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Table of Contents
Year : 2019  |  Volume : 9  |  Issue : 1  |  Page : 27-29

Oral - Resident & Post-Graduate

Date of Web Publication14-May-2020

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2230-9748.284242

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How to cite this article:
. Oral - Resident & Post-Graduate. J Laryngol Voice 2019;9:27-9

How to cite this URL:
. Oral - Resident & Post-Graduate. J Laryngol Voice [serial online] 2019 [cited 2023 May 30];9:27-9. Available from: https://www.laryngologyandvoice.org/text.asp?2019/9/1/27/284242

   Laryngeal videostroboscopy parameters may reveal the pathophysiology of vocal cords' damage in laryngopharyngeal reflux (ABS_012) Top

Yonian Gentilis, Susyana Tamin, Syahrial M. Hutauruk, Saptawati Bardosono, Elvie Z. Rachmawati

Department of Otorhinolaryngology Head and Neck Surgery, Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia

E-mail: [email protected]

Background: Reflux of gastric content into the upper aerodigestive track may cause a microtrauma to vocal cords and leads to many vocal cords' pathologies. Laryngeal videostroboscopy (LVS) is a modality to evaluate the vibratory function of vocal cords using ten parameters such as vibratory amplitude, mucosal wave, vibratory behavior, supraglottic activity, glottal closure, vertical level, free edge contour, phase closure, phase symmetry, and regularity. These parameters have an important role in early diagnosis and defining the pathophysiology of vocal cord abnormality in a laryngopharyngeal reflux (LPR) patient.

Objective: The purpose of the study was to determine which LVS parameters can be used as an indicator to identify the difference of vocal cord damage in LPR compared to normal control group.

Subjects and Methods: This study involved 61 patients who underwent LVS in Cipto Mangunkusumo Hospital. Seven patients were excluded and result in total 54 patients with 27 patients in each group. An analytic cross-sectional study was conducted to compare LVS parameters between two groups, followed by regression statistics to find which parameter has the most significant value to LPR. The author also conducted correlation analysis to find relationship among each LVS parameter and relationship between LVS parameters with grade of dysphonia.

Results: Of the 27 patients in the LPR group, only 5 (18.5%) patients have dysphonia. Eight from ten LVS parameters were significantly different (P < 0.005) between LPR group and normal control group, i.e., vibratory amplitude, mucosal wave, vibratory behavior, supraglottic activity, free edge contour, phase symmetry, regularity, and phase closure. Among these eight parameters, supraglottic activity was the most important parameter in understanding the vocal cord pathology in LPR as much as 40.3% with R(2) of 0.776. There was a significant correlation among each parameter in the LPR group, such as amplitude, mucosal wave, supraglottic activity, and vibratory behavior (P < 0.001). Grade of dysphonia only has correlation with right and left mucosal wave with P = 0.028 and 0.017, respectively, and no correlation with other parameters.

Conclusion: Comprehensively, eight of ten LVS parameters (vibratory amplitude, mucosal wave, vibratory behavior, supraglottic activity, free edge contour, phase symmetry, regularity, and phase closure) can be used as a tool to evaluate the complex pathophysiology process of vocal cord damage in LPR. Furthermore, those parameters may simultaneously reveal the severity of vocal cords' abnormality due to reflux.

   Injection laryngoplasty: Our experience (ABS_022) Top

Sai Belsare, Gauri Belsare

Department of Otorhinolaryngoly, Bharati Vidyapeeth Deemed University Medical College, Pune, Maharashtra, India

E-mail: [email protected]

Objectives: To analyze the results of injection laryngoplasty at our center.

Materials and Methods: Sixteen patients reporting to our department from August 2017 to August 2019, with change in voice, diagnosed as unilateral vocal cord paralysis, were evaluated before and after the injection laryngoplasty procedure. The evaluation included voice-related quality of life questionnaire, perceptual evaluation of voice, and videostroboscopy. Autologous fat and hyaluronic acid were used as materials for augmentation of the paralyzed vocal cords in different indications. The clinical follow-up was done 1 month postoperatively.

Results: The voice-related quality of life questionnaire as well as perceptual evaluation of voice showed satisfactory results in 93% of patients. Eight-seven percent of patients showed adequate closure of the phonatory gap on videostroboscopy.

Conclusion: The results of injection laryngoplasty are satisfactory .This procedure can be effectively used to improve voice and glottal protective function in selective patients with unilateral vocal cord palsy.

   Laryngeal dimension between genders in relation to transcutaneous injection laryngoplasty (ABS_027) Top

Azman Mawaddah, Mohammad Nasir Zuraini, Mat Baki Marina, Mohd Zaki Faizah, Kew Thean Yean

Department of Otorhinolaryngology, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia

E-mail: [email protected]

Objective: To determine laryngeal dimension between genders in relation to three transcutaneous injection laryngoplasty techniques using computed tomography (CT) scan.

