Andrew J. McWhorter

Vocal fold augmentation with calcium hydroxylapatite (CaHA)

Objectives Evaluate the effectiveness of CaHA injection for patients with glottal incompetence. Methods Multi-center, open-label, prospective clinical study with each patient serving as his/her own control. Voice-related outcome measures were collected for pre-injection and 1, 3, and 6 months. Results Sixty-eight patients were available for evaluation. Fifty percent of the injection procedures were done in office. Fifty-seven percent were diagnosed with unilateral paralysis and 42% with glottal incompetence with mobile vocal folds. Patient satisfaction 6 months post showed 56% had significantly improved voice and 38% reported moderately improved voice. Paired t tests from baseline to 6 months showed significant improvements on the VHI and VAS (vocal effort), CAPE-V judgments of voice severity and videoendostroboscopy ratings of glottal closure, and objective voice measures of glottal closure (MPT and S:Z ratio). Conclusions Preliminary results in this large cohort of patients demonstrate excellent clinical results.

Tracheotomy: timing and techniques.

Purpose of reviewUntil the past 40 years, the timing of tracheotomy was of little concern. It was an emergency procedure developed for the relief of airway obstruction. Following the development of positive pressure ventilation, tracheotomy became an elective procedure. Today, the optimal time for tracheotomy is a subject of dispute and continued investigation. As this operation has become one of the most commonly performed procedures in the intensive care unit, nonoperative dilational methods have gained acceptability. The purpose of this review is to analyze the recent literature and draw insight into the timing and technique of the current state of tracheotomy. Recent findingsIndividualized assessment of patients should guide the timing of tracheotomy, with a preference toward early tracheotomy. Percutaneous dilational tracheotomy (PDT) can be performed with equivalent safety to open tracheotomy. Bedside open tracheotomy negates the cost-saving benefits of PDT. Endoscopic guidance in PDT decreases complications with needle placement and posterior tracheal wall injury. Major complications of PDT usually are associated with displacement of the tracheotomy tube. SummaryTracheotomy indications have remained unchanged, but the timing of the procedure has advanced to individualized assessment with a predilection for earlier tracheotomy. The traditional operative technique is a much safer procedure today. Percutaneous dilational tracheotomy has become an acceptable alternative with proper patient selection. A multidisciplinary team with a surgeon provides the best care for the patient undergoing percutaneous tracheotomy.

Investigation of voice initiation and voice offset characteristics with high-speed digital imaging

This study involves preliminary investigation of the characteristics of the voice initiation period (VIP) and voice offset period (VOP) using high-speed digital imaging. The goals of the study were to develop a methodology to objectively analyze these periods of phonation and to explore the feasibility of studying the effects of aging on these phonation segments. Results of the analysis of the data from two female subjects, one younger and one older, with the developed methodology, demonstrated that the older subjects VIP was characterized by a slow and irregular increase in glottal area waveform (GAW) until reaching 90% of the maximum opening of the glottis at 244 frames or 122 ms. The younger subject demonstrated a sharp increase in GAW during VIP, taking only 155 frames or 77.5 ms to reach the 90% mark. Also, the older subject took a greater number of frames for the vocal fold vibration to come to a complete stop than the younger subject during the VOP; 275 frames and 150 frames respectively.

Positron Emission Tomography―Computed Tomography Surveillance for the Node-Positive Neck After Chemoradiotherapy

To review our results with positron emission tomography and computed tomography fusion imaging (PET‐CT) surveillance of the postchemoradiotherapy neck in patients with advanced head and neck squamous cell carcinoma.

Variability of normal vocal fold dynamics for different vocal loading in one healthy subject investigated by phonovibrograms.

