Is it Always Laryngopharyngeal Reflux? How Voice Disorders Can Manifest as LPR

Introduction: Laryngopharyngeal reflux (LPR) manifests with a constellation of common throat symptoms and inconclusive signs on laryngoscopic exam. It is a diagnosis, often made clinically, that can lead to prescriptions of proton pump inhibitors that are unnecessary and potentially harmful. Glottic insufficiency (GI) and the accompanying hyperfunctional laryngeal behaviors can also present with similar, common throat complaints that may or may not include a qualitative change to the voice. Methods: This is a reflection article. It is written to summarize, explain, and support with evidence the opinion of the author on the topic of how symptoms of voice disorders can easily be mistaken for symptoms of LPR. The offered reflection is based on his experience, research and the available literature. Reflection: This article intends to explore the similarities between GI and LPR, how to ultimately differentiate them and how to approach treatment with a broader differential diagnosis. Conclusion: LPR and GI can present with identical, vague throat, and voice symptoms. Empiric medication trials, behavioral interventions and objective laryngovideostroboscopy, impedance-based reflux, and esophageal motility testing may all be needed, sometimes in a trial and error fashion, to correctly diagnose and treat a patient's symptoms.

Introducción: El reflujo laríngeo-faríngeo (LPR, por sus siglas en inglés) se manifiesta con una serie de síntomas comunes en la garganta y signos no concluyentes en el examen larinoscópico. Es un diagnóstico que a menudo se realiza clínicamente y que puede llevar a la prescripción de inhibidores de la bomba de protones que son innecesarios y potencialmente perjudiciales. La insuficiencia glótica (IG) y los comportamientos laríngeos hiperfuncionales que la acompañan también pueden presentar síntomas de garganta comunes similares, que pueden o no incluir un cambio cualitativo en la voz. Métodos: Este es un artículo de reflexión. Está escrito para resumir, explicar y respaldar con evidencia la opinión del autor sobre cómo los síntomas de los trastornos de la voz pueden confundirse fácilmente con los síntomas del LPR. La reflexión ofrecida se basa en su experiencia, investigación y la literatura disponible. Reflexión: Este artículo tiene la intención de explorar las similitudes entre la IG y el LPR, cómo diferenciarlos finalmente y cómo abordar el tratamiento con un diagnóstico diferencial más amplio. Conclusión: El LPR y la IG pueden presentar síntomas idénticos y vagos en la garganta y la voz. Puede ser necesario realizar ensayos de medicación empírica, intervenciones conductuales y pruebas objetivas de laringovideostroboscopia, reflujo basado en impedancia y motilidad esofágica, a veces de manera experimental, para diagnosticar y tratar correctamente los síntomas de un paciente.

Infiltración temprana en la parálisis laríngea: evolución y factores pronósticos / Early infiltration in laryngeal paralysis: course and prognostic factors

Introducción y objetivo: La parálisis de las cuerdas vocales (CCVV) es una patología prevalente e incapacitante. El objetivo principal de este estudio es comparar la recuperación de la movilidad y funcionalidad de las CCVV, así como el requerimiento de tiroplastia en dos grupos de pacientes, los que se trataron con infiltración temprana con ácido hialurónico (GIT) y los no infiltrados (GNI). Método: Estudio retrospectivo observacional. Para formar el GNI se filtró la base de datos de 715 exploraciones de parálisis laríngeas y se seleccionaron 33 pacientes que cumplieran los criterios de inclusión. Para el GIT se incluyeron a los pacientes infiltrados por parálisis laríngea en los últimos 3 años (n=22). En el GNI se analizó como medida de resultado: la recuperación de la movilidad y funcionalidad de la cuerda y la necesidad de tiroplastia. En el GIT se midió, adicionalmente, la fecha de la infiltración. Resultados: Los resultados del GIT son significativamente mejores (p=0.001) en la recuperación de la movilidad de las CCVV. Se observa una reducción no significativa (p=0.14) en la necesidad de tiroplastia en los pacientes infiltrados. Existen diferencias significativas entre los pacientes con parálisis unilateral del GNI vs GIT (p=0.009), mientras que los grupos con parálisis bilaterales no son comparables entre sí, debido al compromiso de la vía aérea que sufren los pacientes con la cuerda en posición medial. Discusión: La infiltración con ácido hialurónico proporciona el tratamiento temporal del defecto de cierre glótico con baja tasa de complicaciones, prolongando el tiempo máximo de fonación y la funcionalidad de la cuerda vocal parética, pudiendo reducir tratamientos posteriores. Se ha propuesto como un tratamiento que puede mejorar la calidad de vida del paciente. Sin embargo, es importante seleccionar adecuadamente los pacientes, ya que no todos pueden ser candidatos... (AU)

