Robert T. Sataloff

Laryngopharyngeal reflux: Consensus conference report

On September 16, 1995, a consensus conference was convened in New Orleans, Louisiana, to consider laryngopharyngeal reflux (LPR) and other extraesophageal manifestations of reflux disease. Participants included specialists in otolaryngology, gastroenterology, and pulmonary medicine,* and the conference was supported by Astra Merck. This document summarizes the opinions reached by consensus during the conference.

Vocal fold scarring: current concepts and management.

Scarring of the vocal folds can occur as the result of blunt laryngeal trauma or, more commonly, as the result of surgical, iatrogenic injury after excision or removal of vocal fold lesions. The scarring results in replacement of healthy tissue by fibrous tissue and can irrevocably alter vocal fold function and lead to a decreased or absent vocal fold mucosal wave. The assessment and treatment of persistent dysphonia in patients with vocal fold scarring presents both diagnostic and therapeutic challenges to the voice treatment team. The common causes of vocal fold scarring are described, and prevention of vocal fold injury during removal of vocal fold lesions is stressed. The anatomic and histologic basis for the subsequent alterations in voice production and contemporary modalities for clinical and objective assessment will be discussed. Treatment options will be reviewed, including nonsurgical treatment and voice therapy, collagen injection, fat augmentation, endoscopic laryngoplasty, and Silastic medialization.

Lipoinjection for unilateral vocal cord paralysis.

Injection of Teflon® paste is a commonly accepted procedure to improve the caliber of voice in unilateral vocal cord paralysis. There are several drawbacks to Teflon injection, among them respiratory obstruction (from overinjected Teflon) and unsatisfactory voice quality (Teflon causes stiffness of the vocal folds).

Scope of practice.

Family physicians are trained broadly to provide the majority of health care for patients of all ages and conditions. While providing such a wide range of care remains at the heart of the specialty, the scope of practice of many family physicians has been shrinking. Some believe that a broad scope of practice is becoming more of an ideal than a reality. Despite these changes, family medicine residency training requirements specify that “teaching and role-modeling by family physician faculty” should cover the full spectrum of care. Further, each program must have at least one family physician faculty member who is engaged in obstetrical practice and can supervise and role model this service to residents. However, no specific requirements exist for faculty to role model home visits, nursing home care, or many of the other services traditionally provided by family physicians.

Recurrent laryngeal nerve monitoring versus identification alone on post-thyroidectomy true vocal fold palsy: a meta-analysis.

To compare by meta‐analysis the effect of recurrent laryngeal nerve (RLN) monitoring versus RLN identification alone on true vocal fold palsy rates after thyroidectomy.

Strobovideolaryngoscopy: Results and Clinical Value

Strobovideolaryngoscopy is a valuable addition to the diagnostic armamentarium because it allows the otolaryngologist to perform a detailed physical examination of the vibratory margin of the vocal fold. From 1985 through 1989, we performed 1,876 strobovideolaryngoscopy procedures, the majority on professional voice users. Previously, we reported findings on our first 486 strobovideolaryngoscopy procedures. Stroboscopic information influenced diagnosis or treatment in approximately one third. The present study was undertaken to determine whether additional experience had altered the clinical usefulness of the procedure. Diagnoses were noted before and after stroboscopy prospectively for 377 strobovideolaryngoscopy procedures performed during the calendar year 1989. In 53% of the procedures, strobovideolaryngoscopy resulted in no change in diagnosis. In 29%, preprocedure impressions were confirmed and additional diagnoses were made. In 18%, preprocedure diagnoses were found to be incorrect. The procedure has proven very helpful in caring for voice patients, modifying diagnoses in 47%, and confirming uncertain diagnoses in many of the other patients studied.

Cepstral Peak Prominence: A More Reliable Measure of Dysphonia

Quantification of perceptual voice characteristics allows the assessment of voice changes. Acoustic measures of jitter, shimmer, and noise-to-harmonic ratio (NHR) are often unreliable. Measures of cepstral peak prominence (CPP) may be more reliable predictors of dysphonia. Trained listeners analyzed voice samples from 281 patients. The NHR, amplitude perturbation quotient, smoothed pitch perturbation quotient, percent jitter, and CPP were obtained from sustained vowel phonation, and the CPP was obtained from running speech. For the first time, normal and abnormal values of CPP were defined, and they were compared with other acoustic measures used to predict dysphonia. The CPP for running speech is a good predictor and a more reliable measure of dysphonia than are acoustic measures of jitter, shimmer, and NHR.

Arytenoid dislocation: Diagnosis and treatment

Disruption of the cricoarytenoid joint is a relatively uncommon event, according to the world literature. Only 31 reported cases of arytenoid dislocation or subluxation exist other than the 26 cases described in this paper. Often cases are misdiagnosed as vocal fold paralysis. Knowledge of the signs and symptoms of arytenoid dislocation aids in correct diagnosis and early treatment. Even when diagnosis has been delayed, surgery may be highly effective. Familiarity with state‐of‐the‐art diagnostic techniques and new concepts in management helps optimize the chances for good voice quality.

The aging adult voice

Advancing age produces physiologic changes that may alter voice. Some of these changes are inevitable; others may be avoidable or reversible. In addition, many treatable medical conditions may cause voice changes similar to those of aging. It is essential that all voice care providers be familiar with the expected changes of aging, and be alert to reversible conditions that may adversely affect phonation and be mistaken for presbyphonia.

Autologous fat implantation for vocal fold scar: a preliminary report.

New insights into the anatomy and physiology of phonation, along with technological advances in voice assessment and quantification, have led to dramatic improvements in medical voice care. Techniques to prevent vocal fold scar have been among the most important, especially scarring and hoarseness associated with voice surgery. Nevertheless, dysphonia due to vocal fold scar is still encountered all too frequently. Although it is not generally possible to restore such injured voices to normal, patients with scar-induced dysphonia can usually be helped. Voice improvement is optimized through a team approach. Treatment may include sophisticated voice therapy and vocal fold surgery. Although experience with collagen injection has been encouraging in selected cases (particularly in those involving limited areas of vocal fold scar), there is no consistently successful surgical technique. Attempts to treat massive vocal fold scar, such as may be seen following vocal fold stripping, have been particularly unsuccessful. This paper reports preliminary experience with the implantation of autologous fat into the vibratory margin of the vocal fold of patients with severe, extensive scarring. Using this technique, it appears possible to recreate a mucosal wave and improve voice quality. Additional research is needed.