One Year Outcomes and Longitudinal Changes in Voice Improvement With Single High Dose Intracordal Trafermin Injections for Age-Related Vocal Fold Atrophy.

OBJECTIVE: Although intracordal trafermin injection has been performed in the treatment of age-related vocal fold atrophy, the effects of single high dose trafermin injections are unknown. In this study, we examined the 1 year outcomes and longitudinal changes in voice improvement with single high dose intracordal trafermin injections. STUDY DESIGN: Retrospective study with approval by our Ethics Committee. METHODS: The medical records of 34 patients who underwent single high dose (50ug per side) intracordal trafermin injections under local anesthesia for vocal fold atrophy were retrospectively reviewed at 1 month pre-injection and 1 month, 6 months and 1 year post injection. RESULTS: Maximum phonation time (MPT), pitch range (PR), Japanese version of voice handicap index (VHI), grade of GRBAS evaluation, and jitter% improved significantly at 1-year post-injection compared to 1-month pre-injection. MPT and PR improved as early as 1-month post-injection and continued to improve most at 1-year post-injection. VHI showed negative progression from 6-months to 1-year post-injection, during which time the speaking fundamental frequency (SFF) changed to the high pitch in men. CONCLUSIONS: Single high dose intracordal trafermin injections can be expected to improve voice in the early post-injection period and to maintain its effect for 1 year. SFF may play a role in worsening VHI in men. LEVEL OF EVIDENCE: level 4.

Changes in serum basic fibroblast growth factor concentration following intracordal injection.

Objective: Although many studies have reported improvements in voice outcomes with intracordal trafermin injection, there is a lack of data documenting its changes in serum basic fibroblast growth factor (bFGF) blood concentration. This study examined whether serum bFGF concentrations change after intracordal trafermin injection. Methods: This retrospective study was conducted at Tokyo Voice Center. We investigated serum bFGF concentrations before and after injection in 40 patients who underwent intracordal trafermin injection. There were 26 males and 14 females, with an age ranging from 13 to 88 years (average 53.25 years). They were diagnosed with paralysis (15 patients), atrophy (15 patients), sulcus (8 patients), and others (2 patients: scar and functional), presenting with severe hoarseness that interfered with daily life. Results: The mean pre- and post-injective serum bFGF concentration of the 40 patients was 6.689 and 4.658 pg/mL, respectively. The difference in mean serum bFGF concentration between pre- and post-injective was -2.031 pg/mL. The Pearson correlation coefficient was calculated to evaluate the correlation between dosage of trafermin and post-injective serum bFGF concentration, and a moderate correlation was found at r = 0.52. Generalized linear model regression analysis was performed for the purpose of adjusting for confounding among variables. The only variable that showed a statistically predominant association with post-injective serum bFGF concentrations was the dosage of trafermin, with an estimated regression coefficient of 0.048. Conclusion: In this study, the dosage of trafermin we injected and post-injective serum bFGF concentrations were dose-dependent but the amount of changes in the serum bFGF concentration was negligible within the physiological range. Therefore, as with subcutaneous and wound administration, intracordal trafermin injections may be safe. Level of Evidence: Level IV.

Evaluation of Safety After Intracordal Basic Fibroblast Growth Factor Injection.

OBJECTIVES: Although there are many reports of voice improvement with intracordal trafermin (a basic fibroblast growth factor) injections under local anesthesia, few papers have documented the safety of trafermin. Therefore, we aimed to investigate whether trafermin is safer than control drugs (triamcinolone acetonide) early after intracordal injection under local anesthesia. METHODS: We conducted a retrospective review from the medical records of patients who underwent intracordal injection with trafermin and triamcinolone acetonide under local anesthesia at our institution. Early postinjective complications were defined as changes in vital signs and chief complaints early after intracordal injection. RESULTS: A total of 699 and 297 patients underwent intracordal injection under local anesthesia with trafermin and triamcinolone acetonide, respectively. Of these, 227 and 130 patients had early postinjective complications with trafermin and triamcinolone acetonide, retrospectively. The most common complications occurring with trafermin was increased blood pressure in 39 cases (5.58%): 17 cases (2.43%) of blood pressure increase of ≥20 mm Hg. Other complications included pharyngeal discomfort in 37 (5.29%), lightheadedness in 33 (4.72%), and phlegm discharge in 29 (4.15%). Triamcinolone acetonide caused pharyngeal discomfort in 28 patients (9.43%), phlegm discharge in 17 patients (5.72%), lightheadedness in 12 patients (4.04%), sore throat in 11 patients (3.70%), increased blood pressure in 10 patients (3.37%): 7 cases (2.36%) of blood pressure increase of ≥20 mm Hg, and dizziness in seven patients (2.36%). Statistical analysis of the complications between trafermin and triamcinolone acetonide showed no significant differences. CONCLUSIONS: The proportion of early postinjective complications from intracordal injection of trafermin is no significant difference in that of triamcinolone acetonide. The results suggest that the early postinjective complications are not due to the drug action of trafermin, but rather to complications from the intracordal injection procedures. Intracordal trafermin injection may be safe in the short term.

