Background: Puberphonia is inappropriate use of high-pitched voice beyond pubertal age in males. It is usually seen in the immediate post-pubescent period when the male vocal mechanism has undergone significant changes in size and function caused by hormonal changes. Voice therapy is one of the modality of management for puberphonia. Aim: To evaluate the efficacy of voice therapy provided to a group of 30 Puberphonia cases as the sole treatment approach to lower the pitch range. Setting: The study was carried out in a tertiary voice care and laryngology center. Materials and Methods: This is a prospective study of 30 cases diagnosed with Puberphonia managed with various techniques of voice therapy. The subjective assessment was done with GRBAS scale and objective assessment was done by acoustic analysis using Multi Dimensional Voice Profile. Results: All 30 patients achieved appropriate pitch range following Voice Therapy. Conclusion: This study encourages speech and language professionals to advice and use voice therapy as the foremost treatment modality for Puberphonia.

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Context: While clinical successes and descriptions have been reported in a few texts, no data exist to define the utility of flow phonation to improve voice quality in patients with laryngeal hyperfunction. Aims: To provide pilot data regarding the utility of three exercises (gargling, cup bubble blowing, and stretch-and-flow) to improve phonatory airflow during voicing in patients with laryngeal hyperfunction. Settings and Design: Outpatient Voice and Swallowing Center in a University Medical Center. Materials and Methods: Participants received five treatment sessions and were evaluated prior to treatment and after each session using a Phonatory Aerodynamic System to measure airflow during voicing tasks. Noise-to-harmonic ratio and perceptual voice measures were also obtained, as was self-perception of voice handicap. Statistical Analysis Used: Repeated All increased airflow and decreased laryngeal airway resistance over five sessions. Measures Analysis of Variance. Results: Six participants completed the protocol. All participants decreased self-perception of voice handicap and improved on noise-to-harmonic ratio and perceptual ratings of vocal quality. Conclusions: Data derived on a small sample of patients in an exploratory investigation suggest further research into the use of these three exercises to improve airflow with voicing and improve vocal quality in patients with laryngeal hyperfunction is warranted.

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Thyroglossal duct cyst is a congenital lesion of the neck resulting from the remnant of the thyroglossal tract. A 59-year-old male patient presented with a progressive cystic swelling in the neck which moved on swallowing and protrusion of tongue. Investigations were inconclusive and thyroid profile was normal. Sistrunk's operation was performed and histopathological examination revealed it as thyroglossal duct cyst. There were no post-operative complications and no evidence of malignancy. The objective of this article is to emphasize on the importance of considering thyroglossal duct cyst as differential in an unusually large cystic neck swelling in adults with no conclusive evidence on investigations. Complete excision of the cyst with the tract and part of the body of hyoid (Sistrunk's operation) will significantly improve the outcome with reduced risk of recurrence.

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Leukoplakia of larynx has remained a debatable topic in laryngeal pathology for decades as per classification, histology and treatment is concerned. Smoking and alcohol are the major causes and there is sufficient evidence implicating gastroesophageal reflux and human papilloma virus in its pathogenesis. A wide range of therapeutic strategies are available for different grades of dysplasia. Despite this, a significant proportion of patients progress to carcinoma for which the patients with dysplasia need to be kept in regular follow-up.

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Endotracheal intubation is one of the most common procedures performed in the Operating Theatre, Intensive Care Unit or wards, either on an elective or emergency basis. Recurrent laryngeal nerve injury leading to vocal cord paralysis is a lesser known but important complication of intubation. It is important to identify and monitor these patients to prevent confusion with regard to etiology and outcome. This article explores the etiopathogenesis of recurrent laryngeal nerve palsy following intubation and the various risk factors and possible mechanisms which contribute to this complication. Techniques to prevent and recognize this injury are also discussed. PubMed was the main database searched for articles related to the topic which were found through the period 1972–2017.

