Voice and laryngology

Auditory perceptual assessment (APA) of voice and speech disorders

T. Abou-Elsaad                                                                                                                                                      doi: 10.48095/ccorl2025S1_41

Phoniatrics Unit, ENT Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt

Auditory-perceptual assessment (APA) is a fundamental approach to evaluating voice and speech disorders. This method relies on clinicians’ perceptual judgments to assess various aspects of voice and speech, including pitch, loudness, quality, resonance, prosody, and articulation. It plays a pivotal role in diagnosing conditions such as dysphonia, stuttering, nasality, and other communication impairments. Despite its subjectivity, auditory-perceptual assessment remains widely used due to its practicality, cost-effectiveness, and ability to capture the nuanced characteristics of voice and speech. Standardized rating scales, such as the GRBAS (Grade, Roughness, Breathiness, Asthenia, Strain), have been developed to enhance the reliability and validity of this approach. These scales guide clinicians in systematically evaluating voice and speech parameters and provide a framework for consistent documentation and communication among professionals. The aim of the presentation is to explore the different rating scales of APA protocols for voice and speech disorders with the participants. Voice and speech audio/video samples will be presented in order to orient the phoniatricians and speech pathologists with different voice and speech disorders.

Palliative treatment of advanced laryngeal cancers

M. Becirovic, I. Setic-Avdagic, H. Altumbabic                                                                                             doi: 10.48095/ccorl2025S1_42 ENT department, ASA Hospital, Sarajevo, Bosnia-Herzegovina

Introduction: Inoperable or metastatic laryngeal, head and neck squamous cell cancer (HNSCC) is known to be associated with a poor patient prognosis. Techniques for surgery, reconstruction, radiation therapy, chemotherapy, and targeted therapy have evolved, providing patients and providers with more options than ever. Patients with laryngeal cancer often still find themselves facing an incurable disease with significant morbidity. Many patients are ultimately forced to bear the burden of a multitude of symptoms that threaten their physical and psychological well-being. Aim: This article provides a current overview of how palliative care is focused on improving quality of life for people with laryngeal cancer and head and neck carcinoma. Palliative care aims to improve the quality of life (QoL) of patients and their carers facing the problems associated with life threatening illness. Materials and Methods: Literature review. Results: This can be achieved by the prevention and relief of suffering, ensuring comfort and dignity, by means of early identification, assessment and management of pain and other, physical, psychosocial and spiritual issues. Patients with laryngeal cancers, and head and neck cancer are a group in whom both specialist palliative and supportive care is especially appropriate whether the treatment intent is curative or not, since the disease and its treatments result in a huge burden of morbidity: shortand long-term – even lifelong for survivors. Conclusion: Different interventions are used to manage head and neck cancer patients with palliative intent, and these may be associated with significant morbidity. Survival time is variable, often several months; thus, any treatment must take into account morbidity in conjunction with the patient’s wishes.

Strategies for vocal fold hydration and lubrication: exploring new advances in phonatory health

A. Bianchino1, V. Camesasca2, A. B. Torre3, D. Strangis4, I. Mezzacapo5                                                                          doi: 10.48095/ccorl2025S1_43

1 Otorhinolaryngology, Audiology and Phoniatrics, University of Ferrara, Ferrara, Italy

2 Otorhinolaryngology, Grande Ospedale Metropolitano Niguarda, Milano, Italy

3 Foniatria y Logopedia, Centro de Foniatría y Logopedia, Santander, Spain

4 Voice, VoceInForma, Torino, Italy

5 Voice, Crossroad Music Lab, Piombino, Italy

Vocal fold hydration and lubrication play a critical role in maintaining optimal phonatory function and preventing vocal injuries. Recent studies have shifted focus from traditional systemic hydration methods to more localized techniques that enhance surface hydration and improve vocal fold pliability. This workshop explores innovative approaches to optimize vocal fold hydration and lubrication, with an emphasis on practical, evidence-based interventions. One such method is nasal hydration, where the use of a damp gauze is employed to introduce moisture into the vocal fold mucosa. This technique has been shown to significantly enhance the mucosal wave and improve voice quality after just 10 minutes of application. Recent developments also highlight the role of glycosaminoglycans (GAGs) like hyaluronic and galacturonic acids in enhancing moisture retention and improving vocal fold lubrication. These GAG molecules, when combined with hydration techniques, create a more sustained and durable effect on vocal fold health. Additionally, the workshop will delve into the use of endogenous lubricants, particularly saliva, and explore how stimulating its production can contribute to vocal fold lubrication. This approach addresses the impact of factors such as GERD and LPR, which can compromise vocal fold hydration and lubrication. Participants will engage in hands-on experiments to assess the effects of nasal hydration, GAG-based lubricants, and saliva stimulation techniques on vocal fold function. Real-time voice quality monitoring will allow attendees to observe the immediate impact of these interventions on both speaking and singing voices. The goal is to equip clinicians, educators, and researchers with the knowledge to incorporate these strategies into clinical practice and to stimulate further research into novel solutions for improving vocal health.

Therapeutic ultrasound in vocal nodule dysphonia

J. A. B. Ordoñez                                                                                                                                                   doi: 10.48095/ccorl2025S1_44

Department of Phoniatrics, Institute of Medical Rehabilitation of the Ministry of Health and Social Assistance, Caracas, Venezuela

Introduction: General purpose: To determine the efficacy of therapeutic ultrasound as a therapeutic technique in vocal nodule dysphonia. Materials and Methods: Only patients between 20 and 40 years old, singers, speakers and/or teachers, presenting dysphonia due to unilateral or bilateral vocal nodules were included. The material resources included: the therapeutic ultrasound apparatus (EST-SONIC brand). The present study was a double-blind controlled clinical trial, the allocation was randomized. Two groups were formed, a study group and a control group, each of ten patients, who underwent a phoniatric evaluation on the first day before the application of the therapeutic ultrasound. The technique used in the patients consisted of the following steps:

1. Patient in dorsal decubitus; 2. Hyperextension of the neck; 3. Previous application of water gel, at the level of the protruding angle of the thyroid cartilage; 4. Placement of the transducer of the therapeutic ultrasound device on both sides of the thyroid cartilage, with continuous emission for five minutes (2.5 minutes on each side of the thyroid cartilage), and with an intensity of 1.5 watts/ctms; 5. The same technique was applied to the placebo, until completing three sessions per week, in a period of one month; 6. The same technique was applied to the placebo of the control group, but without the intensity of 1.5 watts. Results: Therapeutic ultrasound in dysphonia due to vocal nodules according to age and sex. A total of twenty paired TMT / control / placebo patients participated in the study, who were assigned equally to the groups, 10 in GTMT and 10 in CG, with the predominant sex being entirely female and the median age corresponding to the 31 to 35 age group. Conclusions: The present study demonstrates that therapeutic ultrasound applied at a dose of 1.5 watts/ctms on alternate days, with continuous emission, is an effective treatment.