Introduction and objective: Vocal cord paralysis is a prevalent and disabling pathology. The main objective is to compare the recovery of movility and functionality of vocal cords, as well as the requirement of definitive surgery in two groups of patients: non-infiltrated group (NIG) versus early infiltration group with hyaluronic acid (EIG). Method: Retrospective observational study. To set up the NIG, we sorted the database of 715 videos labeled as “laryngeal paralysis” and selected n=33 patients who met the inclusion criteria of the study. To create the EIG, we selected patients injected with hyaluronic acid in the last 3 years (n=22). In the NIG, the following were analyzed as outcome measures: recovery of mobility and functionality of the cord and the need for thyroplasty. In the EIG, the date of infiltration was also measured. Results: The results of the EIG are significantly better (p=0,001) in terms of vocal cord mobility recovery. A non-significant reduction (p=0.14) was observed in the need for thyroplasty in injected patients. There are significant differences between patients with unilateral paralysis of the NIG vs EIG (p=0.009), while the bilateral groups are not comparable, due to the compromise of the airway suffered by patients with the cord in a medial position. Discussion: Early infiltration with hyaluronic acid provides temporary treatment of the glottic closure defect with a low rate of complications, prolonging the maximum phonation time and improving the vocal movement, which may reduce the need for subsequent treatments. It has been proposed as a treatment that can improve the patient’s quality of life. However, it is important to properly select patients, since not all may be candidates... (AU)

A retrospective analysis of revision framework surgeries for unilateral vocal fold paralysis / Análise retrospectiva das cirurgias de revisão do arcabouço laríngeo para paralisia unilateral de prega vocal

Abstract Introduction Revision framework surgeries might be required for unilateral vocal fold paralyses. However, outcomes and indications of revision surgeries have not been adequately documented. For a better understanding of indications for the procedure and to help in achieving better vocal outcomes, we performed a retrospective chart review of patients who underwent revision framework surgeries for unilateral vocal fold paralysis. Objectives This study aimed to present clinical features of patients who underwent revision framework surgeries for the treatment of unilateral vocal fold paralysis. Methods Of the 149 framework surgeries performed between October 2004 and October 2019, 21 revision framework surgeries were performed in 19 patients. Self-assessments by patients using the voice handicap index-10 questionnaire, and objective aerodynamic and acoustic assessments performed pre- and post-operatively were analyzed using the Wilcoxon's signed-rank test for paired comparisons. Results Undercorrection was indicated as reasons for revision surgeries in all cases. The revision techniques included type I thyroplasty, type IV thyroplasty, and arytenoid adduction, and revision surgeries were completed without any severe complication in all cases. Pre- and post-operative voice handicap index-10 scores were obtained in 12 cases, and other parameters were evaluated in 18 cases. Significant improvements were observed in voice handicap index-10 scores, maximum phonation time, mean flow rate, Current/Direct Current ratio, and pitch perturbation quotient. Conclusion Undercorrection was observed in all patients who underwent revision framework surgeries for unilateral vocal fold paralysis, and the initial assessment and planning are thought to be important in order to avoid revision surgeries. Revision surgeries were performed safely in all cases, and significantly improved vocal outcomes were observed, even after multiple procedures. Revision surgery should be considered for patients with unsatisfactory vocal functions after primary framework surgeries for unilateral vocal fold paralysis.

