Vocal Fold

Laryngeal coccidioidomycosis with vocal fold paralysis

April 30, 2011     Jacqui E. Allen, MBChB, FRACS and Peter C. Belafsky, MD, PhD


We present the case of a 52-year-old woman with recurrent disseminated coccidioidomycosis involving the larynx that was associated with vocal fold paralysis. The diagnosis was confirmed by histologic biopsy, and the patient had an excellent response to systemic antifungal treatment. However, her vocal fold motion did not return. We also review the current world literature.

Reinke edema: Signs, symptoms, and findings on strobovideolaryngoscopy

March 31, 2011     Danielle Gainor, MD, Farhad R. Chowdhury, DO, and Robert T. Sataloff, MD, DMA, FACS

Vocal fold varicosities

February 1, 2011     Stephanie Austin, MSIV, Venu Divi, MD, Mary Hawkshaw, BSN, RN, CORLN, and Robert T. Sataloff, MD, DMA, FACS

Large vocal fold polyp

January 1, 2011     Venu Divi, MD, Robert T. Sataloff, MD, DMA, and Jacqueline Oxenberg, DO

Laryngeal alveolar rhabdomyosarcoma involving the true vocal fold in an adult: Case report

December 17, 2010     Douglas D. Leventhal, MD, Joseph Spiegel, MD, and William Keane, MD


Rhabdomyosarcoma of the larynx is extremely rare in adults, as only 17 well-documented cases have been previously reported in the English-language literature. Of these, only 2 cases (both male) involved the alveolar subtype of rhabdomyosarcoma, and neither involved the true vocal folds. We report a case of alveolar rhabdomyosarcoma of the true vocal fold in 54-year-old woman. She was successfully treated with conservative surgery, radiation, and chemotherapy. Management of head and neck rhabdomyosarcoma has evolved from radical surgery to less morbid procedures supplemented with radiation and chemotherapy. However, because this tumor is so rare in the adult population, no adult-specific treatment regimen has emerged. Nevertheless, the success of treatment in the pediatric population supports its use in adults.

Laryngeal keratosis with underlying invasive carcinoma

December 17, 2010     Sampan S. Bist, MS, Saurabh Varshney, MS, Rakesh Kumar, MS, Sanjeev Bhagat, MS, and Nitin Gupta, MS

Botulinum toxin-assisted endoscopic repair of traumatic vocal fold avulsion

August 31, 2010     Rima F. Abraham, MD, Stanley Shapshay, MD, and Lisa Galati, MD


Blunt traumatic laryngeal injury in children often leads to intralaryngeal soft-tissue damage, which can quickly compromise an already small airway. Injuries requiring operative intervention have historically been repaired via open approaches such as thyrotomy and laryngofissure. These approaches carry significant long-term sequelae that can compromise the airway, deglutition, and voice. We describe a safe and effective alternative to open repair that includes the use of a botulinum toxin chemical myotomy to ensure optimal healing. We used this procedure to treat a 13-year-old boy who had experienced a traumatic avulsion of the true vocal folds. Postoperatively, his voice outcome was satisfactory, as evidenced by a marked improvement in his pediatric Voice Handicap Index score. No complication or compromise of the airway or swallowing occurred, and resolution of the botulinum effect was observed by 6 months postoperatively. The endoscopic approach supplemented by botulinum toxin injection avoids scarring and allows for safe postoperative extubation. Compared with open repair, it is associated with a shorter hospital stay and a lower risk of stenosis and fibrosis.

Laryngeal leiomyoma

July 31, 2010     Thomas Q. Gallagher, DO, LCDR, MC, USN and John T. Sinacori, MD, FACS

Type III thyroplasty for the treatment of glottic gap in a patient undergoing laryngofissure cordectomy for squamous cell carcinoma of the vocal fold: Technique and outcome

May 31, 2010     Tolga Kandogan, MD


A 44-year-old man presented with squamous cell carcinoma (T1aN0M0) on the left vocal fold and was prepared for a combined laryngofissure cordectomy and type III thyroplasty. The author performed both procedures together-not only to lower the tension on the healthy vocal fold, but also to determine whether the thyroplasty would successfully close the glottic gap created by the cordectomy, resulting in relatively fast improvement in the patient's voice. Satisfactory glottic closure and a satisfactory voice result were achieved rather quickly. The patient was satisfied with his new voice, both in the early and late postoperative periods.