Intracordal injection therapy for vocal fold scarring: Steroid versus basic fibroblast growth factor.

Objectives: Vocal fold scarring is caused by replacement of vocal fold mucosa with fibrous tissue due to repeated inflammation or trauma. It can lead to severe dysphonia. It is currently treated conservatively and with phonosurgery and intracordal injections. Intracordal injection of steroid or basic fibroblast growth factor (bFGF) has been recently found to be useful for treating vocal fold scarring that does not respond to voice therapy. Methods: This retrospective study involved the administration of steroid injection and bFGF injection bilaterally under local anesthesia in 16 patients each. Laboratory measurements of voice parameters were performed before and 3-6 months after injection. Results: In the steroid injection group, the Voice Handicap Index (VHI) score significantly improved from 57.1 to 40.5, total Grade, Roughness, Breathiness, Asthenia, Strain (tGRBAS) score significantly improved from 4.2 to 2.6, and mean speech fundamental frequency (SFF) increased from 192.5 to 211.4 dB, but there was no improvement in maximum phonation time (MPT) and mean airflow rate (MFR). In the bFGF injection group, significant improvements in the VHI score (from 53.3 to 35.7), MPT (from 16.9 to 21.8 s) and MFR (from 314.6 to 210.5 ml/s) were seen; however, the tGRBAS score did not improve. In addition, the SFF significantly decreased from 178.1 to 160.5 Hz. Conclusion: These results suggest that both steroid and bFGF injections are effective for treating vocal fold scarring, with steroids improving voice quality and bFGF improving glottic closure, thereby contributing to improvements in VHI scores. Level of Evidence: 4.

Long-term results and safety of fibroblast growth factor injection for unilateral vocal fold paralysis.

Objectives: Treatments for unilateral vocal fold paralysis (UVFP) include conservative voice rehabilitation, vocal fold injection, and laryngeal framework surgery. We proposed basic fibroblast growth factor (bFGF) injection as a potential novel treatment for UVFP and have reported the short-term results. In this study, we present the long-term results and safety of vocal fold bFGF injection as a treatment for UVFP. Methods: This retrospective study included 42 patients (25 males and 17 females) with UVFP who were administered a local injection of bFGF. The injection regimen involved injecting FGF (0.5 µg/ml in 0.5 ml per side) into the bilateral vocal folds using a 23-gauge injection needle. Phonological outcomes were evaluated 6 months and 12 months after the injection. Results: Overall, 26 patients received a single injection of bFGF, six patients received an additional injection, and 10 patients received the additional framework surgery. Maximum phonation time, mean flow rate, pitch range, jitter and shimmer percentages, the total GRBAS (grade, roughness, breathiness, asthenia, strain) score, and voice handicap index scores improved significantly in the long term. In patients who received the additional injection or framework surgery, the effects of bFGF injection were temporary, but did not interfere with the performance of the framework surgery. Conclusion: In total, 42 patients who underwent vocal fold bFGF injections were reviewed. The bFGF injections were effective and safe in the long-term results for UVFP in the selected cases. Some patients with severe symptoms benefited from the additional framework surgery but not the additional bFGF injection.

Effect of intracordal injection under local anesthesia on vital signs in high-risk patients.