Resumo Introdução As cirurgias de revisão do arcabouço laríngeo podem ser necessárias em casos de paralisia unilateral de prega vocal. Entretanto, os resultados e as indicações das cirurgias de revisão não têm sido documentados de forma adequada. Para melhor compreensão das indicações do procedimento e para auxiliar na obtenção de melhores resultados vocais, fizemos uma revisão retrospectiva dos prontuários de pacientes submetidos a cirurgias de revisão do arcabouço laríngeo em paralisia unilateral de prega vocal. Objetivos Apresentar as características clínicas de pacientes submetidos a cirurgias de revisão do arcabouço laríngeo para tratamento de paralisia unilateral de prega vocal. Método Das 149 cirurgias de revisão do arcabouço laríngeo feitas entre outubro de 2004 e outubro de 2019, 21 cirurgias de revisão do arcabouço laríngeo foram feitas em 19 pacientes. As autoavaliações feitas pelos pacientes com o questionário voice handicap index‐10 e avaliações aerodinâmicas e acústicas objetivas feitas no pré e pós‐operatório foram analisadas com o teste de postos sinalizados de Wilcoxon para comparações pareadas. Resultados A hipocorreção foi apontada como o motivo das cirurgias de revisão em todos os casos. As técnicas de revisão incluíram tireoplastia tipo I, tireoplastia tipo IV e adução de aritenoide. As cirurgias de revisão foram feitas sem qualquer complicação grave em todos os casos. Os escores do questionário voice handicap index‐10 pré e pós‐operatórios foram obtidos em 12 casos e outros parâmetros foram avaliados em 18 casos. Melhorias significativas foram observadas nos escores do questionário, no tempo máximo de fonação, taxa de fluxo médio, relação antes/depois e no quociente de perturbação do pitch. Conclusão Hipocorreção foi observada em todos os pacientes submetidos a cirurgias de revisão do arcabouço laríngeo para paralisia unilateral de prega vocal e a avaliação inicial e o planejamento são considerados importantes para evitar cirurgias de revisão. As cirurgias de revisão foram feitas com segurança em todos os casos e melhoria significativa dos resultados vocais foi observada mesmo após múltiplos procedimentos. A cirurgia de revisão deve ser considerada para pacientes com funções vocais insatisfatórias após cirurgia primária do arcabouço laríngeo para paralisia unilateral de prega vocal.

Efectividad de la terapia vocal versus tiroplastía en la voz de mujeres transgénero: una revisión integrativa / Effectiveness of vocal therapy versus thyroplasty in the voice of transgender women: an integrative review

Introducción. Las mujeres transgénero encuentran frecuentemente problemas en ajus-tar su voz a la frecuencia femenina. Para favorecer el cambio vocal deseado por estos in-dividuos, se ofrecen dos técnicas: una quirúrgica (tiroplastía) y otra clínica (terapia vocal). Objetivo. Esta revisión integrativa pretende verificar las publicaciones científicas relacionadas con las dos técnicas, observando cuál reporta mayor efectividad. Método. Se realizó una búsqueda en bases de datos, considerando las palabras clave: Transsexual Persons AND Voice Feminization AND Thyroplasty OR Voice Training. Resultados. Nueve artículos corresponden a estudios observacionales y tres utiliza-ron una metodología cuasi experimental. Los grupos estudiados incluyen un amplio espectro etario. Ninguno de los estudios informa aspectos económicos de las inter-venciones. No existe evidencia de seguimiento a largo plazo. Conclusiones. La vía de tratamiento vocal con adición hormonal puede ser una primera línea, y en caso de no reportar mejoras, la cirugía aparece como otra opción.Recomendación. La recomendación es que se realice terapia vocal, que no im-plica riesgos significativos de complicaciones, siendo además un abordaje relativa-mente económico.

Introduction. Transsexual women frequently encounter problems in adjusting their voices to the characteristics of their new gender. In order to help in the change to the desired voice, two techniques are often used: the surgical (Thyroplasty) and clinical (Speech Therapy). Objective. The aim of this integrative study is to verify through scientific publications the relationship between the two techniques and observe which is the most effective.Method. A systematic database search was conducted considering the keywords: Transsexual Persons AND Voice Feminization AND Thyroplasty OR Voice Training.Results. Nine articles corresponded to observational studies and three used a qua-si-experimental methodology. The groups studied include a broad age spectrum and the quality of the evidence is low. No study reports economic aspects of the interven-tions. There is no evidence of long-term follow-up. Conclusions. The vocal treatment route with hormonal addition can be a first line, and, in case of not reporting improvements, surgery appears as another option.Recommendation. The recommendation is for Speech Therapy, which has no significant risks of complications and is relatively cheap.