Advanced phonosurgical procedures at the University of Pécs – initial results and experiences of a Hungarian phonosurgeon

A. Burián1, K. Smatanová2, I. Szanyi1                                                                                                                                                                     doi: 10.48095/ccorl2025S1_45

1 Department of Otorhinolaryngology and Head and Neck Surgery, University of Pécs, Clinical Centre, Pécs, Hungary

2 Department of Paediatrics, Division of Otorhinolaryngology, University of Pécs, Clinical Centre, Pécs, Hungary

Introduction: Dysphonia – irrespectively of the aetiology – may cause deterioration in quality of life not only among voice professionals. Despite speech therapy, several cases necessitate phonosurgical intervention for the improvement of voice. Aims: Our aim was to demonstrate our institute’s phonosurgical armamentarium that has started nearly 5 years ago. Materials and Methods: Eighty patients with dysphonia had undergone phonosurgical procedures in our institute between April of 2019 and November of 2024. Aetiology of dysphonia included Reinke’s oedema, vocal fold cyst, pseudocyst, polyp, vocal fold scar, sulcus vocalis, mucosal bridge, vocal fold atrophy, granulation tissue, unilateral vocal fold palsy and puberphonia. Both pre and periodical post-treatment laryngostroboscopy and voice assessment were carried out including, Voice handicap index-10, maximum phonation time, perception (Grade, Roughness, Breathiness, Asthenia, and Strain), acoustics (mean F0, jitter and/or shimmer) and voice range profile. Results: Overall ninety-eight phonosurgical interventions were performed including transoral laryngeal microsurgery with mucosal reconstruction under general anesthesia (71 cases), injection laryngoplasty with hyaluronic acid under local anesthesia (17 cases) and laryngeal framework surgery under local anesthesia (11 cases) in the investigated period. Voice quality improvement was achieved in all cases confirmed by the applied subjective and objective assessments. Conclusion: Phonosurgery coupled with appropriate approach and indication can offer efficient solution for treatment of numerous types of dysphonia, as we have experienced during the initial 5 years.

Voice mapping in clinical practice: tracking objective changes after injection laryngoplasty

S. Capobianco1, G. Björck2, F. Forli1, S. Berrettini1, S. Ternström3                                                                                         doi: 10.48095/ccorl2025S1_46

1 ENT, Audiology and Phoniatrics Unit, Pisa University Hospital, Pisa, Italy

2 Division of Ear, Nose and Throat, Department of Otorhinolaryngology, Karolinska Institutet, Stockholm, Sweden

3 Division of Speech, Music and Hearing, School of Electrical Engineering and Computer Science, KTH Royal Institute of Technology, Stockholm, Sweden

Introduction: Unilateral vocal cord paralysis compromises voice quality by reducing glottic closure, leading to air leakage during phonation. Injection laryngoplasty enhances closure and improves voice quality, but its effectiveness is often evaluated subjectively. Voice mapping, which utilizes fundamental frequency (fo) and sound pressure level (SPL) as independent variables, generates scalar maps of vocal parameters across the entire vocal range. Aims: This study investigates the potential of voice mapping as an objective tool to assess changes in glottic closure and voice quality following laryngoplasty. Methods: Eight patients with unilateral vocal cord paralysis (mean age 64.4 years) underwent injection laryngoplasty with hyaluronic acid or calcium hydroxyapatite at Karolinska University Hospital (Stockholm, Sweden). Voice recordings with the software FonaDyn (integrating acoustic and electroglottographic data) were collected preand post-procedure. Perceptual voice evaluations were conducted by three blinded clinicians. Results: With an appropriate periodicity threshold, it was possible to analyze voice maps even in severe dysphonia. Perceptual evaluation (ICC 0.6–0.8) showed reduced dysphonia severity post-treatment, with decreased breathiness and asthenia but increased roughness and vocal effort. Six of eight patients demonstrated improved glottic closure, with greater electroglottographic signal stability. Conclusions: Voice mapping objectively represents vocal changes after laryngoplasty, supporting its role in clinical assessment and therapeutic planning for vocal cord paralysis.

Echoes of a legend: Luciano Pavarotti, the unimitable Maestro of Do di Petto – physiological and phonetic perspectives

V. Caragli1, E. Genovese1, A. Coppi2                                                                                                                                                                         doi: 10.48095/ccorl2025S1_47

1 University of Modena and Reggio Emilia, Modena, Italy

2 Free University of Bolzano and Lecturer in Vocal Pedagogy and Conductor of the University Choir and Orchestra of the University of Modena and Reggio Emilia, Modena, Italy

Luciano Pavarotti, a celebrated tenor of the 20th century, is renowned for his powerful vocal abilities, particularly in executing high notes in the chest register, exemplified by his historic performance of nine “chest C” notes in the aria “Ah, mes amis, quel jour de fête!” from “La figlia del reggimento”. This study aims to examine the physiological and phonetic aspects of Pavarotti’s vocal technique. A comprehensive literature review was conducted utilizing Scopus and Google Scholar, focusing on publications regarding Pavarotti’s vocal methods, with careful screening for original research and sound anatomical insights. Findings highlight that Pavarotti’s impressive vocal capabilities stemmed from a combination of anatomical structure, extensive training, and effective use of resonance, which permitted the execution of high notes with clarity and richness. The interplay between Pavarotti’s technical mastery, interpretive approach, and advancements in recording technology, alongside how lifelong training mitigated vocal aging. As a consequence, Pavarotti’s achievements are not solely attributable to anatomical predisposition but also to disciplined artistry, establishing an enduring standard in operatic performance that highlights the complexities of the vocal art form.

Clinical effects of absolute voice rest and hypofunctional whispering after phonosurgery: a prospective randomized controlled study

C. E. Çavlan, N. Enver                                                                                                                                         doi: 10.48095/ccorl2025S1_48

Department of Otolaryngology, Marmara University Faculty of Medicine, Istanbul, Türkiye

Introduction: Benign vocal cord pathologies, such as polyps and Reinke’s edema, impair voice quality. Postoperative voice rest is recommended, but its effectiveness is unclear. Some studies suggest shorter rest may suffice, and hypofunctional whispering is debated as an alternative. Aims: This study compares absolute voice rest and hypofunctional whispering in postoperative voice recovery. Material and Methods: This prospective, randomized study included patients aged 18–60 undergoing surgery for benign vocal cord lesions. Exclusion criteria were comorbidities, prior phonosurgery, malignancy, neck RT, tracheotomy, or officebased voice surgery. Patients were randomized into Whispering or Absolute rest groups, with blinded evaluators. A single surgeon performed all procedures. The whispering group received 10-minute postoperative training by speech therapists. All patients attended one preoperative and four postoperative therapy sessions. Follow-ups at 0, 1, and 3 months assessed CAPE-V, VHI-30, VRQOL, aerodynamic (MPT, S/Z Ratio), and acoustic (PRAAT: F0, jitter, shimmer, HNR, CPPS, AVQI) parameters. Results: The groups were homogeneously distributed. VHI-30 and VRQOL improved significantly in both groups (P < 0.05), with no difference between them (P > 0.05). MPT and S/Z ratio increased significantly postoperatively (P < 0.05), without intergroup differences (P > 0.05). CAPE-V showed significant improvement in all parameters, with roughness differing between groups (P < 0.05). CPPS increased, AVQI decreased (P < 0.05), while jitter, shimmer, and HNR showed no significant change (P > 0.05). Conclusion: Hypofunctional whispering is as safe as absolute voice rest and may provide a more comfortable recovery by allowing speech. No significant difference was found in voice outcomes, supporting more flexible voice rehabilitation strategies after phonosurgery.

