Reduction in Short- and Long-term Pneumonia Rate With Laryngoplasty for Unilateral Vocal Fold Paralysis.

OBJECTIVE: To examine the association of laryngoplasty, voice therapy, and pneumonia rate in patients with unilateral vocal fold paralysis (UVFP). STUDY DESIGN: Population-based retrospective cohort study. SETTING: Data were collected from the LHID2000 (Longitudinal Health Insurance Database 2000), containing the information of 1 million randomly selected patients in Taiwan. METHODS: In the LHID2000, we identified 439 patients having new diagnoses of UVFP from 1997 to 2013. We grouped the aforementioned patients according to UVFP treatment and probed the occurrence of pneumonia: 305 patients underwent laryngoplasty or voice therapy, and 134 patients did not undergo treatment. Follow-up procedures were executed for the enrollees until death or December 31, 2013, representing the end of the study period. We assessed the association of UVFP treatment and pneumonia by executing Cox proportional hazards regression. RESULTS: The pneumonia cumulative incidence was significantly higher among enrolled patients without treatment than in those receiving treatment (P < .001). The pneumonia incidence was significantly lower in patients receiving UVFP treatment (hazard ratio, 0.49; 95% CI, 0.27-0.88; P = .018), as validated by the Cox proportional hazards model after adjustment. Patients undergoing laryngoplasty with or without voice therapy had a significantly lower incidence of pneumonia at 6 months and 1, 3, and 5 years, whereas those undergoing voice therapy alone did not. CONCLUSION: Laryngoplasty was associated with a lower incidence of short- and long-term pneumonia in patients with UVFP. Physicians should encourage patients with UVFP at risk of aspiration to receive prompt evaluation as well as treatment.

Rehabilitation Protocol for Unilateral Laryngeal and Lingual Paralysis (Tapia Syndrome): Comment About "A Challenging Case of Tapia Syndrome After Total Thyroidectomy" By Ildem Deveci, Mehmet Surmeli, and Reyhan Surmeli.

Tapia syndrome is a rare complication after surgery, with ipsilateral paralysis of vocal cord and tongue due to extracranial involvement of recurrent laryngeal and hypoglossal nerves. Tapia's case report is extremely interesting for both the rarity of the reported cases and for the importance of an early rehabilitation. In a previous work, we reported a case of Tapia syndrome after cardiac surgery for aortic aneurysm, and the protocol of logopedic rehabilitation adopted. In the postoperative period, he developed severe dyspnea and dysphagia that required a tracheostomy and a logopedic rehabilitation therapy that led to a fast and efficient swallowing without aspiration after 47 sessions (less than 4 months). The progressive recovery of the function suggests aprassic nerve damage. However, the logopedic therapy is recommended to limit the possibility of permanent functional deficits and quickly recover swallowing and phonation.

Unilateral Vocal Fold Paralysis and Voice Therapy: Does Age Matter? A Prospective Study With 100 Consecutive Patients.

OBJECTIVE: To use a multidimensional assessment to analyze potential influence of "aging" in the functional outcomes achieved by a group of patients with recent onset of unilateral vocal fold paralysis (UVFP) who underwent voice therapy. DESIGN: Prospective, observational, and cross-sectional study. SETTING: Otolaryngology department, Centro Hospitalar do Porto. PARTICIPANTS: Patients with UVFP who underwent voice therapy. MAIN OUTCOME MEASURES: Data regarding gender, age, side and position of the paralyzed vocal fold, etiology, comorbidities, and Voice Handicap Index (VHI)-30 questions, before and after voice therapy, were collected. Glottal insufficiency was also evaluated, by endoscopic laryngoscopy, before and after voice therapy. RESULTS: A total of 100 patients (76 females and 24 males) with UVFP were included. Mean age was 61.04 years (range: 21-88 years). The mean score of VHI, before and after voice therapy, was statistically different (P < .001) with a lower score after therapy. The score of VHI was not influenced by age (P = .717). However, for each 10-year increase in age, the score of VHI, before and after voice therapy, increased 1.91 and 2.86 units, respectively. As concerns endoscopic findings, 80% of patients exhibited better glottis closure after voice therapy (P < .001), and this was not influenced by age. Nevertheless, for each 10-year increase in age, the chance of endoscopic improvement reduced 3%. CONCLUSIONS: A clear and significant improvement was visible in the endoscopic and self-assessment ratings after rehabilitation by isolated voice therapy. Despite possible anatomical and physiological aging changes in the phonatory system, age did not compromise the successful rate obtained by voice therapy.

