Lesley F. Childs

Laryngeal electromyography for prognosis of vocal fold palsy: A Meta-Analysis

To analyze existing evidence regarding utility of laryngeal electromyography (LEMG) for prognosis in cases of vocal fold palsy (VFP).

A randomized controlled trial of stretch-and-flow voice therapy for muscle tension Dysphonia

To investigate the effect of stretch‐and‐flow voice therapy on vocal function and handicap.

Patient Perceptions of Factors Leading to Spasmodic Dysphonia: A Combined Clinical Experience of 350 Patients

Spasmodic dysphonia (SD) is an idiopathic voice disorder that is characterized by either a strained, strangled voice quality or a breathy voice with aphonic segments of connected speech. It has been suggested that environmental factors play a role in triggering the onset. Clinical observation suggests that some patients associate onset with specific events or factors while others do not. The purpose of this study was to examine a large database of SD patients to determine if specific triggers are associated with the onset of SD.

Laryngeal Manifestations of Relapsing Polychondritis and a Novel Treatment Option

OBJECTIVES Laryngotracheal involvement in relapsing polychondritis (RP) is rare. However, it is one of the most common causes of death in this patient population. We present three patients who primarily presented with laryngeal manifestations of RP and a novel treatment option for bamboo nodules. STUDY DESIGN Retrospective chart review and comprehensive review of the literature. RESULTS Two patients first presented to an otolaryngologist because of hoarseness and chronic cough that eventually progressed to dyspnea upon exertion. Laryngeal examination revealed subglottic stenoses. Upon rheumatologic workup both were diagnosed with RP. After treatment with steroids and immunosuppressive drugs, one of the patients laryngeal symptoms improved, whereas the other required dilation procedures. Neither patient had classic auricular or nasal symptoms upon initial presentation. The third patient was being treated for spasmodic dysphonia and was noted to have bamboo nodules with accompanying dysphonia. Rheumatologic workup revealed RP and systemic treatment ensued. Unfortunately, her symptoms of hoarseness persisted despite systemic treatment. A pulsed-potassium-titanyl-phosphate (KTP) laser was applied to the bilateral bamboo nodules, which eventually caused resolution of her vocal fold lesions and dysphonia. CONCLUSIONS We present three patients with RP, all of whom sought health care by an otolaryngologist primarily. Awareness of this disease entity and the possibility for early laryngeal involvement is crucial for proper care of those with this life-threatening disease.

Relationship between patient‐perceived vocal handicap and clinician‐rated level of vocal dysfunction

The relationship between patient‐reported vocal handicap and clinician‐rated measures of vocal dysfunction is not understood. This study aimed to determine if a correlation exists between the Voice Handicap Index‐10 (VHI‐10) and the Voice Functional Communication Measure rating in the National Outcomes Measurement System (NOMS).

The natural history of recoverable vocal fold paralysis: Implications for kinetics of reinnervation

Patients with unilateral vocal fold paralysis (UVFP) are commonly told to wait 12 months for spontaneous recovery. This study aims to 1) determine the time to vocal recovery in UVFP, 2) use that data to develop a neurophysiologically plausible model for recovery, and 3) use the model to generate meaningful predictions for patient counseling.

The Initial Evaluation and Management of a Vocal Performer With New Voice Complaints

Purpose of ReviewCaring for the vocal performance community represents a great privilege. A multidisciplinary team approach that is both accessible and sensitive to the unique needs of the performing artist is crucial to providing the highest level of care.Recent FindingsThe approach to a vocal performer in the clinical setting must be one that does not trivialize vocal concerns nor ignore vocal demands and habits outside of the performance milieu. Furthermore, relevant historical details and considerations for the performing artist are specific to their craft. Counseling this population often addresses vocal dose awareness, vocal hygiene optimization, and muscle memory pattern adjustments. Behavioral intervention in the form of voice therapy almost always precedes consideration of surgical therapy. Furthermore, prescribed short-term voice rest periods, guided by videostroboscopic exam, can be effective both diagnostically and therapeutically.SummaryVarious medical, surgical, and behavioral intervention recommendations and management strategies are highlighted from the perspective of a fellowship-trained laryngologist and a voice therapist, both with clinical emphasis on performance voice.

A Pilot Study of Quantitative Measurements of Nasal Function in Rhinitis and the Therapeutic Effects of Botulinum Toxin

A Pilot Study of Quantitative Measurements of Nasal Function in Rhinitis and the Therapeutic Effects of Botulinum Toxin Objective: Symptoms of rhinitis can be attributed to the stimulation of cholinergic nerve endings, which leads to mucosal hypersecretion and an increase in nasal blood flow. As botulinum toxin is a powerful cholinergic blocker, the application of this toxin intranasally may help to decrease the symptom complex associated with rhinitis. A pilot study was designed to evaluate the use of hot wire airflow, measurement of stimulated secretions, and the effect of botulinum toxin on both. A quantitative assessment of this use in humans has never been performed. Study Design: Double-blind, placebo controlled randomized control trial. Methods: Botulinum toxin was injected into the inferior turbinates of 8 human subjects. Patients were their own controls, with each side randomized to receive onabotulinumtoxinA (BTX-A) (four 2.5 unit aliquots) or equivalent volume of normal saline.. Airflow was measured at baseline and each visit using hot-wire airflow device. Baseline and stimulated nasal secretions were collected on filter paper then weighed. The patients were followed monthly for a total of 4 months. Results: There was a statistically significantly greater airflow on the BTX-A treated sides compared with control sides at 4 months. There was also a statistically significant decrease in stimulated secretions at 3 months. There was a notable trend toward reduction of resting secretions and stimulated secretions in the BTX-A treated sides during the treatment period. There was also a trend toward greater airflow in the BTX-A treated sides during the treatment period.

Movement Disorder Emergencies of the Upper Aerodigestive Tract

A 52-year-old man was transferred to the emergency room of a major hospital from a referral facility because of recent slurred speech. He had been admitted to the facility the week before for treatment of alcohol abuse. Upon his arrival in the emergency room, the neurology resident was called to evaluate the patient after a normal computed tomography scan was obtained. Examination revealed normal comprehension and expression, slurring of speech, and an inability to fully open his jaw and protrude his tongue. There were no defects in visual field perception, power, or sensation. Review of the medical record from the referring institution revealed that the patient had been started on 5 mg of haloperidol four times daily on his admission to the referral facility as part of his treatment for alcohol abuse—he was unaware he was receiving the medication. An acute dystonic reaction was diagnosed, and 25 mg of intravenous diphenhydramine was administered, with resolution of dysarthria and jaw restriction within 90 seconds of infusion. He was maintained on oral diphenhydramine 25 mg twice daily for one week after discharge.