• 대한후두음성언어의학회지
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• 제33권3호
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• pp.172-178
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• 2022

Background and Objectives Injection laryngoplasty is a common method for treatment of unilateral vocal fold paralysis. Unilateral vocal fold paralysis has various causes, including idiopathic, infection, stroke, neurologic condition, surgery and nerve invasion by cancer. To the knowledge of the authors, there was no study on the relationship between the causes of vocal cord paralysis and the outcome of injection laryngoplasty. Therefore, we tried to investigate the difference in the outcomes of injection laryngoplasty between vocal cord paralysis after surgery group and nerve invasion by cancer group. Materials and Method A retrospective analysis was performed for 24 patients who underwent vocal cord injection due to unilateral vocal cord paralysis caused by surgery or nerve invasion by cancer. The objective quality of the voice was assessed by acoustic voice analysis with the Multi-Dimensional Voice Program. Results Both group showed an improvement of fundamental frequemcy (F0), jitter percent, shimmer (percent), and noise to hearmonic ratio (NHR) after injection laryngoplasty. The vocal cord paralysis due to nerve invasion group showed more improvement in both the mean and median value of F0, shimmer percent and NHR than the vocal cord paralysis due to surgery group, but there was not statistically significant. Conclusion Our study did not show a statistically significant difference in outcome between vocal cord paralysis due to cancer invasion group and surgery group, but statistically tendency was suggested. The vocal cord paralysis due to nerve invasion group showed more improvement in both the mean and median value of acoustic voice analysis than surgery group.

• 대한후두음성언어의학회지
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• 제33권1호
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• pp.1-6
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• 2022

Vocal fold injection (VFI) is widely accepted as a first line treatment in treating unilateral vocal fold paralysis and other vocal fold diseases. Although VFI is advantageous for its minimal invasiveness and efficiency, the invisibility of the needle tip remains an essential handicap in precise localization. Real-time light-guided vocal fold injection (RL-VFI) is a novel technique that was developed under the concept of performing simultaneous injection with precise placement of the needle tip under light guidance. RL-VFI has confirmed its possibility of technical implementation and the feasibility in injecting the needle from various directions through ex vivo animal studies. Further in vivo animal study has approved the safety and feasibility of the procedure when various transcutaneous approaches were applied. Currently, RL-VFI device is authorized for clinical use by the Ministry of Food and Drug Safety in South Korea and is clinically applied to patients with safe and favorable outcome. Several clinical studies are currently under process to approve the safety and the efficiency of RL-VFI. RL-VFI is expected to improve the complication rate and the functional outcome of voice. Furthermore, it will support laryngologists in overcoming the steep learning curve by its intuitive guidance.

• 대한후두음성언어의학회지
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• 제22권1호
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• pp.18-22
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• 2011

Laryngeal framework surgery comprises medialization laryngoplasty and arytenoid adduction. Since their introduction in the 1970s, these procedures have become standard treatments for vocal fold paralysis and glottal incompetence. However, frequency of laryngeal framework surgery is conjectured to relatively decrease along with the introduction of injection laryngoplasty. In this manuscript, indications for laryngeal framework surgery were highlighted in contrast to those of injection laryngoplasty. The authors introduced the basic concepts and principles as well as surgical techniques of laryngeal framework surgery. Even though the incidence of major and/or minor complications after laryngeal framework surgery is not high, surgeons should be well aware of its possible complications and they should be familiar with tips and know-how to avoid or cope with complications.

• 대한후두음성언어의학회지
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• 제6권1호
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• pp.5-8
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• 1995

Bilateral vocal cord palsy is uncommon but is serious because of airway obstruction. Treatments of bilateral vocal cord palsy are initially tracheotomy, vocal cord lateralization and vocal cord reinnervation. Recently, we experienced nerve-muscle pedicle reinnervation in 3 cases of bilateral vocal cord palsy, so reported it with a review of literature.

