Characterizing Dysphonia After Pediatric Open Airway Reconstruction: Systematic Review and Meta-Analysis.

BACKGROUND: Pediatric laryngotracheal stenosis often requires open airway reconstruction. While these surgeries establish an airway for adequate ventilation, many patients develop subsequent dysphonia. Numerous studies have reported outcomes related to voice. OBJECTIVE: This study aims to evaluate dysphonia in pediatric patients following open airway reconstruction, focusing on acoustic parameters, perceptual voice quality, and voice-related quality of life. METHODS: A comprehensive search using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines across 6 databases identified articles involving pediatric patients who underwent open airway reconstruction and reported postoperative vocal acoustic parameters, perceptual voice quality, voice-related quality of life, or vocal mechanics. Articles were assessed for bias risk, and common outcomes were synthesized qualitatively and quantitatively using meta-analyses. RESULTS: Among 4089 articles, 21 were included, involving 497 pediatric patients. Laryngotracheoplasty was the most common procedure followed by cricotracheal resection. The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) scale was frequently used to assess voice quality, with a mean score of 55.6 [95% confidence intervals (CIs): 47.9-63.3]. Voice-related quality of life was measured using the pediatric Voice Handicap Index (pVHI) and Pediatric Voice-Related Quality of Life Survey, with mean scores of 35.6 (95% CI: 21.4-49.7) and 83.7 (95% CI: 74.1-93.2), respectively. The fundamental frequency was 210.5 (95% CI: 174.6-246.3). Other common findings included supraglottic phonation, anterior commissure blunting, posterior glottic diastasis, and abnormal vocal cord mobility. CONCLUSION: Pediatric patients experiencing dysphonia after open airway reconstruction exhibited moderately decreased voice quality and reduced voice-related quality of life. However, there was inconsistency in study protocols and outcome measures used. Preserving voice quality during airway reconstruction is crucial to avoid negative impacts on quality of life.

Outcomes of laryngeal framework surgeries for unilateral vocal cord paralysis in the elderly patients.

OBJECTIVE: Laryngeal framework surgery is a widely accepted treatment for unilateral vocal fold paralysis with good functional outcomes. Recently, with the aging of the population, opportunities to perform this procedure in elderly patients have increased; however, the safety and efficacy of this procedure in elderly patients has not been established. Therefore, this study aimed to investigate the safety and functional outcomes of laryngeal framework surgery in elderly patients. METHODS: Between January 2008 and December 2017, 97 patients with unilateral vocal fold paralysis underwent laryngeal framework surgery, and 71 among them completed pre- and post-operative voice function evaluations. The clinical course of these 71 patients were retrospectively reviewed. RESULTS: Out of 71 patients, 35 were assigned to the younger group (< 65 years) and 36 to the elderly group (≥ 65 years). Complications included post-operative edema and submucosal hematoma that were safely managed in all cases, and no differences were identified between the groups. Significant improvements were observed in maximum phonation time (MPT), mean flow rate, alternating current/direct current ratio, pitch perturbation quotient, amplitude perturbation quotient, and noise-to-harmonic ratio in both groups, and multivariate analysis of variance revealed greater improvement in the younger group in MPT. CONCLUSION: Laryngeal framework surgeries for unilateral vocal fold paralysis are safe and effective, regardless of age. Better improvement was observed in the younger group in the MPT suggesting that the effects of laryngeal framework surgeries is more likely to be present in the younger group than in the elderly.

Implementation of a prototype dynamic laryngoplasty system in standing sedated horses provided arytenoid abduction control at seven days postoperatively.

