VyVy N. Young

Analysis of laryngeal framework surgery: 10-year follow-up to a national survey.

Laryngeal framework surgery, including medialization laryngoplasty (ML) and arytenoid adduction (AA), are common treatments for vocal fold paralysis and glottal incompetence. Little information is known about the incidence of ML/AA surgery nationwide, in particular the success and complication rates.

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.

Arytenoid and posterior vocal fold surgery for bilateral vocal fold immobility.

Purpose of reviewMany procedures exist to address the airway restriction often seen with bilateral vocal fold immobility. We review the most recent studies involving arytenoid and/or posterior vocal fold surgery to provide an update on the issues related to these procedures. Specific focus is placed on selection of the surgical approach and operative side, use of adjunctive therapies, and outcome measures including decannulation rate, revision and complication rate, and postoperative results. Recent findingsTen studies were identified between 2004 and 2011. Modifications to the orginal transverse cordotomy and medial arytenoidectomy techniques continue to be investigated to seek improvement in dyspnea symptoms with minimal decline in voice and/or swallowing function. Decannulation rates for these approaches are high. Postoperative dysphagia appears to be less commonly observed but requires continued study. The use of mitomycin-C in these procedures has been poorly studied to date. SummaryBoth transverse cordotomy and medial arytenoidectomy procedures result in high success rates. However, many questions related to these procedures remain unanswered, particularly with respect to preoperative and postoperative evaluations of voice quality, swallowing function, and pulmonary status. There is need for rigorous prospective clinical studies to address these many issues further.

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

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).

Comparison of voice outcomes after trial and long‐term vocal fold augmentation in vocal fold atrophy

To compare voice outcomes after vocal fold augmentation using a trial (temporary) vocal fold injection (VFI) versus long‐term augmentation in patients diagnosed with vocal fold atrophy.

Prospective evaluation of the clinical utility of laryngeal electromyography.

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

Voice outcomes following treatment of benign midmembranous vocal fold lesions using a nomenclature paradigm.

Benign midmembranous vocal fold lesions (BMVFLs) are common voice disorders, but interpretation of outcomes following treatment is difficult due to the lack of a standardized nomenclature system for these lesions. Outcome results are increasingly important to third party payers. This study aimed to investigate the outcomes of patients with BMVFLs using a previously validated nomenclature, and to provide incidences and outcome results for each diagnosis.

Nomenclature proposal to describe vocal fold motion impairment

The terms used to describe vocal fold motion impairment are confusing and not standardized. This results in a failure to communicate accurately and to major limitations of interpreting research studies involving vocal fold impairment. We propose standard nomenclature for reporting vocal fold impairment. Overarching terms of vocal fold immobility and hypomobility are rigorously defined. This includes assessment techniques and inclusion and exclusion criteria for determining vocal fold immobility and hypomobility. In addition, criteria for use of the following terms have been outlined in detail: vocal fold paralysis, vocal fold paresis, vocal fold immobility/hypomobility associated with mechanical impairment of the crico-arytenoid joint and vocal fold immobility/hypomobility related to laryngeal malignant disease. This represents the first rigorously defined vocal fold motion impairment nomenclature system. This provides detailed definitions to the terms vocal fold paralysis and vocal fold paresis.