Vocal Function Research Articles

Myoneurectomy for Adductor Spasmodic Dysphonia: Long-Term Outcomes, Complications, and Recurrence.

To evaluate the long-term results of endoscopic myoneurectomy (EMN) of the thyroarytenoid (TA) muscle for the treatment of adductor spasmodic dysphonia (AdSD), with an emphasis on vocal outcomes, adverse effects, and recurrence. A total of 48 patients underwent up to three EMNs of the TA muscle and were followed for at least 18 months to evaluate the efficacy, based on patient and examiner assessments, and safety of the procedure(s). Vocal outcomes were evaluated through the use of the 30-item Voice Handicap Index (VHI-30) questionnaire and subjective (patient-reported) assessment. In this group, 38 patients (79.2%) were considered successful. The median VHI-30 score at baseline was 97, decreasing to 26 after treatment, and the median subjective postprocedural improvement was 88.5%. The most common adverse effects were granulomas (in 18 cases), glottic insufficiency (in two), and dyspnea (in one). Although up to three procedures can be needed to achieve a high success rate, EMN of the TA muscle can provide excellent benefits in terms of vocal function with a low rate of complications. 4 Laryngoscope, 2024.

Fatal Nocturnal Stridor after Tracheostomy Decannulation in a Patient with Medullary Infarction and Vocal Cord Palsy

Nocturnal stridor, a high-pitched breathing sound during sleep, is one of the respiratory signs indicating airway narrowing. A 70-year-old man experienced life-threatening nocturnal stridor following tracheostomy decannulation after medullary infarction and vocal cord paralysis. This rare case highlights the importance of evaluating risk of sleep apnea and vocal cord function pre-decannulation to prevent serious complications.

Long-Term Laryngeal Function and Quality of Life Following Treatment of Early Glottic Cancer: A Meta-Analysis.

To review the literature concerning long-term functional outcomes and quality of life (QoL) in patients undergoing transoral laser microsurgery (TLM) versus radiotherapy (RT) for early glottic cancer. A systematic search was conducted across PubMed, Scopus, and Cochrane Library from inception until April 2024. Articles considered were primary studies directly comparing the 2 treatment modalities in a population of T1 and T2 glottic cancer. Interest outcomes were patient report outcome measures (PROMs) of vocal function and QoL, clinician-reported measures, and acoustic analyses parameters. There was no significant difference between TLM and RT in grade, roughness, breathiness, asthenia, strain (relative risk, 1.11; 95% confidence interval [CI], 0.60-2.07; I2 = 90.96; P < .001), Voice Handicap Inventory-30 scores (standardized mean difference [SME] 0.51; 95% CI, -0.04-1.07; I2 = 89.72; P < .001), or fundamental frequency (SME 0.56; 95% CI, -0.14-1.25; I2 = 91.12; P < .001). The TLM group had significantly better performance with regards to jitter (SME 0.54; 95% CI, 0.08-1.00; I2 = 79.42; P < .001) and shimmer (SME 0.53; 95% CI, 0.11-0.95; I2 = 74.94; P < .001). The risk of bias was assessed to be serious. The findings suggest comparable long-term PROMs between TLM and RT in the treatment of early glottic carcinoma, with TLM showing better acoustic analysis outcomes. However, the available evidence remains scarce, of high heterogeneity, and at risk of bias. A direct comparison between TLM and RT through large randomized controlled trials is needed to provide more substantial evidence to determine the optimum treatment.

A meta-analysis on the improvement of vocal function in unilateral vocal cord paralysis by reinnervation of the recurrent laryngeal nerve

