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OBJECTIVES The primary objective was to investigate the left-right vocal fold symmetry in rheological and histological properties using a rabbit model. The other objective was to develop statistical models for the comparison of rheological properties between paired vocal folds. METHODS Viscoelastic shear properties of six pairs of vocal fold lamina propria specimens were measured over a frequency range of 1 to 250 Hz by a linear, controlled-strain, simple-shear rheometer. The rheological data of the left and right vocal folds was statistically compared using the mixed-effects model approach. Six additional rabbit larynges were histologically analyzed for left-right symmetry in distribution patterns and relative densities of major extracellular matrix constituents. RESULTS There were no significant differences in elastic shear modulus (P = 0.1069) and dynamic viscosity (P = 0.944) of the lamina propria between the two vocal folds of the same larynx. Left-right vocal fold symmetry in densities and distribution patterns of the key molecular constituents was also demonstrated in histological results. CONCLUSION By showing that the left and right vocal folds were rheologically and histologically symmetrical in rabbit, this study validated an underlying assumption made in many previous reports. Statistical models for the analysis of hierarchically correlated left-right vocal fold rheological data were also presented. LEVEL OF EVIDENCE NA. Laryngoscope, 128:E359-E364, 2018.

Background: Laryngeal mask airway (LMA) insertion contributes to airway protection in patients with a laryngeal tumor around the glottis. There has been no report of LMA insertion itself exacerbating airway obstruction in such patients. Case presentation: A 62-year-old male underwent elective surgical resection of a large laryngeal polyp. The polyp was attached to the right vocal fold and synchronously swung inward into the trachea and outward to the larynx with inspiration and expiration, respectively. Although manual positive pressure ventilation was easily achieved without any airway obstruction after anesthetic induction, the airway was completely obstructed by the polyp lodged between the vocal cords immediately after LMA insertion. Soon after removal of the LMA, patency of the airway was dramatically improved. Conclusion: Our experience indicates that we should pay attention to airway obstruction due to lodging of the polyp between the vocal cords after LMA insertion in patients with a laryngeal polyp., Article, JA CLINICAL REPORTS.4:43(2018)

Summary Introduction: Dysphonia is the main symptom of lesions that affect the vocal tract. Many of those lesions may require surgical treatment. Polyps are one of the most common forms of vocal cord lesions and the most prevalent indication for laryngeal microsurgery. There are different types of polyps, and their different characteristics can indicate different prognosis and treatments. Aim: To conduct a comparative study of polypoid lesions (angiomatous and gelatinous) in patients undergoing laryngeal microsurgery via an electronic protocol. Method: We prospectively evaluated 93 patients diagnosed with vocal fold polyps; the polyps were classified as angiomatous or gelatinous. Results: In total, 93 patients undergoing laryngeal microsurgery were diagnosed with vocal fold polyps. Of these, 63 (64.74%) had angiomatous and 30 (32.26%) gelatinous polyps. Most patients with angiomatous polyps were men; their polyps were frequently of medium size, positioned in the middle third of the vocal fold, and accompanied by minimal structural alterations (MSA). In contrast, the majority of patients with gelatinous polyps were women; their polyps were smaller, positioned in the middle and posterior third of the vocal fold, and were not accompanied by MSA. Both types of polyps were more frequently located on the right vocal fold. Conclusion: Angiomatous polyps were more frequently encountered than gelatinous polyps. In addition, correlations between polyp type and sex, polyp size, position, location, and the presence of MSA were observed. Different surgical techniques were used, but the postoperative results were similar and satisfactory after speech therapy.

Summary Vocal fold vibratory irregularities can be caused by multiple factors. The underlying mechanism for irregularities is a difference in the mass or tension of the vibratory portion of the left versus the right vocal fold. The purpose of this study is to preliminarily investigate the prevalence of vocal fold vibratory irregularities in vocally normal speakers via high-speed videoendoscopy (HSV). Two aspects of irregularity, glottal width and period irregularity, were investigated in 52 vocally normal speakers undergoing videostroboscopy and HSV. The videostroboscopy and HSV recordings were processed and visually rated for glottal width and period irregularities. These ratings were also accomplished through the use of the novel digital kymography playback and from still kymographic images of the medial line of the vocal folds (mDKG). Objective measures of glottal width and period irregularities from the mDKG, and jitter and shimmer measures of the synchronously recorded acoustic waveforms, were also studied. The results suggest that period irregularities are less frequent in normophonic speakers than glottal width irregularities. However, more participants revealed acoustic jitter rather than acoustic shimmer above normal limits. Thus, speculation regarding the physiological source of these clinically used acoustic parameters continues. The lack of confidence in rating irregularity through stroboscopy and the discrepancies between visual ratings and objective measures requires future research efforts.

The authors describe a male patient who had malignant lymphoma seven years ago which remitted with chemotherapy.Two years ago he developed dysphonia. An unilateral, pediculate smooth red lesion on the right vocal fold was later discovered. Even without benefit of medicamentosus treatment, the patient refused surgery. In a reevaluation using rigid telescopy of the larynx two years later, the lesion had disappeared, completely and spontaneously. As there are no existing publications on this topic, this case report is an alert that surgery should be recommended with extreme caution in this type of vocal disease.

We report a rare case of laryngeal myxoma in a 57-year-old Japanese man. Except for a five-year history of gradually progressive hoarseness, he had been in good health. Video-stroboscopic examination revealed a solid mass in the anterior third of the right vocal fold. Phonosurgery performed with a microscope showed that the mass was encapsulated and located between the epithelium and vocal fold ligaments of the right vocal fold. This hard, elastic mass which measured 7 mm in diameter, was diagnosed as a myxoma. Only three cases of myxoma of the larynx have been reported in the English literature, with only one other case involving the vocal fold.

We report the clinical use of beclomethasone dipropionate inhaler (BDI; Aldecin® inhaler), in the management of contact ulcer and idiopathic granuloma of the larynx.Patient 1 was a 66-year-old woman with an ulcerative lesion at the posterior end of left vocal fold. The lesion was diagnosed as contact ulcer of the larynx and treated by oral spray of BDI, which resulted in improvement in five months.Patient 2 was a 66-year-old man with a small mass at the posterior end of right vocal fold. It was diagnosed as idiopathic granuloma of the larynx and treated by oral spray of BDI. His symptoms and laryngeal lesion markedly improved in three months.BDI appears to be useful in the treatment of contact ulcer and idiopathic granuloma of the larynx.