Libby J. Smith

Electromyographic laryngeal synkinesis alters prognosis in vocal fold paralysis

Synkinesis, or misdirected reinnervation, is likely a confounder when predicting return of function of an immobile vocal fold. Currently, no information exists on the incidence of synkinesis in unilateral vocal fold immobility (UVFI) or the effect synkinesis has on prognosis and treatment. Our objective was to examine a vocal fold adductor synkinesis screening protocol using diagnostic laryngeal electromyography (LEMG). We aim to determine the effect of synkinesis on prognosis of recovery of purposeful vocal fold motion.

Quantitative electromyography improves prediction in vocal fold paralysis

Quantitative laryngeal electromyography (LEMG) using turns analysis can differentiate acute vocal fold paralysis from normal controls. The objective of this study is to determine if using both traditional qualitative LEMG measurements in addition to turns analysis improves prognostic accuracy in patients with acute vocal fold paralysis who demonstrate voluntary motor activity.

Patient tolerance of awake, in‐office laryngeal procedures: A Multi‐Institutional Perspective

An increasing number of laryngeal procedures are performed in the office. However, little is known about how well these procedures are tolerated and what factors determine success or failure.

Voice Outcome following Acute Unilateral Vocal Fold Paralysis

Objectives: We assessed voice outcomes following unilateral vocal fold paralysis (UVFP). Methods: We performed a retrospective chart review of 72 patients with UVFP proven by laryngeal electromyography, including their Voice Handicap Index-10 (VHI-10) scores at presentation and at the study end point (at the return of vocal fold motion or before the decision regarding definitive treatment). Results: The average VHI-10 score on presentation was 26.9 of 40 (27.2 for patients who recovered motion and 26.7 for those who did not; p = 0.847). A recovery of vocal fold motion was experienced by 35% of patients, and 76.4% of patients underwent temporary vocal fold injection. For the patients who recovered motion, the average changes in VHI-10 score were −22.3 for those with injection and −11.4 for those without (p = 0.027). For patients without motion recovery, the average changes in VHI-10 score were −9.5 for those with injection and −0.8 for those without (p = 0.027). At the study end point, 84% of patients with return of motion had normal VHI-10 scores, in contrast to 21% of patients without motion recovery (p = 0.0009). Conclusions: A return of vocal fold motion is a vital determinant of voice outcome in patients with UVFP. However, despite recovery of vocal fold motion, 16% of patients in this study still had significant voice handicap. In contrast, 21% of patients without motion recovery had normal VHI-10 scores. This information can be used to counsel patients on voice outcome (precluding permanent treatment) with and without recovery of motion. There may be long-term voice benefit from early temporary vocal fold injection.

Prospective investigation of nimodipine for acute vocal fold paralysis

Introduction: Nimodipine has been shown to be beneficial for recovery from acute vocal fold paralysis (AVFP) in an animal model. Methods: prospective, open‐label trial of patients with AVFP was performed using nimodipine. Consecutive patients were evaluated and offered nimodipine therapy. Results: Fifty‐three patients were considered for treatment with nimodipine. Thirteen did not qualify for inclusion, 5 were lost to follow‐up, and 7 had side effects requiring cessation of treatment. Thus 28 patients (30 paralyzed vocal folds) were analyzed. Eighteen of the paralyzed vocal folds experienced recovery of purposeful motion (60%). Historical controls and laryngeal electromyography meta‐analysis suggest no more than a 20% recovery rate from AVFP. Conclusions: This open label study using nimodipine for treatment of AVFP demonstrates tripling of the recovery rate of vocal fold motion compared with historical controls. Further study in a randomized, controlled manner is warranted. Muscle Nerve 50: 114–118, 2014

Prevalence and risk factors for musculoskeletal problems associated with microlaryngeal surgery: a national survey.

Microlaryngeal surgery (MLS) presents ergonomic challenges to surgeons and potential risks for developing musculoskeletal symptoms (MSSx). This study describes prevalence and risk factors of MLS‐associated MSSx.

Frailty Measurements and Dysphagia in the Outpatient Setting

Objective: Deconditioning and frailty may contribute to dysphagia and aspiration. Early identification of patients at risk of aspiration is important. Aspiration prevention would lead to reduced morbidity and health care costs. We therefore wondered whether objective measurements of frailty could help identify patients at risk for dysphagia and aspiration. Methods: Consecutive patients (n = 183) were enrolled. Patient characteristics and objective measures of frailty were recorded prospectively. Variables tested included age, body mass index, grip strength, and 5 meter walk pace. Statistical analysis tested for association between these parameters and dysphagia or aspiration, diagnosed by instrumental swallowing examination. Results: Of variables tested for association with grip strength, only age category (P = .003) and ambulatory status (P < .001) were significantly associated with grip strength in linear regression models. Whereas walk speed was not associated with dysphagia or aspiration, ambulatory status was significantly associated with dysphagia and aspiration in multivariable model building. Conclusion: Nonambulatory status is a predictor of aspiration and should be included in risk assessments for dysphagia. The relationship between frailty and dysphagia deserves further investigation. Frailty assessments may help identify those at risk for complications of dysphagia.

Timing of nimodipine therapy for the treatment of vocal fold paralysis

To retrospectively determine optimal timing for initiation of nimodipine within a cohort of patients with acute vocal fold paralysis (VFP).

Prospective evaluation of the clinical utility of laryngeal electromyography.

To prospectively evaluate the clinical utility of laryngeal electromyography (LEMG)

Analysis of supraglottic activity during vocalization in healthy singers.

The present study aims to evaluate the degree of anterior–posterior and medial supraglottic laryngeal compression in healthy singers of different voice classifications while singing different pitches, loudness, and phonatory tasks.