Yong Tae Hong

The effect of total thyroidectomy on the speech production.

Objectives Voice and speech alternations that can occur after total thyroidectomy are usually due to recurrent or superior laryngeal nerve injury. These alterations may also be associated with other extralaryngeal factors, such as neck muscle dysfunction and scar contracture of the neck. We performed a prospective acoustic analysis on speech changes after surgery, in the absence of laryngeal nerve injury. Methods Patients aged 19 to 58 years undergoing total thyroidectomy, in the absence of laryngeal/pulmonary disease, previous neck surgery, or other malignant diseases, were recruited prospectively. For the running speech analysis, the speaking fundamental frequencies (SFo), range of SFo and speaking intensity were evaluated before surgery, 7 days, and 1 and 3 months after surgery. For consonant analysis, the acoustic distinctions of stop consonant, the voice onset time (VOT), vowel duration and closure duration were evaluated at the same periods. Results SFo and range of SFo were specifically diminished after surgery, while speaking intensities were not changed significantly after surgery. The thyroidectomized speakers displayed systematically varied VOT for the consonant production, which was phonetically representative. However, VOT after surgery could be longer in the strong aspirated and glottalized stops, but not in the lax stop than before surgery. The vowel and closure durations were not affected before and after surgery. Conclusion Patients with thyroidectomy have some difficulty of pitch control and consonant articulation during speaking. VOT is also one of the meaningful acoustic parameters and provide a reference for comparing acoustic measures before and after thyroidectomy.

Sternohyoid muscle syndrome

OBJECTIVES Patients presenting with neck mass are challenging for many otolaryngologists. If a mass on the lower lateral neck exists with swallowing and disappears after swallowing, it has been diagnosed as an omohyoid syndrome in most literature. The mechanism of sternohyoid syndrome has not been proven or investigated before. We investigated sternohyoid syndrome, commonly misdiagnosed as an omohyoid syndrome. METHODS AND PATIENTS Two patients were investigated. Outpatient photography, computed tomography and operating findings were reviewed. We found that the sternohyoid muscle was inserted at an abnormal site, the midportion of the clavicle. There was no abnormality of other muscles. We also reviewed all literature that previously diagnosed this condition as an omohyoid syndrome. RESULTS There was no literature about sternohyoid syndrome. We found that the abnormal muscle is a sternohyoid muscle and not omohyoid muscle. The color of the left sternohyoid muscle was dark red, and the fascia covering the muscle was denuded. The muscle had lost elasticity and moved abnormally. CONCLUSION Our patients did not have omohyoid syndrome. The symptoms of omohyoid syndrome are the same as sternohyoid syndrome but the problematic muscle is different. This is the first known report diagnosing sternohyoid syndrome, and should be a consideration in the diagnosis of a lateral neck mass.

The effects of dynamic laryngeal movements on pitch control.

BACKGROUND AND OBJECTIVES Extralaryngeal structures have been known to not only play an important role in swallowing, but also have a significant influence on the voice during phonation. The aim of this study is to evaluate the effect of dynamic laryngeal movements on pitch control. SUBJECTS AND METHODS Videofluoroscopic examinations were analyzed. To accurately analyze the sequence of these movements, the recorded images were digitized using a computer program. The moving distances of the hyoid bone, thyroid cartilage, and cricoid cartilage were analyzed, and they were compared to the cricothyroid distance during pitch elevation. RESULTS The vertical movements of the hyoid bone, and cricoid and thyroid cartilages had an impact on the increase in the pitch with a decrease in the cricothyroid distance. All Ad-R(2) values for distance of the hyoid bone, and cricoid and thyroid cartilages were above 0.9, which showed a higher explanatory power than the cricothyroid distance, showing an Ad-R(2) value of 0.4. CONCLUSIONS Upward movements of the larynx had a more dominant effect on pitch elevation than the cricothyroid distance. We suspect that the pitch is more affected by the antero-vertical movements of the larynx than the horizontal movement by cricothyroid muscle in human study.