Sedation using dexmedetomidine and remifentanil with local anesthesia for intraoperative speech monitoring: a case report / Sedação com dexmedetomidina e remifentanil em anestesia local para monitoração intraoperatória da fala: um relato de caso

Abstract Background and objective Some surgical procedures such as laryngoplasty require patients to remain conscious during the intraoperative phase in order to enable speech monitoring. Dexmedetomidine and remifentanil were used in this study, since they promote appropriate patient collaboration with facilitated awakening, and are rapidly eliminated. Case report The patient complained of dysphonia, which had resulted from unilateral vocal fold paralysis after previous thyroidectomy. The surgical treatment was performed under local anesthesia in association with sedation using dexmedetomidine and remifentanil. The patient was stable and cooperative during the entire intraoperative period, without desaturation and with rapid postoperative awakening. Conclusion Dexmedetomidine and remifentanil can be used for safe sedation; however, the presence of an anesthesiologist is required during the entire intraoperative period.

Resumo Justificativa e objetivos Alguns procedimentos cirúrgicos requerem que o paciente se mantenha consciente no intraoperatório, como as laringoplastias, para que a monitoração da voz seja feita. Optamos pelo uso de dexmedetomidina e remifentanil por serem fármacos que proporcionam adequada colaboração do paciente com fácil despertar, são rapidamente eliminados do organismo. Relato de caso Paciente com queixa de disfonia por paralisia de corda vocal unilateral após realização de tireoidectomia. O procedimento foi realizado com anestesia local associada à sedação com dexmedetomidina e remifentanil. A paciente ficou estável e colaborativa durante toda a operação, sem períodos de dessaturação e com rápido despertar pós-operatório. Conclusão Dexmedetomidina e remifentanil podem ser utilizados para sedação com grande segurança, mas isso não dispensa a necessidade do cuidado por um anestesiologista em tempo integral durante o procedimento.

Hemitiroidectomía izquierda más tiroplastia con anestesia local. Reporte de un caso / Left hemithyroidectomy plus thyroplasty with local anesthesia. A case report

Resumen La asociación entre parálisis cordal y nódulo tiroideo es sugestiva de malignidad; por lo general, se trata de un carcinoma de la glándula tiroides con un tumor avanzado. Presentamos el caso de una paciente con carcinoma papilar de tiroides, parálisis cordal izquierda con aspiración bronquial y complicaciones pulmonares severas, a quien se le realizó hemitiroidectomía izquierda más tiroplastia con anestesia local y control endoscópico utilizando injerto de politetrafluoroetileno en forma artesanal. La evolución quirúrgica mostró buen resultado a corto plazo (13 meses), sin complicaciones relacionadas, fonación aceptable, con ganancia ponderal y sin nuevas complicaciones pulmonares. No existen hasta el momento de realizar este manuscrito reportes de cirugía de tiroides más tiroplastia con anestesia local. Se requiere una serie con mayor número de casos para llegar a conclusiones de validez.

Abstract The association between chordal paralysis and thyroid nodule is suggestive of malignancy, and it is usually a carcinoma of the thyroid gland with an advanced tumor. We present the case of a patient with papillary carcinoma of the thyroid, left cordal paralysis with bronchial aspiration and severe pulmonary complications who underwent left hemithyroidectomy plus thyroplasty with local anesthesia and endoscopic control using handcrafted polytetrafluoroethylene graft. The surgical evolution showed good short-term results (13 months) without related complications, acceptable phonation, with weight gain and without new pulmonary complications. There are no reports of thyroid surgery plus thyroplasty with local anesthesia at the time of this manuscript. A series with a greater number of cases is required in order to draw valid conclusions.

[Sedation using dexmedetomidine and remifentanil with local anesthesia for intraoperative speech monitoring: a case report]. / Sedação com dexmedetomidina e remifentanil em anestesia local para monitoração intraoperatória da fala: um relato de caso.

