Evaluación de la agudeza diagnóstica de la Ecografía Translaríngea Transcutánea (ETLTC) en la valoración de la movilidad de las cuerdas vocales en cirugía de tiroides y paratiroides / Evaluation of the diagnostic acuity of the Transcutaneous Translaryngeal Ultrasound (TCTLUS) in the assessment of the vocal cords mobility in thyroid and parathyroid surgery

Introducción. La evaluación de la movilidad de las cuerdas vocales en cirugía de tiroides y paratiroides hace parte de la adecuada valoración integral. Aunque la laringoscopia directa es prueba de referencia, su uso real no es rutinario por lo que se propone la ecografía translaríngea como alternativa de evaluación. Métodos. Estudio prospectivo de evaluación de una prueba diagnóstica de la movilidad de las cuerdas vocales pre y posoperatoria, comparando la ecografía translaríngea con la video laringoscopia, en pacientes con cirugía de tiroides y paratiroides, de febrero 1° a noviembre 30 de 2022. Se describieron las variables usando frecuencias absolutas y relativas. En el análisis univariado se calcularon Chi cuadrado y T de Student y en el bivariado, regresión logística binaria. La agudeza diagnóstica se determinó con sensibilidad, especificidad y valores predictivos; se consideró la significancia estadística con p < 0,05. Resultados. Se incluyeron 267 pacientes, 219 mujeres y 48 hombres; 196 pacientes (73,4%) tenían malignidad. Se encontró en el preoperatorio, sensibilidad 100 %, especificidad 99,6 %, VPP 83,3 %, VPN 100 %, odds de probabilidad positiva 83 % y Odds de probabilidad negativa 0,004 %. En el posoperatorio, sensibilidad 82,8 %, especificidad 99,2 %, VPP 92,3 % VPN 97,9 %, odds de probabilidad positiva 92 % y odds de probabilidad negativa 0,2 %. Conclusiones. La ecografía translaríngea en nuestro medio tiene alta agudeza diagnóstica. Podría ser usada en el abordaje inicial de la evaluación de la movilidad de las cuerdas vocales y reemplazar la laringoscopia directa, dejando ésta para cuando la visualización ecográfica no sea adecuada, o en casos de afectación o sospecha de invasión, para su confirmación.

Introduction. The evaluation of the mobility of the vocal cords in thyroid and parathyroid surgery is part of the adequate comprehensive assessment. Altough, direct laryngoscopy is the gold standard, its real use is not routine, so translaryngeal ultrasound approach is proposed as an alternative. Methods. A prospective diagnostic test study was carried out to evaluate the translaryngeal ultrasound compared with video laryngoscopy in visualizing vocal mobility in patients with thyroid and parathyroid surgery from February 1 to November 30, 2022. Patients were described using absolute and relative frequencies. Univariate statistical analysis with Chi-square and Student's t tests. T. Bivariate analysis using binary logistic regression. Diagnostic acuity was calculated with sensitivity, specificity, PPV, NPV. Statistical significance with p< 0.05, 95% confidence interval. Results. 267 patients undergoing thyroid or parathyroid surgery were included, 219 women and 48 men. Malignant: thyroid neoplasm 196 patients (73.4%). The findings were for the preoperative period, 100% sensitivity, 99.6% specificity, PPV 83.33%, NPV 100%, 83% positive probability odds, and 0.004% negative probability odds. For the postoperative period, 82.8% sensitivity, 99.2% specificity, 92.3% PPV, 97.9% NPV, 92% positive probability odds, and 0.2% negative probability odds were found.Conclusions. Translaryngeal ultrasound in our series has high diagnostic acuity. It could be used as the initial approach to evaluate vocal mobility and might replace direct laryngoscopy, leaving it when its visualization is not adequate or in cases of involvement or suspected invasion for confirmation.

Metástasis de cáncer de células claras renal en cuerdas vocales. Reporte de un caso / Metastasis of renal clear cell carcinoma in vocal cords. A Case report

Introducción: Las metástasis a distancia de tumores primarios a cuerdas vocales son poco frecuentes. Las metástasis a laringe con mayor frecuencia corresponden a melanomas y carcinomas, afectando principalmente a la región supraglótica. Las metástasis a cabeza y cuello de los carcinomas de células renales (CCR) tienen una incidencia de 14-16%. Se presenta el caso de un paciente con metástasis de carcinoma de células claras renal a cuerdas vocales, cuya importancia recae en que es un caso poco frecuente y no existen reportes similares en el país. Paciente masculino, 57 años, con disfonía de 3 meses de evolución. Nasofibroscopía evidencia lesión polipoídea en cuerda vocal y ventrículo izquierdo. Se realiza microcirugía laríngea, enviando muestra a biopsia diferida, resultando lesión metastásica de CCR células claras. Evaluado por nefrología, se pesquisa tumor renal izquierdo sugerente de CCR. Las metástasis de neoplasias remotas a laringe son infrecuentes. Se considera al CCR el tercero en frecuencia respecto a neoplasias infraclaviculares. Éstas se pueden presentar hasta 10 años después del tratamiento del primario. Se recomienda seguimiento a largo plazo y énfasis a nuevos síntomas en región de cabeza y cuello, teniendo en consideración antecedente de CCR en pacientes con disfonía y lesiones polipoídeas en cuerdas vocales.

Introduction: The metastasis of distant site primary tumors to the vocal cords is infrequent. The most frequent source of metastasis to the larynx is melanomas and carcinomas, mainly affecting the supraglottic region. The metastasis to the head and neck of renal cell carcinomas (RCC) has an incidence of 14-16%. To present a case of metastasis of clear renal cell carcinoma to the vocal cords, since it is very infrequent, and there are no similar reports in the country. A male patient, 57 years old, presenting dysphonia for a duration of 3 months. Nasofibroscopy showed a polypoid lesion in the left vocal cord and ventricle. Larynx microsurgery was performed, and a sample was sent for biopsy, which reported a metastatic lesion of RCC clear cells. When assessed by nephrology, a left renal tumor is found, suggesting RCC. The metastasis of distant site neoplasias are infrequent. RCC is considered the third in frequency concerning to infraclavicular neoplasias. These can present up to 10 years after the treatment of the primary. Long term follow-up is recommended, and an emphasis on new symptoms in the head and neck region, considering the history of RCC in patients with dysphonia and polypoid lesions in vocal cords.