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Introduction: The oral transit time (OTT) and pharyngeal transit time (PTT) are measures that indicate the time taken for bolus transit in oral and pharyngeal cavities, respectively. These measures vary with respect to bolus type and quantity and reflect on the efficiency of the swallow. Objectives: The study aimed to compare OTT and PTT measures for thin (water) and thick (honey) liquid bolus consistencies in 88 typical participants (44 typical adults and 44 typical geriatric persons including males and females) and 10 persons with swallowing disorders. Materials and Methods: OTT and PTT measures for liquid bolus were derived using the equipment Digital Swallowing Workstation-Swallowing Signal Laboratory (DSW-SSL) (Kay/Pentax, Lincoln, New Jersey) Model 7120. In the absence of cited standard procedures to measure OTT and PTT, the measures of OTT and PTT were specifically defined in this study based on the measures obtained from three modules/tests of the DSW-SSL: (a) Tongue array (used to measure the tongue pressure during swallow), cervical auscultation (used to measure the swallow sound), nasal cannula (used to measure the respiratory-swallow coordination). Results and Discussion: The mean group scores of OTT and PTT measures were compared across gender, age, and consistency of bolus and treated with the appropriate statistical procedure. Results revealed that: (i) PTT for honey was longer than water in typical adults and geriatric persons. (ii) There was no significant difference in OTT for honey across age groups. (iii) Atypical patterns in the morphology of tongue pressure, swallow sound and respiratory-swallow coordination during swallow were noted across age and consistency of bolus in typical and atypical population. Conclusion: The OTT and PTT measures can serve as sensitive indices to understand swallow physiology in oral and pharyngeal phase. Increase in PTT is observed for thicker liquid like honey. There are more instances of nonhomogenous patterns across typical and atypical swallows for tongue pressure, swallow sound, and respiratory-swallow coordination.

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Background: Suicide is one of the 10 leading causes of death in the world and cut throat injuries (CTI) are fairly common due to suicide. Aims and Objective: The aim of the present study is to evaluate the pattern of injury, its management and associated psychiatric illness in suicidal CTI. Materials and Methods: A prospective study from August 2011 to April 2013 was carried out in the Department of Ear, Nose, and Throat (ENT) in collaboration with the Department of Psychiatry at  Gauhati Medical College and Hospital. A total of 17 cases of suicidal CTI were included in the study irrespective of age and sex, who were admitted in the department of ENT. Results: Majority of the patients were young adults, 82.35% in the age group of 20-40 years. According to anatomical zone, 77% had injury in Zone 2 and 23% had Zone 1 injury. Hesitation injury involving skin and soft-tissues were seen in the neck in 71% of cases, and common morbidity following CTI is secondary wound infection (23.52%), persistent dysphagia (23.54%) and ugly scar (17.64%). Majority of patients (47.05%) were of acute and transient psychosis. Conclusion: Suicidal CTI is an important cause of cut neck injury in ENT practice. Proper surgical and psychiatric management of suicidal CTI plays an important role in the prevention of complications and resultant death due to CTI.

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Pharyngocele is defined as "lateral pharyngeal wall herniation located in the piriform recess or at the valleculae" and was first described in 1886. The phenomenon is rare. It is characterised by bulging of the pharynx locally and is associated with recurrent increase in intrapharyngeal pressure, reduced muscle resilience, and increasing age. The case describes a 51-year-old recreational trumpeter with bilateral pharyngoceles that demonstrated when blowing into his instrument, reminiscent of a "bullfrog." Differential diagnosis included "Zenker's diverticulum", (pharyngeal pouch), laryngocele, and jugular venous phlebectasia, which may be confirmed through clinical examination and investigation. The report includes remarkable images seen on examination and images of the swelling seen with plain film radiography, barium swallow, and computed tomography. We discuss the management options available, including repair and excision of the pouch, either as an open procedure or endoscopically, and explore the conservative measures as a basis in the management of even significant pharyngoceles.