BACKGROUND AND OBJECTIVE: Some surgical procedures such as laryngoplasty require patients to remain conscious during the intraoperative phase in order to enable speech monitoring. Dexmedetomidine and remifentanil were used in this study, since they promote appropriate patient collaboration with facilitated awakening, and are rapidly eliminated. CASE REPORT: The patient complained of dysphonia, which had resulted from unilateral vocal fold paralysis after previous thyroidectomy. The surgical treatment was performed under local anesthesia in association with sedation using dexmedetomidine and remifentanil. The patient was stable and cooperative during the entire intraoperative period, without desaturation and with rapid postoperative awakening. CONCLUSION: Dexmedetomidine and remifentanil can be used for safe sedation; however, the presence of an anesthesiologist is required during the entire intraoperative period.

Parálisis de cuerda vocal secundaria a intubación endotraqueal y su manejo: revisión en relación a dos casos clínicos / Vocal cord paralysis secondary to endotracheal intubation and its management: review in relation to two clinical cases

La parálisis de cuerda vocal secundaria a intubación endotraqueal es una complicación poco frecuente de la anestesia general. Se manifiesta con disfonía precoz luego de la extubación, y en ocasiones se asocia a aspiración. A continuación se presenta el reporte de dos pacientes sometidos a cirugía abdominal con anestesia general e intubación endotraqueal, que presentan una parálisis cordal unilateral en el posoperatorio inmediato. En ambos pacientes se realiza una laringoplastía de inyección con ácido hialurónico (Restylane®), con buenos resultados vocales. Uno de los casos tiene seguimiento a lo largo de dos años. Se describe esta patología y su manejo mediante una revisión bibliográfica.

Vocal fold paralysis posterior to endotracheal intubation is a very uncommon complication of the general anestesia. The symptoms includes hoarseness posterior to the extubation, and some times aspiration occurs. In this paper we present the report of two cases of abdominal surgery with general anesteshia and endotraqueal intubation procedures. Both subjects developed unilateral vocal fold paralysis after the process. The patients were treated with wedilization injection with Restylane ®, satisfactory voice's results were achieved. One of them has an observational time of two years. We describe this infrequent pathology and the treatment through literature review.

Electromyography-guided hyaluronic acid injection laryngoplasty in early stage of unilateral vocal fold paralysis. / Laringoplastia de inyección con ácido hialurónico guiada por EMG en etapa precoz de parálisis unilateral de cuerda vocal.

INTRODUCTION AND OBJECTIVE: To assess the effectiveness of electromyography-guided hyaluronic acid injection laryngoplasty in the early stage of unilateral vocal fold paralysis in terms of patient recovery from dysphonia and quality of life. METHODS: Between January and December 2014, 28 patients with unilateral vocal fold paralysis underwent electromyography and injection of hyaluronic acid in the thyroarytenoid muscle. We compared the voice handicap index, grade, roughness, breathiness, asthenia, strain scale (GRBAS), videostroboscopic parameters and maximum phonation time assessed before, 15 days and 6 months after the intervention, using the non-parametric Wilcoxon rank test. RESULTS: Out of the 28 patients, 1 had a haematoma in the injected vocal fold (3.57%) and 6 required second injections. The maximum phonation time of the vowel /e/ increased from 6.07 to 12.14 sec. (15 days post-intervention) and subsequently 12.75 (6 months post-intervention). There was also a significant improvement in the grade, roughness, breathiness, asthenia, strain scale in parameters G, B and A both 15 days and 6 months after the intervention. The voice handicap index score decreased from 58.29 to 37.63 (15 days post-intervention) and 29.64 (6 months post-intervention). CONCLUSIONS: Electromyography-guided hyaluronic injection laryngoplasty in unilateral vocal fold paralysis enables, in the same intervention, neuromuscular assessment and temporary treatment of glottic insufficiency with a low risk of complications and improvement in patient's quality of life. This may reduce the need for subsequent treatments, but further research is required to confirm these findings.

