Hoarseness Due to Bamboo Nodes in Patients with Autoimmune Diseases: A Review of Literature

SUMMARY: This is a retrospective report on clinical features, laryngoscopic examinations, and follow-up markers of laryngeal manifestation described as bamboo nodes in three female patients with transverse cystic lesions of the vocal folds, treated with logopedic therapy. This study examines logopedic and phoniatric aspects in patients with submucosal "bamboo joint-like nodes" of both vocal folds, and reveals an improvement of different voice quality features after conservative traditional voice therapy. There still exists no standard treatment regimen in patients with rheumatoid disease of the larynx; a lack of consensus is most evident in the role of voice therapy. We would like to emphasize the favorable impact of logopedic therapy in benign laryngeal disorders with underlying autoimmune diseases.     

Late complication of type 1 thyroplasty: A case report

We present a previously unreported late complication of medialization laryngoplasty (ML), also described as a thyroplasty, type 1. Five years following ML with Silastic, a 64-year-old female presented with dysphonia and a mass in the laryngeal ventricle on the ipsilateral side of the ML. A computed tomography scan of the larynx revealed migration of the thyroid cartilage window into the ventricle without migration of the Silastic implant. These findings were confirmed on surgical exploration. Following removal of the Silastic implant and the thyroid cartilage window fragment, the patient was successfully remedialized with autologous lipoinjection. Migration of the thyroid cartilage window appears to be a late complication of ML when the thyroid cartilage window is left intact and not removed. Complications of ML are discussed; specifically, difficulties resulting from retention of the thyroid cartilage window at the time of the ML are addressed.     

Autologous fat implantation for vocal fold scar: A preliminary report

New insights into the anatomy and physiology of phonation, along with technological advances in voice assessment and quantification, have led to dramatic improvements in medical voice care. Techniques to prevent vocal fold scar have been among the most important, especially scarring and hoarseness associated with voice surgery. Nevertheless, dysphonia due to vocal fold scar is still encountered all too frequently. Although it is not generally possible to restore such injured voices to normal, patients with scar-induced dysphonia can usually be helped. Voice improvement is optimized through a team approach. Treatment may include sophisticated voice therapy and vocal fold surgery. Although experience with collagen injection has been encouraging in selected cases (particularly in those involving limited areas of vocal fold scar), there is no consistently successful surgical technique. Attempts to treat massive vocal fold scar, such as may be seen following vocal fold stripping, have been particularly unsuccessful. This paper reports preliminary experience with the implantation of autologous fat into the vibratory margin of the vocal fold of patients with severe, extensive scarring. Using this technique, it appears possible to recreate a mucosal wave and improve voice quality. Additional research is needed.     

The type I thyroplasty window: Implications of normal thyroid cartilage thickness

This paper describes the dimensions and placement of a standardizedIsshiki Type I thyroplasty window and the thickness of the thyroid cartilage at the window corners. In addition, the intraoperative optimal medialization of a series of windows is compared to these cartilage thickness measurements and these comparisons analyzed for their implications in surgical approach.Fifty-one Type I thyroplasty windows were fashioned on 42 larynges (cadavericand surgical). Measurements were taken of the window sizes, depth of medialization (surgical cases), and thickness of the thyroid cartilage at the four corners of the rectangular window. Sexes were kept separate because of inherent size differences of male and female larynges. From these physical measurements it is found that: (1) the thyroid cartilage window is not uniform in thickness throughout; there is a gradation of thickness from anterior to posterior and from superior to inferior; (2) when comparing the average depth of medialization to the window cartilage thickness in a standardized Isshiki window, the average distance of window depression almost equals the thyroid cartilage thickness, whereas posteriorly there is slightly more distance between the external surface of the window cartilage and the internal surface of the surrounding thyroid cartilage. Implications of the varying thickness of the thyroid cartilage and its relationship to the average depth of medialization in a standardized Isshiki thyroplasty window are discussed.     

Type I thyroplasty: Pitfalls of modifying the Isshiki approach.How I do it

The Isshiki type I thyroplasty medializes the membranous portion of thevocal fold. Since its introduction into this country more than 10 years ago, several authors have reported modifications of the Isshiki approach primarily for the purpose of speeding the operation and “simplifying” the procedure. The major modifications have included: (a) incision, versus retraction, of the strap muscles; (b) removing the window external perichondrium; (c) varying the placement and size of the window and prosthesis; (d) removal of the window cartilage; (e) fiberoptic versus nonvisualization of the larynx intraoperatively; (f) incision of the inner perichondrium; and (d) use of silastic block substitutes. The principles of Isshiki's original technique will be reiterated in the ongoing discussion, and the reasons for not modifying certain aspects of the technique will be examined from the standpoint of complications and negative impact that manifest when modification is done.     