Acute dysphonia secondary to vocal fold hemorrhage after vardenafil use

May 31, 2010     Vikas Singh, MD, Seth M. Cohen, MD, MPH, Bernard Rousseau, PhD, J. Pieter Noordzij, MD, C. Gaelyn Garrett, MD, and Robert H. Ossoff, DMD, MD


Owing to their vasodilatory effects, the phosphodiesterase-5 inhibitors have become widely used for the treatment of erectile dysfunction. Among the reported adverse events of these agents are epistaxis, variceal bleeding, intracranial hemorrhage, and hemorrhoidal bleeding. We report a case of vocal fold hemorrhage that occurred after vardenafil use in a 31-year-old man who was a professional singer.

Type I thyroplasty revision 1 year after a window was mistakenly created on the cricoid cartilage

April 30, 2010     Hilmi Alper Şenkal, MD and Taner Yilmaz, MD


Unilateral vocal fold paralysis causes glottic incompetence and can result in significant morbidity. To prevent such morbidity, surgeons treat affected patients with vocal fold medialization techniques; type I thyroplasty medialization surgery is widely used for this purpose. In this procedure, a window is opened on the thyroid cartilage to allow for placement of a silicon prosthesis to medialize the vocal fold. A 38-year-old woman presented to our clinic for evaluation of hoarseness and a low-pitched voice, which we diagnosed as being caused by left vocal fold paralysis. Two years earlier, she had undergone a thyroidectomy for the treatment of benign thyroid disease. One year after that, she underwent type I thyroplasty medialization surgery at another center. During that operation, the surgeon had mistakenly created the window on the cricoid cartilage rather than the thyroid cartilage. When he inserted the silicon prosthesis into the cricoid window, the patient developed acute respiratory obstruction. At that point, the prosthesis was removed and the operation was terminated. One year later, she presented to us, and we performed a revision type I thyroplasty. Intraoperatively, we discovered that the original window had been opened on the cricoid cartilage instead of the thyroid cartilage, which was intact. We left the cricoid window untouched, opened a new window on the thyroid cartilage, and completed the type I thyroplasty in the usual fashion. The patient's postoperative recovery was uneventful, and she was doing well at 5 years of follow-up. To the best of our knowledge, no case of a thyroplasty window being opened on a cricoid cartilage has been reported in the literature.

Correlation between the Voice Handicap Index and voice laboratory measurements after phonosurgery

March 31, 2010     Jeffrey Cheng, MD and Peak Woo, MD, FACS


Phonosurgery is an effective treatment for some vocal fold pathologies, and the Voice Handicap Index (VHI) survey has been shown to be a useful instrument for evaluating treatment effectiveness. We conducted a nonrandomized, prospective study of 21 patients who underwent phonosurgery for the treatment of non-neoplastic vocal fold lesions at our academic tertiary-care referral center. Our goals were to compare pre- and postoperative VHI scores (subjective assessments) and pre- and postoperative results of acoustic and aerodynamic tests (objective assessments). We sought to determine if there was any correlation between the subjective and objective findings. We looked for differences between professional voice users (n = 10) and nonprofessional voice users (n = 11) in both subjective and objective measures. We found statistically significant differences between pre- and postoperative values in three of four VHI parameters, but in only one of 13 objective measures. There was no correlation between preoperative VHI scores and preoperative acoustic and aerodynamic test results. The professional voice users expressed greater postoperative improvement as reflected by lower VHI scores than did the nonprofessional voice users, confirming that the former are more negatively affected by a voice disability.

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