Sequential occurrence of diffuse large B-cell lymphoma and carcinoma in the nasopharynx: A case report

Background: The sequential occurrence of the 2 malignancies development of nasopharyngeal carcinoma (NPC) and lymphoma is extremely rare and their coexistence raises the question of a common etiologic factor. Clinical findings/clinical concerns: A 71-year-old previously healthy man presented with diffuse large B-cell lymphoma (BCL) followed by NPC almost 2 years later with Epstein–Barr virus (EBV) positive. Diagnosis: Endoscopic examination characterized a fixed, hard and nontender mass in the nasopharynx and biopsies were done. Intervention: A patient successfully underwent chemotherapy for lymphoma and chemoradiation for carcinoma sequentially. Outcomes: He was followed up every 3 months for 1 year with endoscopic and radiological examinations. The nasopharynx mass was completely resolved after chemoradiation therapy. Conclusion: The presentation with diffuse large B-cell lymphoma (BCL) and NPC in this patient was perhaps caused by dual EBV infection or a different oncogenic mechanism.

Characteristics of speech production in patients with T1 glottic cancer who underwent laser cordectomy or radiotherapy

Abstract Purpose: Laser cordectomy (LC) or radiotherapy (RT) is often recommended in the early stage of laryngeal cancer. We conducted perceptual and acoustic analysis to compare sustained vowel and stop consonants since there is no article evaluating both the sustained vowel and stop consonants. Eventually, we might determine which management is superior in terms of speech production. Subjects and methods: A total of 28 patients who underwent LC and RT for early T1 glottic cancer were selected. The sustained vowel /a/ and bilabial stop consonants were used to assess the perceptual scores. The fundamental frequency (Fo), jitter, shimmer and noise-to-harmonic ratio (NHR) levels for sustained vowels were evaluated. Voice onset time (VOT), vowel duration (VD) and closure duration of the bilabial plosives were analyzed. A receiver operating characteristic curve analysis was used to evaluate significant results statistically. Results: The GRBAS and discrimination scores were not significantly different between two groups. Fo and jitter were significantly higher in the LC than RT. The cut-off value was statistically higher in the LC group and statistically lower in the RT group. The VOT was significantly longer in the LC than RT. The cut-off value of the /pipida/ VOT was statistically longer in the LC group and statistically shorter in the RT group. Conclusions: The differences may have been due to muscular fibrosis after RT. Movements of vocal cords with fibrosis were sluggish, when impulsion developed to pronounce the initial /p/ sound, so the VOT was shortened and the VD was longer after RT.

The Relationship Between the Non-recurrent Laryngeal Nerve and the Inferior Thyroid Artery

The non-recurrent inferior laryngeal nerve (NRLN) represents a risk factor for nerve injury during thyroid surgery. The aim of this study is to investigate the traveling patterns of NRLNs and its relationships to inferior thyroid arteries (ITAs). We had 11 patients showing NRLNs on the right side who underwent thyroidectomies. The NRLNs were classified into four different types, according to the traveling patterns. We evaluated the anatomical position of the ITA as follows: (1) three types according to the joint location with the thyroid gland; and (2) three types according to the level of the retro-esophageal subclavian artery (RSA). The traveling patterns of NRLN could be classified into four types, descending, vertical, ascending, and V-shaped. ITA was joined variably with the thyroid gland on the superior, middle, and inferior positions. The levels of the RSA were also located at different positions, the first thoracic vertebra, the second vertebra, and the third vertebra. During thyroid surgery, the surgeon must be aware of the existence of anatomical variations of NRLNs and ITAs. The anatomy of the NRLN and the ITA are frequently irregular, and there is no correlation between the traveling pattern of NRLN and the level of the RSA.

Identification of lymphatic channels in the tracheoesophageal groove during central neck dissection for thyroid cancer

Chyle leakage after central neck dissection for thyroid carcinoma is an extremely rare condition. We investigated chyle leakage in patients with thyroidectomy and central neck dissection.