Rehabilitation Therapy for Vocal Fold Paralysis Caused by Lung Cancer: A Case Report.

OBJECTIVE: Unilateral vocal fold paralysis (UVFP) can be caused by iatrogenic injury or tumor-induced damage to the recurrent laryngeal nerve. Studies of comprehensive rehabilitation therapies for patients suffering from severe UVFP are limited. The purpose of this case report is to describe an improvement in complete aphonia after comprehensive rehabilitation therapies in a patient with severe UVFP due to a lung tumor. METHODS: An 81-year-old woman with a history of bronchial adenoma had complete aphonia due to compression of the left recurrent laryngeal nerve by the tumor. Dynamic fibrolaryngoscope revealed paralysis of the left vocal fold. The patient was treated with interferential current therapy, vocal training, and kinesiology taping. Indicators of voice recovery were scored according to the grade, roughness, breathiness, asthenia, strain scale, and the voice handicap index. RESULTS: After 10 days of comprehensive rehabilitation treatment, the patient recovered from complete aphonia to normal communication. The hoarseness and breathiness of patient were significantly improved. In addition, the grade, roughness, breathiness, asthenia, strain, and the voice handicap index scores changed from severe to mild or absent. CONCLUSION: This case provided a novel comprehensive treatment for a patient with UVFP, which was safe, cost-effective, and easy to implement in clinic.

Is a voice-specific instrument more indicative of stroboscopy results than common clinical queries?

OBJECTIVES: To determine whether the Voice Handicap Index-10 (VHI-10) predicts diagnoses made via laryngoscopy/stroboscopy, as compared to common clinical inquiries about vocal characteristics. METHODS: We prospectively collected data from a cohort of 204 consecutive patients newly presenting for ambulatory laryngology evaluation. Each patient completed the VHI-10 and 16 concurrent mainstream queries about vocal characteristics such as weakness, breathiness, fatiguability, or inability to shout. Using the objective diagnoses made by laryngoscopy/stroboscopy as a gold standard, the area under the receiver operating characteristic curves (AUC), sensitivity, and specificity were determined. RESULTS: For unilateral vocal fold paralysis, VHI-10 scores had an AUC of 0.78 (95% CI, 0.68-0.88) and had better discrimination than 12 common clinical queries. At a threshold score of ≥11, VHI-10 sensitivity was 0.94; at a threshold of ≥31, specificity was 0.91. For laryngeal stenosis, the VHI-10 score demonstrated moderate discrimination, with an AUC of 0.79 (95% CI, 0.56-1.00) and higher discrimination than three common clinical queries. At a threshold score of ≥11, VHI-10 sensitivity was 1.00; at a threshold of ≥31, specificity was 0.89. Both VHI-10 scores and common clinical queries had low diagnostic ability for vocal fold paresis, laryngopharyngeal reflux (LPR), paradoxical vocal fold motion, and vocal fold scar or atrophy. CONCLUSIONS: The VHI-10 score is an effective diagnostic indicator of laryngoscopy/stroboscopy findings of vocal fold paralysis and laryngeal stenosis, performing better than multiple mainstream queries about vocal characteristics. VHI-10 scores and common clinical queries are limited in their ability to indicate paresis, reflux, paradoxical motion, and vocal fold scar or atrophy. LEVEL OF EVIDENCE: 2c Laryngoscope, 130:992-999, 2020.

