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Objective@#To discuss the clinical effect of small dose of botulinum toxin injection in cricothyroid muscle and thyroarytenoid muscle on patients with incomplete bilateral recurrent laryngeal nerve paresis.@*Methods@#Six patients were selected with Ⅰor Ⅱ or Ⅲ degree of dyspnea diagnosed as bilateral recurrent laryngeal nerve injury by laryngeal electromyography, and small dose of botulinum toxin injection was performed in cricothyroid muscle and thyroarytenoid muscle as a treatment. Degree of dyspnea was assessed one month before and after the treatment, and the stroboscopic laryngoscope results, acoustic parameters and CT image of the patients were collected in the 6 patients. The relevant parameters were also collected one month before and after treatment, including the degree of dyspnea, stroboscopic laryngoscope results, acoustic parameters and CT image of the patients. The angle between bilateral vocal cords in stroboscopy at full inspiratory was calculated, acoustic parameters (F0, jitter, shimmer) were analysed, and vocal length, width and the vocal region were measured. Then, the paired t test was performed for statistical analysis between before and after one month injection, the one way analysis of variance was performed among vocal parameters in CT image.@*Result@#Botulinum toxin injection was successfully completed in the 6 patients, followed without any serious complications. The degree of dyspnea was alleviated to some extent after treatment in all 6 patients; the angle between bilateral vocal cords at the end of a deep inspiration was significantly increased (t=2.44, P<0.05) after the treatment. The changes of F0 and jitter between before and after treatment were not statistically significant (t=0.72, t=1.42, P>0.05). Shimmer was significantly decreased after treatment (t=2.61, P<0.05). Vocal fold length, width and vocal region increased with F0, there was a statistically significant difference between different F0 before injection, and there was no statistically significant difference between different F0 after injection. The follow-up time was respectively seven months, 1 year, 1 year, 18 months, 22 months and 2 years respectively.@*Conclusion@#Small dose of botulinum toxin injection in bilateral cricothyroid muscles and thyroarytenoid muscles can relieve the dyspnea caused by bilateral vocal cords paresis to some extent, accompanied without serious complications, despite the sound quality was slightly worse.
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Objective To study the effect of sub-glottal convergence angle on the degree of glottal closure, and to analyze the potential mechanism of dysphonia by the incomplete glottal closure.Methods Three vocal fold positions (adduction, intermediate and abduction) were evaluated by the degree of glottal closure, and divided into three groups.The neck CT images of the subjects were gathered.The vocal folds were adduction group when the normal subjects made a sustaining phonation /i:/ during CT scanning;the vocal folds were abduction group when the normal subjects made a deep breathing during CT scanning, and the unilateral vocal folds were incomplete closing group when the unilateral vocal fold paralysis subjects made a deep breathing during CT scanning.3D models of the vocal folds and the airway were reconstructed using Mimics software, through which the sub-glottal convergence angle was measured.Using one-way factor analysis of variance, we compared the angle among three groups.Results The angle changed with degree of glottal closure, with statistically significant differences among the three groups(P<0.01).The means of the angle in three groups were 33.49°±3.75°, 55.03°±2.61° and 75.02°±7.32°.Conclusion The 3D model generation from CT data is an effective method of measuring the sub-glottal convergence angle, while the angle changes with the degree of glottis closure.The angle may affect sub-glottal pressure distribution in the sub-glottal shear or normal direction and influence vocal fold vibration, which would make vibration and vocal fold mucosal wave generation more difficult, and might cause dysphonia.
