Lucian Sulica

Current practice in injection augmentation of the vocal folds: Indications, treatment principles, techniques, and complications

To identify contemporary indications, treatment principles, technique, injection materials, complications, and success rates of vocal fold injection augmentation.

Recommendations of the Neurolaryngology Study Group on laryngeal electromyography

The Neurolaryngology Study Group convened a multidisciplinary panel of experts in neuromuscular physiology, electromyography, physical medicine and rehabilitation, neurology, and laryngology to meet with interested members from the American Academy of Otolaryngology Head and Neck Surgery, the Neurolaryngology Subcommittee and the Neurolaryngology Study Group to address the use of laryngeal electromyography (LEMG) for electrodiagnosis of laryngeal disorders. The panel addressed the use of LEMG for: 1) diagnosis of vocal fold paresis, 2) best practice application of equipment and techniques for LEMG, 3) estimation of time of injury and prediction of recovery of neural injuries, 4) diagnosis of neuromuscular diseases of the laryngeal muscles, and, 5) differentiation between central nervous system and behaviorally based laryngeal disorders. The panel also addressed establishing standardized techniques and methods for future assessment of LEMG sensitivity, specificity and reliability for identification, assessment and prognosis of neurolaryngeal disorders. Previously an evidence-based review of the clinical utility of LEMG published in 2004 only found evidence supported that LEMG was possibly useful for guiding injections of botulinum toxin into the laryngeal muscles. An updated traditional/narrative literature review and expert opinions were used to direct discussion and format conclusions. In current clinical practice, LEMG is a qualitative and not a quantitative examination. Specific recommendations were made to standardize electrode types, muscles to be sampled, sampling techniques, and reporting requirements. Prospective studies are needed to determine the clinical utility of LEMG. Use of the standardized methods and reporting will support future studies correlating electro-diagnostic findings with voice and upper airway function.

Clinical characteristics of essential voice tremor: a study of 34 cases.

To describe and characterize essential voice tremor, including signs, symptoms, and severity, and its relation to other manifestations of essential tremor. Description of aspects of treatment is a secondary goal.

Management of Benign Vocal Fold Lesions: A Survey of Current Opinion and Practice

Empirical data are often not available to guide clinical practices in the treatment of benign mucosal lesions of the vocal folds. The purpose of this report is to describe opinions and practices in order to identify areas of consensus and discrepancy and thus guide future inquiry. A 16-item survey mailed to all active US members of the American Academy of Otolaryngology—Head and Neck Surgery (n = 7,321) included questions on the use of voice therapy; diagnostic testing; perioperative use of steroids, antibiotics, and antireflux medications; and use of lasers. Responses used a Likert 5-point scale with end anchors of 1 equaling “never” and 5 equaling “always” and were stratified according to lesion (nodules, polyps, cysts). A 16.5% response rate (n = 1,208) was obtained. A lack of consensus was most evident in the use of voice therapy for lesions other than nodules; antireflux medication; and intravenous steroids. Disagreement was also noted regarding the use of lasers, oral steroids, and antibiotics. Other than voice therapy as initial intervention for nodules, no statistically significant differences by lesion type exist regarding use of voice therapy, laser, or any medication. Prospective clinical trials addressing voice therapy, antireflux medications, steroids, and antibiotics are needed to inform clinical practice. Furthermore, treatment practices appear to be largely independent of lesion type. Therefore, traditional diagnostic categories do not seem to be useful guides to treatment, and may need to be reevaluated in light of improvements in diagnostic technology and surgical technique.

The Natural History of Idiopathic Unilateral Vocal Fold Paralysis : Evidence and Problems

Objectives/Hypothesis: To identify clinical evidence regarding outcome and duration of unilateral idiopathic vocal fold paralysis (IVFP).

Advances in office-based diagnosis and treatment in laryngology.

No abtracts.

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).

Vocal fold paresis: evidence and controversies.

Purpose of reviewTo present and assess the current state of knowledge regarding vocal fold paresis. Recent findingsNeurogenic compromise of vocal fold function exists along a continuum encompassing partial denervation (paresis), complete denervation (paralysis), and variable degrees and patterns of reinnervation. Not abundantly recognized clinically until recently, paresis typically presents with symptoms of glottic insufficiency. As a result of preserved vocal fold mobility, paresis can be difficult to diagnose and to distinguish from innocent vocal fold asymmetry. Laryngoscopy alone has proved an unreliable means of diagnosis, and laryngeal electromyography, although not immune to error itself, is often helpful. Treatment consists of medialization procedures that do not compromise remaining nerve function. Significant disagreement exists regarding the incidence, causes and relationship to other pathologies. In the absence of evidence, natural history must be inferred. SummaryVocal fold paresis is probably a significant source of vocal disability, especially among cases that have eluded straightforward diagnosis. An accurate assessment of its clinical impact, patterns of dysfunction, natural history and relationship to other pathologies depends on diagnostic rigor and accuracy and is still evolving.

Voice Rest after Microlaryngoscopy: Current Opinion and Practice

Objective Although voice rest is often recommended after excision of benign mucosal vocal fold lesions, no standard of care exists regarding the use, duration, or extent of vocal restrictions. This prospective study is intended to explore current opinions and practices of otolaryngologists regarding the use of complete and relative voice rest.

Vocal fold paralysis

Bilateral vocal fold paralysis is usually idiopathic. In certain cases, paralysis may occur secondary to central neuromuscular immaturity. Paralysis may also occur because of lesions in the central nervous system, including Arnold-Chiari malformation, cerebral palsy, hydrocephalus, myelomeningocele, spina bifida, hypoxia, or hemorrhage. Birth trauma that causes excessive strain to the cervical spine may cause transient bilateral vocal fold paralysis lasting 6-9 months. Unilateral paralysis is usually idiopathic but may be secondary to peripheral nerve pathology. Birth trauma causing traction injuries to the recurrent laryngeal nerve may be responsible for a number of cases. Lesions in the mediastinum, such as tumors or vascular malformations, may cause unilateral vocal fold paralysis. Iatrogenic injury to the left recurrent laryngeal nerve can occur during surgery for cardiovascular anomalies or tracheoesophageal fistulas or during neck surgery. Clinical presentation