We investigate the potential of high-speed digital imaging technique (HSI) and the phonovibrogram (PVG) analysis in normal vocal fold dynamics by studying the effects of continuous voice use (vocal loading) during the workday. One healthy subject was recorded at sustained phonation 13 times within 2 consecutive days in the morning before and in the afternoon after vocal loading, respectively. Vocal fold dynamics were extracted and visualized by PVGs. The characteristic PVG patterns were extracted representing vocal fold vibration types. The parameter values were then analyzed by statistics regarding vocal load, left-right PVG asymmetries, anterior-posterior PVG asymmetries, and opening-closing differences. For the first time, the direct impact of vocal load could be determined by analyzing vocal fold dynamics. For same vocal loading conditions, equal dynamical behavior of the vocal folds were confirmed. Comparison of recordings performed in the morning with the recordings after work revealed significant changes in vibration behavior, indicating impact of occurring vocal load. Left-right asymmetries in vocal fold dynamics were found confirming earlier assumptions. Different dynamics between opening and closing procedure as well as for anterior and posterior parts were found. Constant voice usage stresses the vocal folds even in healthy subjects and can be detected by applying the PVG technique. Furthermore, left-right PVG asymmetries do occur in healthy voice to a certain extent. HSI in combination with PVG analysis seems to be a promising tool for investigation of vocal fold fatigue and pathologies resulting in small forms of dynamical changes.

Vocal Warm-Up Practices and Perceptions in Vocalists: A Pilot Survey

OBJECTIVES Investigated in a pilot study the type, duration, and frequency of vocal warm-up regimens in the singing community using a survey. METHODS One hundred seventeen participants completed an online survey. Participants included voice students from undergraduate, masters, and doctoral music programs and professional singers. RESULTS Fifty-four percent of participants reported always using vocal warm-up before singing. Twenty-two percent of the participants used vocal cool down. The most preferred warm-up duration was of 5-10 minutes in duration. Despite using vocal warm-up, 26% of the participants reported experiencing voice problems. Females tended to use vocal warm-up more frequently than males. Females also tended to use longer warm-up sessions than males. Education of the participants did not appear to have any noticeable effect on the vocal warm-up practices. The most commonly used singing warm-up exercises were ascending/descending five-note scales, ascending/descending octave scales, legato arpeggios, and glissandi.

Diagnostic and interventional sialendoscopy: a preliminary experience.

To review our preliminary experience with diagnostic and therapeutic sialendoscopy for the management of non‐neoplastic disorders of the salivary gland.

Effects of 2 different swallowing exercise regimens during organ-preservation therapies for head and neck cancers on swallowing function.

This study investigated the effects of 2 different swallowing exercise regimens performed during radiation therapy with/without chemotherapy on swallowing function.

Assessment of the variability of vocal fold dynamics within and between recordings with high-speed imaging and by phonovibrogram†‡§

The goal of the study was to assess the variability of healthy vocal fold dynamics. Quantitative parameters describing mean regularity and vibration characteristics of vocal fold dynamics along the entire glottal axis were analyzed.

Secondary Tracheoesophageal Puncture With In-Office Transnasal Esophagoscopy

OBJECTIVE To evaluate the outcomes of voice restoration using office-based transnasal esophagoscopy (TNE) to guide placement of the secondary tracheoesophageal puncture (TEP). DESIGN Retrospective chart review. SETTING Two tertiary care medical centers. PATIENTS The study included 39 patients who underwent the TNE-TEP procedure from January 2004 to December 2008. MAIN OUTCOME MEASURES Clinical, demographic, and TE speech-related data were recorded to examine the ease, efficiency, complications, and speech-related outcomes. RESULTS Among 39 patients identified, the average age was 65 years (age range, 47-83 years), with 32 male (82%) and 7 female (16%) patients. Twenty-five patients (64%) underwent total laryngectomy; 8 (21%) underwent total laryngectomy with partial pharyngectomy; and 14 (36%) underwent microvascular flap reconstruction. The overall success rate of secondary TNE-assisted TEP placement was 97% (n = 38), with 1 unsuccessful attempt. There was no statistically significant correlation found between patients having undergone radiation therapy (either before or after oncologic resection) or a cricopharyngeal myotomy and successful TEP placement, type of reconstruction used to close the pharyngeal defect when compared with the difficulty in the placement of the TEP, development of complications associated with TEP placement, use of the TEP prosthesis, or speech intelligibility at the last follow-up visit. Thirty-one patients (79%) were still using their TEP prosthesis for speech at the last follow-up visit. Of the patients reviewed, 28 (72%) had understandable TE speech. CONCLUSIONS In-office TNE-assisted TEP placement can safely be performed, with excellent speech outcomes. Reconstruction with musculocutaneous or microvascular free-tissue transfer did not limit our ability to place secondary TEPs with TNE.