To assess the impact of synkinesis on voice restoration in idiopathic vocal fold paralysis (IVFP) patients with different disease courses, a cohort of 130 IVFP patients (comprising 71 males and 59 females; 78 cases with left-sided paralysis and 52 cases with right-sided paralysis) was categorized into two groups according to their disease courses (group 1: < 3months, group 2: 3-6months). Each group was subsequently subdivided based on the presence or absence of synkinesis according to the laryngeal electromyography (LEMG) results, as evaluated by two physicians who are board-certified in electrodiagnostic medicine. The specific information of the IVFP patients were blinded to both the two evaluators, and the LEMG results evaluated by them were also blinded to each other. Then the analysis revealed that the individuals in the group 2 (45 cases) demonstrated significantly greater maximum phonation time (MPT) and maximum sound pressure level (SPLmax) compared to those in the group 1 (85 cases) (MPT, 8.34 ± 7.35s vs 5.55 ± 4.29s, t = - 2.008, P = 0.049; SPLmax, 94.53 ± 14.72dB vs 87.88 ± 9.82dB, t = - 2.101, P = 0.040). Furthermore, the group 2 exhibited a higher prevalence of synkinesis than that in the group 1 (35.56% vs 14.12%, P = 0.005). Notably, within the group 2, the patients with synkinesis had significantly lower MPT values (4.10 ± 1.79s vs 8.20 ± 5.84s, t = - 2.569, P = 0.019), as well as higher amplitudes of paralytic recurrent laryngeal nerve (RLN) compared to those without synkinesis (7.71 ± 8.35mV vs 1.70 ± 1.31mV, t = - 2.493, P = 0.023). Conversely, in the group 1, no significant differences were observed in the comparison of MPT values or amplitudes of RLN between the individuals with synkinesis and those without synkinesis (MPT, 6.01 ± 5.83s vs 5.46 ± 4.01s, t = - 0.334, P = 0.740; the amplitudes of RLN, 2.62 ± 2.35mV vs 2.74 ± 3.14mV, t = 0.104, P = 0.917), which were analyzed by Bonferroni (a multiple-comparison correction method, m = 2, ɑ = 0.025), and the P value less than 0.025 represents a significant difference in such condition. These findings suggest that synkinesis adversely affects voice restoration in the IVFP patients with a disease course of 3-6months, indicating that the IVFP patients should accept diagnosis and treatment within 3months after onset to improve their voice qualities, avoiding the adverse effects caused by synkinesis.

To assess the short-term voice quality in unilateral vocal fold paralysis (UVFP) patients after office-based hyaluronic acid injection laryngoplasty (OBIL) using the European Laryngeal Society (ELS) multidimensional voice quality assessment. Patients with UVFP that underwent OBIL were prospectively recruited from November 2022 to November 2024, at a tertiary university medical center (laryngology unit). Voice handicap index (VHI), GRBAS perceptual evaluation, maximum phonation time (MPT), and acoustic parameters were evaluated seven days and one month post-OBIL. Videolaryngostroboscopy was evaluated to assess the glottic closure (complete or incomplete) using the ELS recommendations. Thirty-two patients with UVFP were included. The amount of injectable ranged from 0.2 mL to 0.8 mL. Improvement in glottal closure was observed in 22/32 (75%) patients at Day-7 and 21/32 (68.8%) at one month post-OBIL. VHI significantly decreased after injection (p = 0.02). Other vocal outcomes (f0, percent jitter, percent shimmer, harmonic to noise ratio) revealed non-significant improvements (p > 0.05). MPT did not change (p = 0.37). Perceptual outcomes decreased non-significantly following OBIL, with 'breathiness' improving the most (p > 0.05). OBIL improves voice quality in patients with UVFP. All voice quality outcomes show early improvement at Day-7 and continue to improve at Month-1 after injection. VHI emerged as the most sensitive tool for detecting voice changes.