OBJECTIVE: Intracordal injection under local anesthesia is widely performed; however, few studies show hemodynamic changes in the heart rate, blood oxygen saturation, and blood pressure during intracordal injection under local anesthesia. This study examined changes in vital signs (heart rate, blood oxygen saturation, systolic blood pressure, diastolic blood pressure) during intracordal injection under local anesthesia among high-risk patients and investigated whether intracordal injection under local anesthesia could be safely conducted. METHODS: A retrospective chart review was adopted as the research design. We investigated the changes in vital signs (heart rate, blood oxygen saturation, blood pressure) before and after intracordal injection with basic fibroblast growth factor (bFGF) preparations under local anesthesia in 46 patients who visited our institution and developed unilateral vocal cord paralysis after a thoracic aortic aneurysm, thoracic aortic dissection surgery, thyroid disease, esophageal disease, idiopathic disease, etc. RESULTS: The average operation time for the high-risk group was 3.67 minutes, with the shortest operating time being 2 minutes and the maximum operating time being 13 minutes. The average operation time for the control group was 3.73 minutes, with the shortest operating time being 1 minute and the maximum operating time being 9 minutes. Results before and after intracordal injection with bFGF preparations under local anesthesia for heart rate, blood oxygen saturation, systolic blood pressure, and diastolic blood pressure had P-values of 0.324, 0.394, 0.215, and 0.508, respectively, in the high-risk group, and no significant differences were found. Conversely, heart rate, blood oxygen saturation, systolic blood pressure, and diastolic blood pressure had P-values of 0.057, 0.232, 0.265, and 0.091, respectively, in the control group, and no significant differences were found. CONCLUSION: Intracordal injection under local anesthesia may be safe, even for patients who require blood pressure management after thoracic aortic disease surgery.

Comparison of therapeutic effects of steroid injection by benign vocal fold lesion type.

BACKGROUND: Benign vocal fold lesions (BVFLs) can cause voice changes, including reduced loudness and pitch range. In recent times, with progression in endoscopic technology, office-based vocal fold steroid injection (VFSI) has been used as an alternative therapy for BVFLs. AIMS/OBJECTIVES: In this study, we analyzed the efficacy and safety of VFSI to investigate the mechanism underlying its therapeutic effects and determine the conditions in which VFSI will be most effective. MATERIALS AND METHODS: In this retrospective cohort study, we included 40 condition-matched patients (8 patients per lesion) with chorditis, vocal nodules, vocal polyps, Reinke's edema (RE), or vocal scars who received similar regimens of steroid injection using a commercial preparation of triamcinolone acetonide. Their phonological outcomes were evaluated 2 or 3 months after the injection. RESULTS: Significant improvements were observed in Voice Handicap Index scores, results of laboratory voice evaluation, and voice quality measured using the Grade, Roughness, Breathiness, Asthenia, Strain scale in all participants. In subgroup analysis, VFSI was highly effective against chorditis and vocal nodules, but less effective against RE and vocal scars. CONCLUSIONS: Single-dose VFSI is valuable as an alternative to voice rehabilitation and laryngo-microsurgery, but higher concentrations or repeated injections are required for intractable lesions.

Validation of the Japanese Version of the Singing Voice Handicap Index.

PURPOSE: The aim of the present study was to translate the Singing Voice Handicap Index (SVHI) into Japanese and validate the Japanese version of the SVHI. METHODS: The SVHI was translated into Japanese from the validated original version, and the questionnaire was administered to 102 singers with voice problems and 88 healthy singers. Internal consistency and test-retest methods were implemented to evaluate the reliability of this index. The internal consistency method assessed validity via Cronbach's α, and test-retest reliability was analyzed by the intraclass correlation coefficient (ICC) and limits of agreement (LoA) according to the Bland Altman method. Construct validity was verified by confirming correlations between SVHI scores and visual analog scale (VAS) scores for disability in singing using Spearman correlation. Discriminant validity was evaluated by comparing SVHI scores between singers with voice problems and healthy singers using t tests. Using the Tukey's honestly significant difference (HSD) test, we also compared the Voice Handicap Index (VHI) and SVHI scores among three groups: healthy singers, singers with voice problems solely during singing, and singers with voice problems during both speaking and singing. RESULTS: The Japanese version of the SVHI showed excellent internal consistency (Cronbach's α = 0.981) and test-retest reliability (ICC: 0.93). The 95 percent LoA was calculated to be between -20.8 and 33.9. Construct validity was verified through correlated SVHI and VAS scores (r = 0.736, P < 0.001). Discriminant validity was verified as the SVHI scores of singers with voice problems were higher than those of healthy singers (77.8±37.5 vs. 30.0±26.5, P < 0.001). There were no statistically significant differences in VHI scores between singers with voice problems solely during singing and healthy singers; however, the SVHI scores of singers with voice problems solely during singing were significantly higher than those of healthy singers (63.4±36.8 vs. 30.0±26.5, P < 0.001). CONCLUSION: We confirmed that the Japanese version of the SVHI is a valid and reliable self-rated questionnaire for measuring the patient-perceived impact of singing voice problems among Japanese singers.

