Diagnostic Assessment (Imaging) and Staging of Laryngeal Cancer.

Diagnosis of larynx cancer relies on a detailed history and physical and objective assessment with endoscopy and imaging. Endoscopy is needed to assess for vocal fold function that directly affects staging. Computed tomography and MRI can be used to assess for tumor extent in relation to intra- and extra-laryngeal structures, especially paraglottic and pre-epiglottic space involvement as well as cartilage invasion. Accurate staging is critical for subsequent treatment decision-making regarding larynx preservation.

Assessment of Early Stage Glottic Cancer Depth of Resection After Transoral Laser Cordectomy.

OBJECTIVE: Surgeons generally determine depth of resection during transoral laser cordectomy by visual inspection of the surgical field. Our aim was to examine the correlation between early glottic cancer depth of resection as reported by surgeons in the operation report and depth of resection defined by pathology specimens, using various staining techniques intended to differentiate between the distinct vocal fold layers based on particular collagen deposition. STUDY DESIGN: Retrospective study. SETTING: A voice and swallowing clinic at a tertiary referral hospital. METHODS: We compared depth of cordectomy assessed intraoperatively by surgeons and by pathologists using Picrosirius red stain and collagen I immunohistochemistry stain in 32 patients who underwent transoral laser cordectomy for early glottic cancer. RESULTS: For type I, II, and III cordectomy, the respective proportions of patients were 14 (47%), 9 (30%), and 7 (23%) according to surgeons' estimations; 2 (6%), 17 (55%), and 12 (39%) according to Picrosirius red stain; and 3 (11%), 12 (44%), and 12 (45%) according to immunohistochemistry for collagen I. CONCLUSION: Surgeons' reported depth of resection did not correlate with depth of resection established by either staining technique. Determining depth of resection necessitates special stains, which should help in the clinical assessment of cordectomy type.

Diagnostic and Therapeutic Outcomes Following Systematic Assessment of Patients with Concurrent Suspected Vocal Cord Dysfunction and Asthma.

BACKGROUND: Vocal cord dysfunction (VCD) is present in 25% to 50% of patients with asthma. When both diagnoses are suspected, accurate diagnosis and targeted management represent a clinical challenge. OBJECTIVE: To evaluate diagnostic and therapeutic outcomes following systematic assessment for patients with concurrent suspected VCD and asthma. METHODS: Patients underwent systematic evaluation by clinical assessment and validated questionnaires, followed by multidisciplinary management. VCD was confirmed by visualization of paradoxical vocal fold motion at baseline or following provocation. Asthma was confirmed by demonstrating variable airflow obstruction. Asthma medications were deescalated in those with low clinical probability of asthma and no variable airflow obstruction. Response to 2 or more sessions of speech pathology was assessed by subjective report and standardized questionnaires. RESULTS: Among 212 consecutive patients, 62 (29%) patients had both VCD and asthma, 54 (26%) had VCD alone, 51 (24%) had asthma alone, and 45 (21%) had neither. Clinician assessment and the Laryngeal Hypersensitivity Questionnaire both predicted laryngoscopy-confirmed VCD. Deescalation or discontinuation of asthma therapy was possible in 37 of 59 (63%) patients without variable airflow obstruction, and was most successful (odds ratio, 5.5) in the presence of laryngoscopy-confirmed VCD (25 of 31, or 81%) Patients with VCD responded subjectively to 2 or more sessions of speech pathology, but laryngeal questionnaire scores did not improve. CONCLUSIONS: Expert clinician assessment and the Laryngeal Hypersensitivity Questionnaire predict the presence of laryngoscopy-confirmed VCD. Systematic assessment for both VCD and asthma facilitates deescalation or discontinuation of unnecessary asthma medications. Subjective symptom improvement following speech pathology was not paralleled by laryngeal questionnaire scores in this cohort.

Assessment of Clinical and Social Characteristics That Distinguish Presbylaryngis From Pathologic Presbyphonia in Elderly Individuals.

