Chronic obstructive pulmonary disease (COPD) is a respiratory condition that can affect voice as respiration is the source for voice production. There are very few studies available on the analysis of voice in individuals with COPD (asthma, chronic bronchitis and emphysema).

The aim of this study was to analyze the acoustic and perceptual characteristics of voice in individuals with COPD.

The study followed a comparative cross-sectional study design. Sixty-four participants were considered, and they were divided into two groups (group 1: individuals with COPD, n = 32; group 2: normal individuals, n = 32). Acoustic analysis was performed using CSL software. The perceptual analysis was done using CAPE-V.

The results showed that there was significant difference between the two groups on acoustic measures (lower fundamental frequency, reduced frequency range, increased pitch and amplitude perturbation measures and increased noise measures), and perceptual measures (presence of increased roughness, breathiness, strain).

We can conclude that COPD has an impact on voice measures as assessed through acoustic and perceptual parameters. These voice deviations may be due to COPD itself or due to the effects of the medication.

The findings of this study provide valuable information regarding voice problems in the individuals with COPD so that an appropriate intervention plan can be designed.

Shastry A, Balasubramanium RK, Acharya PR. Voice Analysis in Individuals with Chronic Obstructive Pulmonary Disease. Int J Phonosurg Laryngol 2014;4(2):45-49.

Previous studies on effects of menopause on voice characteristics have not compared the voice characteristics before, during and after menopause. It is also possible that these voice changes cannot be captured by traditional acoustic measures such as frequency and amplitude perturbation measures. Hence a robust acoustic tool such as cepstrum was chosen to capture these vocal changes before, during and after menopause and hence the present study was attempted.

The present study followed a cross-sectional study design. The participants consisted of 25 premenopausal women, 25 perimenopausal women and 25 postmenopausal women. Sustained production of/a/ and narration was recorded using Z tool and cepstral peak prominence (CPP) and smoothened cepstral peak prominence (CPPS) was analyzed.

The results of one-way ANOVA revealed that there was a significant main effect of the group at p < 0.05 for all the cepstral measures targeted in the study. Post hoc analysis indicated that there was no significant difference between pre and perimenopausal women for all the cepstral measures at p < 0.05. However, there was a significant difference between pre and postmenopausal women and peri and postmenopausal women at p < 0.05. These results suggests that postmenopausal women had overall good voice quality than pre and perimenopausal women.

Results indicated that post menopausal women had increased cepstral measures when compared to pre and perimenopausal women. Further, studies are required to correlate laryngeal examination and hormonal levels with that of the voice changes before, during and after menopausal women.

Balasubramanium RK, Bhat JS. Cepstral Characteristics of Voice before, during and after Menopause: A Cross-sectional Study. Int J Phonosurg Laryngol 2014;4(2):50-54.

Vocal nodules are known to be one of the most common benign lesions, commonly situated at the junction of anterior one third and posterior two third of vocal folds. Voice therapy is considered to be the gold standard of treatment of vocal fold nodule.

To determine the efficacy of voice therapy in the treatment of vocal fold nodules and to identify any possible reason for failure to voice therapy in managing vocal fold nodules.

A prospective study, conducted over a period of 6 months. Eighteen adult patients diagnosed with vocal fold nodules at a tertiary care hospital were subjected to 6 weeks of voice therapy. Pre and post therapy subjective (Voice Handicap Index-10) and objective (Rigid fiber optic laryngoscopy) evaluation was done. Patients with no improvement after 6 weeks of voice therapy underwent micro laryngeal surgery. All patients were followed up at 3 months and 6 months.

In majority of patients, objective and subjective voice outcome parameters were significantly improved after voice therapy. Although a few cases showed no significant improvement after therapy, they recovered completely after microlaryngoscopic surgery. It was found that patients who required surgery even after voice therapy had hard nodules.

Bakat B, Gupta A, Roy A, Roychoudhury A, Raychaudhuri BK. Does Voice Therapy Cure All Vocal Fold Nodules? Int J Phonosurg Laryngol 2014;4(2):55-59.

Laryngotracheal stenosis is a challenging problem in laryngology which is often misdiagnosed and improperly treated. It is also on the rise due to increase in the number of accidental trauma, prolonged intubations or tracheostomy. Laryngotracheoplasty by Shiann Yann Lee's technique with T-tube stenting is a common accepted surgical procedure these days.

Ours is a retrospective study of 14 cases of laryngotracheal stenosis over a period of 20 years from 1993 to 2014, who underwent laryngotracheoplasty with T-tube stenting by a modification of Shiann Yann Lee's technique.

In our study of 14 patients, the incidence of laryngotracheal stenosis was found to be maximum in the age group of 21 to 30 years with a male preponderance. The commonest etiological factor was prolonged endotracheal intubation or cuffed tracheostomy. The commonest site of the stenosis in our study was cervical trachea. The average time for removal of T-tube was 18 months. All the 14 patients had an uneventful period between insertion and removal of T-tube without any complications. The success rate of our study was hence 100%.

