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ORIGINAL ARTICLES
Voice therapy outcome in puberphonia
Vrushali Desai, Prasun Mishra
January-June 2012, 2(1):26-29
DOI:10.4103/2230-9748.94730  
Background: Puberphonia is inappropriate use of high-pitched voice beyond pubertal age in males. It is usually seen in the immediate post-pubescent period when the male vocal mechanism has undergone significant changes in size and function caused by hormonal changes. Voice therapy is one of the modality of management for puberphonia. Aim: To evaluate the efficacy of voice therapy provided to a group of 30 Puberphonia cases as the sole treatment approach to lower the pitch range. Setting: The study was carried out in a tertiary voice care and laryngology center. Materials and Methods: This is a prospective study of 30 cases diagnosed with Puberphonia managed with various techniques of voice therapy. The subjective assessment was done with GRBAS scale and objective assessment was done by acoustic analysis using Multi Dimensional Voice Profile. Results: All 30 patients achieved appropriate pitch range following Voice Therapy. Conclusion: This study encourages speech and language professionals to advice and use voice therapy as the foremost treatment modality for Puberphonia.
  30,278 871 2
CASE REPORTS
Thyroglossal duct cyst: Unusual presentation in an adult
W.V.B.S. Ramalingam, Rajeev Chugh
July-December 2013, 3(2):61-63
DOI:10.4103/2230-9748.132054  
Thyroglossal duct cyst is a congenital lesion of the neck resulting from the remnant of the thyroglossal tract. A 59-year-old male patient presented with a progressive cystic swelling in the neck which moved on swallowing and protrusion of tongue. Investigations were inconclusive and thyroid profile was normal. Sistrunk's operation was performed and histopathological examination revealed it as thyroglossal duct cyst. There were no post-operative complications and no evidence of malignancy. The objective of this article is to emphasize on the importance of considering thyroglossal duct cyst as differential in an unusually large cystic neck swelling in adults with no conclusive evidence on investigations. Complete excision of the cyst with the tract and part of the body of hyoid (Sistrunk's operation) will significantly improve the outcome with reduced risk of recurrence.
  19,024 115 1
ORIGINAL ARTICLES
Treatment of laryngeal hyperfunction with flow phonation: A pilot study
Gary H McCullough, Richard I Zraick, Stamatela Balou, Hylan C Pickett, Balaji Rangarathnam, Ozlem E Tulunay-Ugur
July-December 2012, 2(2):64-69
DOI:10.4103/2230-9748.106980  
Context: While clinical successes and descriptions have been reported in a few texts, no data exist to define the utility of flow phonation to improve voice quality in patients with laryngeal hyperfunction. Aims: To provide pilot data regarding the utility of three exercises (gargling, cup bubble blowing, and stretch-and-flow) to improve phonatory airflow during voicing in patients with laryngeal hyperfunction. Settings and Design: Outpatient Voice and Swallowing Center in a University Medical Center. Materials and Methods: Participants received five treatment sessions and were evaluated prior to treatment and after each session using a Phonatory Aerodynamic System to measure airflow during voicing tasks. Noise-to-harmonic ratio and perceptual voice measures were also obtained, as was self-perception of voice handicap. Statistical Analysis Used: Repeated All increased airflow and decreased laryngeal airway resistance over five sessions. Measures Analysis of Variance. Results: Six participants completed the protocol. All participants decreased self-perception of voice handicap and improved on noise-to-harmonic ratio and perceptual ratings of vocal quality. Conclusions: Data derived on a small sample of patients in an exploratory investigation suggest further research into the use of these three exercises to improve airflow with voicing and improve vocal quality in patients with laryngeal hyperfunction is warranted.
  17,394 543 12
REVIEW ARTICLE
Leukoplakia of larynx: A review update
Ishwar Singh, Divya Gupta, S. P. S. Yadav
July-December 2014, 4(2):39-44
DOI:10.4103/2230-9748.157464  
Leukoplakia of larynx has remained a debatable topic in laryngeal pathology for decades as per classification, histology and treatment is concerned. Smoking and alcohol are the major causes and there is sufficient evidence implicating gastroesophageal reflux and human papilloma virus in its pathogenesis. A wide range of therapeutic strategies are available for different grades of dysplasia. Despite this, a significant proportion of patients progress to carcinoma for which the patients with dysplasia need to be kept in regular follow-up.