Importance: An aging population experiences an increase in age-related problems, such as presbyphonia. The causes of pathologic presbyphonia are incompletely understood. Objective: To determine what distinguishes pathologic presbyphonia from presbylaryngis. Design, Setting, and Participants: This was a cohort study at an outpatient otolaryngology subspecialty clinic of a tertiary academic referral center. Participants were consecutive consenting adults older than 74 years without laryngeal pathologic abnormalities who visited the clinic as participants or companions. Patient questionnaires, otolaryngologic, video stroboscopic, and voice examinations were compiled. Patients were divided into groups based on whether they endorsed a voice complaint. Three blinded authors graded stroboscopic examinations for findings consistent with presbylaryngis (vocal fold bowing, vocal process prominence, glottic insufficiency). Main Outcomes and Measures: Voice Handicap Index-10, Reflux Symptom Index, Cough Severity Index, Dyspnea Index, Singing Voice Handicap Index-10 , Eating Assessment Tool -10, Voice-Related Quality of Life (VRQOL), and Short-Form Health Survey; face-sheet addressing social situation, work, marital status, education, voice use, transportation; acoustic and aerodynamic measures; and a full otolaryngologic examination, including videostroboscopic imaging. Results: A total of 31 participants with dysphonia (21 were female; their mean age was 83 years [range, 75-97 years]) and 26 control participants (16 were female; their mean age was 81 years [range, 75-103 years]) completed the study. Presbylaryngis was visible in 27 patients with dysphonia (87%) and 22 controls (85%). VHI-10 and VRQOL scores were worse in patients with pathologic presbyphonia (median [range] VHI-10 scores, 15 (0-40) vs 0 (0-16) and median VRQOL score, 19 [0-43] vs 10 [10-23]). All other survey results were indistinguishable, and no social differences were elucidated. Acoustic measures revealed that both groups averaged lower than normal speaking fundamental frequency (mean [SD], 150.01 [36.23] vs 150.85 [38.00]). Jitter was 3.44% (95% CI, 2.46%-4.61%) for pathologic presbyphonia and 1.74% (95% CI, 1.35%-2.14%) for controls (d = 0.75). Shimmer means (95% CI) were 7.8 2 (6.08-10.06) for the pathologic presbyphonia group and 4.84 (3.94-5.72) for controls (d = 0.69). Aerodynamic measures revealed an odds ratio of 3.03 (95% CI, 0.83-11.04) for patients with a maximum phonation time of less than 12 seconds who had complaints about dysphonia. Conclusions and Relevance: Presbylaryngis is present in most ambulatory people older than 74 years. Some will endorse pathologic presbyphonia that has a negative effect on their voice and quality of life. Pathologic presbyphonia seems to be influenced by respiratory capacity and sex. Further study is required to isolate other social, physiologic, and general health characteristics that contribute to pathologic presbyphonia.

Three-dimensional imaging assessment of anatomic invasion and volumetric considerations for chemo/radiotherapy-based laryngeal preservation in T3 larynx cancer.

OBJECTIVES: To investigate the impact of 3-Diminsional (3D) tumor volume (TV) and extent of involvement of primary tumor on treatment outcomes in a large uniform cohort of T3 laryngeal carcinoma patients treated with nonsurgical laryngeal preservation strategies. MATERIALS AND METHODS: The pretreatment contrast-enhanced computed tomography images of 90 patients with T3 laryngeal carcinoma were reviewed. Primary gross tumor volume (GTVp) was delineated to calculate the 3D TV and define the extent of invasion. Cartilage and soft tissue involvement was coded. The extent of invasion was dichotomized into non/limited invasion versus multiple invasion extension (MIE), and was subsequently correlated with survival outcomes. RESULTS: The median TV was 6.6 cm3. Sixty-five patients had non/limited invasion, and 25 had MIE. Median follow-up for surviving patients was 52 months. The 5-year local control and overall survival rates for the whole cohort were 88% and 68%, respectively. There was no correlation between TV and survival outcomes. However, patients with non/limited invasion had better 5-year local control (LC) than those with MIE (95% vs 72%, p = .009) but did not have a significantly higher rate of overall survival (OS) (74% vs 67%, p = .327). In multivariate correlates of LC, MIE maintained statistical significance whereas baseline airway status showed a statistically significance trend with poor LC (p = .0087 and 0.06, respectively). Baseline good performance status was an independent predictor of improved OS (p = .03) in multivariate analysis. CONCLUSION: The extent of primary tumor invasion is an independent prognostic factor of LC of the disease after definitive radiotherapy in T3 larynx cancer.

