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Tracheobronchial injury is a rare but potentially life-threatening condition. Various surgical treatment options have been described for symptomatic patients with full-thickness injury. However, studies comprising a meaningful number of patients are sparse. We retrospectively analyzed all patients who received surgical repair of tracheobronchial injury between January 1999 and May 2021 at the Department of Thoracic Surgery, Medical University of Vienna. Patient characteristics, surgical variables, postoperative morbidity, and mortality were retrieved and analyzed. Fifty patients with a median age of 68 years (range, 17-88) were included in the analysis. The etiologies of the iatrogenic tracheobronchial injuries were emergency intubation (48%), elective percutaneous dilatation tracheostomy (38%), or elective intubation (14%). The most common location of tracheobronchial injuries was distal third (28%) with a median length of 50 mm (range, 20-100 mm). The surgical approach was cervicotomy in 52%, thoracotomy in 38%, sternotomy in 2%, and combined approaches in 8% of cases. Moreover, intraoperative venovenous (n = 4) or venoarterial (n = 2) extracorporeal membrane oxygenation support was required in 12% of cases. Procedure-related mortality was 0%. However, as patients with tracheobronchial injury usually have severe comorbidities, the rate of patients discharged alive from the intensive care unit was only 66%. The median follow-up period of discharged patients was 5.5 months (range, 0.7-209). Airway stenosis or dehiscence was not observed in any patient. Surgical repair of tracheobronchial injuries can be performed safely with a low procedure-related morbidity. If possible, the less-invasive cervical access should be preferred for patients with tracheobronchial injury, even for injuries extending to the main bronchi. [ABSTRACT FROM AUTHOR]

Airway management during repair of laryngotracheal stenosis is demanding, and there is currently no accepted standard of care. Recently an increasing number of airway centers have started to use a laryngeal mask until the airway is surgically exposed and cross-table ventilation can be initiated. However detailed data on this approach are missing in the literature. Patients receiving laryngotracheal surgery from November 2011 until October 2018 were retrospectively included in this single-center study, except for patients who presented with a preexisting tracheostomy at time of surgery. Airway management uniformly consisted of laryngeal mask ventilation until cross-table ventilation was established. Clinical variables, perioperative complications, and airway complications were analyzed. One hundred eight patients (65 women, 43 men) receiving tracheal resection (n = 50), cricotracheal resection (n = 49), or single-stage laryngotracheal reconstruction (n = 9) were included in the analysis. Of the included patients 23 (21.3%) had malignant disease and 85 (78.7%) a benign pathology. In the subgroup of patients with subglottic disease 85.1% had high-grade stenosis (Myer-Cotton III°). Airway management with a laryngeal mask was successful in all except 1 patient (99.1%). Mean pulse oximetry and mean end-tidal CO 2 during laryngeal mask ventilation was 98.7% ± 2.4% and 34.8 ± 7.6 mm Hg, respectively. At the end of surgery 95 patients (88%) were successfully weaned from the respirator using the laryngeal mask. The laryngeal mask as the primary airway device is feasible and safe in patients undergoing laryngotracheal surgery even in cases with high-grade stenosis. [ABSTRACT FROM AUTHOR]

Background and objectives Diplophonia is a common symptom in voice disorders. Depending on the underlying aetiology, diplophonic patients typically need treatment such as phonosurgery or speech therapy. In current clinical practice, the presence of diplophonia is assessed by auditive rating. To avoid subjectivity in voice assessment and to follow principles of evidence based medicine, objective instrumental assessment methods are needed. In order to gain insight into instrumental assessment of diplophonic voice, comparisons between different assessment approaches are necessary. The aim of the study is to compare the performance of two independent objective approaches on their ability to detect diplophonia. The compared approaches are the formerly published degree of subharmonics (DSH), and a newly proposed measure for spatial bimodality of the vocal fold vibration. Material and methods From a clinical database of 352 laryngeal high-speed videos with synchronous audio recordings, 60 phonation segments (20 euphonic, twenty diplophonic and twenty non-diplophonic dysphonic) were auditively selected. For all phonation segments, the DSH and the newly proposed measure for spatial bimodality were determined. The DSH is the occurrence rate of audio analysis blocks with ambiguous fundamental frequency in percent. The bimodality measure quantifies the spatial occurrence of secondary oscillation frequencies along the vocal folds’ edges. Both the DSH and the bimodality measure are evaluated on their ability to detect diplophonia by means of cut off threshold classification. Results and conclusions The DSH showed excellent classification rates for separating diplophonic from euphonic phonation (sensitivity: 98.4%, specificity: 100%). In separating diplophonic from non-diplophonic dysphonic phonation, the bimodality measure slightly outperforms the DSH approach (sensitivity: 54.6%, specificity: 92.7%). The separation of diplophonia from other kinds of dysphonia is challenging, and more sophisticated methods are needed. It is concluded that auditive and glottal diplophonia must be distinguished. As the clinical assessment of diplophonia primarily aims at determining glottal conditions, the video-based approach might deliver clinically more relevant data than the auditive approach. [ABSTRACT FROM AUTHOR]

