International Journal of Phonosurgery & Laryngology

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2020 | July-December | Volume 10 | Issue 2

ORIGINAL RESEARCH

Susan P Chacko, Anagha A Joshi, Varun Dave

Acoustic Analysis: An Objective Tool in Evaluating Patients with Voice Disorders

[Year:2020] [Month:July-December] [Volume:10] [Number:2] [Pages:4] [Pages No:29 - 32]

Keywords: Dysphonia, Hoarseness, Multiparametric acoustic analysis, Objective voice assessment, Quality of voice, Vocal cord dysfunction

PDF  |  DOI: 10.5005/jp-journals-10023-1189  |  Open Access |  How to cite  | 

Abstract

Introduction: Acoustic measurements are the most widely studied of all voice measures. Our study aimed to determine the accuracy of acoustic analysis as an objective tool for evaluating patients with voice disorders. Materials and methods: A descriptive cross-sectional study with a total of 73 patients was analyzed using Dr Speech software. Results: When the vocal parameters were compared between normal subjects and patients with vocal cord diseases, significant differences were seen in most of the parameters like jitter, shimmer, Normalized Noise Energy (NNE), Harmonic to Noise Ratio (HNR), Signal to Noise Ratio (SNR) along with a statistically significant difference in voice quality scores like harsh voice, hoarse voice, and breathy voice. Conclusion: Hence, from our study, it can be said that acoustic analysis is a reliable objective tool for evaluating voice disorders.

ORIGINAL RESEARCH

Swapna Sebastian, John Mathew, Rajan Sundaresan, Rajiv Micheal

Speech Intelligibility and Communication-related Quality of Life in Tracheoesophageal Speakers

[Year:2020] [Month:July-December] [Volume:10] [Number:2] [Pages:7] [Pages No:33 - 39]

Keywords: Communication-related quality of life, Laryngectomy, Speech intelligibility

PDF  |  DOI: 10.5005/jp-journals-10023-1190  |  Open Access |  How to cite  | 

Abstract

Introduction: Communication plays a dynamic role in human life in developing a relationship with others. Laryngectomy can limit the effectiveness in communication and in turn result in limitation of activities and active participation in social life. Of the three methods for voice restoration after total laryngectomy followed today, tracheoesophageal (TE) speech which is a surgical voice restoration (SVR) method has become the standard of care. Literature review reveals that there are conflicting results regarding the quality of speech produced using TE speech. Materials and methods: The present investigation was designed to explore the speech intelligibility and communication-related quality of life (QOL) in TE speakers and also to examine correlations between speech intelligibility scores and QOL in tracheoesophageal puncture (TEP) speakers. Results: Speech intelligibility ratings of our patients revealed that on average the rating score was 2.13 which places them into the category—“connected speech could be understood with little effort”. Speech (word) intelligibility score revealed a mean of 94.73%. There was a positive correlation between speech (word) intelligibility score, and scores obtained on the speech intelligibility rating scale. Scores obtained on Self-Evaluation of Communication Experiences after Laryngectomy (SECEL) by our patients fall between the scores for well-adjusted and poorly adjusted according to original SECEL data. There was no positive correlation between speech intelligibility (word) scores or the speech intelligibility rating scale scores with SECEL. Discussion/conclusion: Our study revealed that TE speech by SVR helps the patients in producing speech with sufficient intelligibility to communicate well with their family and friends but more challenging with strangers. The fact that no correlation was found between SECEL scores with the speech intelligibility measurements points toward the fact that speech intelligibility measures are assessed under quiet conditions and do not consider the effect of background noise in communication situations encountered in everyday environments. In addition, it reflects that even though good communication skills are important for socialization with the community around them, other factors like the self-esteem and person\'s personality, family, education, wealth, religious beliefs, and the environment may also contribute to the overall QOL and hence it is essential that these psychosocial aspects are also addressed during rehabilitation.