  16,392 81 4
HOW I DO IT
Management of bilateral abductor palsy: Posterior cordectomy with partial arytenoidectomy, endoscopic approach using CO 2 laser
Sachin Gandhi
July-December 2011, 1(2):66-69
DOI:10.4103/2230-9748.85066  
The treatment of bilateral immobile vocal cords (BAP) is a balance between phonation, airway and swallowing. Various techniques of endoscopic approach for the treatment of bilateral vocal fold immobility have been proposed and have been modified by various surgeons. Trans oral CO 2 laser endoscopic arytenoidectomy has become the most common method for its management. CO 2 laser is arguably the most appropriate tool for cordectomy with the advantage of increased precision, better hemostasis and minimal tissue handling. We describe the procedure of posterior cordectomy with partial arytenoidectomy using trans oral CO 2 laser for management of BAP. The present modality of preservation of part of shelf of arytenoid and use of laser in super pulse mode contribute to good results with minimum complication
  14,374 506 3
REVIEW ARTICLES
Unilateral pediatric vocal cord paralysis: Evolving trends
Nancy Grover, Abir Bhattacharyya
January-June 2012, 2(1):5-9
DOI:10.4103/2230-9748.94727  
Unilateral vocal cord paralysis (UVCP) in children is a rare and challenging disorder for the pediatric otolaryngologist. The overall etiology differs from that in adults, iatrogenic causes are the commonest, followed by traumatic - birth or intubation trauma and neurologic causes. Prolonged spontaneous recovery occurs in up to 50% of cases. Management strategies used for adults have evolved and been utilized in children, with increasing reports of surgical intervention over the last decade. However, number of children treated remains small with no long-term follow-up. We used the terms "vocal cord palsy," "vocal cord paresis," "vocal fold immobility" each limited by "paediatric," "children," to search Medline, Embase, PubMed, Cochrane, and CINHAL. Reference lists were crosschecked to include relevant studies. Only English language literature was searched. Studies specifically relating to unilateral vocal cord or containing relevant data were identified and analyzed. We present our review of literature on pediatric UVCP with emphasis on various interventions for management, especially the growing experience with laryngeal re-innervation.
  14,113 609 2
ORIGINAL ARTICLES
Oral and pharyngeal transit time as a factor of age, gender, and consistency of liquid bolus
J Nikhil, Rahul K Naidu, Gayathri Krishnan, R Manjula
July-December 2014, 4(2):45-52
DOI:10.4103/2230-9748.157465  
Introduction: The oral transit time (OTT) and pharyngeal transit time (PTT) are measures that indicate the time taken for bolus transit in oral and pharyngeal cavities, respectively. These measures vary with respect to bolus type and quantity and reflect on the efficiency of the swallow. Objectives: The study aimed to compare OTT and PTT measures for thin (water) and thick (honey) liquid bolus consistencies in 88 typical participants (44 typical adults and 44 typical geriatric persons including males and females) and 10 persons with swallowing disorders. Materials and Methods: OTT and PTT measures for liquid bolus were derived using the equipment Digital Swallowing Workstation-Swallowing Signal Laboratory (DSW-SSL) (Kay/Pentax, Lincoln, New Jersey) Model 7120. In the absence of cited standard procedures to measure OTT and PTT, the measures of OTT and PTT were specifically defined in this study based on the measures obtained from three modules/tests of the DSW-SSL: (a) Tongue array (used to measure the tongue pressure during swallow), cervical auscultation (used to measure the swallow sound), nasal cannula (used to measure the respiratory-swallow coordination). Results and Discussion: The mean group scores of OTT and PTT measures were compared across gender, age, and consistency of bolus and treated with the appropriate statistical procedure. Results revealed that: (i) PTT for honey was longer than water in typical adults and geriatric persons. (ii) There was no significant difference in OTT for honey across age groups. (iii) Atypical patterns in the morphology of tongue pressure, swallow sound and respiratory-swallow coordination during swallow were noted across age and consistency of bolus in typical and atypical population. Conclusion: The OTT and PTT measures can serve as sensitive indices to understand swallow physiology in oral and pharyngeal phase. Increase in PTT is observed for thicker liquid like honey. There are more instances of nonhomogenous patterns across typical and atypical swallows for tongue pressure, swallow sound, and respiratory-swallow coordination.
