Effects of rosiglitazone on quality of life and prognosis of patients with early stage glottic laryngeal carcinoma.

Early-stage glottic laryngeal carcinoma refers to Tis-T2 lesions without cervical lymph nodes involvement and distant metastasis. Rosiglitazone facilitates expression of anti-inflammatory substances in the body, protecting immune system and improving patient's treatment efficacy and prognosis. We aimed to clarify the influence of rosiglitazone on prognosis of early-stage glottic laryngeal carcinoma. The control group received low-temperature plasma radiofrequency ablation and the observation group additionally received rosiglitazone; 4 mg, 2 times/day for 6 months. After treatment, the observation group showed reduction in the fundamental frequency perturbation and amplitude perturbation and increase in the harmonic-to-noise ratio relative to the control group. Total effective rate was 80.31% and 77.14% for observation and control groups, respectively (P > 0.05). Peripheral blood immune makers were higher in the observation group. The incidence rates of adverse reactions were lower in the observation group. The median survival time was 33 months in control group and 47 months in observation group (P < 0.05). The five-year survival rate was 77.14% in the observation group and 54.29% in the control group (P < 0.05). Rosiglitazone can prolong the survival of early-stage glottic laryngeal carcinoma patients, improving immune function and reducing adverse reactions during treatment.

Effects of Antiacid Therapy on Granuloma after Transoral Type IV-VI Cordectomy in Patients with Early-Stage Glottic Cancer.

OBJECTIVE: To investigate whether preventive administration of a proton pump inhibitor (PPI) can reduce the occurrence and development of traumatic granuloma (TG) following type IV-VI cordectomy. METHODS: We retrospectively analyzed the status of postoperative granulomas in 37 patients who underwent type IV-VI cordectomy due to glottic cancer and determined whether postoperative administration of a PPI had any impact on granuloma formation and development. RESULTS: The percentage and number of patients with granuloma in the PPI treatment group (experimental group) at the 1st, 2nd, 3rd, and 6th month following surgery were 81.25% (13/16), 25.00% (4/16), 18.75% (3/16), and 0.00% (0/16), respectively. The percentage and number of patients with granuloma in the no-PPI group (control group) were 95.24% (20/21), 71.43% (15/21), 52.38% (11/21), and 14.29% (3/21), respectively. The granuloma percentage of the PPI treatment group was lower than that of the control group at all postoperative time points assessed. The differences were not statistically significant at the 1st month (p = 0.175) but were statistically significant at the 2nd and 3rd months after surgery (p = 0.005, p = 0.037). CONCLUSION: Preventive use of a PPI in patients after type IV-VI cordectomy can shorten the TG recovery duration and may reduce the severity of TG, but it cannot prevent TG from occurring. Our results should be confirmed by prospective randomized controlled trials with large sample sizes.

In-Office Laryngology Injections.

The ability to perform in-office vocal fold injections has been greatly enhanced by advances in videolaryngoscopy technology. With improved optics and thin, channeled flexible laryngoscopes, in-office laryngeal injections have expanded from vocal fold augmentation for glottic insufficiency, vocal cold immobility, and botulinum toxin injections for spasmodic dysphonia, to vocal fold steroid injections for benign vocal fold lesions and scars and various injections for neurogenic cough. Efficacy, approaches, post-procedure management, and common complications of in-office laryngeal injections are outlined and supporting evidence discussed.

Accidental aspiration of a solid tablet of sodium hydroxide.

Sodium hydroxide is a corrosive, highly alkaline (PKa=14.8) household product. Ingestion of sodium hydroxide liquid is common, showing toxicity on the oesophagus and stomach. Nevertheless, cases of sodium hydroxide ingestions in pellet are rare and the management of them is unknown. We report the case of a 65-year-old man who accidentally swallowed a bleach tablet of 3.5 g. Six hours later, the patient developed an aphonia associated with dysponea stage IV, motivating a nasofibroscopy showing glottis and supraglottic necrosis and oedema for which the patient received intravenous steroids, was intubated and then underwent a tracheotomy. After 2 weeks under tracheotomy, local evolution was favourable allowing a removal of the cannula and a return back home.

WRAP53ß, survivin and p16INK4a expression as potential predictors of radiotherapy/chemoradiotherapy response in T2N0-T3N0 glottic laryngeal cancer.

