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Nagree Z. Proposal of a Classification for Sulcus Following Microlaryngoscopy with a Retrospective Study of the Results of a Laser-assisted Sulcus Release Surgery. Int J Phonosurg Laryngol 2020; 10 (1):3-8.
Background: Sulcus vocalis has historically remained challenging in terms of both diagnosis and management. The problem is further compounded by a lack of clarity in its classification as an accurate estimation of its presence and depth can be established only during microlaryngoscopy (MLS). We have thus proposed a classification of sulcus following MLS, which would allow for uniform grading. A laser-assisted sulcus release (LASR) technique is described which was performed in 7 patients and 10 vocal folds of isolated sulcus cases with outcome measures studied retrospectively. Materials and methods: The classification proposed of sulcus following MLS is based on depth of invagination of the sulcus, length of the sulcus, presence of keratin debris within, and associated presence of mucosal bridges, polyps and cysts. A LASR technique was performed for type A and D sulci (based on proposed classification) where the multiple points of release were made with a CO2 laser Acublade perpendicular to the lips of the sulcus. All patients received pre- and postoperative voice therapy. Preoperative and 3 months’ postoperative stroboscopy and vocal outcome measures were reviewed retrospectively. Results: Stroboscopic improvement of the mucosal wave and amplitude with decreased phonatory gap and decreased ventricular hyperadduction was observed in all patients postoperatively. There was a significant improvement of grade, roughness, breathiness, asthenia, strain (GRBAS) and maximum phonatory time (MPT) (p < 0.05). Conclusion: The LASR technique performed for type A and D sulci in our limited case series revealed 3-month postoperative stroboscopic improvement along with improvement in vocal parameters. We plan to continue this study to include a larger sample size.
Rajeev K Nishad,
Anil K Jain,
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Nishad RK, Jain AK, Kumar R, Singh M. Efficacy and Safety of USG-guided 95% Ethanol Sclerotherapy in Solitary Benign Thyroid Cysts. Int J Phonosurg Laryngol 2020; 10 (1):9-12.
Thyroid nodule is frequently encountered thyroid diseases and is characterized by growth of abnormal tissues into the thyroid gland. Solitary nodule, defined as palpable, clinically detectable single nodule in otherwise normal thyroid gland, usually presents as asymptomatic mass that is discovered either by patient or clinician. Materials and methods: Twenty patients meeting inclusion criteria were included in study. Under strict aseptic conditions, using ultrasonographic guidance, fluid from cyst was aspirated and 95% ethanol was slowly (approximately 1 mL/minute) instilled into cavity to a volume of approximately 50% of volume of aspirated fluid. Patients were called for follow-up at an interval of 1 month for 3 months. Ultrasound was done to document volume of cyst, intracystic fibrosis and vascularity. Results: The mean pre-procedure volume of cysts was 3.605 cm3. After instillation of ethanol, the mean volumes at the end of 1st, 2nd and 3rd month of treatment were respectively 1.665 cm3, 0.9585 cm3 and 0.442 cm3. The mean volume reduction rates were calculated. Smaller cysts demonstrate better results than the larger cysts i.e., cyst size in range of 2.1–2.5 cm3 shows 97.14% reduction after 3 months, while cysts of >4.1 cm3 had mean reduction of 71.79% only. Conclusion: In the management of benign euthyroid cysts, USG-guided percutaneous ethanol injection is a cost-effective and efficient non-surgical treatment modality with higher success rates. It is a relatively safe procedure with very low or no complication rates and has better patient compliance. Clinical significance: A non-surgical and cost-effective procedure can be treatment of choice for appropriately selected patient thus beneficial to greater majority of society.
Jayakumar R Menon,
Amrita Suzanne Mathew,
Manju Elanjickal Issac,
Arya R Raj
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Menon JR, Mathew AS, Issac ME, Raj AR. A Preliminary Study on the Effect of Botulinum Toxin in the Prevention of Glottic Web Reformation. Int J Phonosurg Laryngol 2020; 10 (1):13-17.
