BACKGROUND AND OBJECTIVES: With the present methods for assessing speech, there are procedures that make effective diagnostics possible for voice disorders. One such procedure is cepstrum. Spectrum is produced by Fourier transformation of sound waves, and if Fourier transformation is performed again about the spectrum, cepstrum is produced. This study compared cepstrum to jitter, shimmer, and noise-to-harmonic ratio (NHR) for assessment of its usefulness. Cepstrum was measured by Cepstral Peak Prominence (CPP) calculated by the Hillenbrand method and Cepstral Mean Values (CMV) calculated using the Computerized Speech Laboratory software. SUBJECTS AND METHOD: We included in the study 30 patients with vocal nodule and unilateral vocal cord palsy who were diagnosed in Kangbuk Samsung Hospital between March 2010 and May 2011, and 30 normal controls. Phonation of sustained vowel /a/ sample and running speech was subjected to acoustic analysis using CMV and CPP. Then we compared the correlation of cepstrum with other acoustic methods. RESULTS: The measured values of CPP-a were 14.16, 17.25, 20.00 and the age adjusted CPP-s values were 11.21, 12.85, 15.00 for vocal cord palsy, vocal nodule and normal group, respectively. There was significant correlation with perceptions of dysphonia (p<0.001), but in CMV-a, CMV-s, there was no significant correlation. When jitter, shimmer, and NHR were compared with cepstrum, the result showed negative correlation among the three groups but CPP values showed significant difference (p<0.001). CONCLUSION: In the assessment of voice disorders, cepstrum may be used as a reliable method for comparing other complementary analysis tools. For the acoustic analysis of voice by cepstrum, however, CPP has more reliable correlations with dysphonia than CMV.
Acoustics ; Dysphonia ; Fourier Analysis ; Hoarseness ; Humans ; Phonation ; Running ; Sound ; Vocal Cord Paralysis ; Voice ; Voice Disorders

PURPOSE: To discuss computed tomography (CT) evaluation of the etiology of vocal cord paralysis (VCP) due to thoracic diseases. MATERIALS AND METHODS: From records from the past 10 years at our hospital, we retrospectively reviewed 115 cases of VCP that were evaluated with CT. Of these 115 cases, 36 patients (23 M, 13 F) had VCP due to a condition within the thoracic cavity. From these cases, we collected the following information: sex, age distribution, side of paralysis, symptom onset date, date of diagnosis, imaging, and primary disease. The etiology of VCP was determined using both historical information and diagnostic imaging. Imaging procedures included chest radiograph, CT of neck or chest, and esophagography or esophagoscopy. RESULTS: Thirty-three of the 36 patients with thoracic disease had unilateral VCP (21 left, 12 right). Of the primary thoracic diseases, malignancy was the most common (19, 52.8%), with 18 of the 19 malignancies presenting with unilateral VCP. The detected malignant tumors in the chest consisted of thirteen lung cancers, three esophageal cancers, two metastatic tumors, and one mediastinal tumor. We also found other underlying etiologies of VCP, including one aortic arch aneurysm, five iatrogenic, six tuberculosis, one neurofibromatosis, three benign nodes, and one lung collapse. A chest radiograph failed to detect eight of the 19 primary malignancies detected on the CT. Nine patients with lung cancer developed VCP between follow-ups and four of them were diagnosed with a progression of malignancy upon CT evaluation of VCP. CONCLUSION: CT is helpful for the early detection of primary malignancy or progression of malignancy between follow-ups. Moreover, it can reveal various non-malignant causes of VCP.
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Lung Neoplasms/complications/pathology ; Male ; Middle Aged ; Neoplasm Invasiveness ; Recurrent Laryngeal Nerve/pathology ; Retrospective Studies ; Thoracic Diseases/*complications ; Tomography, X-Ray Computed ; Tuberculosis, Pulmonary/complications ; Vocal Cord Paralysis/*etiology/*radiography