Efficacy and Safety of Hyadex® for the treatment of unilateral vocal cord paralysis: a prospective observational study

C. E. Çavlan, M. F. Beyaz, N. Enver                                                                                                                  doi: 10.48095/ccorl2025S1_49

Department of Otolaryngology, Marmara University Faculty of Medicine, Istanbul, Türkiye

Introduction: Unilateral vocal cord paralysis (UVCP) is a common cause of dysphonia, frequently managed with vocal fold injection augmentation due to its minimally invasive nature. Recently, dextranomer/cross-linked hyaluronic acid (Hyadex®) has gained attention for its potential to improve glottic closure and voice quality in UVCP-related dysphonia. Objective: This study aimed to evaluate the efficacy and safety of Hyadex® in patients with a clinical diagnosis of UVCP. Materials and Methods: This prospective, single-center observational study was conducted between 2024 and 2025. A total of 138 patients with UVCP underwent Hyadex® injection augmentation under local anesthesia via a transcervical approach, with 146 injections performed (six patients received two injections, and one received three). Demographic data, etiology, complications, and both acoustic and perceptual voice analyses were assessed. Voice evaluations were conducted at two weeks (N = 62) and three months (N = 31). Results: The study included 138 patients (58 females, 80 males; mean: 48.8 years, range: 14–80). The most common UVCP etiologies were post-neck surgery (26%), idiopathic (15.2%), and post-lung surgery (15.2%). Significant improvements were observed in jitter, shimmer, noise-to-harmonic ratio (NHR), and harmonic-to-noise ratio (HNR) at two weeks (P ≤ 0.001), with these gains persisting or increasing at three months. Fundamental frequency (F0) showed no significant change (P = 0.356). Perceptual voice analysis demonstrated significant improvements in overall grade of severity and breathiness (P < 0.001). Adverse events occurred in 5.4% (N = 8) of injections, manifesting as inflammatory reactions (stridor, dyspnea). Six patients required hospitalization, one was managed conservatively, and one left voluntarily. Hospitalized patients received systemic steroids, PPI, and antihistamines. Conclusion: Hyadex® vocal fold injection augmentation demonstrated high efficacy in appropriately selected patients with UVCP and may serve as a first-line treatment. Significant improvements in both acoustic and perceptual voice parameters were observed, with a low rate of manageable complications.

Effects of hydration and a hyaluronic acid-containing lozenge on voice parameters in conjunction with a vocal loading test

Echternach1, M. Köberlein1, J. Kirsch1, M. Döllinger2, T. Pilsl1                                                                                            doi: 10.48095/ccorl2025S1_50

1 LMU University Hospital, Munich, Germany

2 University Hospital Erlangen, Erlangen, Germany

Introduction: This study examines the effects of water intake and a hyaluronic acid (HA) lozenge on acoustic measurements and vocal oscillation patterns following a vocal loading test (VLT). Method: Ten healthy participants (five females, five males) read a standardized text for 10 minutes at 80 dB(A), measured 30 cm from the mouth, under three conditions, each after fasting for 2 hours: a) drinking 0.7 liters of water; b) sucking an HA lozenge; and c) neither intervention before the VLT. The dysphonia severity index (DSI) was assessed before and after the reading task. Additionally, high-speed videolaryngoscopy (HSV), electroglottography, and audio signals during sustained phonation of the vowel /i/ before and after the VLT were analyzed. The glottal area waveform was derived from HSV footage. Results: DSI values decreased for both the H₂O and HA groups, but only reached statistical significance for the H₂O condition, while remaining stable for the control group. These DSI decreases were driven by increases in minimum sound pressure level intensity (Imin), with statistical significance only for the water intake intervention. Statistically nonsignificant changes were observed in periodicity and perturbation parameters across all conditions. No phase differences or aperiodicities were observed in the phonovibrograms. Conclusions: Hydration and HA lozenges did not significantly alter vocal fold biomechanics after a VLT. However, the decrease in DSI values with increased Imin suggests a reduced vocal capacity for the H₂O condition.

Effectiveness of vocal warm-up and cool-down exercises on voice after a vocal loading task: a randomized controlled trial study

Gunduz1, S. Tulunoglu1, N. Enver2                                                                                                                                                                       doi: 10.48095/ccorl2025S1_51

1 Speech and Language Therapy, Istanbul Kent University, Istanbul, Türkiye

2 Otolaryngology-Head and Neck Surgery, Marmara University, Istanbul, Türkiye

Introduction: Due to intensive vocal activities, professional voice users are at higher risk of developing vocal fatigue compared to non-professional users. Vocal warm-ups are widely recommended to enhance efficiency and prevent strain. In contrast, cooldown exercises, which could aid post-use, have received less attention. Aim: This study aims to evaluate the effects of vocal warm-up and cool-down exercises on acoustic parameters and subjective perceptions of vocal fatigue following a period of vocal loading. Materials and Methods: A randomized controlled trial with a pre-test / post-test design was utilized. Thirty-six participants were randomly assigned to three groups: a control group, a vocal warm-up exercises group, and a vocal warm-up and cool-down exercises group. Acoustic analyses were conducted using the MDVP and the ADSV along with Visual analog scale evaluations for subjective vocal fatigue, administered in both pre-test and post-test phases. The vocal loading task consisted of 40 minutes of continuous reading at an 80–85 dB sound pressure level. Groups 2 and 3 performed vocal warm-up exercises before loading, while group 3 also included cool-down exercises. Statistical analyses included paired sample t-tests and Wilcoxon tests for within-group comparisons, and two-way ANOVA for between-group comparisons. Results: The study revealed no significant differences in acoustic measurements between groups. However, reported vocal fatigue scores showed significant differences (P < 0.05). Participants in the cool-down exercise group reported significantly lower vocal fatigue scores compared to the other groups. While the cool-down group showed observable improvements in post-test acoustic measurements, these changes were not statistically significant. Conclusion: This study suggests that vocal cool-down exercises are more effective in reducing perception of vocal fatigue after intense vocal loading than solely warm-up exercises or no exercises at all. While acoustic improvements for the cool-down group were not statistically significant, the reported reduction in vocal fatigue emphasizes the potential benefits of incorporating cool-down exercises.

Management of the exudative lesions of the Reinke’s space – our updated experience

C. Ionita, L. Ghiuzan                                                                                                                                           doi: 10.48095/ccorl2025S1_52

Voice Rehabilitation and Endoscopic Surgery, Institute of Phono-Audiology and Functional ENT Surgery, Bucharest, Romania

Objectives: The authors from the voice department, present the management of the benign vocal fold lesions that affects the Reinke’s space: nodules, polyps and Reinke’s edema. The lesions share common histologic features, but the endoscopic appearance is strong dependent of the presence and duration of certain causative factors. Methods: In this retrospective study, we accessed the medical records of 114 patients who had undergone medical treatment and microsurgery of the vocal folds under general anesthesia, during a period of 40 months in the voice rehabilitation department. There are also underlined some particular cases, regarding the grade of dysphonia and the volume of the tumor that impacts the airway. Results and Conclusions: The aim of the treatment is to restore the voice, removing the suspicion of malignancy and to avoid medico-legal issues especially at the voice professionals.

Impact of nonselective reinnervation on posterior cricoarytenoid muscle tone

M. E. Issac, J. R. Menon, A. Sheeja, R. Aravindakshan                                                                               doi: 10.48095/ccorl2025S1_53 Laryngology, Ananthapuri Hospitals and Research Institute, Trivandrum, India

Introduction: Injury to the vagal or recurrent laryngeal nerve results in a flaccid vocal fold and breathy dysphonia. Management options for unilateral vocal fold palsy include injection augmentation, type 1 medialisation thyroplasty, arytenoid adduction, and non-selective reinnervation (NSR) alone or combined with static procedures. While NSR enhances the tone and bulk of the vocal cords, it does not restore the movement. Despite existing research, the effect of NSR on arytenoid tone has not been studied, which relates to the function of the posterior cricoarytenoid muscle. Aim: To study the impact of NSR on arytenoid tone related to the posterior cricoarytenoid muscle. Materials and Methods: This retrospective study analyzed 35 unilateral vocal fold palsy patients who underwent non-selective reinnervation between 2021 and 2022. Laryngoscopy videos evaluated arytenoid tone, classified into three grades: Grade 1: Arytenoid prolapse across the midline; Grade 2: Prolapse to the lateral margin of opposite vocal fold; Grade 3: Prolapse beyond the lateral margin of opposite vocal fold. Voice function was assessed through maximum phonation duration (MPD) and the Voice handicap index (VHI), a ten-question survey on voice-related disability. Preoperative and postoperative data were compared for improvements in arytenoid tone, MPD, and VHI scores. Results: Most patients were aged 51–60 (29.3%), with a mean age of 43.3 years and nearly equal gender distribution. Idiopathic vocal cord palsy was the most common cause, followed by post-thyroidectomy palsy; other causes included neurological events, tumors, and spinal surgery. 81% improved arytenoid tone postoperatively, while 19% had no change. Statistical analysis revealed significant improvements in MPD and VHI scores with a p-value (P < 0.001). Conclusion: This study shows that NSR provides promising long-term improvements in voice quality for individuals with vocal fold palsy. Our findings reveal significant postoperative enhancements in arytenoid tone and improved MPD and VHI scores.