ORIGINAL RESEARCH

Gautam Khaund, Biswajit Gogoi, Sanchita Kalita, Keshavananda Konwar, Utpaljit Barman, Daisy Gogoi, Partha P Bora, Nayan M Deka

Endoscopic Transtracheal Approach for Tracheobronchial Surgery: Our Experience with This Novel Technique

[Year:2020] [Month:July-December] [Volume:10] [Number:2] [Pages:6] [Pages No:40 - 45]

Keywords: Bronchoscopy, Difficult airway, Endoscopic, Endoscopic transtracheal approach, Pulmonary hemorrhage, Tracheal mass, Tracheobronchial surgery, Transtracheal

PDF  |  DOI: 10.5005/jp-journals-10023-1188  |  Open Access |  How to cite  | 

Abstract

Working field being the same, airway surgery becomes a challenging domain for surgeons as well as the anesthesiologists. In our study, we are highlighting the endoscopic transtracheal approach for tracheobronchial surgery (ETATS) as a novel technique to access tracheal and bronchial pathology. Diagnostic bronchoscopy and imaging aiding in preoperative planning, in conjunction with the anesthesiology team, this technique could aid in the management of airway cases, which might otherwise not be possible by conventional approaches. We have shared our experience with ETATS in three emergency airway cases as the outcome of management has been favorable.

CASE REPORT

Shruti Dhingra, Abhinav Agarwal

A Curious Case of Laryngeal Stridor

[Year:2020] [Month:July-December] [Volume:10] [Number:2] [Pages:4] [Pages No:46 - 49]

Keywords: Factor VIII, Hemophilia A, Laryngeal hemorrhage, Stridor

PDF  |  DOI: 10.5005/jp-journals-10023-1184  |  Open Access |  How to cite  | 

Abstract

Aim and objective: To present a case of acute respiratory obstruction due to isolated hemorrhage in the larynx in a patient with coagulation disorder, which is a very rare presentation. Background: Acute upper airway obstruction can occur due to various causes. Spontaneous, unprovoked hemorrhage in the larynx can be a significant and potentially life-threatening complication. Coagulation disorders constitute a small percentage of such cases. An accurate initial assessment of a struggling, dyspneic patient can make the diagnosis challenging. Case description: Here, we describe a case of spontaneous internal hemorrhage in the larynx leading to upper airway obstruction in a patient with hemophilia A. The patient was admitted to an intensive care unit for airway observation and treatment with factor VIII supplementation. In the first 24 hours, there was a rapid respiratory improvement. The laryngeal hematoma gradually resolved by the 5th day. Conclusion: The patient was managed conservatively, and no intubation or tracheostomy was needed. Clinical significance: Hemophilia A can lead to life-threatening airway obstruction due to isolated laryngeal hemorrhage. Examination and diagnosis can be challenging if the prior history is not known as the condition mimics various other conditions. We need to keep an eye on subtle pointers that instigate an episode of bleeding. Keeping a high index of suspicion with prompt airway control and rapid reversal of coagulopathy can be lifesaving.

CASE REPORT

Puya Dehgani-Mobaraki, Asiya K Zaidi

Consequences of Intubation in COVID-19 Patients: Are We Ready?

[Year:2020] [Month:July-December] [Volume:10] [Number:2] [Pages:4] [Pages No:50 - 53]

Keywords: Benign vocal fold lesions, Dysphonia, Endotracheal intubation, Granulom, Speech therapy, Vocal fold, Voice analysis, Voice disorders

PDF  |  DOI: 10.5005/jp-journals-10023-1185  |  Open Access |  How to cite  | 

Abstract

Aim and objective: We report a case of a 61-year-old man, still recovering from COVID-19, who developed acute respiratory distress syndrome (ARDS) requiring hospitalization and intubation in early March 2020. Consequently, he developed post-intubation bilateral massive vocal fold granulomas. To date, this is the first case report of laryngeal granulomas following intubation since the outbreak. Background: Clinical presentation of COVID-19 ranges from being asymptomatic to mild symptoms while a fraction of them develop ARDS. There is a need to highlight the probability of a rise in the number of patients with complaints of voice change and laryngeal lesions in the coming months. More specifically, post-intubation laryngeal granulomas. Case description: The patient timeline, blood exams, serological tests, radiological examination, voice evaluation, and videolaryngoscopy of a 61-year-old recovered COVID-19 patient with bilateral vocal fold granulomas have been described in detail that would assist in clinical decision-making. Conclusion: A significant number of patients underwent intubation at the beginning of the pandemic. These patients can be expected to be frequent visitors at the outpatient clinic and emergency rooms in the future with complaints of change in voice and laryngeal lesions. The question of whether we are ready for it needs to be assessed. Clinical significance: Patients who underwent long-term intubation following ARDS after contracting COVID-19 infection need to be further evaluated and kept on a regular follow-up. Conclusion: Information regarding intubation granuloma risk, breathing exercises, and speech therapy might be beneficial to such patients. We need to be well prepared to expect a surge in the number of cases reporting with voice disorders shortly.

