Vocal cord paralysis （ VCP ） refers to the movement disorder of the vocal cord caused by the damage of the motor nerve conduction pathway that dominates the laryngeal muscles, which can be accompanied by sensory nerve disorder of the larynx. Symptoms of bilateral vocal cord paralysis include crying hoarseness, sucking cough, and laryngeal stridor, which can lead to asphyxia in severe cases. Our team recently used CO2 laser to treat such children, but the prognosis varies significantly. Case 1: A 2-year-old male, who had undergone tracheotomy 2 years prior, was diagnosed with "bilateral vocal cord paralysis with grade Ⅱ laryngeal obstruction" after birth. He maintained a tracheostomy until recently. Electronic laryngoscopy showed that the bilateral vocal cords were fixed in the midline, with a glottic fissure of about 1 mm. After surgical treatment, the outcome was good, and there was no recurrence during follow-up. A 1-year-old female, who had undergone tracheotomy over a year ago, was diagnosed with ' ①bilateral vocal cord paralysis; ②laryngomalacia; ③neonatal pneumonia.' She maintained a tracheostomy since then. Electronic laryngoscopy revealed that the bilateral vocal cords were retracted and fixed, with a glottic fissure of about 0.5 mm and limited vocal cord abduction. The postoperative outcome for this child was not good, and the tracheostomy tube was not removed.
Humans ; Vocal Cord Paralysis/surgery* ; Male ; Child, Preschool ; Female ; Laser Therapy ; Infant

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*

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*

Objective: To describe the initial outcomes of endoscopic CO2 laser posterior cordectomy and partial arytenoidectomy among patients with bilateral vocal cord paralysis in our institution. Methods: Design: Case Series Setting: Tertiary National University Hospital Participants: 17 Patients Results: Seventeen (17) patients who underwent transoral posterior cordectomy and partial arytenoidectomy using carbon dioxide laser were included in the study consisting of 14 females and 3 males. Iatrogenic injury was the most common cause of bilateral vocal cord paralysis in this subset of patients. Five patients who tolerated decannulation and another six who had no preoperative tracheostomy all reported subjective improvement in breathing. All of them were also observed to have resolution of stridor and increased respiratory comfort compared to their preoperative condition. The most common postoperative complication was granuloma formation at the medial arytenoidectomy site occurring only in 4 patients. None of the patients complained of aspiration episodes or dysphagia during the postoperative period. Conclusion Our initial experience with transoral endoscopic posterior cordectomy and partial arytenoidectomy using carbon dioxide laser has good postoperative outcomes among patients with bilateral vocal cord paralysis.
Human ; Male ; Paralysis ; Vocal Cord Paralysis ; Vocal Cords ; Carbon Dioxide ; Tracheostomy ; Voice Quality