Utility of Laryngeal High-speed Videoendoscopy in Clinical Voice Assessment.

OBJECTIVE: This study aimed to assess the utility of laryngeal high-speed videoendoscopy (HSV) as a clinical tool. DESIGN: This is a prospective study of 151 patients. METHODS: A total of 151 adult patients (52 male, 99 female) underwent both videoendoscopy with stroboscopy (videostroboscopy) and HSV examination as part of a routine clinical voice assessment. At the time of the examination, ratings for videostroboscopy were reported in the clinical report. Next, the clinicians reviewed the HSV examination and indicated the changes in ratings of HSV relative to videostroboscopy. Finally, the clinical reports were reviewed by a clinician not involved in data collection or clinical care of the patients and noted differences between videostroboscopy and HSV clinical ratings, and resulting diagnoses were identified and grouped. RESULTS: Ratings of all vibratory features showed change between videostroboscopy and HSV. Mucosal wave and amplitude of vibration showed the largest percentage change, respectively, in 74% and 53% of the reports. They were followed by the features of glottal closure (36%), phase closure (32%), glottal edge (25%), and phase symmetry (21%). Ratings of supraglottic compression and vocal fold vertical level showed the least change between videostroboscopy and HSV. Changes in initial diagnosis owing to the inclusion of HSV were indicated in 7% of the cases. CONCLUSIONS: HSV may be an important laryngeal imaging technique for functional assessment of the pathophysiology of certain voice disorders. HSV could enable important refinements in the diagnosis and management of vocal fold pathology.

Vocal fold leukoplakia: incidence, management, and prevention.

PURPOSE OF REVIEW: The purpose of this article is to provide an update on English-language literature evaluating the current understanding of incidence, management, and prevention of vocal fold leukoplakia focusing on premalignancy. RECENT FINDINGS: Recent studies have continued to try to elucidate factors influencing recurrence and progression of dysplastic disease, though results vary. Although advanced diagnostic techniques have attempted to predict disease behavior, tissue diagnosis continues to be essential. Studies reinforce the necessity of removal of disease as the primary treatment, whereas use of photoangiolytic lasers via the ablative technique has increased, as has transition of some patients into the office-based settings for treatment. Although genetic and molecular testing may hold promise for predictive purposes, further study is necessary, and chemotherapy for recalcitrant disease continues to be an area of study with few case studies being reported. SUMMARY: Management of vocal fold leukoplakia continues to progress in terms of identification and treatment. Although many work to advance our knowledge in the field and push treatment strategies toward newer avenues, pathologic diagnosis, eradiation of disease on the basis of experience and skill, and close surveillance continue to be paramount.

Narrow-band imaging (NBI) for improving the assessment of vocal fold leukoplakia and overcoming the umbrella effect.

BACKGROUND: It is crucial to find a balance between functional and oncological outcome when choosing an adequate method for the management of vocal fold leukoplakia. Therefore, a detailed examination is a milestone in the decision-making process. AIM: To examine whether narrow-band imaging (NBI) can be helpful in vocal fold assessment in the case of leukoplakia and how to overcome the "umbrella effect"- understood as the submucosal vascular pattern hidden under the plaque. MATERIAL AND METHODS: Prospective cohort of 41 consecutive patients. Inclusion criteria: vocal fold leukoplakia, no previous procedures (surgery, radiotherapy), and preoperative endoscopy with an optical filter for NBI. Two groups: "suspicious" and "normal", according to the submucosal microvascular pattern of peripheral regions of the mucosa surrounding the plaque, were distinguished. Patients were qualified for a full-thickness or partial-thickness biopsy, respectively. Criteria defining suspected characters were well-demarcated brownish areas with scattered brown spots corresponding to type IV, Va, Vb, and Vc NI classifications. RESULTS: In 22/41 (53.7%) patients with "suspected" microvascular pattern, full-thickness biopsy was performed. Moderate and severe dysplasia was revealed in 15 type IV and 7 type Va NI patients. In 19/41 (46.3%) patients with proper NBI vessel pattern treated by partial-thickness biopsy, hyperkeratosis was diagnosed. There was a strong correlation between the NBI pattern and final histology: Chi2 (2) = 41.0 (p = 0.0000). CONCLUSION: The results demonstrate that NBI endoscopic assessment of the submucosal microvascular pattern of mucosa surrounding the plaque can be an effective method to categorise the risk in vocal fold leukoplakia prior to treatment.

