare, adult-onset, slowly progressive hereditary vacuolar myopathy in which the weakness and atrophy affect oculofacial, pharyngeal and distal skeletal muscles. The underlying genetic defect is yet unknown. Swallowing difficulties and hoarseness due to oropharyngeal involvement are two of the most prominent features of the condition affecting the quality of life and survival of the patients. Swallowing difficulty due to cord paresis and atrophy causes aspiration, compromises respiration and cause premature death. Vocal fold injection augmentation with different types of materials is a method used to treat vocal cord paralysis, paresis, atrophy and scars. It is a safe, repeatable, practical and effective procedure and can be performed in awake patients or under general anesthesia. Here, we report the dramatic outcome after vocal cord injection augmentation in a 43 years old female patient with OPDM, evidenced by improvement in ENT examination, videolaryngostroboscopic evaluation, Voice Handicap Index (Validated in Turkish), MDVP Analysis, M.D. Anderson Dysphagia Inventory, FEES (Fiberoptic Endoscopic Evaluation of Swallowing). We examined the patient, and performed all the tests during preoperative and postoperative 1st week, 1st month and 3rd month visits. No complications occurred during or after the procedure. The method was very successful in that aspirations stopped immediately after the injection, the voice became less hoarse and speech was more understandable. Augmentation was more effective for aspiration than for voice quality. Oculopharyngodistal myopathy is a non-curable genetic disease which threatens life due to respiratory insufficiency even in ambulatory patients. Application of vocal cord injection augmentation can be a promising symptomatic therapy option to decrease or stop aspiration in patients with OPDM. A larger study with more patients and longer follow-up is ongoing.

Outcome with immediate direct anastomosis of recurrent laryngeal nerves injured during thyroidectomy

Management of unrecognized recurrent laryngeal nerve injury typically entails delayed phonosurgical intervention and laryngeal reinnervation, but in cases of recognized injury, nerve anastomosis has been considered standard management. However, the well-organized outcome analysis of nerve anastomosis has been insufficient. We performed immediate direct anastomosis of recurrent laryngeal nerves injured during surgery for thyroid cancer, and subsequent patient outcomes were analyzed. A total 14 patients sustaining recurrent laryngeal nerve injury during thyroidectomy were recruited for the study. Patients undergoing immediate direct reparative anastomosis of the injured nerves constituted the test group, whereas the controls of group 2 (n = 4) did not. At follow-up, all patients submitted to rigid laryngoscopy at 3, 6, and 12 months postoperatively. Subjective and objective outcomes of the two groups were then compared. At 12 months postoperatively, group 1 showed greater improvement in maximum phonation time, glottic gap scores, GRBAS (grade, roughness, breathiness, asthenia, and strain) scales, aspiration scoring, and Voice Handicap Index than controls of group 2. Moreover, group 1 showed an improvement in all five categories at 12 months postoperatively, compared with status at 3 months. None of the patients in group 1 showed laryngoscopic evidence of vocal cord atrophy. In this study, patients undergoing immediate direct recurrent laryngeal nerve anastomosis demonstrated better phonation and perceptually rated voice quality than those who did not undergo repair. 3b.

Laryngeal reinnervation for unilateral vocal fold paralysis using ansa cervicalis nerve to recurrent laryngeal nerve anastomosis

In laryngeal paralysis, the stiffness of the denervated vocal fold is decreased. This leads to deviant vibratory patterns involving 2 asymmetric vocal folds and results in abnormal vocal quality. Follow-up studies of medialization thyroplasty patients have noted that decrement in vocal quality after medialization is often because of continuing vocal fold atrophy. Vocal cord atrophy from denervation injury can be countered by reinnervation. This article reviews the most commonly performed laryngeal reinnervation procedure for unilateral vocal fold paralysis: ansa cervicalis nerve to recurrent laryngeal nerve anastomosis.

Autologous fat augmentation for phonatory gap: Prospective study of postoperative voice outcome

Background: Substances available for vocal cord augmentation procedure have their own advantages and limitations. Autologous fat is accepted to be one of the safest substance for augmentation. Objective: To evaluate the subjective and objective changes in vocal outcome following fat augmentation surgery for phonatory gaps. Materials and Methods: 30 patients with phonatory gap <2 mm were included in this prospective study. These consisted of sulcus vocalis (14), vocal cord atrophy (05) and vocal cord palsy (11). Per-operatively harvested umbilical fat was used for augmentation after mincing it and removing all the connective tissue. Follow-up of patients was done at 1, 3 and 6 months interval. Pre- and postoperative videostroboscopy was done. Objective analysis of voice was done using maximum phonatory time (MPT) and noise to harmonic ratio (NHR). Subjective assessment of voice was done using the voice handicap index (VHI) and subjective change in quality of voice as assessed by the patient. Results: Patients with early stage sulcus, vocal atrophy and vocal cord palsy, with small vocal gap, showed significantly good results after fat augmentation; however, results of patients with sulcus vocalis of grade II and III were not very satisfactory.