Pirfenidone injection to prevent vocal fold scar in a canine model: a pilot study

J.-Y. Ji1, Y. B. Han2, S. Y. Kim1, S. H. Kang1, S. H. Han1, S. J. Park3, W.-J. Jeong1, W. Cha1                             doi: 10.48095/ccorl2025S1_53

1 Department of Otorhinolaryngology – Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Korea

2 Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Korea

3 Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong-si, Korea

Introduction: Postoperative vocal fold (VF) scarring remains a challenging issue in laser cordectomy. Pirfenidone (PFD) is an FDA- -approved antifibrotic agent. However, its potential in preventing VF scarring after laser cordectomy has not been extensively studied. Aims: This study aimed to evaluate the safety and preventive effect of PFD injection for postoperative VF scarring in a canine model. Materials and Methods: To assess toxicity, various concentrations (0.5, 1.0, 2.5, 5.0, and 10.0 mg/mL) of PFD, along with saline were injected into each VFs of three dogs. Larynges were removed for histologic evaluation at 2 weeks. In the efficacy test, three dogs were assigned to different concentrations of PFD: saline, 1.0 mg/mL-PFD, and 2.5 mg/mL-PFD. Saline, 1.0 and 2.5 mg/mL PFD were injected on unilateral VFs, followed by laser cordectomy type III. Contralateral VFs were left untreated. Wound status was examined under direct laryngoscopy at 4 and 8 weeks. At 8 weeks, larynges were excised for vibratory evaluation with a high-speed camera and histologic examinations including H&E staining and immunohistochemistry for collagen type I (COL1) and alpha-smooth muscle actin (a-SMA). Results: In the toxicity test, VFs injected with 2.5 mg/mL PFD or less, exhibited complete epithelial healing, while those injected with 5 mg/mL PFD or more had epithelium detachment from lamina propria. In the efficacy test, laryngoscopy at the 8th week revealed that VF mucosa was healed in all the groups. High-speed evaluation demonstrated higher mucosal wave amplitudes in PFD groups. In H&E staining, less fibrotic change was shown in PFD groups. Expression levels of COL1 and a-SMA were lower in the PFD groups than in the control group. Conclusion: PFD injection into VF has the potential to prevent postoperative scarring after laser cordectomy.

Real-time light-guided vocal fold injection with hyaluronic acid for unilateral vocal fold paralysis: single-center experience in 378 consecutive cases

S. Y. Kim1, J.-Y. Ji1, S. J. Park2, W.-J. Jeong1, W. Cha1                                                                                                                         doi: 10.48095/ccorl2025S1_55 1

Department of Otorhinolaryngology – Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Korea

2 Department of Otorhinolaryngology – Head and Neck Surgery, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong-si, Korea

Introduction: Accurate localization of the needle tip is challenging in the cricothyroid (CT) approach due to its invisibility. To address this, real-time light-guided vocal fold injection (RL-VFI) was developed for enhanced precision under simultaneous light guidance. Recently, the RL-VFI device was approved for clinical use in the United States and South Korea. Aims: This single-center study evaluated the real-world application of RL-VFI with hyaluronic acid (HA) for the treatment of unilateral vocal fold paralysis (UVFP), assessing its feasibility, safety, and technical aspects. Materials and Methods: This IRB-approved, single center, retrospective cohort study included 378 consecutive RL-VFI procedures with HA performed on 257 patients with UVFP between October 2020 and February 2024. Adverse events were monitored during the procedure and for 4 weeks postoperatively. Voice handicap index-10, GRBAS scale, aerodynamic study, and acoustic analysis were used to evaluate voice improvement after 4 weeks with the baseline values. Results: Vocal fold paralysis primarily affected on the left side (83.3%) and was mainly caused by surgery (63.4%) and metastasis (26.1%). In all cases, HA was injected at the intended point in the paralyzed vocal fold under light guidance, with no instances of superficial injection or penetration of the free margin of the vocal folds. The mean procedure time was 114.0 ± 105.1 seconds for the initial injection and 87.9 ± 88.1 seconds for the additional injection. No acute and delayed severe adverse events were reported. Preand post-operative voice analyses were completed in 180 cases, demonstrating significant improvements in glottic gap and voice parameters, including voice handicap index, GRBAS scale, maximum phonation time, mean expiratory airflow, fundamental frequency, jitter, shimmer, and noise-to-harmonics ratio after RL-VFI. Conclusions: The RL-VFI device effectively confirms needle tip localization and ensures accurate injection on the intended point during the CT approach. RL-VFI with HA is feasible and safe for treating patients with UVFP.

Vocal fold electromyography in patients with endoscopic features of unilateral laryngeal paralysis

P. Krasnodębska, B. Miaśkiewicz, A. Szkiełkowska                                                                                   doi: 10.48095/ccorl2025S1_56 Audiology and Phoniatrics, Institute of Physiology and Pathology of Hearing, Warsaw, Poland

Introduction: Laryngeal electromyography (LEMG) provides information about the electrophysiological status of the muscles and innervation of the larynx. Integration of this information with clinical data from other laryngeal assessment modalities (endoscopy, perceptual and acoustic analysis, voice self-report) provides a multidimensional picture of dysphonia, which is of particular importance in patients with vocal fold (VF) immobility and glottal insufficiency. Aim: The aim of this study was to evaluate LEMG recordings in patients with unilateral VF immobilisation and features of VF atrophy and glottal insufficiency.

Materials and Methods: From the available material of 74 recordings of patients referred for LEMG due to unilateral laryngeal paralysis, recordings of 17 patients with endoscopic features suggestive of complete laryngeal muscle denervation were selected. LEMG testing during rest and voluntary activity during free phonation of the vowel /e/ [ε] was evaluated qualitatively and quantitatively in the immobile and mobile VF thyroarytenoid muscle. Results: In all patients, the LEMG recording of the immobile VF was significantly different from that of the mobile VF. Despite endoscopic features of paralysis, only 2 patients recorded no activity fulfilling neurophysiological conditions of paralysis. In 88%, electromyographic activity of the thyroarytenoid muscle was found despite immobilisation and atrophy of the fold. In these patients, a neurogenic type of recording was found, with numerous high-amplitude units. On the basis of the results, quantitative features of the LEMG recording indicative of paralysis and residual activity of the thyroarytenoid muscle were determined. Conclusions: Qualitative and quantitative analysis of LEMG recordings provides detailed information about the innervation and muscular status of the VF. The LEMG recordings of the mobile and immobile VF differ significantly. Endoscopic examination is not definitive for the diagnosis of total laryngeal denervation.