  13,926 63 4
CASE REPORTS
Was the rapid resolution of a laryngeal granuloma due to high dose double proton pump inhibitor treatment?
Omer N Develioglu, Ceki Paltura, Murat Topak, Mehmet Kulekci
July-December 2011, 1(2):60-62
DOI:10.4103/2230-9748.85064  
A laryngeal granuloma (LG) is a benign tumor that usually develops on the cartilaginous vocal process of the vocal cords. Gastroesophageal reflux (GER), hyperfunctional use of the voice, and intubation injury are etiological factors. Patients usually complain of dysphagia, and dysphonia. A 53-year-old male consulted the Taksim Educational and Research Hospital ENT Department, complaining of a 6-month history of hoarseness, dysphagia, and globus sensation. On laryngoscopic examination, a granuloma was found on his left vocal process He was given an anti reflux treatments and advised on vocal hygiene. At the 1-month follow-up, the granuloma had disappeared. A thorough history was taken and disclosed that at time of his first visit, he saw a gastroenterologist for his heartburn and regurgitation and was administered pantoprazole 40 mg once daily. Consequently, the rapid resolution of the granuloma was thought have resulted from the high-dose double PPI treatment.
  13,464 246 -
ORIGINAL ARTICLES
Autologous fat augmentation for phonatory gap: Prospective study of postoperative voice outcome
Sachin Gandhi, Namita Narhari, Vrushali Desai
July-December 2011, 1(2):55-59
DOI:10.4103/2230-9748.85063  
Background: Substances available for vocal cord augmentation procedure have their own advantages and limitations. Autologous fat is accepted to be one of the safest substance for augmentation. Objective: To evaluate the subjective and objective changes in vocal outcome following fat augmentation surgery for phonatory gaps. Materials and Methods: 30 patients with phonatory gap <2 mm were included in this prospective study. These consisted of sulcus vocalis (14), vocal cord atrophy (05) and vocal cord palsy (11). Per-operatively harvested umbilical fat was used for augmentation after mincing it and removing all the connective tissue. Follow-up of patients was done at 1, 3 and 6 months interval. Pre- and postoperative videostroboscopy was done. Objective analysis of voice was done using maximum phonatory time (MPT) and noise to harmonic ratio (NHR). Subjective assessment of voice was done using the voice handicap index (VHI) and subjective change in quality of voice as assessed by the patient. Results: Patients with early stage sulcus, vocal atrophy and vocal cord palsy, with small vocal gap, showed significantly good results after fat augmentation; however, results of patients with sulcus vocalis of grade II and III were not very satisfactory.
  12,816 388 -
A study on behavior and management of suicidal cut throat patients
Kalpana Sharma, Kaberi Kakati, Subodh C Goswami, Dipesh Bhagawati, Manigreeva Krishnatreya
July-December 2013, 3(2):57-60
DOI:10.4103/2230-9748.132051  
Background: Suicide is one of the 10 leading causes of death in the world and cut throat injuries (CTI) are fairly common due to suicide. Aims and Objective: The aim of the present study is to evaluate the pattern of injury, its management and associated psychiatric illness in suicidal CTI. Materials and Methods: A prospective study from August 2011 to April 2013 was carried out in the Department of Ear, Nose, and Throat (ENT) in collaboration with the Department of Psychiatry at  Gauhati Medical College and Hospital. A total of 17 cases of suicidal CTI were included in the study irrespective of age and sex, who were admitted in the department of ENT. Results: Majority of the patients were young adults, 82.35% in the age group of 20-40 years. According to anatomical zone, 77% had injury in Zone 2 and 23% had Zone 1 injury. Hesitation injury involving skin and soft-tissues were seen in the neck in 71% of cases, and common morbidity following CTI is secondary wound infection (23.52%), persistent dysphagia (23.54%) and ugly scar (17.64%). Majority of patients (47.05%) were of acute and transient psychosis. Conclusion: Suicidal CTI is an important cause of cut neck injury in ENT practice. Proper surgical and psychiatric management of suicidal CTI plays an important role in the prevention of complications and resultant death due to CTI.