声帯内自家脂肪注入術

We describe here not only the technical up-sides but also the pitfalls of the intracordal autologous fat injection technique. Buccal fat pads were used for the following reasons:1) No blood was visible in the fat at the time of collection thereby eliminating the need for rinsing and consequent removal of excessive water. Without admixed blood, the amount of fat available for injection could be accurately determined.2) Fat harvesting was not limited by physical characteristics of the patient.3) There are relatively few variations in the size of fat cells. 4) Compared with subcutaneous fat tissues used in the past, it is expected that the post-injection effects will last relatively longer.The determination of intracordal autologous fat injection sites is dependent on the laryngeal condition of the patient. With cases of unilateral vocal cord paralysis, the needle should be set at the middle of vocal cord membranous region and the injection should be made in to the center of vocal cord muscle. In cases of sulcus vocalis and vocal cord atrophy, the injection should firstly be made into the muscle and then the needle should be slightly drawn out and the injection made further into the mucosa.The ideal attributes of means of injection are as follows: 1) An 18G needle with 28cm in length, designed for injection under direct laryngoscopy.2) A Motor-driven injection instrument for consistent injection procedure with gradual and constant speed.Injection procedure should be stopped (at the time) when the edge of the injected of vocal cord crosses over the median line. If an excess quantity is injected, there may be undesired influences on the para-glottic space, and a part of mucosa may collapse, resulting in the leakage of the injected fat tissue.

An Analytical Study of Age and Gender Effects on Voice Range Profile in Bengali Adult Speakers using Phonetogram

ABSTRACT The study was aimed to analyze the changes in acoustic parameters based upon age and gender effects and to obtain normal voice range profile (VRP) of adult male and female of three different age range. Total no. of 90 subjects were grouped into three groups as per their age (20-30, 40-50 and 60-70 years) consisting 15 males and 15 females in each group. All participants were native Bengla speakers, not reported to have any speech, language, hearing, respiratory, or any other motor/ sensory deficits. Dr. Speech Software Phonetogram (version 4) and SPSS software (version 11.0) were used as tools. VRP parameters such as maximum and minimum fundamental frequency (F0), fundamental frequency range, sound pressure level (SPL), semitone and area were measured. Subjects were asked to phonate /a/ vowel in seven consistent registering in normal loudness. The mentioned parameters were measured by the tools. Responses were statistically analyzed by SPSS software (version 11.0). There was significant difference in fundamental frequency of males and females. But, there were no such significant difference in other parameters. For females endochronological changes results in more massive vocal folds and consequently, reduced F0 in old age group. Elderly males had a significantly higher F0 than young and middle aged due to vocal cord atrophy and tissue stiffening. In daily practice, the clinician prefers to make use of visual tools to treat the patient with voice problem.

Phrenic-Recurrent Nerve Anastomosis in Animal Models with Unilateral Cutting of the Recurrent Nerve

In our experimental study, the aim was to recover vocal cord physiology in cutting of recurrent laryngeal nerve, thus phrenic-recurrent nerve transposition was planned in rabbits. Experiments were performed on 10 experimental and 10 control rabbits. The right recurrent nerve was cut in the control group, while in the experiment group, the right recurrent nerve was cut. Then, a right phrenic-recurrent nerve end-to-end anastomosis was performed and the results were evaluated. After the 3rd postoperative week, videolaryngoscopy (VLS) and intramuscular electromyography (EMG) could not be evaluated in 1 rabbit from the experimental group which had died during anesthesia. In eight of the nine rabbits in the experiment which underwent VLS and EMG, activity was recorded in the right vocal cords. On light microscopic examination, atrophy was not detected in the vocal cord muscles of 9 rabbits among the 10 in the experiment group, while all rabbits in the control group and 1 rabbit in the experiment group were diagnosed with vocal cord atrophy. A success rate of approximately 90% was obtained based on the pathologic examination. We believe that the method can be used in patients without any contraindications, considering the complications of tracheostomy and the quality of life.