Métodos utilizados na análise morfométrica do trato vocal em cantores: revisão integrativa / Methods used in morphometric analysis of singers' vocal tracts: an integrative review

RESUMO Objetivo descrever os principais métodos quantitativos utilizados para análise morfométrica do trato vocal em cantores, suas aplicações e os principais segmentos estudados. Estratégia de pesquisa trata-se de uma revisão integrativa guiada pela pergunta condutora: "Quais os principais métodos quantitativos utilizados para análise morfométrica do trato vocal, suas aplicações e os principais segmentos estudados em cantores?". Foram utilizadas as bases eletrônicas PubMed, Scopus e BVS, por meio da chave de busca Vocal tract OR Oropharynx AND Morphology OR Geometry AND Evaluation OR Diagnosis AND voice, sem restrições de ano de publicação, sendo incluídos artigos em três idiomas: português, inglês e espanhol. Critérios de seleção: a seleção se deu de forma independente, por meio da leitura por pares e posterior aplicação dos critérios de exclusão e inclusão. Resultados dos 380 estudos, foram excluídos 30 duplicados. A partir da leitura dos resumos, aplicando-se os critérios de seleção, foram selecionados 18 estudos para leitura na íntegra, dos quais, 12 foram incluídos nesta revisão. A ressonância magnética foi o principal instrumento utilizado e os segmentos analisados incluíram desde o comprimento e volume do trato vocal, como segmentos isolados e suas particularidades morfológicas. Conclusão os métodos de quantificação morfológica do trato vocal integram instrumentos importantes para a avaliação instrumental do trato vocal e de seus segmentos, colaborando na atualização tecnológica em voz para melhor compreensão e intervenções fonoaudiológicas na voz cantada

ABSTRACT Purpose To describe the main quantitative methods used for morphometric analysis of the vocal tract in singers, their applications and the main segments studied. Research strategy This is an integrative review guided by the guiding question "What are the main quantitative methods used for morphometric analysis of the vocal tract, their applications and the main segments studied in singers?". The electronic databases PubMed, Scopus and VHL were used through the search key (Vocal tract OR Oropharynx) AND (Morphology OR Geometry) AND (Evaluation OR Diagnosis) AND (voice), without restriction of years of publication, including articles in three languages: Portuguese, English and Spanish. Selection criteria The selection took place independently through reading by pairs and subsequent application of exclusion and inclusion criteria. Results Of the 380 studies, 30 duplicates were excluded. After reading the abstracts, applying the selection criteria, 18 studies were selected for full reading, of which 12 were included in this review. Magnetic resonance imaging was the main instrument used and the analyzed segments ranged from the length and volume of the vocal tract to isolated segments and their morphological particularities. Conclusion Vocal tract morphological quantification methods are important for the instrumental evaluation of the vocal tract and its segments, a technological update leading to better understanding of singers' voice and therapeutical intervention.

Long-term outcomes of lateral vocal fold autologous fat injection for unilateral vocal fold paralysis / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate the long-term outcomes of patients with unilateral vocal fold paralysis resulting in dysphonia treated with lateral vocal fold autologous fat injection. To analyze the factors that may affect the long-term efficacy of the procedure. Methods: From July 2003 to June 2020, 163 patients (86 males and 77 females), aged 9-73 years (mean (34.50±12.94) years) with unilateral vocal fold paralysis resulting in dysphonia underwent transoral laryngoscopic injection of autologous fat into the lateral vocal folds. Subjective auditory perception assessment (GRBAS scale), objective acoustic assessment, voice handicap index (VHI) evaluation and stroboscopic laryngoscopy were compared before and after the surgery. Patients were followed up for 1 to 18 years, with median follow-up time of 6 years. SPSS 22.0 software was used for statistical analysis. Results: Of 163 patients, 17 patients (10.4%) had mild hoarseness (G1) and 146 patients (89.6%) had moderate to severe hoarseness (G2-3). Stroboscopic laryngoscopy revealed an arch-shaped vocal fold on the affected side, fixed in the paramedian position or abduction position, with obvious glottic closure fissure. Postoperatively, voice recovered to normal (G0) in 139 patients (85.3%), mild hoarseness (G1) in 18 patients (11.0%) and moderate hoarseness (G2) in 6 patients (3.7%). Of these, 131 patients (80.4%) showed significant improvement in hoarseness, 29 patients (17.8%) showed mild improvement and 3 patients (1.8%) showed no significant improvement in hoarseness. Objective acoustic parameters of Jitter, Shimmer, NHR and MPT improved significantly, as did VHI scores. Stroboscopic laryngoscopy showed medialization of the affected vocal folds, improved vocal fold closure and normal or nearly normal vocal fold mucosal waves. With a fat injection volume of 3.0-4.5 ml, the patient's subjective auditory perception scores of G, R, B and A improved more significantly within 3 months after surgery, and both VHI and MPT were significantly better since 1 year after surgery. With bilateral vocal fold injection, the B and A scores improved significantly from 1 month postoperatively compared to unilateral injections(unilateral vs. bilateral injection 1 month post-operation, tB scores=1.42,tA scores=1.51,P<0.05). Conclusions: The long-term efficacy of autologous fat injection in the paraglottic space for the treatment of unilateral vocal fold paralysis was stable. The efficacy of the surgery was related to the amount of fat injected, unilateral or bilateral of the injection.