The current treatment recommendation for T2-3N0M0 glottic squamous cell carcinoma (SCC) in the Nordic countries comprises of radiotherapy (RT) and chemoradiotherapy (CRT). Tumor radiosensitivity varies and another option is primary surgical treatment, which underlines the need for predictive markers in this patient population. The aim of the present study was to investigate the relation of the proteins WRAP53ß, survivin and p16INK4a to RT/CRT response and ultimate outcome of patients with T2-T3N0 glottic SCC. Protein expression was determined using immunohistochemistry on tumors from 149 patients consecutively treated with RT or CRT at Helsinki University Hospital, Karolinska University Hospital, and Linköping University Hospital during 1999-2010. Our results demonstrate a significantly better 5-year relapse-free survival, disease-free survival (DFS), disease-specific survival and overall survival of patients with T3N0 tumors treated with CRT compared with RT alone. Patients with tumors showing a cytoplasmic staining of WRAP53ß revealed significantly worse DFS compared with those with nuclear staining. For survivin, we observed a trend towards better 5-year DFS in patients with strong nuclear survivin expression compared with those with weak nuclear survivin expression (p=0.091). Eleven (7%) tumors showed p16 positivity, with predilection to younger patients, and this age group of patients with p16-positive SCC had a significantly better DFS compared with patients with p16-negative SCC. Taken together, our results highlight WRAP53ß as a potential biomarker for predicting RT/CRT response in T2-T3N0 glottic SCC. p16 may identify a small but distinct group of glottic SCC with favorable outcome. Furthermore, for T3N0 patients better outcome was observed following CRT compared to RT alone.

The use of injectable calcium hydroxylapatite in the surgically pretreated larynx with glottal insufficiency.

OBJECTIVES/HYPOTHESIS: To evaluate the efficacy of vocal fold (VF) augmentation with calcium hydroxylapatite (CaHA) microspheres in the surgically pretreated larynx with glottal insufficiency. STUDY DESIGN: Prospective clinical pilot study. METHODS: After several prior reconstructive attempts (following tumor resection, VF paralysis, in sulcus vocalis, and VF scarring), CaHA was injected under general anaesthesia using a transoral microlaryngoscopic approach in 10 patients with residual glottal insufficiency ≤1.5 mm. The postinterventional result was assessed after 1 day, and 1 and 3 months. Evaluation of augmentation comprised intraoperative video/photo documentation, pre-/postoperative videolaryngostroboscopy, as well as established subjective and objective voice function diagnostics (Grade, Roughness, Breathiness [GRB] Scale; Voice Handicap Index; voice range profile; and acoustic-aerodynamic analysis). RESULTS: In the pretreated VF with no or minimal lamina propria remaining, the exact placement of CaHA was not possible due to unpredictable propagation into the scarred tissue. The results showed an insufficient postoperative augmentation. Accordingly, the voice function did not improve. However, a significant increase of the vocal range from 6.2 ± 3.2 to 8.7 ± 3.9 semitones was observed in the speaking voice profile (P =.02). All other acoustic and aerodynamic parameters remained on the whole unchanged; the slight differences between pre- and postoperative findings were not significant. CONCLUSIONS: The application of CaHA in the surgically pretreated scarred larynx is not reliable to achieve a sufficient glottal closure and a satisfactory improvement of voice. Though CaHA is a welcome addition to our armamentarium against glottal insufficiency, the suitability for augmentation of scar tissue in the larynx must be considered carefully in each individual case. LEVEL OF EVIDENCE: 4 Laryngoscope, 127:1125-1130, 2017.

Prevention of anterior glottis web with hyaluronic acid derivatives in rabbit model.

OBJECTIVES/HYPOTHESIS: Validating an antiadhesive strategy to prevent anterior glottic web (AGW) development. STUDY DESIGN: Prospective animal study in rabbits. METHODS: Fifteen New Zealand white rabbits were randomly divided into three equal groups (five rabbits each), applying either HyFence (HF: 0.1 g/vocal fold), an antiadhesive test agent; mitomycin-C (MMC: 1 mg/ml, 4 min) as reference therapy; or saline (control group) to AGWs induced by laryngofissure technique (previously reported by us). At week 8, the extent of AGW was measured to assess preventive effects of HF and MMC, and laryngeal specimens were sampled for high-speed recording and histologic analysis. RESULTS: AGW induction was successful in all five (100%) control rabbits, each demonstrating fibroconnective tissue and collagen fibers at anterior commissure, with AGW ratio averaging 0.57 ± 0.052. An AGW was seen in 100% of the rabbits survived in the MMC group (n = 2) with the 60% (n = 3) of the MMC rabbits expired due to postprocedure infections. The average AGW ratio was 0.28 ± 0.070 in the MMC group. AGW formation rate was 50% in HF group with one rabbit expired from infection. Mean AGW ratio was lowest in the HF group (0.23 ± 0.10; P = 0.013). Microscopically, AGW induction sites in HF-treated rabbits displayed significantly fewer collagen fibers (P = 0.009) by comparison. CONCLUSION: This is the first reported use of a cross-linked hyaluronic acid gel that may prevent AGW formation. LEVEL OF EVIDENCE: N/A. Laryngoscope, 126:2320-2324, 2016.

