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The spectrum of voice disorders – presentation
Published in Stephanie Martin, Working with Voice Disorders, 2020
Vocal fold paresis and paralysis comprise a range from mild to severe of abnormal laryngeal muscle function. Paresis can easily be missed as the patient may experience only a very mild vocal fatigue at the end of the day. On videostroboscopy, the affected fold will be seen to be lacking in tension and to have no mucosal wave. The position of the vocal fold may vary. If the paralysed fold is fixed in the paramedian position (in adduction), respiration may be disturbed but voice may be only slightly impaired. In bilateral adductor paralysis, there may be severe dyspnoea but almost normal phonation. Conversely, if the paralysis results in the intermediate position, the effects on voice are profound, with phonatory loss, breathy voice and disturbance of normal breathing patterns during attempted phonation. In vocal fold paralysis normal coughing may be disturbed. There may be a reduction in contact and glottal closure and some patients may report a degree of dysphagia.
Laryngeal tumours
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Philip Touska, Steve Connor, Robert Hermans
In addition to the features of vocal cord paresis, it is important to be aware of treatment modalities used which can potentially create a pseudolesion on imaging if the reader is unaware of their appearances. A wide range of surgical treatments exist to restore glottic closure, including vocal fold injections and implants, for example, methylcellulose, bovine collagen, calcium hydroxylapatite, Teflon, and silicone (Figure 3.43). These may appear as paraglottic densities, simulating enhancement (126,127).
Converting a total disc replacement to an ACDF
Published in Gregory D. Schroeder, Ali A. Baaj, Alexander R. Vaccaro, Revision Spine Surgery, 2019
Joseph D. Smucker, Rick C. Sasso
An anterior surgical approach to the cervical spine is taken consistent with a Smith-Robinson technique. Utilization of the former skin incision or a same-side surgical approach as the index procedure is considered when issues related to existing unilateral vocal cord paresis are identified. A contralateral approach has some advantages, including the presence of native tissue with fewer concerns for scarring related to the former index approach. Careful soft-tissue manipulation is considered as the dissection to the prevertebral spaces ensues. The arthroplasty device may be further identified via palpation and imaging during the approach. The entire arthroplasty device is exposed anteriorly, including the adjacent vertebrae. Placement of Caspar pins in the vertebrae adjacent to the arthroplasty device may allow device manipulation, exposure, and further removal. A device with presurgical loosening may be carefully removed following removal of the primary fixation device fixation method (screws) utilizing the implantation tools provided by the manufacturer or other surgical instrumentation that allows for a firm grasp of the device. In some circumstances, the device may not be removed as a single implant, but in parts.
Patient reported voice handicap and auditory-perceptual voice assessment outcomes in patients with COVID-19
Published in Logopedics Phoniatrics Vocology, 2023
Emel Tahir, Esra Kavaz, Senem Çengel Kurnaz, Fatih Temoçin, Aynur Atilla
Nonetheless, the infection can also have a significant impact on the upper airway [2]. Olfactory and taste dysfunctions, in particular, have been widely described as characteristic and early signs of COVID-19. Patients infected with COVID-19 may experience typical and non-specific upper airway infection symptoms such as rhinorrhea, nasal congestion, and symptoms due to laryngeal involvement in the inflammatory process [3]. Dysphonia be caused by anything that restricts the vocal chords from vibrating normally, such as edema or inflammation. The most common cause of dysphonia is acute laryngitis prompted by an upper respiratory tract infection [3,4]. Dysphonia has previously been reported in 26.8% of patients with mild-to-moderate COVID-19 [4]. The occurrence of dysphonia with upper respiratory infections is well described in the literature. Also, it is a known fact that viral pathogens may cause vagal neuropathy and vocal cord paralysis [5]. A vagal neuropathy that results in vocal fold paresis or paralysis can impair voice quality due to paradoxical vocal fold movement, persistent coughing, laryngeal paresthesia, laryngospasm, and vocal fatigue. COVID-19 affects the same systems and structures used for voice production; therefore, it may decrease voice quality [4,5].
Diagnostic vocal fold injection as an intervention for secondary muscle tension dysphonia
Published in Hearing, Balance and Communication, 2021
Christopher D. Dwyer, Thomas L. Carroll
The diagnosis of vocal fold paresis remains a recognised challenge, even among experienced, fellowship trained laryngologists. It is an increasingly reported diagnosis in laryngology, but there remain inconsistencies in the objective laryngoscopic/stroboscopic findings and sidedness of the paresis [15]. The most commonly reported factors suggestive of paresis include vocal fold motion abnormalities in both adductor and abductor tasks, and diadochokinesis (rapid alternating movement while patient repeats i/hi/i/hi/i/hi). Additionally, vocal fold degeneration (hemilaryngeal atrophy or reduced tone seen as ‘bowing’) and mucosal wave abnormalities have also been considered paresis clues [16]. Contralateral false vocal fold hyperfunction is reported [17]. Findings of an increased amplitude or an asynchronous ‘chasing wave’ may be seen. Most laryngologists agree that they can identify if a paresis is present, however the sidedness is not guaranteed. Laryngeal electromyography may improve the diagnostic acumen of side involved, however, itself being a qualitative tool, has its limitations [17,18].
Single-session high-intensity focused ultrasound (HIFU) ablation for benign thyroid nodules: a systematic review
Published in Expert Review of Medical Devices, 2020
Eleftherios Spartalis, Sotirios P. Karagiannis, Nikolaos Plakopitis, Maria Anna Theodori, Dimosthenis Chrysikos, Stavroula A. Paschou, Georgios Boutzios, Dimitrios Schizas, Michael Spartalis, Theodore Troupis, Nikolaos Nikiteas
HIFU has been proven to be a relatively safe technique. There is no evidence that it causes any kind of alteration in the thyroid gland function [35,36]. Pain is the most commonly observed side effect, but in most cases, it is described as mild. It seems that younger patients tend to experience more pain than older ones since they metabolize the anesthetic drugs at a higher rate [37]. It has been noted that perithyroidal lignocaine infusion (PLI) is significantly associated with less pain during the HIFU ablation [37]. The most serious, but thankfully, temporary complication occurring after treatment, is vocal cord paresis (VCP) [38]. The data presented by Lang et al [38] suggest that risk for VCP is proportional to the distance of the nodule from the ipsilateral tracheo-esophageal groove (TEG) [38]. It is believed that damage to the recurrent laryngeal nerve is caused by the high temperatures produced by the US beam. As far as safe distances from neighboring tissues are concerned, it appears that a distance of more than 1.1 cm from the TEG, more than 0.3 cm from the trachea, and more than 0.2 cm from the carotid artery would lower the risk of damage on each one of them respectively [38]. Finally, it has been shown that HIFU ablation may cause hematomas. Since there is an increasing number of people under antiplatelet and anticoagulation therapy, it is important to note that HIFU appears to be safe and efficacious for patients who continue their therapy, although further studies need to be conducted [39].