Laringoplastía de inyección con ácido hialurónico, experiencia del Hospital Clínico de la Pontificia Universidad Católica de Chile / Laryngoplasty injection with hyaluronic acid, Hospital Clinico de la Pontificia Universidad Catolica de Chile experience

Introducción: El manejo inicial de la parálisis cordal unilateral incluye la observación en espera de la recuperación de la movilidad o la compensación, terapia fonoaudiológica o inyección de medialización temporal para llevar la cuerda a una posición más favorable para el cierre glótico. Este procedimiento puede realizarse en pabellón, o vía percutánea en paciente despierto. Existen varias opciones, siendo el ácido hialurónico (Restylane®) uno de los más usados. Objetivo: Revisar la experiencia pionera en el país en la inyección de medialización de cuerda vocal con ácido hialurónico en el manejo de la parálisis cordal unilateral. Material y método: Estudio retrospectivo, que incluyó a 15 pacientes con insuficiencia glótica a los que se les realizó una inyección percutánea con ácido hialurónico. Se evaluó la calidad de la voz pre y posprocedimiento (VRQOL), tolerancia al procedimiento y complicaciones. Resultados: El 100% de los pacientes mostró cambios significativos en el VRQOL, con un cambio promedio pre y post de 37%. El procedimiento fue bien tolerado en el 93%. No se produjeron incidentes durante la inyección ni tampoco posteriores. Conclusión: La inyección de medialización es un procedimiento bien tolerado, seguro y sencillo, que permite mejoras significativas en la calidad vocal. El ácido hialurónico es seguro y eficaz para la inyección de medialización.

Introduction: Initial treatment options for unilateral vocal fold paralysis include observation for spontaneous return of function or compensation, voice therapy to stimulate recovery of motion or function, or temporary vocal fold injection medialization to improve glottic closure. Temporary injection medialization can be performed under general anesthesia or in the awake-patient setting with local anesthesia. There are different options of temporary injection materials, being hyaluronic acid (Restylane®) one of the most popular. Aim: To review our pioneer experience in Chilewith the use of temporary vocal fold injection with hyaluronic acid in the initial management of unilateral vocal fold paralysis. Material and method: Retrospective study involving 15 patients with glottic insufficiency, who underwent percutaneous vocal fold injection medialization with hyaluronic acid. Pre and post procedure quality of voice (VRQOL), tolerance to the procedure, and complications were evaluated. Results: All patients showed significant changes in VRQOL, with a 37% average improvement. The procedure was well tolerated in 93%. No incidents occurred during injection orlater. Conclusions: The temporary vocal fold injection medialization is a well-tolerated, safe and simple procedure that allows significant short-term improvements in vocal quality of patients. Hyaluronic acid is a safe and effective material for temporary vocal foldinjection medialization.

Manejo de disfonía post cirugía tiroidea con laringoplastía por inyección con ácido hialurónico / Hyaluronic acid in the management of post-thyroidectomy vocal cord paralysis

Introduction: Thyroid surgery rates have tripled over the past 3 decades. Currently, the main postoperative complications of this surgery are vocal fold paralysis because of recurrent laryngeal nerve dysfunction and hypocalcemia. Case report: We report the case of a 58 years old woman who presented with persistent dysphonia post total thyroidectomy. Laryngeal videostroboscopy evidenced unilateral vocal fold paralysis. We performed a percutaneous injection laryngoplasty with hyaluronic acid achieving significant improvement in voice. Conclusions: Percutaneous injection laryngoplasty with hyaluronic acid is a safe and effective procedure in the management of post thyroidectomy vocal cord paralysis.

Introducción: La tasa de cirugía tiroidea se ha triplicado en las últimas 3 décadas. Dentro de sus complicaciones se encuentra la parálisis de cuerda vocal unilateral secundaria a lesión transitoria o permanente del nervio laríngeo recurrente, lo que se presenta clínicamente como disfonía. Caso clínico: Paciente de 58 años, post tiroidectomía total evoluciona con disfonía persistente. Videoestroboscopia evidencia parálisis cuerda vocal izquierda en posición paramediana, con hiato fonatorio longitudinal amplio. Se maneja con laringoplastía por inyección con ácido hialurónico a cuerda vocal paralítica, logrando mejora significativa de voz. En videoestroboscopia de control al 7º día se evidencia cuerda vocal izquierda en línea media, con borde libre recto, sin presencia de hiato al fonar. Conclusiones: La laringoplastía por inyección percutánea con ácido hialurónico es un procedimiento seguro y eficaz para el tratamiento de la disfonía secundaria a parálisis cordal unilateral post cirugía tiroidea.