OBJECTIVE: Evaluate a prototype dynamic laryngoplasty system (DLPS) in horses; a feasibility study. ANIMALS: 7 healthy Standardbred adult horses. METHODS: This was an in vivo experimental study. Horses had a standing surgical procedure to induce complete laryngeal hemiplegia, which was subsequently treated using the dynamic laryngoplasty system (DLPS). Activation of the DLPS was achieved using an injection port exiting through the skin (n = 2) or a subcutaneous injection port (n = 5). For each horse, endoscopic examinations of the upper respiratory tract were performed preoperatively, intraoperatively, and 7 days postoperatively. Left-to-right quotient ratios calculated during inactivated and activated states were obtained from still images of the rima glottidis acquired during day 7. In 3 horses, the device was intentionally overinflated to evaluate for device failure, and postmortem examinations were performed on day 7. For the remaining 4 horses, upper respiratory tract endoscopy was repeated at 1 month postoperatively, with no subsequent postmortem exam. RESULTS: No perioperative complications occurred, and the DLPS was effectively delivered in all horses under standing sedation. The left-to-right quotient ratio at day 7 postoperatively could be altered from a resting position of 0.76 (± 0.06) to a maximum of 0.97 (± 0.06; P < .05). The degree of arytenoid abduction could not be significantly altered after 1 month of device implantation, suspected to be due to peri-implant fibrosis. No coughing nor tracheal contamination was observed at all time points or during inflation. CLINICAL RELEVANCE: The ability to alter the degree of abduction at 7 days postoperatively with the DLPS may be beneficial in selective cases.

The Long Term Results of Hyaluronic Acid/Dextranomer Injection Laryngoplasty in Unilateral Vocal Fold Paralysis.

OBJECTIVE: This study was conducted to present the long-term functional outcomes of injection laryngoplasty (IL) with hyaluronic acid/dextranomer (HA/D) in unilateral vocal fold paralysis (UVFP). METHODS: A total of 40 patients who underwent HA/D injection for UVFP were enrolled. The acoustic analysis of the voice was evaluated with jitter percentage, shimmer percentage, maximum phonation time, harmonics-to-noise ratio, and fundamental frequency. The psychosocial effect of the voice was determined using the Voice Handicap Index-10. Fiberoptic endoscopic evaluation of swallowing was performed and 2 scales were used for quantification: a modified penetration-aspiration scale and a dysphagia score. All measurements were performed at preoperative day and postoperative months 1, 6, and 24. RESULTS: A statistically significant improvement was observed for all of the evaluated parameters except the maximum phonation time for postoperative months 1, 6, and 24 (P < .05). In the evaluation of the maximum phonation time, although there was a significant improvement for the postoperative months 1 and 6, no significant difference was observed between the postoperative 24th month and the preoperative value. CONCLUSIONS: HA/D injection laryngoplasty is an effective method both in the short- and long-term to improve voice and swallowing functions in patients with UVFP.

Voice outcome in medialisation thyroplasty with and without arytenoid adduction: a prospective comparison using intraoperative voice measurements.

PURPOSE: Arytenoid adduction as an addition to medialisation thyroplasty is highly advocated by some surgeons in selected cases but deemed less necessary by others in patients with unilateral vocal fold paralysis. This study aims to evaluate the additional benefits on voice outcome of arytenoid adduction in patients with unilateral vocal fold paralysis undergoing medialisation thyroplasty using intra-operative voice measurements. DESIGN/METHODS: A prospective study was conducted. Voice audio recordings were obtained at 4 moments; 1. direct prior to the start of surgery, 2. during surgery after medialisation thyroplasty, 3. during surgery after medialisation and arytenoid adduction, 3 months postoperative. At these same timepoints patients rated their own voice on a numeric rating scale between 0 and 10. The blinded recordings were rated by consensus in a team of experienced listeners, using the Grade of the GRBAS scale. Furthermore, the Voice Handicap Index was administered before and at 3 months after surgery. RESULTS: Ten patients who underwent medialisation and arytenoid adduction at our tertiary referral hospital between 2021 and 2022, were included. One patient was excluded after surgery. The intraoperative measurements showed a Grade score of 1.4 preoperatively, improving to 1.2 after medialisation, 1.2 after medialisation and arytenoid adduction, and further improving to 0.4 at 3 months postoperative, which was a not statistically significant improvement (p = 0.2). The intraoperative subjective numeric rating scale showed a statistically significant improvement from 3.9 preoperatively, to 6.1 after medialisation, 7.1 after medialisation and arytenoid adduction and a 7.6 at 3 months postoperative (p = 0.001). The Voice Handicap Index total score showed a statistically significant improvement from 71 points before surgery to 13 at 3 months after surgery (p = 0.008). CONCLUSIONS: Our study using intraoperative voice measurements indicate that the addition of arytenoid adduction to medialisation thyroplasty is a benefit in selected patients although more studies are needed due to the many limitations inherent to this field of investigation.