Objective:To conduct a systematic description and meta-analysis of the treatment of unilateral vocal cord paralysis（UVCP） with recurrent laryngeal nerve reinnervation through literature search, and to analyze the therapeutic effect of recurrent laryngeal nerve reinnervation on improving vocal function in UVCP. Methods:Electronic databases Pubmed, Web of Science, EMBASE, Cochrane Library, CNKI, and Wanfang databases were searched using relevant keywords and screened in strict accordance with the inclusion and exclusion criteria, and quality evaluations were conducted. Reported treatment outcomes were measured by relevant data extracted from literature, such as auditory perception assessment（GRBAS）, voice handicap index（VHI）, maximal phonation time（MPT）, jitter, shimmer, and noise harmonic ratio（NHR）, etc. Meta-analysis was performed by Revman5.3 and heterogeneity was analyzed using fixed effects or random effects models. Results:Eight articles were included in this study, all of which showed that the postoperative maximum phonation time of patients was significantly prolonged compared to preoperative, while the postoperative GRBAS score, Jitter, Shimmer, and NHR decreased compared to preoperative with statistical significance. Conclusion:The innervation of the internal laryngeal muscle was obtained through the reinnervation of the recurrent laryngeal nerve, which effectively improved the patient's vocal function and had a good long-term therapeutic effect. Although there was no difference in the efficacy of surgical methods for reconstructing the recurrent laryngeal nerve, the anastomosis between ansa cervicalis nerve and the recurrent laryngeal nerve is more ideal. Further randomized controlled studies with longer follow-up periods and larger samples will increase the credibility of their effectiveness.

A comparative study on the efficacy of different treatment methods for preventing vocal cord adhesion after laser treatment for glottic cancer

Objective:Comparing the primary tumor control, vocal function recovery, postoperative adhesion rate and degree of adhesion in early glottic cancer involving the anterior commissure treated with CO₂ laser staged and lateral surgery, one-stage surgery combined with laryngeal stent placement, and simple CO₂ laser excision. Methods:This study focuses on 83 patients with T1-2N0M0 stage glottic squamous cell carcinoma involving the anterior commissure who underwent CO₂ laser treatment. The study was divided into three groups: Group A with 15 cases, treated with staged resection surgery; Group B with 18 cases, treated with one-stage surgery combined with the placement of a silicone laryngeal stent; and Group C with 50 cases, treated with simple CO₂ laser excision. The Voice Handicap Index-10（VHI-10）, the GRBAS auditory-perceptual assessment, and the maximum phonation time（MPT） were used to evaluate the vocal function of the patients before and six months after surgery. The degree of vocal cord adhesion was assessed using the Cohen classification of vocal cord adhesion. Statistical analysis was performed to determine the differences in each indicator before and after surgery, and the primary tumor control rates among the three groups. Results:Local recurrence occurred in 1 case each in Groups A and B, and in 4 cases in Group C, with no distant metastasis observed. Postoperative vocal cord adhesion of varying degrees occurred in a total of 77 cases, with an adhesion rate of 73.3%（11/15） in Group A, 88.9%（16/18） in Group B, and 100%（50/50） in Group C. The postoperative vocal cord adhesion rate and degree in Group C were significantly higher than in Groups A and B. The postoperative VHI-10 scores in all three groups were significantly increased compared to preoperative scores（P<0.05）, and when compared between groups postoperatively, Group C was significantly worse than Groups A and B （P<0.05）. The postoperative maximum phonation time（MPT） in Group C was significantly reduced compared to preoperative and was markedly shorter than that of Groups A and B postoperatively（P<0.05）. The postoperative grades of G（Grade） and R（roughness） in Group C were significantly higher than preoperatively, indicating a noticeable deterioration in voice quality, and were also significantly worse than those postoperatively in Groups A and B, with all differences（P<0.05）. Conclusion:For early glottic cancer involving the anterior commissure, choosing staged surgery or one-stage surgery combined with the placement of a silicone anterior commissure laryngeal stent were better than simple laser tumor excision in terms of secondary vocal cord adhesion and voice function preservation.