  12,451 115 -
CASE REPORT
"Doctor I have a frog in my throat": Bilateral pharyngoceles in a recreational trumpet player
Charles Daultrey, Steve Colley, Declan Costello
January-June 2013, 3(1):18-21
DOI:10.4103/2230-9748.118712  
Pharyngocele is defined as "lateral pharyngeal wall herniation located in the piriform recess or at the valleculae" and was first described in 1886. The phenomenon is rare. It is characterised by bulging of the pharynx locally and is associated with recurrent increase in intrapharyngeal pressure, reduced muscle resilience, and increasing age. The case describes a 51-year-old recreational trumpeter with bilateral pharyngoceles that demonstrated when blowing into his instrument, reminiscent of a "bullfrog." Differential diagnosis included "Zenker's diverticulum", (pharyngeal pouch), laryngocele, and jugular venous phlebectasia, which may be confirmed through clinical examination and investigation. The report includes remarkable images seen on examination and images of the swelling seen with plain film radiography, barium swallow, and computed tomography. We discuss the management options available, including repair and excision of the pouch, either as an open procedure or endoscopically, and explore the conservative measures as a basis in the management of even significant pharyngoceles.
  10,688 163 3
CASE REPORTS
Congenital vallecular cyst with laryngomalacia: A report of two cases
Sachin Gandhi, SA Raza, Pallavi Thekedar, Prasun Mishra
January-June 2011, 1(1):27-29
DOI:10.4103/2230-9748.76134  
Vallecular cyst in an infant is uncommon, and it finds infrequent mention in the literature as well. However when present, it accounts for severe inspiratory stridor, causing airway compromise, and sometimes even death. Laryngomalacia is the commonest congenital anomaly of the larynx, which is present after birth giving rise to inspiratory stridor. Laryngomalacia results as a collapse of supraglottic structures of the larynx. Clinical co-presentation of vallecular cyst and laryngomalacia is very rare. This is a report of two cases of 2-month-old infants who presented with the history of noisy breathing and refusal to feeds since 10-15 days. CT scan of the neck revealed a huge cyst in the vallecula compromising the airway. Microlaryngoscopic-guided aspiration and marsupilization of the cyst was done using CO 2 laser and the release of aryepiglottic fold was done using microlaryngeal scissors. Respiratory and feeding problems dramatically improved in these patients by immediate surgical intervention.
  10,195 287 2
STUDENTS CORNER
Herpes simplex laryngitis following primary genital herpes
Purnima Sangwan, Rakesh Datta, Ashwani Sethi, Awadhesh K Mishra, Satwinder P Singh
July-December 2013, 3(2):70-72
DOI:10.4103/2230-9748.132062  
Primary genital herpes is associated with involvement of extragenital sites like thighs, buttocks, fingers and pharynx. This involvement occurs due to autoinoculation, orogenital exposure from the source and also seeding due to viremia in the initial period. Involvement of larynx in a case of primary genital herpes is extremely rare prompting us to report this case.