Acoustics and aerodynamic effects following glottal and infraglottal medialization in an excised larynx model.

OBJECTIVE: This study aimed to investigate the impact of the implant's vertical location during Type 1 Thyroplasty (T1T) on acoustics and glottal aerodynamics using excised canine larynx model, providing insights into the optimal technique for treating unilateral vocal fold paralysis (UVFP). METHODS: Measurements were conducted in six excised canine larynges using Silastic implants. Two implant locations, glottal and infraglottal, were tested for each larynx at low and high subglottal pressure levels. Acoustic and intraglottal flow velocity field measurements were taken to assess vocal efficiency (VE), cepstral peak prominence (CPP), and the development of intraglottal vortices. RESULTS: The results indicated that the implant's vertical location significantly influenced vocal efficiency (p = 0.045), with the infraglottal implant generally yielding higher VE values. The effect on CPP was not statistically significant (p = 0.234). Intraglottal velocity field measurements demonstrated larger glottal divergence angles and stronger vortices with the infraglottal implant. CONCLUSION: The findings suggest that medializing the paralyzed fold at the infraglottal level rather than the glottal level can lead to improved vocal efficiency. The observed larger divergence angles and stronger intraglottal vortices with infraglottal medialization may enhance voice outcomes in UVFP patients. These findings have important implications for optimizing T1T procedures and improving voice quality in individuals with UVFP. Further research is warranted to validate these results in clinical settings.

Current approaches to gender-affirming vocal care.

PURPOSE OF REVIEW: This review addresses the challenges faced by transgender women in achieving congruence between gender identity and voice characteristics and emphasizes the importance of a multidisciplinary approach involving therapeutic and surgical interventions. RECENT FINDINGS: Recent literature on gender-affirming vocal care emphasizes key themes such as assessment, voice feminization therapy, and various surgical techniques, including glottoplasty and its modifications. Recent publications focused on outcomes, duration, and impact on vocal quality and scrutinized complications associated with surgical interventions. SUMMARY: Most publications in the last 18 months advocate for the integration of voice therapy and surgery for optimal outcomes. Utilising a combined approach is significantly more effective in terms of fundamental frequency gain compared to therapy alone. Modified Wendler's glottoplasty remains the preferred and most reliable surgical intervention. However, surgery is not without its complications and vocal trade-offs, in particular, its impact on vocal projection and the risk of long-term dysphonia. Postsurgery rehabilitation improves long-term outcomes. Recent publications on alternative surgical approaches, namely laser reduction glottoplasty and feminization laryngoplasty, show promise but the results are more difficult to generalise. FUTURE DIRECTION: Prospective multicentre studies with standardized protocols are needed to establish best evidence-based practices.

An Integrated Experimental-Computational Study of Vocal Fold Vibration in Type I Thyroplasty.

Subject-specific computational modeling of vocal fold (VF) vibration was integrated with an ex vivo animal experiment of type 1 thyroplasty to study the effect of the implant on the vocal fold vibration. In the experiment, a rabbit larynx was used to simulate type 1 thyroplasty, where one side of the vocal fold was medialized with a trans-muscular suture while the other side was medialized with a silastic implant. Vocal fold vibration was then achieved by flowing air through the larynx and was filmed with a high-speed camera. The three-dimensional computational model was built upon the pre-operative scan of the laryngeal anatomy. This subject-specific model was used to simulate the vocal fold medialization and then the fluid-structure interaction (FSI) of the vocal fold. Model validation was done by comparing the vocal fold displacement with postoperative scan (for medialization), and by comparing the vibratory characteristics with the high-speed images (for vibration). These comparisons showed the computational model successfully captured the effect of the implant and thus has the potential for presurgical planning.