CASE REPORT

Nupur Kapoor Nerurkar, Ranjita Krishnan, Deeksha Agrawal

Anterior Commissure Granuloma with Chondronecrosis: A Late Complication of Type I Thyroplasty

[Year:2020] [Month:July-December] [Volume:10] [Number:2] [Pages:4] [Pages No:54 - 57]

Keywords: Anterior commissure granuloma, Chondronecrosis, Medialization laryngoplasty, Silicone implant, Vocal fold paralysis

PDF  |  DOI: 10.5005/jp-journals-10023-1186  |  Open Access |  How to cite  | 

Abstract

Aim and objective: The development of an anterior commissure granuloma following medialization of the vocal fold with a silicone implant is a rare complication as silicone is a relatively inert material. However, when such granulomas do develop, they are often picked up late due to slow progression over years. Case description: Our article focuses on the clinical presentation, evaluation, and management of a patient with an anterior commissure granuloma and thyroid cartilage chondronecrosis who presented to us with a history of multiple medialization laryngoplasties in the past, following an immobile vocal fold which was after a parapharyngeal tumor excision. Conclusion: Though anterior commissure granulomas following medialization laryngoplasty are not frequently seen currently due to the use of implants that produce minimal foreign body reaction and sterile conditions, we believe that in our case the etiology of the granuloma formation with chondronecrosis of the thyroid cartilage may be due to the very large size of the revision implant with resultant extrusion with foreign body reaction leading to long-standing infection. Clinical significance: Any implant however inert, runs a small risk of infection with granuloma formation which is more likely with large implants and multiple surgeries causing devascularization of tissues. Close observation following thyroplasty with stroboscopy and imaging when needed may help pick up complications early, avoiding progression to chondronecrosis and possibly respiratory distress.

CASE REPORT

BV Manjula, R Kamala, R Vaishnavi, Brinda A Poojari

Lateral Thyrotomy Approach in the Era of Transoral Laser Surgeries

[Year:2020] [Month:July-December] [Volume:10] [Number:2] [Pages:4] [Pages No:58 - 61]

Keywords: Benign laryngeal tumor, Hoarseness, Laryngeal framework, Laryngeal lipoma, Laryngeal neoplasm, Lateral thyrotomy, Lipoma

PDF  |  DOI: 10.5005/jp-journals-10023-1187  |  Open Access |  How to cite  | 

Abstract

Background: Laryngeal lipomas are rare benign lesions and are usually asymptomatic till they grow in size to become obstructive. Excision of a laryngeal submucosal lesion presents with the dilemma of an external or an endoscopic approach. The transoral endoscopic approach is preferred for smaller lesions and external approach for large tumors. This report introduces the external lateral thyrotomy approach for excision of a paraglottic space lipoma. Case description: A 33-year-old female patient, teacher by profession, presented with complaints of voice change and choking sensation for 3 months. Flexible laryngoscopy revealed a smooth submucosal swelling of the right false cord and aryepiglottic (AE) fold with fullness in the right pyriform fossa and bilateral mobile vocal cords. Contrast-enhanced computed tomography (CECT) scan of neck was suggestive of a right paraglottic 5 × 3 cm dumbbell-shaped lipoma that was excised by the lateral thyrotomy approach. Conclusion: The lateral thyrotomy approach provided adequate exposure of the tumor and excellent visibility of the entire paraglottic space under direct vision. A complete excision could be performed without any breach of the laryngeal mucosa or tracheostomy and with preservation of voice and laryngeal framework. Clinical significance: An individualized approach is needed for rare tumors and sometimes a simple procedure may outweigh the benefits of an advanced technique.

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