Multidimensional vocal assessment after laser treatment for recurrent respiratory papillomatosis.

OBJECTIVES/HYPOTHESIS: Recurrent respiratory papillomatosis (RRP) is a benign epithelial tumor that exhibits a high frequency of recurrence. This study assesses the vocal function after laser treatment for RRP, particularly in relation to the frequency of surgery. STUDY DESIGN: Retrospective study. METHODS: Thirty RRP patients who underwent laser surgery that controlled the tumor were included. Preoperative and postoperative Grade, Roughness, Breathiness, Asthenia, and Strain Scale, videostroboscopic findings, aerodynamic and acoustic parameters, and self-assessment questionnaires were measured and compared with an age- and sex-matched control group. Subsequently, to evaluate the association between postoperative voice quality and the number of surgeries, the patients were divided into three groups (group 1: single surgery, group 2: 2-5 surgeries, group3: >6 surgeries), and comparative multidimensional vocal assessments were performed. RESULTS: The mean number of surgeries was 3.4 (range, 1-8). Although all patients exhibited poorer vocal function than the control group preoperatively, they showed improvement in postoperative subjective and objective parameters. However, four patients who underwent one surgery with relatively aggressive ablation exhibited vocal cord scarring and deteriorated objective parameters. All remaining patients showed voice quality that was on par with the control group. Subgroup analysis proved no association between post-therapeutic voice quality and the patient characteristics, including preoperative staging and the number of surgical treatments performed. CONCLUSIONS: RRP patients can achieve a close to normal voice with high satisfaction even after recurrent surgical treatment when ablation of a subepithelial lesion using sufficient laser energy is adequate. LEVEL OF EVIDENCE: 3b Laryngoscope, 127:679-684, 2017.

Quantitative assessment of videolaryngostroboscopic images in patients with glottic pathologies.

INTRODUCTION: Digital imaging techniques enable exploration of novel visualization modalities of the vocal folds during phonation and definition of parameters, facilitating more precise diagnosis of voice disorders. AIM: Application of computer vision algorithms for analysis of videolaryngostroboscopic (VLS) images aimed at qualitative and quantitative description of phonatory vibrations. MATERIALS AND METHODS: VLS examinations were conducted for 45 females, including 15 subjects with vocal nodules, 15 subjects with glottal incompetence, and 15 normophonic females. The recorded VLS images were preprocessed, the glottis area was segmented out, and the glottal cycles were identified. The glottovibrograms were built, and then the glottal area waveforms (GAW) were quantitatively described by computing the following parameters: open quotient (OQ), closing quotient (CQ), speed quotient (SQ), minimal relative glottal area (MRGA), and a new parameter termed closure difference index (CDI). RESULTS: Profiles of the glottal widths assessed along the glottal length differentiated the study groups (P < 0.001). Moreover, it was shown that the OQ, CQ, CDI, and MRGA indices can be considered as viable parameters for quantifying kinematics of the vocal folds for normophonic subjects and patients with diagnosed vocal nodules and glottal incompetence (P < 0.001). CONCLUSIONS: Computer image processing and analysis methods applied to videolaryngostroboscopic images allow for their quantitative assessment. Computation of the size-related and time-related parameters characterizing glottic pathologies is of interest for evidence-based voice diagnostics. Results of the performed ROC curve analysis suggest that the evaluated parameters can distinguish patients with voice disorders from normophonic subjects.

Using Transcutaneous Laryngeal Ultrasonography (TLUSG) to Assess Post-thyroidectomy Patients' Vocal Cords: Which Maneuver Best Optimizes Visualization and Assessment Accuracy?