  10,051 104 1
REVIEW ARTICLE
Contact Endoscopy - A promising tool for evaluation of laryngeal mucosal lesions
Awadhesh Mishra, Ajith Nilakantan, Rakesh Datta, Kavita Sahai, Satwinder P Singh, Ashwani Sethi
July-December 2012, 2(2):53-59
DOI:10.4103/2230-9748.106978  
Early diagnosis of laryngeal cancer is important for favourable treatment outcome. Due to morbidity and difficulties associated with surgical biopsy, a need has always been felt for an easy, non invasive yet accurate tool for knowing histopathological nature of mucosal lesions. Contact Endoscopy (CE) is one such technique which is capable of providing real time and magnified images of cellular structure of superficial layers of various mucosal surfaces with obvious advantages and potential for wide clinical application. In this review, a summary of role and efficacy of CE in diagnosis, treatment and follow up of various laryngeal mucosal lesions is presented. We searched Pubmed, Medline, Cochrane and Google scholar for articles on CE for mucosal lesions of larynx. For better understanding of the technique, articles on CE of other non-laryngeal sites of head and neck were also reviewed. Article selection was limited to human studies without restriction to language and year of publication. Reference lists from identified articles were also searched. Six prospective original articles, three descriptive studies and one review article on CE of laryngeal lesions are included in this review and their findings summarized. Common findings on examination of cellular architecture and vascular patterns described by various authors are also tabulated. The literature revealed high sensitivity (90-94.7%), specificity (81-100%) and accuracy (88-94%) of CE in diagnosis of laryngeal lesions across the published studies. CE is a promising non invasive tool for evaluation of laryngeal mucosal lesions. However, further prospective, randomized, double blinded studies as well as research to improve the technique to overcome the existing limitations are required before defining its precise role in clinical practice.
  9,706 305 3
ORIGINAL ARTICLES
The effects of ILFN-exposure on voice acoustic parameters of commercial cabin crewmembers
Ana Mendes, Andreia Graça, Ana Jorge, Mariana Alves-Pereira, Nuno A. A. Castelo Branco, Adriana Freitas, Mara Laranjeira, Íris Bonança
July-December 2012, 2(2):70-80
DOI:10.4103/2230-9748.106983  
Background: Long-term exposure to infrasound and low frequency noise (ILFN <500 Hz, including infrasound) can lead to the development of vibroacoustic disease (VAD). VAD is a systemic pathology characterized by the abnormal growth of extracellular matrices in the absence of inflammatory processes, namely of collagen and elastin, both of which are abundant in the basement membrane zone of the vocal folds. ILFN-exposed workers include pilots, cabin crewmembers, restaurant workers, ship machinists and, in previous studies, even though they did not present vocal symptoms, ILFN-exposed workers had significant different voice acoustic patterns (perturbation and temporal measures) when compared with normative population. Study Aims: The present study investigates the effects of age and years of occupational ILFN-exposure on voice acoustic parameters of 37 cabin crewmembers: 12 males and 25 females. Specifically, the goals of this study are to: 1) Verify if acoustic parameters change over the age and years of ILFN-exposure and 2) Determine if there is any interaction between age and years of ILFN-exposure on voice acoustic parameters of crewmembers. Materials and Methods: Spoken phonatory tasks were recorded with a C420 III PP AKG head-worn microphone and a DA-P1 Tascam DAT. Acoustic analyses were performed using KayPENTAX Computer Speech Lab and Multi-Dimensional Voice Program. Acoustic parameters included speaking fundamental frequency, perturbation measures (jitter, shimmer and harmonic-to-noise ratio), temporal measures (maximum phonation time and s/z ratio) and voice tremor frequency. Results: One-way ANOVA analysis revealed that as the number of ILFN-exposure years increased male cabin crewmembers presented significant different shimmer values of /i/ as well as tremor frequency of /u/. Females presented significantly different jitter % of /i, a, ɔ/ (p <0.05). Lastly, Two-way ANOVA analysis revealed that for females, there was a significant interaction between age and occupational ILFN-exposure for voice acoustic parameters, namely for jitter's mean for /a, ɔ/ and shimmer's (%) mean for /a, i/ (p <0.05). Discussion and Conclusion: These perturbation measure patterns may be indicative of histological changes within the vocal folds as a result of ILFN-exposure. The results of this study suggest that voice acoustic analysis may be an important tool for confirming ILFN-induced health effects.