Impact of Wendler glottoplasty on acoustic measures and quality of voice in transgender women: a systematic review and meta-analysis.

PURPOSE: Since new evidence regarding the impact of Wendler glottoplasty (WG) on the voice in transgender women became available in the literature in recent years, we aimed to perform an updated systematic review and meta-analysis to determine the actual safety and efficacy of WG in the process of vocal feminization. METHODS: PubMed, Embase, and Cochrane were searched for English-language articles published until July 4, 2023. Studies were found eligible if they evaluated the impact of WG on the acoustic-aerodynamic measures and quality of voice in transgender women. RESULTS: Twenty-three studies were identified. After exclusion of three studies due to incomplete data, 20 studies including 656 patients were included in the meta-analysis. After WG, there was a significant increase of fundamental frequency, speaking fundamental frequency, and lower limit of the frequency range (p < 0.001). Concurrently, a significant reduction of frequency range and maximum phonation time was observed (p < 0.001). No significant differences were found between the pre- and postoperative values regarding the Grade, Roughness, Breathiness, Asthenia, and Strain scale score (p = 0.339). The overall score in the Trans Woman Voice Questionnaire (TWVQ) significantly improved after WG (p < 0.001). CONCLUSIONS: WG is an effective voice feminization method in transgender women, associated with a high procedural success and low risk of postoperative complications. Significantly improved TWVQ score after surgery suggests its positive impact on the voice-related quality of life. Postoperative decrease of maximum phonation time and frequency range does not seem to significantly impact the effectiveness of voice production.

Long-Term Outcomes and Revision Rates in Laryngeal Reinnervation.

OBJECTIVES: Nonselective laryngeal reinnervation is an effective procedure to improve voice quality after unilateral vocal fold paralysis. Few studies have captured long-term outcome data, and the revision rate for this operation is currently unknown. The objective of this study is to describe the long-term outcomes and revision rates of unilateral, nonselective reinnervation in pediatric and adult patients. METHODS: Patients who underwent laryngeal reinnervation from 2000 to 2022 with a single surgeon were identified for inclusion. Patients who underwent bilateral, super selective, deinnervation and reinnervation, and/or concurrent arytenoid adduction procedures were excluded. Outcome measures included maximum phonation time [MPT], voice handicap index score [VHI], patient-reported percent normal voice, revision procedures, and complications. Data were compiled and analyzed using paired t-tests, repeated measures analysis of covariance, and binary logistic regression analysis. RESULTS: One hundred thirty-two patients underwent unilateral, nonselective ansa-recurrent laryngeal nerve [RLN] laryngeal reinnervation. Reinnervation significantly improved MPT and patient-reported percentage of normal voice and significantly decreased VHI. Eleven patients underwent revision procedures, corresponding to a revision rate of 8.3%. Additional procedures included medialization laryngoplasty [n = 3], medialization laryngoplasty with arytenoid adduction [n = 3] and injection augmentation greater than 1 year after reinnervation [n = 5]. The only factor associated with the need for additional surgery was time lapse from nerve injury to reinnervation. The overall complication rate was 6.8%; no patient required reintubation or tracheostomy. CONCLUSION: Unilateral, nonselective laryngeal reinnervation can provide reliable improvement in vocal symptoms after recurrent laryngeal nerve injury. The revision rate after laryngeal reinnervation is favorable and comparable to framework surgery. LEVEL OF EVIDENCE: 4 Laryngoscope, 134:3187-3192, 2024.

3D-exoscopic microlaryngoscopy in phonosurgery for glottic insufficiency.