Parálisis vocal, logopedia y análisis acústico. Estudio de resultados de 43 pacientes / Vocal paralysis, speech therapy and acoustic analysis. 43-patient-results study

Introducción y objetivos: Consideramos que existe patología vocal cuando apreciamos anomalías en el tono, volumen y/o calidad de emisión que en conjunto afectan a la comunicación oral. La literatura actual en torno al trastorno vocal subraya la importancia de una voz cuidada y de calidad para cumplir requisitos sociales y ocupacionales. Además, la voz es una herramienta profesional esencial para un tercio de la población adulta laboralmente activa. Nuestro objetivo es conocer la evolución de pacientes diagnosticados de parálisis vocal con apreciaciones subjetivas y el estudio de las variaciones sucedidas en el análisis acústico antes y tras el periodo de rehabilitación logopédica. Métodos: Se ha realizado un estudio descriptivo, longitudinal, prospectivo, observacional y unicéntrico de 43 pacientes por medio de entrevista, exploración ORL completa, estudio de voz instrumental y puntuaciones subjetivas profesionales y del paciente, mediante encuestas de satisfacción y valoración del daño. Tras ello, se realizó un análisis multidimensional de los resultados con el programa SPSS. Resultados: Una vez analizados los datos, hallamos que la parálisis de cuerda vocal se manifestó más frecuentemente en el sexo femenino, en edades alrededor de los 50 años, tras cirugía tiroidea, y especialmente en la cuerda vocal izquierda. Por medio de la terapia se obtuvieron mejorías significativas y medibles en los parámetros jitter, shimmer, GRABS, tiempos máximos fonatorios (TMF) e índice de incapacidad vocal (VHI). De las variables estudiadas, las que mejor correlacionan entre sí son jitter, shimmer, y TMF /e/ y /s/. Destaca la alta correlación positiva de los VHI entre sí; y en cuanto a correlaciones negativas, destaca la existente entre shimmer y la razón armónicos-ruido (HNR). Conclusiones: A la vista de los resultados, consideramos eficaz iniciar terapia logopédica precoz y valorar la evolución antes de plantear opciones quirúrgicas. Además, sin duda, sería preciso reducir las demoras tanto en el diagnóstico como en los tratamientos en la atención especializada. Creemos necesario mejorar la comunicación entre especialistas ORL y logopedas para aumentar el éxito de la rehabilitación, obteniendo mayores cuotas de información desde ambos profesionales

Introduction and objectives: A voice disorder exists when there is a change in pitch, volume and/or emission quality that, together, affects oral communication. Currently, literature related to vocal impairment highlights the importance of a healthy voice to achieve social and occupational requirements. Besides, voice is a basic professional tool for a third of active working population. It was our intention to study the evolution of patients diagnosed of vocal paralysis with subjective measurements and also acoustic analysis variations before and after speech therapy. Methods: In this study, 43 patients were included and underwent an instrumental examination and interview, with complete endoscopic otolaryngologic examination, as also subjective punctuations and damage and satisfaction standard scores filling out. Further statistic study shows results and conclusions are inferred. Results: Vocal cord palsy has been brought about more frequently in the left side, in women, at an age around 50, and after thyroid surgery. Significant improvement in measurements were observed in jitter, shimmer, GRABS, Maximum Phonation Time (MPT) and Voice Handicap Index (VHI). Best correlating parameters are jitter, shimmer and MPT /e/ and /s/. It stands out a high positive correlation between VHI, and as for negative, the one between shimmer and Harmonics-Noise-Ratio (HNR) is flashy. Conclusions: We find speech therapy very effective in early rehabilitation, before surgery is considered. It would be desirable to shorten delays in specialized medical care diagnosis and therapy onset. It is our believe that a better and wider communication between ENT specialists and speech and language specialists would improve results and prognosis

Liuzijue Qigong: A Voice Training Method For Unilateral Vocal Fold Paralysis Patients.

