Voice and laryngology

Injection laryngoplasty using polydimethylsiloxane for the treatment of unilateral vocal fold paralysis: efficacy and safety

W. Aldalabeeh, O. T. Alshdaifat, O. Hamarneh                                                                                         doi: 10.48095/ccorl2025S1_102 Otolaryngology, Head and Neck Surgery, Abdali Hospital, Amman, Jordan

Introduction: Polydimethylsiloxane, commercially available in the form of the VOX® implant system is a non-resorbable abiotic material used for the treatment of unilateral vocal fold paralysis (UVFP) in patients with longstanding dysphonia by permanently augmenting the paralysed or atrophic vocal fold until medialisation is achieved. Aims: Assessment of the efficacy and safety of VOX® injection laryngoplasty on the shortand long-term using objective and subjective measures of voice quality, and incidence of postoperative complications. Methods: 20 patients who underwent VOX® injection laryngoplasty between 2015 and 2024 by a single surgeon were retrieved for this retrospective study. Voice quality was evaluated preand post-operatively using the Voice handicap index (VHI10) andGRBAS scores. Age ranged from 18 to 87 at the time of procedure (median age = 53 years). Median follow-up time was 43 months (IQR = 44). 19 patients underwent the injection using direct laryngoscopy under general anesthesia in the operation theater, and one patient underwent the procedure in the outpatient clinic using flexible fiberoptic laryngoscopy under local anesthesia. Results: Of the 20 patients, 17 (85%) showed statistically significant improvement in both VHI10 and GRBAS scores, and the results were sustained at the time of the follow-up interview. 3 patients (15%) reported minimal improvement in voice quality. 4 patients (20%) attended voice therapy sessions for a mean duration of 7 weeks. 19 patients (95%) reported no complications, while one patient (5%) experienced an anterior superficial neck abscess at the site of injection, which was successfully treated with incision and drainage in addition to oral antibiotic therapy. One patient underwent reinjection two months after the first procedure, yielding satisfactory results. Conclusion: VOX® injection laryngoplasty is a safe and effective treatment modality for the short and long-term treatment of UVFP, and can be successfully performed without serious complications under local or general anaesthesia.

Voice outcomes post total thyroidectomy with continuous intraoperative nerve monitoring

O. T. Alshdaifat, O. Jbarah, T. Alqadi, O. Al Hamarneh                                                                           doi: 10.48095/ccorl2025S1_103 Otolaryngology, Head and Neck Surgery, Abdali Hospital, Amman, Jordan

Introduction: Total thyroidectomy carries a risk of recurrent laryngeal nerve (RLN) injury, which can lead to significant voice impairment. Continuous intraoperative nerve monitoring (CIONM) has been introduced to improve RLN preservation, but its impact on post-thyroidectomy voice outcomes remains under investigation. Aims: This study aims to compare the Voice handicap index-10 (VHI10) post total thyroidectomy in patients operated with and without CIONM. Methods: A prospective analysis was conducted on patients who underwent total thyroidectomy by a single surgeon without (group 1, N = 98) or with CIONM (group 2, N = 46). Postoperative voice outcomes were assessed using the VHI-10 at 1 and 12 months. VHI10 > 11 was considered abnormal. Results: In group 1, N = 15 (15.3%) of patients had VHI10 > 11 at 1 month, while N = 6 (6.1%) had VHI10 > 11 at 12 months. In group 2, N = 9 (19.5%) of patients had VHI10 > 11 at 1 month, while N = 2 (4.3%) had VHI10 > 11 at 12 months. t-test showed no significant difference in the two groups studied. Conclusion: CIONM in total thyroidectomy showed no significant difference in VHI10 outcomes at 1 and 12 months when compared to patients who had no CIONM. Routine use of CIONM during total thyroidectomy has not proven beneficial for better voice outcomes. The value of the routine use of CIONM in thyroid surgery is to predict nerve injury and voice quality changes during the patient’s recovery period with potential benefit and better voice outcomes on long-term follow-up.