• 대한후두음성언어의학회지
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• 제29권1호
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• pp.30-36
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• 2018

Background and Objectives : The effect of palliative injection laryngoplasty in cancer-related unilateral vocal cord paralysis patients on voice and swallowing function is uncertain and there are few previous studies of its suitability, benefits as a palliative treatment option. The purpose of this study is to confirm the objective results of voice and swallowing function after palliative office-based hyaluronic acid injection laryngoplasty in cancer-related unilateral vocal cord paralysis patients. Materials and Method : 36 patients who had unilateral vocal cord paralysis from non-thyroidal, extralaryngeal neoplasms were included in this study. To evaluate the clinical outcome, we analyzed perceptual GRBAS grading, acoustic analysis, aerodynamic study, Electroglottography (EGG), Voice Handicap Index (VHI-30) about voice function and disability rating scale (DRS), gastric tube dependency, aspiration pneumonia about swallowing function and 36-Item Short Form Survey version 2 (SF-36v2) about quality of life. Results : In GRBAS scale, G (p<0.001), R (p=0.004), B (p=0.001), A (p=0.011), and S (p=0.007) showed significant improvement. Jitter, shimmer, speaking fundamental frequency, maximal phonation time, VHI-30, DRS score, gastric tube dependency, aspiration pneumonia, and SF-36v2 were significantly improved after injection (p=0.016, p=0.011, p=0.045, p=0.005, p<0.001, p<0.001 p=0.003, p<0.001, and p<0.001 respectively). Conclusion : From this study we concluded office-based hyaluronic acid injection can be used as a useful palliative treatment option in cancer-related ill patients with unilateral vocal cord paralysis. Palliative hyaluronic acid injection laryngoplasty avoids the need for tube feeding, thus reducing the risk of aspiration pneumonia. These outcomes are accompanied by significant improvement in voice quality.

• 대한후두음성언어의학회지
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• 제22권2호
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• pp.119-125
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• 2011

Background and Objectives : Temporary or permanent vocal paralysis can be occurred after head and neck surgery such as thyroid cancer, esophageal resection, and chest operation including lung parenchymal resection, due to a vagus or recurrent laryngeal nerve injury. The authors aimed to determine the clinical efficacy of using Calcium-Hydroxyapatite (CaHA) for permanent unilateral vocal cord palsy patients. Materials and Method : Between July 2008 to July 2010, among patients with chief complain of hoarseness and aspiration, only who were diagnosed as unilateral vocal cord palsy under laryngoscopy, were selected. The patients included 3 females and 13 males age range between 29 to 79 and average age was 60 years old. Results : The hoarseness range were $8.94{\pm}0.77$, $4.63{\pm}1.02$, $4.31{\pm}1.30$ statistically showing significant postoperative improve at preoperative, 1 week and 3 months. Also aspiration were $7.44{\pm}2.48$, $3.63{\pm}1.82$, $3.19{\pm}1.91$ statistically improved during the same period. The result of voice analysis showed that the frequency range shows decrease at 1 week and 3 months after the injection compared to that of the preoperative result in both male and female group (Male: $161.63{\pm}32.78$ Hz, $139.13{\pm}30.63$ Hz, $146.67{\pm}34.20$ Hz ; Female: $244.62{\pm}26.62$ Hz, $244.91{\pm}42.03$ Hz, $237.50{\pm}38.95$ Hz). The Maximal phonation time were $2.75{\pm}1.06$ (sec), $8.88{\pm}3.46$ (sec), $8.44{\pm}3.71$ (sec) statistically showing significant postoperative improve at preoperative, 1 week and 3 months. Conclusion : Injection laryngoplasty with CaHA in unilateral vocal cord paralysis is very safe and efficient procedure to improve a voice disorder, a swallowing difficulty, and a quality of life for those patients with a sacrificed RLN, a cancer invasion of the nerve, and a prolonged vocal cord paralysis which is more than six to twelve months.

• 대한후두음성언어의학회지
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• 제30권2호
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• pp.107-111
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• 2019

Background and Objectives Idiopathic unilateral vocal fold paralysis (IVFP) is believed to be due to inflammation and edema of the recurrent laryngeal nerve caused by viral diseases such as upper respiratory tract infections. Corticosteroid has a potent anti-inflammatory action which should minimize nerve damage. The purpose of this study was to investigate the effect of oral steroid therapy on IVFP. Materials and Method Study was performed for the IVFP patient from January 2012 to August 2017. Patient's dermography, direction and location of paralyzed vocal cords, history of hypertension, diabetes, cerebrovascular disease, and other underlying disease, smoking history, alcohol consumption and upper respiratory tract infection, and symptoms were investigated. Treatment was divided into three groups: the observation group, low-dose group, and high-dose group, and the recovery rate and time of vocal cord paralysis were analyzed in each group. Results Thirty-seven patients were enrolled in this study. There was no relationship between oral steroid use, dosage and recovery of vocal cord paralysis. Oral steroids showed a rapid recovery of vocal cord paralysis, but there was no statistically significant difference in the time of recovery of vocal palsy with or without steroids (p=0.673). In addition, there was no statistically significant difference in recovery rate between the period to start of treatment, presence of diabetes mellitus, and treatment modality, but the recovery rate was high in the group with upper respiratory tract infection history (p=0.041). Conclusion In IVFP, oral steroid therapy has no significant difference in time and extent of recovery compared to the case of spontaneous recovery.