Critical evaluation of a prospective study of concurrent chemoradiotherapy with S-1 for early glottic carcinoma.

AIM: To improve the outcomes of radiotherapy alone for T2 glottic carcinoma (GC), we initiated a prospective study of concurrent chemoradiotherapy with S-1 for patients with early GC, primarily T2 cases. We report the efficacy and safety of this protocol. PATIENTS AND METHODS: Eligible patients had T1b or T2 glottic squamous cell carcinomas. Patients received S-1 (55.3 mg/m(2)/day, once daily) and radiotherapy (2 Gy/day, five days/week, to a total of 30 fractions). RESULTS: Thirteen patients were eligible. Complete responses were observed in all 13 patients (100%). At a median follow-up duration of 53 months (range=23-68 months), the 3-year local control and overall survival rates were both 100%. Grade 3 dermatitis occurred in only one patient. CONCLUSION: This chemoradiotherapy protocol is well -tolerated and effective in patients with early glottic carcinoma. Furthermore, due to its once-daily administration, this protocol is considered to be easier than usual chemoradiotherapy, and makes outpatient-treatment possible.

Effect of inhaled carbon dioxide on laryngeal abduction.

Hypercapnia produces a profound effect on respiratory drive and upper airway function to maintain airway patency. Previous work has evaluated the effects of hypercapnia on the sole arytenoid abductor, the posterior cricoarytenoid (PCA), using indirect measures of function, such as electromyography and direct nerve recording. Here we describe a novel method to evaluate PCA function in anesthetized animals and use this method to determine the effects of hypercapnia on PCA function. Eight dogs were anesthetized, and a laryngeal mask airway was used, in combination with high-speed videoendoscopy, to evaluate laryngeal function. A stepwise increase in inspired partial pressure of CO2 produced marked arytenoid abduction above 70-mmHg end-tidal CO2 (ETCO2 ) (P < 0.001). Glottic length increased above 80-mmHg ETCO2 (P < 0.02), and this lead to underrepresentation of changes in glottic area, if standard measures of glottic area (normalized glottic gap area) were used. Use of a known scale to determine absolute glottic area demonstrated no plateau with increasing ETCO2 up to 120 mmHg. Ventilatory parameters also continued to increase with no evidence of a maximal response. In a second anesthetic episode, repeated bursts of transient hypercapnia for 60 s with an ETCO2 of 90 mmHg produced a 43-55% increase in glottic area (P < 0.001) at or shortly after the end of the hypercapnic burst. A laryngeal mask airway can be used in combination with videoendoscopy to precisely determine changes in laryngeal dimensions with high temporal resolution. Absolute glottic area more precisely represents PCA function than normalized glottic gap area at moderate levels of hypercapnia.

Lidocaine reduces endotracheal tube associated side effects when instilled over the glottis but not when used to inflate the cuff: A double blind, placebo-controlled, randomized trial.

BACKGROUND: Tracheal intubation results in an alteration of the laryngeal mucosa which can lead to undesirable effects at emergence from anaesthesia. Local anesthetics, when administered topically, may represent an interesting alternative to reduce these side effects. AIM: In this trial, we aimed to evaluate the effect of lidocaine in preventing tracheal intubation related side effects at emergence from anaesthesia, when instilled onto the glottis before intubation or used to inflate the endotracheal tube cuff. METHODS: Eighty patients scheduled to elective surgery of less than 120 minutes under general anaesthesia were enrolled in this prospective, randomized, controlled, double blind study. As they receive instillation of 2% lidocaine or saline onto the glottis before intubation, and as they have their endotracheal tube cuff filled with 2% lidocaine or saline, the patients were randomized in four groups. S-S (Saline instillation and saline in the cuff); S-Lido (saline instillation and lidocaine in the cuff); Lido-S (lidocaine instillation and saline in the cuff); Lido-Lido (lidocaine instillation and lidocaine in the cuff). The primary outcome was the incidence of coughing before extubation. The secondary outcomes were sore throat scores at H1 and H24 postoperatively and incidence of dysphagia, dysphonia and laryngeal dyspnea during the first 24 hours. RESULTS: Coughing occurred in 80%, 70%, 30% and 20% of patients in S-S, S-Lido, Lido-S and Lido-Lido groups respectively. When compared to S-S group, the incidence of coughing was significantly reduced in Lido-S and Lido-Lido groups but not in S-Lido group (p1=0.003; p2=0.0003; p3=0.7 respectively). Sore throat scores at H1 and H24 were significantly lower in Lido-S and Lido-Lido groups (p1=0.00002 and p2=0.01). There was no significant difference between groups regarding the incidence of dysphagia, dysphonia and laryngeal dyspnea. CONCLUSION: When instilled onto the glottis before intubation, lidocaine reduced both the incidence of coughing and the severity of postoperative sore throat in surgery of less than 120 minutes. Intracuff lidocaine was not effective to reduce neither coughing nor sore throat severity.

