The role of voice therapy in the treatment of dyspnea and dysphonia in a patient with a vagal nerve stimulation device.

Vagal nerve stimulators (VNS) are implanted to treat medically refractory epilepsy and depression. The VNS stimulates the vagus nerve in the left neck. Laryngeal side effects are common and include dysphagia, dysphonia, and dyspnea.

Development and validation of the cough severity index: a severity index for chronic cough related to the upper airway.

Objectives/hypothesis: To develop and validate a cough severity index (CSI) which quantifies patients' symptoms associated with upper airway chronic cough and to provide a tool for treatment outcome measures.

Methods: Two hundred patients who had a complaint of chronic cough and/or dyspnea were given a 49- item questionnaire developed through a clinical consensus of the most common symptoms of chronic cough of upper airway origin. The instrument was reduced to 10 questions using statistical methodology.

Voice outcome following acute unilateral vocal fold paralysis.

Objectives: We assessed voice outcomes following unilateral vocal fold paralysis (UVFP).

Methods: We performed a retrospective chart review of 72 patients with UVFP proven by laryngeal electromyography, including their Voice Handicap Index-10 (VHI-10) scores at presentation and at the study end point (at the return of vocal fold motion or before the decision regarding definitive treatment).

Results: The average VHI-10 score on presentation was 26.

Quantifying component parts of indirect and direct voice therapy related to different voice disorders.

Voice therapy changes how people use and care for their voices. Speech-language pathologists (SLPs) have a multitude of choices from which to modify patient's vocal behaviors. Six SLPs performed 1461 voice therapy sessions and quantified the percentage of time spent in eight component parts of indirect and four component parts of direct voice therapy across five common voice disorders.

Voice outcomes following the gray minithyrotomy.

Objectives: Most practitioners have limited treatment options for vocal fold scar and sulcus vocalis. The Gray minithyrotomy (GMT) is a surgical procedure for the treatment of these conditions, although limited objective data exist regarding voice outcomes. This study compares the quantified subjective and visual perceptual outcomes following GMT for the treatment of vocal fold scar and sulcus vocalis.

Should antiviral medications be considered preoperatively for microlaryngoscopy in patients with a history of recurrent herpes stomatitis?

Infectious complications following phonomicrosurgery are rare. Reports of herpetic laryngitis are in the literature but none following microlaryngoscopy. We present a case of a 55-year-old female who underwent microsurgical excision of a left vocal fold (VF) lesion and KTP ablation of bilateral vascular ectasias.

A nomenclature paradigm for benign midmembranous vocal fold lesions.

Objectives/hypothesis: There is a significant lack of uniform agreement regarding nomenclature for benign vocal fold lesions (BVFLs). This confusion results in difficulty for clinicians communicating with their patients and with each other. In addition, BVFL research and comparison of treatment methods are hampered by the lack of a detailed and uniform BVFL nomenclature.

Quantitative electromyography improves prediction in vocal fold paralysis.

Objectives: Quantitative laryngeal electromyography (LEMG) using turns analysis can differentiate acute vocal fold paralysis from normal controls. The objective of this study is to determine if using both traditional qualitative LEMG measurements in addition to turns analysis improves prognostic accuracy in patients with acute vocal fold paralysis who demonstrate voluntary motor activity.

Study Design: Retrospective review of LEMG data (qualitative and quantitative) and charts of patients with vocal fold paralysis on flexible laryngoscopy, recurrent laryngeal neuropathy, and varying degrees of motor unit recruitment.

Saccular cysts: a current review of characteristics and management.

Objectives/hypothesis: To review a large cohort of adult saccular cyst patients and update current management of saccular cysts.

Study Design: Retrospective review of treatment of adult patients with saccular cysts.

Methods: Medical records were reviewed of all adult patients with saccular cysts identified between July 1, 2005 and August 31, 2009 at a tertiary care voice center.

Patient tolerance of awake, in-office laryngeal procedures: a multi-institutional perspective.

Objectives/hypothesis: An increasing number of laryngeal procedures are performed in the office. However, little is known about how well these procedures are tolerated and what factors determine success or failure.

Study Design: Prospectively collected patient and physician surveys from five surgeons at two institutions describe patient tolerance of awake, in-office laryngeal procedures (AIOLPs).

Arytenoid and posterior vocal fold surgery for bilateral vocal fold immobility.

Purpose Of Review: Many procedures exist to address the airway restriction often seen with bilateral vocal fold immobility. We review the most recent studies involving arytenoid and/or posterior vocal fold surgery to provide an update on the issues related to these procedures. Specific focus is placed on selection of the surgical approach and operative side, use of adjunctive therapies, and outcome measures including decannulation rate, revision and complication rate, and postoperative results.

Treatment success for age-related vocal fold atrophy.

