Aims and objectives: The coronavirus disease-2019 (COVID-19) pandemic has changed lives and caused great loss and hardship to many people around the world. Not wanting to break the chain of our annual Phonosurgery Workshop, the decision was taken to plunge into the virtual world. This article aims to share the challenges faced by the organizing committee and the advantages (some unexpected) and limitations of this academic venture, which may encourage and possibly guide our colleagues in hosting their own meetings. Materials and methods: Several major decisions were taken: (1) create a 1-day event instead of the usual 3 days; (2) include a maximum number of invited faculty from abroad; (3) select very specific areas of interest; (4) employ a professional online communications group; (5) broadcast prerecorded presentations; (6) include a live Q and A session immediately following each lecture; (7) incorporate audience polling, e-posters, e-crossword, e-stalls, and live chat communication. Results: The average number of delegates increased from 197 to 1071 delegates. The number of international delegates was much higher. Since no “physical” space for the delegates was needed, the number of registrations did not need to be restricted. Conclusion: The decisions described above had a positive impact on the number of registrations, without hampering the quality of the course. The experience of hosting this webinar has encouraged the organizing committee to consider a hybrid meeting in the year 2021 with both physical and virtual attendance.

Aim and objective: To determine the demographic and clinical characteristics, disease type, and appropriate treatment for laryngeal amyloidosis. Materials and methods: A retrospective descriptive study was conducted which included the data of 16 patients who had a laryngeal lesion which was excised and diagnosed as amyloidosis on histopathological examination, evaluated for systemic disease, and followed up. Demographic details, symptomatology, videolaryngoscopic examination findings, disease type, and treatment modality were analyzed. Results: The male:female ratio was 1:1.29. The mean age of patients was 35.19 ± 6.76 years, with 87.5% aged between 30 years and 40 years. The mean duration of symptoms was 5.44 ± 4.53 months, ranging from 2 to 12 months. Symptoms included hoarseness of voice (62.5%) and dyspnea (37.5%). Lesions were located in the supraglottis (50%), subglottis (37.5%), and glottis (12.5%). Macroscopically, 25% of lesions were polypoid and 75% were infiltrative. Microlaryngeal excision of the lesion was performed using cold steel instruments in 68.75% of cases and coblation assisted in 31.25% of cases. On immunohistochemistry, 93.75% were AL type and 6.25% were AA type. All cases were the primary localized type. All patients were followed up regularly. One recurrence and thus revision surgery aided with laser was recorded. Conclusion: The diagnosis of laryngeal amyloidosis requires a high index of suspicion based on its clinical features. The localized laryngeal disease can be successfully treated by endoscopic excision of the lesion using either cold steel instrumentation, laser or coblation, as was performed in our study with favorable results. The importance of continued long-term follow-up is emphasized in view of a high predilection for recurrence in amyloidosis.

Introduction: Muscle tension dysphonia (MTD) is a voice disorder characterized by excessive muscular tension in the perilaryngeal areas (Roy and Leeper). Laryngeal manual therapy (LMT) is one of the direct approaches of voice therapy that involves kneading the laryngeal area without voicing to reduce hyperfunction of the muscles and improve the quality of voice. Aims and objectives: The present study was conducted to determine the outcome of LMT in females with MTD by comparing assessment data between pre-therapy, immediate post-LMT, and 1 week after LMT. Materials and methods: Ten females (20–40 years) with MTD were taken. Palpatory assessment, Dr Speech (Version 4), GRBAS scale, and voice handicap index (VHI) were used for voice evaluation. First, a pre-therapy assessment of all the voice parameters was collected. Second, LMT was carried out. Immediately after LMT, post-LMT data collection was done. No intervention was given following LMT. After 1 week of LMT, again data collection was done. Results: A significant reduction in vocal parameters of jitter, shimmer, and NNE (p < 0.05) were found after LMT except for Mean Fo (p > 0.05). Hoarseness was reduced. A significant difference was found between VHI measures (p < 0.05), GRBAS scale (p < 0.05), and palpatory assessment (p < 0.05) in pre-LMT, immediate post-LMT, and 1-week post-LMT. Conclusion: The present study would assist to determine the therapeutic efficacy of direct voice therapy and in predicting voice therapy outcomes in persons with MTD.