Analysis of therapeutic effect of fibrocystic degeneration of vocal folds

Objective:To explore the differences in clinical presentation and therapeutic outcomes between vocal fold fibrocystic degeneration and other common benign lesions, such as vocal fold polyp and cyst. Methods:Vocal function was assessed before and after surgery in 10 cases of vocal fold fibrocystoids, 30 cases of vocal fold polyps and 10 cases of vocal fold cysts at Department of Voice Medicine, Xiamen University Zhongshan Hospital. The voice Assessments included GRBAS（G-scale）, VHI-10 scale, Reflux Symptom Index（RSI） scale, stroboscope, acoustic objective analysis, and aerodynamics measurements. The acoustice analysis parameters included fundamental frequency（F0）, fundamental frequency perturbation（Jitter）, amplitude perturbation（Shimmer） and voice disturbance severity index（DSI）, while the maximum phonation time（MPT） was assessed for aerodynamics. Stroboscopic parameters included vocal fold straightness, vocal fold color, glottic closure and mucosal wave. All three groups underwent phonomicrosurgery and a follow-up review was conducted one month later. Pre-and post-operative function assessment parameters were compared across the three groups. Results:Significant differences were founded in the G grade, Jitter, Shimmer, DSI, glottic closure and mucosal wave between the vocal fold fibrocystic degeneration group and the vocal fold polyp and vocal fold cyst group（P<0.05）. Most voice function parameters in all three groups showed significant improvement after surgery（P<0.05）. The improvement of VHI（10）, RSI and mucosal wave scores in the vocal fold fibrocystic lesion group was significantly different from that of the vocal fold polyp group（P<0.05）. Conclusion:Vocal fold fibrocystic degeneration is a more severe than that of vocal fold polyps and cysts, which are two common benign vocal fold lesions. Phonomicrosurgery is an effective treatment for vocal fold fibrocystic degeneration, but its curative effect are less favorable compared to those for vocal fold polyps and vocal fold cysts. Therefore, a detailed preoperative evaluation is essential for predicting surgical outcomes.

Delayed-onset vocal cord palsy after thyroidectomy occurring despite normal initial post-operative endoscopy.

Recurrent laryngeal nerve (RLN) injury is a known complication of thyroidectomy. Most cases manifest immediately and are promptly recognized. Rarely, some patients experience delayed-onset vocal cord palsy. This can occur despite normal findings on intra-operative nerve monitoring and initial post-operative endoscopy. This can cause considerable distress for patients, and its incidence and prognosis should be recognized. We report seven patients experiencing delayed-onset RLN palsy (RLNP) after thyroidectomy. All had normal findings on pre-operative flexible nasoendoscopy (FNE), intra-operative nerve monitoring at conclusion of surgery, and initial post-operative FNE. All diagnoses of RLNP were confirmed on endoscopy. Serial FNE examinations were performed to evaluate recovery. Of seven patients (43% male, median age 65 years), the median timing of delayed-onset RLNP was 12 (range 9-35) days. RLNP was diagnosed on the unilateral side of surgery in six out of seven patients (86%). All received conservative management, including referral to voice therapy. All seven patients recovered vocal cord function after a median duration of 24 weeks (range 8-52 weeks), and six within ~6 months (28 weeks). The incidence of this complication was 0.1% (among 6607 thyroidectomies). We report the first Australian series of delayed-onset vocal cord palsy after thyroidectomy. We explore its prognosis, discussing different pathophysiological mechanisms and the timeframe for recovery compared to most other RLN injuries. This may assist recognition of a rare complication, reassure patients, and facilitate early intervention to improve a patient's quality of life.

Does Intralesional Steroid Injection Effectively Mitigate Vocal Fold Scarring in A Rabbit Model?

To assess the efficacy of intralesional steroid treatment in preventing vocal fold scarring following vocal fold surgery using a rabbit model. The research involved 42 male New Zealand white rabbits. Fourteen rabbits underwent vocal fold scar surgery using a 532nm laser and served as controls (control group). The remaining rabbits were divided into two groups of 14: one group received vocal fold scar surgery followed by dexamethasone injection (Dexa group) and the other received the same surgery followed by triamcinolone injection (Triam group). Four weeks after surgery, histological examinations and high-speed video analyses of vocal fold vibration were conducted. The maximum amplitude of vibration was the primary measure for assessing vocal fold function. In addition, real-time polymerase chain reaction (PCR) studies were undertaken to analyze scar regeneration and remodeling. The maximum amplitude differences were notably higher in the Dexa and Triam groups than in controls. Histologically, the collagen density (CD) ratios in both the Dexa and Triam groups were significantly reduced compared with controls. Real-time PCR analysis indicated marked elevations of Has-2 and Mmp-9 in the Dexa and Triam groups relative to controls. Intralesional steroid injections after vocal fold surgery are effective for reducing vocal fold scarring in a rabbit model. NA Laryngoscope, 2024.