Accuracy and clinical findings of saliva digestive biomarkers in laryngopharyngeal reflux disease

R. Lechien1, N. De Vos2, S. Saussez3                                                                                                                                                                   doi: 10.48095/ccorl2025S1_58

1 Surgery, UMONS, Mons, Belgium

2 LHUB, Brussels, Belgium

3 UMONS, Mons, Belgium

Background: Salivary pepsin has served as the primary diagnostic biomarker for laryngopharyngeal reflux disease (LPRD). To date, the diagnostic accuracy of other digestive enzymes in saliva remains largely unexplored. The aim was to evaluate the diagnostic performance of multiple digestive enzyme biomarkers in detecting and characterizing LPRD. Methods: Patients with LPRD at the 24-hour hypopharyngeal-esophageal multichannel intraluminal impedance-pH testing (HEMII-pH) were consecutively recruited from January 2020 to May 2024 from two European Hospitals. The control group consisted of adults without symptoms. Prospective clinical data collection included demographics, gastrointestinal endoscopy, HEMII-pH, reflux symptom score (RSS), and reflux sign assessment (RSA) findings. At baseline, pepsin, elastase, cholesterol, bile acids, trypsin, pancreatic and gastric lipase were measured in saliva samples of LPRD patients and asymptomatic individuals. Sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy (receiver operating characteristic (ROC) curve and area under the curve (AUC)) were evaluated. Results: One hundred and twenty-three patients and forty-eight asymptomatic individuals were prospectively recruited. Patients exhibited significantly elevated salivary pH and elastase levels, but decreased cholesterol compared to controls. Salivary cholesterol demonstrated superior diagnostic performance (AUC 0.989), with a 2.05 mg/dL threshold yielding excellent sensitivity (100%), specificity (94.3%), and predictive values. Elastase showed moderate-to-high diagnostic performance (AUC 0.811; threshold > 49.2 μg/ml). Combined RSS > 13 and salivary pH demonstrated robust diagnostic accuracy (SE 88.8%; SP 97.1%). Cholesterol positively correlated with 3-month RSS (r = 0.538). Conclusion: Salivary cholesterol, elastase, and the salivary pH emerge as promising diagnostic biomarkers for LPRD, demonstrating superior accuracy to other digestive enzymes and potential value in predicting treatment outcomes.

Expanding the capacity of general practitioners in Sub-Saharan Africa with artificial intelligence: a humanitarian outreach experience

J. R. Lechien                                                                                                                                                         doi: 10.48095/ccorl2025S1_59

Surgery, UMONS, Mons, Belgium

Background: The aim of the study was to evaluate POE, a multi-modal large language model platform, for diagnostic accuracy, clinical consistency, and usefulness as an adjunctive tool for otolaryngological care in resource-limited rural Kenyan settings. Methods: Consecutive patients with otolaryngological conditions were prospectively evaluated by both a board-certified otolaryngologist and primary care practitioner (PCP) at a rural Kenyan facility from December 2024 to January 2025. Clinical data and portable micro-otoscopic images were submitted to POE‘s interface following PCP assessment. The otolaryngologist compared POE outputs with PCP assessments with the Artificial intelligence performance instrument (AIPI) to evaluate diagnostic, management, and therapeutic concordance. Results: The primary diagnoses generated by POE demonstrated concordance with otolaryngologist findings in 50 cases (79.4%), while management recommendations aligned in 61 cases (96.8%). Differential diagnoses were judged as plausible and correct in 46 cases (73.0%). Among the discordant cases (N = 17), POE correctly included the confirmed diagnosis within its differential considerations in 16 outputs. POE demonstrated superior diagnostic accuracy compared to PCPs (79.4% [50/63] vs. 50.8% [32/63]; P = 0.001) in establishing primary diagnoses. Among cases where PCPs failed to establish the diagnosis, POE successfully identified the primary diagnosis in 61.3% (19/31). Cases with PCP-established diagnoses (N = 32) demonstrated higher AIPI diagnostic subscores compared to undiagnosed cases (N = 31). When provided with clinical examination images, POE correctly identified the condition as either primary (N = 7/14; 50.0%) or potential (N = 5/14; 35.7%) diagnoses. Conclusion: The implementation of integrated LLM platforms in lowand middle-income countries demonstrates usefulness as clinical decision support tools, augmenting PCP diagnostic and therapeutic capabilities.

Voice problems and transient vocal fold paresis after vagal nerve stimulation in epilepsy – a case study

B. Maciejewska1, A. M. Barciszewska2, M. Karlik1                                                                                                                                    doi: 10.48095/ccorl2025S1_60

1 Department and Clinic of Phoniatrics and Audiology, Poznan University of Medical Sciences, Poznan, Poland

2 Department of Neurosurgery, Poznan University of Medical Sciences, Poznan, Poland

Introduction: Vagus nerve stimulation is a form of therapy aimed at reducing seizures in patients with drug-resistant epilepsy. One of the main side effects of vagus nerve stimulation is a change in voice. Primary vagus nerve stimulation is usually well tolerated. Aim: To present a patient with transient vocal fold paresis after vagus nerve stimulator implantation. Material and Methods: A 36-year-old male, non-smoker, with drug-resistant epilepsy. A few days after implantation, he noticed changes in his voice. Results: Examination revealed a dysphonic voice, a healthy larynx but paresis of the left vocal fold. X-ray of the neck and chest was normal with a visible shadow of the pacing system electrodes along the neck of the anterior chest wall on the left side. CT scan of the neck and chest – no features of haematoma, soft tissue oedema on examination. Conclusions: It is known that stimulation can induce adduction contraction of the ipsilateral vocal fold or vestibular fold. However, paresis of the left vocal fold was observed several days after surgery without any postoperative complications. The problem of neuropathy of the vagus nerve causing vocal fold paralysis, vagus nerve compression associated with VNS, and different innervation of the vagus nerve is presented.

Digital PROMS for patients receiving laryngeal botulinum toxin injections for laryngeal dystonia

J. McGlashan1, C. Gass2, R. Hutchings3, M. Humberstone4, R. Nouraei1                                                                        doi: 10.48095/ccorl2025S1_61

1 ENT, Nottingham University Hospitals, Nottingham, UK

2 ENT Speech Therapy, Nottingham University Hospitals, Nottingham, UK

3 Neurophysiology, Nottingham University Hospitals, Nottingham, UK

4 Neurology, Nottingham University Hospitals, Nottingham, UK

Introduction: Laryngeal dystonia is a rare chronic condition most commonly treated with injections of botulinum toxin every three months. Paper-based outcome forms are often used to monitor the patient’s perceived response to treatment. Forms are not always completed, are often filled in at the last minute and require scanning into digital health records. ISLA Care is an NHS approved media sharing platform, created for sharing of images from dermatology patients and expanded to include forms and questionnaires. Aims: To further adapt the ISLA platform to replace paper-based PROMS and include voice recordings. Material and Methods: A pilot study using a patient focus group was conducted. It was then offered to all patients attending the clinic with laryngeal dystonia. A text message is sent to patients on a weekly basis with a click-link to complete a simple online outcome form where they rate their voices from 1–5 (poor to good). They then record their voices using their mobile phones by reading a set text which is then saved as a .wav file. The submitted data are stored within ISLA and is accessible and linked to their NHS digital health record. Graphs of weekly can be displayed and shown to patients. The voice can be played back and an auditory perceptual evaluation performed. Results: 72 patients have signed up to date with a median (range) number of submissions 85 (2–487). Barriers to participation include no smart phone, difficulty with digital technology. Patients report easy and easier to use functionality. Being able to listen to the voice samples and changes over time help clinicians plan treatment adjustments. Reviewing data remains challenging and long-term compliance needs to be assessed. Conclusions: Digital PROMS using a text-initiated prompt allows better insight into patients’ response to treatment and is more convenient for, and acceptable to patients.

