One hundred years of external approach medialisation thyroplasty.

It has been 100 years since Erwin Payr first developed an operation to improve the effects of a paralysed vocal fold, and operations based on this technique are still in use today. This technique, medialisation thyroplasty, aims to improve the symptoms caused by vocal fold palsy by realigning the lateralised vocal fold into the midline. Whilst the effects of vocal fold palsy were recognised in antiquity, it was only with the development of indirect laryngoscopy in the late nineteenth century that the vocal fold paralysis could be identified as an aetiology for poor phonation and dysphagia. Payr, in 1915, was the first to perform a recognisable form of medialisation thyroplasty, which was further developed in the early twentieth century, but medialisation thyroplasty did not begin to be widely used until the development of the modern technique by Isshiki et al., in 1974. Since then, medialisation thyroplasty has continued to be developed and is currently the most widely used technique for correcting the effects of vocal fold palsy. However, a wide array of therapeutic options is now available for vocal fold palsy and it is impossible to say whether or not medialisation thyroplasty will still be used in another 100 years.

The evolution of laryngeal reinnervation, the current state of science and thoughts for future treatments.

The treatment of unilateral vocal fold palsy (UVFP) or bilateral vocal fold palsy (BVFP) has been the subject of debate and experiment for 150 years. To date, dozens of different surgical methods have been described to reinnervate this most complex of organs, the larynx. As yet, there is no consensus on the most functionally effective method of reinnervation. However, it is a rapidly expanding area of research and remains an area of controversy. Indications for reinnervation for both UVFP and BVFP are still evolving and our understanding of the neuromuscular supply to the larynx continues to expand. What may have been considered unacceptable results from previous studies with one pathology may actually be of benefit in patients with different pathologies. This uncertainty of treatment options and potential outcomes can be confusing. In addition alternative techniques have been postulated as mainstays or adjuncts of treatment to the stalwart of reinnervation, neurorrhaphy. Determining what the correct treatment for an individual patient should be is still a gray area. With this in mind, this article reviews the evolution of laryngeal reinnervation, reviews the current state of the science, and suggests directions in which it might move in the future.

[Felix Semon's contribution to the research on motor innervation of the larynx]. / Udzial Felixa Semona w badaniach nad unerwieniem ruchowym krtani.

AIM: It remains of great interest of many scientists to establish the motor innervation of the larynx. MATERIAL AND METHODS: The authors of this study analyzed available literature regarding progress in research in motor innervation of the larynx. RESULTS: Vocal folds paralysis may occur in central as well as in peripheral lesions. The movement of internal laryngeal muscles is controlled by efferent fibers of recurrent laryngeal nerves. For over 150 years intensive research has been conducted on efferent laryngeal innervation. CONCLUSIONS: The authors have commented on its progress since the second half of the XIXth century until present day. Results of the scientific investigation on the nature of laryngeal nerve supply performed by Felix Semon has been discussed.

Electrotherapy and the human voice: a literature review of the historical origins and contemporary applications.

SUMMARY: The present article surveys the literature on the electrotherapy treatment for voice disorders from the mid-18th century to World War I (1914--1918) and the post 1970s reappearance of such therapies. The reappearance of electrotherapy as treatment for voice disorders in the past 20 years has been heralded as a major breakthrough. In light of our reading of the scientific literature of the 19th century, it can be shown to repeat many of the presuppositions of electrotherapists of that time. The current resurgence of interest and research in electrical stimulation of the larynx is buoyed by technological innovations analogous to those in the 19th century. Although the current state of research has enhanced our understanding of vocal fold physiology, it does not necessarily provide a new therapeutic approach as a survey of the most recent literature shows.

War, politics, and voice: the vocal fold paralysis of George Orwell.

BACKGROUND: In 1936, like many individuals who felt the menace of fascism, George Orwell traveled to Spain to lend his support to the cause of the Republic, battling a right-wing coup. Spain, during its Civil War, was an eye-opening experience for him, yielding insights that allowed, and even compelled him to write Animal Farm and 1984. Spain was also a close brush with death. In May of 1937, in a trench on a windswept ridge near Huesca, Orwell was shot through the neck by a sniper, leaving him with a paralyzed vocal fold. DESIGN: A thorough review of firsthand accounts of Orwell's injury and subsequent care was made. These are presented in the context of current knowledge of ballistics, penetrating neck trauma, and vocal fold paralysis. RESULTS AND CONCLUSION: Orwell survived largely because of the nature of his wounding with a high-velocity jacketed military round. His recovery followed a course in many ways typical for patients with vocal fold paralysis. His writings leave us a unique and extraordinary account of the experience of being shot, of the medical care of the day, of the handicap of paralytic dysphonia, and of survival and heroism under extraordinary circumstances.

The evolution of the assessment and treatment of paralytic dysphonia.

Vocal fold paralysis has been an omnipresent disorder throughout the annals of laryngologic history since the origin of the specialty in 1858. The attendant complexity of laryngoscopic presentation, physiologic dysfunction, and surgical rehabilitation have led to a rich heritage of scientific investigations that can be traced through the past 140 years. The following historical summary provides the reader with a working knowledge of past experiences that connect to current initiatives and portend future progress.

Tapia's syndrome. The erratic evolution of an eponym.

The syndrome first described in 1904 by the Spanish otolaryngologist, Antonio Garcia Tapia, has been variously interpreted by subsequent authors such that there is little current agreement as to the site of the lesion responsible for the condition or the specific symptoms included in this disorder. The confusion arose in part because Tapia's original patient had associated neurologic findings. Careful review of Tapia's reports reveals (1) that he regarded the syndrome as consisting of ipsilateral hemiplegia of the larynx and tongue with normal function of the soft palate and (2) that he believed the lesion resulting in these signs was outside the CNS.

Reconstruction of laryngeal function for recurrent laryngeal nerve paralysis: historical view, advancement of latest investigations and a preliminary experiment.

Historical investigations of the functional restoration for recurrent laryngeal nerve paralysis are reviewed and some advancement in recent studies are introduced. A preliminary experiment is reported in which the ansa hypoglossi and the sternothyroid muscle pedicle was implanted into the denervated posterior cricoarytenoid muscle in dogs. From these experiments we have concluded that the ansa hypoglossi and sternothyroid muscle pedicle, which has been shown to transmit efferent inspiratory bursts, is capable of restoring function to the paralyzed posterior cricoarytenoid muscle in some dogs.