Microlaryngeal surgery in severely obese elite vocal performers.

This study showed that microlaryngeal surgery under general anesthesia is feasible for patients with severe obese elite vocal performers if proper simulations are conducted beforehand and the position of the patient and anesthesia is considered.

Predominant Vertical Location of Benign Vocal Fold Lesions by Sex and Music Genre: Implication for Pathogenesis.

OBJECTIVES/HYPOTHESIS: Vertical locations of vocal fold mucosal lesions (VFMLs) vary along the free edge. As the vertical contact area of vocal folds (VFs) depends on the vocal register, lesions may occur in the contact area of more frequently used vocal registers. This study investigated the cause of location variations by comparing the vertical sites of VFMLs in singers of both sexes with different music genres. STUDY DESIGN: Retrospective review. METHODS: Sixty professional classical and rock singers (11 male classical [M-classical], 22 male rock [M-rock], 13 female classical [F-classical], and 14 female rock [F-rock] singers) who underwent microlaryngeal surgery for VF polyps and nodules and their 108 lesions were enrolled. The VF free edge was vertically divided into three equal parts and classified into the following four lesion sites: upper, middle, lower, and multiple sites. RESULTS: Upper lesions were most common among F-classical singers (73.9%), whereas lower lesions were most common among M-classical (90.0%) and M-rock (60.6%) singers. Among lesions localized to a single site, lower lesions were most common among F-rock singers (37.0%). F-classical singers had significantly more upper lesions than the other groups (P < .001). M-classical singers had significantly more lower lesions than female singers of any genre (P < .001). CONCLUSION: Upper lesions were most common among F-classical singers who mostly used the head voice. Lower lesions were most common among singers who mainly used the modal voice. This study suggests that sex, the dominant vocal register used for singing, and mechanical stress on VFs influence the vertical site of VFMLs. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E2284-E2291, 2021.

Therapeutic Efficacy of Basic Fibroblast Growth Factor in Patients With Vocal Fold Atrophy.

OBJECTIVES/HYPOTHESIS: In recent years, basic fibroblast growth factor (bFGF) injection has been used in the treatment of aging-related vocal fold atrophy. This injection not only improves closure by increasing the mass of the vocal fold but also improves its viscoelasticity. However, it has been reported that fibroblasts targeted by bFGF treatment decrease in number with age. The purpose of this study was to examine the effects of local injection of bFGF on age-related vocal atrophy as well as the influence of age on phonological outcomes. STUDY DESIGN: Retrospective chart review. METHODS: Fifty-three patients with age-related vocal fold atrophy underwent single injections of bFGF in their vocal folds. Phonological outcomes were evaluated 3 and 6 months after injection by acoustic and aerodynamic measurements. RESULTS: Voice Handicap Index (VHI), maximum phonation time (MPT), jitter, shimmer, and pitch range improved after injection, and the effects continued for 6 months. In those over 70 years of age, VHI and MPT showed improvement at 3 and 6 months after injection. In addition, the degree of improvement in VHI and MPT did not differ significantly between those older than 70 years and those younger than 70 years. CONCLUSIONS: Regenerative treatments dependent on bFGF single injection was safe and effective for both early and late elderly patients suffering of vocal fold atrophy. LEVEL OF EVIDENCE: 2c Laryngoscope, 2020.

Safety and short-term outcomes of basic fibroblast growth factor injection for sulcus vocalis.