[Balloon laryngoplasty for acquired subglottic stenosis in children: predictive factors for success]. / Laringoplastia com balão para estenose sub-glótica adquirida na infância: fatores preditivosde sucesso.

INTRODUCTION: The treatment of subglottic stenosis in children remains a challenge for the otorhinolaryngologist, and may involve both endoscopic and open surgery. OBJECTIVE: To report the experience of two tertiary facilities in the treatment of acquired subglottic stenosis in children with balloon laryngoplasty, and to identify predictive factors for success of the technique and its complications. METHODS: Descriptive, prospective study of children diagnosed with acquired subglottic stenosis and submitted to balloon laryngoplasty as primary treatment. RESULTS: Balloon laryngoplasty was performed in 37 children with an average age of 22.5 months; 24 presented chronic subglottic stenosis and 13 acute subglottic stenosis. Success rates were 100% for acute subglottic stenosis and 32% for chronic subglottic stenosis. Success was significantly associated with acute stenosis, initial grade of stenosis, children of a smaller age, and the absence of tracheostomy. Transitory dysphagia was the only complication observed in three children. CONCLUSION: Balloon laryngoplasty may be considered the first line of treatment for acquired subglottic stenosis. In acute cases, the success rate is 100%, and although the results are less promising in chronic cases, complications are not significant and the possibility of open surgery remains without prejudice.

Balloon laryngoplasty for acquired subglottic stenosis in children: predictive factors for success / Laringoplastia com balão para estenose sub-glótica adquirida na infância: fatores preditivos de sucesso / Laringoplastia com balão para estenose sub-glótica adquirida na infância: fatores preditivos de sucesso

INTRODUCTION: The treatment of subglottic stenosis in children remains a challenge for the otorhinolaryngologist, and may involve both endoscopic and open surgery. OBJECTIVE: To report the experience of two tertiary facilities in the treatment of acquired subglottic stenosis in children with balloon laryngoplasty, and to identify predictive factors for success of the technique and its complications. METHODS: Descriptive, prospective study of children diagnosed with acquired subglottic stenosis and submitted to balloon laryngoplasty as primary treatment. RESULTS: Balloon laryngoplasty was performed in 37 children with an average age of 22.5 months; 24 presented chronic subglottic stenosis and 13 acute subglottic stenosis. Success rates were 100% for acute subglottic stenosis and 32% for chronic subglottic stenosis. Success was significantly associated with acute stenosis, initial grade of stenosis, children of a smaller age, and the absence of tracheostomy. Transitory dysphagia was the only complication observed in three children. CONCLUSION: Balloon laryngoplasty may be considered the first line of treatment for acquired subglottic stenosis. In acute cases, the success rate is 100%, and although the results are less promising in chronic cases, complications are not significant and the possibility of open surgery remains without prejudice. .

INTRODUÇÃO: O tratamento das estenoses subglóticas em crianças ainda representa um desafio para o otorrinolaringologista, e pode envolver tanto procedimentos endoscópicos quanto cirurgias reconstrutivas abertas. OBJETIVO: Apresentar a experiência de dois serviços terciários no manejo das estenoses subglóticas adquiridas em crianças, através da laringoplastia com balão e identificar fatores preditivos de sucesso e as complicações. MÉTODO: Estudo descritivo prospectivo de crianças com estenose subglótica adquirida submetidas à laringoplastia com balão como tratamento primário. RESULTADOS: Foram incluídas 37 crianças (média de idade 22,5 meses): 24 crianças portadoras de estenose subglótica crônica e 13 de estenose subglótica aguda. A taxa de sucesso do tratamento foi de 100% para os casos agudos e 32% para os casos crônicos. O sucesso do tratamento teve correlação significativa com: tempo de evolução da estenose, grau inicial da estenose, menor idade das crianças e a ausência de traqueostomia prévia. Disfagia transitória foi a única complicação observada em três pacientes. CONCLUSÃO: A laringoplastia com balão pode ser considerada como primeira linha de tratamento nas estenoses subglóticas. Nos casos agudos a taxa de sucesso é de 100% e o ganho, mesmo que parcial nos casos crônicos, é insento de complicações significativas e não traz prejuízo para cirurgias reconstrutivas posteriores. .

