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Background: Suprastomal granulation tissue is a common complication of long-term tracheostomy. It may be associated with bleeding, aphonia, airway obstruction and delayed decannulation., Methods: This study describes the experience of a tertiary paediatric medical centre with Coblation TM -assisted suprastomal granulation tissue excision., Results: Thirteen children (mean age, 5.7 years) who underwent the procedure from 2013 to 2019 because of delayed decannulation or aphonia were included. Lumen obstruction ranged from 50 to 90 per cent, with a mean of 68.8 per cent. After the procedure, decannulation was successfully performed in 7 patients, and voice quality improved in 10 patients. There were no peri- or post-operative complications., Conclusion: This is the largest series to date that describes Coblation used for the treatment of suprastomal granuloma. Coblation has advantages of high precision, relatively low temperature (thereby avoiding thermal injury to adjacent tissue), haemostatic resection and feasibility for use for even large granulomas. The promising results should prompt further studies in larger samples.

Objective: The aim of this study was to investigate if there are predictors for success with Passy Muir Valve (PMV) placement for medically complex pediatric patients., Methods: Retrospective chart review of 52 pediatric patients with a tracheostomy with or without ventilator dependence who received PMV assessments from October 2017 through October 2018 in intensive care units and acute care units within Children's Healthcare of Atlanta (Atlanta, GA). Univariate analysis and logistic regression modeling were used to identify factors associated with a successful PMV trial., Results: Factors found to be associated with a successful PMV trial were as follows: transtracheal pressure measurement, presence of voicing, age of patient >2 years, weight of patient, and ventilator rate., Conclusion: Medically complex infants and children in the intensive care units and acute care units on or off the ventilator can be considered candidates for PMV use; several factors can be predictive of a successful trial., Level of Evidence: 2C Laryngoscope, 130:E632-E639, 2020., (© 2019 The American Laryngological, Rhinological and Otological Society, Inc.)

Background: Voice restoration after laryngopharyngectomy can be achieved with an autologous ileocolic flap. We have observed that the length of the flap influences vocal outcome. This investigation aimed to evaluate the association between ileocolic flap length and vocal quality after laryngopharyngectomy., Methods: The charts of patients who underwent voice rehabilitation with an ileocolic flap after laryngopharyngectomy between 1 January 2011 and 30 December 2012 were abstracted. The length of ileum segment in the ileocolic flap was stratified, and voice outcome was evaluated three months post-operatively, while adjusting for confounding variables., Results: There was a significant association between flap length and loudness, maximum phonation time and sound pressure level (p < 0.05). All three parameters were best in the 10 cm length group., Conclusion: Voice rehabilitation after laryngopharyngectomy is possible with an ileocolic flap. The optimal ileocolic flap contains a 10 cm ileum segment. Complications are frequent but amenable to revision surgery.

Objectives/hypothesis: Placement of a Passy-Muir speaking valve is considered best practice for infants and children with a tracheostomy. The Passy-Muir valve enables phonation by redirecting exhaled air via the glottis. Poor tolerance of the Passy-Muir valve is associated with excessive transtracheal pressures on exhalation due to upper airway obstruction. Drilling a small hole in the side of the Passy-Muir valve creates a pressure relief port to allow partial exhalation through the tracheostomy tube while enabling phonation., Study Design: A retrospective case series is presented of 10 aphonic pediatric patients with a tracheostomy trialed with a drilled Passy-Muir valve., Methods: Valve tolerance was assessed clinically and objectively. Handheld manometry was used to determine transtracheal pressures on passive exhalation. All patients had a diagnosis of upper airway obstruction and demonstrated excessive pressures wearing a standard Passy-Muir valve. Patients were assessed wearing a Passy-Muir valve with up to two 1.6-mm holes drilled in the side of the valve. Patients progressed to trials if clinically stable and if transtracheal pressure did not exceed 10 cm H(2) O when wearing the valve., Results: Eight patients progressed to trial, with five of eight patients able to phonate within 1 week and six of eight able to tolerate wearing the valve for ≥ 2-hour periods within 2 weeks of introduction. All eight patients were able to phonate within 6 months of valve introduction., Conclusions: These findings support drilling Passy-Muir speaking valves as a promising option to facilitate phonation in pediatric patients with a tracheostomy for upper airway obstruction., (Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.)