ObjectiveTo evaluate the clinical and oncological outcomes of transoral endoscopic thyroidectomy via the vestibular approach (TOETVA) in the management of pediatric patients with benign and malignant thyroid lesions in Vietnam.MethodsA cross-sectional study was performed on pediatric patients (≤18 years old) who underwent TOETVA for thyroid cancer and benign thyroid nodules between August 2019 to September 2024.ResultsOf the 28 patients included in the study, 23 were female (82.1%), and 5 were male (17.9%) with a mean age of 15.86±2.45 years. Mean tumor size on ultrasound was 19.47±13.63 mm. TOETVA was completed successfully in all cases. Postoperative histopathological findings revealed benign lesions in 13 patients, differentiated thyroid carcinoma in 14 patients and non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) in one patient; central neck dissection (CND) was performed in 15 patients; nine of them had occult lymph node metastasis. Postoperative complications included transient hypoparathyroidism (3.6%) and vocal cord palsy (7.1%), all of which resolved. No permanent complications or recurrences were observed over a median follow-up of 26.5 months.ConclusionsTOETVA appears feasible for the treatment of thyroid nodules in children. However, larger prospective studies are needed to confirm these findings.

Intraoperative neuromonitoring (IONM) has been increasingly used in thyroid surgery, yet its clinical value remains controversial. This randomized controlled trial aimed to evaluate the efficacy and safety of IONM in thyroid cancer surgery. The standardized four-step monitoring protocol was used in the IONM group. Primary endpoints included RLN injury rates and postoperative voice function recovery. Secondary endpoints included surgical parameters (operation time, blood loss), complication rates, and oncological outcomes. Voice function was assessed using VHI-10 scoring and maximum phonation time (MPT). Patients were followed up for a median of 6months. The IONM group demonstrated significantly lower rates of temporary vocal cord paralysis (2.0% vs 10.0%, P = 0.038) and higher nerve identification rates (100% vs 96.0%) compared to the control group. Voice function recovery was notably faster in the IONM group, with smaller changes in VHI-10 scores (Δ = 4.2 ± 1.5 vs 7.6 ± 2.1, P < 0.001) and shorter MPT recovery time (14.2 ± 3.5 vs 25.6 ± 5.2days, P < 0.001). Although operation time was longer in the IONM group (125.6 ± 18.3 vs 108.4 ± 15.7min, P < 0.001), no significant differences were found in blood loss (45.3 ± 12.6ml vs 48.7 ± 13.2ml, P = 0.183), complication rates, or oncological outcomes between the groups. IONM technology greatly lowers the risk of temporary recurrent laryngeal nerve injury and speeds up voice function recovery in thyroid cancer surgery. Although operation times are slightly extended, the technique is safe and preserves oncological integrity.

Efficacy of an Eclectic Voice Therapy Protocol in Unilateral Vocal Fold Paralysis: Evidence from Multidimensional Clinical Evaluation.

Surgeon-performed transcutaneous laryngeal ultrasonography after thyroidectomy: Diagnostic accuracy and learning curve.

Neurofibromas are benign peripheral nerve sheath tumors. It is more common in neurofibromatosis type Ⅰ. However, isolated vagal nerve neurofibroma（VNN） of the neck is extremely rare, and only a few case reports have been reported. Its etiology and pathogenesis are not clear. The diagnosis is mainly based on pathological examination and immunohistochemistry, and surgical resection is the main treatment. This study reports a rare case of giant solitary vagus neurofibroma in the neck. The patient was a 29-year-old female who was found to have a mass on the right side of the neck by physical examination, which was considered to be a vagus nerve tumor by neck ultrasound and imaging examination. The tumor was completely removed during the operation, with the size of about 10.0 cm×2.5 cm, and the patient had no special discomfort. Postoperative pathology and immunohistochemistry confirmed neurofibroma. After surgery, the patient had right vocal cord paralysis, hoarseness, choking and paroxysmal cough. After swallowing function training and voice rehabilitation treatment in the department, the patient recovered satisfactorily. There was no complication and recurrence during the follow-up of 1 year. This article reviews the literature to improve the diagnosis and treatment of solitary vagus neurofibroma in the neck by combining its medical history, imaging features, pathology and immunohistochemistry, and surgical treatment.

Unilateral vocal cord paralysis (UVCP) is a debilitating disorder that affects patients' vocalization and swallowing. Medialization thyroplasty (MT) and injection laryngoplasty (IL) are the most widely used surgical procedures for treating UVCP. This is the first direct meta-analysis on the effectiveness of IL in treating UVCP in comparison with MT. On the 15th of December, 2024, a systematic search was conducted in biomedical databases. Search results were gathered and screened for relevant primary studies. Data were extracted, and inverse variance meta-analysis was conducted whenever applicable using the RevMan software. The results were pooled as mean difference (MD) or standardized MD, each reported with its corresponding 95% confidence interval. Statistical significance was determined when the P-value was under 0.05. Thirteen studies that enrolled 896 patients were included (428 underwent IL while 444 underwent MT). A trend towards short- and long-term improvements was noticed in voice jitter with IL (short-term: MD=-0.59, 95% CI: [-1.03, -0.14], P = 0.01; long-term: MD=-0.70, 95% CI: [-1.00, -0.41], P < 0.001) and in voice shimmer with MT (short-term: MD=-2.06, P = 0.003; long-term: MD=-2.51, P = 0.003), likely of the variation in each procedure's mechanics. Both IL and MT resulted in comparable improvements in the harmonic-to-noise ratio (P = 0.3), the maximum phonation time (P = 0.8), and the voice handicap index (P = 0.6) within six months post-operatively. We conclude comparable improvements in UVCP with both IL and MT. Further long-term studies that investigate this comparison on a large scale are required to provide case-specific conclusions.