To assess vocal cord (VC) movement with transcutaneous laryngeal ultrasound (TLUSG), three maneuvers, namely passive (quiet respiration), active (phonation), and Valsalva maneuvers have been described. It remains unclear which maneuver or using more maneuvers provides better visualization and assessment accuracy. We prospectively evaluated 342 post-thyroidectomy patients from two centers. They underwent TLUSG with direct laryngoscopic (DL) validation afterwards. During TLUSG, patients were instructed to perform all three maneuvers (passive, active, and Valsalva). VC visualization rate and accuracy between three maneuvers were compared. Visualization rate tended to be higher in Valsalva maneuver than that in other two maneuvers (92.1% vs. passive: 91.5%; active: 89.8%). While 19 patients had post-operative VC palsy, passive maneuver had lower test specificity than active (94.3 vs. 97.6%, p = 0.01) and Valsalva maneuvers (94.3 vs. 97.4%, p = 0.02). In assessable VCs, passive maneuver has a higher ability to differentiate between mobile VCs and VC palsy (Area under ROC curve--passive: 0.942, active: 0.863, Valsalva: 0.893). TLUSG with more maneuvers did not improve sensitivity or specificity. On applying TLUSG as a screening tool (i.e., only selected patient with "unassessable" VCs or VCP on TLUSG for DL), Valsalva maneuver (85.96%) saved more patients from DL than passive (81.87%) or active (84.81%) maneuver. Passive maneuver has a higher ability to differentiate VC palsy from normal. Using TLUSG as a screening tool, Valsalva was the preferred maneuver as it was more specific, had high visualization rate, and saved more patients from DL.

A portable high-speed camera system for vocal fold examinations.

AIM: In this article, we present a new portable low-cost system for high-speed examinations of the vocal folds. Analysis of glottal vibratory parameters from the high-speed recordings is compared with videostroboscopic recordings. METHODS AND RESULTS: The high-speed system is built around a Fastec 1 monochrome camera, which is used with newly developed software, High-Speed Studio (HSS). The HSS has options for video/image recording, contains a database, and has a set of analysis options. The Fastec/HSS system has been used clinically since 2011 in more than 2000 patient examinations and recordings. The Fastec 1 camera has sufficient time resolution (≥4000 frames/s) and light sensitivity (ISO 3200) to produce images for detailed analyses of parameters pertinent to vocal fold function. The camera can be used with both rigid and flexible endoscopes. The HSS software includes options for analyses of glottal vibrations, such as kymogram, phase asymmetry, glottal area variation, open and closed phase, and angle of vocal fold abduction. It can also be used for separate analysis of the left and vocal fold movements, including maximum speed during opening and closing, a parameter possibly related to vocal fold elasticity. A blinded analysis of 32 patients with various voice disorders examined with both the Fastec/HSS system and videostroboscopy showed that the high-speed recordings were significantly better for the analysis of glottal parameters (eg, mucosal wave and vibration asymmetry). CONCLUSIONS: The monochrome high-speed system can be used in daily clinical work within normal clinical time limits for patient examinations. A detailed analysis can be made of voice disorders and laryngeal pathology at a relatively low cost.

[Voice assessment on patients with Reinke's edema of vocal fold by application of micro-suture techniques].

OBJECTIVE: To evaluate the vocal quality of patients with Reinke's edema before and after the endolaryngeal phonosurgery combined with micro-suture techniques. METHOD: Twenty male patients with bilateral Reinke's edema were submitted to surgery. All patients received the endolaryngeal phonosurgery combined with micro-suture techniques on vocal fold and completed voice evaluation preoperative and postoperative 2 weeks, 3 months and 6 months. Acoustic voice parameters were compared with the control group without voice pathology. RESULT: The result showed that at postoperative 2 weeks, compared with the preoperative evaluation the patients' subjective sound quality improved obviously. Acoustic voice parameters improved significantly (P<0.05). At postoperative 3 months, vocal form kept well, vocal cord vibration amplitude and mucous wave seemed normal. Acoustic voice parameters had no statistical difference compared with the control group and tended to reach normal values (P>0.05). At postoperative 6 months, voice quality still remain stable, all of the analyzed parameters had no obvious difference. CONCLUSION: The phonosurgery combined with micro-suture techniques treat on the Reinke's edema, vocal cord postoperative recovery time is short, the sound quality receive basic recovery after 3 months.

Usefulness of ultrasonography in assessment of laryngeal carcinoma.

