Pattern of Gross Displacement of the Vocal Fold in Adduction and Abduction Movements

The pattern of gross displacement of the vocal fold during adduction and abduction was studied in 4 adult fresh human larynges (2 males and 2 females). Markers were placed on specific sites along the edge of the vocal fold. Preliminary observations showed upward and lateral movement of the free edge during abduction. The vocal fold as a whole glides into and fills the cavity of the laryngeal ventricle. To quantify this observation 14 larynges (8 males and 6 females) were studied, using a technique designed to measure vertical and horizontal displacement of the vocal fold. An average of a 1.34 mm elevation and 4.43 mm lateral excursion were observed at mid-vocal fold level. A model for studying the pattern of vocal fold abduction is suggested and discussed.     

Vocal fold injection: review of indications, techniques, and materials for augmentation

Vocal fold injection is a procedure that has over a 100 year history but was rarely done as short as 20 years ago. A renaissance has occurred with respect to vocal fold injection due to new technologies (visualization and materials) and new injection approaches. Awake, un-sedated vocal fold injection offers many distinct advantages for the treatment of glottal insufficiency (vocal fold paralysis, vocal fold paresis, vocal fold atrophy and vocal fold scar). A review of materials available and different vocal fold injection approaches is performed. A comparison of vocal fold injection to laryngeal framework surgery is also undertaken. With proper patient and material selection, vocal fold injection now plays a major role in the treatment of many patients with dysphonia.     

Research opportunities at the Institute of Laryngology and Otology, London.

Emphasis is placed on the need to encourage original research in our training programs. This implies an obligation to help trainees inexperienced in research to bridge the gap between theory and practice. Four examples of patterns of research at a postgraduate institute are presented. All are in areas in some way relevant to carcinoma of the larynx: a) the effect of experimental hypothermia on transplanted tumors in rats; b) isotope detection of deep vein thrombosis following head and neck surgery; c) stomal calibre after laryngectomy related to airflow, esophageal voice and cineradiographic appearances; d) a case-controlled study of the etiologic role of asbestos in laryngeal cancer. These studies are still in progress but some preliminary observations can be reported.     

Vocal hygiene education, voice production therapy, and the role of patient adherence: a treatment effectiveness study in women with phonotrauma.

PURPOSE: To assess the effectiveness of vocal hygiene education (VHE) and voice production therapy (VP) in altering patient perception of vocal handicap in adult women with benign, bilateral phonotraumatic vocal fold lesions and the role of adherence in that perception. METHOD: Sixty-two women were randomly assigned to 6 weeks of VP (n = 31) or VHE (n = 31), followed by 4 weeks of self-study. The primary outcome measure was the Voice Handicap Index (VHI) score, assessed at baseline, post-therapy, and post-self-study. Patient adherence was assessed as a cofactor. RESULTS: Both groups achieved a decrease in VHI scores from baseline to completion of the study, although the improvement was significantly greater for the VP group. The treatment effect size was large for the VP group and small for the VHE group. More participants adhered to VP than to VHE. Only adherent participants achieved significant improvement. Only adherent participants in the VP group improved with self-study. More than two thirds of the VP group achieved final VHI scores within normal limits, compared with approximately one third of those in the VHE group. CONCLUSIONS: VP therapy may be more effective than VHE in addressing patient perception of vocal handicap in adult women with phonotrauma, and self-study may be an important component of therapy. However, adherence is a critical mediator of outcome.