Objective assessment of voice quality and quality of life in relation to Derkay staging system results in patients with recurrent respiratory papilloma (RRP) treated surgically with CO₂ laser and Cidofovir injection

B. Miaśkiewicz1, P. Krasnodębska1, A. Szkiełkowska1, B. Miaśkiewicz2                                                                           doi: 10.48095/ccorl2025S1_62

1 Audiology and Phoniatric Clinic, Institute of Physiology and Pathology of Hearing, Warsaw, Poland

2 Institute of Physiology and Pathology of Hearing, Nadarzyn, Poland

Introduction: RRP is a rare disease that may cause voice disorders and airway obstruction. Low-oncogenic HPV 6 and 11 are responsible for over 90% of RRP cases. The biggest problem in the treatment of this disease is the very high tendency to recurrence, requiring re-operations. The aim of the study was to objectively assess the voice quality and quality of life of patients with RRP during and after CO₂ laser surgery and Cidofovir laryngeal injection. Material and Methods: The material included 21 patients with RRP treated surgically with CO₂ laser and Cidofovir injection. The average number of operations in the treatment cycle was 8. All patients underwent laryngovideostroboscopy, acoustic assessment of the voice and the patient‘s subjective assessment of the voice using the Voice handicap index questionnaire. The advancement of papillomatous lesions in the larynx was assessed clinically and anatomically based on the grading system developed by Derkay et al. The analysis of data was made before the first surgery, in the middle of the treatment cycle, before the last surgery and on the first follow up visit. Results: After treatment a decrease in scores was observed in both the clinical (from 0.9 to 0.58; P = 0.055) and anatomical (from 7.29 to 1.11; P < 0.001) Derkay system in subsequent stages of the treatment cycle and after the end of therapy. During the evaluated period of time, a statistically significant reduction in the VHI value in the physical (from 16,71 to 8,61), functional (from 13,1 to 6,78) subscales and the total score (from 42,05 to 23,17) were observed. Among the assessed objective acoustic parameters of the voice, we noticed a statistically significant improvement for Jitt. Conclusions: Surgical CO₂ laser treatment with cidofovir injection provide objective and subjective improvement in the voice quality and quality of life of patients with RRP.

Are there other registers in the falsetto of countertenors?

K. Neumann1, P. Mathmann1, J. Euler2, M. Kob3, N. Clemente4, M. Echternach5, M. Döllinger6, P. Pabon7                                                                                                                                                                                                       doi: 10.48095/ccorl2025S1_63

1 Department of Phoniatrics and Pediatric Audiology, University Hospital Münster, Münster, Germany

2 Hannover University of Music, Drama and Media, Hannover, Germany

3 Erich Thienhaus Institute, Detmold University of Music, Detmold, Germany

4 Pediatric Clinic, Catholic Clinic Bochum, Ruhr-University of Bochum, Bochum, Germany

5 Division of Phoniatrics and Pediatric Audiology, Dept. of Otorhinolaryngology, Munich University Hospital (LMU), Munich, Germany

6 Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany

7 Institute of Sonology, Royal Conservatoire The Hague, The Hague, the Netherlands

Introduction: Transition of the male singing voice from the modal (M1) to the falsetto (M2) register has been well studied both acoustically and physiologically. Registers within the modal voice were also studied for male and female voices. The falsetto register has been regarded a relatively uniform register. However, professional countertenors have expressed that they too must manage register transitions in their falsetto voice. Aims: The aim of the study is to answer the question of whether there are other registers within the trained falsetto voice of countertenors, and if so, what characterizes them physiologically and acoustically. This question has been addressed in a joint research project of phoniatricians, acousticians, and voice researchers. Material and Methods: Twenty-seven professional countertenors were examined during various vocal exercises such as ascending and descending scales with soft, medium and loud tones on different vowels or glissandi. Vocal range profiling with spectral Voice profiler software, high-speed glottography, ingressive phonation, spectral cluster analysis, electroglottography, impedance measurements, perceptual analysis by the examiners, and self-assessment of the singers through questionnaires were conducted to obtain as much information as possible to answer the research question. Results: The most valuable information was obtained from the acoustic analysis using vocal range profiles. The majority of countertenor singers showed spectral and level transitions within M2 suggesting (sub)register transitions, characterized by a spectral peaking followed by a steep drop in level when with raising pitch, subsequently H4, H3 and H2, stop contributing to the overall spectral power. Most singers seemed to have two transitions, some only one, mostly in their lower M2 range. A few singers covered their falsetto register without any evident discontinuity. Conclusion: This qualitative and quantitative study suggests the existence of (sub)registers in the falsetto voice of professional countertenors that seem to be caused by acoustic rather than laryngeal adjustments.

Awareness of human papillomavirus exposure risk and vaccination among laryngeal surgeons: a survey study

T. Chen1, J. Prasad2, C. Robotti1, Y. Karagama3, F. G. Dikkers4, N. van der Poel5, S. Hey1                            doi: 10.48095/ccorl2025S1_64

1 Department of Otolaryngology, Guy’s and St Thomas’ Hospitals, London, UK

2 King’s College London Medical School, London, UK

3 Department of Otolaryngology, Guy’s and St Thomas’ Hospitals and King’s College London Medical School, London, UK

4 Department of Otorhinolaryngology Head and Neck Surgery, Amsterdam UMC, Amsterdam, the Netherlands

5 Department of Otorhinolaryngology and Faculty of Medicine and Translational Neurosciences, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium

Introduction: Recurrent respiratory papillomatosis poses occupational risks of human papillomavirus (HPV) exposure. The risk of HPV exposure has been documented in other specialties (dermatology, gynaecology), and consistent use of safety measures (masks, smoke extractors) as well as prophylactic HPV vaccination have been advocated. Nevertheless, the awareness of this risk among laryngeal surgeons remains uncertain. Aims: To explore the awareness of occupational HPV exposure risks and HPV vaccination practices among laryngeal surgeons treating RRP. Materials and Methods: A 21-item survey was electronically distributed to members of the European Laryngological Society and the Union of the European Phoniatricians (May–July 2024). Results: Out of 158 participants, 79.1% (125) were based in Europe. Of them, 67.7% (107) treated RRP exclusively in theatres, 29.8% (47) in both theatres and office settings, and 2.5% (4) exclusively in-office. Over half of respondents (53.2%; 84) expressed concerns about HPV transmission during RRP surgeries, with perceived occupational risk rated as mild-to-moderate by 80.4% (127). The use of protective measures (surgical masks, FFP3 masks, cloth masks, face shields, smoke evacuators, suction systems, HEPA filters) varied significantly among participants. The majority of respondents (65.8%; 104) were not vaccinated against HPV, though 76.0% (79) of unvaccinated participants expressed willingness to consider vaccination. Barriers to vaccination included time constraints (36.0%; 9), perceived lack of demonstrated efficacy (32.0%, 8), concerns regarding vaccine safety (20.0%; 5), and cost (16.0%; 4). Only 5.7% (9) indicated their employer provided financial support. Conclusion: Our survey reveals gaps in awareness and preventive practices among laryngologists regarding occupational exposure to HPV. Enhancing education, expanding vaccine access, standardizing safety protocols, and strengthening institutional support are essential for mitigating occupational risks in RRP management. Additionally, further research on HPV-related occupational risks within in-office practice is advocated.