BACKGROUND: Sulcus vocalis (SV) is characterized by the appearance of a groove and fibrotic changes in the vocal fold mucosa and an often irrevocable loss of tissue viscoelasticity and vibratory potential. Although several surgical approaches have been proposed, none are ideal treatments. Basic fibroblast growth factor (bFGF) may stimulate fibroblasts in the superficial layer of the lamina propria (SLP) and increase the vibration of vocal fold mucosa. AIMS/OBJECTIVES: The aim of this study was to evaluate the safety and short-term outcomes of bFGF injection for SV. MATERIALS AND METHODS: This study was registered with the University Hospital Medical Information Network-Clinical Trials Registry (UMIN000019347). Twelve cases of pathological SV were treated using a method involving bFGF injection. The treatment regimen involved the injection of 50 µg of bFGF into the SLP. More than 3 months after the injection, aerodynamic and acoustic outcomes were examined. RESULTS: No adverse events were recorded. Significant improvements were observed in the maximum phonation time (MPT) and Voice Handicap Index (VHI) after treatment. Multiple injections achieved additional effects. CONCLUSIONS AND SIGNIFICANCE: bFGF injection may be a safe and suitable office-based surgery for the alleviation of hoarseness caused by SV based on this preliminary short-term study.

Injection of basic fibroblast growth factor for unilateral vocal cord paralysis.

OBJECTIVE: Unilateral vocal cord paralysis (UVCP) not only induces severe dysphonia, but aspiration as well. Although laryngeal framework surgery is usually performed to treat this condition, the procedure is not tolerated by some patients. In the previous study, basic fibroblast growth factor (bFGF) injections for vocal cord scarring and sulcus have been reported to provide favorable outcomes while being minimally invasive. In this study, the authors retrospectively investigated phonological outcomes after bFGF injection in patients with UVCP. METHODS: This study was registered in University hospital Medical Information Network - Clinical Trials Registry (UMIN000019347). Nineteen patients with unilateral cord paralysis were treated with bFGF injection. The treatment regimen involved a single injection of 50 µg of bFGF into the muscle layer. More than six months after the injection, aerodynamic and acoustic outcomes were examined. RESULTS: The voice handicap index, maximum phonation time, mean airflow rate, and pitch range improved significantly after injection of bFGF. No sex-related differences were observed in any phonological parameter. CONCLUSION: bFGF injection, an easy method and suitable as an office procedure, significantly improved the hoarseness caused by UVCP. It is expected to be widely adopted and effective adjunctive drugs, and procedures are anticipated to be developed.

Sex Differences in Pitch Range and Speech Fundamental Frequency After Arytenoid Adduction and Thyroplasty.

OBJECTIVE: The purpose of this study was to clarify the sex differences in pitch range (PR) and speech fundamental frequency (SFF) after arytenoid adduction (AA) combined with type 1 thyroplasty (TP1) in patients with unilateral vocal fold paralysis (UVFP) and to assess the cause of these differences. STUDY DESIGN: This is a retrospective review of clinical records. METHODS: The records of 50 patients with UVFP for whom PR, SFF, and maximum phonation time (MPT) had been evaluated before and 1 year after AA combined with TP1 were analyzed. Patients consisted of 36 men and 14 women. In particular, in the 37 patients (24 men and 13 women) who had ≥2 semitones (STs) in preoperative PR (pre-PR), the differences and correlations between the pre-PR and the postoperative PR (post-PR), SFF, and MPT were compared between the sexes. We also discussed cases of post-PR deterioration and abnormal SFF. RESULTS: The characteristics of PR in men are narrow pre-PR (14.7 ± 11.5 STs) and significant extension of post-PR (22.6 ± 6.3 STs). MPT extended from 4.6 ± 2.5 seconds to 14.8 ± 7.2 seconds. In contrast, women had a wide pre-PR (18.1 ± 7.2 STs) and showed no significant post-PR extension (21.7 ± 7.8 STs). MPT extended from 5.1 ± 1.9 seconds to 16.8 ± 7.2 seconds. Although there were no significant changes in average SFF, as well as the highest and lowest pitch after the operation, the variance of the pre-SFF tended to converge into the physiological range in the post-SFF (P = 0.08). Compared with the SFF data of normal adult controls, post-SFF in the normal range was 46.0% (23/50). In patients who showed a >20% improvement in PR, normal post-SFF appeared in 68.8% of the patients (11/16). Particularly in those women, 83.3% (5/6) showed a normal post-SFF. Men showed greater difficulty in recovery of normal PR, SFF, and MPT; however, there were fewer patients (4.2%; 1/24) with a PR deterioration of >20%. Regarding women, although some patients showed a parallel recovery in PR and SFF to the normal range, there was a high rate of patients showing PR deterioration (30.8%; 4/13). CONCLUSIONS: AA combined with TP1 resulted in the recovery of not only MPT but also PR and SFF. In addition, sex differences in operative effects were suggested. In men, although MPT is difficult to be fully recovered, PR deterioration was mild. In women, although MPT was more easily extended, PR deterioration occurred more readily because of operative effects such as hypermedialization of their smaller larynx. The post-PR variation appeared to be associated with SFF. Our results indicate the necessity to assess patients' PR and SFF even if their MPTs recover, particularly in patients with postoperative voice insufficiency.

