Medialization Thyroplasty and Arytenoid Adduction for Management of Neurological Vocal Fold Immobility.
Authors: Prasad VMN, Remacle M Abstract Vocal fold immobility can be either unilateral or bilateral and partial or complete. The aim of this chapter is to discuss the management of unilateral paresis using medialization thyroplasty with or without arytenoid adduction as a means of treating neurogenic causes as opposed to mechanical fixation. Medialization thyroplasty is an open surgical procedure that is performed under local or general anesthesia. Essentially, it aims to close the glottic gap, approximating both vocal folds together and thereby allowing for restoration of the efficiency of the larynx. The...
Source: Advances in Oto-Rhino-Laryngology - November 12, 2020 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Injection Laryngoplasty for Management of Neurological Vocal Fold Immobility.
Authors: Courey MS, Naunheim MR Abstract Injection laryngoplasty as used in this chapter is synonymous with the term "injection augmentation." Injection augmentation is a technique designed to enhance glottic closure in patients with glottic insufficiency, or failure of glottic closure, by injecting material into the lateral aspect of the vocal fold to move the vibrating surface to the midline. This type of injection augments the vocal fold and improves glottic closure. Injection augmentation originated over 100 years ago. However, the current indications, techniques, and materials have changed significant...
Source: Advances in Oto-Rhino-Laryngology - November 12, 2020 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Laryngeal Transplantation.
Authors: Bewley AF, Farwell DG Abstract Laryngeal transplantation offers the hope of replacing voice and laryngeal function in patients with debilitating laryngeal injuries or loss of the larynx from trauma or oncologic reasons. Our group at UC Davis performed a laryngotracheal transplantation, and our experience is reviewed in this chapter. The indications, challenges, and limitations of this procedure are highlighted, and the world's other published cases are reviewed. PMID: 33166969 [PubMed - in process] (Source: Advances in Oto-Rhino-Laryngology)
Source: Advances in Oto-Rhino-Laryngology - November 12, 2020 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Spasmodic Dysphonia.
Authors: Lin J, Sadoughi B Abstract Spasmodic dysphonia (SD) is a rare focal laryngeal dystonia. It is characterized by task-specific voice dysfluency resulting from selective intrinsic laryngeal musculature hyperfunction. Symptoms may be attenuated by a sensory trick. Although SD can be seen at times in generalized dystonia syndromes, it is typically a sporadic phenomenon. Involvement of the laryngeal adductor muscles is more common than abductor muscles. The standard treatment of this disorder is with botulinum toxin injection, usually electromyography-guided, which must be repeated periodically as the t...
Source: Advances in Oto-Rhino-Laryngology - November 12, 2020 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Vocal Fold Immobility: An Algorithm for Treating Glottal Insufficiency.
The objectives of this chapter are to discuss the factors involved in the decision-making algorithm of an appropriate intervention for glottal insufficiency. Management strategies not only depend on the etiology, history, symptoms, size of glottal gap on visualization, but also on patient goals and expectations. The goal of this chapter is to organize the management of glottal incompetence for patients and providers, supported by an evidence-based approach. PMID: 33166971 [PubMed - in process] (Source: Advances in Oto-Rhino-Laryngology)
Source: Advances in Oto-Rhino-Laryngology - November 12, 2020 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Laryngeal Synkinesis: A Viable Condition for Laryngeal Pacing.
Authors: Müller AH Abstract Laryngeal synkinesis as a form of defective healing is the rule rather than the exception in persistent vocal fold paralysis. It typically occurs 4-6 months after the onset of the recurrent laryngeal nerve paralysis. The incidence is up to 85%. Not all laryngeal muscles need to be equally affected. Reliable evidence can only be provided by a laryngeal electromyography. Physiological co-activation of the laryngeal muscles during antagonistic maneuvers must be considered. Although synkinesis undeniably worsens the prognosis for a motion recovery, it protects the muscle fibers fro...
Source: Advances in Oto-Rhino-Laryngology - November 12, 2020 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Addressing the Arytenoid in Paralytic Dysphonia Using the Adduction Arytenopexy.
Authors: Franco RA Abstract Adduction arytenopexy is a surgical procedure that allows the surgeon to position the arytenoid cartilage in a vocally favorable position with a suture. It is not needed in most cases of vocal paralysis when there is favorable synkinesis and good positioning of the arytenoid body. When there is a large posterior gap (intercartilaginous region), height discrepancy, or an anteriorly displaced arytenoid, adduction arytenopexy is used to suture the arytenoid cartilage into the posterior and medial aspect of the cricoarytenoid joint facet, bringing the medial bodies of the arytenoid ...
Source: Advances in Oto-Rhino-Laryngology - November 12, 2020 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Hidden Anatomy of Opera Singers.
