International Journal of Phonosurgery & Laryngology

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2019 | July-December | Volume 9 | Issue 2

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Original Article

Aparaajita Upadhyay, Anshu Singh, Anubhav Shrivastava, Raj Kumar Mundra

Outcome Analysis by Voice Assessment and Videostroboscopy in Laryngopharyngeal Reflux

[Year:2019] [Month:July-December] [Volume:9] [Number:2] [Pages:5] [Pages No:25 - 29]

Keywords: Hoarseness, Laryngopharyngeal reflux, Reflux finding, Reflux symptom index, Voice assessment, Voice handicap index

   DOI: 10.5005/jp-journals-10023-1176  |  Open Access |  How to cite  | 


Introduction: Change in voice in the patient of laryngopharyngeal reflux is a common symptom. In this study, we are assessing the improvement in severity of the laryngopharyngeal reflux disease by its symptoms, signs, severity, and videostroboscopy to detect even earliest change and document it. Materials and methods: A prospective study in 50 subjects at a tertiary referral center who were subjected to answer a questionnaire of the voice handicap index, the reflux symptom index, and assessed reflux finding score and vocal fold mucosa changes by videostroboscopy. All subjects were reassessed after 12 weeks of treatment. Result: Improvement was found statistically significant (<0.05) in all parameters and scales. Conclusion: Preventing the insult by acid reflux in the laryngeal mucosa by proton pump inhibitors resulted in improvement of symptoms and signs, which proves the efficacy of treatment. Videostroboscopy is a useful tool to early diagnose the lesion.



Maria CRC Caçador, Ana L Papoila, Carlos Brás-Geraldes, Carlos S Garcia, Tânia Constantino, Mafalda Almeida, Joâo Paâo

Is Computerized Dynamic Posturography Analysis in Dysphonic Patients Different after Vocal Rehabilitation Treatment? A Longitudinal Study

[Year:2019] [Month:July-December] [Volume:9] [Number:2] [Pages:6] [Pages No:30 - 35]

Keywords: Cohort study, Posture, Posturography, Speech rehabilitation, Unilateral vocal fold paresis/paralysis, Voice disorders

   DOI: 10.5005/jp-journals-10023-1172  |  Open Access |  How to cite  | 


Aim: Vocal pathology and vocal rehabilitation may influence posture, and changes in postural pattern can influence the mechanisms of vocal production. This study aimed to evaluate the postural pattern in subjects with unilateral vocal fold paresis/paralysis before and after speech rehabilitation, using computerized dynamic posturography (CDP). Materials and methods: This is a prospective cohort study, studying the posture pattern of 16 patients affected by dysphonia, caused by unilateral vocal fold paresis/paralysis, never treated with speech therapy, and by CDP before and after vocal rehabilitation. Each patient underwent videolaryngostroboscopy, acoustic voice analysis, aerodynamic evaluation, GRBAS scale, and voice handicap index questionnaire. Fifteen healthy volunteers were also submitted to a posturographic analysis as a control group. Results: All patients showed an improvement in voice quality after vocal training. The auditory-perceptual evaluation with the GRBAS scale showed a decrease in all parameters for both vowel (/a/, /i/, /e/) and spontaneous speech (p < 0.001 for all). Furthermore, the acoustic analysis showed an improvement in fundamental frequency, shimmer, harmonic-to-noise ratio, and normalized noise energy. Posturographic results showed an improvement in equilibrium score; conditions 1, 2, 4, 5, and 6; and composite score. Strategic analysis results showed an improvement in conditions 2, 5, and 6. Conclusion: Posturographic analysis showed a significant difference in the proprioceptive, visual, and vestibular component of posture, after voice therapy. These results confirmed an improvement in the postural performance of dysphonic patients after a successful voice treatment. Clinical significance: The results of this study indicate that modifications of voice production techniques lead to objective and measurable postural changes in dynamic posturographic analysis.



X Anton Dev, Somnath Saha

A Study of Rehabilitation of Speech in Post-laryngectomy Cases, as Seen in a Tertiary Care Institution of Esophageal Speech vs Speech with Tracheoesophageal Puncture Prosthesis

[Year:2019] [Month:July-December] [Volume:9] [Number:2] [Pages:4] [Pages No:36 - 39]

Keywords: Esophageal speech, Post-laryngectomy, Tracheoesophageal puncture prosthesis

   DOI: 10.5005/jp-journals-10023-1170  |  Open Access |  How to cite  | 


Aim: To assess the preference of the different modalities of post-laryngectomy speech rehabilitation in patients and review the outcome parameters of esophageal speech and tracheoesophageal puncture (TEP) prosthesis modalities in comparison with the corresponding existing data. Materials and methods: A longitudinal prospective study conducted over a period of 1 year in the Department of ENT and Head-Neck Surgery in a tertiary care hospital. Patients of advanced laryngeal malignancies that were planned for total laryngectomy were included in this surgery. Based on the patients’ choice different modalities were adopted and the patients were followed up with regular training. Maximum takers were for esophageal speech followed by TE puncture and prosthesis insertion, and the outcomes in these two modalities were evaluated in detail. Six outcome parameters were assessed for the patients and consolidated. Then they were compared with the corresponding values obtained from previous studies to arrive at the results. Results: A total of ten cases of total laryngectomy was studied during the period of study. It was found that greater patient preference was for the TEP prosthesis modality. The mean frequency of phonation, mean intensity for vowels, and word production per minute in the TEP prosthesis were almost 80% of that seen in the esophageal prosthesis group. The most significant difference was in mean maximum phonation time which was only 37% of that seen in the TEP prosthesis group. Conclusion: In the present scenario until more advanced modalities of post-laryngectomy speech rehabilitation become more easily accessible to and affordable for the economically weaker sections of the society, esophageal speech modality is a dependable alternative. Further with proper training and follow-up, results with esophageal prosthesis are promising.