A comprehensive treatment for benign laryngeal neoplasms: our experience

E. Putkaradze1, V. Egorov1, M. Gerasimenko2, D. Mustafaev1, S. Smirnova3                                                             doi: 10.48095/ccorl2025S1_65

1 ENT, Moscow Regional Research Clinical Institute named after M. F. Vladimirsky, Moscow, Russian Federation

2 Physiotherapy, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation

3 Physiotherapy, Moscow Regional Research Clinical Institute named after M. F. Vladimirsky, Moscow, Russian Federation

Introduction: Our study examines the effectiveness of rehabilitation therapy performed in addition to phonosurgery benign vocal fold lesions. Relevance of the topic is justified by the lack of established protocols for an early postoperative management of patients with a certain pathology of the vocal apparatus, which would improve the results of an operation, prevent additional trauma to the vocal folds and restore voice in a short period of time. Aims: To confirm the effectiveness of using a low-frequency stationary pulsed magnetic field in combination with inhaled corticosteroid therapy in the postoperative period for a quick voice recovery. Materials and Methods: 95 patients with unilateral polypous vocal fold neoplasm (no more than 5 mm) on the vocal fold were selected for the study. The patients were divided into 2 groups: the 1st main group and the 2nd control group. The main group included 50 patients. Since the first day after surgery, they had been supplemented with a standard inhalation treatment regimen by exposure to a low-frequency stationary pulsed magnetic field with frequency of 100 Hz, intensity of 6 MT in mode 3, 15 minutes lasting, 2-times a day, during 4 days. The control group of 45 patients underwent a standard inhaled corticosteroid therapy for 7 days. Results: Videolaryngostroboscopy indices, % jitter, % shimmer, NHR, Maximum phonation time (c) (PRAAT), VHI-30 significantly improved in group 1 on day 5–7 (P < 0.05) compared with group 2. Conclusion: The parameters of a pulsed magnetic field used in the study allowed to optimize the volume of rehabilitation measures and achieve a bright, sonorous, plastic voice in a shorter time. Comprehensive voice rehabilitation after phonosurgery is necessary in the early postoperative period, especially for patients of vocal and speech professions, to restore a high-quality voice formation.

Health justice and transgender voice care-updates

H. S. Sims1, L. S. McGinn2                                                                                                                                                                                                   doi: 10.48095/ccorl2025S1_66

1 Otolaryngology – Head and Neck Surgery, The Chicago Institute for Voice Care, Chicago, USA

2 Otolaryngology, University of Illinois Health System, Chicago, USA

Introduction: Transgender health justice is a crucial aspect of achieving equitable healthcare for all individuals, regardless of their gender identity. Despite significant progress in recent years, transgender individuals continue to face numerous challenges in accessing appropriate and respectful healthcare services, particularly in the United States. These challenges include discrimination, lack of provider knowledge, and limited availability of gender-affirming care. Transgender patients in the United States face proposed laws to limit transgender care. In Europe, a 2024 report identified several barriers to healthcare parity for LGBTI individuals. Many countries in the Asia Pacific region lack national guidelines on transgender healthcare. Globally, the major barriers to care are widespread stigma and discrimination, lack of knowledgeable healthcare providers, and limited access to professionals with experience in gender affirming care which reflects a general lack of awareness regarding transgender health needs and the best practices and policies. Aims: This study aims to discuss barriers to achieving equitable healthcare for LGBTQiA patients, with particular reference to transvoice surgery. It applies the Wesp model of intersectionality research for transgender health justice and reviews specific cases for illustration. Materials: De-identified medical records were reviewed for this study. Methods: A chart review was conducted to gather relevant data including information about barriers to care. Results: The study identified several significant barriers faced by transgender patients, including intimate partner violence, vulnerability of sex workers, HIV disease, housing insecurity, employment discrimination, and negative healthcare experiences. Conclusion: Transgender patients often experience multiple barriers to equitable access and a welcoming environment when receiving healthcare. These barriers are multiplied and amplified for transwomen of color, notably in the United States, but global statistics provide evidence of this trend. Addressing these barriers through informed policy changes and increased provider education is essential for achieving true health justice for transgender individuals.

Outcomes of non-selective laryngeal reinnervation and its impact on arytenoid position

N. Snovak, R. Shah, K. J. Heathcote                                                                                                               doi: 10.48095/ccorl2025S1_67

ENT Department, University Hospitals Dorset NHS Foundation Trust, Poole, UK

Introduction: Non-selective laryngeal reinnervation is an effective treatment for unilateral vocal fold paralysis. The procedure involves creating an anastomosis between the ansa cervicalis and the recurrent laryngeal nerve (RLN), reinnervating both abductor and adductor muscles. This improves muscle tone and stabilizes the arytenoid. Aims: Our objective is to evaluate the impact of this procedure on arytenoid position. Methods: We conducted a retrospective review of patients who underwent nonselective laryngeal reinnervation between 2014 and 2024 by a single surgeon. Outcome measures included GRBAS, maximum phonation time (MPT), voice handicap index (VHI), and stroboscopy, with a focus on arytenoid position. Results: Fifty-five patients underwent unilateral ansa-RLN reinnervation. Significant improvements were observed in GRBAS, MPT, and VHI scores. Arytenoid position improved fully in some patients, while others showed partial stabilization. Overall, results were promising. Conclusion: Unilateral non-selective laryngeal reinnervation provides reliable improvements in voice quality and muscle function. The effects on arytenoid position are encouraging, suggesting potential benefits for long-term vocal fold stability. Further studies are needed to assess long-term outcomes.

Efficacy of total selective reinnervation in bilateral vocal cord palsy

A. Sreeparvathi                                                                                                                                                   doi: 10.48095/ccorl2025S1_68

Laryngology, Dr Jayakumars Laryngology group, Trivandrum, India

BVCP is mainly treated with static surgical procedures which improve airway at the expense of voice. For improving the airway without compromising the voice a dynamic procedure is needed like Total selective reinnervation. Here we are analysing our experience with 8 cases of total selective reinnervation. Aim: To assess the efficacy of total selective reinnervation in cases of bilateral vocal cord palsy. Objective: 1. To assess improvement in airway post total selective reinnervation; 2. To assess improvement in voice post total selective reinnervation; 3. To assess involvement of swallowing function in total selective reinnervation. Methods: A prospective study of bilateral vocal cord palsy who underwent total selective reinnervation during 7 years period. All patients had a minimum follow up period of 12 months. All the 8 cases were seen within 2 years of their complaint. EUA was done in all cases to rule out cricoarytenoid joint fixity. Preop assessment of voice quality was done with dyspnoea index and VHI. Glottic space was assessed with endoscopy. A repeat assessment was done at 6 and 12 months postop and the results were compared. Result: In immediate postop period patient had worsened voice quality. Voice improvement and lower VHI noted in all patients by 12 months. Regarding airway; 6 patients were decannulated in 2 weeks time, 1 patient was decannulated after 4 months and the youngest one after 1 year. By 6 months time all patients had improvement of dyspnoea index by 1. However between 8 and 12 months 4 patients had worsening of dyspnoea index requiring static procedures. The immediate swallowing dysfunction improved in a period of 2 weeks. Conclusion: Total selective reinnervation improved the voice in all cases and it dint have any adverse effect on swallowing, however the long-term effect in improving the airway was ambiguous.

Comparison and quantification of vocal tract efficiency strategies across different voice qualities in four professional singers

F. Stritt1, S. Rummel2, J. Fischer3, M. Bock3, B. Richter1, M. Echternach4, L. Traser1                                          doi: 10.48095/ccorl2025S1_69

1 Freiburg Institute for Musicians’ Medicine, Medical Center – University of Freiburg, Faculty of Medicine, Freiburg, Germany

2 Institut Rummel, Frankfurt, Germany

3 Department of Radiology, Medical Physics, Medical Center – University of Freiburg, Freiburg, Germany

4 Department of Otorhinolaryngology, Ludwig-Maximilians-Universität München, Division of Phoniatrics and Pediatric Audiology, LMU Klinikum, München, Germany

Understanding vocal efficiency across voice qualities is crucial for vocal health, benefiting both singers and speaking professionals like teachers. Efficient voice production can be described as achieving high sound pressure levels with minimal energy expenditure and biomechanical strain, relying among others on the interaction between the voice source and vocal tract (VT) acoustics. Fleischer et al. (2022) introduced a measure that quantifies acoustic sound intensity within the human glottis depending on different VT configurations and thus determines the energy required to excite the respective VT in a single-subject study. This study aims to generalize these findings to a broader sample of male and female voices. Four still Voice Training®-trained singers (2♂, 2♀) phonated [a:] in six voice qualities (Belting, Twang, Opera, Sob, Falsetto, Speech) at ♀415 Hz/♂207 Hz. Using 3D-MRI and finite-element modeling, the volume velocity transfer function (VVTF) was calculated. Combined with audio recordings, particle velocity and acoustic pressure at the glottis were used to derive calculated sound intensity at the glottis. VT configurations grouped into three patterns: Belting/Twang (megaphone shape), Speech/Falsetto (neutral), and Sob/Opera (hourglass shape). These patterns align with distinct VVTF profiles, such as Opera clustering R3–R5 resonances and Belting/Twang shifting VVTF above 0 dB. Sob required high Sound intensity to excite its VT, indicating lower efficiency mostly compared to Belting and Opera. Twang, Speech, and Falsetto showed variability consistent with VVTF differences in efficiency strategies. Despite the small sample size, consistent VT configurations, resonance properties, and efficiency across six voice qualities suggest voice efficiency strategies are trainable. Variances likely reflect more practiced styles. Further research is needed to examine how anatomy influences ease and preference for specific qualities. A single efficiency metric could improve understanding, encourage conscious use of less efficient qualities, and, with acoustic amplification, help prevent voice disorders. Future studies will assess the effects of different vowels and pitches.