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The treatment of bilateral immobile vocal cords (BAP) is a balance between phonation, airway and swallowing. Various techniques of endoscopic approach for the treatment of bilateral vocal fold immobility have been proposed and have been modified by various surgeons. Trans oral CO ₂ laser endoscopic arytenoidectomy has become the most common method for its management. CO ₂ laser is arguably the most appropriate tool for cordectomy with the advantage of increased precision, better hemostasis and minimal tissue handling. We describe the procedure of posterior cordectomy with partial arytenoidectomy using trans oral CO ₂ laser for management of BAP. The present modality of preservation of part of shelf of arytenoid and use of laser in super pulse mode contribute to good results with minimum complication

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Cough and hoarseness are common symptoms that may be encountered in general or specialist clinical practice. Hoarseness, especially when found in isolation, could have an origin other than in the airway. An important example of this is cardiovocal hoarseness. A literature review of cardiovocal hoarseness or Ortner's syndrome reveals many clinical presentations. Several case reports have been published, but none so far has put into context issues that could come in the way of diagnosis and management of such patients. Hoarseness as a symptom, when not explained by usual causes such as a preceding upper respiratory tract infection or allergy, must be expediently looked into by simple means such as an indirect laryngoscopy. If a vocal cord paralysis is evident, especially on the left side, the possibility of an underlying cardiac condition must be borne in mind. Surgical or nonsurgical intervention could resolve the problem except in cases where the patient is extremely moribund.

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Unilateral vocal cord paralysis (UVCP) in children is a rare and challenging disorder for the pediatric otolaryngologist. The overall etiology differs from that in adults, iatrogenic causes are the commonest, followed by traumatic - birth or intubation trauma and neurologic causes. Prolonged spontaneous recovery occurs in up to 50% of cases. Management strategies used for adults have evolved and been utilized in children, with increasing reports of surgical intervention over the last decade. However, number of children treated remains small with no long-term follow-up. We used the terms "vocal cord palsy," "vocal cord paresis," "vocal fold immobility" each limited by "paediatric," "children," to search Medline, Embase, PubMed, Cochrane, and CINHAL. Reference lists were crosschecked to include relevant studies. Only English language literature was searched. Studies specifically relating to unilateral vocal cord or containing relevant data were identified and analyzed. We present our review of literature on pediatric UVCP with emphasis on various interventions for management, especially the growing experience with laryngeal re-innervation.

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Background: Substances available for vocal cord augmentation procedure have their own advantages and limitations. Autologous fat is accepted to be one of the safest substance for augmentation. Objective: To evaluate the subjective and objective changes in vocal outcome following fat augmentation surgery for phonatory gaps. Materials and Methods: 30 patients with phonatory gap <2 mm were included in this prospective study. These consisted of sulcus vocalis (14), vocal cord atrophy (05) and vocal cord palsy (11). Per-operatively harvested umbilical fat was used for augmentation after mincing it and removing all the connective tissue. Follow-up of patients was done at 1, 3 and 6 months interval. Pre- and postoperative videostroboscopy was done. Objective analysis of voice was done using maximum phonatory time (MPT) and noise to harmonic ratio (NHR). Subjective assessment of voice was done using the voice handicap index (VHI) and subjective change in quality of voice as assessed by the patient. Results: Patients with early stage sulcus, vocal atrophy and vocal cord palsy, with small vocal gap, showed significantly good results after fat augmentation; however, results of patients with sulcus vocalis of grade II and III were not very satisfactory.

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A laryngeal granuloma (LG) is a benign tumor that usually develops on the cartilaginous vocal process of the vocal cords. Gastroesophageal reflux (GER), hyperfunctional use of the voice, and intubation injury are etiological factors. Patients usually complain of dysphagia, and dysphonia. A 53-year-old male consulted the Taksim Educational and Research Hospital ENT Department, complaining of a 6-month history of hoarseness, dysphagia, and globus sensation. On laryngoscopic examination, a granuloma was found on his left vocal process He was given an anti reflux treatments and advised on vocal hygiene. At the 1-month follow-up, the granuloma had disappeared. A thorough history was taken and disclosed that at time of his first visit, he saw a gastroenterologist for his heartburn and regurgitation and was administered pantoprazole 40 mg once daily. Consequently, the rapid resolution of the granuloma was thought have resulted from the high-dose double PPI treatment.