Renuka Balu, Vellani Kuttan Stella Mol

Usefulness of Drug-induced Sleep Endoscopy to Diagnose Laryngeal Cause in Obstructive Sleep Apnea Patients

[Year:2019] [Month:July-December] [Volume:9] [Number:2] [Pages:3] [Pages No:40 - 42]

Keywords: Laryngoscopy, Muller's maneuver, Obstructive sleep apnea, Sleep endoscopy

   DOI: 10.5005/jp-journals-10023-1174  |  Open Access |  How to cite  | 


Background: Knowledge of the site of obstruction and the pattern of airway collapse is essential for determining correct surgical and medical management of patients with obstructive sleep apnea (OSA). To this end, several diagnostic tests and procedures have been developed. These include endoscopic and imaging modalities. However, the latter is not practical as it has issues of logistics and feasibility. The former includes routine awake flexiblescopy (FS) in outpatient department and drug-induced sleep endoscopy (DISE). This study intends to compare the incidence of epiglottic fall, which is the most common laryngeal cause of OSA, in routine awake FS vs DISE. Materials and methods: Thirty patients with OSA were prospectively enrolled in this sectional analytic study. All underwent proper history taking, ENT evaluation including awake FS with Muller's maneuver, polysomnography, and DISE. The upper airway collapse was documented as per velum oropharynx tongue base epiglottis (VOTE) classification. Results: The incidence of epiglottic collapse seen in FS was 6.7% (2 patients) and in DISE was 40% (12 patients), which was statistically significant (p 0.002). Conclusion: Drug-induced sleep endoscopy is a more accurate diagnostic option for detecting the level of obstruction and degree of collapse, especially laryngeal collapse in OSA than FS.



Ben Barsties v Latoszek, Ewa v Latoszek

Perceptual Recovery Effects of Thyme Drops after Vocal Loading for Professional Voice Users: A Randomized Placebo-controlled Single-blind Trial

[Year:2019] [Month:July-December] [Volume:9] [Number:2] [Pages:4] [Pages No:43 - 46]

Keywords: Drops, Professional voice user, Thyme, Vocal health, Vocal loading

   DOI: 10.5005/jp-journals-10023-1173  |  Open Access |  How to cite  | 


Objective: The present study aimed to evaluate perceived recovery effects of drops after vocal loading. Particularly, thyme was evaluated, which has promising effects on the mucosa, throat, and airway system. Materials and methods: In total, 48 of 56 vocally healthy professional voice users were included because they presented with vocal fatigue after vocal loading. The subjects were randomized into two groups who received a thyme drop (TD), or a placebo drop (PD), after a 20-minute vocal loading task. The recovery effect by using drops was rated perceptually. Results: The results of the self-perceived rating showed higher significant outcomes for the TD group (p = 0.050 to p = 0.002). The TD group revealed a higher agreement for perceived well-being in the throat (i.e., 83.3%), a higher comfort in talking (i.e., 50.0%), and lower malaise/pain in the throat (58.3%) than the PD group (i.e., agreement of 50.0%, 16.7%, and 20.8%, respectively). Conclusion: Thyme drops might increase the comfort, well-being in the throat, and talking after vocal loading. Further research is necessary to investigate thyme and drops as potential benefit for professional voice users with high vocal loading.



Rajlaxmi Panigrahi, Soumya Jee

Primary Malignant Melanoma of the Larynx: A Case Report

[Year:2019] [Month:July-December] [Volume:9] [Number:2] [Pages:2] [Pages No:47 - 48]

Keywords: Larynx, Malignant, Melanoma, Primary, Tracheostomy

   DOI: 10.5005/jp-journals-10023-1175  |  Open Access |  How to cite  | 


Malignant melanoma of the larynx is a rare cancer that can appear as a primary tumor or as a metastasis from a cutaneous head and neck primary site. It is known for its poor outcomes and survival. Owing to rarity of the disease every reported case of primary malignant melanoma of the larynx is important for understanding the natural course of disease, presentation, tumor biology, treatment, and prognosis for establishing guidelines for further management of the disease. Here we report a case of primary malignant melanoma of the larynx. Diagnosis was based on histological, immunohistochemical findings from excisional biopsy specimen from the larynx.


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Esophag Speech

A Study of Rehabilitation of Speech in Post Laryngectomy Cases, as Seen in a Tertiary Care Institution Esophageal Speech vs Speech with Tracheoesophageal Puncture Prosthesis.

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