OBJECTIVES: Liuzijue Qigong (LQG), a kind of traditional Chinese health exercise (TCHE), is not only widely used to strengthen physical fitness and maintain psychological well-being in the elderly but has also been utilized to help improve respiratory function. As respiratory support is an important driving force for speech production, it is logical to postulate that the LQG training method with 6 monosyllabic speech sounds, xu, he, hu, si, chui, and xi, can help individuals (1) experience a relaxing and natural state of speech production, (2) eliminate voice symptoms, and (3) improve their overall body function and mood. In the current study, we hypothesized that the LQG method with these 6 sounds can be effective in improving vocal function in subjects with unilateral vocal fold paralysis (UVFP) in comparison with a conventional voice therapy method. METHODS: A total of 48 patients with UVFP who met the inclusion criteria were randomly divided into 2 groups. Twenty-four subjects in the experimental group were trained with LQG, and those in the control group received conventional voice training (abdominal breathing and yawn-sign exercises) for a total of 4 sessions, twice a week. Patients in both groups were assessed with acoustic tests, the GRBAS scale, the Voice Handicap Index (VHI-10), and the Hospital Anxiety and Depression Scale (HADS) pre- and posttreatment. Statistical analysis was conducted using nonparametric tests and t tests. RESULTS: There existed significant changes in maximum phonation time (MPT), jitter, shimmer, normalized noise energy (NNE), GRBAS scores, VHI-10 scores, and grade of A in HADS scores pre- and posttreatment in both the experimental group and the control group ( P < .004). However, no significant changes were seen posttreatment between the 2 groups ( P > .05). CONCLUSIONS: LQG could help improve vocal function in UVFP patients as our preliminary data showed no significant differences between LQG and conventional voice therapy methods.

Vocal Fold Motion Recovery in Patients With Iatrogenic Unilateral Immobility: Cervical Versus Thoracic Injury.

OBJECTIVES:: Prognostic information about the return of vocal fold mobility in patients with iatrogenic unilateral vocal fold immobility (UVFI) can help with informed decisions about temporary and permanent treatment options. Although many variables can influence the likelihood of recovery, clinical experience suggests that cervical versus thoracic injury is a determining factor. The purpose of this study was to compare recovery rates from UVFI between cervical and thoracic injuries. METHODS:: A retrospective review of the medical record was performed on all adult patients diagnosed with complete iatrogenic UVFI from 2005 to 2015 (n = 923). Patients with incomplete data and etiologies of idiopathic, malignancy, or stenosis were excluded, leaving a study cohort of 502 patients who were categorized as having UVFI after cervical (n = 329) or thoracic (n = 173) injury. Data regarding site of iatrogenic injury (cervical vs thoracic), mobility status, and time interval to recovery or surgical intervention were recorded and compared using χ2 analyses. RESULTS:: Overall, 15% of patients recovered vocal fold mobility at a median of 4.1 months. Patients with cervical injury (65 of 329 [20%]) were significantly more likely to recover mobility than patients with thoracic injury (11 of 173 [6.4%]) (odds ratio, 3.63). The cervical cohort contained more women (68% vs 31%) and was younger (mean age, 60.4 ± 13.8 vs 64.1 ± 16.1 years; Cohen's D = 0.25). CONCLUSIONS:: Patients with cervical injuries resulting in UVFI are 4 times more likely to recover mobility than patients with thoracic injuries. This information can be valuable in counseling patients with UVFI and may affect clinical decision making.

Recurrent laryngeal nerve reinnervation: is this the standard of care for pediatric unilateral vocal cord paralysis?

PURPOSE OF REVIEW: Ansa to recurrent laryngeal nerve reinnervation, otherwise known as a nonselective laryngeal reinnervation (NSLR), is growing in popularity for the management of pediatric unilateral neuronal vocal fold movement impairment (VFMI). In this chapter, we will review the current treatment options for neuronal VFMI and role that NSLR plays in the treatment algorithm. RECENT FINDINGS: In 2018, Bouhabel and Hartnick published a survey of fellowship trained pediatric otolaryngologists and found an increasing comfort level with NSLR. Respondents felt that NSLR resulted in favorable subjective and objective postsurgical voice outcomes. Furthermore, NSLR may decrease the risk of aspiration in children with neuronal VFMI. Although NSLR appears to work, the voice results are not perfect for all children. Further work is being done to understand which preoperative variables, such as age, time from injury, and preop laryngeal electromyography, may predict a better voice outcome. SUMMARY: A variety of treatment options exist for unilateral neuronal VFMI. Recent data and developments demonstrate the effectiveness of reinnervation as a potential first-line surgical intervention in children with unilateral neuronal VFMI.

