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Laryngeal Function (laryngeal + function)

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Medical Sciences	100%

Selected Abstracts

Early Laryngeal Inhalation Injury and its Correlation with Late Sequelae

THE LARYNGOSCOPE, Issue 2 2006
Tulio A. Valdez MD
Abstract Objective: Inhalation injury can permanently alter normal laryngeal function. The aim of this study was to examine the early changes in voice, swallowing, and breathing in laryngeal inhalation injuries. Study Design: This was a prospective analysis of nine patients with inhalation injuries at a tertiary care institution. Methods: Laryngeal function of patients admitted for inhalation injury requiring intubation was documented using videostroboscopy and swallowing evaluation by the speech pathology service. Bronchoscopy was used to classify the degree of inhalation injury. Association among total body surface area, facial burns, severity of laryngotracheal injuries, and loss of function was attempted. Results: All three patients with severe tracheal inhalation injury presented persistent hoarseness at 1-year follow up with abnormal videostroboscopy findings. No association was found between inhalation injury and total body surface area burned. None of the patients in this series presented permanent swallowing dysfunction. Conclusion: The otolaryngologist plays an important role in the initial and long-term management of inhalation injuries. Inhalation injuries should be managed in a multidisciplinary fashion. There may be a correlation between the degree of tracheal injury and laryngeal injury and hoarseness. [source]

Sedation with detomidine and acepromazine influences the endoscopic evaluation of laryngeal function in horses

EQUINE VETERINARY JOURNAL, Issue 6 2007
C. Lindegaard
Summary Reasons for performing study: Endoscopy of the upper airways of horses is used as a diagnostic tool and at purchase examinations. On some occasions it is necessary to use sedation during the procedure and it is often speculated that the result of the examination might be influenced due to the muscle-relaxing properties of the most commonly used sedatives. Objectives: To evaluate the effect of detomidine (0.01 mg/kg bwt) and acepromazine (0.05 mg/kg bwt) on the appearance of symmetry of rima glottidis, ability to abduct maximally the arytenoid cartilages and the effect on recurrent laryngeal neuropathy (RLN) grade. Methods: Forty-two apparently normal horses underwent endoscopic examination of the upper airways on 3 different occasions, under the influence of 3 different treatments: no sedation (control), sedation with detomidine and sedation with acepromazine. All examinations were performed with a minimum of one week apart. The study was performed as an observer-blind cross-over study. Results: Sedation with detomidine had a significant effect on the RLN grading (OR = 2.91) and ability maximally to abduct the left arytenoid cartilages (OR = 2.91). Sedation with acepromazine resulted in OR = 2.43 for the RLN grading and OR = 2.22 for the ability to abduct maximally. The ability to abduct maximally the right arytenoid cartilage was not altered. Conclusions: Sedating apparently healthy horses with detomidine or acepromazine significantly impairs these horses' ability to abduct fully the left but not the right arytenoid cartilage. This resulted in different diagnosis with respect to RLN when comparing sedation to no sedation. Potential relevance: Since the ability to abduct the right arytenoid cartilage fully is not altered by sedation, it is speculated that horses changing from normal to abnormal laryngeal function when sedated, might be horses in an early stage of the disease. To confirm or reject these speculations, further studies are needed. Until then sedation during endoscopy should be used with care. [source]

Transoral laser surgery for supraglottic cancer

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 5 2008
Juan P. Rodrigo MD
Abstract The goal of treatment for supraglottic cancer is to achieve cure and to preserve laryngeal function. Organ preservation strategies include both endoscopic and open surgical approaches as well as radiation and chemotherapy. The challenge is to select the correct modalities for each patient. Endoscopic procedures should be limited to tumors that can be completely visualized during diagnostic microlaryngoscopy. If complete resection can be achieved, the oncologic results of transoral laser surgery appear to be comparable to those of classic supraglottic laryngectomy. In addition, functional results of transoral laser resection are superior to those of the conventional open approach, in terms of the time required to restore swallowing, tracheotomy rate, incidence of pharyngocutaneous fistulae, and shorter hospital stay. The management of the neck remains of paramount importance, as survival of patients with supraglottic cancer depends more on cervical metastasis than on the primary tumor. Most authors advocate bilateral elective neck dissection. However, in selected cases (T1,T2 clinically negative [N0] lateral supraglottic cancers), ipsilateral selective neck dissection could be performed without compromising survival. The authors conclude that with careful selection of patients, laser supraglottic laryngectomy is a suitable, and often the preferred, treatment option for supraglottic cancer. © 2008 Wiley Periodicals, Inc. Head Neck, 2008 [source]

Transoral carbon dioxide laser microsurgery for recurrent glottic carcinoma after radiotherapy