Authors: Hînganu D, Hînganu MV Abstract The history of research on the voice of opera soloists shows that there are certain functional features of the cranial nerves and cortical nerve centers. In this chapter, we review the most important findings in the field of canto voice neuroanatomy, which we corroborate with the results of our team research and experience. Our study focuses on the nerve structures involved in phonation at each level of the vocal formants: infraglottic, glottic, and oropharyngeal. We consider this research to have direct applicability in the fields of neurolaryngology, neuroscience...
Source: Advances in Oto-Rhino-Laryngology - November 12, 2020 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Radiology in Neurolaryngology.
Authors: Qureshi S Abstract The role of imaging in assessment of neurolaryngology will predominantly involve the assessment of pathology along that of laryngeal nerve pathways. The anatomical pathways of the vagus and laryngeal nerves are well described in standard anatomical textbooks and will not be detailed here. Whilst there are 3 principle laryngeal nerves/branches, the recurrent laryngeal nerve will clearly constitute the mainstay of imaging input. This chapter will elaborate on the pathology encountered at the various levels and the imaging characteristics of these disorders. Prior to this, there wi...
Source: Advances in Oto-Rhino-Laryngology - November 12, 2020 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Acoustic Assessment.
Authors: Costello D Abstract In the setting of a voice clinic, the voice may be assessed in a number of different ways. As a bare minimum, assessment should include stroboscopic examination, patient self-reported questionnaires, and clinician-reported perceptual evaluation. In addition, recordings of the voice may be analyzed using computer software: several different measures exist, but the most widely used are jitter, shimmer, and noise-to-harmonic ratio. There are, however, significant limitations of these measures, including access to the equipment, inter-test reliability of the measurements, and a lac...
Source: Advances in Oto-Rhino-Laryngology - November 12, 2020 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Visual Neurolaryngology.
Authors: Thomas JP Abstract Visual diagnosis of laryngeal neurologic impairments is not only possible but is perhaps the most accurate method for evaluating the neurologic status of the upper airway. Precise assessments may lead to appropriate treatment without an EMG study. Principles of the neurolaryngology examination include: (1) each muscle has a single action; (2) that action can be elicited and to some degree isolated and visualized; (3) each muscle has an appropriate time to contract; (4) that timing can be compared to the opposite side; (5) inappropriate timing represents reinnervation; (6) inappr...
Source: Advances in Oto-Rhino-Laryngology - November 12, 2020 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Laryngeal Electromyography.
Authors: Volk GF, Guntinas-Lichius O Abstract Laryngeal electromyography (LEMG) is an important diagnostic and prognostic tool in neurolaryngology. This chapter presents the advances in LEMG in the last 5 years based on clinical trials. LEMG is in most cases an office-based procedure for decision making in neurolaryngology. When performed in a standardized way, LEMG helps to differentiate abnormal function of the vocal folds from nonorganic disorders. It is mainly used to confirm the diagnosis of vocal fold paralysis (VFP) and is less frequently used for the diagnosis of myopathies and motor neuron disorde...
Source: Advances in Oto-Rhino-Laryngology - November 12, 2020 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Objective Measures of Stroboscopy and High-Speed Video.
Authors: Woo P Abstract Videostroboscopy and high-speed imaging is now an accepted way to evaluate laryngeal function in patients with voice disorders. In patients with neurolaryngological diseases such as tremor, laryngeal spasm, and paralysis, having an objective way to evaluate vocal function is desirable. Using digital imaging and analysis, both the videostroboscopy and the high-speed video can be analyzed to obtain relevant measures of vocal function. From the videostroboscopy, the montage of the glottal cycle derived from steady of vocal vibration can be analyzed by using edge tracking software to ob...
Source: Advances in Oto-Rhino-Laryngology - November 12, 2020 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Neuromuscular Disease Affecting the Larynx.
Authors: Lau D Abstract Neuromuscular diseases (NMDs) are diseases involving the motor nuclei of the cranial nerves and anterior horn cells of the spinal cord, the peripheral nerves, the neuromuscular junction, and/or muscle itself. The following groups of disorders from the WHO International Classification of Diseases are usually included in the classification of NMDs: (1) Motor neuron diseases or related disorders; (2) Disorders of nerve root, plexus or peripheral nerves; (3) Diseases of neuromuscular junction or muscle. These diseases include myasthenia gravis or certain specified neuromuscular junction...
Source: Advances in Oto-Rhino-Laryngology - November 12, 2020 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Laryngeal Reinnervation: The History and Where We Stand Now.
Authors: van Lith-Bijl JT, Desuter GRR Abstract Injury to the recurrent laryngeal nerve (RLN) can result in impairment of all three laryngeal functions. The RLN is capable of regeneration, but laryngeal functions in cases of severe injury remain impaired. This permanent impairment is caused by either incomplete regeneration and/or occurrence of laryngeal synkinesis. Laryngeal reinnervation can be approached either nonselectively, focusing on nerve reconstruction, or selectively, focusing on separate target muscle reinnervation. Nonselective reinnervation comprises anastomosis to the mainstem of the RLN lea...
Source: Advances in Oto-Rhino-Laryngology - November 12, 2020 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research