Thyroplasty in unilateral vocal fold paresis with coexisting hereditary hemorrhagic telenagiectasia: A case report.

RATIONALE: The coincidence of an idiopathic unilateral vocal fold paresis and hereditary hemorrhagic telenagiectasia (HHT) is extremely rare and has not been described in the available literature yet. PATIENTS CONCERNS: A 55-year-old female was admitted to hospital due to acute onset of hoarseness, voice fatigue, and effort dyspnea. In the past, the patient was diagnosed with HHT and on admission presented characteristic vascular lesions in the oral cavity. She reported also experiencing a moderate epistaxis at least once per month. DIAGNOSES: The otolaryngological examination (fiberolaryngoscopy, phoniatric examination) revealed unchanged mobility and morphology of the right vocal fold and paresis of the left vocal fold in intermediate position. Computed tomography and magnetic resonance imaging of head, neck, and chest were inconclusive and showed no pathologic findings. INTERVENTIONS: The unilateral paresis was treated for 12 months as idiopathic, with extensive rehabilitation. However, no improvement was observed. As a patient suffering from HHT is a challenge for anesthesiologists in terms of general anesthesia, the decision to perform type I thyroplasty (medialization) in local anesthesia was made. OUTCOMES: There were no complications intraoperatively or in postoperative period. The implemented treatment was successful, as the voice quality improved both in perceptual evaluation (GRBAS scale) and acoustic analysis (F0, jitter, shimmer, NHR). LESSONS: A routine surgical treatment in patients with HHT is a challenge. However, in this case, it was uneventful and successful, thus it can be recommended in other patients with similar background.

Assessment of short-term functional voice therapy in patients with unilateral paralysis of the larynx.

Introduction Laryngeal paralysis deteriorates all laryngeal functions. Therefore the therapeutic process must include restoration of respiratory, defensive and vocal function. Selection of a proper rehabilitation path plays a key role. Appropriate research protocol that includes objective methods of voice evaluation is an important element of monitoring the return of vocal efficiency. Voice efficiency is important for the patient particularly due to psychological and social reasons. Aim The aim of the study was the assessment of short-term functional voice therapy (FVT) in patients with unilateral paralysis of the larynx with the usage of objective parameters describing the glottis and voice quality. Material and Method During the last 10 years 355 patients with laryngeal paralysis were hospitalized in the Audiology and Phoniatrics Clinic due to dysphonia. All patients undergone 5-day FVT. From 2015 we unified diagnostic protocol measuring parameters obtained from videostrobokymography (VSK), electroglottography (EGG), perceptual and acoustic voice analysis before and after 5 day hospitalization. Results After FVT patients improved voice quality and glottal compensation. The majority of patients achieved a statistically significant improvement in the VSK, EGG, MDVP and perceptual analysis. Group of patients with unsatisfactory voice improvement after therapy required a prolonged rehabilitation or has been qualified for laryngeal microsurgery. Potential factors that could have cause insufficient effects of FVT were analysed. Conclusions The complexity of voice rehabilitation is crucial for the success of therapy. Interdisciplinary therapeutic team plays a significant role during voice rehabilitation in patients with vocal fold paralysis.

Effects of Voice Therapy on Laryngeal Motor Units During Phonation in Chronic Superior Laryngeal Nerve Paresis Dysphonia.