BACKGROUND AND OBJECTIVES: The Voice Handicap Index (VHI) was developed to assess patients' perception on the severity of their voice disorders. The purpose of this study was to determine the severity of handicap expressed by patients with various voice disorders, and to help clinicians in making future treatment plan. VHI may also be used as a guideline in making diagnosis according to different factors of voice quality. SUBJECTS AND METHOD: The people who had visited the Asan Medical Center with hoarseness from August 2000 to August 2001 were studied. They filled out the questionnaire composed of 30 questions about their voice disorders. The subjects were consisted of 6 groups; 50 patients with vocal cord nodule, 43 patients with laryngitis, 42 patients with vocal cord polyp, 25 patients with glottic cancer and 14 patients with unilateral vocal cord paralysis. Descriptive statistics were used to analyze the data and mean value of VHI scores. RESULTS: The mean score of VHI was found to be statistically higher in the subjects with the history of voice abuse (p<0.002). Overall, the group with unilateral vocal cord paralysis showed the highest VHI score that was statistically significant (p<0.001). When the functional factor is considered, groups with unilateral vocal cord paralysis and glottic cancer had shown higher scores compared to the other groups. When the physical factor is considered, groups with unilateral vocal cord paralysis and vocal cord polyp had shown higher scores. When the emotional factor is considered, groups with unilateral vocal cord paralysis had shown higher scores. CONCLUSION: Measurement of VHI in patients with voice disorders provides a measure of self-perception on the severity of the problems that cannot be assessed through visual perception or objective acoustic and aerodynamic measures. In addition, the measurement of VHI score was easy to perform, non-invasive, and inexpensive. In using this method, we expect to reveal the efficacy of the treatment for voice disorders.
Acoustics ; Chungcheongnam-do ; Diagnosis ; Fibrinogen ; Hoarseness* ; Humans ; Laryngitis ; Polyps ; Surveys and Questionnaires ; Self Concept ; Visual Perception ; Vocal Cord Paralysis ; Vocal Cords ; Voice Disorders ; Voice Quality ; Voice*

BACKGROUND AND OBJECTIVES: Although laryngeal tuberculosis is not common, it still occurs with an increasing incidence of pulmonary tuberculosis. The clinical pattern and spread mechanism of this disease have also changed as well. This study was performed to examine the current propensity seen in laryngeal tuberculosis and the clinical characteristics of this disease in patients showing atypical clinical pattern. SUBJECTS AND METHOD: We retrospectively analyzed 60 cases of laryngeal tuberculosis diagnosed from 1994 to 2004 in the department of otorhinolaryngology at Severance Hospital by evaluating clinical and videostroboscopic records. RESULTS: The age of the patients ranged from 25 to 78 years, with their average age being 49.7 years. The ratio between men and women was 1.9 : 1. The major symptom encountered was hoarseness (96.6%). Clinically, granulomatous (n=22) and ulcerative types (n=11) of laryngeal tuberculosis were still prevalent, however, the incidence of atypical types such as polypoid (n=16) and nonspecific (n=11) were on the rise. Among 27 cases that showed polypoid or nonspecific types, unilateral lesion was seen in 20 cases (74%). The most frequently affected area by this disease was true vocal cord, followed by false vocal cord, epiglottis, arytenoids and posterior commissure. Active pulmonary tuberculosis was present in 28 (46.7%), inactive pulmonary tuberculosis in 20 (33.3%), normal lung status in 12 cases (20%). Primary laryngeal tuberculosis was present in 9 cases (15%). Single lesion, polypoid and nonspecific type were the prevalent characteristics found in patients with inactive tuberculosis or normal lung status. CONCLUSION: Physicians should be aware of changes in the clinical pattern of laryngeal tuberculosis, which pose serious complications and risk of spreading.
Epiglottis ; Female ; Hoarseness ; Humans ; Incidence ; Laryngeal Diseases ; Larynx ; Lung ; Male ; Otolaryngology ; Retrospective Studies ; Tuberculosis ; Tuberculosis, Laryngeal* ; Tuberculosis, Pulmonary ; Ulcer ; Vocal Cords