Laryngotracheoplasty with T-tube stenting by our modification of Shiann Yann Lee's technique is an effective and successful method in the management of laryngotracheal stenosis with a success rate of 100%.

Kumar MHM, Jayaraju RM. Laryngotracheoplasty with T-tube Stenting by Modification of Shiann Yann Lee's technique. Int J Phonosurg Laryngol 2014;4(2):60-62.

Lymphangiomas are benign lymphatic malformations frequently seen in head and neck region. Most reported cases are cervical lesions with mediastinal extension.^1,2

Most are conceived as due to failure of fetal lymph sacs. Synchronous or metachronus lymphangiomatosis with cystic hygroma of the neck is also reported.³

Massive multicompartmental mediastinal lymphangioma with cervical extension and concomitant visceral involvement is presented. It is proposed as a hamartomatous tumor rather than malunion of fetal jugular lymphatic sacs.² Solid intrathoracic component with cystic neck extension supports mediastinal origin. Cell culture lines at 4 months were positive for endothelial cell lines positive for factor VIII antigen.

Giant thoracocervical lymphangioma is more likely to be a tumor rather than simple fetal failure of lymphatic sac fusion. Surgical excision is curative.

Prasad GR, Nori M, Naseeruddin MD Rao JVS, Quadri SS. Giant Thoracocervical Lymphangioma with Multivisceral Involvement: A Different Concept. Int J Phonosurg Laryngol 2014;4(2):63-66.

Kanaujia SK, Soni A. A Rare Benign Tumor of Vocal Cord: Myxofibrolipoma. Int J Phonosurg Laryngol 2014;4(2):67-68.

Khaund G, Agarwal V, Barman S, Baruah D, Gogoi B. Papillary Carcinoma in Thyroglossal Cyst. Int J Phonosurg Laryngol 2014;4(2):69-70.

Mary P, Dominic M. An Elusive Submucosal Laryngeal Malignancy. Int J Phonosurg Laryngol 2014;4(2):71-72.

Khaund G, Baruah D, Agarwal V, Barman S. Invasive Fungal Laryngitis in an Immunocompetent Person. Int J Phonosurg Laryngol 2014;4(2):73-75.

To report our experience on the treatment of subglottic stenosis (SS) in patients with Wegener's granulomatosis (WG).

We endoscopically treated five patients with SS due to WG. Out of 5, two patients were treated with endoscopic balloon dilatation, two patients underwent CO₂ laser resection and dilatation and 1 patient underwent a cold steel resection and dilatation. Outcomes were assessed based on improvement in preoperative symptoms, complications, and need for additional procedures.

Balloon dilatation was done in two patients. They are asymptomatic at follow-up and the one with tracheostomy is in the process of decannulation. The other two patients were treated with CO₂ laser. Favorable outcome was obtained in one of the patient who is in the process of decannulation, the other developed recurrent stenosis at 3 years and is on tracheostomy. Cold steel resection was used to treat one patient. After undergoing multiple interventions, she developed severe stenosis and underwent an open procedure and is currently on tracheostomy.

Both use of balloon and laser resection are safe and successful method to manage soft, subglottic stenosis due to WG and avoids the need of open procedure. In our series balloon dilatation gave better outcomes as compared to Laser resection and dilatation. Regular follow-up is necessary to rule out recurrence.

Nerurkar NK, Deshmukh S. Therapeutic challenges in Management of Subglottic Stenosis in Wegener's Granulomatosis. Int J Phonosurg Laryngol 2014;4(2):76-79.

To report a rare benign condition of larynx in a very rare subsite. To emphasize on the role of coblator in the treatment of laryngeal cysts and to highlight the fact that arytenoid cyst should be considered in the differential diagnosis of dysphagia and hoarseness.

A 76-year-old adult male, Resident of Trichy, Tamil Nadu, Presented with Discomfort in throat—2 years, Change of voice—2 months and Dysphagia—2 months. Indirect Laryngoscopy and Flexible Laryngoscopy revealed a mass in the right arytenoid which was pedunculated and filling the supraglottis. The airway was however adequate. Contrast Enhanced CT scan of the neck revealed a cystic soft tissue mass arising from Right arytenoids extending into supraglottis. A provisional diagnosis of Arytenoid cyst was made. The patient underwent Direct Laryngoscopy and coblator assisted excision of the cyst under General Anesthesia.

This case report highlights the fact that an arytenoid cyst, although rare, must be considered in the differential diagnosis of any case presenting with dysphagia and/or hoarseness.

It also explains the role of coblation in the management of such lesions.

Gnanatilakan S, Prasad V, Jeyalakshmi R. A Rare Case of Arytenoid Cyst presenting as Dysphagia. Int J Phonosurg Laryngol 2014;4(2):80-82.