Single injection of basic fibroblast growth factor to treat severe vocal fold lesions and vocal fold paralysis.

OBJECTIVES/HYPOTHESIS: Severe vocal fold lesions such as vocal fold sulcus, scars, and atrophy induce a communication disorder due to severe hoarseness, but a treatment has not been established. Basic fibroblast growth factor (bFGF) therapies by either four-time repeated local injections or regenerative surgery for vocal fold scar and sulcus have previously been reported, and favorable outcomes have been observed. In this study, we modified bFGF therapy using a single of bFGF injection, which may potentially be used in office procedures. STUDY DESIGN: Retrospective chart review. METHODS: Five cases of vocal fold sulcus, six cases of scars, seven cases of paralysis, and 17 cases of atrophy were treated by a local injection of bFGF. The injection regimen involved injecting 50 µg of bFGF dissolved in 0.5 mL saline only once into the superficial lamina propria using a 23-gauge injection needle. Two months to 3 months after the injection, phonological outcomes were evaluated. RESULTS: The maximum phonation time (MPT), mean airflow rate, pitch range, speech fundamental frequency, jitter, and voice handicap index improved significantly after the bFGF injection. Furthermore, improvement in the MPT was significantly greater in patients with (in increasing order) vocal fold atrophy, scar, and paralysis. The improvement in the MPT among all patients was significantly correlated with age; the MPT improved more greatly in younger patients. CONCLUSIONS: Regenerative treatments by bFGF injection­even a single injection­effectively improve vocal function in vocal fold lesions. LEVEL OF EVIDENCE: 4

Evaluation of mechanical properties of esthetic brackets.

Plastic brackets, as well as ceramic brackets, are used in various cases since they have excellent esthetics. However, their mechanical properties remain uncertain. The purpose of this study was to determine how deformation and stress distribution in esthetic brackets differ among materials under the same wire load. Using the digital image correlation method, we discovered the following: (1) the strain of the wings of plastic brackets is within 0.2% and that of ceramic and metal brackets is negligible, (2) polycarbonate brackets having a stainless steel slot show significantly smaller displacement than other plastic brackets, and (3) there is a significant difference between plastic brackets and ceramic and stainless steel brackets in terms of the displacement of the bracket wing.

[The Correlation between the Size of Vocal Polyps, Vocal Nodules and Vocal Dysfunction, before and after Laryngeal Microsurgery].

When we operate on a vocal polyp or a vocal nodule with laryngeal microscopy, we always carefully measure their length and width then multiply the length by the width to get the area. We examined whether there is a correlation between the area of these lesions and the acoustic analysis of voice. Before the surgery and one month post-operation, we checked five acoustic parameters, maximum phonation time (MPT), range of voice, mean air flow rate (MFR) and acoustic analyses (jitter% and shimmer%). By doing this, we could arrive at the improvement rate of each of the five acoustic parameters. We examined whether there was a correlation between the lesion area and acoustic parameters before surgery and the improvement rates of these acoustic parameters. Examinations of polyps showed a correlation between the size and range of voice and Jitter% pre-operation, and showed a correlation between the size and improvement rate of range of voice, MFR, Jitter% and Shimmer% post-operation. On the other hand, examination of nodules showed a correlation only between the size and range of voice pre-operation. Next we examined the correlation between the size and these acoustic parameters in the Elite vocal performer (EVP) group and extra EVP group. In the examinations of polyps, the EVP group showed a lower correlation between the size and acoustic parameters than in the extra EVP group. On the other hand, in the examinations of nodules, correlation between the size and acoustic parameters was low in both the EVP and extra EVP group.

