Consensus for voice quality assessment in clinical practice: guidelines of the European Laryngological Society and Union of the European Phoniatricians.

Introduction: To update the European guidelines for the assessment of voice quality (VQ) in clinical practice.

Methods: Nineteen laryngologists-phoniatricians of the European Laryngological Society (ELS) and the Union of the European Phoniatricians (UEP) participated to a modified Delphi process to propose statements about subjective and objective VQ assessments. Two anonymized voting rounds determined a consensus statement to be acceptable when 80% of experts agreed with a rating of at least 3/4.

Pre-clinical evaluation of APrevent® VOIS for unilateral vocal fold paralysis medialization.

Objective: To evaluate the concept and efficacy of an adjustable implant (Prototype SH30: porcine implant and APrevent® VOIS: human concept) for treatment of unilateral vocal fold paralysis (UVFP) via in vivo mini-pig studies, human computed tomographic (CT) and magnetic resonance (MR) image analysis, ex-vivo aerodynamic and acoustic analysis.

Methods: Feasibility testing and prototype implantation were performed using in-vivo UVFP porcine model ( = 8), followed by a dimensional finding study using CT and MR scans of larynges ( = 75) for modification of the implant prototypes. Acoustic and aerodynamic measurements were recorded on excised canine ( = 7) larynges with simulated UVFP before and after medialization with VOIS-Implant.

Differences in Glottal Closure and Visibility of the Anterior Commissure during Rigid-90°, Rigid-70°, and Flexible Laryngostroboscopy.

Introduction: The conventional rigid-90° and rigid-70° laryngostroboscopy has been so far considered the gold standard in assessing the vibratory behavior of the vocal folds and the glottal closure configuration during phonation. Meanwhile, this rigid laryngostroboscopy is more and more replaced by flexible chip-on-tip systems. The aim of this study was to evaluate the influence of these different endoscopic techniques on glottal closure configuration and on visibility of the complete focal fold length including anterior commissure during phonation.

Ultrasound-guided injection into the lateral crico-arytenoid muscle: a pilot study.

Objectives: The anterior, percutaneous Botulinum neurotoxin (BoNT) injection in the lateral cricoarytenoid muscle (LCA) guided by laryngeal electromyography (LEMG) is considered the golden standard treatment for several neurolaryngological disorders. The study presented in this article aims to assess the effectiveness of an alternative approach by which the injection is performed laterally under ultrasound monitoring.

Study Design: Anatomical dissection study in human cadavers.

An Endoscopic Cap Electrode for Posterior Cricoarythenoid Muscle Stimulation in a Porcine Model.

Objective: Laryngeal pacing (LP) is a highly anticipated therapeutic option for patients suffering from bilateral vocal fold paralysis with synkinesis. Identification of candidate patients requires confirmation of a stimulable posterior cricoidarythenoid muscle (PCA) by neuromuscular electrical stimulation (NMES). A silicone endoscopic cap electrode (ECE50) was designed to be operated as an endoscopic extension tip for selective PCA stimulation and confirmation of a glottic opening movement in a setting comparable to a gastroscopy procedure.

Electromyography of the posterior cricoarytenoid muscles: a consensus guideline.

Purpose: Since the introduction of transcutaneous-transcricoidal needle approaches, electromyography (EMG) of the posterior cricoarytenoid muscle (PCA) became easier to perform and teach. Among the Neurolaryngology working group of the European Laryngological Society, several centers have adopted PCA EMG as part of their routine EMG workup in vocal fold immobility collectively gathering long-term experience. The purpose is to give an update and an extension to already existing guidelines on laryngeal EMG with specific regard to PCA EMG.

Selective Electrical Surface Stimulation to Support Functional Recovery in the Early Phase After Unilateral Acute Facial Nerve or Vocal Fold Paralysis.

