ABSTRACT
OBJECTIVE: Several surgical techniques have been reported for the treatment of unilateral vocal fold paralysis (UVFP). Although the fenestration approach has recently been applied for arytenoid adduction (AA) in some cases, long-term large-cohort studies on its usefulness are lacking. Therefore, this study aimed to evaluate the long-term voice outcomes of this technique in patients with UVFP. STUDY DESIGN: Retrospective study. METHODS: A total of 168 patients with UVFP underwent laryngoplasty comprising AA performed through fenestration of the thyroid ala combined with a type I thyroplasty (TPI). The maximum phonation time (MPT) and mean airflow rate (MFR) were measured before and after surgery, and voice analysis included an estimation of shimmer and jitter. Anterior and posterior surgical windows were created in the lower thyroid ala and were used for typical TPI and AA, respectively. The window locations were determined based on three-dimensional computed tomography data. AA was performed by pulling the muscular process of the arytenoid cartilage toward the lateral cricoarytenoid muscle through the posterior window without releasing the cricothyroid joint. All surgeries were performed under local anesthesia, and medialization was endoscopically confirmed. RESULTS: Postoperative MPT >10 seconds was achieved in 156 of the 168 patients. Postoperatively, MFR improved to <250 mL/s in all but two patients, and MPT, MFR, jitter, and shimmer significantly improved in all patients. Furthermore, perceptual evaluation using the Grade, Roughness, Breathiness, Asthenia, and Strain scale revealed significant improvement in all patients. CONCLUSIONS: The fenestration approach preserves the cricothyroid joint and does not open the cricoarytenoid joint; therefore, the laryngeal cartilage is stabilized, and no distortion of the laryngeal framework occurs. Our results showed that combined AA and TPI via the fenestration approach provided stable long-term postoperative voice improvement in patients with UVFP. LEVEL OF EVIDENCE: Level 3.
ABSTRACT
Laryngeal cryptococcosis is a rare condition. While there is no reliable evidence regarding the treatment of laryngeal cryptococcosis, oral fluconazole was successful in most previous cases. We experienced a case where we could not continue fluconazole because of adverse drug effects. An 88-year-old female was referred to our department with a 5-month history of sore throat and cough. She had used oral steroids and a corticosteroid inhaler for poorly controlled asthma. Flexible laryngoscopy showed leukoplakia of the vocal cords and subglottic mucosa, and biopsy revealed cryptococcal infection. We started the treatment with fluconazole but changed to itraconazole because of adverse events. Since laryngoscopy performed 6 months later was unremarkable and drug interactions had occurred, we stopped the itraconazole use at 6 months. Our experience suggests that itraconazole is also useful for treating laryngeal cryptococcosis.
ABSTRACT
OBJECTIVE: In recent years, the incidence of vocal fold atrophy has increased among the elderly. Vocal function exercises (VFE) are performed in patients with age-related vocal fold atrophy; however, treatment could be challenging if the patient is unable to go to the hospital or in hospitals that do not have a speech pathologist. Breath-holding pulling exercises are simple and can be performed anywhere for the management of such patients. This study aimed to examine the effectiveness of breath-holding pulling exercises in patients with vocal fold atrophy. STUDY DESIGN: Retrospective study METHODS: With the hands folded in front of the chest, the patients were instructed to take a deep breath, pull their hands to the left and right, and then hold their breath for 5 seconds. The physician instructed the patients to do this 10 times each morning, afternoon, and evening. Speech function, acoustic analysis, pitch range, and Voice Handicap Index-10 (VHI-10) were evaluated and compared before and 4-8 weeks after treatment. RESULTS: Maximum phonation time (MPT), the primary endpoint, significantly improved after treatment from 14.2 ± 6.6 to 20.3 ± 9.3 seconds. Among the secondary endpoints, mean flow rate (207.5 ± 104.4 to 165.1 ± 66.5 mL/s), pitch range (22.9 ± 8.3 to 26.2 ± 8.1 semitones), VHI-10 (18.1 ± 7.2 to 12.5 ± 6.3 points) jitter (2.5±1.6 to 1.7±1.2%), and shimmer (5.9±3.5 to 4.8±3.3%) showed significant improvement. CONCLUSION: Breath-holding pulling exercises were found to be effective in patients with vocal fold atrophy. These can be performed in hospitals with no speech pathologists, in patients who are unable to go to the hospital, and in patients who are hospitalized or unable to speak loudly. Moreover, as with conventional VFE, the training method achieves a high level of patient satisfaction.