Factors predisposing to post thyroidectomy vocal cord paralysis at Ospital ng Maynila Medical Center

Objective@#To determine the prevalence of vocal cord paralysis among post thyroidectomy patients based on severity and laterality, and explore possible associations with age, sex, diagnosis and type of thyroid lesion and surgical procedure.@*Methods@#Design: Cross-sectional study. Setting: Tertiary Government Training Hospital. Participants: Records of patients who underwent thyroidectomy under the Department of Otorhinolaryngology – Head and Neck Surgery of the Ospital ng Maynila Medical Center from January 1, 2014 to June 30, 2021. @*Results@#There were strong associations between the type of lesion and the presence of recurrent laryngeal nerve injury (V=.211, p=.001) and the diagnosis and the presence of RLNI (V=.245, p=.006). There were no significant associations between patient’s sex, age, diagnosis, type of thyroid lesion, surgical procedure with laterality and severity of RLNI. It was notable that all cases of bilateral recurrent laryngeal nerve injury were due to carcinoma only. Patients with malignant tumors were 2.8x (95% CI: 1.48-5.29) as likely to develop post surgical RLNI than those with benign tumors (p=.0015).@*Conclusion@#The factors that had a strong association with the presence of vocal cord paralysis among post-thyroidectomy patients were the diagnosis and type of thyroid lesion. Malignant thyroid lesions (specifically thyroid carcinoma) had a higher incidence of recurrent laryngeal nerve injury compared to benign thyroid lesions. More data from different institutions and including other predisposing factors may confirm our findings.

Adult Glottic Hemangioma: A case report

@#Glottic hemangioma is a benign vascular tumor that is rarely seen in the adult population. We report a rare Filipino case of glottic hemangioma in a 65-year-old female presenting with 2 weeks history of hoarseness and a smooth, pedunculated, bluish mass at the anterior one-third of the right vocal cord in flexible laryngoscopy. Direct suspension laryngoscopy showed a pedunculated mass that was paler-looking, similar to the color of the surrounding mucosa, exhibiting the Phonation sign of Menzel. The patient underwent microlaryngeal excision and histopathology showed findings consistent with cavernous hemangioma.

Risk factors of recurrence and canceration for premalignant vocal fold lesions after surgery / 临床耳鼻咽喉头颈外科杂志

Objective:To analyze the risk factors of recurrence and canceration for premalignant vocal fold lesions after surgery, and to provide a reasonable basis for preoperative evaluation and postoperative follow-up. Methods:This study retrospective analyzed the relationship between clinicopathological factors and clinical outcome（recurrence, canceration, recurrence-free survival, and canceration-free survival） in 148 patients undergoing surgical treatment in Chongqing General Hospital from 2014 to 2017. Results:The five-year overall recurrence rate was 14.86% and the overall recurrence rate was 8.78%. Univariate analysis showed that smoking index, laryngopharyngeal reflux and lesion range were significantly associated with recurrence（P<0.05）, and smoking index and lesion range were significantly associated with canceration（P<0.05）. Multivariate logistic regression analysis showed that smoking index ≥600 and laryngopharyngeal reflux were independent risk factors for recurrence（P<0.05）, and smoking index ≥600 and lesion range ≥1/2 vocal cord were independent risk factors for canceration（P<0.05）. The mean carcinogenesis interval for the postoperative smoking cessation group was significantly longer（P<0.05）. Conclusion:Excessive smoking, laryngopharyngeal reflux and a wide range of lesions may be related to postoperative recurrence or malignant progression of precancerous lesions in the vocal cord, and further large-scale multi-center prospective randomized controlled studies are needed to clarify the effects of the above factors on recurrence and malignant changes in the future.

Preliminary analysis of the effect of individualized voice therapy on pediatric voice disorders / 临床耳鼻咽喉头颈外科杂志

Objective:To determine the effectiveness of individualized voice therapy in persistent pediatric voice disorders. Methods:Thirty-eight children who were admitted to the Department of Pediatric Otolaryngology Shenzhen Hospital, Southern Medical University due to persistent voice disorder from November 2021 to October 2022 were included. All children were evaluated by dynamic laryngoscopy before voice therapy. Two voice doctors performed GRBAS score and acoustic analysis on the children's voice samples to obtain the relevant parameters including F0, Jitter, Shimmer, and MPT; All children were given personalized voice therapy for 8 weeks. Results:Among 38 children with voice disorders, 75.8%（29 cases） were diagnosed with vocal nodules, 20.6%（8 cases） were vocal polyps, and 3.4%（1 case） were vocal cysts. And in all children. And 51.7%（20 cases） had the sign of supraglottic extrusion under dynamic laryngoscopy. GRBAS scores decreased from 1.93 ± 0.62, 1.82 ± 0.55, 0.98 ± 0.54, 0.65 ± 0.48, 1.05 ± 0.52 to 0.62 ± 0.60, 0.58 ± 0.53, 0.32 ± 0.40, 0.22 ± 0.36, 0.37 ± 0.36. F0, Jitter, Shimmer decreased from（243.11±39.73） Hz, （0.85±0.99）%, （9.96±3.78）% to（225.43±43.20） Hz, （0.33±0.57）%, （7.72±4.32）%, respectively MPT was prolonged from（5.82±2.30） s to（7.87±3.21） s after treatment. All parameters changes had statistical significance. Conclusion:Voice therapy can solve children's voice problems, improve their voice quality and effectively treat children's voice disorders.

