Vocal Fold Research Articles

Morbidity and neurodevelopmental outcomes at 2 years in preterm infants undergoing percutaneous transcatheter closure vs. surgical ligation of the PDA.

Review a cohort of preterm infants ≤29 weeks of gestation at birth and compare morbidities and neurodevelopmental outcomes based on PDA status and type of PDA closure. Single center observational retrospective-prospective case control study of premature infants who had no hsPDA, underwent surgical ligation or percutaneous transcatheter closure of the PDA. Neurodevelopmental testing was done using the Bayley Scales of Infant Development 3rd ed. The percutaneous transcatheter closure group had an older post menstrual age and greater weight at the time of procedure, and started enteral feeds and achieved room air status at an earlier post procedure day. Infants in the surgical ligation group were more likely to experience vocal cord paralysis. There was no difference in neurodevelopmental outcomes between groups. Waiting for infants to achieve the appropriate size for percutaneous transcatheter closure of the PDA may lead to reduced short-term complications without increasing the risk of neurodevelopmental impairment.

New Model and Public Online Prediction Platform for Risk Stratification of Vocal Cord Leukoplakia.

To extract texture features from vocal cord leukoplakia (VCL) images and establish a VCL risk stratification prediction model using machine learning (ML) techniques. A total of 462 patients with pathologically confirmed VCL were retrospectively collected and divided into low-risk and high-risk groups. We use a 5-fold cross validation method to ensure the generalization ability of the model built using the included dataset and avoid overfitting. Totally 504 texture features were extracted from each laryngoscope image. After feature selection, 10 ML classifiers were utilized to construct the model. The SHapley Additive exPlanations (SHAP) was employed for feature analysis. To evaluate the model, accuracy, sensitivity, specificity, and the area under the receiver operating characteristic (ROC) curve (AUC) were utilized. In addition, the model was transformed into an online application for public use and further tested in an independent dataset with 52 cases of VCL. A total of 12 features were finally selected, random forest (RF) achieved the best model performance, the mean accuracy, sensitivity, specificity, and AUC of the 5-fold cross validation were 92.2 ± 4.1%, 95.6 ± 4.0%, 85.8 ± 5.8%, and 90.7 ± 4.9%, respectively. The result is much higher than the clinicians (AUC between 63.1% and 75.2%). The SHAP algorithm ranks the importance of 12 texture features to the model. The test results of the additional independent datasets were 92.3%, 95.7%, 90.0%, and 93.3%, respectively. The proposed VCL risk stratification prediction model, which has been developed into a public online prediction platform, may be applied in practical clinical work. 3 Laryngoscope, 134:4329-4337, 2024.

Preliminary Findings of Vocal Fold Vibratory Characteristics of Singers Analyzed by Laryngeal High-Speed Videoendoscopy

ObjectivesThis study investigates the vocal fold vibratory dynamics of singers, which are postulated to differ from those of normal speakers due to the singers' regular vocal training. The measurement of vocal fold vibration involved the utilization of laryngeal high-speed video endoscopy (LHSV) and subsequent LHSV-based analysis. The focus is to characterize and compare the LHSV-based measures derived from the glottal area waveform (GAW), namely fundamental frequency (F0GAW), glottal perturbation (jitterGAW and shimmerGAW), open quotient (OQGAW), and Nyquist plots, between singers and normal speakers across genders. MethodsParticipants comprised 13 singers from a local cultural and heritage academy and 56 normal speakers from a local university, all were evaluated to have normal voices. Each participant underwent LHSV procedures to capture images of vocal fold vibration, which were subsequently analyzed to generate the LHSV-based measures. ResultsMale singers exhibited lower F0GAW, jitterGAW, shimmerGAW, and OQGAW than female singers. When compared to normal speakers, male singers demonstrated higher F0GAW, and lower jitterGAW and shimmerGAW. No difference in OQGAW was found between male singers and normal speakers. Female singers exhibited lower jitterGAW compared to normal speakers, but no differences were observed in shimmerGAW and OQGAW. The results of Nyquist plots indicated no gender-related associations between types of rim width and among singers. However, for rim pattern, male singers were associated with a higher percentage of clustered rim, suggesting more regular vocal fold vibration, compared to female singers and male normal speakers. ConclusionsSingers, particularly male singers, demonstrate distinct and potentially superior vocal fold vibrations compared to normal speakers, likely attributed to their regular vocal training, resulting in refined vocal fold configurations even during speaking. Despite the limited sample of singers, the study offers valuable insights into the vocal fold vibratory behaviors in singers analyzed using LHSV.