Results of transoral injection laryngoplasty in the apneic window.

Case series: Suture lateralization for neonatal vocal fold movement disorders.

Background and Objectives: This study aimed to evaluate postoperative changes in voice quality and glottic function following early injection laryngoplasty with hyaluronic acid performed using a modified general anesthesia approach without airway instrumentation in patients with unilateral vocal fold paralysis. Materials and Methods: Thirty-two patients (19 females, 13 males; mean age 51.8 years, range 21–70) who underwent injection laryngoplasty within the first three months after the onset of paralysis were included in this retrospective study. All procedures were performed under general anesthesia without endotracheal intubation, using endoscopic visualization. Objective acoustic and aerodynamic analyses and videostroboscopic examinations were performed preoperatively and postoperatively. Data were analyzed using the Wilcoxon signed-rank test, with p &lt; 0.05 considered statistically significant. Results: Significant postoperative improvement was observed in acoustic and aerodynamic parameters. Shimmer, jitter, and noise-to-harmonic ratio (NHR) values significantly decreased (p &lt; 0.001, p &lt; 0.001, and p = 0.001, respectively), while maximum phonation time (MFT) increased markedly (p &lt; 0.001) and the S/Z ratio decreased (p = 0.006). The mean fundamental frequency (F0) decreased slightly but not significantly (p = 0.085). Videostroboscopic findings demonstrated improved glottic closure and vocal fold vibration. No major complications occurred. Conclusions: Early injection laryngoplasty with hyaluronic acid performed under general anesthesia and endoscopic guidance provides significant improvement in objective voice parameters and glottic efficiency in unilateral vocal fold paralysis. Early intervention appears to enhance phonatory stability and may prevent maladaptive laryngeal changes.

Transoral thyroidectomy, including transoral endoscopic thyroidectomy vestibular approach (TOETVA) and transoral robotic thyroidectomy (TORT), offers cosmetic advantages over conventional open thyroidectomy (OT). However, few studies have directly compared these three approaches in a single analysis. We evaluated the oncological adequacy and perioperative outcomes of OT, TOETVA, and TORT for papillary thyroid carcinoma using propensity score matching (PSM). We retrospectively reviewed 819 consecutive patients who underwent OT (n = 559), TOETVA (n = 128), or TORT (n = 132) between 2016 and 2023. PSM was performed using 10 baseline clinicopathological variables to create three balanced cohorts (n = 124 each). The outcomes included central lymph node (LN) yield, complications, operative time, postoperative pain, hospital stay, and thyroglobulin and radioactive iodine (RAI) parameters. After matching, OT and TORT achieved similar central LN yields (7.1 ± 5.4 vs. 6.9 ± 2.9), both significantly higher than TOETVA (4.8 ± 2.8; p < 0.001). Hospital stay was shortest in the OT group (2.8 ± 1.7 days), intermediate in the TORT group (3.3 ± 0.7), and longest in the TOETVA group (4.0 ± 1.9; p < 0.001). Operation-day pain was lowest in the OT group (2.6 ± 0.5), intermediate in the TORT group (3.2 ± 0.9), and highest in the TOETVA group (3.8 ± 0.9; p < 0.001). Transient vocal cord palsy occurred least frequently in the TORT group (1.6%), followed by the TOETVA (7.3%) and OT (8.1%) groups (p = 0.056). The rates of permanent palsy and hypocalcemia were similar between the groups. The operative time was significantly longer in the TORT group than in the OT or TOETVA groups. Thyroglobulin levels and RAI parameters did not differ significantly between the groups. Both transoral approaches were safe and feasible. TORT achieved oncologic adequacy comparable to that of OT while providing scarless benefits despite prolonged operative time. TOETVA was feasible but was associated with a low LN yield. The choice of the surgical approach should be individualized according to oncological adequacy, recovery, and cosmetic preferences.