This article addresses the potential clinical value of surface electrical stimulation in the acute phase of denervation after the onset of facial nerve or recurrent laryngeal nerve paralysis. These two nerve lesions are the most frequent head and neck nerve lesions. In this review, we will work out several similarities concerning the pathophysiology features and the clinical scenario between both nerve lesions, which allow to develop some general rules for surface electrical stimulation applicable for both nerve lesions.

Effect of FFP2/3 Masks on Voice Range Profile Measurement and Voice Acoustics in Routine Voice Diagnostics.

Introduction: Voice diagnostics including voice range profile (VRP) measurement and acoustic voice analysis is essential in laryngology and phoniatrics. Due to COVID-19 pandemic, wearing of 2 or 3 filtering face piece (FFP2/3) masks is recommended when high-risk aerosol-generating procedures like singing and speaking are being performed. Goal of this study was to compare VRP parameters when performed without and with FFP2/3 masks.

[Voice diagnostics in phonosurgical interventions].

Voice diagnostics before and after phonosurgical interventions should aim at detailed planning of surgical techniques and evaluability of postoperative outcome. They should consider multimodal concepts and include measurements of perceptual voice analysis, laryngostroboscopy, voice acoustics, aerodynamics, and self-evaluation by the patients. Selected methods for voice diagnostics should reflect current knowledge and define the departmental procedure.

Applicability of Selective Electrical Surface Stimulation in Unilateral Vocal Fold Paralysis.

Objective: Selective electrical surface stimulation (SES) of the larynx is not yet routinely considered therapy option in treatment of unilateral vocal fold paralysis (UVFP). Goal of this monocentric feasibility study was to provide systematic data on applicability of SES of intrinsic laryngeal muscles in UVFP under consideration of sensitivity and discomfort thresholds and nonselective side effects.

Methods: Thirty-two UVFP patients were included in the study.

Preparation and antibiofilm studies of curcumin loaded chitosan nanoparticles against polymicrobial biofilms of Candida albicans and Staphylococcus aureus.

Polymicrobial biofilms related infections are an important clinical problem with classical antibiotics being not sufficient in therapy. Here, curcumin (Cur) was loaded on positively charged chitosan nanoparticles (CSNP). The antibiofilm activities against mono- and polymicrobial biofilms of Candida albicans and Staphylococcus aureus were evaluated.

Laryngeal Mask as the Primary Airway Device During Laryngotracheal Surgery: Data From 108 Patients.

Background: Airway management during repair of laryngotracheal stenosis is demanding, and there is currently no accepted standard of care. Recently an increasing number of airway centers have started to use a laryngeal mask until the airway is surgically exposed and cross-table ventilation can be initiated. However detailed data on this approach are missing in the literature.

Objectivation of laryngeal electromyography (LEMG) data: turn number vs. qualitative analysis.

Purpose: This paper describes a first attempt to quantify LEMG data based on turn number calculation. The results obtained for both healthy and ailing thyroarytenoid (TA) muscles of patients with unilateral vocal fold immobility (UVFI) were compared with the respective qualitative evaluation concerning volitional activity to determine whether the two types of analyses deliver similar results.

Methods: LEMG data obtained from 44 adults with UVFI were considered for the study.

Co-immobilization of cellobiose dehydrogenase and deoxyribonuclease I on chitosan nanoparticles against fungal/bacterial polymicrobial biofilms targeting both biofilm matrix and microorganisms.

Polymicrobial biofilm related infections have been a major threat in health care. In this study, the co-immobilization of cellobiose dehydrogenase (CDH) and deoxyribonuclease I (DNase) on positively charged chitosan nanoparticles (CSNPs) resulted in a bi-functional nanoparticle (CSNP-DNase-CDH) targeting both biofilm matrix and microorganisms. The in-vitro antibiofilm activities of CSNPs against monomicrobial and polymicrobial biofilms of Candida albicans and Staphylococcus aureus were evaluated.

Pre- and intraoperative acoustic and functional assessment of the novel APrevent VOIS implant during routine medialization thyroplasty.