Quantitative Assessment of True Vocal Fold Movement by the Lateral-Approach Laryngeal Ultrasonography: A Pilot Study

Background/ObjectivesUltrasonography is a new method for subjective and qualitative assessment of true vocal fold movement, and true vocal fold visualization with the lateral approach could be better than that with the anterior approach. Our aim was to explore the feasibility of the lateral-approach ultrasonography in objective and quantitative assessment of true vocal fold movement. MethodsThe lateral-approach laryngeal ultrasonography was performed during calm breathing and breath-holding in young healthy adult volunteers. The morphology and anatomical position of false vocal fold, true vocal fold and arytenoid cartilage were observed and measured through the ultrasonic self-contained measurement function. All parameters, including the distance from false vocal fold to thyroid cartilage lamina, true vocal fold length, and the distance from true vocal fold to thyroid cartilage lamina, were obtained at the end of the calm inspiratory and breath-holding phases. Data were analyzed using a t test (P <0.05). ResultsForty healthy adult volunteers (age 20-34 years, Body Mass Index 19.5-23.8 kg/m2, 20 males and 20 females) with satisfactory ultrasonic images were included in the study. There were no significant differences in all laryngeal parameters between the left and right sides in either phase (P > 0.05). From the end of the calm inspiratory phase to the breath-holding phase, changes in all laryngeal parameters were significantly different (P < 0.05), regardless of gender. ConclusionsThis study demonstrated that the lateral-approach laryngeal ultrasonography seemed feasible to quantify and objectively assess true vocal fold movement, utilizing differences between laryngeal parameters before and after true vocal fold movement.

Enhanced object detection in pediatric bronchoscopy images using YOLO-based algorithms with CBAM attention mechanism

Background and ObjectiveBronchoscopy is a widely used diagnostic and therapeutic procedure for respiratory disorders such as infections and tumors. However, visualizing the bronchial tubes and lungs can be challenging due to the presence of various objects, such as mucus, blood, and foreign bodies. Accurately identifying the anatomical location of the bronchi can be quite challenging, especially for medical professionals who are new to the field. Deep learning-based object detection algorithms can assist doctors in analyzing images or videos of the bronchial tubes to identify key features such as the epiglottis, vocal cord, and right basal bronchus. This study aims to improve the accuracy of object detection in bronchoscopy images by integrating a YOLO-based algorithm with a CBAM attention mechanism. MethodsThe CBAM attention module is implemented in the YOLO-V7 and YOLO-V8 object detection models to improve their object identification and classification capabilities in bronchoscopy images. Various YOLO-based object detection algorithms, such as YOLO-V5, YOLO-V7, and YOLO-V8 are compared on this dataset. Experiments are conducted to evaluate the performance of the proposed method and different algorithms. ResultsThe proposed method significantly improves the accuracy and reliability of object detection for bronchoscopy images. This approach demonstrates the potential benefits of incorporating an attention mechanism in medical imaging and the benefits of utilizing object detection algorithms in bronchoscopy. In the experiments, the YOLO-V8-based model achieved a mean Average Precision (mAP) of 87.09% on the given dataset with an Intersection over Union (IoU) threshold of 0.5. After incorporating the Convolutional Block Attention Module (CBAM) into the YOLO-V8 architecture, the proposed method achieved a significantly enhanced mAP0.5 and mAP0.5:0.95 of 88.27% and 55.39%, respectively. ConclusionsOur findings indicate that by incorporating a CBAM attention mechanism with a YOLO-based algorithm, there is a noticeable improvement in object detection performance in bronchoscopy images. This study provides valuable insights into enhancing the performance of attention mechanisms for object detection in medical imaging.