Phonological outcome of laryngeal framework surgery by different anesthesia protocols: a single-surgeon experience.

CONCLUSION: Similar to combined arytenoid adduction and medialization laryngoplasty (i.e. combined surgery) under local anesthesia, general anesthesia by intubation or by the laryngeal mask airway (LMA) method significantly improves phonological outcome. Thus, laryngeal framework surgery under general anesthesia is a promising surgical approach for selected patients with unilateral vocal cord paralysis (UVCP). OBJECTIVE: The advantages of laryngeal framework surgery under local anesthesia have been described, but no studies exist concerning the difference in phonological outcome of laryngeal framework surgery performed under general anesthesia. To add new information, we retrospectively investigated the phonological outcome of the combined surgery performed under three different anesthesia protocols. METHODS: Thirty-nine consecutive patients with severe UVCP underwent the combined surgery under three anesthesia protocols performed by a single surgeon: (1) under general anesthesia by intubation, (2) under general anesthesia using LMA, and (3) under local anesthesia. RESULTS: Under all anesthesia protocols, the vocal cords of most patients could be positioned such that the best vocal outcome could be expected. Statistical analyses demonstrated improved maximum phonation time and mean airflow rate, and grade, roughness, breathiness, asthenia, and strain (GRBAS) scale in all patients, regardless of their anesthesia protocol. Furthermore, of the three protocols, local anesthesia had the shortest operation time.

Application of pitch range evaluation subsequent to arytenoid adduction and thyroplasty.

OBJECTIVE: The purpose of this study was to figure out the application of pitch range (PR) evaluation subsequent to arytenoid adduction (AA) combined with type 1 thyroplasty (TP1) in unilateral vocal fold paralysis (UVFP). STUDY DESIGN: Retrospective review of clinical records. METHODS: Subjects were 50 patients with UVFP for whom PR and maximum phonation time (MPT) could be evaluated before and 1 year after AA + TP1. Subjects were divided into two groups based on preoperative PR (pre-PR) (group 1: ≤1 semitone (ST); group 2: ≥2 ST). Correlations among pre-PR and post-PR, MPT, and age were assessed. We also evaluated PRs in subjects with PR deterioration and PRs by causative diseases. RESULTS: PR was significantly extended from a median of 17.0-22.0 ST in all subjects. Pre-PR was correlated with post-PR. Post-PR correlated with post-MPT in group 2 but not in group 1. There was no correlation between post-PR and age or causative diseases. The mean change in PR among subjects with PR deterioration (28.0%, 14/50) was -3.6 ST. Pre-PR and the improvement of post-PR were negatively correlated in group 2. CONCLUSION: PR evaluation can be useful for predicting post-PR. The effects of age and causative diseases were small compared with other factors, such as pre-PR width and surgical effects. The successful surgery may improve both PR and MPT. However, several cases showed obvious discrepancy of those postoperative improvements. It will be necessary to assess this discrepancy, particularly in subjects with postoperative voice insufficiency.

Type 3 thyroplasty for patients with mutational dysphonia.

INTRODUCTION: The cases consisted of three men with mutational dysphonia, who were aged 37, 35, and 38 years. The speaking fundamental frequencies (SFFs) at the time of the initial diagnosis were 174.6, 170.2, and 180.0 Hz. METHODS: In all three patients, voice therapy proved ineffective; therefore, surgery was considered. In the anterior-posterior compression test performed preoperatively in the three patients, the voice became low-pitched. RESULTS: The SFFs decreased postoperatively to 106.9, 115.4, and 87.5 Hz, respectively, in the three patients. CONCLUSIONS: Type 3 thyroplasty (TP3) is effective for the treatment of patients with mutational dysphonia in whom voice therapy proved unsuccessful. OBJECTIVE: The SFF of men is high in childhood. At the time of the second pubescent sexual orientation, the frequency usually decreases. However, in some cases, the high-pitched voice of childhood may persist without successful switch to a low-pitched voice during puberty. Thus, there are rare cases of adults with a high-pitched boyish voice. Voice therapy is usually effective for the treatment; however, it may fail in some cases. We performed TP3 for subjects in whom voice therapy proved ineffective. With TP3, the tension of the vocal folds decreases, and the voice becomes low-pitched.