Tubo de resonancia: opción terapéutica en pacientes con sulcus vocalis / Resonance tube: therapeutic option in patients with sulcus vocalis / Tubo de resonência: opção terapêutica em pacientes com sulcus vocalis

INTRODUCCIÓN: La terapia vocal con tubos de resonancia, pertenece al grupo de ejercicios de tracto vocal semiocluido. Este método busca generar cambios de impedancia y de patrones vibratorios de los pliegues vocales a través de la modificación de la longitud, del diámetro y la profundidad de los tubos utilizados. El objetivo del trabajo es presentar los resultados obtenidos luego de diez sesiones de terapia vocal, utilizando tubos de resonancia en dos pacientes con diagnóstico de sulcus vocalis bilateral...

INTRODUCTION: Vocal therapy with resonance tubes, belongs to the Semi-Occluded Vocal Tract (SOVT) exercises. This method, seeks to generate changes in impedance and the vibratory pattern of vocal folds through the modification of the long, diameter and depth of the tube . The objective of the article is to present the results obtained after 10 sessions of vocal therapy, using resonance tubes as a therapeutic resource, in 2 patients diagnosed with bilateral sulcus vocalis...

INTRODUÇÃO: A terapia vocal com tubos de ressonância, pertence aos exercícios do Trato Vocal Semi-Ocluído (SOVT). Este método, busca gerar mudanças na impedância e no padrão vibratório das pregas vocais através da modificação do comprimento, diâmetro e profundidade do tubo. O objetivo do artigo é apresentar os resultados obtidos após 10 sessões de terapia vocal, utilizando tubos de ressonância como recurso terapêutico, em 2 pacientes diagnosticados com sulco vocal bilateral...

Surgical Treatment of Sulcus Vocalis Using KTP Laser

Sulcus vocalis remains a surgical challenge despite many recent advances in laryngomicrosurgeries. We previously reported that 585-nm Pulsed dye laser (PDL) exerts favorable outcome in treatment of sulcus vocalis due to its therapeutic effects of collagen rearrangement and improved wound remodeling. In spite of the usefulness of PDL glottoplasty for treating sulcus vocalis, the device is no more available in the country. It prompted us to focus another angiolytic laser ; 532-nm KTP laser which has similar mechanisms of action and has been used for treatment of other laryngeal lesions elsewhere. Herein, we present a case of sulcus vocalis successfully treated with KTP laser. A patient underwent laryngomicrosurgery with angiolytic KTP laser (KTP glottoplasty) by the same surgical procedure with PDL glottoplasty. After the surgery, the patient presented improved voice outcome in time without complications.

Injection Laryngoplasty for The Treatment of Vocal Fold Scar, and Sulcus

BACKGROUND AND OBJECTIVES: The clinical reports for the treatment of vocal fold scar and sulcus vocalis are limited, also there is no best one for the treatment of them. This study is to evaluate the effect of Injection laryngoplasty (IL) for the treatment of vocal fold scar and sulcus vocalis. MATERIALS AND METHODS: from January 2013 to May 2015, the Nineteen patients who were diagnosed as vocal fold scar, sulcus and atrophy, and underwent IL, were engaged in this study. Clinical information and voice parameters were analyzed by retrospective chart review. Pre and post voice parameters were compared. RESULTS: Subgroups of diagnosis were classified into sulcus vocalis for 12 patients, vocal fold scar for 5, and atrophy for 2. IL was performed under local anesthesia through cricothyroid membrane except one patient. Atesense®, Radiessess®, and Rofilan® were used as injected materials in 9, 9, and 1 patients respectively. Maximal phonation time (p=0.0124), dynamic range (p=0.0028), pitch range (p=0.0141), voice handicap index (p=0.028), glottal closure (p=0.0229), and mucosal wave (p=0.0132) had significant improvement for post-IL voice assessment than Pre-IL. While GRBAS, Mean flow rate, Jitter, Shimmer, Harmony to Noise ratio didn't have improvement. CONCLUSION: IL is a feasible option for the treatment of glottis incompetence with normally mobile vocal folds such as sulcus vocalis and vocal fold scar.