The current status and development of nerve repair techniques for bilateral vocal cord paralysis

The related research of nerve repair for bilateral vocal cord paralysis（BVCP） can be traced back to a century ago. There is still no standardized surgical therapeutic schedule and the evaluation of curative effect, due to the variability and complexity of laryngeal nerve innervation. Otolaryngologists have been constantly weighing and improving the surgical plan in relieving airway obstruction, maintaining vocal function and reducing cough to protect the normal physiological function of the larynx. Different medical institutions have great differences in the treatment methods. Many studies and literatures were published on the treatment of BVCP, yet have few related works on the application of it's nerve repair technology presently. The research progress of nerve repair technology for BVCP were described, along with its developing trend, aiming to lay the foundation for the future technical exploration and development.

Clinical Effects of Voice Therapy on Vocal Outcomes in Unilateral Vocal Fold Paralysis: Proof-of-Concept Study for Two SOVT-Based Treatment Protocols

BackgroundStudies on treatment efficacy in unilateral vocal fold paralysis (UVFP) often lack a predetermined treatment protocol, and little is known about the effects of specific vocal techniques on vocal outcomes and quality of life in UVFP patients. The purpose of this preliminary proof of concept study is to investigate the effects and feasibility of two intensive treatment protocols based on water-resistance therapy (WRT) and vocal function exercises (VFE). MethodsTen participants with acute or chronic UVFP/paresis were recruited in the study and randomly assigned to the WRT or VFE group. Three of these participants presented with aphonia and could not complete the program as prescribed. The remaining participants completed an intensive therapy program with the assigned vocal technique. Before, during, and after the program, a multidimensional voice assessment was performed. Maximum phonation time, acoustic, perceptual, and patient-reported outcome measures were obtained. ResultsWRT and VFE had positive clinical effects on instrumental and auditory-perceptual voice quality, glottal closure, and patient-reported outcome measures, but inter-individual variability was high. Studies with larger sample sizes are necessary to confirm or refute these findings. ConclusionThe WRT- and VFE-based therapy programs are both feasible and seem to elicit positive clinical changes in UVFP patients. Suggestions on how to improve the programs are provided, as well as considerations for implementation in clinical practice. Follow-up research is needed to examine the efficacy of both programs on group level.

Fiberoptic Bronchoscope Guided Assessment of Vocal Cord Function Using Bailey's Manoeuvre With an I-Gel Supraglottic Airway Device in Patients Undergoing Thyroid Surgery: An Initial Exploratory Prospective Study.

Fiberoptic Bronchoscope Guided Assessment of Vocal Cord Function Using Bailey's Manoeuvre With an I-Gel Supraglottic Airway Device in Patients Undergoing Thyroid Surgery: An Initial Exploratory Prospective Study.

Likelihood of Laryngeal Involvement in Autoimmune Thyroid Disorder Patients: A Meta-Analysis.

The involvement of the larynx in many situations can have a substantial impact on a person's voice, breathing, and general health. Individuals with autoimmune thyroid disorders can experience a variety of conditions affecting the larynx. Autoimmune thyroid disorders, such as Hashimoto's thyroiditis [HT] and Graves' disease [GD], are prevalent conditions affecting the thyroid gland. Beyond their established impact on thyroid function, these disorders have been associated with laryngeal involvement. The current study aims to explore the likelihood of laryngeal involvement in patients with Autoimmune Thyroid Disorders [AITD]. This study involved a retrospective analysis of medical records from patients diagnosed with autoimmune thyroid disorders. Inclusion criteria were a confirmed diagnosis through laboratory investigations and clinical assessment. Patients with pre-existing laryngeal pathologies or other conditions affecting the larynx were not considered. We collected data from 4 research articles and 3 clinical trials from Embase, PubMed, and NCBI-Trials portals, focusing on reported laryngeal symptoms. The severity of laryngeal involvement was assessed and categorized based on its extent and impact on vocal function. Preliminary analysis of the collected data indicated a significant proportion of patients with autoimmune thyroid disorders reporting laryngeal symptoms. Among these patients, various manifestations of laryngeal involvement were observed, including vocal changes, hoarseness, and throat discomfort. The findings show that laryngeal symptoms may be an underappreciated feature of these diseases, potentially impacting vocal function and quality of life in affected people. Further research is also needed for more precise projections in this direction.