Neuropatía laríngea y movimiento paradojal de cuerdas vocales en la edad pediátrica: reporte de un caso / Laryngeal neuropathy and paradoxical vocal fold motion in the pediatric age: case report

Resumen La neuropatía laríngea es una condición de hipersensibilidad, hiperreactividad e hiper-función laríngea secundaria a un desequilibrio entre las aferencias y eferencias laríngeas. La respuesta individual y exagerada frente a diversos gatillantes específicos puede generar síntomas como tos crónica, parestesia laríngea, carraspera, disfonía, estridor, sensación de globus faríngeo, movimiento paradojal de las cuerdas vocales (también conocido como disfunción cordal) y/o laringoespasmo. Existe abundante literatura sobre neuropatía laríngea en adultos, sin embargo, en niños es limitada. El objetivo de este artículo es dar a conocer un caso de neuropatía laríngea en la edad pediátrica y la importancia de su consideración en el enfrentamiento de estos pacientes. Se presenta caso clínico de un paciente de 13 años, con antecedente de cirugía cardiaca reciente, evoluciona con disfonía severa evidenciándose aparente inmovilidad cordal bilateral con resultados discordantes entre nasofibrolaringoscopía y electromiografía laríngea. Posteriormente presenta mejorías en su voz, sin embargo, se agregan otros síntomas laringológicos como carraspera, globus faríngeo y estridor no explicados por causas anatómicas. Se expone la evaluación y abordaje otorrinolaringológico-fonoaudiológico para el caso. Se concluye que el diagnóstico de neuropatía laríngea requiere un alto índice de sospecha clínica ante signos laringológicos sugerentes, debiendo descartarse causas orgánicas y estructurales. El abordaje otorrinolaringológico-fonoaudiológico constituye el pilar terapéutico asociado al uso de neuromoduladores en casos seleccionados.

Abstract Laryngeal neuropathy is a condition of hypersensitivity, hyperresponsiveness and laryngeal hyperfunction secondary to an imbalance between laryngeal afferent and efferent information. The individual and exaggerated response to diverse specific triggers can lead to symptoms such as chronic cough, laryngeal paresthesia, throat clearing, dysphonia, stridor, globus pharyngeus, vocal cord dysfunction, and/or laryngospasm. There is plentiful literature on laryngeal neuropathy in adults, however, in children, it is limited. Here, we present a case report of laryngeal neuropathy in the pediatric age and discuss the importance of its consideration in the approach of these patients. A case of a 13-year-old patient, recently intervened with cardiac surgery that evolves with severe dysphonia is presented. Nasofibrolaryngoscopy shows apparent bilateral vocal fold immobility with discordant results in laryngeal electromyography. Later, his voice improves but other laryngological symptoms appeared, such as throat clearing, globus pharyngeus and stridor, not explained by anatomical causes. The otolaryngological-speech therapy evaluation and approach for the case is exposed. We conclude that for the diagnosis of laryngeal neuropathy, a high index of clinical suspicion is required in the presence of suggestive laryngological symptoms, and organic and structural causes must be previously ruled out. The otorhinolaryngological-logopedic approach constitutes the mainstay of treatment associated with the use of neuromodulators in selected cases.

Wavelet packet transform and multilayer perceptron to identify voices with a mild degree of vocal deviation / Transformada Wavelet packet y Perceptrón Multicapa para identificación de voces con grado leve de desvío vocal

Introduction. Laryngeal disorders are characterized by a change in the vibratory pattern of the vocal folds. This disorder may have an organic origin described by anatomical fold modification, or a functional origin caused by vocal abuse or misuse. The most common diagnostic methods are performed by invasive imaging features that cause patient discomfort. In addition, mild voice deviations do not stop the in-dividual from using their voices, which makes it difficult to identify the problem and increases the possibility of complications. Aim. For those reasons, the goal of the present paper was to develop a noninvasive alternative for the identification of voices with a mild degree of vocal deviation ap-plying the Wavelet Packet Transform (WPT) and Multilayer Perceptron (MLP), an Artificial Neural Network (ANN). Methods. A dataset of 74 audio files were used. Shannon energy and entropy mea-sures were extracted using the Daubechies 2 and Symlet 2 families and then the processing step was performed with the MLP ANN. Results. The Symlet 2 family was more efficient in its generalization, obtaining 99.75% and 99.56% accuracy by using Shannon energy and entropy measures, re-spectively. The Daubechies 2 family, however, obtained lower accuracy rates: 91.17% and 70.01%, respectively. Conclusion. The combination of WPT and MLP presented high accuracy for the identification of voices with a mild degree of vocal deviation

ntroducción. Los trastornos laríngeos se caracterizan por un cambio en el patrón vibratorio de los pliegues vocales. Este trastorno puede tener un origen orgánico, descrito como la modificación anatómica de los pliegues vocales, o de origen fun-cional, provocado por abuso o mal uso de la voz. Los métodos de diagnóstico más comunes se realizan mediante procedimientos invasivos que causan malestar al pa-ciente. Además, los desvíos vocales de grado leve no impiden que el individuo utilice la voz, lo que dificulta la identificación del problema y aumenta la posibilidad de complicaciones futuras.Objetivo. Por esas razones, el objetivo de esta investigación es desarrollar una he-rramienta alternativa, no invasiva para la identificación de voces con grado leve de desvío vocal aplicando Transformada Wavelet Packet (WPT) y la red neuronal artifi-cial del tipo Perceptrón Mutlicapa (PMC). Métodos. Fue utilizado un banco de datos con 78 voces. Fueron extraídas las me-didas de energía y entropía de Shannon usando las familias Daubechies 2 y Symlet 2 para después aplicar la red neuronal PMC. Resultados. La familia Symlet 2 fue más eficiente en su generalización, obteniendo un 99.75% y un 99.56% de precisión mediante el uso de medidas de energía y en-tropía de Shannon, respectivamente. La familia Daubechies 2, sin embargo, obtuvo menores índices de precisión: 91.17% y 70.01%, respectivamente. Conclusión. La combinación de WPT y PMC presentó alta precisión para la iden-tificación de voces con grado leve de desvío vocal

Efecto inmediato de dos ejercicios con tracto vocal semiocluido en el contacto glótico de usuarios ocupacionales de la voz / Immediate effect of two semi-occluded vocal tract exercises in glottal contact of occupational voice users

