• Nuclear Medicine and Molecular Imaging
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• v.40 no.1
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• pp.23-27
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• 2006

Purpose: There are a few case reports on asymmetric vocal cord uptake on FDG-PET in patients with unilateral vocal cord paralysis, which could be a potential pitfall in the interpretation of FDG-PET images. We evaluated the metabolic activity of laryngeal muscles of patients with unilateral vocal cord paralysis in comparison to normal controls during both speech and silence. Methods: Eleven patients with unilateral vocal cord palsy (thyroldectomy=7, lung cancer=1, others=3) and 12 normal controls underwent FDG-PET with usual protocol. They were divided into two groups respectively; one group read books aloud for 20 minutes (phonation group) and the other kept silence (non-phonation groups) after FDG injection. Recent neck CT scan were co-registered with FDG-PET to produce PET-CT fusion images to elaborate small laryngeal muscles. Results: In patients with unilateral vocal cord palsy, contralateral non-paralyzed vocal cord showed hypermetabolism mainly on thyroarytenoid muscle, more intensely with phonation group ($SUV=5.88{\pm}2.65$) than with non-phonation group ($SUV=2.30{\pm}0.39$). Normal control subjects showed hypermetabolism ($3.68{\pm}0.96$) in interarytenoid muscle and symmetric mild hypermetabolism in both lateral cricoarytenoid muscles in only phonation group. Conclusion: FDG-PET with fusion images using CT scan in patients with unilateral vocal cord paralysis showed hypermetabolism of contralateral non-paralyzed thyroarytenoid muscle, suggesting compensatory action during phonation. Phonation durung FDG PET study enhanced FDG uptake on different laryngeal muscles between patients with unilateral vocal cord paralysis and normal subjects.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1993.05a
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• pp.71-71
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• 1993

Diplophonia is produced by the voice of two separate tones and produced through quasi-periodic variations in the vocal cord vibration. Diplophonia is generally regarded as a symptom of laryngeal pathology. The difference in the vibratory frequency between the vocal cords can be seen in a tension imbalance and a difference in the level of the vocal folds under the special condition such as incomplete glottal closure. So authors have experienced 19 cases of patient with diplophonia for the unilateral vocal cord paralysis, intracordal cysts and other mass lesions. And we analysed the diplophonic voice with peak variability and noise level for the quasi-periodic waveforms and spectrograms pre-and postoperatively.

• Proceedings of the KSLP Conference
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• 2012.03a
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• pp.25-25
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• 2012

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.28 no.2
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• pp.112-117
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• 2017

Background and Objectives : The purpose of this study was to classify patients with unilateral vocal fold paralysis according to their fixed location and to analysis the effects of two treatment methods by early voice therapy and injection laryngoplasty. Materials and Methods : Twenty patients who were classified as full abduction and slight abduction according to the position of paralysis were treated injection laryngoplasy, and 23 patients were treated by voice therapy. Twenty patients were treated injection laryngoplasy and 23 patients were treated voice therapy. Results were evaluated by acoustic analysis, electroglottography, cepstrum analysis before and after therapy. The voice therapy was conducted by improving the larynx movement and glottal contact, whilst removing hypertension of the supraglottic and use the breathing. Results : Significant improvement was found in the acoustic parameter, cepstrum parameter, and EGG before and after treatment in both groups. There was no significant difference between the two groups when compared before and after treatment to compare the effects of injection laryngoplasty and voice therapy. Conclusion : The initial treatments for unilateral vocal cord paralysis are injection laryngoplasty and voice therapy. however, there is no precise standard about which method should be applied first. Therefore, in this study, we tried to classify patients according to their paralysis position and then apply two methods. The results of this study suggest that voice therapy and Injection laryngoplasty at the initial stage is a very useful method to improve voice quality of vocal fold paralysis and improve laryngeal function.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.13 no.2
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• pp.188-192
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• 2002

Unilateral vocal cord palsy which is associated with laryngeal trauma is not uncommon event. In a 42-year-old male, a cricoid cartilage fracure had been developed after blunt trauma. The endoscopic findings showed contusion and diffuse swelling around the left arytenoid and false cord. During phonation, the mobility of left side true vocal cord was decreased. There were no level difference and displacement of the left side arytenoid. We used the laryngeal electromyography (LEMG) to make a differential diagnosis between the cricoarytenoid joint dislocation and the injury of recurrent laryngeal nerve. At the right thyroarytenoid muscle and cricothyroid muscle, the findings of LEMG were normal. But the amplitude and frequency during phonation were decreased (partial denervation) at the left thyroarytenoid muscle. LEMG is a very useful method to predict the diagnosis of vocal cord palsy.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.30 no.1
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• pp.61-64
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• 2019

Sarcoidosis is a multisystem granulomatous disease of unknown etiology. Vocal fold paralysis secondary to sarcoidosis is extremely rare but it can develop as a result of compressive lymphadenopathy, granulomatous infiltration, and neural involvement. We report the case of a 56-year-old woman who presented with unilateral vocal fold paralysis and enlarged supraclavicular lymph nodes. Computed tomography of the neck revealed multiple, enlarged, and matted lymph nodes at the cervical level of IV. An ultrasound-guided core needle biopsy of the lymph node was performed, and a histopathological diagnosis of sarcoidosis was made by validating the presence of noncaseating granuloma. After implementation of steroid therapy, the patient exhibited immediate recovery from vocal fold paralysis. Although an extremely rare disease, sarcoidosis should be included in the differential diagnosis of vocal fold paralysis. Accurate diagnosis and prompt steroid treatment may reduce the morbidity of patients with vocal fold paralysis secondary to sarcoidosis.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1995.04a
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• pp.90.2-90
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• 1995