OBJECTIVES: Injury to the superior laryngeal nerve can result in dysphonia, and in particular, loss of vocal range. It can be an especially difficult problem to address with either voice therapy or surgical intervention. Some clinicians and scientists suggest that combining vocal exercises with adjunctive neuromuscular electrical stimulation may enhance the positive effects of voice therapy for superior laryngeal nerve paresis (SLNP). However, the effects of voice therapy without neuromuscular electrical stimulation are unknown. The purpose of this retrospective study was to demonstrate the clinical effectiveness of voice therapy for rehabilitating chronic SLNP dysphonia in two subjects, using interspike interval (ISI) variability of laryngeal motor units by laryngeal electromyography (LEMG). METHODS: Both patients underwent LEMG and were diagnosed with having 70% recruitment of the cricothyroid muscle, and 70% recruitment of the cricothyroid and thyroarytenoid muscles, respectively. Both patients received voice therapy for 3 months. Grade, roughness, breathiness, asthenia, and strain (GRBAS) scale, stroboscopic examination, aerodynamic assessment, acoustic analysis, and Voice Handicap Index-10 were performed before and after voice therapy. Mean ISI variability during steady phonation was also assessed. RESULTS: After voice therapy, both patients showed improvement in vocal assessments by acoustic, aerodynamic, GRBAS, and Voice Handicap Index-10 analysis. LEMG indicated shortened ISIs in both cases. CONCLUSIONS: This study suggests that voice therapy for chronic SLNP dysphonia can be useful for improving SLNP and voice quality.

Comparison of EMG signals recorded by surface electrodes on endotracheal tube and thyroid cartilage during monitored thyroidectomy.

A variety of electromyography (EMG) recording methods were reported during intraoperative neural monitoring (IONM) of recurrent laryngeal nerve (RLN) in thyroid surgery. This study compared two surface recording methods that were obtained by electrodes on endotracheal tube (ET) and thyroid cartilage (TC). This study analyzed 205 RLNs at risk in 110 patients undergoing monitored thyroidectomy. Each patient was intubated with an EMG ET during general anesthesia. A pair of single needle electrode was inserted obliquely into the TC lamina on each side. Standard IONM procedure was routinely followed, and EMG signals recorded by the ET and TC electrodes at each step were compared. In all nerves, evoked laryngeal EMG signals were reliably recorded by the ET and TC electrodes, and showed the same typical waveform and latency. The EMG signals recorded by the TC electrodes showed significantly higher amplitudes and stability compared to those by the ET electrodes. Both recording methods accurately detected 7 partial loss of signal (LOS) and 2 complete LOS events caused by traction stress, but only the ET electrodes falsely detected 3 LOS events caused by ET displacement during surgical manipulation. Two patients with true complete LOS experienced temporary RLN palsy postoperatively. Neither permanent RLN palsy, nor complications from ET or TC electrodes were encountered in this study. Both electrodes are effective and reliable for recording laryngeal EMG signals during monitored thyroidectomy. Compared to ET electrodes, TC electrodes obtain higher and more stable EMG signals as well as fewer false EMG results during IONM.

Úlcera penetrante de aorta torácica con parálisis del nervio recurrente (síndrome de Ortner) / Penetrating ulcer of the thoracic aorta with recurrent nerve palsy (Ortner's syndrome)

No disponible

[The modern approach to the conservative treatment of the patients presenting with postoperative bilateral vocal fold palsy]. / Sovremennyi podkhod k konservativnomu lecheniiu bol'nykh s posleperatsionnym dvustoronnim narusheniem podvizhnosti golosovykh skladok.

The objective of the preset study was to further improve the diagnostics and treatment of unilateral palsies of the laryngeal recurrent nerves associated with transitory reflective spasm of the functionally competent vocal fold. The study included 49 patients (46 women and 3 men) at the age varying from 21 to 75 years presenting with unilateral palsies of the laryngeal recurrent nerves associated with transitory reflective spasm of the functionally competent vocal fold that developed after the surgical intervention on the thyroid gland. The electromyographic test for latent tetany was performed for diagnostics and objective evaluation of the results of the treatmen. In addition, the blood ionized calcium levels were measured and videolaryngostroboscopy was used. The treatment included respiratory gymnastics, reflexotherapy (novocaine blockade of the Zakhar'in - Head's zone for the larynx, auricolotherapy, and pharmacotherapy with the prescription of vitamin-calcium preparations, myorelaxants, sedatives, and phonopedia. A loud enough resounding voice was restored in all the 49 participants of the study with the normalization of respiration and the complete cessation (or reduction to a minimum) of the reflexive coughing spells and laryngeal reflex spasms. None of the patients required tracheotomy during the follow-up period.

[On the problem of voice rehabilitation in the case of unilateral vocal fold paresis]. / O reabilitatsii golosa pri odnostoronnem pareze golosovykh skladok.