Materials and Methods: CT scan of the neck of 122 patients were analyzed by two independent raters. For thyrohyoid (TH) approach, the mean distance from the superior border of thyroid cartilage (STH) to epiglottis (TH1) and the mean angle from STH to mid-true cords (TH2) were measured. For cricothyroid (CT) approach, the mean distance from inferior border of thyroid cartilage (ITH) to trachea (CT1) and the mean angle from ITH to mid-true cords (CT2) were measured. For transthyroid (TT) approach, the mean distance from mid-thyroid cartilage to mid-true cords (TT1) and thyroid cartilage calcification (TT2) was measured.

Results: For TH approach, the mean TH1 distance was 16.7 mm (standard deviation [SD]: 2.88 mm) in males and 12.6 mm (SD: 1.98 mm) in females (P < 0.05). The mean TH2 angle in males was 88.1°C (SD: 8.9°C) and 97.0°C (SD: 10.6°C) in females (P < 0.05). For CT approach, mean CT1 distance was 2.0 mm (SD: 0.48 mm) in males and 1.5 mm (SD: 0.4 mm) in females (P < 0.05). The mean CT2 angle in males was 134.5°C (SD: 10.8°C) and 136.3°C (SD: 9.9°C) in females (P > 0.05). For TT approach, the mean TT1 distance was 12.6 mm (SD: 3.6 mm) in males and 9.0 mm (SD: 2.8 mm) in females (P < 0.05). Statistically significant weak correlation was found between age and TT2 (P < 0.05). Moderate-to-excellent reliability was observed across all variables.

Conclusion: There was statistically significant difference in CT measurements for TH and TT techniques between genders.

   Low-risk dysphonia and dysphagia: An integrated ear, nose, and throat perspective in Queensland, Australia (ABS_029) Top

T. Tynan, B. Whitfield

Department of Ear, Nose, Throat, Logan Hospital, Queensland, Australia

E-mail: [email protected]

Dysphonia and dysphagia are common conditions and often represent a large number of referrals to ear, nose, and throat (ENT) units. Often, these conditions are considered of a lower priority compared to head and neck cancer referrals.(1) Research showed that greater than 80% of patients were unable access appointments within the clinically recommended timeframe, one patient waiting 7 years for an ENT appointment.(2) At Logan Hospital (Queensland, Australia), a change in the existing model of service delivery was felt needed due to unsustainable growth in the number of ENT referrals. In response to this demand, Logan Hospital was the first unit in Australia to implement an Integrated Model of Care for the treatment of public patients requiring an ENT consultation, with an allied health first point of contact. The ENT-speech pathology dysphagia and dysphonia pathway was one of three streamlined allied health pathways developed using specific referral criteria and processes. All patient referrals are triaged by an ENT consultant and specific to the low risk dysphagia/dysphonia pathway all cases/fiberoptic nasoendoscopy images are discussed with an ENT specialist. This significantly reduced patient wait times and there were nil adverse events noted, which found this model can achieve safe effective changes to ENT service delivery.(3) Established in 2016, this has extended to other or ENT units across Queensland with similar successes. In conclusion, an integrated model of care provides a collaborative and clinically viable approach for the management of low risk dysphonia and dysphagia with wider implications on a global scale.

   References Top

  1. Young G, Hulcombe J, Hurwood A, Nancarrow S. The Queensland Health Ministerial Taskforce on health practitioners' expanded scope of practice: Consultation findings. Aust Health Rev 2015;39:249-54.
  2. The Honourable Cameron Dick. Innovative ENT Service cuts Long Waits by 90 Percent. Minister for Health and Minister for Ambulance Services Media Statement. Queensland Government Cabinet and Ministerial Directory; 23 September, 2016.
  3. Seabrook M, Schwarz M, Ward EC, Whitfield B. Implementation of an extended scope of practice speech-language pathology allied health practitioner service: An evaluation of service impacts and outcomes. Int J Speech Lang Pathol 2019;21:65-74.

   A long-term 18-year evaluation of voice production and aspiration of patients who underwent total laryngectomy with Ureta primary voice reconstruction (ABS_031) Top

Leighnette Geronimo, Maria Shamylle Quinto, Celso Ureta

Veterans Memorial Medical Center, Quezon City, Philippines

E-mail: [email protected]

Objective: To determine the effectiveness of voice production in communicational skills and prevalence of aspiration among patients who underwent Ureta primary voice reconstruction after total laryngectomy and to determine the correlation between degree of aspiration with patients' voice production, onset of voice acquisition postoperatively, and number of spoken words.