PURPOSE: We hypothesized that using a 3D-exoscope (3Dex) in microlaryngoscopic phonosurgery is non-inferior to using a standard operating microscope (OM). To compare the above, we utilized a 3Dex and an OM for microlaryngoscopic vocal fold augmentation with autologous fat in patients with glottic insufficiency and compared the procedure itself and the long-term impact of vocal fold augmentation on subjective and objective voice parameters in both groups. METHODS: 36 patients with glottic insufficiency received microlaryngoscopic laryngeal augmentation with autologous fat. A 3Dex was utilized in 24 cases for visualization and compared to twelve cases in which an OM was used. Voice parameters were evaluated over a period of twelve months. RESULTS: Comparison of operation time and voice parameters between the 3Dex and OM groups did not reveal significant differences. Significant improvement of mean voice quality in all parameters excluding roughness was observed at 3 and 6 months followed then by a slight decrease of voice quality parameters between the 6 and 12 months interval in both groups. CONCLUSION: Our findings indicate no difference concerning operation time and outcome between the use of a 3Dex and an OM in phonosurgery. Our results highlight a significant voice improvement after vocal fold augmentation with autologous fat in glottic insufficiency mediated dysphonia. The smaller viewing system, better ergonomics for the primary surgeon and the assistant and a direct view for the entire surgical team make a 3Dex an interesting alternative for visualization in microlaryngoscopic phonosurgery.

Modified Montgomery thyroplasty: Customisation of the cartilage window according to laryngeal anatomy.

We described a Montgomery's thyroplasty using a set of measurement devices designed to achieve accurate individualised prosthesis placement. The objective of the present study was to describe the surgical techniques employed via a step-by-step video and show our results. In total, 42 modified thyroplasties were performed during the 10-year study period. The verification of both points: adequate location and size of the prosthesis are the keys to the success of this intervention. The individualisation of the cartilage window location produces optimal functional results in patients post-intervention in terms of the MPT, GRB score, and VHI-30.

[Present situation and progress of surgical treatment for laryngeal clefts].

At present, there is no unified gold standard for the treatment of laryngeal clefts. Type Ⅰ laryngeal clefts with mild symptoms can be treated conservatively, such as thick diet feeding and using proton pump inhibitor to control reflux, while Ⅱ-Ⅳ laryngeal clefts mostly requires surgical intervention.There are many different surgical methods for the treatment of laryngeal clefts, including injection laryngoplasty, endoscopic surgical repair of laryngeal clefts and open laryngoplasty through anterior cervical approach. How to choose a more suitable surgical plan for children is a problem worth discussing. This article will review the literature on the surgical treatment of laryngeal clefts both domestically and internationally, and summarize the current situation and challenges of surgical treatment of laryngeal clefts.

Infiltración temprana en la parálisis laríngea: evolución y factores pronósticos / Early infiltration in laryngeal paralysis: course and prognostic factors

Introducción y objetivo: La parálisis de las cuerdas vocales (CCVV) es una patología prevalente e incapacitante. El objetivo principal de este estudio es comparar la recuperación de la movilidad y funcionalidad de las CCVV, así como el requerimiento de tiroplastia en dos grupos de pacientes, los que se trataron con infiltración temprana con ácido hialurónico (GIT) y los no infiltrados (GNI). Método: Estudio retrospectivo observacional. Para formar el GNI se filtró la base de datos de 715 exploraciones de parálisis laríngeas y se seleccionaron 33 pacientes que cumplieran los criterios de inclusión. Para el GIT se incluyeron a los pacientes infiltrados por parálisis laríngea en los últimos 3 años (n=22). En el GNI se analizó como medida de resultado: la recuperación de la movilidad y funcionalidad de la cuerda y la necesidad de tiroplastia. En el GIT se midió, adicionalmente, la fecha de la infiltración. Resultados: Los resultados del GIT son significativamente mejores (p=0.001) en la recuperación de la movilidad de las CCVV. Se observa una reducción no significativa (p=0.14) en la necesidad de tiroplastia en los pacientes infiltrados. Existen diferencias significativas entre los pacientes con parálisis unilateral del GNI vs GIT (p=0.009), mientras que los grupos con parálisis bilaterales no son comparables entre sí, debido al compromiso de la vía aérea que sufren los pacientes con la cuerda en posición medial. Discusión: La infiltración con ácido hialurónico proporciona el tratamiento temporal del defecto de cierre glótico con baja tasa de complicaciones, prolongando el tiempo máximo de fonación y la funcionalidad de la cuerda vocal parética, pudiendo reducir tratamientos posteriores. Se ha propuesto como un tratamiento que puede mejorar la calidad de vida del paciente. Sin embargo, es importante seleccionar adecuadamente los pacientes, ya que no todos pueden ser candidatos... (AU)