  9,347 218 1
Translation and validation of the voice handicap index in Hindi
Rakesh Datta, Ashwani Sethi, Shashank Singh, Ajith Nilakantan, MD Venkatesh
January-June 2011, 1(1):12-17
DOI:10.4103/2230-9748.76131  
Objectives: To adapt the voice handicap index (VHI) for usage in Hindi and evaluate its internal consistency, reliability, and clinical validity in cases of dysphonia. Setting: Tertiary healthcare centers. Materials and Methods: The original VHI was translated into Hindi and was completed by 175 patients with voice disorders and 84 asymptomatic subjects. Internal consistency was analyzed through Cronbach's alpha coefficient. For test-retest reliability, the Hindi VHI was filled twice by 63 randomly selected patients and assessed through the Spearman rank correlation coefficient test. For the clinical validity assessment, the scores obtained in the pathological group were compared with those found in asymptomatic individuals through the Kruskal-Wallis test. Also, the correlation between VHI and the patients' self-perceived grade of voice disorder was assessed. Finally, the effect of age and gender on overall VHI and its three subscales was analyzed. Results: Internal consistency was found to be good (alpha = 0.95); the test-retest reliability was high (r = 0.95). Nonparametric Kruskal-Wallis analysis revealed that the control group scored significantly lower than the dysphonics. The overall VHI score positively correlated with the patients' self-perceived grade of voice disorder (r = 0.44). In the voice-disorder group, age and gender were not correlated to the overall VHI score and to their three domains. Conclusion: The Hindi VHI so developed is a valid and reliable measure for use in the Hindi-speaking population.
  8,775 524 9
STUDENTS CORNER
Student's corner: Cardiovocal hoarseness - Challenges in diagnosis and management
Paresh Naik, Jayita Poduval
July-December 2015, 5(2):44-46
DOI:10.4103/2230-9748.183965  
Cough and hoarseness are common symptoms that may be encountered in general or specialist clinical practice. Hoarseness, especially when found in isolation, could have an origin other than in the airway. An important example of this is cardiovocal hoarseness. A literature review of cardiovocal hoarseness or Ortner's syndrome reveals many clinical presentations. Several case reports have been published, but none so far has put into context issues that could come in the way of diagnosis and management of such patients. Hoarseness as a symptom, when not explained by usual causes such as a preceding upper respiratory tract infection or allergy, must be expediently looked into by simple means such as an indirect laryngoscopy. If a vocal cord paralysis is evident, especially on the left side, the possibility of an underlying cardiac condition must be borne in mind. Surgical or nonsurgical intervention could resolve the problem except in cases where the patient is extremely moribund.
  9,193 24 -
ORIGINAL ARTICLES
Etiological profile of unilateral vocal cord paralysis: A single institutional experience over 10 years
Sachin Gandhi, Sheetal Rai, Nilanjan Bhowmick
July-December 2014, 4(2):58-62
DOI:10.4103/2230-9748.157471  
Objective: Unilateral vocal cord palsy is a major cause of dysphonia. With umpteen number of causes being attributed to it and changing trends in etiology from place-to-place and over time, it is of utmost importance to arrive at a correct diagnosis to plan further management and to determine the prognosis. The aim was to evaluate the etiological profile of unilateral vocal cord palsy in our institute that is a tertiary referral center over the past 10 years. Materials and Methods: Case records of all patients diagnosed with unilateral vocal cord palsy who presented to Deenanath Mangeshkar Hospital, Pune, Maharashtra, India between 2003 and 2013 were retrospectively reviewed. The exclusion criteria included patients with laryngeal/hypopharyngeal malignancies, intubation trauma, congenital vocal cord palsy and cricoarytenoid joint ankylosis. The age, gender, laterality and etiology were the factors taken into consideration. Results: A total of 277 cases spanning over the age range of 2 months to 98 years met our inclusion criteria, out of which 179 were males, and 98 were females with a male to female ratio being 1.82:1. In terms of laterality, 182 patients had left sided, and 95 had right sided vocal cord palsy. Majority of the cases were found to be in the fourth and fifth decades. The most common etiology was idiopathic 136 (49.1%). The incidence of various other etiologies were surgical trauma 60 (21.6%), nonsurgical trauma 10 (3.7%), nonlaryngeal malignancy 36 (12.9%), central/neurological 17 (6.1%), postradiation 1 (0.3%), and other benign lesions 17 (6.1%). Among the surgical causes, the incidence of nonthyroidectomy surgeries (58.3%) was more than that of thyroidectomy (41.6%). Thyroidectomy was the single most common surgical cause for unilateral vocal cord palsy, followed by other nonthyroid neck surgeries (20%) and anterior cervical decompression (18.3%). Conclusion: The most common cause for unilateral vocal cord palsy is idiopathic. Nevertheless it is still an important sign of various underlying diseases. A thorough evaluation which must necessarily include a computerized tomographic scan from base of the skull to upper mediastinum is essential before labeling a case as idiopathic; hence, also the need for extended follow-up of the cases to avoid misdiagnosis of any underlying subclinical malignancy.