OBJECTIVE: To evaluate the usefulness of ultrasonography in assessing laryngeal cancer. METHODS: 72 patients with laryngeal carcinoma proven by surgery and pathology were enrolled. The pre-therapeutic ultrasonography and CT images were retrospectively evaluated, including tumour detection, localisation and invasion of intra- and extralaryngeal structures. A comparative assessment was made between the detection rate, correspondence rate of localisation and sensitivity and specificity of ultrasonography and CT. The mobility of the larynx was observed on real-time ultrasonography and compared with laryngoscopy. RESULTS: The detection rate of ultrasonography [63 (87.5%)/72] was lower than that of CT [72 (100.0%)/72] (p=0.006). The primary foci were accurately located in 59 (93.7%) of 63 lesions using ultrasonography compared with 70 (97.2%) of 72 lesions using CT (p=0.392). In the evaluation of invasion, the sensitivity and specificity of ultrasonography were similar to that of CT in most of the intra- and extralaryngeal structures (p=0.059-1.000). A higher specificity was obtained during the assessment of the paraglottic space involvement when using ultrasonography than CT (94.9% vs 66.7%, p=0.001). For vocal cord fixation, no statistical difference was found between ultrasonography and laryngoscopy (p=0.223). CONCLUSION: Ultrasonography could be used as a valuable supplementary imaging method to CT and laryngoscopy in the assessment of laryngeal carcinoma, even in male adults with some calcifications of the thyroid cartilage. ADVANCES IN KNOWLEDGE: Our study demonstrates that ultrasonography, which has been used scarcely in the larynx, could supply useful information on the detection, localisation and intra- and extralaryngeal invasion of laryngeal carcinoma.

Assessment of fine needle aspiration feasibility and specimen adequacy for molecular diagnostics of benign vocal fold lesions.

OBJECTIVES/ HYPOTHESIS: The use of molecular testing is becoming more significant for the diagnosis and classification of disease. The application of fine-needle aspiration (FNA) biopsy as the means of sampling lesions in union with molecular testing could be a powerful combination in laryngology. The objectives of this study were to investigate 1) if FNA was feasible to sample benign vocal fold lesions; 2) if FNA samples provided sufficient RNA quality for molecular analysis; and 3) if gene expression of FNA samples matched paired surgical excised specimens. STUDY DESIGN: Prospective cross-sectional. METHODS: Fifteen vocal fold specimens were obtained from adult patients undergoing routine surgical removal for benign vocal fold lesions using FNA and surgical excision. Comparisons were made between FNA and excision biopsies for RNA quality. Correlative analysis was completed for RNA expression of nine genes, including decorin (DCN), connective tissue growth factor (CTGF), vascular endothelial growth factor (VEGF), collagen type VI alpha 3 (COL6A3), superoxide dismutase 1 (SOD1), glutathione S-transferase (GST2), collagen type I alpha 2 (COL1A2), ATP binding cassette (ABC), and procollagen I alpha 1 (COL1A1). RESULTS: FNA and excision samples demonstrated similar RNA quality (P > 0.05). Per gene expression, four out of nine genes were moderately correlated between the paired samples (P < 0.05). CONCLUSIONS: FNA of the vocal fold lamina propria is technically feasible to perform. Further improvement in the FNA technology is desirable to optimize RNA quality for reliable gene expression analysis.

Comparative assessment of the voice in patients treated for early glottis cancer by laser cordectomy or radiotherapy.

INTRODUCTION: Adaptation of laser surgery in laryngeal cancer treatment in 1970s led to great successes and common acceptation of this treatment method in cancer treatment. The results of cancer treatment with CO(2) laser are the same as after radiotherapy or external access method. MATERIAL AND METHODS: The study included 63 patients treated for glottis cancer T1. 33 persons were treated by cordectomy type III with transmuscular cordectomy using CO(2) laser. The remaining 30 persons are patients treated using radiotherapy with so called "small spots". The tested material consisted of 100% squamosus carcinoma. The patients qualified for the examination received a card of voice self-examination. The perceptive examination of the voice was performed according to the GRBAS scale where each of parameters is defined in a four degree scale of the particular disturbance degree. The mobility and vibrations of the vocal folds were accessed using videolaryngoscopy while the acoustic analysis was performed on the basis of the acoustic analysis module. RESULTS: On the basis of the patients' voice quality self-assessment and the perceptive assessment of the voice quality based on the GRBAS scale, no significant differences between the groups were found. Furthermore no statistically significant differences were found for the phonation closure and maximal phonation time in both groups.