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 6 2004
Wolfgang Steiner MD
Abstract Background. Transoral laser microsurgery is successfully performed in the treatment of primary laryngeal carcinomas. Few publications deal with the application in patients with recurrent glottic carcinomas after radiation failure. Our study aims to review our experience with transoral laser microsurgery in these patients. Methods. Thirty-four patients with early and advanced recurrent glottic carcinoma after full-course radiotherapy (rT1, n = 11; rT2, n = 10; rT3, n = 10; rT4, n = 3) had CO2 laser treatment with curative intent between 1987 and 1998. Results. Twenty-four patients (71%) were cured with one or more laser procedures. In nine patients, recurrences could not be controlled by laser microsurgery: six patients underwent total laryngectomy and three palliative treatment. One patient received total laryngectomy because of chondronecrosis after laser treatment. With a median follow-up interval of 38.6 months, the 3-year and 5-year disease-specific survival was 86%. The overall 3-year survival rate was 74%; the corresponding 5-year survival rate was 53%. No major complications occurred. In three cases, temporary tracheostomy was needed. Conclusions. In early-stage and advanced-stage recurrent glottic carcinomas after radiotherapy, CO2 laser treatment can successfully be used as a curative organ-preserving procedure. Compared with salvage laryngectomy, results are superior with respect to preservation of laryngeal function. Great expertise is required, especially in resections of advanced-stage recurrent carcinomas. © 2004 Wiley Periodicals, Inc. Head Neck26: 477,484, 2004 [source]

Diagnosis of vocal cord dysfunction in asthma with high resolution dynamic volume computerized tomography of the larynx

RESPIROLOGY, Issue 8 2009
Peter W. HOLMES
ABSTRACT Background and objective: Vocal cord dysfunction (VCD) often masquerades as asthma and reports have suggested that up to 30% of patients with asthma may have coexistent VCD. Diagnosis of VCD is difficult, in part because it involves laryngoscopy which has practical constraints, and there is need for rapid non-invasive diagnosis. High speed 320-slice volume CT demonstrates laryngeal function during inspiration and expiration and may be useful in suspected VCD. Methods: Endoscopy and high resolution 320-slice dynamic volume CT were used to examine and compare laryngeal anatomy and movement in a case of subglottic stenosis and in a patient with confirmed VCD. Nine asthmatics with ongoing symptoms and suspected VCD also underwent 320-slice dynamic volume CT. Tracheal and laryngeal anatomy and movement were evaluated and luminal areas were measured. Reductions in vocal cord luminal area >40%, lasting for >70% duration of inspiration/expiration, were judged to be consistent with VCD. Results: Studies of subglottic tracheal stenosis validated anatomical similarities between endoscopy and CT images. Endoscopy and 320-slice volume CT also provided comparable dynamic images in a patient with confirmed VCD. A further nine patients with a history of severe asthma and suspected VCD were studied using CT. Four patients had evidence of VCD and the median reduction of luminal area during expiration was 78.2% (range 48.2,92.5%) compared with 10.4% (range 4.7,30%) in the five patients without VCD. Patients with VCD had no distinguishing clinical characteristics. Conclusions: Dynamic volume CT provided explicit images of the larynx, distinguished function of the vocal cords during the respiratory cycle and could identify putative VCD. The technique will potentially provide a simple, non-invasive investigation to identify laryngeal dysfunction, permitting improved management of asthma. [source]

Phonation threshold flow measurements in normal and pathological phonation

THE LARYNGOSCOPE, Issue 4 2009
Peiyun Zhuang MD
Abstract Objectives/Hypothesis: Phonation threshold flow (PTF) may provide a tool to assess laryngeal function and could differentiate between normal and pathological voices. Both polyps and nodules contribute to an increased PTF by creating an incomplete glottal closure and increased vocal fold mass and thickness. Study Design: Prospective study. Methods: The Kay Elemetrics Phonatory Aerodynamic System (PAS) (Kay Elemetrics Corp., Lincoln Park, NJ) was used to collect mean flow rate (MFR) and PTF measurements from 40 normal subjects, 21 patients with vocal fold nodules, and 23 patients with vocal fold polyps. Gender-based differences were assessed using a t test. The effect of vocal pathology on PTF and MFR was determined with an ANOVA. Diagnostic potential was evaluated using a receiver operation characteristics (ROC) analysis. Results: Both PTF (P = .047) and MFR (P = .008) were significantly affected by gender. Using a two-way ANOVA and correcting for gender differences, the influence of pathology on PTF was determined to be significant (P < .001). Post hoc tests found a significant difference between normal and polyp subjects (P < .001) but not normal and nodule subjects (P = .177) or nodule and polyp subjects (P = .246). ROC analysis found that PTF (area under the curve [AUC] = 0.691) and MFR (AUC = 0.684) had a similar diagnostic utility. Conclusions: PTF can be used to differentiate between normal and pathological voices. As a parameter that is experimentally sensitive to the biomechanical parameters providing its theoretical basis, it could be used clinically to analyze laryngeal functionality. Future research could focus on measuring PTF in other pathologies, such as paralysis or scarring, which would also affect the effort required to produce voice. Laryngoscope, 2009 [source]