Auto-crosslinked hyaluronan gel injections in phonosurgery

Objectives To evaluate the clinical performance of an auto-crosslinked gel obtained from hyaluronic acid (ACP-based gel) as an anti-adhesive agent and/or augmentative agent in vocal cord surgery for the treatment of vocal fold (VF) atrophy, sulcus vocalis, and postsurgery scarring as well as its tolerability at short- and long-term follow-up. Study Design This was a prospective multicenter trial conducted between 2007 and 2009. Setting Academic center. Subjects and Methods Inclusion criteria were patients with glottic gap due to previous endoscopic phonosurgery, VF scars, vocal cord atrophy, and sulcus vocalis. Forty patients who underwent endoscopic injection of hyaluronic acid under general anesthesia were enrolled. Two different injections sites were used: the thyroarytenoid muscle in cases of glottic gap for augmentative purposes, and the lamina propria for treatment of scars and sulcus vocalis. A voice-evaluation protocol was performed before surgery, at the first follow-up visit (3 mo), and at the final follow-up (12 mo). Results Follow-up data at three months were available for 38 patients, while data at 12 months follow-up were available for 27 patients. No side effects, hematoma, or infection and allergic reactions were reported in either the perioperative or postoperative period. Patients had statistically significant improvement in voice parameters compared with the baseline data at the first follow-up visit and at the 12-month follow-up. Conclusion ACP-based gel seems to be a new tool in the challenging treatment of VF scarring, functioning as both an anti-adhesive product and an augmentation agent. Improvements in all glottal parameters and in both objective and subjective evaluation of voice performance were observed.

水痘帯状疱疹ウイルスによる多発脳神経障害をきたした３例

Varicella-Zoster virus infection sometimes causes multiple nerve paralysis. We report three cases of multiple cranial nerve paralysis due to Varicella-Zoster virus infection. The first patient, a 58-year-old man, presented with right otalgia, dysphagia and hoarseness. There were painful vesicles on the right auricle, and clinical examination demonstrated right hearing impairment and right vocal paralysis. There was no facial palsy. He was diagnosed with VIIIth, IXth and Xth cranial nerve palsy. The second patient, a 60-year-old woman, presented with right otalgia, vertigo, right hearing loss, and dysphagia. There were painful vesicles on the right auricle, and clinical examination demonstrated right hearing impairment, right canal paralysis and deviation of the tongue. Right facial palsy appeared on the 5th disease day. She was diagnosed with VIIth, VIIIth and XIIth cranial nerve palsy. The third patient, a 70-year-old woman, presented with right otalgia and dysphagia. There were painful vesicles on the right auricle and in the larynx, and clinical examination demonstrated soft palatine paralysis, right vocal cord paralysis and atrophy of the right sternocleidomastoid muscle. She was diagnosed with IXth, Xth and XIth cranial nerve palsy. Serum antibody titers for Varicella-Zoster virus were significantly elevated in all patients. All patients were successfully treated with intravenous or oral steroid and intravenous acyclovir.Varicella- Zoster virus infection should be considered, particularly if unilateral cranial nerve palsy with pain is identified.

REGENERATION OF THE RECURRENT LARYNGEAL NERVS USING A WOVEN POLYGLYCOLJCACID (PGA) TUBE COATE WITH COLLAGEN

A) Purpose: The recurrent laryngeal nerve is one of the most difficult nerves to regenerate functionally. Therefore, no reconstruction of the recurrent laryngeal nerve is commonly performed after the surgical removal associated with head or neck cancer. We report the animal experiment on regeneration of the recurrent laryngeal nerve using woven PGA tube coated with collagen. B) Methods: The animal experiment was performed using 10 adult beagle dogs divided into 2 groups. In group I (n=G), the left recurrent laryngeal nerve was excised 10mm around about 20mm distal portion from the cricoid cartilage. This gap was bridged with a woven PGA tubs coated with collagen (5mm in diameter and 20mm in length). This bioabsorbable tube has no antigenicity. In control group II (n=4), the left recurrent laryngeal nerve was excised the same portion as in grous I and the great auricular nerve was auto-grafted to the gap. In order to estimate morphological and functional recovery of the nerve, not only fiberscopic observation for vocal cords but also the test for axona transport and EMG were performed. C) Result: The recurrent laryngeal nerve was morphologically and functionally regenerated in one of the group I. In other dogs of this grous vocal cord atrophy were prevented in some degree. In group II, functional recovery of the recurrent laryngeal nerve was not observed. Atrophy of the vocal cord was more severe than that of dogs in group I. These results suggest that a woven PGA tube coated with collagen may be useful for functional regeneration of the recurrent laryngeal nerve.

Does hoarseness of voice from recurrent nerve paralysis after esophagectomy for carcinoma influence patient quality of life?

