Updates in neurolaryngology

Neurolaryngology is becoming increasingly important in the evaluation and management of patients with voice disorders. The field of neurolaryngology is no longer limited to the evaluation and treatment of patients with vocal cord paralysis and spasmodic dysphonia. This article reviews developments of the past year in the field of neurolaryngology, including the diagnosis of patients with vocal fold paresis, intraoperative monitoring techniques for laryngeal nerve preservation, and the current understanding of laryngeal muscle basic science, including age-related changes of the thyroarytenoid muscle. © 2001 Lippincott Williams & Wilkins, Inc

Perspectives on medialization laryngoplasty

Medialization laryngoplasty has become the new gold standard for the permanent management of patients with vocal fold paralysis and paresis. This article reviews the conceptual developments of the diagnosis and management of patients with vocal fold paresis and paralysis. We identify the specifics of operative decision-making as well as surgical complications associated with medialization laryngoplasty. The role of revision surgery is detailed. We suggest a standardized evaluation using both objective and subjective data for analysis of surgical outcomes

Intubation Related Vocal Cord Paresis: Outcomes from a Patient Cohort

Vocal cord paresis and paralysis are recognized complications of endotracheal intubation; the effects of such complications can range from quality of life changes such as effortful speaking, vocal fatigue, and loss of high register, to more severe outcomes like aspiration pneumonia and complete voice loss.1 62 patients were included in this study; each of these subjects was diagnosed with vocal fold paresis/paralysis based on five assessments: patient history, subjective rating scales, laryngeal examination, laryngeal electromyography (EMG), and acoustic/aerodynamic measures. Subjects were classified into four groups based on EMG interpretations of reinnervation or denervation: mixed, reinnervation, denervation, and none. The above groupings, plus the duration of time between the intubation date and EMG date, were combined to create a new definition of prognosis of each subject\u27s vocal cord paresis/paralysis. Using these criteria, a score was determined for each patient—a score closer to 2 indicated a good prognosis while a score closer to 0 indicated a poor prognosis. Data analysis was conducted on 3 tiers of patients. Our analyses of all patients showed that subjects less than or equal to 60 years of age had an average prognosis score of 1.21 while subjects above the age of 60 had a score of 0.79; the difference was statistically significant (p = 0.05). Hypertension was found to be the most common comorbidity seen in patients diagnosed with a post-intubation vocal cord paresis/paralysis. Results from the second tier of analysis showed that of all 38 patients for whom we had post-treatment data for, only 9 patients (24%) achieved complete resolution of their vocal cord paresis/paralysis (defined as a Glottal Function Index (GFI) of 7 or below and a physical exam score of 0). The average age of subjects that did and did not achieve complete resolution was 54.44 and 59.94 years, respectively. A chi-squared analysis assessing the relationship between age at intubation and outcomes showed no statistically significant differences (p = 0.05). We also found that patients with complete resolution of their vocal cord dysfunction had a post-treatment average GFI of 2.89, which was 4.77 points lower than the average GFI for patients without complete resolution. This difference was statistically significant at p = 0.05. Using the compiled data we were able to show how various cofactors can be used to determine both the initial prognosis and outcomes of the patients with post-intubation vocal cord paresis

Effects of botulinum toxin on pathophysiology in spasmodic dysphonia

To determine the mechanism of symptom relief with treatment by botulinum toxin injection in persons with adductor spasmodic dysphonia (ADSD), we evaluated the effects of unilateral thyroarytenoid muscle injections on both injected and noninjected muscles in 10 subjects with ADSD, using electromyography on both sides of the larynx before and after treatment. The subjects\u27 speech symptoms were reduced (p = .005) 2 weeks following injection, when the electromyographic study occurred. Muscle activation levels and the numbers of spasmodic muscle bursts decreased significantly (p ≤ .03) postinjection in both the injected and noninjected muscles. The reductions in laryngeal muscle bursts correlated with symptom reduction (r ≥ .7) in all muscles. Reductions in laryngeal muscle bursts did not relate to either absolute or normalized levels of muscle activity before or after botulinum toxin injection. The results suggest that changes in the central pathophysiology are responsible for changes in speech symptoms following treatment