Translation and validation of voice handicap index in Punjabi language

P. Arya                                                                                                                                                                  doi: 10.48095/ccorl2025S1_104

SPEAKwell speech and hearing clinic, Noida Extension, Uttar Pradesh, India

Introduction: Voice handicap index (VHI) is considered to be the most relevant patient friendly and versatile tool to assess voice related quality of life. The VHI is a patient-based self-assessment tool and is considered the most relevant and accessible tool available at present to assess the voice related quality of life. The tool VHI consists of total 30 items equally distributed having 10 items each having three domains such as functional, physical, and emotional. No such tool is available in Punjabi language, a language spoken by many people in Punjab state of country India. Therefore, this study focuses on development of VHI in Punjabi language and considered its own kind to meet the language-oriented need in the voice clinic. Aim and Objectives: To translate and validate the voice handicap index (VHI) into the Punjabi language, and to evaluate its clinical validity. Methods: Thirty adult individuals proficient in speaking, reading writing Punjabi language will be considered as participants for the present study. VHI was translated in Punjabi language by a native Punjabi speaker and the translated questionnaire was given to three other native Punjabi speaker to validate. Later, the translated version of VHI was implemented on the two groups of participants to evaluate voice handicapness. For the clinical validity assessment, the scores obtained in the individuals with voice problem group were compared with those found in asymptomatic using SPSS software for appropriate statistical analysis. Result and Conclusion: The use of native language-specific implies much broader ways in consideration to assessment and management process in handling patients with care and sensitivity towards language. The present study shall be a reliable tool to the Punjabi speaking population and for the clinician to understand the patient’s perception of voice disorder and the degree of functional, physical and emotional handicap in patient.

Tracheoesophageal voice prosthesis outcomes: is there a risk factor for complication and satisfactory fonation?

M. Bonaventurová, Š. Novák, E. Košľabová, M. Zábrodský, V. Koucký                                              doi: 10.48095/ccorl2025S1_105 Department of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of Medicine, Charles University, and Motol University Hospital, Prague, Czech Republic

Objectives: Total laryngectomy is still the treatment of choice in locally advanced laryngeal tumors not eligible for organ preservation protocols. Loss of speech capacity has been reported as one of the most critical factors that affect the patient‘s quality of life. Tracheoesophageal speech using a voice prosthesis is considered the gold standard for voice rehabilitation for these patients. This study aims to identify voice prosthesis effectivity and complication rate according to therapy preceding laryngectomy, adjuvant treatment, and type of surgical reconstruction. Methods: We performed a retrospective analysis of patients who underwent total laryngectomy between January 2020 and December 2023 at the Department of Otorhinolaryngology and Head and Neck Surgery, 1st Medical Faculty, Charles University and University Hospital Motol, Prague. Results: Of the 92 patients who underwent total laryngectomy, 70 (76%) had primary voice prosthesis insertion. Usable speech could be produced by 84,5% of patients after primary and 80% of patients after salvage laryngectomy. We considered a healing complication following: leakage around the prosthesis, voice prosthesis extrusion, and granulation. Such complication was registered in 14% of primary laryngectomy cases and 40% of patients who underwent salvage procedures. There was no significant relationship between primary voice prosthesis insertion and healing complication rate both in primary and salvage laryngectomy patients. Also, the rate of complications associated with voice prosthesis, was not significantly dependent on the timing of the total laryngectomy or the type of reconstruction. Conclusions: Tracheoesophageal puncture with primary voice prosthesis insertion is a safe and effective voice rehabilitation method regardless of the preceding therapy and type of reconstruction following total laryngectomy.

FBFS method (Floor barre for singers method)

D. Bontempi                                                                                                                                                       doi: 10.48095/ccorl2025S1_106

Vocal Coach, Bologna, Italy

Introduction: The method is aimed at adapting the attitude of the body in space and the different stresses to which the subject is subjected, whether they come from external sources or are related to the need for movement or even to an emotional activation. The goal is to gradually develop awareness with a coherent path for the research and consolidation of the head register (M2) and mixed register (M1) and for the resolution of voice problems. Materials and Methods: The key element of the method is the relationship between four elements: Voice: Floor barre concepts (matwork/pilates/yoga); Chakras: Theory of psychosomatic blocks formulated by Wilhelm Reich. Aims: The innovative Fan Technique® inseparably binds these four ingredients. The pedagogical thought of the FBFS method is mainly based on body perception, on balancing emotions, on unlocking the emotional and muscular armor. The goal is to gradually develop awareness with a coherent path for the research and consolidation of the head register (M2) and mixed register (M1) and for the resolution of voice problems. Conclusion: Knowledge of the method is essential not only for the training of the professional singer, but also in the educational-didactic and therapeutic fields: The Fan Technique® is in fact useful for re-education in the speech therapy field, also in the field of social and cultural educator thanks to the connections between the concepts of mind-body-voice and some aspects of clinical psychology. It also provides a new vision of the discipline of singing and its study, simultaneously encouraging the discovery of a particular and very personal sensitivity, which stimulates creativity and expression and a considerable growth of one‘s personality.