RESEARCH OF MANIFESTATION OF THE ORAL MUCOSA IN COVID-19

The oral cavity is one of the main gates for coronavirus (SARS-CoV-2); the oral cavity also suffers greatly from this infection, because it is one of the most vulnerable places. In addition, since the salivary glands can serve as a reservoir for viruses and support their release into the external environment, it was concluded that saliva, as a component of oral fluid, can play an important role in the spread of coronavirus infection. This is mainly due to the ACE-2 receptor, which have a high level of expression in the keratinized surface epithelial cells of the oral mucosa, especially in the epithelial cells of the dorsal part of the tongue, tonsils, vocal cords, salivary glands and sinuses, due to which the virus replicates in and causes both oral lesions and oral symptoms mouth After entering the cell, the virus delays the response of the immune system, allowing the infection to progress, and it becomes much more difficult to fight it. Accordingly, due to the relatively high level of COVID-19-associated complications, timely diagnosis of clinical forms, including high-risk patients with prognosis their clinical course and the selection of drug treatment appropriate to the severity of the clinical course remain quite complex and controversial issues. It was emphasized that in some cases oral symptoms may be the initial or only sign of disease, and dentists should take this into account when performing a thorough clinical examination of the oral cavity.

Phonosurgical Histoanatomy of the Maculae Flavae of the Vocal Folds as a Stem Cell Niche

Phonosurgical Histoanatomy of the Maculae Flavae of the Vocal Folds as a Stem Cell Niche

Treatment of Unilateral Vocal Fold Paralysis Using Laryngoplasty

Treatment of Unilateral Vocal Fold Paralysis Using Laryngoplasty

Hoarseness after general endotracheal anesthesia: A single-center retrospective analysis

BackgroundAfter the extubation of endotracheal tubes or removal of laryngeal masks in patients who underwent general anesthesia, complications such as hoarseness often occur, potentially leading to serious adverse effects on patients. Therefore, this study aimed to analyze the causes of hoarseness to provide improved prevention and treatment options. MethodsWe conducted a retrospective analysis of patients who underwent general anesthesia at the Renmin Hospital of Wuhan University from January 2017 to December 2021, excluding patients under 18 years of age, over 80 years old, with preoperative hoarseness and undergoing multiple surgeries. The incidence, duration, influencing factors and causes of hoarseness after tracheal intubation were analyzed. ResultsThe study found that the incidence of hoarseness after tracheal intubation was 11.77%. Of those patients experiencing hoarseness immediately after the operation, 79.56% could recover on the same day, 15.37% of patients could recover on the day after operation, 4.23% could recover within 3 days of the operation, and 0.83% of patients might need 5 or more days to recover. Patients aged 50 years and older, with an intubation time of more than 3 h, who underwent neck and cardiothoracic surgery, with a low BMI and with difficult airways exhibited a higher incidence of hoarseness after tracheal intubation. The main causes of hoarseness were vocal cord paralysis and arytenoid joint dislocation, with the number of patients at 8.97% (1106) and 7.32% (902) respectively. The incidences of hoarseness caused by psychological stress accounted for 4.15% of the cases. with a total of 512 patients affected. ConclusionsAge, intubation time, surgical site, low BMI and difficult airway were important factors affecting hoarseness after intubation. The vocal cord paralysis and arytenoid joint dislocation were major causes of hoarseness.

Transcutaneous Laryngeal Ultrasonography for the Assessment of Vocal Cord Mobility before and after Thyroidectomy

Transcutaneous Laryngeal Ultrasonography for the Assessment of Vocal Cord Mobility before and after Thyroidectomy

Bilateral Abductor Vocal Fold Paralysis; Outcomes of Surgical Management in Adult Yemeni Patients

Bilateral Abductor Vocal Fold Paralysis; Outcomes of Surgical Management in Adult Yemeni Patients

Unilateral Vocal Cord Paralysis Following COVID-19 Infection: A Case Report and Literature Review

Unilateral Vocal Cord Paralysis Following COVID-19 Infection: A Case Report and Literature Review