Vocal dysfunction following thyroid surgery: a multidimensional subjective and objective study

Background and objectiveFollowing thyroid surgery, vocal changes are a common complication and well-known morbidity that may be linked to neuronal and non-neuronal voice breakdown. Nevertheless, their effects on different voice characteristics are not fully understood, and their bases are still poorly characterized. In order to determine the diagnostic indicators that address the nature of such post-thyroidectomy voice alternations, this study was designed to provide a multidimensional assessment of vocal function after thyroid surgery.MethodsThis research was a 1-year prospective cohort study conducted on 100 adult patients aged 40.19 (± 12.82) years who were recruited from the outpatient clinic of Phoniatric Unit, Assiut University Hospital, and scheduled to undergo thyroid surgery during the period from November 2020 to November 2021. All subjects underwent vocal assessment preoperatively and 15 days, 1 month, and 2 months postoperatively by filled in subjective evaluation of voice complaints via voice handicap index (VHI-30), auditory perceptual assessment (APA) of the voice, and videolaryngoscopy in addition to acoustic analysis using computerized speech lab (CSL). Statistical analysis was performed to compare multi-parameter voice assessment tools across different assessment time points.ResultsThe voice changes were significantly decreased from 51.0% after 15 days postoperatively to 33.0% after 2 months of follow-up. Among these cases, 35.0% cases developed vocal fold paralysis and complained of a breathy voice (27% developed unilateral vocal fold paralysis, and 8% developed bilateral focal fold lesions), and the remaining 16.0% cases had no paralytic manifestations. Also, only one case developed gross lesion “bilateral vocal fold nodules.” The subjective evaluation of voice outcome after thyroidectomy showed significant improvement in VHI subscales and total score from 15 days postoperatively to 2 months of follow-up (P < 0.001). All of the acoustic parameters except HNR showed a significant difference across the different assessment settings (P < 0.001).ConclusionThyroidectomy can result in significant vocal alterations, even in cases where the laryngeal nerve is unharmed. These changes should be taken into consideration in patient having thyroid surgery, especially a total thyroidectomy because of malignant lesions. More efforts are needed in order to determine the extent and pathophysiological reasons for the vocal alterations following thyroid surgery in order to reduce the morbidity associated with one of the most popular surgical procedures performed globally.

Seasonal variation in the ultrasonic vocal activity of Humboldt's flying squirrel (Glaucomys oregonensis).

Most mammals rely on vocal communication to increase survival and reproductive success. While the functions of audible vocalizations have been well-studied across mammal species, ultrasonic vocalizations in small mammals outside of bats are less understood. North American flying squirrel species (Glaucomys spp.), including the newly described Humboldt's flying squirrel (Glaucomys oregonensis), produce numerous call-types that extend into the ultrasonic range. To investigate the potential function of ultrasonic call-types in the Humboldt's flying squirrels, we used ultrasonic recorders to record squirrels in the wild across multiple seasons to determine if there are temporal and seasonal patterns in nightly vocal activity and rates of different call-types. We recorded Humboldt's flying squirrels in two geographic locations - Humboldt and San Bernardino counties-in California from 2018 to 2022 in the summer and winter across multiple study areas. We found that although seasonal weather conditions differ between locations, flying squirrels in Humboldt and San Bernardino had similar vocal activity patterns across nightly active periods between locations and between summer and winter. Nightly activity patterns of when the three main chirp-like call-types (arc chirps, tonal chirps, upsweeps) were given varied between seasons in both geographic locations, and these call-types were given at greater rates in the summer in San Bernardino, but rates did not vary by season in Humboldt. Trills, the most structurally complex of the four main call-types, were produced more in the summer than in winter, and also differed in their nightly activity patterns, in both geographic locations. Flying squirrels may use certain call-types earlier or later in the nightly active period due to their potentially varying functions, and may produce more trills in the summer coinciding with the breeding season. Further understanding of the function of different call-types can provide insight into social, foraging, and antipredator behavior of this nocturnal and elusive species.

