Laryngoscopic and stroboscopic signs in the diagnosis of vocal fold paresis

Estes, Christine; Sadoughi, Babak; Christos, Paul J.; Sulica, Lucian

doi:10.1002/lary.26570

Cited by 24 publications

(39 citation statements)

References 25 publications

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“…In cases with EBSLN injury, the symmetry of the vocal cord mucosal wave existed, but the bilateral fluctuation was weak compared with the preoperative values. Since the observed change was weak, it was challenging to diagnose intraoperative EBSLN injury, consistent with previous EBSLN research results (27). Some limitations were present in this study.…”

Section: Discussionsupporting

confidence: 58%

The area under the waveform of electromyography for monitoring the external branches of the superior laryngeal nerve during thyroid surgery

Zhao¹,

Zhao²,

Wang³

et al. 2021

Gland Surg

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Background: Injuries to the external branches of the superior laryngeal nerve (EBSLN) are difficult to identify during thyroidectomy. Monitoring the low amplitudes of the EBSLN during surgery has proven to be complicated. Therefore a new parameter, the area under the waveform (AUW), was designed to improve monitoring efficiency. The aim of this study was to determine the effectiveness of using AUW to monitor the EBSLN during thyroidectomy.Methods: A total of 927 patients and 927 recurrent laryngeal nerves (RLN) and EBSLNs who underwent monitored unilateral thyroidectomy were included. Standardized intraoperative neuromonitoring procedures were followed. RLN injuries were confirmed using stroboscopic laryngoscopy after surgery. EBSLN injuries were identified by means of observing changes in cricothyroid muscle (CTM) twitches when stimulated. Amplitude and AUW changes were assessed using statistical analysis. The correlations between AUW and amplitude were verified using the ratio of the two parameters to determine any decreases that were observed in the number of nerve injury cases. The receiver operating characteristic (ROC) curve was used to estimate the prediction of nerve injury.Results: The overall injury rates of the RLN and EBSLN were 3.56% and 2.05%, respectively. The AUW for the RLN and EBSLN presented linear correlations with amplitude. In the RLN injury cases, no significant difference was observed between the two parameters (P>0.05). In the cases with EBSLN injuries, the AUW decreased 64.5%±14.1%, on average, which was a greater decrease compared to that observed for amplitude 49.7%±22.2% (P<0.0001). The summary of the EBSLN injury prediction included, amplitude vs.

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Section: Discussionsupporting

confidence: 58%

The area under the waveform of electromyography for monitoring the external branches of the superior laryngeal nerve during thyroid surgery

Zhao¹,

Zhao²,

Wang³

et al. 2021

Gland Surg

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“…6,8 These treatments are thought to work by altering the neuromuscular sensory input that leads to chronic cough. 5 Irregularities of vocal fold motion have been characterized as the result of laryngeal nerve damage and experienced clinicians frequently site videostroboscopic evidence of vocal fold motion and mucosal wave abnormalities as evidence of vocal fold paresis 6,9 . Furthermore, previous literature has described increased efficacy of pharmacologic agents for treatment of neurogenic cough in patients with evidence of superior and/or recurrent laryngeal neuropathy.…”