Aims and objectives: Assessment of outcome of cases with benign vocal lesions treated by a combination of methods aimed at voice improvement, rather than only cure of lesion. Materials and methods: A prospective study was conducted in the Department of Otorhinolaryngology, MGM Medical College and Maharana Yashwant Rao Holkar Hospital, Indore from October 2018 to March 2020. We selected 85 patients in the age group of 18–60 years with complaints of hoarseness of voice and in whom benign vocal fold lesions were observed on stroboscopy. Pretreatment analysis was done by video-stroboscopy and voice analysis by a combination of simple subjective and objective parameters. Treatment was planned individually for each case from a variety of available modalities, with vocal fold exercises being the essential part of the plan in each case. After 2 months from the initiation of therapy, the analysis was repeated and compared with initial observations. The data were recorded and compared using paired t-test. Results: Statistically significant (p < 0.05) improvement was observed in all the parameters of stroboscopic and voice analysis. Conclusion: The contemporary approach of benign vocal fold lesions is aimed at cure of lesion with the achievement of the best possible voice outcome. This makes voice therapy an essentially irreplaceable part of the treatment plan. Clinical significance: Establishment of the importance of voice therapy and patient cooperation in the treatment of hoarseness.

Aims and objectives: (1) To examine vocal symptoms and acoustic changes perceived within 24 hours after endotracheal intubation and (2) to find the association between these changes and endotracheal tube (ET) parameters and determine which parameter affects voice the most. Materials and methods: A prospective analysis of 75 patients was done. They were examined preoperatively, and 2 and 24 hours postoperatively. The vocal symptoms of hoarseness, vocal fatigue, loss of voice, throat clearing (hawking), globus pharyngeus, throat pain, and the acoustic variables mainly average fundamental frequency, shimmer, harmonic noise ratio (HNR), and maximum phonation time (MPT) were assessed. The ET parameters considered were duration of anesthesia, number of attempts at intubation, size of the tube, ET cuff volume, and mean cuff pressure. Results: Approximately 60% of patients with cuff volume above 3 cm³ and 80% of patients with more than two intubation attempts developed postoperative vocal fatigue, while 70% with mean cuff pressure above 20 cm of water developed postoperative hawking. Conclusion: The ET parameters, mean cuff pressure, and ET cuff volume are the most important variables that are associated with the increase in vocal symptoms. An increase in the value of these parameters is associated with more postoperative discomfort.

Aim and objective: To discuss a rare case of supraglottic paraganglioma presenting as stridor and its management. Background: Paragangliomas are tumors anatomically arising from the dispersed neuroendocrine system (paraganglia), derived from the neural crest of the autonomic ganglia and characterized by similar neurosecretory cells. They are rarely seen in larynx. Most cases have polypoidal presentation in the endolarynx and diagnosis is usually confirmed after histopathology. Case description: We present a rare case of laryngeal paraganglioma in which the patient presented with stridor and was successfully treated by open laryngofissure approach leading to excision of the tumor with complete preservation of laryngeal function. Conclusion: Paragangliomas of the larynx are vascular benign tumors and can have varied presentations. Familiarity with these rare masses is essential for the treating otolaryngologist to prevent an inadvertent biopsy. A carefully selected surgical approach helps preserve adequate laryngeal function and decreases the risk of recurrence.

A laryngocele is an abnormal dilation of the laryngeal saccule going up into the false vocal fold that is usually air-filled and communicates with the laryngeal lumen with an incidence of about 1 in 2.5 million. These can be internal or combined laryngoceles and presentation depends on the type and size of the laryngocele. Small laryngoceles may be asymptomatic and may be incidentally detected. Management depends on the type, extent, and presentation and it ranges from close observation to surgical excision externally or microlaryngoscopically. We discuss a case of a large combined laryngocele that was managed using an external approach with complete resolution.