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Primary genital herpes is associated with involvement of extragenital sites like thighs, buttocks, fingers and pharynx. This involvement occurs due to autoinoculation, orogenital exposure from the source and also seeding due to viremia in the initial period. Involvement of larynx in a case of primary genital herpes is extremely rare prompting us to report this case.

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Early diagnosis of laryngeal cancer is important for favourable treatment outcome. Due to morbidity and difficulties associated with surgical biopsy, a need has always been felt for an easy, non invasive yet accurate tool for knowing histopathological nature of mucosal lesions. Contact Endoscopy (CE) is one such technique which is capable of providing real time and magnified images of cellular structure of superficial layers of various mucosal surfaces with obvious advantages and potential for wide clinical application. In this review, a summary of role and efficacy of CE in diagnosis, treatment and follow up of various laryngeal mucosal lesions is presented. We searched Pubmed, Medline, Cochrane and Google scholar for articles on CE for mucosal lesions of larynx. For better understanding of the technique, articles on CE of other non-laryngeal sites of head and neck were also reviewed. Article selection was limited to human studies without restriction to language and year of publication. Reference lists from identified articles were also searched. Six prospective original articles, three descriptive studies and one review article on CE of laryngeal lesions are included in this review and their findings summarized. Common findings on examination of cellular architecture and vascular patterns described by various authors are also tabulated. The literature revealed high sensitivity (90-94.7%), specificity (81-100%) and accuracy (88-94%) of CE in diagnosis of laryngeal lesions across the published studies. CE is a promising non invasive tool for evaluation of laryngeal mucosal lesions. However, further prospective, randomized, double blinded studies as well as research to improve the technique to overcome the existing limitations are required before defining its precise role in clinical practice.

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Stuttering is a psychosomatic condition with a high degree of social dysfunction characterized by involuntary interruptions in the flow of speech. The etiology is considered to be multifactorial. Speech therapy is the first-line treatment, and therapeutic alternatives have been proposed with different pharmacological agents. In this case report, we describe the use of botulinum toxin type A (BTX-A) in the facial muscles for treating a patient with developmental stuttering which showed a significant temporary improvement after undergoing the procedure. This is a single-subject study. In the current medical literature, there are a few descriptions of using BTX-A injections in the intrinsic laryngeal muscles with favorable results, but no reports of its use in facial muscles for the treatment of stuttering. Therefore, this report may be important to highlight BTX-A as a safe and effective option when managing to stutter. Hopefully, it will assist in the search for effective treatment and form part of the multi-disciplinary approach in the treatment of stuttering, helping these patients to reduce their social dysfunction and improve their speech and their lives.

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Traumatic laryngeal injuries can be life-threatening medical events which often require intervention by otolaryngologists. To our knowledge, this is the fourth case report of laryngeal injury resulting from a sneezing episode, and the first to be treated with observational treatment alone. The following is a case report of a 33-year-old man with subcutaneous emphysema caused by laryngeal injury as a result of a sneezing episode. The patient presented to his local emergency department with anterior neck pain, odynophagia, hoarseness, and trace hemoptysis. The Division of Otolaryngology – Head and Neck Surgery was consulted after an enhanced computerized tomography scan revealed extensive subcutaneous emphysema seemingly centered around the level of the hyoid bone. Nasopharyngoscopy and gastrografin swallow were performed. Nasopharyngoscopy revealed a right vocal cord hematoma extending into the immediate anterior subglottis. Gastrografin swallow revealed no signs of esophageal perforation. The patient was discharged without further medical intervention with follow-up scheduled. Repeat nasopharyngoscopy was performed during follow-up, 6 weeks later and demonstrated complete resolution of the vocal cord hematoma. The patient was noted to have developed significant muscle tension dysphonia on the follow-up visit, likely secondary to defensive laryngeal posturing stemming from the initial injury. He was subsequently referred for voice therapy. We demonstrate the first case of treating an endolaryngeal barotrauma injury as a result of a sneezing episode with observational treatment alone. To the best of our knowledge, only three other case reports of sneezing causing laryngeal injury have been published, all of which necessitated additional medical or surgical interventions, ranging from voice restriction to systemic corticosteroids.