Section: Discussionmentioning

confidence: 99%

Superior Laryngeal Nerve Block for Treatment of Neurogenic Cough

2021

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Objectives: This study aimed to add to the body of evidence for efficacy of Superior Laryngeal Nerve (SLN) blocks for treatment of neurogenic cough. Efficacy at short-and long-term intervals are presented as well as relationships with laryngoscopic findings.Methods: A retrospective chart review of patients treated with SLN block between 2018 and 2020 was conducted. Patient demographics, videostroboscopic findings, and patient-subjective perception of outcomes were recorded and analyzed. Cough Severity Index (CSI) scores from pre-injection, short-term follow-up, and long-term follow-up were compared.Results: Twenty patients underwent SLN block in the clinic setting. Four patients were excluded for incomplete records. The indication was neurogenic cough refractory to medical management and/or cough suppression therapy. Patients with short-term follow-up (n = 13) had statistically significant decrease in CSI scores, with a mean baseline CSI of 24.3 decreasing to 16.15 (P = .006). Patients with evidence of Vocal Fold Motion/Vibratory Abnormalities (VFA) (n = 8) showed improvement in short-term CSI scores, with a mean baseline CSI of 24.13 decreasing to 14.5 (P = .004). Those without evidence of VFA did not have statistically significant improvement in short-term CSI scores. At long-term follow-up, patients with VFA had improvements that approached statistical significance with a mean baseline CSI of 22.56 decreasing to 14.56 (P = .057), while patients without VFA showed no improvement.Conclusions: Our results are consistent with previous literature indicating efficacy of SLN block. The presence of VFA may be an indicator of patients who experience increased therapeutic effect.

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“…Vediostroboscopy: There has been much advancement in the laryngeal treatment protocols in last 50 years. 17 Office base procedures are gaining much importance nowadays. Treatment modalities can be used with the following aims: a) To develop the best possible voice quality based on physical status of larynx; b) To eliminate abusive vocal behaviours; c) To develop appropriate respiratory support.…”

Section: Quality Of Life Measures (Patients Self-reporting Toolsmentioning

confidence: 99%

“…investigations including fiber optic laryngoscopy, rigid endoscopy (through mouth), and computed tomography (CT) scan, stroboscopy were done to find out the causes of vocal cord paralysis. 17 Those with structural, neoplastic or inflammatory causes were excluded from the study. All patients were given voice therapy by speech pathologist for 5 months once weekly, each of 30 min sessions and patients who improved with speech therapy were continued with the same treatment.…”

Section: Thoroughmentioning

confidence: 99%

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Voice outcome after type-1 thyroplasty for unilateral vocal cord paralysis: our experience at tertiary care hospital

Ali

Shafi

Khalid

et al. 2020

Int J Otorhinolaryngol Head Neck Surg

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Background: Vocal cord paralysis is a clinical sign caused by paralysis of intrinsic muscles of larynx due to dysfunction of recurrent laryngeal nerve or injury to the vagus nerve. One of the common and effective methods of medialization is by using silicone implants. This study was aimed at prospectively assessing and analysing the vocal outcomes and quality of life of patients in type 1 medialization thyroplasty using silicone implants.Methods: Prospective study of 18 months was done on 17 patients with unilateral vocal cord paralysis. Surgical procedure for the patients was standardized by using silicon implant to medialize the cord. The parameters used for the pre and post treatment objective analysis were stroboscopic analysis, psychoacoustic evaluation, maximum phonation time (MPT) and patient’s self-assessment. Results: In our study all 17 patients with unilateral vocal cord paralysis who were subjected to vocal cord medialization using silicone implant showed a statistically highly significant improvement in all the parameters of assessment. The mean preoperative MPT was 7.260 and post-operative MPT showed significant improvement and was 17.428 seconds. mean preoperative GRBAS score was 11.695 and post-operative was 3.826. Similarly, pre op vocal handicap index was 31.173 which decreased significantly after the procedure was 7.695.Conclusions: In the present study, we obtained favourable results of medialization thyroplasty as expressed by objective analysis of voice including GRABS score and acoustic analysis as well as maximum phonation time apart from traditional voice recording.

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Laryngoscopic and stroboscopic signs in the diagnosis of vocal fold paresis

Abstract: 4. Laryngoscope, 127:2100-2105, 2017.

Cited by 24 publications

References 25 publications

The area under the waveform of electromyography for monitoring the external branches of the superior laryngeal nerve during thyroid surgery

The area under the waveform of electromyography for monitoring the external branches of the superior laryngeal nerve during thyroid surgery

Superior Laryngeal Nerve Block for Treatment of Neurogenic Cough

Voice outcome after type-1 thyroplasty for unilateral vocal cord paralysis: our experience at tertiary care hospital

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