Backgrounds: Since the introduction and practice of functional tracheoesophageal shunt (FTES) for voice rehabilitation after total laryngectomy, patients have often suffered from fistula-related complications such as aspiration, tract stenosis and infection partly as a result of nonstandardized or incorrectly made flap operation. In striving to solve these problems as far as possible, a triangular flap cutter (TFC) was developed to perform the flap operation., Methods: Flap operations were performed using a TFC on 10 tracheoesophageal models (pigs) and 10 fresh esophageal models (esophageal cancer patients, with their informed consent) and incision parameters and incision effects were detected., Results: Perfect triangular flaps were achieved in 18 out of 20 cases using the TFC with minimal peripheral tissue injury (average time, 2-3 min). Of the 2 unsuccessful cases, 1 case exhibited insertion failure and the other experienced flap creation failure due to clinical contraindication for TFC use and insufficient operational skills, respectively., Conclusions: The TFC is a new device, which offers the unique advantage of precise incision for the creation of a flap, with the potential to resolve fistula-related problems and improve operation efficiency., (Copyright © 2010 S. Karger AG, Basel.)

Objective: To determine the importance of prelinguistic babbling by studying patterns of speech and language development after cricotracheal resection in aphonic children., Study Design: Retrospective review of seven previously aphonic children who underwent cricotracheal resection by our pediatric thoracic airway team. The analyzed variables include age, sex, comorbidity, grade of stenosis, length of resected trachea, and communication methods., Methods: Data regarding the children's pre- and postsurgical communication methods, along with their utilization of speech therapy services, were obtained via speech-language pathology evaluations, clinical observations, and a standardized telephone survey supplemented by parental documentation. Postsurgical voice quality was assessed using the Pediatric Voice Outcomes Survey., Results: All seven subjects underwent tracheostomy prior to 2 months of age when corrected for prematurity. The subjects remained aphonic for the entire duration of cannulation. Following cricotracheal resection, they experienced an initial delay in speech acquisition. Vegetative functions were the first laryngeal sounds to emerge. Initially, the children were only able to produce these sounds reflexively, but they subsequently gained voluntary control over these laryngeal functions. All subjects underwent an identifiable stage of canonical babbling that often occurred concomitantly with vocalizations. This was followed by the emergence of true speech., Conclusions: The initial delay in speech acquisition observed following decannulation, along with the presence of a postsurgical canonical stage in all study subjects, supports the hypothesis that babbling is necessary for speech and language development. Furthermore, the presence of babbling is universally evident regardless of the age at which speech develops. Finally, there is no demonstrable correlation between preoperative sign language and rate of speech development., (Copyright © 2010 The American Laryngological, Rhinological, and Otological Society, Inc.)

Conclusion: The factors responsible for the observed failures can be broken into two major groups: (1) a wrong indication and (2) an inadequate technique to achieve relief from an excessively tight glottal closure. The use of a titanium bridge in place of a silicone shim was found to be essential. Type II thyroplasty can relieve the symptoms of adductor spasmodic dysphonia (AdSD) when implemented with a modern technique using titanium bridges., Objectives: To identify the factor or factors that necessitated revision surgery in type II thyroplasty for AdSD, detailed analytical examinations were made of individual cases with unsatisfactory outcomes., Patients and Methods: A retrospective analysis of a case series with follow-up periods of 2-5 years., Results: Ninety AdSD patients underwent type II thyroplasty. The results in one patient were limited because a pathological mechanism other than AdSD was also involved. One patient, a singer, who wanted a more intense voice for singing was dissatisfied with the results. In three patients, the material used for fixation was inadequate. In two other patients, the method of application of the fixative material was found to be insufficient as it did not include both the upper and lower sides.

Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting the synovial membrane and causing joint damage and bone destruction. The symptoms of cricoarytenoid joint (CJ) arthritis often include hoarseness, and a sense of pharyngeal fullness in the throat. Sometimes, in cases with bilateral CJ involvement, an urgent tracheostomy might be required for acute airway obstruction. In this report, we describe a woman suffering from aphonia due to hampered adduction of the vocal fold which was caused by RA with unilateral CJ involvement. Arytenoid adduction surgery on the affected side was performed. She retrieved a normal voice immediately after the surgery.

Unlabelled: This report reviews the speech and language development of a child who, as result of complete subglottic stenosis, was aphonic from birth until 2 years and 11 months of age at which time laryngotracheal reconstruction provided normal respiration. The boy had congenital subglottic stenosis requiring neonatal tracheostomy. The congenital subglottic stenosis progressed to complete subglottic stenosis during the neonatal period. The child's speech and language development was monitored for a 24-week period following airway reconstruction., Learning Outcomes: The reader will learn about and be able to describe: (1) the speech and language development of a child who was aphonic from birth until 35 months of age, (2) the effects of surgical repair of a tracheotomy on the child's speech and language development, (3) the likely importance of babbling in speech and language development.

The first successful composite human laryngeal transplantation was performed by a team led by the senior author on January 4, 1998. The recipient was a 40-year-old male who had sustained a crush injury to his larynx 20 years prior, rendering him aphonic. Multiple previous attempts for reconstruction at an outside hospital were unsuccessful. The donor was a 40-year-old male who had died from a ruptured cerebral aneurysm. The specifics of the procedure have been detailed elsewhere. Throughout the patient's postoperative course, serial fiberoptic evaluations and voice testing were performed to evaluate laryngeal reinnervation reflected in phonatory function. We herein report the results of these exams, as well as the results of electromyographic recordings of the laryngeal musculature 4 years posttransplantation.

An antrochoanal polyp, a common clinical entity, with a rare presentation is being reported. A 12 year old boy was brought to Accident and Emergency department with an unusual sudden presentation of polypoidal mass filling the oral cavity up to his incisors as a result of which he could not swallow and speak. Prior to this episode he had no complaints of the disease. An emergency removal was planned and only during the operation could it be diagnosed as a antrochoanal polyp because of its pedicle in the lateral wall of the nose, which was confirmed by histopathological examination.

The combination of a narrow oesophageal lumen and a hypertonic pharyngo-oesophageal (P-E) segment following laryngectomy and secondary tracheo-oesophageal puncture (TEP) can cause obstruction of a voice prosthesis and consequently prevent phonation. The 'Allan Johnson' modification of the Bivona voice prosthesis incorporates a stainless steel slide and has been successfully used to remedy such a circumstance.

The lack of positive health effect in the treatment of cordis vocalis insufficiency after having used the accessible methods, made the authors analyze the anatomic conditions of the organ of voice. Long-lasting observation brought to our mind an original idea the appliance of which gave us rapid and fruitful effect.

The clinical features of 12 patients with spasmodic dysphonia are described. In 11 patients, the voice was strained, harsh, tight, and tremulous, and was low in volume and pitch. Speech, which was sometimes barely intelligible, was interrupted by irregular stoppages and catches of the voice; it required considerable effort, and was accompanied by facial grimacing. The dysphonia was part of a more widespread neurological disorder (idiopathic torsion dystonia) in one case, while it coexisted with blepharospasm in another, and with postural tremor in two. There was a buccolingual hyskinesia in another of these 11 patients, but this may have been related to her previous drug regime. In the twelfth patient, who had a familial tremor, the voice was characterised by marked breathiness, with intermittent aphonia. The disorder is probably due to a focal dystonia of the laryngeal musculature, and this would be consistent with the type of neurological disorders that were associated with it in our cases. Symptomatic benefit follows the therapeutic division of one of the recurrent laryngeal nerves, in selected cases.