The voice triangle as an effective diagnostic method for vocal pathologies

J. A. Bracho Ordoñez, R. Hernandez                                                                                                            doi: 10.48095/ccorl2025S1_107

Locucion, Universidad Católica Santa Rosa de lima, Caracas, Venezuela

The voice is a key instrument in human communication, and its correct functioning depends on the harmonic interaction between three fundamental components: the vocal cords, the nose and the ear. Objective: To demonstrate the effectiveness of the “voice triangle” as a comprehensive diagnostic method to identify pathologies that affect vocal production. 200 voice-over candidates (70 women and 130 men) were evaluated, aged between 18 and 32 years. Materials and Methods: Using medical equipment specialized in that area of study: a nasopharyngolaryngoscope to examine the vocal cords, a 0° rigid endoscope to analyze the nasal cavity and ears, and other supplies such as 0.025% nasal oxymetazoline solution, nasal specula, bayonets and Frazier suction cannulas. In addition, rhinomanometry tests were performed to assess nasal obstruction and tonal and vocal audiometry to measure hearing function. Results: Results showed that 70% of participants were not fit to take the speech course due to various alterations detected by this comprehensive method. Regarding nasal structures, 50% presented: 25% septal deviation, turbinate hypertrophy and nasal polyps 20% and 5% nasal spurs, which made it difficult to properly project the voice. On the other hand, 8% showed hearing problems, including conductive and neurosensory hearing loss, affecting volume control and vocal modulation. Finally, 12% presented vocal pathologies such as glottic hiatus and outlines of vocal nodules, indicating misuse or overuse of the vocal cords. Conclusion: The “voice triangle” method has proven to be an effective tool for identifying pathologies that affect vocal quality. This comprehensive approach allows for the detection of alterations in the three key areas involved in voice production, facilitating early interventions and improving the vocal health of future singers.

Primary vocal fold mucosa repair and Reinke’s space reconstruction during transoral laryngeal microsurgery – What can be done if secondary healing is not an option?

A. Burián1, K. Smatanová2, I. Szanyi1                                                                                                                                                                  doi: 10.48095/ccorl2025S1_108

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: Aim of phonosurgery is to treat benign vocal fold pathology and improve voice quality at the same time. Nevertheless, most surgeons prefer secondary healing of the vocal fold mucosa. The following phrases can be regularly heard: “...these defects heal very well spontaneously…”, “re-epithelization will do its own job…”. Aims: To emphasize the importance of primary vocal fold mucosa repair and Reinke’s space reconstruction during transoral laryngeal microsurgery. Material and Methods: Between April 2019 and October 2024, 71 phonosurgical procedures were performed under general anesthesia due to benign vocal fold lesions including vocal fold polyps, cysts, pseudocysts, vocal fold sulcus, scars, mucosal bridge, Reinke’s edemas and granulomas. Mucosal defect was reconstructed in all cases either with microsuture or tissue sealant. Preand postsurgical laryngostroboscopy and voice assessment (VHI-10, MPT, GRBAS, mean F0, jitter, shimmer, voice range profile) were carried out. Results: All lesions were treated successfully using microflap technique. Mucosal defects were primarily closed with microsuture (33 cases) or with tissue sealant (34 cases). Lack of Reinke’s space (2 cases of vocal sulcus) required

reconstruction with autologous tragal perichondrium implantation and lipotransfer from earlobe. A unique case of extensive vocal fold scarring necessitated autologous buccal mucosal graft transplantation for alignment of irregular contour of the injured vocal fold. Mobilization of bipedicled mucosal flap from the Morgagni sac were utilized in 2 cases to cover the exposed free edge of the vocal fold. All the measured parameters improved. Based on laryngostroboscopy, mucosal wave disturbances and glottic insufficiencies also resolved following ceasing of postprocedural edema/irritation. Conclusion: Vocal fold mucosa repair with microsuture or tissue sealant during transoral laryngeal microsurgery is a considerable step for minimizing postoperative mucosal scarring and consecutive vocal fold mucosa rigidity. Structural vocal fold abnormalities seriously affecting the Reinke’s space (e. g. vocal fold sulcus, scars) requires more complex microsurgical management including autologous tissue transfer.