Nowadays left vocal cord paralysis is a rare presenting sign of cardiovascular diseaes, associated with pulmonary hypertension. This condition is known as Cardiovocal syndrome. The mechanism of this condition is thought to be due to compression of the recurrent laryngeal nerve by a dilated, tense pulmonary artery against its adjacent structure. Two patients complaining hoarseness were proven to have cardiovascular diseases. The one had patent ductus arteriosus and the other had primary pulmonary hypertension. A causal relation between cardiovascular problem and the vocal cord paralysis is proposed. We describen two cases of Cardiovocal syndrome with a review of the literature.
Cardiovascular Diseases ; Ductus Arteriosus, Patent* ; Hoarseness ; Humans ; Hypertension, Pulmonary* ; Pulmonary Artery ; Recurrent Laryngeal Nerve ; Transcutaneous Electric Nerve Stimulation ; Vocal Cord Paralysis* ; Vocal Cords*

Objective: To investigate the long-term outcomes of patients with unilateral vocal fold paralysis resulting in dysphonia treated with lateral vocal fold autologous fat injection. To analyze the factors that may affect the long-term efficacy of the procedure. Methods: From July 2003 to June 2020, 163 patients (86 males and 77 females), aged 9-73 years (mean (34.50±12.94) years) with unilateral vocal fold paralysis resulting in dysphonia underwent transoral laryngoscopic injection of autologous fat into the lateral vocal folds. Subjective auditory perception assessment (GRBAS scale), objective acoustic assessment, voice handicap index (VHI) evaluation and stroboscopic laryngoscopy were compared before and after the surgery. Patients were followed up for 1 to 18 years, with median follow-up time of 6 years. SPSS 22.0 software was used for statistical analysis. Results: Of 163 patients, 17 patients (10.4%) had mild hoarseness (G1) and 146 patients (89.6%) had moderate to severe hoarseness (G2-3). Stroboscopic laryngoscopy revealed an arch-shaped vocal fold on the affected side, fixed in the paramedian position or abduction position, with obvious glottic closure fissure. Postoperatively, voice recovered to normal (G0) in 139 patients (85.3%), mild hoarseness (G1) in 18 patients (11.0%) and moderate hoarseness (G2) in 6 patients (3.7%). Of these, 131 patients (80.4%) showed significant improvement in hoarseness, 29 patients (17.8%) showed mild improvement and 3 patients (1.8%) showed no significant improvement in hoarseness. Objective acoustic parameters of Jitter, Shimmer, NHR and MPT improved significantly, as did VHI scores. Stroboscopic laryngoscopy showed medialization of the affected vocal folds, improved vocal fold closure and normal or nearly normal vocal fold mucosal waves. With a fat injection volume of 3.0-4.5 ml, the patient's subjective auditory perception scores of G, R, B and A improved more significantly within 3 months after surgery, and both VHI and MPT were significantly better since 1 year after surgery. With bilateral vocal fold injection, the B and A scores improved significantly from 1 month postoperatively compared to unilateral injections(unilateral vs. bilateral injection 1 month post-operation, t_{B scores}=1.42,t_{A scores}=1.51,P<0.05). Conclusions: The long-term efficacy of autologous fat injection in the paraglottic space for the treatment of unilateral vocal fold paralysis was stable. The efficacy of the surgery was related to the amount of fat injected, unilateral or bilateral of the injection.
Male ; Female ; Humans ; Vocal Cords/surgery* ; Dysphonia/surgery* ; Hoarseness ; Treatment Outcome ; Vocal Cord Paralysis/surgery*

Pediatric vocal ford paralysis is a vocal cord movement disorder caused by damage to the pediatric laryngeal motor nerves.It is mainly characterized by voice, breathing,and swallowing difficulties,and in severe cases,it can lead to choking in affected children. Currently, the diagnosis and treatment of this condition pose a significant challenge for pediatric otolaryngologists, as the goal is to minimize damage to the vocal folds and laryngeal framework.In order to standardize the diagnosis and treatment of pediatric vocal cord paralysis, the Pediatric Otolaryngology Committee of the Chinese Medical Association,in collaboration with multiple children's medical centers nationwide, have formulated this consensus document.
Humans ; Child ; Vocal Cord Paralysis/therapy* ; Consensus ; Vocal Cords/surgery* ; Larynx ; Voice ; Laryngeal Diseases/complications*

