Improved Glottic Exposure for Robotic Microlaryngeal Surgery: A Case Series

Publication date: Available online 18 March 2017
Source:Journal of Voice
Author(s): Dehra A. McGuire, Jennifer P. Rodney, Nilesh R. Vasan
Robotic surgery has become the standard of care for many procedures outside of otolaryngology and now is gaining momentum within our specialty. The da Vinci (Intuitive Surgical, Sunnyvale, CA) robot has several advantages to human hands, including removal of tremor and better access to lesions because of increased degree of movement of the articulated instruments. The glottis has rarely been addressed using robotic surgery because access was previously thought to be difficult because of the limitations of currently used retractors, which include poor base of tongue and oral commissure retraction resulting in lack of exposure of the glottis in many patients and lack of space for the robotic instruments to occupy. We present a case series using the Modular Oral Retractor (MOR) system to show that the glottic larynx can be accessed by the da Vinci instrumentation. The MOR system provides better exposure of the anterior commissure and by using oral commissure retraction provides excellent space for the robotic arms to work. The MOR system potentially makes robotic microlaryngeal surgery more feasible for the otolaryngology-head and neck surgeon.



from #Audiology via xlomafota13 on Inoreader http://ift.tt/2mGzImI
via IFTTT

Clinical Significance of Contralateral Reactive Lesion in Vocal Fold Polyp and Cyst

Publication date: Available online 18 March 2017
Source:Journal of Voice
Author(s): Jung-Hae Cho, Yong-Sug Choi, Young-Hoon Joo, Young-Hak Park, Dong-Il Sun
ObjectiveWe investigated the clinical significance of contralateral reactive lesions in patients undergoing laryngeal microsurgery for benign vocal fold lesions such as vocal polyps and cysts.Study DesignThis was a retrospective, single institution cohort study.MethodsPatient medical records were reviewed for demographic characteristics; acoustic, aerodynamic, and perceptual analyses; and Voice Handicap Index score before and after laryngeal microsurgery. Definitive diagnoses were made via intraoperative microlaryngoscopic evaluations. Clinical parameters were assessed to identify risk factors for contralateral reactive lesions. We evaluated surgical outcome using voice analysis.ResultsWe enrolled 268 patients (109 men and 159 women) with benign vocal fold lesions. A total of 195 (72.8%) had a contralateral reactive vocal fold lesion. A multivariable analysis revealed that being a never smoker and having a hoarseness duration ≥6 months, vocal polyps, and small primary lesions were independent risk factors for contralateral reactive lesions (P < 0.05). The preoperative perceptual evaluation and maximum phonation time were significantly worse in patients with a contralateral reactive lesion than in those without one (P = 0.014, P = 0.004, respectively). The voice parameters in patients who underwent excision of the contralateral reactive lesion were generally better than those who received conservative treatment, particularly the noise-to-harmonic ratio (P = 0.004).ConclusionsContralateral reactive vocal fold lesions are frequently detected in patients with vocal polyp and cyst. The reactive lesions had an adverse effect on voice quality. Simultaneous excision of primary and contralateral reactive lesions may be an alternative treatment for better voice outcome.



from #Audiology via xlomafota13 on Inoreader http://ift.tt/2nkCoK8
via IFTTT

Relationship Between Laryngeal Electromyography and Video Laryngostroboscopy in Vocal Fold Paralysis

Publication date: Available online 17 March 2017
Source:Journal of Voice
Author(s): Joel A. Maamary, Ian Cole, Paul Darveniza, Cecilia Pemberton, Helen Mary Brake, Stephen Tisch
Objectives/HypothesisThe objective of this study was to better define the relationship of laryngeal electromyography and video laryngostroboscopy in the diagnosis of vocal fold paralysis.Study DesignRetrospective diagnostic cohort study with cross-sectional data analysisMethodsData were obtained from 57 patients with unilateral vocal fold paralysis who attended a large tertiary voice referral center. Electromyographic findings were classified according to recurrent laryngeal nerve, superior laryngeal nerve, and high vagal/combined lesions. Video laryngostroboscopy recordings were classified according to the position of the immobile fold into median, paramedian, lateral, and a foreshortened/hooded vocal fold. The position of the paralyzed vocal fold was then analyzed according to the lesion as determined by electromyography.ResultsThe recurrent laryngeal nerve was affected in the majority of cases with left-sided lesions more common than right. Vocal fold position differed between recurrent laryngeal and combined vagal lesions. Recurrent laryngeal nerve lesions were more commonly associated with a laterally displaced immobile fold. No fold position was suggestive of a combined vagal lesion. The inter-rater reliability for determining fold position was high.ConclusionLaryngeal electromyography is useful in diagnosing neuromuscular dysfunction of the larynx and best practice recommends its continued implementation along with laryngostroboscopy. While recurrent laryngeal nerve lesions are more likely to present with a lateral vocal fold, this does not occur in all cases. Such findings indicate that further unknown mechanisms contribute to fold position in unilateral paralysis.



