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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Forestier's disease or diffuse idiopathic skeletal hyperostosis (DISH) is a skeletal pathology characterized by paravertebral osteophyte formation and calcification and ossification of the anterior longitudinal vertebral ligament. It is being increasingly recognized as a cause of dysphagia and rarely leads to obstructive airway symptoms such as snoring, dyspnea on exertion, and laryngeal stridor. We report an unusual case presenting with acute respiratory distress due to obstructing laryngeal edema and bilateral arytenoid sclerosis, with the fixation of left cricoarytenoid joint in association with DISH.

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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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Muscle tension dysphonia (MTD) is a subtype of functional dysphonias that believed to be the result of misuse or abuse of an anatomically and neurologically intact larynx. MTD is usually seen in young to middle aged population who use his/her voice extensively in stressful situations. We had a 56-year-old female patient who underwent total thyroidectomy surgery and developed bilateral vocal fold paresis after the surgery. She had immediate tracheotomy and followed with tracheotomy tube for years. In our clinic examination, we found hyperadduction of the vocal folds and minimum activity and performed Botox^® (Allergen, Irvine, California, USA) injection to the thyroarytenoid muscles. After 1 week, she decannulated. MTD is a rare and special disease. The disease can be primary without any organic pathology or secondary to a glottic closure problem. First treatment option must be speech therapy, but in resistant cases, surgery or Botox^® (Allergen, Irvine, CA, USA) is suggested.

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Benign laryngeal cysts have the potential to cause airway compromise. Proper anesthetic and surgical management should be planned in advance to avoid undue complications. We present a case of 52-year-old male with concomitant vallecular and saccular cysts (VaC and SC) which were managed successfully. To the best of our knowledge, this is the first report on concomitant existence of VaC and SC.

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Context: Since the last two decades, the research has been concentrated on professional voice; there is a curiosity among researchers to find out whether singers (S) are really special in their voice use than nonsingers (NS). Although there have been studies regarding singer's formant in Indian classical singers, underlying physiological adjustments made by singers and its relation with acoustical features need to be studied. Thus, the aims of the present study were to explore the possibility of singer's formant in Hindustani classical singers, to study the physiological adjustments made by the singers, and also to find out the effect of number years of experience on acoustical as well as auditory-visual perceptual parameters. Subjects and Methods: Twenty Hindustani classical singers and ten nonsingers within the age range of 18–50 years were considered for the study. The singers were again grouped into three Subgroups (S1, S2, S3) based on their years of music experience. Acoustical as well as auditory-visual perceptual evaluation was carried out for singers and nonsingers. Results and Discussion: The study revealed that S3 (>10 years of experience) Group had the highest amplitude at 2–4 kHz as well as higher singing power ratio values as compared to S1 and S2. Nasoendoscopic evaluation was done for all the participants by a well-experienced ENT professional. S3 Group had the widest pharyngeal opening. Hence, the results of the present study point out the possibility of occurrence of singer's formant in Hindustani classical singers. Conclusions: The result of the acoustical analysis indicates that there is an effect of years of music experience on the acoustical as well as perceptual parameters. The study highlights the possibility of developing training material for singers to improve their pharyngeal widening.

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