510. INNOVATIVE ROBOTIC-ASSISTED ESOPHAGECTOMY WITH THREE-FIELD LYMPHADENECTOMY: A NOVEL APPROACH TO ESOPHAGEAL CANCER SURGERY

Abstract Background Esophageal squamous cell carcinoma, the predominant form of esophageal cancer in Thailand, often presents at advanced stages (III - IV), necessitating surgical intervention. Radical esophagectomy, including three-field lymphadenectomy, stands as one of the most invasive gastrointestinal surgeries. However, in the era of minimally invasive surgery (MIS), robotic systems have emerged as a formidable approach to achieve radical treatment goals while minimizing surgical invasiveness. This video showcases a novel surgical technique and its challenges. Methods A case of mid-thoracic esophageal squamous cell carcinoma, clinically staged III, treated via robotic-assisted esophagectomy and three-field lymphadenectomy using the Da Vinci Xi system. The operation encompassed three phases: Initially, the thoracic phase with patient in semi-prone position with three robotic and one assistant trocars for complete esophageal mobilization and mediastinal lymph node retrieval. The abdominal phase, followed by the cervical phase, utilized four robotic trocars and one assistant trocar in supine position with hyperextended neck, facilitating perigastric lymph node retrieval, gastric tube reconstruction via the posterior mediastinal route, and cervical esophago-gastric tube anastomosis using a circular stapler. Results The patient experienced an uneventful recovery. Postoperative esophagogastroduodenoscopy on day 1 revealed the integrity of the anastomosis and normal vocal cord function. Imaging conducted on day 7 confirmed that the anastomosis was patent without any leakage. Surgical outcomes included an operative time of 615 minutes, estimated blood loss of 150 ml, a 14-day hospital stay, and recovery without complications. This video highlights the intricacies of the procedure and the robotic system's ability to access anatomically challenging spaces, thereby minimizing surgical invasiveness and enhancing recovery. Conclusion The robotic system is capable of performing radical procedures in anatomically challenging areas, such as narrow spaces and areas requiring precise maneuverability among vital structures. It enables a comprehensive approach spanning from the upper to the lower thoracic regions and diversity of surgery in thoracic and abdominal cavity. Additionally, this presentation highlights unique surgical tips and techniques that enhance the safety and feasibility of robotic-assisted esophagectomy. By significantly reducing surgical errors and optimizing outcomes for both oncologic and minimally invasive surgeries, it thereby marks a significant leap forward in the field of esophageal surgery. https://drive.google.com/file/d/1vrmu2D8TGoetnplcREPWQocXJle4PrOX/view?usp=share_link

Long-term Results of Endoscopic Percutaneous Suture Lateralization for Newborns with Bilateral Vocal Cord Paralysis.

Bilateral vocal fold paralysis (BVFP) is a critical condition in newborns, which may present with significant airway distress necessitating tracheostomy. The purpose of this study is to report the safety and effectiveness of endoscopic percutaneous suture lateralization (EPSL) for newborns with BVFP, and evaluated the long-term results and the stability of the lateralization. A review of patients undergoing EPSL for BVFP at our institutions was performed between October 2018 and June 2023. Preoperative and postoperative clinical information was collected. The functional outcomes of the surgery in terms of breathing, voice, and swallowing were evaluated and recorded. Twenty seven patients were included, with a median age at diagnosis of 12 days (range, 1-33 days). The maximum follow-up is for 5 years. EPSL was successful in 77.8% of cases, effectively avoiding the need for tracheostomy. Dyspnea was relieved within a month after surgery, enabling patients to tolerate oral feeds within 2 months after surgery. Notably, some patients experienced a return of vocal fold function, particularly in successful EPSL cases, underlining the procedure's efficacy. Minor complications, including granulation tissue and wound infection, were observed but were manageable. Major complications were notably absent. The results are durable and stable at long-term follow-up. EPSL for BVFP is a relatively simple, minimally invasive, non-destructive, safe, and effective procedure in newborns, which may avoid the need for a tracheostomy, preserves the laryngeal framework, and does not affect the natural recovery of vocal cords. Level 3: retrospective case series Laryngoscope, 2024.