Risk-adapted partial larynx and/or carotid artery sparing modulated radiation therapy of glottic cancer.

BACKGROUND: To evaluate outcome in patients with glottic cancer treated with intensity-modulated radiotherapy (IMRT) and to show effectiveness of partial laryngeal- and/or carotid artery sparing in low to intermediate risk tumors. STUDY DESIGN: Retrospective analysis. MATERIAL AND METHODS: From 01/2004 to 03/2013 77 consecutive patients presenting with glottic cancer were treated in our department with IMRT as definitive treatment. T-stages distributed as follows: T1: n = 17, T2: n = 24, T3: n = 15, T4: n = 13 and recurrences: 8 patients. Concomitant systemic therapy was applied in 39 patients consisting of either cisplatin or cetuximab. RESULTS: Mean/median follow-up (FU) time was 32.2/28 months (range: 4-98.7). Three year local control (LC), ultimate LRC and laryngectomy free survival rate was 77%, 92% and 80%, respectively. Three year overall survival of the entire cohort was 81%. Three year local control for T1/T2, T3/T4, and recurred tumors was 95%, 65%, and 38%, respectively. Three year overall survival was 86% for T1-4 stages, 55% for recurred disease, respectively. Partial laryngeal/carotid artery sparing was performed in all T1 patients (n = 17) and 17/22 T2N0 patients. Rate of late sequels was low. CONCLUSION: IMRT for glottic cancer shows high control rates. In low to intermediate risk tumors an individualized treatment volume with partial larynx +/- carotid artery sparing is effective and holds the potential to reduce long term toxicity. The therapeutic outcome was not compromised.

Patient-reported voice and speech outcomes after whole-neck intensity modulated radiation therapy and chemotherapy for oropharyngeal cancer: prospective longitudinal study.

PURPOSE: To describe voice and speech quality changes and their predictors in patients with locally advanced oropharyngeal cancer treated on prospective clinical studies of organ-preserving chemotherapy-intensity modulated radiation therapy (chemo-IMRT). METHODS AND MATERIALS: Ninety-one patients with stage III/IV oropharyngeal cancer were treated on 2 consecutive prospective studies of definitive chemoradiation using whole-field IMRT from 2003 to 2011. Patient-reported voice and speech quality were longitudinally assessed from before treatment through 24 months using the Communication Domain of the Head and Neck Quality of Life (HNQOL-C) instrument and the Speech question of the University of Washington Quality of Life (UWQOL-S) instrument, respectively. Factors associated with patient-reported voice quality worsening from baseline and speech impairment were assessed. RESULTS: Voice quality decreased maximally at 1 month, with 68% and 41% of patients reporting worse HNQOL-C and UWQOL-S scores compared with before treatment, and improved thereafter, recovering to baseline by 12-18 months on average. In contrast, observer-rated larynx toxicity was rare (7% at 3 months; 5% at 6 months). Among patients with mean glottic larynx (GL) dose ≤20 Gy, >20-30 Gy, >30-40 Gy, >40-50 Gy, and >50 Gy, 10%, 32%, 25%, 30%, and 63%, respectively, reported worse voice quality at 12 months compared with before treatment (P=.011). Results for speech impairment were similar. Glottic larynx dose, N stage, neck dissection, oral cavity dose, and time since chemo-IMRT were univariately associated with either voice worsening or speech impairment. On multivariate analysis, mean GL dose remained independently predictive for both voice quality worsening (8.1%/Gy) and speech impairment (4.3%/Gy). CONCLUSIONS: Voice quality worsening and speech impairment after chemo-IMRT for locally advanced oropharyngeal cancer were frequently reported by patients, underrecognized by clinicians, and independently associated with GL dose. These findings support reducing mean GL dose to as low as reasonably achievable, aiming at ≤20 Gy when the larynx is not a target.