양측성 성대 마비의 수술적 치료

Bilateral vocal fold paralysis (BVFP) is characterized by the complete or partial inability to move the vocal folds. BVFP presents with inspiratory dyspnea resulting from airway narrowing at the glottic level, where both vocal folds are positioned paramedian. Historically, iatrogenic damage to the recurrent laryngeal nerves has been identified as a common cause of BVFP. This condition is often critical, necessitating immediate treatment such as intubation for short-term relief, and potentially surgical procedures like tracheostomy to address the compromised airway. The primary objective in managing BVFP is to alleviate dyspnea in affected patients. Treatment options include tracheostomy, arytenoidectomy, laterofixation, and cordotomy, each with varying degrees of effectiveness in improving airway function, though voice quality may be negatively impacted or remain unchanged. The diversity in study methodologies, the absence of large-scale controlled randomized trials, and the challenge of distinguishing BVFP from posterior glottic stenosis hinder the ability to definitively determine the superiority of one treatment approach over another.

양측 성대 마비의 치료

Laryngeal reinnervation has been investigated as a treatment option for bilateral vocal fold paralysis (BVFP) that can restore laryngeal function while preserving laryngeal anatomy. Traditionally, BVFP treatment involves irreversible structural changes to the larynx, such as tracheostomy, arytenoidectomy, or cordectomy, which often result in impaired voice and swallowing. In contrast, laryngeal reinnervation aims to restore laryngeal muscle tone and function by providing new neural input to the paralyzed larynx. Reinnervation techniques can be broadly categorized into non-selective and selective methods. Non-selective reinnervation, such as recurrent laryngeal nerve (RLN) end-to-end anastomosis or ansa cervicalis-to-RLN anastomosis, primarily focuses on maintaining muscle bulk and tone. Selective reinnervation techniques, including nerve-muscle pedicle with the ansa cervicalis, selective reinnervation using the phrenic nerve, and bilateral selective laryngeal reinnervation, aim to restore both abduction and adduction function of the larynx. This review summarizes the current laryngeal reinnervation techniques for BVFP treatment.

Strategies to prevent bilateral vocal fold paralysis in thyroid surgery

Thyroid surgery carries the risk of bilateral vocal fold paralysis (VFP), which can lead to airway compromise and necessitate intervention. Despite surgical advancements, 45% of patients experience permanent paralysis, with a 30% risk of tracheotomy. Bilateral VFP can compromise the airway, presenting with noisy breathing and voice changes. Hemi-thyroidectomy carries a lower VFP risk than total thyroidectomy. IONM aids RLN preservation but hasn't consistently lowered VFP rates. Continuous IONM benefits RLN preservation but its effect on VFP rates is debated. Staged surgery post-ipsilateral nerve injury may reduce bilateral VFP risk. Preventing bilateral VFP in thyroid surgery is of paramount importance. Utilizing routine IONM and implementing staged surgery following ipsilateral nerve injury could potentially reduce the incidence of bilateral VFP. However, additional research is warranted to establish the most effective management strategies for optimizing patient outcomes in thyroid surgery.

반회후두신경을 침범한 갑상선 유두암 환자에서 수술 중 신경감시의 적용

Intraoperative neuromonitoring (IONM) has been widely applied for thyroidectomy in patients with papillary thyroid carcinoma (PTC) to identify and preserve the recurrent laryngeal nerve (RLN). Moreover, IONM may be helpful to predict the postoperative function of the vocal fold and provide rationales to decide the extent of surgery, including staged operation. However, the usefulness of IONM in patients with PTC involving the RLN has not been well introduced. Invasion of the PTC to the RLN may have lesser impact on survival of the patient compared to that to the trachea or esophagus. Therefore, preservation or resection of a functioning nerve involved by cancer may be a controversial issue. In this article, usefulness of IONM in patients with PTC involving the RLN will be reviewed based on recent related studies and guidelines.

갑상선 및 부갑상선 수술 중 신경 모니터링에 대한 가이드라인과 표준 술식

The benefits of intraoperative neuromonitoring (IONM) extend beyond merely reducing the incidence of vocal cord paralysis. Although widely used, a review of various literatures and clinical studies indicates diverse applications of nerve monitoring. To advance and standardize IONM techniques, the International Neural Monitoring Study Group (INMSG) has published guidelines for monitoring the recurrent laryngeal nerve (RLN) and the external branch of the superior laryngeal nerve (EBSLN). While IONM effectively preserves RLN function, application methods vary among surgeons. Implementing standardized setups and guidelines can reduce vocal cord paralysis and facilitate appropriate decisions when loss of signal (LOS) occurs, thereby ensuring the best outcomes for patients. This review aims to synthesize the current INMSG guidelines and summarize standard procedures for RLN monitoring.