Objective: To analyze the clinical characteristics of neonatal tracheotomy in neonatal intensive care unit (NICU). Methods: This single-center retrospective study included 14 neonates admitted to NICU of Beijing Children's Hospital, Capital Medical University from January 2016 to August 2021, and were<28 days of age on admission, who met the criteria of tracheotomy and finally completed the procedure. The clinical characteristics including age, weight, duration of ventilation, etiology of tracheotomy, length of hospital stay and prognosis were summarized and analyzed. Wilcoxon signed-rank test was used to compare the weight gain velocity and the duration of ventilation before and after tracheotomy. Paired t-test was used to compare the hospitalization length before and after tracheotomy. Spearman correlation was used to analyze the correlation between the clinical characteristics and outcomes. Results: For the 14 neonates, the gestational age was (38±4) weeks and birth weight was (2 824±949) g. Nine of them were male. The age on transportation was 16 (6, 25) d. A total of 10 neonates were on invasive ventilation on admission, the other 4 were on nasal continuous positive airway pressure support. Bilateral vocal cord paralysis (7 cases) was the commonest cause of tracheotomy. The age on operation was 33 (22, 44) d. There were statistically significant differences in duration of ventilation and weight gain velocity before and after operation (19.00 (10.50, 34.00) vs. 0.86 (0.06, 3.25) d, 1.66 (-0.16, 5.54) vs. 4.69 (2.30, 9.32) g/(kg·d), Z=3.01 and -1.98, both P<0.05). The total hospital stay in NICU was (37±12) d. One neonate died during hospitalization. The existence of pneumonia on admission was positively correlated to NICU stay length (r=0.57, P=0.027), the pre-operational weight gain velocity was negatively correlated to the post-operational NICU stay length (r=-0.73, P=0.020). There were 4 neonates de-cannulated during 7-38 months after the tracheotomy, and 5 neonates still wearing the tracheal cannulation during 15-66 months after the tracheotomy. Two neonates died and 2 neonates lost follow-up after discharge. All neonates could not vocalize normally before de-cannulation, and the language development obviously lagged behind the normal age group after de-cannulation. Conclusions: Bilateral vocal cord paralysis is the commonest cause of neonatal tracheotomy. The benefit of tracheotomy for NICU neonates with surgical indications is obvious, especially in facilitating extubation and improving weight gain.
Child ; Female ; Humans ; Infant ; Infant, Newborn ; Intensive Care Units, Neonatal ; Male ; Retrospective Studies ; Tracheotomy ; Vocal Cord Paralysis ; Weight Gain

Objective: To investigate the treatment outcomes and risk factors of postoperative recurrence in T4a papillary thyroid carcinoma (PTC). Methods: A total of 185 patients with locally advanced T4a PTC treated in Beijing Tongren Hospital, Capital Medical University from January 2006 to December 2019 were retrospectively analyzed, including 127 females and 58 males, aged between 18 and 80 years, with 74 patients aged over 55 years. According to AJCC thyroid tumor staging, 111 cases were stage I (T4aN0M0 26 cases, T4aN1aM0 35 cases, and T4aN1bM0 50 cases) and 74 cases were stage Ⅲ (T4aN0M0 29 cases, T4aN1aM0 19 cases, and T4aN1bM0 26 cases). Kaplan-Meier method was used to calculate the overall survival and the recurrence-free rate, and univariate and multivariate logistic regression analyses on the clinical data were performed. Results: Recurrent laryngeal nerve invasion was observed in 150 cases, trachea invasion in 61 cases, esophagus invasion in 30 cases, and laryngeal structure invasion in 10 cases. Postoperative follow-up periods were 24-144 months, with an average of 68.29 months. Of the 185 patients, 18 (9.73%) had recurrences or metastases, including 9 cases (4.86%) died of recurrences or metastases. The 5-year and 10-year overall survival rates were respectively 95.21% and 93.10%. The 5-year and 10-year disease-free survival rates were respectively 89.65% and 86.85%. Univariate analysis showed that age of onset, tumor diameter, preoperative recurrent laryngeal nerve palsy, esophageal invasion and cervical lymph node metastasis were the risk factors for postoperative recurrence of T4a PTC(all P<0.05). Multivariate analysis showed that preoperative recurrent laryngeal nerve palsy (OR=3.27, 95%CI: 1.11-9.61, P=0.032) and lateral cervical lymph node metastasis (OR=4.71, 95%CI: 1.19-18.71, P=0.027) were independent risk factors for T4a PTC recurrence. Survival rate of patients with T4a PTC involving only the recurrent laryngeal nerve or the outer tracheal membrane was significantly better than that of patients with tracheal invasion (P<0.05). Conclusions: T4a PTC patients with R0 resection can still achieve good efficacy. Preoperative recurrent laryngeal nerve palsy and lateral cervical lymph node metastasis are independent risk factor for postoperative recurrence in the patients.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Carcinoma/pathology* ; Carcinoma, Papillary/surgery* ; Female ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Recurrence, Local/surgery* ; Retrospective Studies ; Risk Factors ; Survival Analysis ; Thyroid Cancer, Papillary/surgery* ; Thyroid Neoplasms/pathology* ; Thyroidectomy/adverse effects* ; Vocal Cord Paralysis/etiology* ; Young Adult

Consensus ; Humans ; Laryngoscopy ; Retrospective Studies ; Vocal Cord Paralysis/therapy* ; Vocal Cords

Consensus ; Humans ; Laryngoscopy ; Vocal Cord Paralysis/therapy* ; Vocal Cords

Objective: The primary objective of this meta-analysis is to compare locoregional recurrence, vocal cord paralysis, and permanent hypoparathyroidism in patients with thyroid papillary carcinoma without neck node metastases, after total thyroidectomy with and without prophylactic central neck dissection.