Single-stage laryngotracheal reconstruction (SSLTR) provides a definite surgical treatment for patients with complex glotto-subglottic stenosis. To date, the influence of SSLTR on the functional outcome after surgery has not been analyzed. A retrospective analysis of all patients receiving a SSLTR between November 2012 and October 2019 was performed. Preoperatively and 3 months postoperatively, patients received a full functional evaluation, including spirometry; voice measurements (eg, fundamental frequency; dynamic range, singing voice range, and perceptual voice evaluation using the Roughness-Breathiness-Hoarseness [RBH] score, and fiberoptic endoscopic evaluation of swallowing [FEES]). A total of 15 patients with a mean age of 45 ± 17 years underwent SSTLR. Two (13%) patients were men and 13 (87%) were women. The majority of patients (67%) had undergone previous surgical or endoscopic treatment attempts that had failed. At the 3-month follow-up visit, none of the patients had signs of penetration or aspiration in their swallowing examination. Voice measurements revealed a significantly lower fundamental voice frequency (201.0 Hz vs 155.5 Hz; P =.006), whereas voice range (19.1 semitones vs 14.9 semitones; P =.200) and dynamic range (52.5 dB vs 53.0 dB; P =.777) was hardly affected. The median RBH score changed from R1 B0 H1 to R2 B1 H2. In spirometry, breathing capacity increased significantly (peak expiratory flow, 44% vs 87% [ P <.001] and mean expiratory flow at 75% of vital capacity, 48% vs 90% [ P <.001]). During a median follow-up of 32.5 months (range, 7-88 months), none of the patients developed re-stenosis. For complex glotto-subglottic stenoses, durable long-term airway patency together with reasonable voice quality and normal deglutition can be achieved by SSLTR. [Display omitted] [ABSTRACT FROM AUTHOR]

Summary Objectives Diplophonia is an often misinterpreted symptom of disordered voice, and needs objectification. An audio signal processing algorithm for the detection of diplophonia is proposed. Diplophonia is produced by two distinct oscillators, which yield a profound physiological interpretation. The algorithm's performance is compared with the clinical standard parameter degree of subharmonics (DSH). Study Design This is a prospective study. Methods A total of 50 dysphonic subjects with (28 with diplophonia and 22 without diplophonia) and 30 subjects with euphonia were included in the study. From each subject, up to five sustained phonations were recorded during rigid telescopic high-speed video laryngoscopy. A total of 185 phonations were split up into 285 analysis segments of homogeneous voice qualities. In accordance to the clinical group allocation, the considered segmental voice qualities were (1) diplophonic, (2) dysphonic without diplophonia, and (3) euphonic. The Diplophonia Diagram is a scatter plot that relates the one-oscillator synthesis quality ( S Q 1 ) to the two-oscillator synthesis quality ( S Q 2 ). Multinomial logistic regression is used to distinguish between diplophonic and nondiplophonic segments. Results Diplophonic segments can be well distinguished from nondiplophonic segments in the Diplophonia Diagram because two-oscillator synthesis is more appropriate for imitating diplophonic signals than one-oscillator synthesis. The detection of diplophonia using the Diplophonia Diagram clearly outperforms the DSH by means of positive likelihood ratios (56.8 versus 3.6). Conclusions The diagnostic accuracy of the newly proposed method for detecting diplophonia is superior to the DSH approach, which should be taken into account for future clinical and scientific work. [ABSTRACT FROM AUTHOR]