Efeito da injeção do biopolímero da cana-de-açúcar na prega vocal de coelhos: estudo comparativo com a hidroxiapatita de cálcio

A insuficiência glótica é uma condição clínica caracterizada pelo fechamento inadequado das pregas vocais durante a fonação ou a deglutição. Nos casos mais leves, os pacientes são geralmente encaminhados para tratamento fonoterápico. Nos casos com sintomas mais importantes ou insucesso na fonoterapia, o tratamento cirúrgico se faz necessário. A melhor abordagem cirúrgica para a insuficiência glótica vem sendo debatida há mais de um século. As injeções laringoplásticas são procedimentos tecnicamente simples e com possibilidade de realização sob regime ambulatorial, no entanto seus resultados não são sempre previsíveis. Esses procedimentos também trazem consigo a possibilidade de rigidez da mucosa vocal por causa da reação inflamatória ao material utilizado. Apesar do crescente interesse por procedimentos ambulatoriais na laringologia e da popularização das injeções laringoplásticas, é sabido que se carece de materiais de melhor qualidade para resultados ainda mais consistentes. O surgimento do biopolímero de cana-de-açúcar (BPCA) e as pesquisas sobre seu uso em outras especialidades médicas apontaram para a possibilidade de que o referido material possa ser adequado ao uso nas injeções laringoplásticas. O presente trabalho foi desenvolvido para estudar a reação inflamatória causada pela injeção do BPCA na prega vocal de coelhos e comparar com a reação causada pela hidroxiapatita de cálcio (HCa). Para tal, foi procedida a injeção de 0,1mL HCa e BPCA na forma de gel nas pregas vocais direita e esquerda, respectivamente, de coelhos machos adultos da raça Oryctolagus cuniculus. Os coelhos foram divididos em dois grupos de 15, os quais foram sacrificados com 3 e 12 semanas...

he glottal insufficiency is a clinical condition featured by abnormal closure of vocal folds during the process of phonation or deglutition. In most mild, cases patients are usually referred to speech therapy. In those cases presenting more relevant symptoms or failure in speech therapy, the surgical procedure is mandatory. The best surgical approach for glottal insufficiency has been debated over the past one hundred years. Laryngoplastic injections are technically simple procedures and possible to be performed in an outpatient basis, however their results are not always predictable. Such procedures may also present stiffness in the vocal mucosa due to the inflammatory reaction to the material which has been used. Despite of the fact that the growing interest in outpatient basis procedures in laryngology as well as the popularization of laryngoplastic injections, it is well known the lack of better quality materials for inducing much more consistent results. The arising of sugarcane biopolymer (SCB) along with researches on its use in other medical specialties demonstrated that there is a possibility for adequately using the mentioned material in laryngoplastic injections. The present work has been developed for the purpose of studying the inflammatory reaction which is caused by sugarcane biopolymer (SCB) injected in rabbits vocal folds as well as comparing to that reaction caused by calcium hydroxyapatite (HCa). For this experiment adult male rabbits from the race Oryctolagus cuniculus have been used, thus, 0.1 ml of HCa and of SCB in gel form were injected in their right and left vocal folds respectively. Rabbits have been divided into two groups of 15 each which were sacrificed at 3 and 12 weeks...

Laringoplastia de relajación o tiroplastia de tipo III / Relaxation laryngoplasty (thyroplasty tipe III)

La tiroplastia de relajación está indicada en pacientes con alteraciones de la muda vocal (cambio de voz en la pubertad) resistentes al tratamiento con fonoterapia. El acortamiento de los pliegues vocales tiene como objetivo reducir la frecuencia de vibración, con lo cual el tono adquiere un carácter masculino. Presentamos el caso de un paciente masculino con puberfonía que alteraba su calidad de vida. Se revisan la técnica quirúrgica y los resultados...

Relaxation laryngoplasty is a surgical procedure that is indicated in mutational falsetto that does not respond well to voice therapy. By shortening the vocal cords, thefundamental frequency diminishes and gains a more male voice. We present the case of a male patient, with mutational dysphonia characterized with inadequate tone elevation in relation to its gender. We describethe surgical technique and its outcome...