BACKGROUND AND OBJECTIVES: Some objective and quantitative diagnositc methods are introduced to evaluate vocal cord paralysis, such as electro glottography (EGG) and laryngeal electromyography (LEMG). LEMG is an invasive and highly technical method requiring patient's cooperation. It records action potential generated when intrinsic laryngeal musculature contracts. EGG, on the other hand, records changes of impedence between both vocal cords when theses vibrate and represents many information of vocal cord movements. This method is non-invasive and very simple offering some valuable information about voice function of laryngeal diseases. MATERIALS AND METHODS: From January 1998 through May 2000, we evaluated 15 vocal cord paralysis patients by LEMG and EGG and compared the usefulness of these two methods by determining the lesions of vagal nerve injury. RESULTS: For patients who had severe recurrent laryngeal nerve injuries, EGG and dEGG showed no plateau phase but a loss of two-mass movements. Some showed very irregular saw-tooth shaped wave patterns. Patients with vagal nerve injury, EGG and dEGG showed relatively well maintained plateau phases because they had paralyzed cricothyroid muscles which are counteract to abductor of vocal cord. CONCLUSION: Although EGG did not provide information about such diseases as laryngeal myopathy and arthropathy, it is simple and non-invasive, and may he much valuable as a topodiagnostic method of vocal cord paralysis.
Action Potentials ; Diagnosis* ; Electromyography ; Hand ; Humans ; Laryngeal Diseases ; Laryngeal Muscles ; Muscular Diseases ; Ovum ; Recurrent Laryngeal Nerve Injuries ; Vocal Cord Paralysis* ; Vocal Cords* ; Voice

Although many factors associated with difficult intubation have been known, predictors of difficult mask ventilation are not well known. We experienced a case of nearly complete airway obstruction following usual anesthetic induction which needed various emergency treatments. The patient had a preoperative diagnosis of contact granuloma of right posterior vocal cord and bilateral vocal cord palsy but later was found out as invasive laryngeal cancer. Upon the surgical field of view, both vocal cords were showing significantly thickened and fixated appearance and was considered as in the critical narrowing state with the potential of complete obstruction. Using C-MAC® video laryngoscope we were able to see the narrowed vocal cord and choose proper size of endo-tracheal tube. Consequently, intubation was successfully done and operation was conducted. From this case, we have lessons that physicians should examine the patient's airway more carefully in case of laryngeal mass and prepare emergency measures.
Airway Obstruction ; Bays* ; Diagnosis ; Emergencies ; Emergency Treatment ; Granuloma ; Humans ; Intubation ; Laryngeal Neoplasms ; Laryngoscopes* ; Masks ; Ventilation ; Vocal Cord Paralysis ; Vocal Cords

BACKGROUND AND OBJECTIVES: The various types of varix which has a dilated, tortous, elongated blood vessel arising from the microcirculation of the vocal folds may cause different types of dysphonia. There have not been many specific studies on the characteristics of microvascular lesions of the vocal folds, so authors tried to evaluate the shapes, traveling pathway, and predilection site of the microvascular lesions. MATERIALS AND METHODS: A retrospective review of 119 patients with dysphonia was undertaken. All findings of videotapes were evaluated according to the shapes, the traveling pathway, the predilection sites and accompanying disorders of the microvascular lesions. RESULTS: The most common shapes of the microvascular lesions were the abrupt developed type and the multiple dilated type. The longitudinal type was the most common traveling type. The superolateral surface of the vocal folds was the predilection site of the microvascular lesions. Functional voice disorders, such as laryngeal nodule, laryngeal polyp, laryngeal edema, were more common as accompanying disorders. CONCLUSION: Authors found that there were a variety of types of microvascular lesions.
Blood Vessels ; Dysphonia ; Hoarseness* ; Humans ; Laryngeal Edema ; Microcirculation ; Polyps ; Retrospective Studies ; Varicose Veins ; Videotape Recording ; Vocal Cords* ; Voice Disorders