The effect of initiating oral contraceptive use on voice: a case study.

OBJECTIVE: To examine the effects of initiating oral contraceptive (OC) use on spectrally based acoustic measures. STUDY DESIGN: Case history. METHODS: A 23-year-old female volunteered to participate in the study. Voice recordings were obtained during eight consecutive menstrual cycles: two cycles before the onset of OC use and six cycles after the initiation of OC use. Recordings consisted of three trials of the sustained vowel /æ/ and were obtained during the follicular phase (preovulation, days 9-11) and luteal phase (premenstruation, days 20-22) of each cycle. Measurements obtained included the following: (1) H1-H2, the ratio of the amplitude of the first harmonic to the amplitude of the second harmonic, which correlates to closed quotient duration; (2) H1-A1, the ratio of the amplitude of the first harmonic to the amplitude of the first formant, which correlates to glottal width; and (3) H1-A3, the ratio of the first harmonic to the amplitude of the third formant, which correlates to the abruptness of vocal fold closure. In addition, acoustic measures of voice perturbation, jitter, shimmer, and noise-to-harmonic ratio were measured. RESULTS: The participant exhibited changes in glottal characteristics in conjunction with initiation of OC use. Both the H1-H2 and H1-A1 differences changed with OC use relative to menstrual cycle phase. These two measures have been correlated with the glottal measures of closed quotient and glottal width, respectively. However, there was no significant change in the H1-A3 difference, indicating no effect of OC use on the speed of vocal fold closure. CONCLUSIONS: The results of this study indicate that the onset of OC use can result in vocal changes as noted by different patterns of glottal adjustment across menstrual cycle phases.

Phase I/II trial of concurrent use of S-1 and radiation therapy for T2 glottic cancer.

OBJECTIVE: A Phase I/II study of S-1 combined radiation therapy was conducted in patients with Stage II (T2N0) glottic cancer. The purpose of the Phase I study was to identify the maximum tolerated dose, the recommended dose and the dose limiting toxicity. The objectives in the phase II study were to estimate the local control and the overall survival, and the incidence of adverse events. METHODS: In Phase I, S-1 was administered orally in a split-course fashion as two doses of 40 mg/m(2), for a total daily dose of 80 mg/m(2). The course involved a 2-week rest after a 2-week administration (Level 1) and a 1-week rest after a 3-week administration (Level 2). Radiation therapy was administered in 2-Gy daily (total 60-Gy) standard fractionation. RESULTS: Seven patients were enrolled in the Phase I, and 19 in the Phase II study. Mucositis was the most common toxicity encountered. All 26 patients completed radiation therapy without delay. The overall response rate was 100% (26/26) with all patients showing a complete response. One patient developed a local recurrence 28 months after the treatment. The 3-year local control and overall survival rates were 94.7 and 85.4%, respectively (limited to 22 patients from Level 2). CONCLUSIONS: The use of S-1 at 80 mg/m(2) per day in a split-course with 1-week rest during the course of radiation therapy was safe and effective for Stage II glottic cancer. The treatment strategy employing orally available S-1 proved to be beneficial over the conventional injection of antitumor agents for maintaining the patients' quality of life.

Beta-adrenergic blockade and voice: a double-blind, placebo-controlled trial.

This study investigated the effects of laboratory-induced stress and beta-adrenergic blockade on acoustic and aerodynamic voice measures. In a double-blind, placebo-controlled trial, 12 participants, six males and six females, underwent cold pressor-induced sympathetic activation followed by placebo or treatment with 40 mg propranolol. Aerodynamic and acoustic parameters of voice were collected at baseline, during cold pressor and after treatment with propranolol or placebo. Fundamental frequency, jitter, shimmer, maximum airflow declination rate, voice onset time, speaking rate, and subglottal pressure were measured at baseline, during cold pressor-induced stress, and after treatment with propranolol or placebo. Cardiovascular measures served as indicators of sympathetic nervous system (SNS) activation by cold pressor and antagonism by propranolol, and were collected during all conditions. Cold pressor appeared to adequately agonize the SNS as indicated by significant increases in resting systolic and diastolic blood pressure and heart rate. Propranolol appeared to adequately antagonize the SNS for the participants. Jitter ratio demonstrated a statistically significant increase in the participants treated with propranolol. Speaking rate demonstrated a small but significant increase in the placebo control group during cold pressor. Gender differences were observed in a few measures. Cold pressor adequately agonized and propranolol adequately antagonized the SNS. No statistically significant differences across subjects were observed in the voice parameters during cold pressor-induced stress before treatment. Jitter ratio increased significantly during propranolol treatment and cold pressor. Speaking rate demonstrated a statistically significant increase during cold pressor in the placebo control group. Gender differences were observed, but were few.