부갑상선 절제술에 있어 반회후두신경의 수술 중 신경감시술의 임상적 의의

Background and Objectives Intraoperative nerve monitoring (IONM) has been gaining acceptance as a formal practice of thyroid and parathyroid surgery. However, most studies of IONM for recurrent laryngeal nerve (RLN) primarily focused on thyroid surgery. In this study, we evaluated clinical implications of IONM solely in parathyroid surgery, by comparing results of parathyroidectomy in patients with or without IONM. Materials and Methods This study designed as a retrospective cohort study. Between 2010 and 2022, patients who underwent parathyroidectomy for the treatment of hyperparathyroidism were included. Patients were divided into the no IONM and IONM groups and compared clinicopathological and surgical parameters according to the use of IONM. Results A total of 107 patients involving 65 patients in the IONM group and 42 patients in the IONM group were included in the study. In the IONM group, proportion of surgical type of uni- and bilateral neck exploration was significantly higher in the IONM group than the no IONM group (35.7% vs. 6.2%, p&lt;0.001). Rate of RLN identification during surgery was significantly higher in the IONM group than the no IONM group (81.0% vs. 43.1%, p&lt;0.001). Operating time for minimal invasive/focused parathyroidectomy was significantly shorter in the IONM group than the no IONM group (61.8 min vs. 85.6 min, p&lt;0.001). Vocal cord paralysis occurred only 1 case in each group without significant difference in the incidence. Conclusion Use of IONM would contribute to safe and faster parathyroidectomy, justifying its routine use in parathyroid surgery.

Post traumatic disruption of the trachea: About three adolescents’ cases with literature review

Introduction: Tracheal lesions are rare but potentially serious and can cause significant morbidity and mortality. Early diagnosis is essential for optimal management. We report 3 cases of adolescents who were victims of external cervicothoracic trauma. All three patients presented with neck pain, inspiratory dyspnea, and polypnea with subcutaneous cervical emphysema in clinical examination. Nasofibroscopy showed normal appearance and mobility of the vocal cords. Cervical and thoracic CT scan with contrast enhancement was carried out in all our patients that showed tracheal breach in various localizations. The first patient underwent surgical exploration of the penetrating wound in the cervical area. The surgical exploration revealed no damage to the anterior and lateral faces of the trachea. In this case, a sagittal discontinuity on the posterior wall of the trachea was revealed using a rigid bronchoscope. All patients were admitted to the intensive care unit for monitoring and follow-up for 24 to 72 hours and received antibiotics and corticosteroids for 10 days. The patient's symptoms improved throughout the evolution. Conclusion: Early diagnosis is necessary to prevent complications. The gold standard for diagnosis is bronchoscopy. Conservative management is recently considered the best therapeutic choice which also allows the morbidity of surgical treatment to be avoided

Various methods for intraoperative neural monitoring during thyroid surgery

Intraoperative neural monitoring (IONM) during thyroidectomy is an essential technique to safeguard the recurrent laryngeal nerve (RLN) and the external branch of the superior laryngeal nerve (EBSLN), both critical for vocal cord function. Utilizing electromyography (EMG), IONM provides real-time feedback on nerve integrity, significantly reducing the risk of nerve damage during surgery. The primary methods of IONM include endotracheal tube electrodes, surface electrodes, needle electrodes, and continuous monitoring, each with distinct advantages and limitations. Endotracheal tube electrodes offer direct measurements but can be difficult to position, while surface electrodes are non-invasive but may experience signal interference. Needle electrodes provide precise measurements but are invasive, and continuous monitoring offers ongoing feedback but requires advanced equipment. The evolution of IONM began in the mid-20th century and has progressed significantly, leading to its widespread adoption in thyroid surgery by the mid-2000s. Enhanced by recent technological advancements and standardized by professional guidelines, IONM has become integral in reducing postoperative complications. Ongoing research aims to further refine IONM techniques, ensuring optimal patient outcomes and the preservation of nerve function in thyroid surgery.