Voice and stomatognathic system

V. Camesasca                                                                                                                                                      doi: 10.48095/ccorl2025S1_109

Department of Otolaryngology and Head and Neck Surgery, Grande Ospedale Metropolitano Niguarda – Centro Clinico NEMO (NeuroMuscolar Omnicenter), Milano, Italy

The term voice comes from the Latin “vox” and originally it referred to “any sonority (sound or noise) that comes out of the mouth”. However, over time, it acquired a deeper meaning, since “what comes out of the mouth”, the product of the vocal folds, is much more than just a sound or noise. Voice means word, language, singing… it has an informative and communicative value. The larynx is an organ in the middle of the neck, at the crossroads of the upper aero-digestive tracts and it is involved in breathing, swallowing and phonation. It has a unique role as aero-digestive carrefour and it is in a special position in the neck, “hanging” from the hyoid bone and in close connection with the other cranio-facial structures through the pre-laryngeal cervical muscles. The simple morphological description of the cranio-cervico-facial system is not sufficient to adequately represent its structural complexity. We need to observe all the anatomical components and their close dynamic connection to adequately interpret their function. Phono-articulation, in fact, is achieved through an extremely complex system which includes not only larynx, but also the supraglottic structures of the vocal tract, the pulmonary system, the nervous system and the musculoskeletal system. The stomatognathic system is a very complex anatomical and functional system, that includes the muscular, skeletal and nervous structures involved in chewing, swallowing and phonation and it is mechanically and functionally connected to the other body districts through the myofascial chains that determine the global posture. So, stomatognathic system and posture play a key role in this mechanical model of connections. Occlusal alterations, wrong lingual posture and dysfunctional swallowing can cause asymmetries in the postural chains, with consequent voice alterations. Therefore, a multidisciplinary and interdisciplinary approach to Voice disorders is essential to obtain optimal and long-lasting results.

Transnasal endoscopy an office based diagnostic & therapeutic intervention: a retrospective evaluation

A. S. Kumar1, T. M. Nolli2, A. Campbell2, S. Majumdar2                                                                                                                  doi: 10.48095/ccorl2025S1_110

1 University of Dundee, Dundee, UK

2 ENT Department, NHS Tayside, Dundee, UK

Aims: Transnasal endoscopy (TNE) is a minimally invasive technique for diagnosing and managing upper aerodigestive tract disorders in an outpatient setting, eliminating the need for general anaesthesia and reducing waiting times. This study evaluates the indications, interventions, and outcomes of our tertiary TNE clinic while assessing referral patterns, patient demographics, and discharge outcomes. Materials and Methods: A retrospective review of patients attending our TNE service (2023–2025) was conducted. Data on demographics, smoking status, referral source, procedural indications, findings, and outcomes were analyzed to assess clinical efficacy and resource utilisation. Results: Among 76 TNE procedures, 12 (15.8%) were abandoned due to fasting non-compliance or anatomical limitations, and 3 (3.9%) were converted to oral endoscopy. Nineteen patients underwent TNE-guided biopsy of the oropharynx, larynx, or hypopharynx, facilitating histopathological diagnosis without general anaesthesia. Ten patients underwent endoscopic dilatation for cricopharyngeal or post-laryngectomy strictures, with one case abandoned due to discomfort. Tracheobronchoscopy under local anaesthetic was performed in 11 patients to assess subglottic stenosis. Botulinum toxin injections were administered in 13 sessions for spasmodic dysphonia, palatal myoclonus, and salivary gland hypersecretion. Blue laser therapy was performed seven times in six patients for laryngeal papillomatosis. Referrals primarily originated from ENT specialists, with contributions from national tertiary centres and primary care. Most patients were discharged without further intervention, highlighting TNE’s diagnostic efficiency. Conclusions: Our tertiary TNE clinic provides a safe, effective, and resource-efficient alternative for diagnosing and treating laryngeal, tracheal, and oesophageal disorders. By reducing reliance on general anaesthesia and inpatient care, TNE optimises healthcare resources while improving patient accessibility. Its high diagnostic accuracy, procedural success rate, and cost-effectiveness reinforce its role as a front-line investigative and therapeutic tool in outpatient settings.

Anxiety and depression in patients with subglottic stenosis

K. Dewan                                                                                                                                                             doi: 10.48095/ccorl2025S1_111