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Bilateral vocal fold immobility is characterized by narrowing of the glottic chink which could precipitate in the form of an acute airway insufficiency. The vocal cords may be immobile or fixed in the paramedian position depending upon the etiology and the time duration. The standard approach till the early part of the 19th century was to perform a tracheostomy in such patients. The glottis dilating operations which included cordectomy, arytenoidectomy were introduced in 1922 and have evolved over time. However most of the procedures being irreversible, were not the best line of management in cases with a recovering bilateral vocal fold paralysis. Suture lateralization was introduced as an alternative in the year 1978 which could be reversed if the paralysis resolved. This procedure had two main approaches 1) Endo – Extra laryngeal approach and 2) Extra- Endolaryngeal approach which have been published by different authors over the last 35 years. This current article reviews these techniques alongwith the published results.

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Laryngocele is a rare cystic swelling arising from the saccule of larynx. It is seen mostly among trumpeters and glassblowers. In others, it is often associated with underlying malignancy. Here we report a case of external laryngocele in a young farmer who did not have any of the above mentioned associations.

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Vallecular cyst in an infant is uncommon, and it finds infrequent mention in the literature as well. However when present, it accounts for severe inspiratory stridor, causing airway compromise, and sometimes even death. Laryngomalacia is the commonest congenital anomaly of the larynx, which is present after birth giving rise to inspiratory stridor. Laryngomalacia results as a collapse of supraglottic structures of the larynx. Clinical co-presentation of vallecular cyst and laryngomalacia is very rare. This is a report of two cases of 2-month-old infants who presented with the history of noisy breathing and refusal to feeds since 10-15 days. CT scan of the neck revealed a huge cyst in the vallecula compromising the airway. Microlaryngoscopic-guided aspiration and marsupilization of the cyst was done using CO ₂ laser and the release of aryepiglottic fold was done using microlaryngeal scissors. Respiratory and feeding problems dramatically improved in these patients by immediate surgical intervention.

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Objectives: To adapt the voice handicap index (VHI) for usage in Hindi and evaluate its internal consistency, reliability, and clinical validity in cases of dysphonia. Setting: Tertiary healthcare centers. Materials and Methods: The original VHI was translated into Hindi and was completed by 175 patients with voice disorders and 84 asymptomatic subjects. Internal consistency was analyzed through Cronbach's alpha coefficient. For test-retest reliability, the Hindi VHI was filled twice by 63 randomly selected patients and assessed through the Spearman rank correlation coefficient test. For the clinical validity assessment, the scores obtained in the pathological group were compared with those found in asymptomatic individuals through the Kruskal-Wallis test. Also, the correlation between VHI and the patients' self-perceived grade of voice disorder was assessed. Finally, the effect of age and gender on overall VHI and its three subscales was analyzed. Results: Internal consistency was found to be good (alpha = 0.95); the test-retest reliability was high (r = 0.95). Nonparametric Kruskal-Wallis analysis revealed that the control group scored significantly lower than the dysphonics. The overall VHI score positively correlated with the patients' self-perceived grade of voice disorder (r = 0.44). In the voice-disorder group, age and gender were not correlated to the overall VHI score and to their three domains. Conclusion: The Hindi VHI so developed is a valid and reliable measure for use in the Hindi-speaking population.

