Changes in Peak Airflow Measurement During Maximal Cough After Vocal Fold Augmentation in Patients With Glottic Insufficiency

Dion, Gregory R.; Achlatis, Efstratios; Teng, Stephanie; Fang, Yixin; Persky, Michael J.; Branski, Ryan C.; Amin, Milan R.

doi:10.1001/jamaoto.2017.0976

Cited by 17 publications

(16 citation statements)

References 19 publications

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“…Vocal fold paralysis, paresis, and atrophy are commonly treated with vocal fold augmentation, or injection laryngoplasty, to improve vocal function, breathing, and airway protection 1,2 . Providing bulk to the affected vocal fold(s) increases vocal fold contact area, improving control of glottic closure and mucosal wave generation with little to no recovery time required.…”

Section: Introductionmentioning

confidence: 99%

Augmentation and vocal fold biomechanics in a recurrent laryngeal nerve injury model

Miar

Walters

Gonzales

et al. 2022

Laryngoscope Investig Oto

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Objectives/hypothesis Composite vocal fold (VF) biomechanical data are lacking for augmentation after recurrent laryngeal nerve (RLN) injury. We hypothesize resulting atrophy decreases VF stiffness and augmentation restores native VF biomechanics. Methods Sixteen Yorkshire Crossbreed swine underwent left RLN transection and were observed or underwent carboxymethylcellulose (CMC) or calcium hydroxyapatite (CaHa) augmentation at 2 weeks. Biomechanical measurements (structural stiffness, displacement, and maximum load) were measured at 4 or 12 weeks. Thyroarytenoid (TA) muscle cross‐sectional area was quantified and compared with two‐way ANOVA with Tukey's post hoc test. Results After 4 weeks, right greater than left structural stiffness (mean ± SE) was observed (49.6 ± 0.003 vs. 28.4 ± 0.002 mN/mm), left greater than right displacement at 6.3 mN (0.54 ± 0.01 vs. 0.46 ± 0.01 mm, p < .01) was identified, and right greater than left maximum load (72.3 ± 0.005 vs. 40.8 ± 0.003 mN) was recorded. TA muscle atrophy in the injured group without augmentations was significant compared to the noninjured side, and muscle atrophy was seen at overall muscle area and individual muscle bundles. CMC augmentation appears to maintain TA muscle structure in the first 4 weeks with atrophy present at 12 weeks. Conclusions VF biomechanical properties match TA muscle atrophy in this model, and both CMC and CaHa injection demonstrated improved biomechanical properties and slower TA atrophy compared to the uninjured side. Taken together, these data provide a quantifiable biomechanical basis for early injection laryngoplasty to improve dysphonia and potentially improve healing in reversible unilateral vocal fold atrophy. Level of evidence N/A

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Section: Introductionmentioning

confidence: 99%

Augmentation and vocal fold biomechanics in a recurrent laryngeal nerve injury model

Miar

Walters

Gonzales

et al. 2022

Laryngoscope Investig Oto

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“…We also suggest that all patients with high risk of aspiration will be tested and followed for cough effectiveness using peak flow meter, as suggested by others. 28,30 The current study did not evaluate the natural history of postoperative VFMI with no injection and did not compare VFSS to FEES. Moreover, we did not evaluate the outcomes of delayed injection laryngoplasty (>30 days following injury) nor the long-term follow-up outcomes.…”

Section: Discussionmentioning

confidence: 99%

Early Injection Laryngoplasty After Surgery: 30 Cases and Proposed Aspiration Assessment Protocol

et al. 2020

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“…When glottal insufficiency occurs due to UVFP, it becomes difficult to raise the intrathoracic pressure, leading to a decreased cough strength; thus, patients with UVFP have a decreased CPF. To the best of our knowledge, only two previous reports [18,19] have described the CPF values in patients with UVFP, but the association between dysphagia and CPF values in such patients has not been reported.…”

Section: Introductionmentioning

confidence: 90%

“…To assess cough power objectively, the CPF of each participant was measured using a Mini-Wright Peak Flow Meter (Clement Clarke International Ltd, Harlow, UK) and a facemask. The participant was asked to sit on a chair, wearing a facemask attached to a spirometer to prevent leakage from the mouth and nose, as previously described by Dion et al [19] and Kimura et al [33]. The participants were instructed to breathe in and out deeply and then to cough with their maximum strength.…”

Section: Examination Of Cough Strengthmentioning

confidence: 99%

“…There are a few reports regarding CPF measurements in patients with UVFP, but no studies have compared the CPF values between patients with UVFP and healthy participants. Dion et al [19] measured the CPF values in patients with UVFP before and after vocal fold augmentation and reported that most of the participants had improved CPF values after surgery. The decreased CPF values in patients with UVFP was attributed to the difficulty in raising the intrathoracic pressure caused by glottal closure insufficiency.…”

Section: Relationship Between Cpf and Swallowingmentioning

confidence: 99%

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Analysis of Dysphagia and Cough Strength in Patients with Unilateral Vocal Fold Paralysis

et al. 2021

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The association between swallowing function and cough strength in patients with unilateral vocal fold paralysis (UVFP) is unknown. We evaluated the relationship between voluntary cough strength and dysphagia among patients with UVFP (UVFP group) by comparing their data with that of corresponding healthy participants (healthy control [HC] group) in a prospective observational study. From February 1st, 2018 to March 30th, 2019, we recruited patients with a voice disorder due to UVFP, who were referred to our university hospital. Patients with a history of laryngeal surgery, vagal nerve paralysis, or cardiac and respiratory failure were excluded. Descriptive and clinical data regarding swallowing, voice, and cough peak flow (CPF) were collected as a measure of cough strength. The UVFP group comprised six women and seven men (median age, 68.0 years), and the HC group comprised six women and eight men (median age 65.5 years). The groups differed significantly in the Eating Assessment Tool (EAT)-10 scores and CPF rates (P < 0.001). Among patients with UVFP, 84.6% had an abnormal EAT-10 score of ≥ 3. Additionally, 16.7% of the patients exhibited liquid aspiration with contrast medium on a videofluorographic swallowing study (VFSS). There was no correlation between the CPF values, EAT-10 scores, or the VFSS results. Therefore, patients with severe UVFP, whose condition had been fixed, had difficulties when swallowing (85% of cases), and some even presented with aspiration on VFSS (20% of cases), while receiving a regular diet.

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Changes in Peak Airflow Measurement During Maximal Cough After Vocal Fold Augmentation in Patients With Glottic Insufficiency

Abstract: Peak airflow during maximal cough may improve with vocal fold augmentation. Additional assessment and measurements are needed to further delineate which patients will benefit most regarding their cough from vocal fold augmentation.

Cited by 17 publications

References 19 publications

Augmentation and vocal fold biomechanics in a recurrent laryngeal nerve injury model

Augmentation and vocal fold biomechanics in a recurrent laryngeal nerve injury model

Early Injection Laryngoplasty After Surgery: 30 Cases and Proposed Aspiration Assessment Protocol

Analysis of Dysphagia and Cough Strength in Patients with Unilateral Vocal Fold Paralysis

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