Applying Translaryngeal Ultrasonography in Unilateral Vocal Cord Paralysis before Thyroid Cancer Reoperation: A Single Center Study

Background: One of the most dangerous complications of thyroid surgery is recurrent laryngeal nerve (RLN) paralysis. The gold standard method to assess this damage is Videolaryngoscopy. However, we aimed to modify this approach by using Translaryngeal Ultrasonography (TLUS). We performed TLUS with a highly trained thyroid sonographer and an endocrine surgeon in 47 patients with recurrent thyroid cancer and unilateral RLN paralysis preoperatively, and compared the results with Videolaryngoscopy. The experienced sonographer identified 45 injuries in 47 patients, and the endocrine surgeon found 39 vocal cord injuries. It appears that TLUS, when performed by experienced practitioners, is a more accurate and safe modality for assessing vocal cord function in the preoperative setting of thyroid cancer reoperation.

Prospective Outcomes After Serial Platelet-Rich Plasma (PRP) Injection in Vocal Fold Scar and Sulcus.

Vocal fold scar and sulcus pose significant treatment challenges with no current optimal treatment. Platelet-rich plasma (PRP), an autologous concentration of growth factors, holds promise for regenerating the superficial lamina propria. This study aims to evaluate the potential benefits of serial PRP injections on mucosal wave restoration and vocal function. In a prospective clinical trial across two institutions, patients with vocal fold scar underwent four serial PRP injections, one month apart. Blinded independent laryngologists and expert listeners used pretreatment and one-month post-fourth injection videostroboscopy and CAPE-V assessments to evaluate mucosal wave and voice quality changes, respectively. Additionally, patient reported outcome measures (PROMs) were evaluated. In the study, 15 patients received 55 PRP injections without adverse effects. Eight patients (53.3%) had mild, three patients (20%) had moderate, and four patients (26.7%) had severe scar. There was an average reduction of 8.7 points in post-treatment VHI-10 scores (p = 0.007). The raters observed an improvement in post-treatment voice in 73.4% of cases, and CAPE-V scores showed a reduction of 18.8 points on average (p = 0.036). The videostroboscopic VALI ratings showed an improvement in mucosal wave rating from 2.0 to 4.0. On average, the raters perceived the post-PRP exams to be better in 56.7% of cases. PRP has been validated as a safe autologous option for treatment of vocal fold scar. While results for mucosal wave and voice quality varied, there was a consistent improvement in PROMs. Level 3: Prospective cohort study, with blinded analysis Laryngoscope, 2024.

Extended resections in locally advancer laryngeal cancer: clinical case

The larynx is a vital and socially important organ performing respiratory, vocal, and protective functions. Therefore, organ-preserving approaches are the preferred methods in treatment of patients with laryngeal cancer.The article presents a possibility of performing organ-preserving surgical treatment of locally advanced laryngeal cancer, describes a clinical case of extended resection of the larynx, demonstrates options for defect reconstruction stages. The goal of the presented technique is to improve patients’ quality of life.

Preservation of Vocal Function in Amyotrophic Lateral Sclerosis (ALS) Patients Following Percutaneous Dilatational Tracheostomy (PDT) and Adjuvant Therapies.

We performed a retrospective analysis of 47 ALS patients who underwent PDT at the Rodem Hospital from 2021 to 2023. Post-operatively, these patients were provided with a comprehensive treatment plan that included regenerative injection therapy, low-frequency electrical stimulation, respiratory rehabilitation, and swallowing rehabilitation therapy. Additionally, a balloon reduction program was implemented for effective tracheostomy tube (T-tube) management. The preservation of vocal functions was evaluated 4 weeks following the procedure. While some patients maintained or slightly improved their ALSFRS-R speech scores, the overall trend indicated a decrease in speech scores post-PDT. This suggests that PDT in combination with adjuvant therapies may not universally improve vocal function, but can help maintain it in certain cases. Our findings indicate that PDT combined with mesotherapy, low-frequency electrical stimulation, and swallowing rehabilitation therapy may play a role in maintaining vocal function in limb type ALS patients, though further research is needed to optimize patient management and to validate these results.