Sistematización en el proceso de evaluación y terapia del pólipo de cuerda vocal: encuesta a médicos otorrinolaringólogos chilenos / Assessment and therapy process systematization of vocal fold polyps: a survey to Chilean otorhynolaryngologists

Esta investigación tiene por propósito describir las indicaciones terapéuticas, prescritas por médicos otorrinolaringólogos a pacientes diagnosticados con pólipo cordal. Se describen las etapas de evaluación, reposo vocal e indicaciones terapéuticas. El estudio intenta develar la presencia de una sistematización en el proceso anterior. Dicha información es recabada a partir de una encuesta vía mail aplicada a 29 médicos pertenecientes a la Sociedad Chilena de Otorrinolaringología (N=205). Los datos obtenidos permiten concluir que no existe un estándar en las indicaciones que se preguntan en la encuesta. Sin embargo, el total de médicos consultados manifiesta que sería útil la elaboración de protocolos para la evaluación y tratamiento de los pacientes con alteración vocal.

This research is aimed at describing the therapeutic indications, prescribed by otorhynolaryngologists polyp patients diagnosed with tailpiece, including assessment, voice rest and therapeutic indications. The study attempts to reveal the presence of systematization in the previous process. This information is collected from a survey via e-mail applied to 29 physicians belonging to the Chilean Society of Otolaryngology (n =205). The data obtained indicate that there is no standard in the information asked for in the survey. However, the total number of doctors surveyed stated that the development of protocols for assessment and treatment of patients with vocal alteration would be useful.

Ultrasound assessment of vocal fold paresis: a correlation case series with flexible fiberoptic laryngoscopy and adding the third dimension (3-D) to vocal fold mobility assessment.

BACKGROUND: Perioperative examination ofthe vocal folds with flexible fiberoptic laryngoscopy is not always feasible. Prior studies suggest vocal fold ultrasound may provide a useful screening tool, however, correlation to laryngoscopic findings is necessary. The purpose of the case series was to validate vocal fold ultrasound in the adult population and to correlate the ultrasound findings to the assessment provided by flexible fiberoptic laryngoscopy. MATERIALS AND METHODS: This IRB approved study accrued sixteen patients. Vocal fold ultrasound performed by the anesthesiologist was correlated with the laryngoscopy performed by the otolaryngologist. RESULTS: Assessment of vocal fold motion was congruent in thirteen patients with normal vocal fold mobility; however, there was discordance between the findings in three patients. CONCLUSION: Vocal fold ultrasound may be useful to screen for vocal fold motion abnormalities in the adult population. Abnormal findings on vocal fold ultrasound should be confirmed with subsequent laryngoscopy.

Correlation of vocal fold nodule size in children and perceptual assessment of voice quality.

OBJECTIVES: We examined the relationship between the size of vocal fold nodules and perceptual rating of voice quality in children. METHODS: We carried out an Institutional Review Board-approved retrospective study in a voice clinic within a tertiary-care pediatric medical center. We studied children seen between 2000 and 2009 with a primary diagnosis of vocal fold nodules as the cause of their voice disturbance. Pediatric vocal fold nodule size was rated with a published validated scale, and voice quality was rated on the Consensus Auditory-Perceptual Evaluation of Voice scale. RESULTS: One hundred forty-five patients met the inclusion criteria. Small nodules were noted in 23% of patients, medium nodules in 39%, and large nodules in 37%. Univariate and multivariate analyses demonstrated a statistically significant relationship (p < 0.05) between vocal fold nodule size and rated perceptual qualities of overall severity of voice disturbance, roughness, strain, pitch, and loudness. With the exception of loudness, as vocal fold nodule size increased, the mean value of perceptual characteristics became larger. The age of the patient was a significant factor associated with the overall severity of the voice disturbance and roughness. CONCLUSIONS: The overall severity of a child's voice disturbance and qualities of roughness, strain, pitch, and loudness have a strong correlational relationship with pediatric vocal fold nodule size, which is suggestive of causality.