Dynamic 3D vocal fold MRI enables in vivo quantification of voice production mechanisms

L. Traser1, J. Fischer2, P. Jordan2, F. Stritt1, M. Köberlein3, J. Kirsch3, S. Rummel4, B. Richter1, M. Bock2, M. Echternach3                                                                                                                                                                                                   doi: 10.48095/ccorl2025S1_70

1 Freiburg Institute for Musicians’ Medicine and Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany

2 Department of Radiology, Medical Physics and Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany

3 Department of Otorhinolaryngology, Ludwig-Maximilians-Universität München, Division of Phoniatrics and Pediatric Audiology, LMU Klinikum, Munich, Germany

4 Institut Rummel, Frankfurt, Germany

Introduction: Voice research traditionally uses superficial 2D endoscopic views of the vocal folds (VF) to assess VF oscillation – this technique cannot provide depth information of the complex 3D oscillation dynamics. Computational and ex vivo studies underscore the significance of vertical VF thickness and medial surface shape in shaping glottal closure patterns. Aims: This study provides the first in vivo assessment of the 3D VF dynamics, including vertical and horizontal displacement and VF contact area, using dynamic 3D VF MRI. Material and Methods: A trained singer performed phonation under six voice production mechanisms involving variations in VF thickness and degree of adduction (“Thick,” “Thin,” “Stiff ”), ventricular fold (FVF) ab-/adduction, and aryepiglottic sphincter (AES) constriction. During singing, MR data were acquired on a 3T MRI system with zero echo time sequences and compared to open quotient (OQ) values from high-speed imaging and electroglottography (EGG) recorded in a separate session. Results: VF contact area and displacement varied across phonation types. “Stiff” had the smallest contact area, while “Thick & FVF constrict” had the largest, aligning with OQ values. VF contact curves showed distinct geometric patterns: leftward skewing for “Thick,” a central maximum for “Thin,” and rightward skewing for “Stiff.”Vertical VF motion often exceeded horizontal motion, with minimal displacement in “Thick & FVF constrict” and maximal displacement in “Thick” (horizontal) and “Thick & FVF retract”/ “Stiff” (vertical). Conclusions: Dynamic 3D VF MRI provides absolute measurements of VF contact area and VF displacement, enabling differentiation of voice production mechanisms. Vertical motion, often overlooked in endoscopic views, plays a critical role. These findings highlight the need for 3D quantification in understanding VF function and dysfunction. Future efforts will focus on automated analyses, larger sample sizes, and applications to patients with voice disorders.

Nanofat as a long-term tissue option for injection laryngoplasty in glottic insufficiency

Z. Urbaniová, Ľ. Verešpejová, L. Murgašová, M. Jedlička, M. Chovanec                                              doi: 10.48095/ccorl2025S1_71 Department of Otorhinolaryngology, 3rd Faculty of Medicine, Charles University, University Hospital Královské Vinohrady, Prague, Czech Republic

Introduction: Glottic insufficiency, caused by incomplete vocal fold closure, results in dysphonia and reduced quality of life. Unilateral vocal fold palsy (UVFP), commonly due to neural impairment, is a frequent etiology. Videolaryngostroboscopy is essential for differential diagnosis. Injection laryngoplasty with autologous fat is a well-established treatment due to its biocompatibility and durability. Advances in nano-fat processing enhance its regenerative potential, making it a promising option. Aims: This study aimed to evaluate the efficacy of injection laryngoplasty using autologous nano-fat in patients with glottic insufficiency. Materials: This study evaluated the efficacy of injection laryngoplasty using autologous nano-fat in UVFP patients. Adipose tissue was processed into nano-fat to increase stromal vascular fractions and growth factors before being injected into the affected vocal fold. Vocal function outcomes were assessed using acoustic and aerodynamic parameters and quality-of-life measures. Results: A total of 27 patients with glottic insufficiency underwent nano-fat injection, showing significant vocal function improvement. The most common cause was vagal or recurrent laryngeal nerve paresis, with a median of 2 ml of nano-fat applied per side. VAS scores improved from 8.56 to 2.03; with near-complete glottic closure confirmed on videolaryngostroboscopy. Reoperation was required in 22% of cases, primarily due to material resorption or persistent insufficiency. Long-term improvement was observed in 78% of patients, supporting nano-fat’s effectiveness in restoring vocal function. Conclusion: Injection laryngoplasty with autologous nano-fat is a promising, minimally invasive treatment for glottic insufficiency. Its regenerative potential and precise application reduce resorption and improve vocal outcomes. Further refinement of techniques may enhance long-term efficacy and establish nano-fat as a standard treatment for UVFP. This work was supported by research projects of Charles University: GA UK No. 260623, and COOPERATIO 43 SURG.

Angiolytic laser cordotomy for bilateral vocal cord paralysis

A. Yenikale, Ç. Oysu, N. Enver                                                                                                                          doi: 10.48095/ccorl2025S1_72

Otorhinolaryngology, Marmara University, Istanbul, Türkiye

Introduction: Angiolytic laser has emerged as a promising technique in laryngeal surgery due to its precision and reduced intraoperative bleeding. This study evaluates the effectiveness, safety, and clinical outcomes of the angiolytic laser cordotomy compared to non-angiolytic modalities. Aim: To compare the clinical outcomes of angiolytic laser cordotomy and non-angiolytic techniques. Materials and Methods: A retrospective analysis was conducted. In the angiolytic laser group, the 445 nm Blue Laser B-TECH PRO was used, while microcautery and cold knife were used in the non-angiolytic group. Twenty-five cordotomy operations were performed in 2019–2024. In the angiolytic laser group, 11 patients underwent 11 operations, while in the non-angiolytic group, 10 patients underwent 14 operations. The outcomes assessed included postoperative discharge times, revision surgery requirement, hospital readmissions within first 7 days and first 30 days. Results: Average postoperative discharge time was 1.5 days and 2.78 days in angiolytic laser group and in non-angiolytic modalities group respectively. One patient (10%) was required revision surgery in angiolytic laser group. In non-angiolytic group 3 patients required revision surgery 6-times (42.8%). Within the first 7 days 1 (10%) and 2 (14.2%) patients in the angiolytic laser group and non-angiolytic group required hospital readmissions, respectively. Within the first 30 days 2 (20%) and 3 (21.4%) patients in the angiolytic laser group and non-angiolytic group required hospital readmissions, respectively. Conclusion: Angiolytic laser provides a significantly more bloodless surgical field compared to other modalities. Advantages of angiolytic laser, such as faster discharge, reduced need for revision surgeries and lower complication rates, makes it a preferable choice. However, there is a potential risk of granulation tissue formation due to laser use. Angiolytic laser shows significant potential as a reliable and effective modality for laryngeal surgeries