Introducción. Los docentes son usuarios ocupacionales de la voz con alto riesgo de desarrollar patologías vocales a causa de su labor. Para enfrentar esta proble-mática, suelen usarse ejercicios con tracto vocal semiocluido (TVSO), estrategia de educación/rehabilitación empleada para generar un cambio en el patrón de vibración de los pliegues vocales, minimizando el riesgo de lesión vocal al reducir el estrés de colisión al que se someten los tejidos. Diversos reportes han indicado que este tratamiento tiene efectos en el cociente de cierre (CQ), medida indirecta del estrés de colisión.Objetivo. Examinar el efecto fisiológico de dos ejercicios con TVSO en la actividad laríngea de profesores con esfuerzo vocal constante pero sin patología vocal. Metodología. Se registraron muestras de 43 profesores antes, durante y después de la realización de dos ejercicios con TVSO (vibración lingual y fonación en tubos). Las muestras de electroglotografía se analizaron para obtener el CQ. Resultados y conclusión. Se observó una diferencia significativa al comparar los valores del CQ antes y durante la realización de ambos ejercicios. No se encontraron cambios en este parámetro después de ejecutar la actividad. Estos hallazgos concuer-dan con reportes previos en los cuales el CQ tiende a aumentar durante la fonación en tubos; contrariamente, la realización de la vibración lingual tiende a decrecer el valor del CQ. Es posible que este comportamiento se deba a los mecanismos biome-cánicos particulares de cada ejercicio

Introduction. Teachers are occupational voice users with high risk of developing vocal pathologies due to their work. To face this situation, it is common the use of semi-occluded vocal tract (SOVT) exercises, a strategy of voice education/rehabil-itation implemented to induce a change in the vibration pattern of the vocal folds, mitigating, therefore, the risk of vocal lesion by reducing the collision stress applied to tissues. A variety of reports have indicated that this treatment has effects in the closed quotient (CQ), an indirect measure of collision stress. Aim. The purpose of this study was to examine the physiological effect of two dif-ferent SOVT exercises in larynx activity of teachers with constant vocal effort but without vocal pathology. Methods. 43 samples of teachers were recorded before, during and after executing two SOVT exercises (tongue trill and tube phonation). Electroglottographic samples were analyzed in order to obtain CQ. Results and conclusion. Both exercises had a significant difference of CQ scores when before and during conditions were compared. Any difference was found on this parameter after executing the activity. These findings agree with previous reports where CQ tends to increase during phonation through resonance tubes; on the con-trary, execution of tongue trill tends to decrease CQ values. This behavior might be because of the particular biomechanical mechanisms of each exercise

Medidas perceptivo-auditivas e acústicas de mulheres com e sem nódulos vocais / Auditory-perceptual and acoustic measures in women with and without vocal nodules

RESUMO Objetivo Comparar as medidas acústicas e perceptivo-auditivas de mulheres com e sem nódulos vocais. Métodos Participaram do estudo 12 mulheres com nódulos vocais (grupo MNV) e 12 sem nódulos vocais (grupo MSNV). Foram submetidas à gravação da vogal /a/ sustentada, com o objetivo de extrair a média da frequência fundamental (f0), desvio padrão de f0 (DP f0), jitter, shimmer, Glottal Noise Excitation, medidas relacionadas ao Cepstral Peak Prominence-Smoothed, medidas espectrais das diferenças do primeiro e segundo harmônico (H1-H2) e gravação das frases-veículo: "Digo papa baixinho", "Digo pipa baixinho" e "Digo pupa baixinho", para extração do primeiro (F1) e segundo formante (F2) dos segmentos vocálicos /a, i, u/. Para avaliação perceptivo-auditiva, utilizou-se a Escala Visual Analógica. Resultados A análise comparativa entre os grupos evidenciou maiores valores para o grupo MNV nos parâmetros grau geral, rugosidade e soprosidade e para a medida acústica shimmer. Os valores de F1 para as vogais /a/ e /u/ e os valores de F2 para a vogal /a/ apresentaram-se mais elevados no mesmo grupo. Conclusão mulheres com nódulos apresentaram vozes mais desviadas, com presença de rugosidade e soprosidade e modificações nos ajustes do trato vocal, com possível redução na amplitude dos articuladores, quando comparadas às mulheres sem nódulos vocais.

ABSTRACT Purpose To compare the acoustic and auditory-perceptual measures of the voice of women with and without vocal nodules. Methods Twelve women with vocal nodules (MNV group) and 12 without vocal nodules (MSNV group) participated in the study. They were submitted to the recording of their sustained /a/ vowel, in order to extract the mean of the fundamental frequency (f0), standard deviation of f0 (SD f0), jitter, shimmer, GNE, cepstral measure of CPPS, and spectral measures of differences of the first and second harmonics (H1-H2); and recording of the carrier phrases: "I say papa baixinho", "I say pipa baixinho" and "I say pupa baixinho", to extract the first (F1) and second formant (F2) of the vowel segments /a, i, u/. For auditory-perceptual assessment, the visual-analog scale (VAS) was used. Results The comparative analysis between the groups shows higher values for the MNV in the parameters general degree, roughness and breathiness, and for the shimmer acoustic measure. The F1 values for the vowels /a/ and /u/, and the F2 values for the vowel /a/ were higher in the same group. Conclusion According to the data observed in the investigated sample, women with nodules have more deviated voices, with the presence of roughness and breathiness, and changes in vocal tract adjustments, with a possible reduction in the amplitude of the articulators, when compared to women without vocal nodules.