Otolaryngology, Louisiana State University, Shreveport, USA

Introduction: Patients suffering with chronic diseases have been shown to have increased healthcare utilization and higher rates of anxiety and depression. These associations have been explored in other aspects of laryngology, but have yet to be explored in subglottic stenosis (SGS). Aims: 1. To determine the prevalence of depression and anxiety in adult patients with subglottic stenosis; 2. To identify risk factors for the development of depression and anxiety in the SGS population. Methods: This is a retrospective chart review of all adults diagnosed with SGS at a tertiary care academic otolaryngology clinic over a 10-year period. Data collection focused on demographics, disease etiology, disease duration, surgical history, tracheostomy status, medication use, dyspnea index score and psychiatric history, including past diagnoses of anxiety or depression. Results: 246 of 568 patients with SGS met inclusion criteria. The average age of the study population was 55 years, with a BMI of 32 and an average SGS diagnosis duration of 5.7 years. Intubation-related injury was the most common cause of SGS. 31.3% of patients had a concurrent diagnosis of depression. Patients with anxiety or depression were significantly older than those without (P = 0.01). Those patients with anxiety were significantly older than those without anxiety (P = 0.02). Patients’ intubation related SGS had a significantly higher incidence of depression than patients with SGS of other etiologies (P = 0.03). Depression was significantly associated with open surgical procedures compared to endoscopic procedures (P = 0.02). Patients with a history of tracheostomy were significantly more likely to also have a history of depression than those who had never had a tracheostomy (P < 0.00). Conclusion: This study found that anxiety and depression rates in SGS patients were significantly higher than the national average, with key factors including open procedures, intubation-related causes, age, and disease duration.

The impact of socioeconomic status on management of pediatric subglottic stenosis and outcomes

K. Dewan                                                                                                                                                             doi: 10.48095/ccorl2025S1_112

Otolaryngology, Louisiana State University, Shreveport, USA

Introduction: There is currently a paucity of literature detailing the socioeconomic implications on management and outcomes of pediatric subglottic stenosis. Aims: To ascertain whether disparities of social determinants of health have a discernible impact on management of subglottic stenosis through endoscopic vs open procedures. Methods: This is a multiinstitutional, academic center, retrospective chart review examining pediatric patients evaluated between May 2012 to May 2022 with the diagnosis of subglottic stenosis, acquired or congenital. Patients were stratified into low and high socioeconomic status (SES), which served as independent variables, using principal component analysis of several social determinants. Interventions reviewed included endoscopic treatment, open airway surgery, and presence of tracheostomy. Outcome measurements included decannulation, time to decannulation, and death. Chi squared analysis was performed on dichotomous variables and student T test was performed for continuous variables. Results: The groups were similar in demographics: gender, age, ethnicity, and surprisingly, and proportion with college degree. Cotton Meyer grade was significantly higher in low SES compared to high SES (P = 0.04). Patients of low SES were significantly more likely to die (P < 0.001). Low SES patients were more likely to have an acquired rather than a congenital subglottic stenosis as compared to their high SES counterparts (P = 0.02). Low SES patients were also more likely to undergo endoscopic intervention (P = 0.03). There was no statistically significant difference in tracheostomy status or decannulation success between the two groups. Conclusion: There were statistically significant findings between low and high SES groups. Overall, patients of low SES appeared to have greater severity of subglottic stenosis, with greater number of endoscopic interventions, and greater mortality. The study which collected data from an area with marginalized patients with poor health literacy, demonstrates that sociodemographic factors contribute to disparate intervention and outcomes in pediatric patients with subglottic stenosis.

“Use it or lose it” – the “ISTP – six voice care exercises by Evemarie Haupt”

E. Haupt1, S. Forer-Kaufmann2                                                                                                                                                                                  doi: 10.48095/ccorl2025S1_113

1 Salzburg, Austria

2 Bachelor’s Degree Programme Logopedics-Phoniatrics-Audiology, University of Applied Sciences Campus Vienna, Vienna, Austria

Introducion: The flexible vocal function is fundamental for expression in communication. A healthy voice contributes significantly to everyday participation and therefore to good quality of life (ICF). Maintaining the flexibility of the vocal fold muscles and vocal fold mucosa is essential to preserve the ability to shape the voice throughout life. Aims: The aim of “ISTP, integrative voice therapy and voice pedagogy” by Evemarie Haupt, is to promote patients in their vocal performance in all phases of life by enabling them to help themselves and to train their voice. The “ISTP – six voice care exercises” are didactically structured according to the “ISTP – voice function circle” and lead to a reliable physiological voice-support. Methods: The “ISTP – six voice care exercises” are based on the ISTP concept of “Voice is balance” and the “ISTP – voice function circle” considering the ICF. They will be taught theoretically and practically in the workshop. Results: Thanks to the holistic structure of the exercises, the “ISTP – six voice care exercises” can be easily integrated into everyday life for regular care of the speaking and singing voice. Using them can help to improve the ability to express oneself and thus the “quality of life”. The integration of the exercises into daily routine has a positive long-term effect on the patient’s voice even after therapy has ended. Through practical exercise experiences in the workshop, the participants will be able to use the acquired knowledge and skills in their everyday work. Conclusion: “Use it or lose it” – with the “ISTP – six voice care exercises” patients can remain or regain a balanced and flexible voice in all phases of their life.