• 대한후두음성언어의학회지
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• 제27권1호
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• pp.45-50
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• 2016

Background and Objectives : This study aims to conduct post-voice therapy to patients with unilateral vocal fold paralysis for vocal improvement, motility recovery and analyze the results. Materials and Methods : Voice therapy was conducted to 13 patients who had shown response to voice therapy amongst 98 patients diagnosed with unilateral vocal fold paralysis. In order to be able compare before and after perceptual, acoustic and aerodynamic evaluations were conducted after voice therapy. Also, by using dysphagia checklist, we have verified whether if the patient had dysphagia prior to voice therapy. The therapy was conducted by improving the larynx movement and glottal contact, whilst removing hypertension of the supraglottic. Results : All 13 patients who underwent voice therapy had shown improvements that are statistically significant from 4 scales excluding the S scale from auditory perception evaluation (p<0.05), with enhanced glottal contact. In acoustic evaluation, Jitter, Shimmer and NHR had shown significant improvement after voice therapy. MPT was also notably improved among aerodynamical evaluation (p<0.001). All 11 patients had with dysphagia prior to voice therapy reported to have improved swallowing functions. Conclusion : Application of adequate voice therapy to patients with unilateral vocal fold paralysis, is an effective method that might be employed in the initial phase. Especially, the voice therapy proposed in this study is expected to be useful for patients in hypertension status due to secondary compensation after initial paralysis, since it focuses on improving vocal symptoms in a calm state with the supraglottis sufficiently relaxed. Also, the therapy is expected to be effective for improving swallowing functions.

• 대한후두음성언어의학회지
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• 제17권2호
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• pp.111-114
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• 2006

Objective : The anterior approach to the cervical spine now selves as the surgical across of choice for cervical spine disease. Vocal cord paryalysis(VCP) follow the procedure as a complication, and it is most common complication of this procedure. However, the frequency and etiology of this injury are not clearly defined. This study was performed to establish the clinical features of vocal cord paralysis in anterior cervical spine surgery(ACSS). Material and Method : Retrospectively, medical records of patients who underwent ACSS at Hallym university medical center, Hangang Sacred Heart Hospital between January 2000 and March 2006 were reviewed. Further detailed review of the patients with documented VCP after surgery was then performed. Results : 242 ACSSs were performed and 9 patients with VCP were identified (3.71%) In 9 patients with VCP, 8 patients had right-sided approaches (6.01%) and 1 patient had left-sided approach (0.91%). All 9 patients had VCP on ipsilateral side and 8 patients were recovered completely on follow up period. Duration of ACSS, multilevel exposure and low-level (below the C6 level) exposure have been found to be associated with higher risk. Conclusion : For avoiding the recurrent laryngeal nerve injury, surgeon have to understand the clinical features of VCP in ACSS. As right-sided approach has a greater risk of recurrent laryngeal nerve injury, we suggest that the left-sided approach be given more consideration.

• 대한후두음성언어의학회지
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• 제17권2호
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• pp.138-142
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• 2006

Objectives : Vocal cord paralysis(VCP) is a complex disorder which may result from numerous causes. We reviewed and analyzed the trend of clinical characteristics and causes of VCP in Korean patient. Method : A total 197 patients with VCP who visited St.Mary's hospital from March, 2000 to August, 2006 were reviewed retrospectively. They were analyzed according to sex, age, cause of VCP, position of paralyzed vocal fold, treatment methods. Results : The male and female ratio was 1.6 : 1. The unilateral paralyzed vocal fold was fixed at paramedian position in 84% of the cases. The left vocal fold was paralyzed about 2 1/2 times as much as the right vocal fold. Among the causes of VCP 30.9% of the cases were due to postoperative paralysis, and most of those were developed after lung, mediastinal surgery. laryngeal EMG was performed in 47 patients for determines the prognosis and treatment method. In the unilateral VCP, 90 patients were treated with injection laryngoplasty, 21 patients were performed thyroplasty type I. Conclusion : The causes of VCP include various diseases, so, detection of the primary disease is very important, because many fatal diseases are included among the primary diseases, and late detection can cause serious problems. VCP is not only a disease entity in itself, but can be seen as a sign of an underlying disease.