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Objective: The main purpose of this study was to compare different speech related parameters in dual-mode esophageal and tracheoesophageal speakers. A second purpose was to compare the speech characteristics of these (tracheo) esophageal speakers with age- and gender matched controls. Materials and Methods: Four male laryngectomees who were proficient esophageal and tracheoesophageal speakers provided audio recordings of sustained vowels and connected speech using both alaryngeal methods. The participants from the control group also followed the same procedure. From the recorded samples, fundamental frequency (F0), maximum phonation duration (MPD), formant frequencies, and speech rate related parameters were extracted. Results: Although there was no statistically significant difference between the two alaryngeal modes for any of the measured parameters, the absolute fundamental frequency and MPD values were higher in TE mode. However, when compared to controls, both the alaryngeal modes depicted significantly shorter MPD values, higher first formant frequency values, slower speech rate, and higher frequency of pauses. Conclusion: The results suggest that most group differences found between esophageal and tracheoesophageal speech in the past may be due to large inter-subject variability, and that within speakers, similarity is more between esophageal and tracheoesophageal speech than with laryngeal speech. These results have implications for understanding the pseudoglottic voice mechanism.

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Microlaryngeal tracheal (MLT) tube, when inserted through nasal route, offers adequate space in front of the tube for proper vision, excision and hemostasis of vocal cord lesions in the anterior and middle third portions as compared to oral route. There is less risk of kinking of tube at the point of securing with skin and it provides easy instrumentation for exposure of oral cavity. MLT tube placed nasally lies in the posterior comissure of vocal cord between arytenoids, leaving anterior two-third or more unobscured.

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Hypothyroidism is a common endocrinal disorder which may present as an unusual presentation like dysarthria. Knowledge about unusual presentations in hypothyroidism may help to make correct diagnosis and treatment. This case series includes two cases of hypothyroidism-induced dysarthria. Both cases were misdiagnosed on previous medical consultations. Complete recovery was achieved after correct diagnosis and thyroxin replacement.

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Objective: Unilateral vocal cord palsy is a major cause of dysphonia. With umpteen number of causes being attributed to it and changing trends in etiology from place-to-place and over time, it is of utmost importance to arrive at a correct diagnosis to plan further management and to determine the prognosis. The aim was to evaluate the etiological profile of unilateral vocal cord palsy in our institute that is a tertiary referral center over the past 10 years. Materials and Methods: Case records of all patients diagnosed with unilateral vocal cord palsy who presented to Deenanath Mangeshkar Hospital, Pune, Maharashtra, India between 2003 and 2013 were retrospectively reviewed. The exclusion criteria included patients with laryngeal/hypopharyngeal malignancies, intubation trauma, congenital vocal cord palsy and cricoarytenoid joint ankylosis. The age, gender, laterality and etiology were the factors taken into consideration. Results: A total of 277 cases spanning over the age range of 2 months to 98 years met our inclusion criteria, out of which 179 were males, and 98 were females with a male to female ratio being 1.82:1. In terms of laterality, 182 patients had left sided, and 95 had right sided vocal cord palsy. Majority of the cases were found to be in the fourth and fifth decades. The most common etiology was idiopathic 136 (49.1%). The incidence of various other etiologies were surgical trauma 60 (21.6%), nonsurgical trauma 10 (3.7%), nonlaryngeal malignancy 36 (12.9%), central/neurological 17 (6.1%), postradiation 1 (0.3%), and other benign lesions 17 (6.1%). Among the surgical causes, the incidence of nonthyroidectomy surgeries (58.3%) was more than that of thyroidectomy (41.6%). Thyroidectomy was the single most common surgical cause for unilateral vocal cord palsy, followed by other nonthyroid neck surgeries (20%) and anterior cervical decompression (18.3%). Conclusion: The most common cause for unilateral vocal cord palsy is idiopathic. Nevertheless it is still an important sign of various underlying diseases. A thorough evaluation which must necessarily include a computerized tomographic scan from base of the skull to upper mediastinum is essential before labeling a case as idiopathic; hence, also the need for extended follow-up of the cases to avoid misdiagnosis of any underlying subclinical malignancy.

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