from #Audiology via xlomafota13 on Inoreader http://ift.tt/2mGACzw
via IFTTT

Maximal Ambient Noise Levels and Type of Voice Material Required for Valid Use of Smartphones in Clinical Voice Research

Publication date: Available online 18 March 2017
Source:Journal of Voice
Author(s): Jean Lebacq, Jean Schoentgen, Giovanna Cantarella, Franz Thomas Bruss, Claudia Manfredi, Philippe DeJonckere
PurposeSmartphone technology provides new opportunities for recording standardized voice samples of patients and transmitting the audio files to the voice laboratory. This drastically improves the achievement of baseline designs, used in research on efficiency of voice treatments. However, the basic requirement is the suitability of smartphones for recording and digitizing pathologic voices (mainly characterized by period perturbations and noise) without significant distortion. In a previous article, this was tested using realistic synthesized deviant voice samples (/a:/) with three precisely known levels of jitter and of noise in all combinations. High correlations were found between jitter and noise to harmonics ratio measured in (1) recordings via smartphones, (2) direct microphone recordings, and (3) sound files generated by the synthesizer. In the present work, similar experiments were performed (1) in the presence of increasing levels of ambient noise and (2) using synthetic deviant voice samples (/a:/) as well as synthetic voice material simulating a deviant short voiced utterance (/aiuaiuaiu/).ResultsAmbient noise levels up to 50 dBA are acceptable. However, signal processing occurs in some smartphones, and this significantly affects estimates of jitter and noise to harmonics ratio when formant changes are introduced in analogy with running speech. The conclusion is that voice material must provisionally be limited to a sustained /a/.



from #Audiology via xlomafota13 on Inoreader http://ift.tt/2nkOSkW
via IFTTT

Clinical Auditory Phenotypes Associated with GATA3 Gene Mutations in Familial Hypoparathyroidism-deafness-renal Dysplasia Syndrome.

Clinical Auditory Phenotypes Associated with GATA3 Gene Mutations in Familial Hypoparathyroidism-deafness-renal Dysplasia Syndrome.

Chin Med J (Engl). 2017 Mar 20;130(6):703-709

Authors: Wang L, Lin QF, Wang HY, Guan J, Lan L, Xie LY, Yu L, Yang J, Zhao C, Liang JL, Zhou HL, Yang HM, Xiong WP, Zhang QJ, Wang DY, Wang QJ

Abstract
BACKGROUND: Hypoparathyroidism-deafness-renal dysplasia (HDR) syndrome is an autosomal dominant disorder primarily caused by haploinsufficiency of GATA binding protein 3 (GATA3) gene mutations, and hearing loss is the most frequent phenotypic feature. This study aimed at identifying the causative gene mutation for a three-generation Chinese family with HDR syndrome and analyzing auditory phenotypes in all familial HDR syndrome cases.
METHODS: Three affected family members underwent otologic examinations, biochemistry tests, and other clinical evaluations. Targeted genes capture combining next-generation sequencing was performed within the family. Sanger sequencing was used to confirm the causative mutation. The auditory phenotypes of all reported familial HDR syndrome cases analyzed were provided.
RESULTS: In Chinese family 7121, a heterozygous nonsense mutation c.826C>T (p.R276*) was identified in GATA3. All the three affected members suffered from sensorineural deafness and hypocalcemia; however, renal dysplasia only appeared in the youngest patient. Furthermore, an overview of thirty HDR syndrome families with corresponding GATA3 mutations revealed that hearing impairment occurred earlier in the younger generation in at least nine familial cases (30%) and two thirds of them were found to carry premature stop mutations.
CONCLUSIONS: This study highlights the phenotypic heterogeneity of HDR and points to a possible genetic anticipation in patients with HDR, which needs to be further investigated.

PMID: 28303854 [PubMed - in process]

from #Audiology via xlomafota13 on Inoreader http://ift.tt/2mZUlgd
via IFTTT