BACKGROUND: Unilateral vocal fold paresis (UVFP) significantly deteriorates the patient's quality of life. The leading role in the rehabilitation of the patients presenting with UVFP belongs to stimulation therapy which consists in the activation of muscle re-innervation of the larynx and the compensatory mechanisms allowing to achieve the most complete closure of the vocal folds during phonation. AIM: The objective of the present study was the optimization of the conservative treatment of patients with UVFP. MATERIAL AND METHODS: Fifty patients at the age varying from 18 to 70 years presenting with UVFP (the duration of the disease less than 6 months underwent the comprehensive treatment including electrostimulation of the larynx, vitamin therapy, and speech therapy. The patients were divided into two groups: A and B comprised of 25 subjects each. Those of Group A were given, in addition to the standard treatment, a 1.5 month-long course of Neuromidin therapy. The results of the treatment were evaluated with the use of laryngostroboscopy, flowmetry, the GRBAS scale, acoustic voice analysis (lingWaves), and the VHI questionnaire. RESULTS: The restoration of vocal fold mobility was achieved in 20% and 8% of the patients of groups A and B respectively. The clinical effect was absent in 12% of the patients in Group A and 28% of the patients in Group B. The differences between groups were statistically significant (p<0.05). In the remaining cases, the positive dynamics of the flowmetric characteristics, GRBAS and VHI data, maximum phonation time, Jitter, DSI, frequency and dynamic ranges as well as the intensity of voice were documented in 68% of patients in Group A and 64% of patients in Group B). CONCLUSION: The results of the study confirm the usefulness of the combined treatment of UVFP consisting of electrostimulation of the larynx together with speech therapy and application of cholinergic drugs. The addition of Neuromidin to the conventional scheme of conservative treatment can further improve its efficiency from 72% to 88%.

Laryngeal pacing via an implantable stimulator for the rehabilitation of subjects suffering from bilateral vocal fold paralysis: A prospective first-in-human study.

OBJECTIVES/HYPOTHESIS: To evaluate the performance and safety of the newly developed Laryngeal Pacemaker System (LP System) for the treatment of bilateral vocal fold paralysis (BVFP). STUDY DESIGN: Feasibility, first-in-human, single-arm, open-label, prospective, multicenter study with a group sequential design and a 6-month follow-up period. METHODS: Nine symptomatic BVFP subjects were implanted unilaterally with the LP System. Pre- and 6-month postimplantation evaluations consisted of the 6-Minute Walk Test (6MWT), the Peak Expiratory and Inspiratory Flow (PEF and PIF) evaluation, the PEF meter analysis, the 36-Item Short Form Health Survey (SF-36), the Glasgow Benefit Inventory (GBI), the 12-Item Voice Handicap Index (VHI-12), and the Fiberoptic Endoscopic Evaluation of Swallowing. The safety profile of the LP System was continuously monitored. RESULTS: The LP System implantation was achieved in 8/9 cases. Seven of the nine subjects completed the study. Absolute PEF and PIF values improved significantly 6 months postimplantation (P < .05). 6MWT results showed a non-statistically significant improvement (P = .09). The mental component of the SF-36 showed a significant improvement (P = .043), whereas the other SF-36 components, the GBI, and the VHI-12 results did not changed significantly. The LP System did not affect the voice and swallowing quality and maintained a reliable safety profile for the duration of the study. CONCLUSIONS: This feasibility study showed that the LP System has the potential to become an effective and safe treatment for BVFP subjects without compromising the patients' voice. LEVEL OF EVIDENCE: 2b Laryngoscope, 126:1810-1816, 2016.