Microlaryngeal management of a rare laryngeal pathology: isolated necrobiotic xanthogranuloma

R. Hashimli1, H. Masiyev1, R. Miskinli2                                                                                                                                                              doi: 10.48095/ccorl2025S1_114

1 ENT, LOR Hospital Clinic, Baku, Azerbaijan

2 Head and Neck Surgery, National Oncologic Centre, Baku, Azerbaijan

Case: A 45-year-old male patient presented to our clinic with progressive dysphonia and respiratory difficulty. Laryngostroboscopic examination revealed a large submucosal mass originating from the left aryepiglottic fold and obstructing over 90% of the laryngeal lumen at the supraglottic level, the vocal folds were not visible. An MRI was performed, revealing a large submucosal mass measuring approximately 30 × 42 mm, extending from the left supraglottis to the glottic level. The patient was scheduled for surgery to remove the mass via microlaryngoscopy, the mass, containing a yellow, thick, gelatinous substance, was completely excised from the surrounding tissues using a CO₂ laser and monopolar electrocautery. The postoperative period was uneventful, with the patient experiencing minor pain during swallowing, aspiration, and hoarseness but no major complaints. The patient was discharged two days later. Symptoms persisted for up to two weeks, during which an appropriate diet was followed. Histopathological examination revealed hallmark features of necrobiotic xanthogranuloma (NXG), including extensive xanthogranulomatous inflammation with necrobiosis and cholesterol clefts within the laryngeal tissue. Immunohistochemical analysis supported the diagnosis. At the fifth-month postoperative follow-up, the laryngeal lumen was clear, the lumen remained fully open. A CT scan at this period showed similar findings. Discussion: NXG is a rare, chronic, and often progressive inflammatory disorder primarily affecting the skin, characterized by yellowish plaques or nodules. Systemic involvement, including ocular, cardiovascular, and gastrointestinal manifestations, has been documented; however, laryngeal involvement remains exceedingly rare. Our report presents a case of necrobiotic xanthogranuloma of the larynx, a pathology scarcely described in medical literature. This case underscores the need for awareness of NXG as a potential but rare cause of laryngeal pathology, which can mimic other inflammatory or neoplastic lesions. This clinical case demonstrates that microscopic excision of such masses in the larynx is possible, regardless of their size.

Acute epiglottitis in patients with the common cold

N. Jikhahsvili                                                                                                                                                      doi: 10.48095/ccorl2025S1_115

BAU (Batumi International University), Tbilisi, Georgia

Objective: Acute epiglottitis is a potentially life-threatening condition characterized by rapid inflammation of the epiglottis, leading to airway obstruction. While it is typically associated with bacterial infections such as Haemophilus influenzae type B (Hib), viral upper respiratory tract infections, including the common cold, may weaken local immune defences, predisposing patients to secondary bacterial infections or exacerbating inflammation. This article presents a series of patients with acute epiglottitis who initially experienced symptoms of an upper respiratory tract infection. We discuss the clinical presentation, diagnosis, and management of these cases. Methods: Between October and December 2024, we identified 12 patients (aged 32–56 years) who presented to an ENT clinic with severe sore throat, odynophagia, and fever. The clinical picture was consistent with acute epiglottitis. Patients exhibited symptoms such as sudden high fever, severe sore throat, dysphagia, drooling, and a muffled voice. Two patients developed stridor, indicating impending airway obstruction. In fact, severe sore throat radiating to the ear persisted despite overall clinical improvement. The pharynx examination was normal in all cases and the diagnosis of acute epiglottitis was made after fibreoptic laryngoscopy. Treatment involved airway stabilization, antibiotic therapy, and corticosteroids to reduce inflammation. Conclusion: Although rare, acute epiglottitis can develop in patients with a common cold. Recognizing worsening symptoms is crucial, as severe sore throat may indicate epiglottic involvement. Prompt examination using a fiberscope or indirect laryngoscopy is essential to prevent complications, ensuring timely and effective intervention to protect the airway and overall health.