Experimental model for controlled endoscopic subepithelial vocal fold injury in rats

Purpose: To present a detailed, reproducible, cost-efficient surgical model for controlled subepithelial endoscopic vocal fold injury in the rat model. Methods: Six male Sprague Dawley rats were enrolled in the experiment. The left vocal folds were used to carry out the injury model, and the right vocal fold served as control. After deep sedation, the rats were placed on a custom operating platform. The vocal fold injury by subepithelial stripping was carried out using custom-made microsurgical instruments under endoscopic guidance. Data were analyzed for procedural time and post-procedural pain. Microcomputed tomography (micro-CT) scan and histologic images were obtained to assess the length, area, and depth of injury to the vocal fold. Results: The mean procedural time was 112 s. The mean control vocal fold length was 0.96 ± 0.04 mm. The mean vocal fold injury length was 0.53 ± 0.04 mm. The mean vocal fold surface was 0.18 ± 0.01 mm2 with a mean lesion area of 0.05 ± 0.00 mm2. Mean vocal fold injury depth was 375.4 ± 42.8 µm. The lesion length to vocal fold length ratio was 0.55 ± 0.03, as well as lesion area to vocal fold surface area was 0.29 ± 0.02. Conclusions: Our described experimental vocal fold injury model in rats is found to be fast, safe, cost-efficient, and reproducible with a rapid learning curve.

Initial outcomes of endoscopic CO2 laser posterior cordectomy and partial arytenoidectomy among patients with bilateral vocal cord paralysis: A Case series

Objective@#To describe the initial outcomes of endoscopic CO2 laser posterior cordectomy and partial arytenoidectomy among patients with bilateral vocal cord paralysis in our institution.@*Methods@# Design: Case Series Setting: Tertiary National University Hospital Participants: 17 Patients @*Results@#Seventeen (17) patients who underwent transoral posterior cordectomy and partial arytenoidectomy using carbon dioxide laser were included in the study consisting of 14 females and 3 males. Iatrogenic injury was the most common cause of bilateral vocal cord paralysis in this subset of patients. Five patients who tolerated decannulation and another six who had no preoperative tracheostomy all reported subjective improvement in breathing. All of them were also observed to have resolution of stridor and increased respiratory comfort compared to their preoperative condition. The most common postoperative complication was granuloma formation at the medial arytenoidectomy site occurring only in 4 patients. None of the patients complained of aspiration episodes or dysphagia during the postoperative period. @*Conclusion@#Our initial experience with transoral endoscopic posterior cordectomy and partial arytenoidectomy using carbon dioxide laser has good postoperative outcomes among patients with bilateral vocal cord paralysis.

Preventing and treating anterior commissure adhesion with mucosal flap: a study in canines and clinical cases / 中华耳鼻咽喉头颈外科杂志

Objective: To evaluate the effectiveness of mucosal flap combined with silicone keel for preventing and treating anterior commissure adhesion in canines and clinical cases. Methods: A prospective experiment was performed from November 2019 to June 2021. Twenty five canines were randomly divided into 5 groups(A, B, C, D, E). Group A, B, C, D received anterior commissure injury by CO2 laser, then separately treated with free mucosal flap-keel complex,intralaryngeal mucosal flap-keel complex, silicone keels and without treatment, group E didn't injure the vocal cord after intubation. The keel was removed after 2 weeks, the larynx was harvested after 4 weeks. The effectiveness of anterior commissure adhesion prevention was evaluated by manifestation under laryngoscope, standard vocal cord length and standard glottic area. A retrospective analysis was performed on sixteen patients with anterior commissure lesion, who underwent mucosal flap-keel technique in Huashan Hospital of Fudan University from January 2019 to January 2021 (10 cases with free mucosal flap-keel complex and 6 cases with intralaryngeal mucosal flap-keel complex). All the patients underwent evaluation of laryngeal function included manifestation under laryngoscope each month and voice analysis before and 3 month after surgery. SPSS 20.0 software was used for statistical analysis. Results: No surgery accident or complication happened in canines and patients. The standard vocal cord length and standard glottic area after 4 weeks in group B were significantly higher than those in group A, C, D (Hstandard vocal cord length=31.688, Hstandard glottic area=16.444, P<0.05). The standard vocal cord length and standard glottic area after 4 weeks in group A were also significantly higher than those in group C, D(Hstandard vocal cord length=20.936, Hstandard glottic area=11.786, P<0.05). The standard vocal cord length and standard glottic area after 4 weeks in group A, B, E were not significantly different to that before surgery(tA left standard vocal cord length=2.636, tA right standard vocal cord length=2.582, tB left standard vocal cord length=2.707, tB right standard vocal cord length=2.673, tE left standard vocal cord length=0.370, tE right standard vocal cord length=0.821, tA standard glottic area=2.731, tB standard glottic area=2.753, tE standard glottic area=-0.529, P>0.05). The standard vocal cord length and standard glottic area after 4 weeks in group C, D were significantly lower than those before surgery(tC left standard vocal cord length=16.137, tC right standard vocal cord length=13.984, tD left standard vocal cord length=11.903, tD right standard vocal cord length=14.587, tC standard glottic area=10.280, tD standard glottic area=22.974, P<0.05). During 6-18 months of follow-up in clinical patients, no one developed a glottic web. Three months after surgery, Jitter, Shimmer, noise to harmonic ratio(NHR), the maximum phonation time(MPT)in all patients were significantly different from preoperative(tintralaryngeal mucosal flap jitter=24.885, tintralaryngeal mucosal flap shimmer=22.643, tintralaryngeal mucosal flap NHR=6.202, tintralaryngeal mucosal flap MPT=-9.661, tfree mucosal flap jitter=25.459, tfree mucosal flap shimmer=18.683, tfree mucosal flap NHR=5.705, tfree mucosal flap MPT=-20.840, P<0.05). Conclusion: Mucosal flap combined with silicone keel is an effective technique for preventing and treating anterior commissure adhesion. The effect of pedicled intralaryngea lmucosal flap is better.

