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.     

Complications of collagen injection of the vocal fold: report of several unusual cases and review of the literature

Injection laryngoplasty is one of the most frequently performed procedures in patients with voice complaints. Various biomaterials have been used to medialize vocal folds or to treat symptoms of vocal fold scar. The ideal biomaterial would be easily injected through a fine-gauge needle, well tolerated, and long lasting. Injectable collagen preparations fulfill at least two of these criteria, and collagen has been used widely for vocal fold injections. MATERIALS AND METHODS: We present a retrospective review of two unusual complications of collagen injection and a review of the relevant literature on the complications of medical use of collagen compounds. RESULTS: Two patients in whom collagen was injected formed firm submucosal deposits that interrupted the normal mucosal wave and produced significant dysphonia. Surgical removal of these deposits restored the mucosal wave and improved voice quality. Management of this unusual complication of human collagen injection in the vocal fold has not been reported previously. Other complications of collagen injection include hypersensitivity reactions to bovine collagen, local abscess formation at injection sites, and possibly induction of collagen vascular disease in some patients. CONCLUSIONS: Although collagen injections of the vocal fold rarely result in complications, physicians using collagen must be familiar with the types of complications that can occur. Proper diagnosis and prompt management of complications can result in good outcomes.     

Nonspecific laryngeal granuloma: A case study of a professional singer

A professional singer with laryngeal granuloma underwent surgery following failed response to conservative treatments. Two primary findings emerged. First, although a sizable lesion was present initially, presurgical voice measures were largely normal or superior. The exception was elevated phonatory effort during singing. Second, postsurgical voice functions were entirely normal or superior (including phonatory effort), despite demanding singing performances a few weeks following surgery. The results add to the limited corpus of quantitative, normative-referenced data on voice in patients with granulomas and are inconsistent with previous reports of voice abnormalities in such patients and poor functional response to surgery.     

Paradoxical vocal fold movement: A case report

We present a case of one patient with respiratory stridor that was resolved by speech therapy. Paradoxical vocal fold movements were observed by flexible fiberoptic videolaryngoscopy in this patient during episodes of wheezing and dyspnea. Otherwise, normal vocal fold movement was observed in normal conditions of breathing (out of the crisis) and during phonation. Many different terms have been used to describe this entity in the literature, and it is crucial that clinicians recognize the subtle signs of functional stridor. Paradoxical vocal fold motion has to be considered as an important cause of respiratory disease. Its recognition and treatment are discussed in this report.     

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.     

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.     

The intermediate layer: A morphologic study of the elastin and hyaluronic acid constituents of normal human vocal folds

The lamina propria of vocal folds are important in voice production. We evaluated the morphologic features of elastin and hyaluronic acid, two important constituents of the lamina propria. Thirty normal human vocal folds were obtained from patients dying of traumatic causes without vocal fold injury. These tissues were immediately prepared for histologic and ultrastructural examination by standard methods. For specific study of the ultrastructure of the layers of the lamina propria, six vocal folds were divided horizontally through the midplane of the lamina propria. We found that the elastin composition of the vocal folds is variable, the largest amount being seen in the midportion on elastin-van Gieson (EVG) staining and ultrastructural evaluation. The superficial layer of the lamina propria contains fewer large elastin fibers. In this region, we found that elastin was predominantly composed of elaunin and oxytalan, which stain poorly with EVG. Using computer-assisted image analysis, we quantified the differences in elastin composition between the layers. The amount of elastin varied between men and women, and these differences could not be accurately measured by the methods employed. Hyaluronic acid was abundant especially in the midportion of the lamina propria and was significantly more abundant in men than women on quantification. The significance of these observations in normal vocal folds is discussed.