  9,041 74 3
REVIEW ARTICLE
Postintubation recurrent laryngeal nerve palsy: A review
R Inita Matta, B Kanupriya Halan, Kavita Sandhu
July-December 2017, 7(2):25-28
DOI:10.4103/jlv.JLV_5_16  
Endotracheal intubation is one of the most common procedures performed in the Operating Theatre, Intensive Care Unit or wards, either on an elective or emergency basis. Recurrent laryngeal nerve injury leading to vocal cord paralysis is a lesser known but important complication of intubation. It is important to identify and monitor these patients to prevent confusion with regard to etiology and outcome. This article explores the etiopathogenesis of recurrent laryngeal nerve palsy following intubation and the various risk factors and possible mechanisms which contribute to this complication. Techniques to prevent and recognize this injury are also discussed. PubMed was the main database searched for articles related to the topic which were found through the period 1972–2017.
  9,061 11 2
STUDENTS CORNER
External laryngocele: Points to remember
J Jishana, Jayita Das Poduval
July-December 2013, 3(2):67-69
DOI:10.4103/2230-9748.132061  
Laryngocele is a rare cystic swelling arising from the saccule of larynx. It is seen mostly among trumpeters and glassblowers. In others, it is often associated with underlying malignancy. Here we report a case of external laryngocele in a young farmer who did not have any of the above mentioned associations.
  8,898 123 1
Nasal intubation of microlaryngeal tracheal tube for vocal cord lesion surgery
Anurag Gupta
July-December 2011, 1(2):75-76
DOI:10.4103/2230-9748.85069  
Microlaryngeal tracheal (MLT) tube, when inserted through nasal route, offers adequate space in front of the tube for proper vision, excision and hemostasis of vocal cord lesions in the anterior and middle third portions as compared to oral route. There is less risk of kinking of tube at the point of securing with skin and it provides easy instrumentation for exposure of oral cavity. MLT tube placed nasally lies in the posterior comissure of vocal cord between arytenoids, leaving anterior two-third or more unobscured.
  8,352 253 -
REVIEW ARTICLES
Olfaction following total laryngectomy
Elizabeth Ward, Anna Rumbach, Corina J van As-Brooks
January-June 2012, 2(1):10-20
DOI:10.4103/2230-9748.94728  
Total laryngectomy (TL) results in the complete disconnection of the upper and lower respiratory tract, ceasing orthonasal airflow. Hence, olfaction and olfactory acuity are negatively impacted. Prior to the late 1990s, impaired olfaction was simply accepted as a negative consequence of TL surgery. However, a growing body of research conducted within this past decade has demonstrated that rehabilitation is possible with a simple and effective behavioral technique. The current review outlines the literature supporting the negative impact of altered olfaction on quality of life, details of known best practice methods for olfactory assessment both for research and clinical use, and outlines the evidence for interventions known to improve olfactory performance in the TL population. Intervention for olfactory impairment should be part of a holistic, evidence-based rehabilitation process for patients post-laryngectomy.
  7,955 436 2
ORIGINAL ARTICLES
Comparison of esophageal and tracheoesophageal speech modes in dual-mode alaryngeal speakers
Santosh Maruthy, Marie Karla Mallet, Rajashekhar Bellur
January-June 2014, 4(1):6-11
DOI:10.4103/2230-9748.141444  
Objective: The main purpose of this study was to compare different speech related parameters in dual-mode esophageal and tracheoesophageal speakers. A second purpose was to compare the speech characteristics of these (tracheo) esophageal speakers with age- and gender matched controls. Materials and Methods: Four male laryngectomees who were proficient esophageal and tracheoesophageal speakers provided audio recordings of sustained vowels and connected speech using both alaryngeal methods. The participants from the control group also followed the same procedure. From the recorded samples, fundamental frequency (F0), maximum phonation duration (MPD), formant frequencies, and speech rate related parameters were extracted. Results: Although there was no statistically significant difference between the two alaryngeal modes for any of the measured parameters, the absolute fundamental frequency and MPD values were higher in TE mode. However, when compared to controls, both the alaryngeal modes depicted significantly shorter MPD values, higher first formant frequency values, slower speech rate, and higher frequency of pauses. Conclusion: The results suggest that most group differences found between esophageal and tracheoesophageal speech in the past may be due to large inter-subject variability, and that within speakers, similarity is more between esophageal and tracheoesophageal speech than with laryngeal speech. These results have implications for understanding the pseudoglottic voice mechanism.