Causas de estridor congénito / Causes of congenital stridor

INTRODUCTION. Airway abnormalities are rare but potentially fatal. Stridor is a res-piratory noise with greater predominance in the inspiratory phase. OBJECTIVE. To evaluate the etiology of stridor, determine its comorbidities and mortality. MATERIALS AND METHODS. Retrospective cross-sectional study. Population of 110 and sample of 33 data from the Medical Records of neonatal or infant patients who presented stri-dor at the Carlos Andrade Marín Specialties Hospital of Quito-Ecuador, from january 2009 to december 2020. RESULTS. The 51,51% (17; 33) of cases were men. The age of the first consultation for stridor was within the first month in 18,00% (6; 33) and 40,00% (13; 33) at 3 months. The most frequent congenital laryngeal patholo-gy was: laryngomalacia 81,82% (27; 33), followed by subglottic stenosis 9,09% (3; 33), bilateral chordal paralysis 6,06% (2; 33) and tracheal stenosis 3,03% (1; 33). The 51,51% (17; 33) presented comorbidities of causes: neurological, pulmonary and genetic among the main ones. Mortality was 18,20% (6; 33) related to the severity of comorbidities, except one secondary to tracheal stenosis. CONCLUSION. Laryn-gomalacia and subglottic stenosis were the predominant pathologies with congenital stridor. The comorbidities that occurred were neurological, pulmonary, genetic and caused mortality within 90 days after diagnosis.

INTRODUCCIÓN. Las anomalías de la vía aérea son poco frecuentes, pero potencialmente mortales. El estridor es un ruido respiratorio con mayor predominio en la fase inspiratoria. OBJETIVO. Evaluar la etiología del estridor, determinar sus comorbilidades y la mortalidad. MATERIALES Y MÉTODOS. Estudio transversal retrospectivo. Población de 110 y muestra de 33 datos de Historias Clínicas de pacientes neonatos o lactantes que presentaron estridor en el Hospital de Especialidades Carlos Andrade Marín de Quito - Ecuador, de enero 2009 a diciembre 2020. RESULTADOS. El 51,51% (17; 33) de casos fueron hombres. La edad de la primera consulta por estridor fue dentro del primer mes en el 18,00% (6; 33) y del 40,00% (13; 33) a los 3 meses. La patología congénita laríngea más frecuente fue: laringomalacia 81,82% (27; 33), seguida de estenosis subglótica 9,09% (3; 33), parálisis cordal bila-teral 6,06% (2; 33) y estenosis traqueal 3,03% (1; 33). El 51,51% (17; 33) presentaron comorbilidades de causas: neurológica, pulmonar y genética entre las principales. La mortalidad fue 18,20% (6; 33) relacionada con la severidad de las comorbilidades, excepto una secundaria a estenosis traqueal. CONCLUSIÓN. La laringomalacia y la estenosis subglótica fueron las patologías que predominaron con estridor congénito. Las comorbilidades que se presentaron fueron neurológica, pulmonar, genética y causaron mortalidad dentro de los 90 días posteriores al diagnóstico.

Regenerative potential of basic fibroblast growth factor contained in biodegradable gelatin hydrogel microspheres applied following vocal fold injury: Early effect on tissue repair in a rabbit model / Potencial regenerativo do fator básico de crescimento de fibroblastos contido em microesferas biodegradáveis de hidrogel de gelatina aplicadas após lesão de prega vocal: efeito inicial no reparo tecidual em modelo de coelho

Abstract Introduction Postoperative dysphonia is mostly caused by vocal fold scarring, and careful management of vocal fold surgery has been reported to reduce the risk of scar formation. However, depending on the vocal fold injury, treatment of postoperative dysphonia can be challenging. Objective The goal of the current study was to develop a novel prophylactic regenerative approach for the treatment of injured vocal folds after surgery, using biodegradable gelatin hydrogel microspheres as a drug delivery system for basic fibroblast growth factor. Methods Videoendoscopic laryngeal surgery was performed to create vocal fold injury in 14 rabbits. Immediately following this procedure, biodegradable gelatin hydrogel microspheres with basic fibroblast growth factor were injected in the vocal fold. Two weeks after injection, larynges were excised for evaluation of vocal fold histology and mucosal movement. Results The presence of poor vibratory function was confirmed in the injured vocal folds. Histology and digital image analysis demonstrated that the injured vocal folds injected with gelatin hydrogel microspheres with basic fibroblast growth factor showed less scar formation, compared to the injured vocal folds injected with gelatin hydrogel microspheres only, or those without any injection. Conclusion A prophylactic injection of basic fibroblast growth factor -containing biodegradable gelatin hydrogel microspheres demonstrates a regenerative potential for injured vocal folds in a rabbit model.

Resumo Introdução A disfonia pós-operatória é causada principalmente por cicatrizes nas pregas vocais. Tem sido relatado que o manejo cuidadoso da cirurgia das pregas vocais reduz o risco de formação de cicatriz. No entanto, a depender da lesão da prega vocal, o tratamento da disfonia pós-operatória pode ser desafiador. Objetivo Desenvolver uma nova abordagem regenerativa profilática para o tratamento de pregas vocais lesionadas após a cirurgia, com microesferas biodegradáveis de hidrogel de gelatina como sistema de administração de medicamentos para o Fator Básico de Crescimento de Fibroblastos (bFGF). Método A cirurgia laríngea videoendoscópica foi feita para criar lesão nas pregas vocais em 14 coelhos. Imediatamente após esse procedimento, microesferas biodegradáveis de hidrogel de gelatina com bFGF foram injetadas na prega vocal. Duas semanas após a injeção, as laringes foram excisadas para avaliação da histologia das pregas vocais e do movimento da mucosa. Resultados A presença de função vibratória deficiente foi confirmada nas pregas vocais lesionadas. A histologia e a análise de imagem digital demonstraram que as pregas vocais lesionadas injetadas com microesferas de hidrogel de gelatina com bFGF apresentaram menor formação de cicatriz, em comparação com as pregas vocais lesionadas injetadas apenas com microesferas de hidrogel de gelatina ou aquelas sem injeção. Conclusão Uma injeção profilática de microesferas biodegradáveis de hidrogel de gelatina com bFGF demonstra um potencial regenerativo para pregas vocais lesionadas em um modelo de coelho.