The Acoustic Characteristics of the Voice of the Sulcus Vocalis Patients with Minimum Glottal Areas / 听力学及言语疾病杂志

Objective To investigate the voicing acoustic characteristics of sulcus vocalis patients with mini-mum glottal area(MGA) .Methods 60 normal subjects (30 male ,30 female) ,and 62 subjects with sulcus vocalis (33 male and 29 female)were recruited .They all had stroboscopic laryngoscopy ,and had MGA measured when say-ing /i:/using software supporting KIPS .The acoustic parameters consisted of vocal cord fundamental frequency (F0) ,jitter and shimmer ,normalized noise energy ( NNE) ,harmony to noise ratio (HNR) and signal noise ratio (SNR) ,maximum phonation time(MPT) and respectively make correlation analysis with voice MGA .Results The voicing MGA of male patients with sulcus vocalis was 434 .74 ± 112 .83 ,larger than the males with normal vocalis 298 .25 ± 93 .63 .This was statistically significant (P<0 .05) .The voicing MGA of females with sulcus vocalis was (484 .75 ± 143 .91) ,significantly larger than those of females with normal vocalis (293 .43 ± 93 .73) and the differ-ence was statistically significant (P<0 .05) .The voicing MGA on both males and females with sulcus vocalis was noticeably relation to the F0 (r=0 .972 ,P<0 .05) and (r=0 .928 ,P<0 .05) ,Jitter (r=0 .978 ,P<0 .05) and (r=0 .910 ,P<0 .910) and Shimmer (r=0 .973 ,P<0 .05) and (r=0 .921 ,P<0 .05) ,normalized noise energy(r=0 .883 ,P<0 .05) and (r=0 .960 ,P<0 .05) ;and negative relation to the signal noise ratio (r= -0 .947 ,P<0 .05) and (r = -0 .957 ,P<0 .05) ,signal noise ratio (r= -0 .959 ,P<0 .05) and (r= -0 .944 ,P<0 .05) ,max-imum phonation time (r= -0 .891 ,P<0 .05) and (r= -0 .936 ,P<0 .05) .Conclusion Patients with pathological sulcus vocalis have glottal areas larger than normal .Acoustic analysis of the voices of the sulcus vocalis can be used as an objective laboratory examination .

Manejo del sulcus vocalis con injerto de fascia temporal / Sulcus vocalis management with fascia temporal graft

El sulcus vocalis es una lesión en la cual el epitelio del pliegue vocal tiende a invaginarse y adherirse al ligamento y/o músculo resultando en disfonía. Existen múltiples tratamientos descritos ninguno con resultados ideales. Este es un estudio descriptivo-prospectivo en el Hospital Militar Central en pacientes operados por sulcus vocalis tipos II y III e implantados con fascia autóloga entre junio de 2006 y diciembre de 2008. De 17 pacientes operados cumplieron los criterios de inclusión 11. Edad promedio 32 años. 9 presentaron mejoría del análisis acústico de la voz con una tendencia a la mejoría en todas las variables, particularmente en el Shimmer y la frecuencia fundamental. En la estroboscopia, 10 pacientes presentaron recuperación de la onda mucosa y en 5 del cierre glótico. Ningún paciente presentó reacciones adversas al procedimiento. Del presente estudio se puede considerar que el manejo del sulcus vocalis con injerto autólogo de fascia temporal es un procedimiento seguro que en la mayoría de los casos representa una mejoría subjetiva y objetiva de la calidad de voz. Es necesario aumentar el tamaño de la muestra para obtener resultados de mayor poder estadístico y definir los criterios de éxito.

Sulcus vocalis is an injury in which the epithelium of the vocal fold tends to invaginate and attach to the ligament and / or muscle resulting in dysphonia. There are multiple treatments as described but none has ideal results. This is a descriptive – prospective study carried out at the Hospital Militar Central in patients that had been operated on due to sulcus vocalis of the type II and III and who have been given implants with autologous fascia between June, 2006 and December, 2008. Out of 17 patients that were operated on, 11 complied with the inclusion criteria. The average age was 32 years old. 9 of them exhibited an improvement on the acoustic analysis of the voice with a tendency to improvement in all variables, especially in Shimmer and the basic frequency. 10 patients exhibited a recovery of the mucous wave in the stroboscope analysis and 5 in the glottal closure. Not one patient showed adverse reactions to the procedure. It can be considered from this study that managing sulcus vocalis with a temporalis fascia autologous graft is a safe procedure that represents a subjective and an objective improvement of the quality of the voice. It is necessary to increase the size of the simple in order to obtain results with a greater statistical power and be able to define the criteria for success.