A case of interdigitating dendritic cell sarcoma studied by whole-exome sequencing

Interdigitating dendritic cell sarcoma (IDCS) is an aggressive neoplasm and is an extremely rare disease, with a challenging diagnosis. Etiology of IDCS is also unknown and most studies with only case reports. In our case, immunohistochemistry showed that the tumor cells were positive for S100, CD45, and CD68, but negative for CD1a and CD21. This study aimed to investigate the causative factors of IDCS by sequencing the protein-coding regions of IDCS. We performed whole-exome sequencing with genomic DNA from blood and sarcoma tissue of the IDCS patient using the Illumina Hiseq 2500 platform. After that, we conducted Sanger sequencing for validation of sarcoma-specific variants and gene ontology analysis using DAVID bioinformatics resources. Through comparing sequencing data of sarcoma with normal blood, we obtained 15 nonsynonymous single nucleotide polymorphisms (SNPs) as sarcoma-specific variants. Although the 15 SNPs were not validated by Sanger sequencing due to tumor heterogeneity and low sensitivity of Sanger sequencing, we examined the function of the genes in which each SNP is located. Based on previous studies and gene ontology database, we found that POLQ encoding DNA polymerase theta enzyme and FNIP1 encoding tumor suppressor folliculin-interacting protein might have contributed to the IDCS. Our study provides potential causative genetic factors of IDCS and plays a role in advancing the understanding of IDCS pathogenesis.

Primary Carcinosarcoma of the Parotid Gland Mimicking as Parotid Abscess With Deep Neck Infection

Abstract Carcinosarcoma, true malignant mixed tumor, of the parotid is an extremely rare tumor. Pathologically, it is composed of malignant epithelial and malignant mesenchymal elements. The carcinosarcoma of the salivary glands comprised only 0.04% to 0.16% of all malignant salivary tumors with 65% occurring in the parotid gland. This tumor has an aggressive characteristic and is often regarded as a high-grade tumor with distant metastasis occurring in 54% of the patients. Patients usually present between 60 and 65 years of age and most series report no sex predominance. Radiologically, this tumor has a low attenuation center with a thick-enhancing wall and can be misdiagnosed deep neck infection in the parapharyngeal space. In this report, the authors report a patient of true malignant mixed tumor of the parotid gland mimicking as deep neck infection. Radiologic and histologic features including immunohistochemical results are discussed.Carcinosarcoma, true malignant mixed tumor, of the parotid is an extremely rare tumor. Pathologically, it is composed of malignant epithelial and malignant mesenchymal elements. The carcinosarcoma of the salivary glands comprised only 0.04% to 0.16% of all malignant salivary tumors with 65% occurring in the parotid gland. This tumor has an aggressive characteristic and is often regarded as a high-grade tumor with distant metastasis occurring in 54% of the patients. Patients usually present between 60 and 65 years of age and most series report no sex predominance. Radiologically, this tumor has a low attenuation center with a thick-enhancing wall and can be misdiagnosed deep neck infection in the parapharyngeal space. In this report, the authors report a patient of true malignant mixed tumor of the parotid gland mimicking as deep neck infection. Radiologic and histologic features including immunohistochemical results are discussed.

The Phonetic Characteristics in Patients of Bilateral Vocal Fold Paralysis Without Tracheotomy

Objectives Patients with bilateral vocal fold paralysis (BVFP) theoretically have difficulty producing voiceless consonants. However, perceptual studies have revealed clear production of voiceless consonants with good articulation scores in nontracheostomized patients. The purpose of this study was to clarify the production of voiceless stops during articulation in patients with BVFP compared to normal speakers. Methods The perceptual, acoustic, and aerodynamic characteristics of patients with BVFP and those with normal speech were investigated with special reference to voiceless stop consonants. Test words were prepared to place the stop consonants in different phonological environments, and were all nonsense words. Results The patients with BVFP perceptually produced the three types of stops successfully. However, they acoustically varied voice onset time to produce phonetically representative stops but decreased voice onset time of /ph/ and /p/ compared to those of normal speakers. These patients may properly control air pressure to produce the three types of stop consonants similar to normal speakers. Conclusion The patients with BVFP realized the distinctions between the three types of stops similar to the normal speakers. Although vocal mobility was absent in the patients with BVFP, voice onset time, vowel duration, closure duration, and air pressure were similar to those of normal speakers.