The effect of topical intraoperative corticosteroid application on voice quality in thyroid surgery with preserved RLN remains unclear. This randomized controlled trial aimed to evaluate the efficacy and safety of this intervention. Between January 2023 and June 2024, 134 patients scheduled for thyroid surgery were screened for eligibility. Patients who developed loss of signal (LOS) during surgery or who had postoperative impaired vocal cord motility on laryngoscopy were not included in the final analysis. Fourteen patients were excluded (six for previous thyroid/parathyroid surgery, four for preoperative vocal cord paralysis, and four for corticosteroid allergy), leaving 120 patients who were randomized equally to receive either topical intraoperative corticosteroids (n=60) or standard treatment (n=60). Baseline demographic and clinical data were comparable between the groups. Dynamic function of the larynx was monitored intraoperatively using electromyography (EMG), and vocal outcomes were assessed 1week postoperatively using the Voice Handicap Index (VHI) and voice-related quality of life (V-RQOL). Laryngeal findings and adverse events were also recorded. No EMG signal was recognized in any patient. The EMG amplitudes and latencies of the vagus nerve (V1 and V2) did not differ significantly between the groups. EMG signal changes between V1 and V2 were observed in 16% of RLNs in the control group and in 18% in the corticosteroid group, but these were not associated with clinically significant decreases in amplitude or increases in latency. Postoperatively, the corticosteroid group had significantly lower (better) mean VHI scores (12.4±3.2 vs. 19.6±4.7; p<0.01) and higher V-RQOL scores (88.3±6.1 vs. 77.5±8.8; p=0.02) than the control group. The subgroup analysis of patients with EMG changes showed similar trends. Vocal fold edema occurred in 2 patients in the corticosteroid group and 5 in the control group, with complete resolution of stroboscopic abnormalities in all patients after 4weeks. No local or systemic complications related to the use of corticosteroids were observed, and the postoperative courses were uneventful in both groups. Topical intraoperative use of corticosteroids in thyroid surgery with preserved RLN is safe and associated with improved early postoperative voice outcomes. No significant adverse events were observed, and RLN function was preserved in all cases. Further studies are needed to assess the long-term clinical relevance of these results.

Cite this article as: Gulası S, Coskun H, Cekınmez EK. Tapia syndrome in aneonate following difficult birth: A rare cause of tongue deviation and vocalcord paralysis. Turk Arch Pediatr. Published online November 20, 2025.doi:10.5152/TurkArchPediatr.2025.25270.

Efficacy of Intraoperative Injection Laryngoplasty for Vocal Fold Paralysis during Thyroidectomy.

Tapia syndrome following orotracheal intubation in intensive care unit

Foreign bodies (FBs) in the external auditory canal (EAC) are common in children but rarely cause cranial neuropathies. We report the first documented case of vagal and glossopharyngeal nerve palsies secondary to a migratory ear FB penetrating the jugular foramen. A 2.5-year-old boy presented with a 50-day history of right otalgia, bloody otorrhea, and new-onset dysphonia with aspiration. Initial workup revealed granulation tissue and methicillin-resistant Staphylococcus aureus (MRSA) infection, refractory to antibiotics. Flexible endoscopy demonstrated right vocal cord paralysis as well as diminished pharyngeal sensation and paralysis, suggesting cranial nerve (CN) IX and X dysfunction. Temporal bone imaging initially overlooked a 22 mm glass fragment embedded in the hypotympanum, extending into the jugular foramen. Multidisciplinary review identified the FB, previously misclassified as an artifact. Surgical extraction, performed through mastoidectomy through a post-auricular incision, led to symptom resolution, and confirmed neuropraxia secondary to FB-induced neuritis. This case highlights a novel mechanism of cranial neuropathy, direct FB migration to the skull base, and underscores the importance of reevaluating imaging in refractory otologic cases. Clinicians should suspect occult FBs in pediatric patients with persistent ear bleeding and cranial nerve deficits, even without a clear history of insertion.