Introduction and objective: Vocal cord paralysis is a prevalent and disabling pathology. The main objective is to compare the recovery of movility and functionality of vocal cords, as well as the requirement of definitive surgery in two groups of patients: non-infiltrated group (NIG) versus early infiltration group with hyaluronic acid (EIG). Method: Retrospective observational study. To set up the NIG, we sorted the database of 715 videos labeled as “laryngeal paralysis” and selected n=33 patients who met the inclusion criteria of the study. To create the EIG, we selected patients injected with hyaluronic acid in the last 3 years (n=22). In the NIG, the following were analyzed as outcome measures: recovery of mobility and functionality of the cord and the need for thyroplasty. In the EIG, the date of infiltration was also measured. Results: The results of the EIG are significantly better (p=0,001) in terms of vocal cord mobility recovery. A non-significant reduction (p=0.14) was observed in the need for thyroplasty in injected patients. There are significant differences between patients with unilateral paralysis of the NIG vs EIG (p=0.009), while the bilateral groups are not comparable, due to the compromise of the airway suffered by patients with the cord in a medial position. Discussion: Early infiltration with hyaluronic acid provides temporary treatment of the glottic closure defect with a low rate of complications, prolonging the maximum phonation time and improving the vocal movement, which may reduce the need for subsequent treatments. It has been proposed as a treatment that can improve the patient’s quality of life. However, it is important to properly select patients, since not all may be candidates... (AU)

Comparison of Short and Long-Term Results after Injection Laryngoplasty with Radiesse® Voice and Thyroplasty Type I in Unilateral Vocal Fold Palsy.

OBJECTIVES: Unilateral vocal fold palsy independently of etiology results in glottic insufficiency leading to unfavorable short or long-term impact on voice quality. Our aim was to evaluate the effect of injection laryngoplasty using Radiesse® Voice and thyroplasty type I on glottic closure, voice quality and aerodynamics by comparing preoperative, short- and long-term results. MATERIALS AND METHODS: Data of 32 consent patients were reviewed between 2012 and 2023. All patients underwent either injection laryngoplasty (14 patients) or thyroplasty type I (18 patients) under local anesthesia. Maximum phonation time, glottic closure based on videolaryngostroboscopy, VHI-30 values and GRBAS scale were recorded prior, short-term (3 month) and long-term (12 months) after procedures for statistical comparison. Friedman test, Mann-Whitney test and Wilcoxon signed rank tests were used for statistical analysis. RESULTS: In injection laryngoplasty group, we found significant improvement in maximum phonation time (p = 0.002), grade of hoarseness (p = 0.002) and breathiness (p = 0.000) when comparing results before and short-term after procedure. In thyroplasty type I group we saw significant improvement of maximum phonation time (p = 0.000), glottic insufficiency (p = 0.000), all three VHI-30 components (p = 0.000), as well as grade of hoarseness, breathiness (both p = 0.000) and roughness (p = 0.011) of GRBAS scale when comparing voice outcome before and short-term after procedure. There was no significant difference in voice outcome results neither between short and long-term results nor between the two groups in any parameter. CONCLUSION: These results demonstrate both short and long-term efficiency of injection laryngoplasty and thyroplasty type I in the improvement of voice quality and glottic closure.