Parálisis de cuerda vocal unilateral: estudio de la calidad vocal después del tratamiento logopédico / Unilateral vocal fold paralysis: quality of voice after speech therapy

Fundamento: Describir los factores sociodemográficos de pacientes con parálisis de cuerda vocal unilateral (PCVU) a los que se aplica un tratamiento logopédico y analiza el impacto en la calidad vocal tras la terapia. Metodología: Se incluyeron 47 pacientes con PCVU diagnosticada mediante vídeo-laringoscopia. Todos recibieron intervención logopédica repartida en 15 sesiones y estructurada en tres etapas progresivas. Se instruyó al paciente en técnicas vocales, coordinación fono-respiratoria, control del soplo, tonificación glótica e impostación vocal. Los parámetros incluidos en el estudio antes y después de la terapia fueron: cierre glótico, Voice Handicap Index-10 (VHI-10) para medir la autopercepción de calidad vocal y escala GRABS para la calidad vocal. Resultados: La edad media fue 51 años (rango 20-80), 60% mujeres. La causa quirúrgica fue la más frecuente (72%). El 40% desempeñaban una profesión relacionada con la voz. El tiempo medio desde el diagnóstico hasta el inicio del tratamiento fue 5 meses (2-12). El cierre glótico completo aumentó de 34 a 80% (p<0,001), la puntuación en VHI-10 descendió de 24,24 a 16,09 puntos (p<0,001) y los valores de GRABS mejoraron en todas las cualidades de la voz (p<0,001). Solo un 8,5% requirió cirugía post-tratamiento. Conclusiones: La terapia de reeducación vocal es eficaz como primera indicación terapéutica en pacientes con PCVU, reservando la medialización con material no reabsorbible o cirugía de tiroplastia a aquéllos con mala evolución. No obstante, es necesario reducir el tiempo que se demora el paciente en llegar a la Unidad de Voz tras el diagnóstico laringoscópico (AU)

Background: To describe demographic factors and voice quality parameters of patients with unilateral vocal fold paralysis (UVFP) after a voice therapy protocol. Methods: Forty-seven patients with a diagnosis of UVFP by video-laryngoscopy were included. Voice therapy was applied to all patients during 15 sessions that were structured in three progressive stages. The objective was to train patients in vocal techniques, phonic-breathing coordination, blow control, vocal exercises for glottic closure and vocal setting. Glottal closure, Voice Handicap Index-10 for perception of voice impairment and GRBAS scale were used before and after the speech therapy. Results: The average age was 51 years (range 20-80), 60% women. Surgery was the most frequent cause (72%), and 40% had a profession related to voice use. Median time from diagnosis to treatment was 5 months (2-12). After voice therapy, 80% had complete glottal closure, previously this had been 34% (p<0.001), the score of VHI-10 decreased from 24.24 to 16.09 points (p<0.001) and GRBAS values improved in all the qualities of voice (p<0.001). Only 8.5% of the patients required surgical intervention after treatment. Conclusions: Voice therapy is effective as first line therapy in patients with UVFP, reserving medialization with non-absorbable material or thyroplasty surgery for those with a poor outcome. However, it is necessary to reduce the time it takes the patient to reach the Voice Unit after laryngoscopic diagnosis (AU)

Early voice rehabilitation with injection laryngoplasty in patients with unilateral vocal cord palsy after thyroidectomy.

Injection laryngoplasty is a safe and efficient procedure for the management of hoarseness resulting from unilateral vocal cord paralysis (VCP). However, proper timing and material of injection after the occurrence of VCP are still under discussion. This study aimed to evaluate the efficacy of early injection laryngoplasty with long-lasting soft tissue filler in patients with post-thyroidectomy unilateral VCP. We retrospectively reviewed the medical records of 59 consecutive patients who developed unilateral VCP after thyroidectomy and received ArteSense™ injection laryngoplasty. Objective and subjective voice outcomes were compared between early (within 3 months) and late (after 3 months) injection groups. The mean duration from thyroidectomy to injection laryngoplasty was 39.7 and 334.2 days in the early and late injection groups, respectively. All of the tested objective and subjective voice parameters were significantly improved in both the early and late groups. However, the amount of voice improvement was significantly larger in the early injection group, especially jitter% (P = 0.02) and shimmer% (P = 0.03) improvement. Four patients showed spontaneous recovery from VCP after early injection laryngoplasty; nevertheless, their voice outcomes were excellent and there was no significant discomfort or complication. Early voice rehabilitation with injection laryngoplasty is a safe and efficient treatment in the patients with post-thyroidectomy unilateral VCP.