Purpose: Persistent unilateral vocal fold paralysis (UFVP) with glottal insufficiency often requires type I medialization thyroplasty (MT). Previous implants cannot be adjusted postoperatively if necessary. The newly developed APrevent VOIS implant (VOIS) can provide postoperative re-adjustment to avoid revision MT.

Growth Media for Mixed Multispecies Oropharyngeal Biofilm Compositions on Silicone.

Aims: Microbial colonization of silicone voice prostheses by bacteria and species limits the device lifetime of modern voice prostheses in laryngectomized patients. Thus, research focuses on biofilm inhibitive properties of novel materials, coatings, and surface enhancements. Goal of this study was the evaluation of seven commonly used growth media to simulate growth of mixed oropharyngeal species as mesoscale biofilms on prosthetic silicone for future research purposes.

Inter-rater reliability of seven neurolaryngologists in laryngeal EMG signal interpretation.

Purpose: Laryngeal electromyography (LEMG) has been considered as gold standard in diagnostics of vocal fold movement impairment, but is still not commonly implemented in clinical routine. Since the signal interpretation of LEMG signals (LEMGs) is often a subjective and semi-quantitative matter, the goal of this study was to evaluate the inter-rater reliability of neurolaryngologists on LEMGs of volitional muscle activity.

Methods: For this study, 52 representative LEMGs of 371 LEMG datasets were selected from a multicenter registry for a blinded evaluation by 7 experienced members of the neurolaryngology working group of the European Laryngological Society (ELS).

Therapy of bilateral vocal fold paralysis: Real world data of an international multi-center registry.

Purpose: To collect data on diagnosis, treatment, patient's management, and quality of life in patient with bilateral vocal fold paralysis (BVFP).

Methods: A retrospective, observational, multicenter registry study was performed. Medical records of 326 adults with permanent BVFP (median age: 61 years; 70% female, 60% after thyroid surgery) generated between 2010 and 2017.

Use of the myocutaneous serratus anterior free flap for reconstruction after salvage glossectomy.

Purpose: To describe the use of a myocutaneous serratus anterior free flap (SAFF) for tongue reconstruction after salvage subtotal (STG) and total glossectomy (TG).

Methods: In this prospective case series, seven patients underwent salvage STG or TG and reconstruction with a myocutaneous SAFF between 10/2015 and 02/2017. Functional and oncologic outcomes were prospectively evaluated.

Antibiofilm efficacy of curcumin in combination with 2-aminobenzimidazole against single- and mixed-species biofilms of Candida albicans and Staphylococcus aureus.

Mixed fungal and bacterial biofilm associated infections of implants have been a huge challenge in health care because of the increased resistance to antimicrobials and the critical biological differences between fungi and bacteria. In this study, we evaluated the 2-aminobenzimidazole (2ABI) and curcumin (CUR) alone to inhibit planktonic cell growth, adhesion as well as single and mixed species biofilms of Candida albicans and Staphylococcus aureus on silicone. The combined effects between 2ABI and CUR on mixed species biofilm formation and pre-formed biofilm were assessed.

Enhancing antibiofilm activity with functional chitosan nanoparticles targeting biofilm cells and biofilm matrix.

Bacterial biofilms play a key role during infections, which are associated with an increased morbidity and mortality. The classical antibiotic therapy cannot eradicate biofilm-related infections because biofilm bacteria display high drug resistance due to biofilm matrix. Thus, novel drug delivery to overcome biofilm resistance and eliminate biofilm-protected bacteria is needed to be developed.

Pre-emptive glottic enlargement before laryngotracheal surgery in patients at high risk for postoperative bilateral vocal fold paralysis.

Objectives: Bilateral vocal fold paralysis (VFP) is a severe complication after laryngotracheal (LT) surgery. The reduced glottic opening leads to significant respiratory distress immediately after the operation and requires the placement of a tracheostomy in most cases. Patients with a pre-existing unilateral VFP or expected recurrent nerve resection are at the highest risk for glottic failure.