Present situation and progress of surgical treatment for laryngeal clefts / 临床耳鼻咽喉头颈外科杂志

At present, there is no unified gold standard for the treatment of laryngeal clefts. Type Ⅰ laryngeal clefts with mild symptoms can be treated conservatively, such as thick diet feeding and using proton pump inhibitor to control reflux, while Ⅱ-Ⅳ laryngeal clefts mostly requires surgical intervention.There are many different surgical methods for the treatment of laryngeal clefts, including injection laryngoplasty, endoscopic surgical repair of laryngeal clefts and open laryngoplasty through anterior cervical approach. How to choose a more suitable surgical plan for children is a problem worth discussing. This article will review the literature on the surgical treatment of laryngeal clefts both domestically and internationally, and summarize the current situation and challenges of surgical treatment of laryngeal clefts.

Development of simulation platforms for Laser Phonosurgery, Laryngeal Endoscopy, and Fiber-carried Laser Procedures

@#<p style="text-align: justify;"><strong>Background.</strong> Simulators in laryngology are an essential part of training. They provide an avenue for medical students and resident trainees to practice valuable psychomotor skills outside the realm of an actual patient encounter - thereby decreasing the risk of possible patient morbidity. Herein we present three locally manufactured simulation devices that can be used to train residents in laryngology procedures.</p><p style="text-align: justify;"><strong>Objective.</strong> To present three simulation platform devices (Laser Box, Flexible Endoscopy Simulation, Thiel Cadaver Chair) and their applications in simulation-based learning</p><p style="text-align: justify;"><strong>Methods.</strong> The Laser Box, Flexible Endoscopy Simulation, and Thiel Cadaver Chair were manufactured by outside parties designated as 'Laser Machinists'.</p><p style="text-align: justify;"><strong>Results.</strong> Ten (10) units of the Laser Box, two (2) units of the Thiel Cadaver Chair, and two (2) units of the Flexible Endoscopy Simulation were constructed. They were used in a laryngology postgraduate course in our institution to teach the participants on endoscopies and laser phonosurgery.</p><p style="text-align: justify;"><strong>Conclusion.</strong> Simulation for otolaryngologic procedures should be an essential part of training. The learning curve for procedures such as laryngoscopy and laser phonosurgery can be addressed with the production of simulation platforms. Most institutions in the Philippines still adopt the "see one, do one, teach one" approach, which lacks standardization and puts patients at risk. Various task trainers for laser phonosurgery and flexible endoscopy have been reported in the literature, but there seems to be no published data on the use of a cadaver chair for simulation. In the COVID-19 era, aside from being excellent teaching tools, simulation platforms derive their importance in helping train residents, educate medical students, and review consultants - maximizing skill development - and thereby decreasing repeated attempts, and indirectly, exposure to the SARS-CoV-2. Future validation studies are required for the models, with the eventual long-term goals to further standardize training, increase patient safety and incorporate a simulation-based curriculum for the specialty locally.</p>

Single stage transoral cordectomy and medialization thyroplasty in early glottic squamous cell carcinoma: A case report

Objective@#To present the case of a 78-year-old man with Glottic SCCa stage I who underwent single stage transoral cordectomy type IV with medialization thyroplasty under general anesthesia. @*Methods@#Design: Case Report. Setting: Tertiary Government Training Hospital. Patient: One. @*Results@#Postoperatively, patient was able to phonate and gave a VHI score of 12 and GRBAS score of 4. He was able to resume oral feeding without any signs of aspiration. Postoperative flexible laryngoscopy showed fully mobile vocal cords with good approximation in the midline. @*Conclusion@# This report suggests that vocal cord medialization via thyroplasty may be performed after cordectomy in a single stage, providing acceptable postoperative voice as well as good swallowing outcome