A Macintosh laryngoscope blade for videolaryngoscopy reduces stylet use in patients with normal airways.

BACKGROUND: Although most tracheal intubations with direct laryngoscopy are not performed with a styletted endotracheal tube, it is recommended that a stylet can be used with indirect videolaryngoscopy. Recently, there were several reports of complications associated with styletted endotracheal tubes and videolaryngoscopy. In this study, we compared three videolaryngoscopes (VLSs) in patients undergoing tracheal intubation for elective surgery: the GlideScope Ranger (GlideScope, Bothell, WA), the V-MAC Storz Berci DCI (Karl Storz, Tuttlingen, Germany), and the McGrath (McGrath series 5, Aircraft medical, Edinburgh, UK) and tested whether it is feasible to intubate the trachea of patients with indirect videolaryngoscopy without using a stylet. METHODS: Four hundred fifty consecutive adults (ASA PS I-II) undergoing tracheal intubation for elective surgery were randomly allocated for airway management with one of the three devices. Anesthesia induction for tracheal intubation consisted of fentanyl-propofol-rocuronium. An independent anesthesiologist used the Cormack-Lehane grading system to score an initial direct laryngoscopic view using a classic metal Macintosh blade. After subsequent positive-pressure ventilation using a face mask and an oxygen-sevoflurane mixture for 1 min, the trachea was intubated using one of the three VLSs. During intubation, the following data were collected: intubation time, number of intubation attempts, use of extra tools to facilitate intubation, and overall satisfaction score of the intubation conditions. RESULTS: The trachea of every patient was intubated using the VLSs, and none of the patients required conversion to the classic Macintosh laryngoscope. All three VLSs offered equal or better view of the glottis as assessed by the mean Cormack-Lehane grade, compared with the traditional Macintosh laryngoscopy, including a larger viewing angle of the glottic entrance. The average intubation time was 34 +/- 20 s for the GlideScope, 18 +/- 12 s for the V-MAC Storz, and 38 +/- 23 s for the McGrath VLS. Intubation with the Storz was faster (P < 0.05) than the other two VLS tested and necessitated fewer additional tools (P < 0.01), resulting in a higher first-pass successful intubation rate. A stylet had to be used in 7% of the patients in the Storz group versus about 50% of the patients when the other two VLS were used. CONCLUSIONS: The trachea of a large proportion of patients with normal airways can be intubated successfully with certain VLS blades without using a stylet, although the three studied VLSs clearly differ in outcome. The Storz VLS displaces soft tissues in the fashion of a classic Macintosh scope, affording room for tracheal tube insertion and limiting the need for stylet use compared with the other two scopes. Although VLSs offer several advantages, including better visualization of the glottic entrance and intubation conditions, a good laryngeal view does not guarantee easy or successful tracheal tube insertion. We recommend that the geometry of VLSs, including blade design, should be studied in more detail.

Laryngeal aerodynamics associated with oral contraceptive use: preliminary findings.

UNLABELLED: The purpose of this study was to examine possible differences in laryngeal aerodynamic measures during connected speech associated with oral contraceptive (OC) use. Eight women taking an OC, and eight others not taking an OC, participated in the study. Three trials of syllable /p/repetitions were obtained using a circumferentially vented face mask and small translabial tube. All participants were recorded on or near days 7 and 14 of their menstrual cycle. Subglottal pressure (P(SG)) and average airflow rates were obtained to determine laryngeal airway resistance. Glottal airflow measures of peak flow, minimum flow, alternating flow, as well as relative sound level (RSL) were obtained. P(SG) was obtained from the pressure peak associated with/p/. All airflow parameters and RSL were obtained from the vowel portion. No significant differences were found related to day of recording or OC use, indicating that OC use does not significantly affect laryngeal airflow regulation. LEARNING OUTCOMES: The reader will better understand the effects of hormones and oral contraceptives on the female voice, as well as the specific changes in vocal function that may occur in conjunction with the use of oral contraceptives.