Methods: Two independent reviewers performed a detailed literature search of MEDLINE (PubMed), HERDIN and Cochrane Library electronic databases to assess research studies until 2018 for inclusion. The primary endpoints of locoregional recurrence, permanent hypoparathyroidism, and vocal cord paralysis were included in the assessment.

Design:           Meta-analysis of Retrospective Cohort Studies

Setting:          University Hospitals and Tertiary Referral Centers

Participants:            Patients with node-negative papillary thyroid cancer who underwent either total thyroidectomy alone or total thyroidectomy with prophylactic central neck dissection (either unilateral or bilateral).

Results: This meta-analysis showed that there is a significantly increased risk for locoregional recurrence in the total thyroidectomy alone group (1.96% TT with pCND VS 2.60% TT, RR=0.62, 95% Cl=0.40-0.95, p=.03), permanent hypoparathyroidism in the total thyroidectomy with prophylactic central neck dissection group (5.72% TT with pCND vs 3.34% TT, RR=2.19, 95% Cl=1.62-2.98, p=.00001) and no significant difference for vocal cord paralysis between the 2 groups (RR=1.56, 95% Cl=0.86-2.84, p=.14).

Conclusion: This meta-analysis revealed that performing pCND in patients with node-negative PTC increases the risk of morbidity for hypoparathyroidism but not for vocal cord paralysis. More importantly, the incidence of recurrence is decreased in the pCND group, which may have implications on the overall survival of patients. The benefit of performing pCND may outweigh the risk but the role of prophylactic CND in the treatment of patients with PTC with clinically negative lymph nodes is still debatable in terms of overall survival.

Keywords:  thyroidectomy, complications; neck dissection; papillary thyroid carcinoma; lymph node dissection; recurrence; vocal cord paralysis; hypoparathyroidism

Introduction: Ortner’s syndrome encompasses any intrathoracic process resulting to stretching of the recurrent laryngeal nerve. The stress to this nerve weakens the intrinsic muscles of the larynx and manifests as vocal hoarseness. Case: A 46-year-old female was admitted due to progressive hoarseness. She tolerated this for six months until the onset of other symptoms like orthopnea, bipedal edema, and chest pain. She consulted various doctors and was initially diagnosed with chronic laryngitis from gastroesophageal reflux disease. She was given omeprazole and spironolactone that afforded little help. On examination, the precordium was dynamic with heaves and thrills, PMI was displaced, and systolic murmurs were heard. The ECG revealed left ventricular hypertrophy with left atrial abnormalities. Chest radiograph showed leftsided cardiomegaly. A 2D-echocardiogram divulged severe mitral regurgitation, anterior mitral valve leaflet thickening, and dilated left atrium. Therefore, the impression was Ortner’s syndrome, rheumatic heart disease. The patient underwent mitral valve replacement. She was given warfarin, bisoprolol, losartan, spironolactone, and vitamin B complex. At subsequent visits, she reported improvement in her voice. Penicillin injections were also given as secondary prophylaxis. A repeat 2D-echocardiogram displayed a decrease in size of the left atrium. Conclusion This case has emphasized three important points: First, a comprehensive history and physical examination is vital to reach the correct diagnosis. Second, once the common causes of hoarseness have been excluded yet symptoms persist, it is therefore prudent to look beyond the larynx. And third, the vocal cord paralysis experienced by the patient is just the tip of the iceberg. Her heart is the one dying to be heard.
Vocal Cord Paralysis ; Hoarseness ; Heart Failure