Estimating Subglottal Pressure via Airflow Redirection,

THE LARYNGOSCOPE, Issue 8 2007
Christopher D. Baggott
Abstract Subglottal pressure (SGP) is a valuable parameter in the research and clinical assessment of laryngeal function. The lungs serve as a constant pressure source during sustained phonation, and that pressure, SGP, can be used to determine the efficiency with which the larynx converts aerodynamic power to acoustic power. As the larynx serves as an aerodynamic transducer, the vocal efficiency (Ve) coefficient, defined as acoustic power (dB) divided by aerodynamic power (SGP × glottal airflow) has been shown to reliably reflect vocal health. However, current SGP measurement techniques are hesitantly used because of either an invasive nature or the requirement of intensive patient training. This study tests a novel device that has been designed to noninvasively estimate SGP through mechanical airflow redirection, producing a numeric output on completion of the trial, which lasts only a few seconds. The novelty of this design lies in the ease of use for both the patient and the clinician. Multiple mechanical airflow redirections occlude the airway for only 135 ms, which is predicted to limit the effect of confounding laryngeal reflexes that may occur during the trials. Additionally, the airflow redirection into a retention device allows for the pneumatic in-trial comparison of the estimated SGP with the pressure achieved by the patient, providing a numeric output to the clinician on completion. [source]

Salvage Conservation Laryngeal Surgery after Irradiation Failure for Early Laryngeal Cancer

THE LARYNGOSCOPE, Issue 3 2006
Mehdi Motamed FRCS
Abstract Objectives: One third of recurrences after radiotherapy for early laryngeal cancer remain localized. Salvage conservation laryngeal surgery, with total laryngectomy held as reserve, is a surgical management option that is arguably underused. The aim of this review is to report the oncologic and functional results of salvage conservation laryngeal surgery, using the external or the endolaryngeal laser approach. Study Design: Review article. Methods: A computerized literature search of the Medline database from 1985 to 2005 was performed using the following search strategy: laryngeal neoplasm/AND salvage therapy/. Studies with a sample size less than 10 and an average follow-up of less than 24 months were excluded from analysis. The oncologic outcome, functional outcome, length of hospitalization, and the frequency of complications were recorded. Results: The average reported local control rate for recurrent early glottic cancer after radiotherapy salvaged by using the external or the endolaryngeal laser approach is 77% and 65%, respectively. The average reported overall local control rate, including cases that subsequently required total laryngectomy, is 90% and 83%, respectively. The endolaryngeal approach when compared with the extralaryngeal approach does have the advantage of reduced complications, lesser requirement for tracheostomy and nasogastric feeding, and shortened hospitalization time. Conclusions: Conservation laryngeal surgery is a safe and effective treatment for recurrent localized disease after radiotherapy for early stage glottic cancer. Local control may be achieved without the sacrifice of laryngeal function, and total laryngectomy may be held in reserve as the ultimate option for salvage without compromising ultimate survival significantly. [source]

Early Laryngeal Inhalation Injury and its Correlation with Late Sequelae

Aerodynamics of the Human Larynx During Vocal Fold Vibration,

THE LARYNGOSCOPE, Issue 12 2005
Randall L. Plant MD
Abstract Objectives: The goal of this study was to comprehensively analyze the influence of aerodynamics on laryngeal function. Three specific aspects were considered: 1) a multidimensional comparison of the interaction of subglottic pressure, sound intensity, and fundamental frequency; 2) examination of instantaneous changes in subglottic pressure during each glottic cycle; and 3) determination of the threshold subglottic pressure for vocal fold vibration and its dependence on other aerodynamic factors. Study Design: Prospective study with six healthy individuals without history of voice disorders. Methods: The subjects vocalized the vowel sound /i/ with a variety of different intensities, pitch, and sound intensity. Subglottic air pressure, fundamental frequency, sound intensity, and the electroglottography signal were simultaneously measured. Results: Linear relationships were seen in all subjects between subglottic air pressure and sound intensity, although there were large variations in the slopes of these relationships. Rapid variations in subglottic pressure during each glottic cycle were detected, corresponding to the opening of the vocal folds with each individual vibration. Threshold pressures for vocal fold vibration were dependent primarily on sound intensity and fundamental frequency and tended to be higher at vibration onset than at offset. Conclusion: The larynx responded in a predictable pattern to general aerodynamic forces, but there was tremendous variability in its specific behavior. Fundamental frequency and sound intensity tended to increase with subglottic air pressure, but that relationship was not seen consistently in all subjects. The relationship between subglottic air pressure and sound intensity was usually linear, unlike the exponential relationship seen in previous studies. Subglottic pressure was noted to undergo rapid change with each glottic cycle in some, but not all, subjects and was most strongly affected by average subglottic pressure. Phonation threshold air pressure was influenced by the sound intensity and, to a smaller extent, by the fundamental frequency of the voiced sound. [source]