Background: Recurrent laryngeal nerve injury caused by esophageal cancer surgery is worrisome but often temporary; it is unclear when and how the paralysis is resolved. Hoarseness of voice from vocal cord paralysis (VCP) can have detrimental effects on postoperative patients. The aims of this study were to clarify the progress of nerve paralysis related to difficulty in talking after surgery and to assess whether hoarseness influences patient quality of life. Study Design: Between 1985 and 1996, 141 esophageal cancer patients undergoing a resection by the Akiyama procedure were cancer free 1 year after surgery. Among them, 51 patients with VCP on discharge from the hospital were retrospectively reviewed. Their VCPs, body weights, and pulmonary functions were examined yearly. They were given a questionnaire relating to the difficulty in talking 1 year after surgery. Results: VCP on discharge spontaneously healed within 1 year of surgery in 21 patients (41.2%), with the mean duration of difficulty in talking 5.7 months. The remaining 30 patients had persistent VCP 1 year after surgery; 4 VCPs spontaneously healed approximately 2 years after surgery. Eleven of the 30 patients with persistent VCP, who complained of severe hoarseness at 1 year postoperatively from inability to close the glottis during exertion, showed debilitation in performance status, abilities to go up stairs, and swallowing. In the group of patients with severe hoarseness, the percentage of ideal body weight (90.6% ± 11.0%) preoperatively and pulmonary functions at 3 years postoperatively were deteriorated, resulting in 3 patients with repeated aspiration pneumonia. Conclusions: The inability to compensate for aspiration, presenting as severe hoarseness, may be dependent on the preoperative nutritional state of patients along with degree of vocal cord atrophy and a decrease in pulmonary support. Persistent nerve paralysis deteriorates quality of life until it is adequately treated.

喉頭枠組手術 再手術例の検討

Between 1988 and 1995, 54 patients underwent laryngeal framework surgery, to treat glottal insufficiency due to unilateral vocal cord paralysis at Osaka Red Cross Hospital. Thyroplasty type I was performed initially in 33 patients, arytenoid adduction was performed in 18 patients, and combined thyroplasty type I and arytenoid adduction was performed in 3 patients. To date, 5 patients who had poor results from their initial surgery have undergone revision laryngeal framework surgery. Three patients who initially underwent arytenoid adduction underwent revision thyroplasty type I as a secondary procedure. Patients with vocal cord atrophy initially had to undergo combined thyroplasty type I and arytenoid adduction. Two patients who initially underwent thyroplasty type I underwent revision thyroplasty type I, with placement of a larger silicon block implant. At surgery, the tissue adjacent to the previously implanted silicon block exhibited the formation of a thin fibrous capsule. The silicon block implant was easily removed and replaced with a different, largersized, silicon block implant. The results of the revision surgery were satisfactory in all five patients.

変声障害に対する外科的治療の適応

In general, the primary therapy for mutational voice disorder is voice therapy since the disorder is believed to be mainly functional. However, we sometimes see organic changes such as slight vocal cord atrophy in some patients with mutational voice disorder who have mainly voice breaks as well as high pitch and hoarseness. We assume that asynchronous growth of the laryngeal cartilage and vocal cords might cause imbalance of tension of the vocal cords that results in atrophic appearance of vocal cord and prolonged mutational voice. When organic changes such as atrophy or tension imbalance of the vocal cords exist, voice therapy may not be effective and surgical treatment may yield better results.We performed thyroplasty type III with lateral compression in three patients with mutational voice disorder with organic change. If the imbalance of the vocal cord tension causes mutational voice disorder associated with vocal cord atrophy, thyroplasty type III conbined with lateral compression may correct both the imbalance of the vocal cord tension and the glottal gap caused by vocal cord atrophy.The effect of the operation was rapid and dramatic. In all three patients the voice pitch became much lower immediately after the procedure, and breathiness and voice breaks were reduced or disappeared. None of the patients required voice therapy after the operation. In conclusion, thyroplasty type III is quite effective for mutational voice disorder with unilateral vocal cord atrophy.

発声にともなう麻ひ声帯の形状変化に関する画像解析 空気力学的な力の関与について

The development of digital radiography (DR) has made it possible to analyze the contour of the laryngeal soft tissue structures in more detail than the conventional screen-film method. We analyzed the contour of the paralyzed vocal cord during phonation using motion subtraction technique. Forty four patients with unilateral recurrent nerve palsy were examined. The images were obtained by means of frontal tomography of the larynx during quiet inspiration and normal (expiratory) phonation. Tomography during inspiratory phonation was also examined in ten patients who can perform it. The thickness of the slices was 5.0 mm. The authors found that the free margin of the paralyzed vocal cord shifted by the aerodynamic power along the direction of the air flow, i.e. it shifted to the cranial direction during normal phonation and to the caudal during inspiratory phonation. The displacement phenomenon of the paralyzed vocal cord was significantly correlated with the degree of vocal cord atrophy (p less than 0.01). The result would indicate that the aerodynamic power during phonation is one of the factors eliciting the higher position of the paralyzed vocal cord during phonation, in addition to its anatomical displacement due to abduction of the paralyzed arytenoid. This notion should be taken into consideration in selecting the surgical approach for the treatment of unilateral recurrent nerve palsy.