Long-term recurrent laryngeal papillomatosis: effects on voice quality – a 10-year center-based analysis

M. Kampmann, M. Fleischer, D. Mürbe                                                                                                      doi: 10.48095/ccorl2025S1_116 Clinic for Audiology and Phoniatrics, Charité – Universitätsmedizin Berlin, Berlin, Germany

Background: Recurrent laryngeal papillomatosis (RLP) is caused by the human papillomavirus (HPV) primarly subtype 6 and 11. Since papilloma infections typically affect the vocal folds, the main symptom is hoarseness. Treatment is based on the removal of lesions using either a CO2 laser or cold steel instruments. Due to pathology of the disease, repeated surgical interventions for recurrent lesions may increase the risk of permanent impairments in the vibratory cycle of the vocal folds. This study aimed to investigate changes in voice quality in patients with long-term recurrent laryngeal papillomatosis (RLP). Materials and Methods: The study period covered clinical visits to the Clinic for Audiology and Phoniatrics at Charité Universitätsmedizin Berlin from 2013 to 2023. All patients underwent regular preand postoperative acoustic speech and singing voice analysis, acoustic-perceptual voice assessment, and video stroboscopic laryngoscopy. The acoustic analysis of voice quality included parameters such as fundamental frequency (F0), jitter, shimmer, and the harmonics-to-noise ratio (HNR). Results: Long-term follow-up acoustic analysis showed no clear correlation between the number of recurrences requiring microsurgical papilloma removal and relevant variations in fundamental frequency (F0), jitter, shimmer, or harmonics-to-noise ratio (HNR). Discussion: A high recurrence rate with frequent microsurgical interventions increases the likelihood of a higher degree of hoarseness, including roughness and breathiness. The underlying cause is morphologically induced vibratory changes in both vocal folds due to microstructural alterations. The risk of such changes rises with the number of microsurgical papilloma removals. Conclusion: In addition to the established laser surgical treatment of recurrent laryngeal papillomatosis, alternative treatment approaches should be explored to reduce repetitive microsurgical papilloma removals and improve the basis for maintaining high voice quality. The indication for intralesional application of bevacizumab (a humanized monoclonal antibody against vascular endothelial growth factor) and its potential to reduce surgical frequency could be one such approach.

Effectiveness of inpatient voice rehabilitation

A. Keilmann1, J. Lukaschyk2, F. Lu3                                                                                                                                                                        doi: 10.48095/ccorl2025S1_117

1 Voice Care Center Bad Rappenau, Bad Rappenau, Germany

2 CJD School for Breath, Speech and Voice Teachers, Bad Nenndorf, Germany

3 Practice for ENT Phoniatrics and Pediatric Audiology, Ludwigshafen, Germany

Introduction: In Germany, people with severe voice problems have the option of inpatient voice rehabilitation, especially if the disorder jeopardises their professional activity. It was shown that patients were significantly more likely to be able to attend work after a rehabilitation. Aims: We investigated the extent to which subjective complaints caused by a voice disorder can be influenced by inpatient voice rehabilitation. Materials and Methods: We prospectively recorded the subjective concerns of 172 female and 57 male patients with severe voice disorders who were admitted for inpatient voice rehabilitation. These were patients who had to fulfil high vocal demands at work and did not experience sufficient relief through outpatient voice therapy. The Voice handicap index (VHI) and the German version of the Vocal tract discomfort scale (VTD-S) were assessed at the beginning and end of 3-week rehabilitation. Results: Both the results of the VHI and those of the VTD scale improved significantly after the intervention. The total score of the VHI decreased from –x = 23.66; to –x = 18.75. The median was thus in the range of a high-grade subjective handicap at the beginning of therapy and in the range of a medium-grade subjective handicap at the end of rehabilitation. The VTD scale score improved from –x = 35.78 to –x = 27.92. Almost half of the patients were in the normal range post-therapy. Conclusion: Inpatient intensive voice rehabilitation can achieve an improvement in the subjective assessment of voice handicap and the accompanying symptoms of dysphonia such as discomfort in the vocal tract.

Voice analysis as a tool for monitoring and evaluating the treatment of laryngeal dystonia: initial findings

Ž. Korim, E. Číčelová, M. Tedla                                                                                                                       doi: 10.48095/ccorl2025S1_118

Department of Otolaryngology, Head and Neck Surgery, Comenius University, University Hospital Bratislava, Bratislava, Slovakia

Introduction: Laryngeal dystonia (LD) is a neurological disorder characterized by abnormal, repetitive movements of various groups of laryngeal muscles. Symptoms include a strained, breathy voice and voice breaks. Some laryngeal dystonias can also impair breathing and swallowing. They are characterized by an exacerbation of difficulties in psychologically stressful situations and so-called task specificity, which means selective impairment of voice during speech, but not during singing and vegetative vocalization (laughter, cough). Aim: The aim of this poster is to present initial findings on the use of voice analysis as a tool for monitoring and evaluating the treatment of laryngeal dystonia. Methods: The study included patients diagnosed with laryngeal dystonia who underwent various forms of treatment (e. g., botulinum toxin, myoneurectomy). Voice recordings were obtained before the start of treatment and at regular intervals during postoperative management. Voice analysis was performed using special software that allowed the extraction of quantitative parameters such as frequency, intensity, jitter, shimmer, and others. In addition, auditory-perceptual, aerodynamic parameters and subjective patient voice assessment were evaluated. Results: Preliminary results suggest that voice analysis is a sensitive method for detecting changes in voice parameters in patients with LD. Voice analysis can therefore be a useful tool for monitoring the effectiveness of laryngeal dystonia treatment. Conclusion: Voice analysis appears to be a promising method for the objective evaluation of laryngeal dystonia treatment. Further research with a larger number of patients is needed to confirm these initial findings and to better understand the relationship between changes in voice parameters and the clinical condition of patients with LD.