Objectives/hypothesis: To characterize perceived voice handicap of patients diagnosed with vocal fold atrophy and review treatment success.

Study Design: Retrospective study.

Methods: Two hundred seventy-five patients diagnosed with vocal fold atrophy (January 2007-January 2009) were reviewed from a preexisting clinical database.

Vocal fold injection: review of indications, techniques, and materials for augmentation.

Vocal fold injection is a procedure that has over a 100 year history but was rarely done as short as 20 years ago. A renaissance has occurred with respect to vocal fold injection due to new technologies (visualization and materials) and new injection approaches. Awake, un-sedated vocal fold injection offers many distinct advantages for the treatment of glottal insufficiency (vocal fold paralysis, vocal fold paresis, vocal fold atrophy and vocal fold scar).

The influence of clinical terminology on self-efficacy for voice.

Self-efficacy is defined as one's belief in one's ability to carry out a specific behavior successfully. The current study's objective is to obtain initial evidence in support of the hypothesis that the terms 'vocal abuse/misuse' have the potential to harm self-efficacy for voice and may impact adherence with therapeutic directives. Teachers with voice problems were exposed to the terms 'abuse/misuse' or 'phonotrauma/muscle tension' as describing the origin of common voice problems.

Isolated laryngeal myokymia: diagnosis and treatment.

Myokymia is an uncommon neuromuscular disorder that rarely affects the human larynx. No previous reports of isolated laryngeal myokymia are present in the literature, and as such, established treatment protocols are lacking. We report the first case of isolated laryngeal myokymia in a 48-year-old woman with no other neurological findings, and our successful results in initial treatment and maintenance therapy with focal intralaryngeal injections of botulinum toxin A.

Mucosal bridge and pitting of the true vocal fold: an unusual complication of cidofovir injection.

We describe a unique complication of intralaryngeal cidofovir injection and present the case of a patient with recurrent respiratory papillomatosis in whom both a mucosal bridge and a pit of the true vocal fold developed after intralaryngeal cidofovir injection. A 40-year-old man presented with laryngeal papillomatosis 19 years after being treated with surgery and adjuvant radiotherapy for leiomyosarcoma of the cervical esophagus. The patient underwent 5 papillomatosis excisions combined with subepithelial injections of cidofovir to the bilateral true vocal folds at a concentration of 5 mg/mL without any complications.

Ergonomic analysis of microlaryngoscopy.

Objectives/hypothesis: To apply ergonomic principles in analysis of three different operative positions used in laryngeal microsurgery.

Study Design: Prospective case-control study.

Methods: Laryngologists were studied in three different microlaryngeal operative positions: a supported position in a chair with articulated arm supports, a supported position with arms resting on a Mayo stand, and a position with arms unsupported.

Electromyographic laryngeal synkinesis alters prognosis in vocal fold paralysis.

Objectives/hypothesis: Synkinesis, or misdirected reinnervation, is likely a confounder when predicting return of function of an immobile vocal fold. Currently, no information exists on the incidence of synkinesis in unilateral vocal fold immobility (UVFI) or the effect synkinesis has on prognosis and treatment. Our objective was to examine a vocal fold adductor synkinesis screening protocol using diagnostic laryngeal electromyography (LEMG).

Odor provocation test for laryngeal hypersensitivity.

This study was to present an odor provocation/challenge test for laryngeal hypersensitivity in a suspected odor induced dysphonic patient. The second aim was to rule out secondary gain from organic laryngeal hypersensitivity. Two steps were taken for this purpose.

Vocal fold augmentation with calcium hydroxylapatite (CaHA).

Objectives: Evaluate the effectiveness of CaHA injection for patients with glottal incompetence.

Methods: Multi-center, open-label, prospective clinical study with each patient serving as his/her own control. Voice-related outcome measures were collected for pre-injection and 1, 3, and 6 months.

Primed fibroblasts and exogenous decorin: potential treatments for subacute vocal fold scar.

Objective: To investigate hepatocyte growth factor (HGF) primed fibroblasts and decorin application on skin and vocal fold fibroblasts in vitro and in vivo in rabbit vocal fold scar model.

Study Design And Setting: Vocal fold and skin fibroblasts underwent five in vitro treatment conditions: control, epidermal growth factor, HGF, both decorin and HGF, and decorin alone. Hyaluronic acid and collagen enzyme-linked immunosorbent assays were performed.

Influenza and the vocal performer: update on prevention and treatment.

Upper respiratory tract infections (URIs) are a major cause of morbidity among vocal arts professionals, both from their acute impairment of the vocal mechanism and their predisposing influence for the development of serious vocal sequelae. In this review, we present some of the salient features of currently available treatments effective against influenza, the virus family responsible for the most serious form of URI. At present, these include an inactivated vaccine and four antiviral drugs, each approved in the United States and many other countries for the prevention and treatment of influenza.