Supracricoid partial laryngectomy as salvage surgery for radiation therapy failure

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 8 2008
Alberto Deganello MD
Abstract Background The main concern in the treatment of laryngeal carcinomas is tumor control with preservation of laryngeal functions. We believe that salvage supracricoid partial laryngectomy (SPL) should be carefully considered in selected cases of radiotherapy failure, because it can offer the possibility of achieving adequate tumor control with preservation of laryngeal functions. Methods A series of 31 patients who underwent an SPL as salvage procedure after radiotherapy failure was reviewed. Results Locoregional control rate was 75%, with 60% 5-year overall survival; no patients were lost to follow-up, and a death-from-disease rate of 19.35% was recorded. Restoration of laryngeal functions was achieved in 89.29% of the patients. No statistically significant differences were found in locoregional control regarding anterior commissure involvement, elective neck dissection versus wait-and-see policy, pathologic positive neck disease, and restage I,II versus restage III,IV. Conclusion The oncologic and functional results indicate the consistency of salvage SPL, proposing this type of operation as a serious alternative to total laryngectomy in carefully selected cases. © 2008 Wiley Periodicals, Inc. Head Neck, 2008 [source]

Spray cryotherapy for the treatment of glottic and subglottic stenosis

THE LARYNGOSCOPE, Issue 3 2010
William S. Krimsky MD
Abstract Objectives/Hypothesis: Functional partial occlusion of the glottic and subglottic areas by stenosis and strictures is challenging to manage despite a variety of surgical and endoluminal approaches that are prone to complications and inconsistent outcomes. We report here the first three human cases of glottic and subglottic narrowing treated with spray cryotherapy alone or in combination with balloon dilation. Study Design: Institutional review board-approved clinical human trial. Methods: A 42-year-old female with idiopathic subglottic strictures, a 74-year-old female with glottic strictures and vocal cord stenosis following neck radiation, and a 33-year-old female with strictures from a previous tracheal stent were treated by four cycles of a 5-second cryotherapy spray alone or with balloon dilation. The effects of treatment were observed up to 6 months, 12 weeks, and 9 months, respectively. Results: In all cases, patency of the stenosed areas was achieved with minimal bleeding and at least some degree of normalization of the glottic and subglottic mucosa. Airway patency and laryngeal functions were restored without complications. Conclusions: The use of spray cryotherapy alone or in conjunction with balloon dilation is a promising and effective therapeutic approach to treating glottic and subglottic narrowing. Laryngoscope, 2010 [source]

Dysphagia and dysphonia among persons with post-polio syndrome , a challenge in neurorehabilitation

ACTA NEUROLOGICA SCANDINAVICA, Issue 5 2010
S. Söderholm
Söderholm S, Lehtinen A, Valtonen K, Ylinen A. Dysphagia and dysphonia among persons with post-polio syndrome , a challenge in neurorehabilitation. Acta Neurol Scand: 2010: 122: 343,349. © 2009 The Authors Journal compilation © 2009 Blackwell Munksgaard. Objective,,, To study the occurrence of dysphagia and dysphonia in persons with post-polio syndrome admitted into the centre for neurological rehabilitation in Finland. Materials and methods,,, Fifty-one persons with post-polio syndrome who were rehabilitated at Käpylä Rehabilitation Centre, Helsinki, Finland, in 2003,2004 were interviewed on problems with swallowing and voice production. Pulmonary function testing and grip strength measurement were performed. A clinical assessment of oral motor and laryngeal functions was carried out for those who reported daily problems with voice production or swallowing. Results,,, Fifteen persons (29.4%) reported daily problems with swallowing or voice production. In the clinical assessment, the most commonly observed deficits in swallowing included decreased pharyngeal transit (n = 13) and the food catching in the throat (n = 4). The disturbance of co-ordination of breathing and voice production was seen in 12 persons. There were no significant differences in any of the potential predictors between the groups. Conclusions,,, Professionals need to be aware of the routine evaluation of dysphagia and dysphonia in patients with post-polio syndrome. [source]