기관 협착증은 기관 삽관, 기관절개술 혹은 외상 등에 의해 주로 발생하고 드물게 종양이나 염증성 질환에 의해 생길 수 있다. 치료의 원칙은 정상 발성기능을 가진 충분한 기관강을 유지하는데 있으며 여러 치료방법 중 기관절제 및 단단문합술은 다른 방법이 실패하였거나 협착정도가 심한 경우에 시행할 수 있고, 정상기관강을 유지함으로써 해부, 생리학적으로 가장 이상적인 수술방법으로 알려져 있다. 저자들은 1990년부터 1994년까지 경부기관 8례, 경부 및 흉부기관을 동반한 기관협착증 1례에서 기관 절제 및 단단문합술을 실시하였다. 전례에서 suprahyoid release를 시행하였으며, 술중 가능한한 회귀신경은 확인하지 않았으며 술후 2일째 기관발거를 실시하였다. 합병증으로 술후 1례에서 일측성대마비가 있었으며 문합부 육아조직 형성이 2례가 있었으나 전례에서 성공적인 기관발거가 가능하였다.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.22 no.2
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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.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.15 no.1
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• pp.16-20
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• 2004

Purpose : To assess perceptual, acoustic and aerodynamic measure of voice quality in patients with unilateral vocal cord paralysis before and after type I thyroplasty. Methods : The clinical records of patients operated type I thyroplasty in the Departement of otorhinoalryngolgy, Yongdong Severance hospital from November 2001 to November 2003 were reviewed. All patients uderwent a vocal function evaluation including perceptual, acoustic and aerodynamic measures of voice preoperative and on $60^{th}$ postoperative day. The perceptual and acoustic measures were obtained from recording of patients' reading a 'Sanchak' passage. The perceptual evaluation was performed by 2 speech pathologist using a 4-point rating scale. Acoustic parameters(voice range profile low(RAL), voice range profile high(RAH), average fundamental frequency(AFX), closed quotient, harmonic to noise ratio, jitter and shimmer) were investigated by Lx speech studio. Mean flow rate(MFR), subglottic pressure(Psub) and intensity were measured using the Phonatory function analyzer. The maximum phonation time was also measured. The data were statistically analyzed. A paired t-test (p<0.1) was used to compare preoperative and postoperative results. And multiple regression test was used to find which parameter was most correlated to improvement of postoperative voice quality. Results : Among aerodynamic parameters, Psub $(88.11mmH_2O{\rightarrow}58.7mmH_2O)$, MPT(7.87sec${\rightarrow}$12.53sec), MFR (359.8ml/sec${\rightarrow}$161.06ml/sec) were statistically improved. AFx(205.5Hz${\rightarrow}$163.27Hz), AQx(23.9%${\rightarrow}$48.3%), RAL, RAH. Jotter and shimmer were improved. In multiple regression test, AFx and AQx was noted as the two meost correlated parameters to improvement of postoperative breathiness. But general grade of voice quality was more correlated to Psub and shimmer. Conclusion : Vocal fold medialization procedures effectively reduce glottic gap. Increasing of contact area of both vocal folds induced improvement in aerodynamic parameters and leaded stabilizing of vocal fold vibration. That effect results in improvement in acoustic parameters (shimmer, jitter, signal-to-noise ratio, voice range profile) and voice quality.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1979.05a
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• pp.6.3-7
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• 1979

During last two. decades, microlaryngeal surgery opened now era in the laryngeal surgery. In 1960, using Lynch's suspension laryngoscope, Seal co et al performed the first successful microsurgery in the treatment of polyp and other laryngeal diseases. In 1968, Kleinsasser reported a new technique of microlaryngeal surgery with a self retaining laryngoscope. Authors studied the statistic analysis of 53 cases (75 times) of the suspension laryngoscopic microsurgery at E.N.T. department of Han Yang University Hospital from May 1972 to April 1979 an reported this result. 1) sex distribution was male 1.3 : female 1. 2) age distribution was 3rd decade 14 cases (26.4%), 2nd decade 10 cases (18.7%) and 5th decade 9 cases (17%) in order. 3) chief compliant was hoarseness 48 cases (90.6%), dyspnea 16 cases (30.5%) and sore throat 8 cases (15.1%) in order. 4) diagnostic impression was polyp 18 cases (34%), nodule 12 cases (22.6%), papilloma 9 cases (17%), tumor 7 cases (13.2%), intubation granuloma 3 cases (5.7%) in order and other kinds were laryngeal stenosis with decannulation difficulty, laryngeal paralysis and hematoma. 5) histopathologic result of 48 cases was polyp 17 cases (35.4%), papilloma 11 cases (23%), nodule 9 cases (18.9%), malignancy 3 cases (6.3%), chronic inflammation 2 cases (4.2%) in order and others were hyperkeratosis, mucous retension cyst, nodule associated abscess, granuloma, hematoma and unconfirmed case. 6) in involved site, both sides 15 cases (60%), Lt.side 5 cases (19%), Rt side 3 cases (12%), anterior commissure 3 cases (12%) on the nodule and polyp (26 cases) and whole laryngeal involvement 7 cases (63.6%), one side cord involement 3 cases (23.7%), extralaryngeal involvement 1 cases (9.1%) on the papilloma (11 cases).