A comparison of type I thyroplasty and arytenoid adduction

Glottal incompetence is a common laryngeal disorder causing impaired swallowing and phonation. The resultant voice has been characterized as weak and breathy with a restricted pitch range. Currently, medialization thyroplasty and arytenoid adduction are two of the surgical treatments for patients with glottal incompetence. However, few studies have evaluated the changes in objective measures of speech with type I thyroplasty and arytenoid adduction. In this study, 59 patients with glottal incompetence underwent either type I thyroplasty or arytenoid adduction. Acoustic (jitter, shimmer, and harmonics-to-noise ratio) and aerodynamic (airflow, subglottic pressure, and glottal resistance) measures were obtained both pre- and postoperatively. No significant differences were found among acoustic or aerodynamic measures for operation type. However, a significant pre/postsurgery effect was observed for translaryngeal airflow. In addition, no significant differences were found among the measures for patients with traditional compared with nontraditional operative indications. Patients who developed glottal insufficiency due to previous laryngeal surgery (e.g., vocal fold stripping) demonstrated no statistically significant improvement in acoustic or aerodynamic measures following thyroplasty or arytenoid adduction.     

Migration of the anterior segment following anterior commissure advancement: A case report

A 53-year-old man with severe vocal fold atrophy underwent bilateral type 1 thyroplasty and anterior commissure advancement. Postoperatively, he developed a strained voice with less projection and volume than prior to surgery. This was verified by objective assessment of vocal function. Videoendoscopy revealed bilateral false vocal fold fullness and blunting of the anterior commissure. Magnetic resonance imaging demonstrated cephalic migration of the posterior ends of the implants and retrusion of the anterior commissure segment. Surgical exploration revealed that the type 1 implants had rotated and buckled. The anterior commissure segment was rotated and displaced inferiorly, and its inferior surface was tethered to the cricoid by scar tissue. The implants were removed, the anterior segment was repositioned and rigidly fixed, and bilateral lipoinjection performed. Vocal function was significantly improved, and endoscopy revealed normal tension and length of the vocal folds and restoration of the anterior commissure. This case demonstrates the importance of stable fixation during laryngeal framework surgery     

Laryngeal Manifestations of Postpoliomyelitis Syndrome

Postpoliomyelitis syndrome (PPS) is a disease that may occur in survivors of acute poliomyelitis several decades after their initial infection. It can present as dysphonia, with vocal weakness and fatigue. Swallowing, respiratory, and other laryngopharyngeal symptoms may be manifestations of the disease or they may represent worsening of previously stable and compensated deficits. Three cases of laryngeal changes in PPS with videostroboscopic and laryngeal electromyography findings highlight the features of this disorder. We review possible etiologies of laryngeal PPS, diagnostic criteria, and treatment, as well as the current literature.     

Botox for hyperadduction of the false vocal folds: A case report

We present a patient with severe hyperadduction of the false vocal folds (FVF) treated with Botulinum Toxin injections to each FVF. This patient presented with severe dysphonia and was found to demonstrate severe hyperadduction of the FVF's with all phonatory tasks. The patient was treated with extensive speech therapy without improvement in voice quality nor FVF motion pattern. He was then injected with Botox A bilaterally using a peroral approach to the FVFs. Shortly after treatment the patient experienced dramatic improvement in voice quality. Videolaryngoscopy revealed no adduction of the FVFs with phonation and essentially normal true vocal fold motion. He remained with normal voice quality one year after treatment without any further treatment. Possible mechanism of action of this type of treatment are discussed.     

Risk factors and management of vocal cord hemorrhages: An experience with 44 cases

Risk factors for vocal cord hemorrhages were reviewed in 44 professional voice users. In a majority of cases, the direct cause of hemorrhage was temporally related to singing, public speaking, or some form of forceful laryngeal activity. Sixteen of the 44 patients had a concomitant upper respiratory tract infection, and in the case of women patients, eight of 30 had hormonal imbalances. These included abnormal menstrual cycles, use of estrogen supplements, gynecological surgery, and the use of birth control pills. In most of these cases, correction of the underlying hormonal disturbance prevented the recurrence of bleeding episodes. We stress that such abnormalities should be ruled out by history and appropriate tests when necessary, to prevent the occasional crippling sequelae of vocal cord hemorrhages and review the various treatment options available for this condition.     

Granular Cell Tumors of the Larynx: Diagnosis and Management

In this case study, a retrospective review of chart and literature was done to discuss the presentation and treatment of granular cell tumors of the larynx. One patient was diagnosed and treated successfully with surgical resection of a laryngeal granular cell tumor. Excellent voice recovery was obtained and there is no evidence of recurrence 6 months after surgery. Granular cell tumors should be considered in the differential diagnosis of laryngeal masses, particularly in the posterior glottis.     

Perturbation and hoarseness: A pilot study of six children's voices

Fundamental frequency (F0) perturbation has been found to be useful as an acoustic correlate of the perception of dysphonia in adult voices. In a previous investigation, we showed that hoarseness in children's voices is a stable concept composed mainly of three predictors: hyperfunction, breathiness, and roughness. In the present investigation, the relation between F0 perturbation and hoarseness as well as its predictors was analyzed in running speech of six children representing different degrees of hoarseness. Two perturbation measures were used: the standard deviation of the distribution of perturbation data and the mean of the absolute value of perturbation. The results revealed no clear relation.