Methods: This cross-sectional survey was done in a tertiary hospital, in 57 males with ages ranging from 47 to 87-year-old. Patients had Stage III and IV laryngeal squamous cell carcinoma who underwent total laryngectomy with Ureta primary voice reconstruction, with neck dissection and completed postoperative radiotherapy from 1995 to October 2013. With proper consent, the patients were asked to answer the validated Philippine postlaryngectomy Questionnaire.

Results: All acquired voice with 94.7% patients have effective conversational speech and only 1.8% prevalence of severe aspiration. There was a significant inverse correlation between degree of aspiration versus voice production. All patients with no or mild degree of aspiration acquired an efficient, understandable, conversational voice. Also there was significant direct relationship between degree of aspiration versus onset of voice acquisitions postoperatively, wherein patients without aspiration acquired voice earlier as 2 weeks postoperatively. Significant inverse relationship between degree of aspiration versus number of spoken words per breath showed that all patients without aspiration to milder degree of aspiration can speak from phrases to sentences per breath.

Conclusion: All acquired voice with effective communicational skills and only 1.8% prevalence of severe aspiration. Patients without aspiration have efficient voice production, produce voice immediately, and can easily verbalize understandable words like a normal person.

   Subglottic stenosis in a tertiary hospital: A review of management (ABS_042) Top

Bernard Lyons, Kaman Dhillon

Department of ENT, St Vincent's Hospital, Melbourne, Australia

E-mail: [email protected]

Subglottic stenosis is defined as either a congenital or acquired narrowing of the subglottic airway from the vocal cords inferiorly to the trachea. It has increased in prevalence with the increase in surgical procedures worldwide, with 90% of all acquired cases in adults attributed to endotracheal intubation. While the symptomology for subglottic stenosis can be varied from asymptomatic to life-threatening airway compromise, the treatment plan is largely site or operator dependent, and with a multitude of treatment from medical to surgical, there is little consensus nor research on optimal care.

Aim: This study aims to evaluate the management strategies and treatment outcomes for subglottic stenosis.

Methods: Data were collected retrospectively from all procedures undertaken for subglottic stenosis at St. Vincent's Hospital Melbourne between 2014 and 2018. The data on 134 patients were then analyzed looking at type of procedure, symptom resolution or complication, and recurrence rate.

Results: Of the 134 patients, 68% received laser balloon dilatation with a recurrence interval of at least 1 year minimum. In comparison to other modalities, laser balloon dilatation recurrence rates were significantly lower than simple balloon dilatation (P ≤ 0.05). Of the remaining procedures, cold steel dilatation was the next most utilized. Idiopathic subglottic was the most common etiology and only three patients had poor complication requiring tracheostomy.

Conclusion: Laser balloon dilatation remains the most commonly employed and effective option for treatment of subglottic stenosis; however, there is currently no gold standard and more wide ranging and larger studies are required.

   Detecting aspiration with narrow band imaging (ABS_043) Top

Claire Stanley1, Paul Paddle1,2, Susie Griffiths1, Adnan Safdar1,2, Debra Phyland1,2

1Department of Otolaryngology, Head and Neck Surgery, Monash Health,2Department of Surgery, Monash University, Clayton, Australia

E-mail: [email protected]

Objectives: Narrow band imaging (NBI) is used to improve the visualization of abnormal tissue in endoscopy compared to white light (WL). Recently, it has been suggested that NBI light may increase the sensitivity of penetration and aspiration detection in flexible endoscopic evaluation of swallowing (FEES). Given that most FEES equipment has this technology, it has been proposed as an easy and cost-effective tool to improve dysphagia evaluation, leading to more reliable interpretation of findings.(1) We tested this hypothesis regarding NBI technology in patients with unilateral vocal fold paralysis, as they are typically a difficult population in which to detect the presence of aspiration during FEES.

Materials and Methods: A prospective observational outcome study of 22 outpatients with unilateral vocal cord paralysis were evaluated with FEES using standard WL compared to NBI. Expert raters blinded to patient identification, clinical history, and bolus types were asked to assess digital recordings of the FEES using both light sources. Intra- and inter-rater reliability for aspiration and penetration measures were calculated. These outcomes were also compared with EAT-10 scores, etiology, and demographic data.

Results: Twenty-two patients were included in the study with expert ratings across 144 test conditions (72 WL vs. 72 NBI). There was no statistical significant difference between NBI and standard light in the detection of laryngeal penetration and aspiration with milk boluses in patients with unilateral vocal fold paralysis. Further results will be discussed including demographic data, EAT-10 scores, and percentage of penetration and aspiration from the sample.

Conclusion: NBI during flexible FEES did not improve the detection of laryngeal penetration or aspiration of milk in patients with unilateral vocal fold paralysis.

   Reference Top

  1. Nienstedt JC, Müller F, Nießen A, Fleischer S, Koseki JC, Flügel T, et al. Narrow band imaging enhances the detection rate of penetration and aspiration in FEES. Dysphagia 2017;32:443-8.


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