Background: Office-based injection laryngoplasty is a surgical procedure that becomes more popular for vocal fold (VF) augmentation. Hydroxylapatite (Radiesse) is used to narrow the glottal gap in cases with glottal insufficiency. Objective: To assess voice outcome and patient's quality of life in selected group of dysphonic patients using office-based hydroxylapatite injection under local anesthesia in cases with glottal insufficiency. Materials and methods: Forty-one patients with different voice disorders, namely sulcus vocalis, unilateral VF immobility, and VF atrophy were selected. All patients underwent office-based injection of hydroxylapatite under local anesthesia. All patients were evaluated by using auditory perceptual analysis, laryngeal videostroboscope (LVS), acoustic analysis, and voice handicap index (VHI) preoperatively and 3 months postoperatively. Results: Improvement in glottal gap in all groups of patients was measured by LVS examination. Also, there was significant improvement in acoustic correlates of dysphonia, namely jitter%, shimmer%, noise to harmonic ratio (NHR), and maximum phonation time (MPT) in patients with unilateral VF immobility and VF atrophy. Also improved quality postinjection was reported in all groups measured by VHI. Conclusion: Office-based injection laryngoplasty with hydroxylapatite is a reliable and effective procedure in management of mild and moderate glottal gap because of unilateral VF immobility and VF atrophy.
Introduction: The laryngopharyngeal reflux (LPR) is defined as the retrograde flow of gastric contents to the upper respiratory tract causing mucosal damage. Objectives: The study aims to determine the relationship between the incidence of LPR and the presence of benign lesions of the vocal folds. Materials and methods: Using the reflux finding score (RFS), we determined the incidence of the LPR in patients with changes such as Reinke's edema, polyps, and granulomas of the vocal folds. Results: The prevalence of pathologic LPR was 25% in the control group, 81% in the Reinke's edema group, 60% in the vocal folds granulomas group, and 41% in the vocal cord polyps group. The most common manifestation of the LPR in the videolaryngoscopic examination is hypertrophy of the posterior commissure, which is anatomically explained by the closest location to the esophagus. Conclusion: In conclusion, the LPR might be an etiologic factor in Reinke's edema, polyps, and granulomas of the vocal folds.
Aim: To demonstrate the functional voice outcomes following external medialization thyroplasty using autologous cartilage from the nasal septum. Materials and methods: The study included four patients (three males and one female) who presented to the ENT outpatient department diagnosed with unilateral vocal fold paralysis. Medialization thyroplasty type I was performed for all the patients using autologous nasal septal cartilage with the patients under local anesthesia. Results: All four patients showed significant improvement in the form of glottis closure on laryngoscopic examination. Complete glottis closure was achieved in three patients while one patient had a small posterior glottis gap. The maximum phonation duration improved significantly in three patients, i.e., average 13.33 seconds; while one patient with the small posterior glottis gap showed minor improvement, i.e., 7.1 seconds. However, the complaint of aspiration of liquids was relieved in all the four patients. Conclusion: External medialization thyroplasty using an autologous nasal septal cartilage graft is considered safe and efficient phonosurgical procedure and provides proper positional adjustment of the paralyzed vocal fold with significant improvement in the subjective and objective functional voice outcomes.
Shaoni D Sanyal,
Aim: The objective of this study was to assess exposure of postgraduate trainees in otolaryngology to phonosurgery in various colleges across India Materials and methods: A questionnaire was distributed to residents attending the 15th Annual Conference of the Association of Phonosurgeons of India (APSI) held at Kolkata in 2019. No personal or residency program identifying information was collected. The e-mail contained a hyperlink to the online survey. Data were extracted from online survey forms and processed by Microsoft Excel. Results: Our study shows that of the 67 respondents, only 3 had access to all the necessary infrastructure [speech and language therapist (SLT), stroboscopy unit, and multidisciplinary voice clinic] required to treat patients. Fifty-seven respondents did not have a stroboscopy unit at their institution. The exposure to phonosurgery was restricted with only 25 respondents having a case load of more than 10 microscopic laryngeal surgeries (MLSs) per month. In our study, only 18% of the trainees were able to follow-up patients for a period of 6 months. Most trainees (55%) in our study had performed MLS under supervision, and only 12% were able to perform it independently. Conclusion: Our survey shows that of the 181 departments which offer masters as well as diploma in ENT in India, few are fully equipped to offer modern phonosurgical assessment and management, as a result of which very few trainees have adequate exposure in this subspeciality. Clinical significance: Few ENT departments in India are fully equipped to offer modern phonosurgical training. Workshops and cadaver dissections may be an effective way to impart better understanding of this field.
Subepithelial cysts (SECs), sulci, and mucosal bridges are often found in association with one another, resulting in dysphonia due to disturbed vibratory characteristics of the vocal folds along with an incomplete glottic closure in most instances.1 Histologically, cysts may be epidermoid or mucous retention and both are challenging to tackle, when other lesions such as mucosal bridges and sulci are coexistent. Epidermoid cysts may occasionally be open to the airway, referred to then as open cysts.2 The infrequent diagnosis of open cysts has consequently resulted in a few articles discussing the management of this entity. In this article, we have discussed four cases of open cysts of the vocal fold, which we diagnosed over the last 3 years (2015–2017) with a discussion of their management along with a review of the literature. All four open cysts were situated on the left vocal fold, and two cases had coexistent lesions, in the form of a mucosal bridge or a sulcus.
Aim: The aim of this study was to document the assessment and therapeutic management of dysphagia in a case of postoperative medulloblastoma. Background: Medulloblastoma is a highly malignant and rapidly growing central nervous system (CNS) tumor that arises from the cerebellum, the lower and rear portion of the brain. The tumor causes hydrocephalus and symptoms of increased intracranial pressure (ICP) as well as affected functions like problem in controlling balance, posture, and complex motor functions such as finer hand movement, speech, and swallowing as noted on examination also nystagmus and papilledema. Patients with neurosurgical conditions like medulloblastoma exhibit serious swallowing problem mainly in oral transit, pharyngeal, and esophageal stage such as delayed or even absence of pharyngeal trigger, restricted tongue, and laryngeal movement with no true pharyngeal swallow. Case description: A 35-year-old male was diagnosed with pharyngoesophageal dysphagia and was advised for swallowing therapy. The swallowing therapy including the oromotor exercises included Masako or tongue hold, and Shaker and modified Shaker exercises along with the swallowing maneuvers included effortful swallow, Mendelsohn maneuvers, and super-supraglottic swallow. The therapy was provided twice a week for the duration of 45 minutes. Conclusion: This study concluded that early intervention or early implementation of swallowing therapy plays a significant role in triggering the rate of improvement and helps the patient to experience an improved quality of life. Clinical implication: A combination of swallow therapy techniques with each technique aimed to treat specific impairment has the ability to boost the rate of recovery. In 15 sessions, the feeding tube was removed and the patient was able to swallow safely and efficiently.