Correlação de padrões vasculares na imagem de banda estreita com a densidade imuno-histológica de microvasos em lesões de pregas vocais / Correlation of narrow band imaging vascular patterns with immunohistological microvessel density in vocal fold lesions

Resumo Introdução: A microarquitetura dos vasos mucosos e submucosos é crucial para o diagnóstico. A neoangiogênese é um parâmetro biológico confirmado que implica progressão e metástase no câncer de laringe. Objetivo: Investigar a correlação entre as classificações de padrões vasculares por imagem de banda estreita e densidade imuno-histológica de microvasos em diferentes tipos de lesões intraepiteliais da prega vocal. Método: A análise da densidade imuno-histológica de microvasos com o uso de anticorpos CD31 e CD34 foi feita em 77 lesões, inclusive: 20 lesões não displásicas, 20 com displasia de baixo grau, 17 com displasia de alto grau e 20 com câncer invasivo. A avaliação dos padrões vasculares com a imagem de banda estreita, de acordo com as diretrizes de classificação de Ni e da European Laryngological Society, foi feita antes da ressecção cirúrgica. Resultados: O valor médio da densidade imuno-histológica de microvasos com CD31 foi o mais alto para as lesões do Tipo IV de Ni (20,55), enquanto para o padrão longitudinal e perpendicular, de acordo com a classificação da European Laryngological Society, foi de 12,50 e 19,45, respectivamente. O maior valor médio da densidade imuno-histológica de microvasos com CD34 foi identificado nas lesões de Ni Tipo Va (35,43) e nos padrões longitudinal e perpendicular de acordo com a classificação da European Laryngological Society foi de 15,12 e 30,40, respectivamente. Conclusões: As alterações morfológicas microvasculares das lesões laríngeas intraepiteliais observadas na endoscopia por imagem de banda estreita foram positivamente correlacionadas com os índices de angiogênese da avaliação imuno-histológica.

High speed digital videolaringoscopy: evaluation of vocal nodules and cysts in women / Videolaringoscopia digital de alta velocidade: avaliação de nódulos e cistos de pregas vocais de mulheres

ABSTRACT Purpose To evaluate and compare the parameters of Digital kymography obtained through the High-speed Videolaryngoscopy of women without laryngeal disorders, of women with vocal fold nodules and of women with vocal cysts. Methods A cross-sectional observational study in which 60 women aged 18 years and 45 years were selected. Three study groups were formed: 20 women without laryngeal disorder forming the control group (Group 1), 20 women with diagnosis of vocal fold nodules forming Group 2 and 20 women with diagnosis of vocal cysts forming Group 3. Subsequently the participants were evaluated by High-speed Videolaryngoscopy for analysis and comparison of laryngeal images using Digital kymography. The laryngeal parameters processed by the program KIPS® were: minimum, maximum and mean opening; dominant amplitude of the left and right vocal folds; dominant frequency of the right and left vocal folds; and close. Results The analysis of Digital kymography suggests that the presence of the vocal fold nodules and the vocal cysts tend to restrict more to the maximum and minimum opening of the vocal fold and the dominant amplitude of the opening variation in the middle region of the glottis. Conclusion Digital kymography parameters were similar in the presence of vocal fold nodules and vocal cysts lesions.

RESUMO Objetivo Avaliar e comparar os parâmetros da videoquimografia digital obtidos pela videolaringoscopia de alta velocidade de mulheres sem alterações laríngeas, de mulheres com nódulos de prega vocal e de mulheres com cistos vocais. Método Estudo observacional transversal, no qual foram selecionadas 60 mulheres com idade entre 18 e 45 anos. Três grupos foram formados: 20 mulheres sem alterações laríngeas formando o grupo controle (Grupo 1), 20 mulheres com diagnóstico de nódulos nas pregas vocais formando o Grupo 2 e 20 mulheres com diagnóstico de cistos vocais formando o Grupo 3. Posteriormente, os participantes foram avaliados por Videolaringoscopia de alta velocidade para análise e comparação de imagens da laringe usando videoquimografia digital. Os parâmetros videoquimográficos avaliados pelo programa KIPS® foram: aberturas mínima, máxima e média; amplitudes da prega vocal direita e esquerda; frequências da abertura da prega vocal direita e esquerda; e fechamento. Resultados A análise da videoquimografia digital sugere que a presença dos nódulos e dos cistos de pregas vocais tendem a restringir a abertura máxima e média da prega vocal e a amplitude dominante da variação de abertura na região média da glote. Conclusão Os parâmetros da videoquimografia digital foram semelhantes na presença de nódulos nas pregas vocais e lesões de cistos vocais.

Kymographic characteristics of voice in women with Polycystic ovary syndrome

ABSTRACT Purpose Polycystic ovary syndrome (PCOS) is heterogenous condition with commonly associated symptoms include irregular menstrual cycle, hirsutism, baldness, adult acne, and weight gain There have been few attempts at profiling the voice characteristics of women with polycystic ovary syndrome. Videokymography enables to detect even subtle variations in vocal fold vibrations. The aim of the present study was to study the videokymographic characteristics among women with PCOS. Methods A cross-sectional study was carried out among 50 women with and without PCOS diagnosed on ultrasonography. Videokymography was carried out and the characteristics were perceptually analyzed using a vocal fold kymographic rating scale. The analysis of the kymogram was done for the following characteristics; presence of vocal fold vibration,interference of surroundings, Cycle to cycle variability, left-right asymmetry,cycle aberrations and shape of lateral peaks. The kymographic images were obtained for all the participants of both the groups and a subjective consensus evaluation was done by two clinicians. The percentage of participants with the listed kymographic characteristics were tabulated. Chi Square test was also done to decide if there was a significant difference between the two groups for different kymographic features of vocal fold vibration. Results Six of the 25 women with PCOS were found to have abnormal kymographic features such as surrounding structural interference, presence of cycle to cycle variability and the shape of lateral peaks. Conclusion Early detection of the vocal abnormalities in individuals with PCOS would help in the vocal rehabilitation especially for professional voice users.