Voice and Videostroboscopic Analysis of Sulcus Vocalis after Slicing Mucosa Surgical Technique / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sulcus vocalis is not an uncommon cause of breathy dysphonia. One of the treatment options may be the slicing mucosa surgical technique which has been met with some criticism. This study was designed to investigate the efficiency of slicing mucosa surgical technique for the treatment of sulcus vocalis with voice and stroboscopic analysis. MATERIALS AND METHODS: In 18 sulcus vocalis patients (10 males, 8 females), the slicing mucosa surgical technique was performed followed by voice therapy for 4 weeks. Postoperative parameters of perceptual analysis, acoustic analysis, aerodynamic study, and videostroboscopy after 6 months were compared with those of preoperative results. RESULTS: In the perceptual analysis, the rough component of dysphonia was improved in 71.4% of patients, whereas the breathy component was improved in 25.0% of patients. Fundamental frequency, jitter, shimmer of acoustic analysis were significantly improved, but MPT, MFR of aerodynamic study showed no changes. There was anatomical evidences of sulcus in 4 of 18 patients postoperatively. Videostroboscopy mucosa waves during phonation showed improvement in 72.2% of patients, but glottic insufficiencies showed improvement only in 38.9%. CONCLUSION: The results of this study indicate that the slicing mucosa surgical technique is effective in improving the anatomical abnormality and stiffness of vocal cord mucosa, but unsatisfactory in improving glottic insufficiency of sulcus vocalis. It may be helpful to develop a new or an additional technique that can simultaneously promote improved rnucosa vibration and glottic closure.

Voice and Stroboscopic Analysis of Sulcus Vocalis / 대한이비인후과학회지

OBJECTIVES: We aimed to describe objectively the voice features of sulcus vocalis, thereby setting up some useful guidelines for its treatment. MATERIALS AND METHODS: The voices of thirty-seven sulcus vocalis pateints were analyzed. RESULTS: In the acoustic analysis, the fundamental frequency, jitter, and shimmer were significantly increased. Noise to harmonic ratio was also increased although it was not statistically significant. In the aerodynamic study, we found that maximal phonation time was decreased, whereas the mean air flow rate and subglottic pressure were increased. The glottic insuffiency on phonation, small vibratory mucosal wave and amplitude were frequently observed by videostroboscopy. CONCLUSION: The bowing of vocal fold edge results in an incomplete glottic closure during vibratory cycles. The increase in stiffness of the vocal fold edge during phonation results in small mucosal wave and small vibratory amplitude. Glottic insufficiency and stiffness of vibratory movement contribute to dysphonia of sulcus vocalis.

Combined Modality Treatment of Sulcus Vocalis with AutologousFat Injection and Slicing Technique / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Incomplete glottic closure of sulcus vocalis is one of the most common causes of breathy dysphonia. The results of treatment for sulcus vocalis were not satisfactory even though a variety of methods of treatment were applied because of incomplete glottic closure and improper mucosal waves of vocal fold on phonation. Authors studied to evaluate the efficacy of the combined modality treatment with autologous fat injection and slicing technique in patients with sulcus vocalis. MATERIALS AND METHODS: Patients with sulcus vocalis complaining of breathy dysphonia and difficult phonation were diagnosed through detailed history using questionnaires, physical examination and stroboscopy. Autologous fat taken from the lower abdomen was injected for medialization of the bowed vocal fold under general anesthesia. After that, the dissected mucosa of the vocal fold was sliced. Follow-up studies were performed with patients' own subjective evaluations, perceptual analysis, stroboscopic findings and acoustic analysis. RESULTS: Patients' own subjective evaluations, mucosal waves and glottic closure of vocal fold were much improved and perceptual and acoustic analysis were improved moderately in the follow-up results. CONCLUSION: Patients could have better voice and easy phonation after surgery because more improved mucosal waves and glottic closure allowed vocal fold to vibrate more efficiently and allowed patients to accept the voice therapy comfortably. Combined modality treatment of autologous fat injection and slicing technique was therefore an effective method for patients with sulcus vocalis.