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OBJECTIVE@#To analysis the acoustic characteristics in patients with unilateral arytenoid dislocation and unilateral vocal fold paralysis, and evaluate the application value of acoustic analysis technique in these two diseases.@*METHOD@#The voice signals of sustained vowel /a/ were measured using the software MDVP in 50 healthy adults and 67 patients with unilateral vocal cord movement disorders. The acoustic parameters (jitter, shimmer, NHR and F₀) were analyzed. All patients were divided into arytenoid dislocation group (36 cases) and vocal fold paralysis group (31 cases) through the laryngeal electromyography. All groups were divided into male and female group again. The acoustic characteristics between the two experimental groups and normal control groups were observed and compared. Results were analyzed using Rank sum test.@*RESULT@#(1) In both male or female groups, there were significant differences in jitter and shimmer between two experimental group and control group. In both male or female groups, there were significant differences in NHR between arytenoid dislocation group and control group. There were no significant differences in NHR between vocal fold paralysis group and control group. Except for the male vocal fold paralysis group, there were significant differences in F between the other experimental groups and control groups. (2) In both male or female groups, there were no significant differences in jitter and shimmer between vocal fold paralysis group and arytenoid dislocation group. There were significant differences in NHR.@*CONCLUSION@#The acoustic parameters are effective parameters to measure the voice quality of patients with unilateral arytenoid dislocation and unilateral vocal fold paralysis. NHR is the most sensitive parameter in the distinction of vocal cord paralysis and arytenoid dislocation.
Subject(s)
Adult , Female , Humans , Male , Acoustics , Arytenoid Cartilage , Case-Control Studies , Electromyography , Software , Vocal Cord Paralysis , Diagnosis , Vocal Cords , Voice QualityABSTRACT
<p><b>OBJECTIVE</b>To investigate the role of airflow parameters of some specific examinations in voice function assessment.</p><p><b>METHODS</b>The s/z ratio, pulmonary function and phonatory aerodynamic parameters were measured in subjects with benign vocal fold lesions and with normal voice. The effect of treatment in subjects with benign vocal fold lesions was evaluated with the phonatory aerodynamic parameters.</p><p><b>RESULTS</b>The value of s/z ratio in the disease group was higher than that in the normal group (P<0.05). The value of PEF was significantly different between the disease group and the normal group for male (P<0.05). MFR, MPT, PTF, SGP, PTP, VE were significantly different between the disease group and the normal group (P<0.05). MFR, MPT, PTF, SGP, PTP of the disease group after surgery for both sex were significantly different from before surgery (P<0.05). The disease group was subdivided into two groups through stroboscopic examination before and one month after surgery: the worse group (with some functional laryngeal abnormality, or organic abnormality except benign vocal fold lesion) and the better group. PTF, PTP, SGP, VE were significantly different between the worse group and the normal voice group. There was almost no significant difference for aerodynamic parameters between the better group and the normal voice group (P>0.05). There was no significant difference between the worse group after 8 weeks'voice training and the normal voice group (P>0.05).</p><p><b>CONCLUSIONS</b>s/z ratio, aerodynamic parameters (MFR, MPT, SGP, PTF, PTP, VE) are valuable for the diagnosis and assessment of the voice disorders. Aerodynamic parameters are sensitive to the change of glottal function during the treatment. Voice training can increase the glottal function of patients after laryngeal microsurgery.</p>
Subject(s)
Female , Humans , Male , Larynx , General Surgery , Microsurgery , Phonation , Respiration , Vocal Cords , Voice Disorders , General Surgery , Therapeutics , Voice TrainingABSTRACT
OBJECTIVE@#To investigate the effect of hyalinized chorda tympani nerve canal in mastoid segment to landmark facial nerve in middle ear surgery by means of observing the location relationship between hyalinized chorda tympani nerve canal and facial nerve.@*METHOD@#118 cases of cholesteatoma otitis media in our hospital undergoing tympanoplasty from 2008 to 2011 were retrospectively analyzed. In all the cases, the position of horizontal semicircular and fossa incus as well as the hyalinized chorda tympani nerve canal were used for landmark the height of facial ridge and vertical segment of facial nerve.@*RESULT@#The chorda tympani nerve of 99 patients were higher than the vertical segment of the facial nerve which were not exposed, and the vertical segment of the facial nerve in 9 patients, which were exposed, were 1-2 mm lower and 2-3 mm ahead or backward than the chorda tympani nerve. The horizontal semicircular and fossa incus were broken in 9 patients, of whom the vertical segments of the facial nerve were 1-2 mm lower and 2-3 mm ahead or backward than the chorda tympani nerve. The chorda tympani nerve of 1 patient were lower than the exposed vertical segment of facial nerve.@*CONCLUSION@#The hyalinized chorda tympani nerve canal in mastoid segment can landmark the positon of facial ridge, and it would be the complement to the traditional method of landmarking vertical segment of facial nerve, especially for those whose horizontal semicircular canal and fossa incus had been broken.