BackgroundNasogastric tube syndrome (NGTS) is a rare yet potentially life‐threatening complication caused by prolonged compression of the laryngeal structures by a nasogastric tube, resulting in bilateral vocal fold paralysis and acute upper airway obstruction. While NGTS has been reported in patients requiring enteral feeding due to conditions such as stroke or impaired consciousness, no cases during the treatment of catatonia have been documented. NGTS remains underrecognized despite common nasogastric use in catatonia.Case PresentationThe patient was a 66‐year‐old woman with probable dementia with Lewy bodies who presented with catatonia characterized by psychomotor retardation. Due to impaired oral intake, a nasogastric tube was inserted for nutritional support. On the 38th day after the tube was inserted, she gradually developed stridor and worsening respiratory distress, followed by paradoxical breathing. Laryngoscopy revealed bilateral abductor vocal fold paralysis accompanied by marked arytenoid edema, and an emergency tracheostomy was performed. CT imaging confirmed arytenoid edema, while brain and cervical imaging revealed no evidence of central or peripheral lesions affecting the vagus or recurrent laryngeal nerves. Based on the clinical course and findings, a diagnosis of NGTS was made. Following removal of the nasogastric tube, vocal fold mobility gradually returned to normal. Her catatonic symptoms improved significantly after a course of electroconvulsive therapy.ConclusionThis case highlights the potential severity of NGTS in psychiatric settings. In patients with catatonia, who are often unable to communicate their symptoms, careful clinical monitoring is essential. When upper airway symptoms such as stridor or hoarseness arise during nasogastric feeding, NGTS should be considered as a possible cause. A multidisciplinary approach—including prompt consultation with otolaryngology—is crucial to prevent serious complications.

Bilateral vocal fold immobility (BVFI) results from posterior glottic stenosis (PGS) or bilateral vocal fold paralysis (BVFP). In the context of prolonged intubation, PGS often presents with additional airway stenosis (PGS+). There is a paucity of literature comparing isolated PGS (iPGS), PGS+, and isolated BVFP (iBVFP). The objective of this study is to analyze demographics, airway prosthesis (AP) dependence, and risk factors for failed decannulation within these cohorts. Retrospective case series of patients with BVFI managed at a tertiary academic institution between 2011 and 2021. Univariate analysis determined factors associated with decannulation rates and AP dependence at last contact. 118 patients were identified: 39 iPGS, 54 PGS+, 25 iBVFP. PGS+ patients were younger than iPGS or iBVFP (P = .009). iPGS, PGS+, and iBVFP were less common in men than women (P = 0.838). The mean number of airway operations per year was higher in PGS+ versus iPGS or iBVFP patients (P = .001). Decannulation rate was similar in iPGS, PGS+, and iBVFP (P = 0.739). The AP dependence rate was 39% in the PGS+ cohort and 26% and 24% in patients with isolated glottic pathology (iPGS, iBVFP respectively, P = 0.105). Active smoking was associated with a higher rate of AP dependence in the iPGS group only (P = .020). PGS+ and a history of head and neck radiation both had higher observed rates of AP dependence without achieving statistical significance (P = .092, P = .073). 58% of PGS patients had additional stenosis beyond the glottis. These patients were younger and received more airway surgeries than iPGS or iBVFP patients, however there was no statistically significant difference in AP dependence or decannulation rate between the groups. Independent analysis of iPGS and PGS+ elucidates the relative complexity of treating PGS patients with additional airway stenosis.

To identify factors influencing time-to-operating room and time-to-airway intervention in urgent tracheotomy and synthesize strategies to reduce delays in airway emergencies. A scoping review was conducted following the Joanna Briggs Institute framework and reported according to PRISMA-ScR guidelines. MEDLINE, Embase, Scopus, Web of Science, and Google Scholar were searched from inception to June 2024. Eligible studies involved adults (≥18 years) undergoing urgent tracheotomy for airway obstruction due to malignancy or infection. Trauma, angioedema, laryngotracheal stenosis, post-radiation edema, and vocal fold paralysis were excluded to reduce heterogeneity and focus on institutional/system-level factors. Of 1339 records identified, 3 studies (n = 531 patients) met the inclusion criteria. Dyspnea and stridor were the most common presenting symptoms. Malignancy and deep neck infection accounted for most indications. Reported delays were related to operating room access, staffing shortages, and coordination challenges. Complication rates ranged from 8% to 28%, with hemorrhage and infection most frequent; no deaths were directly attributed to tracheotomy. Decannulation rates were higher in non-malignant than in malignant cases. Urgent tracheotomy for airway obstruction due to malignancy or infection is time-sensitive, with delays shaped by institutional barriers. Standardized protocols, improved staffing, simulation-based training, and rapid-response teams represent actionable strategies to enhance airway emergency readiness and outcomes.