  8,204 157 1
Laryngeal ultrasound in diagnosis of vocal cord palsy: An underutilized tool?
Inita R Matta, Kanupriya B Halan, Ramesh H Agrawal, Mandar S Kalwari
January-June 2014, 4(1):2-5
DOI:10.4103/2230-9748.141439  
Background: Despite the prevalence of ultrasonography in medical practice, its use in laryngeal disorders appears underutilized. It provides a simple, easy, cheap and non-invasive method to diagnose vocal cord palsy in real time, dynamic 2 or 3-dimensional image mode. It can be an alternative diagnostic tool where flexible fibreoptic laryngoscopy is limited by an uncooperative patient, xylocaine sensitivity or where stroboscopy is not available due to cost restraints. Especially it is useful in the preoperative workup of a patient undergoing thyroid surgery. Aims: The present study evaluates the accuracy of ultrasonography in diagnosis of vocal cord palsy in 25 patients. We have used fibreoptic laryngoscopy purely as a comparative tool for purposes of this study. Materials and Methods: It was a prospective study carried out in 25 patients presenting with hoarseness. Patients underwent laryngeal ultrasound followed by flexible fibreoptic laryngoscopy. Results: We were able to accurately diagnose vocal cord palsy by ultrasound in all but two patients where the examination was limited by extensive laryngeal cartilage calcification. Discussion and Conclusion: There is every evidence to suggest that ultrasonography has a place in diagnosis of vocal cord palsies. It is easy, cheap, available, and non-invasive. It is a useful tool where fibreoptic laryngoscopy is limited by an uncooperative patient and where strobolaryngoscopy is not available. Further study and more familiarity would extend its use to other laryngeal disorders.
  8,176 169 3
REVIEW ARTICLE
Voice outcomes after laser cordectomy
Faustino Nunez-Batalla, Juan Pablo Díaz-Molina, Andres Coca-Pelaz, Carlos Suarez-Nieto
January-June 2011, 1(1):6-11
DOI:10.4103/2230-9748.76130  
Early glottic carcinoma can be treated using endoscopic surgery, radiotherapy, or partial open surgery. Lesions limited to the vocal fold are normally treated with endoscopic surgery or partial open surgery, with local control results between 80% and 90%. The choice of one treatment over another should contemplate the cure rate, larynx preservation rate, post-treatment voice quality, morbidity, and treatment cost. Although both external beam radiotherapy and endoscopic carbon dioxide laser excision of early glottic cancer will affect voice quality, it is difficult to compare them. A complete voice assessment including perceptual, objective, and subjective evaluation is mandatory whenever a meaningful analysis of the pathological voice is to be accomplished. Meta-analyses of the results of voice treatments are generally limited and may even be impossible owing to the major diversity in the ways functional outcomes are assessed. The postsurgical voice outcome depends upon having a straight postoperative vocal fold for glottic closure and intact vibration from the contralateral vocal fold. Subepithelial and subligamental cordectomies are oncologically safe resections and have a quality of voice comparable to that of controls. By contrast, with wider resections (types III-V cordectomies), a concave neocord may form resulting in an aerodynamic glottic incompetence. In order to select the most appropriate treatment modality according to the patient's age, gender, compliance, and professional activity, a detailed preoperative counseling concerning vocal outcome is recommended. After phonosurgical resection, patients who have lost paraglottic musculature may benefit from medialization and augmentation procedures to re-establish glottic competence.
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