Introduction: The risk of recurrence is associated with all currently available surgical modalities for the treatment of congenital anterior glottic webs. Physical separation of the raw mucosal surfaces is essential until complete healing. Botulinum toxin injected into the thyroarytenoid muscle of a vocal fold for achieving separation between healing tissues has successfully prevented further synechiae formation. Aim: To compare and evaluate the effect of intraoperative botulinum toxin injection for prevention of recurrence in endoscopically treated congenital anterior glottic webs. Materials and methods: A prospective comparative analytical study of six cases was carried out over 1 year. Cases with a thin Cohen\'s grade I or II congenital anterior glottic web were included and randomized into two groups. Group I underwent endoscopic cold knife web division with keel placement, and Group II subjects additionally received botulinum toxin injection intraoperatively. Patients were followed up after 6 weeks and the degree of residual/recurrent web was recorded. Results: The preoperative mean percentage of anterior glottic web in both groups was 46.67 ± 2.36. The postoperative mean percentage of anterior glottic web was 26.67 ± 6.24 in Group I and 13.33 ± 4.71 in Group II. The mean percentage of the length of the glottis involved by web improved in both groups postoperatively, i.e., by 20.0 in Group I (p = 0.00065; significant) and by 33.34 in Group II (p = 0.0004; significant). The difference in improvement between both the groups postoperatively was 13.34% (p = 0.0417; significant). Conclusion: Botulinum toxin due to its paralytic effect on the thyroarytenoid muscle decreases web reformation and can therefore be used along with the established techniques in the treatment of anterior glottic webs.
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Alam N, Munjal S, Kumar R, Nair D, Panda N. Application of Speech Range Profile in Hindi in Hyperfunctional Voice Disorders: A Case-controlled Observational Study. Int J Phonosurg Laryngol 2020; 10 (1):18-22.
Background: Speech range profile (SRP) is defined as the graphical plot of an individual\'s frequency–intensity interactions occurring during connected speech production. As speech stimuli are better method to assess the functional limit of voice, SRP has advantage over voice range profile (VRP) in terms of application, easiness to administer the test, and duration needed to complete the test. There is a need for a simple tool to measure the physiologic limit of phonatory system in Hindi for Indian population. Objective: The objectives of the present study were to (1) measure SRP in persons with hyperfunctional voice disorders and to compare the findings with persons with normal voice in both male and female groups and (2) find whether SRP measure can be used to differentiate between the hyperfunctional voice disorder and normal voice. Design: A case-controlled observational study. Setting: The study was conducted at speech and hearing unit at the Postgraduate Institute of Medical Education and Research, Chandigarh. The data were collected during 6 months between January and June 2019. Patients: The subject group (n = 70) comprised 35 male and 35 female participants with hyperfunctional voice disorders, while the control group (n = 70) comprised age- and gender-matched participants with normal voice quality. Measurements: After the videolaryngostroboscopy examination, SRP was obtained using the VRP module in Computerized Speech Lab software from Pentax Medical. The parameters analyzed were the lowest frequency (Fmin, Hz), highest frequency (Fmax, Hz), minimum intensity (Imin, dB SPL–sound pressure level), and maximum intensity (Imax, dB SPL). Results: The SRP values were compared between the two groups using Mann–Whitney U test. A significant difference was found between the subject group and the control group in mean values of minimum frequency and maximum frequency in female groups. In male groups, significant difference was seen in values of minimum frequency, maximum frequency, Imax, as well as intensity range. Subject group with hyperfunctional voice disorder had significantly lower values (p < 0.05). Limitations: The number of subjects is less. There is a need to perform SRP in a larger population and across various voice disorders. Effect of smoking habit was not considered in the study. Also, it is difficult to measure Fmax especially in early post-phonosurgery assessment. Conclusion: Our study shows that SRP can be used clinically to differentiate the hyperfunctional voice disorders from normal voice in both male and female groups.
Phonomicrosurgery places specific demands on the otolaryngologist. One of the key skills requiring mastery in phonosurgery is cold steel dissection. Here we describe the technique of holding microsurgical instruments with further stability for fine control surgery.
Ashish C Agarwal,
Issac M Macharia
Aim: This study describes the findings seen in patients suffering from stenosis of the upper airway secondary to tuberculosis (TB) and its management. Materials and methods: A prospective study was done at a tertiarycare hospital between August 2017 and April 2019 on four patients diagnosed with airway stenosis secondary to TB. Results: There were three males and one female, and the age ranged from 18 to 38 years. Rechanneling of the stenosed segment was done using cold instruments and CO2 laser, used alone or in combination. One patient developed recurrence even after undergoing two procedures which had to be eventually treated by resection anastomosis. Conclusion: Early diagnosis and treatment with antitubercular medications is the key to prevent the development of airway stenosis. The treatment of stenosis involves surgical intervention using cold instruments and laser, and the chances of getting satisfactory results are good. Regular follow-up of such patients is extremely important. Clinical significance: Development of airway stenosis secondary to TB is a dreaded sequelae of the disease pathogenesis. This entity should be kept as one of the differential diagnoses while evaluating patients with upper airway stenosis in whom the etiology of the condition remains elusive.