Comparison of voice parameters before and after thyroid surgery – first results

T. Kostlivý1, M. Vohlídková1, P. Nový2, D. Slouka1                                                                                                                                doi: 10.48095/ccorl2025S1_119

1 Department of Otorinolaryngology and Head and Neck Surgery, Faculty of Medicine in Pilsen, Charles University, University Hospital in Pilsen, Pilsen, Czech Republic

2 Department of Computer Science and Engineering, Faculty of Applied Sciences, University of West Bohemia, Pilsen, Czech Republic

Introduction: Palsy of the recurrent laryngeal nerve is one of the most feared complications of thyroid surgery. Less frequently diagnosed is the palsy of the superior laryngeal nerve manifested only by vocal range limitation. The presented work is part of a study dealing with patients with surgery without postoperative complications. Aims: The aim of the study is to analyze the voice changes in patients after thyroid surgery at the Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine, Charles University and University Hospital in Pilsen. Materials and Methods: The retrospective monocentric study included 54 patients between September 2024 and January 2025 who met inclusion criteria. The cohort was predominantly female (51; 94.4%) compared to male (3; 5.6%). All patients underwent voice range profile examination and multidimensional voice program analysis on the day of admission, 7 days and one month after surgery and the results were subsequently analyzed. Results: Analysis of the voice range profile in patients before and after thyroid surgery showed no clinically significant differences in the dynamic or frequency range of the voice. Multidimensional voice program analysis in the key parameters shimmer, jitter and soft phonation index showed surprising results, with the observed parameters being paradoxically more stable in the postoperative patients, thus indicating better voice function. Conclusion: In our cohort, uncomplicated thyroid surgery did not result in clinically significant changes in the dynamic and frequency range of the voice. Paradoxically, key parameters of multidimensional voice program analysis were more stable in the study sample during examination in the postoperative period. This work was supported by the Cooperatio Program, research area SURG. Supported by MH CZ – DRO (FNPl, 00669806).

Validation of the Czech version of the Voice handicap index 10 (VHI-CZ 10)

J. Krtičková1, J. G. Švec2, J. Haviger3, J. Havigerová4, K. V. Phadke2, L. Hodačová4, K. Nema1,

J. Dršata1, L. Školoudík1, M. Homoláč1, A. Švejdová1, J. Mejzlík1, V. Chrobok1                                                  doi: 10.48095/ccorl2025S1_120

1 Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Hradec Králové, Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic

2 Voice Research Laboratory, Department of Experimental Physics, Faculty of Science, Palacký University, Olomouc, Czech Republic

3 Department of Informatics and Quantitative Methods, Faculty of Informatics and Management, University of Hradec Králové, Hradec Králové, Czech Republic

4 Department of Preventive Medicine, Charles University, Faculty of Medicine in Hradec Králové, Hradec Králové, Czech Republic

Introduction: Comprehensive assessment of a voice disorder should include patient self-assessment. The Voice handicap index 30 (VHI 30) and its abbreviated version, the Voice handicap index 10 (VHI 10), are the most commonly used self-assessment questionnaires to assess the quality of life in people with voice disorders. Unlike the VHI 30, the Czech version of VHI 10 has not yet been validated. Aims: The aim of the study is to validate the Czech version of the Voice handicap index 10 (VHI-CZ 10). Materials and Methods: Prospective study. Parallel group design. The study included 200 adults. In the pilot study, the intelligibility of the VHI-CZ 10 was tested on 30 adults (15 healthy subjects, 15 dysphonic patients). The next study included 102 adult dysphonic patients, divided into three groups based on the etiology of the voice disorder (neurogenic, functional, and structural), of which 35 patients were used for test-retest analysis. The control group consisted of 68 healthy subjects. All subjects completed the VHI-CZ 10 and were examined with videolaryngostroboscopy. Internal consistency (Cronbach’s alpha), test-retest reliability (ICC – intra-class correlation coefficient), and construct validity were analyzed. Results: The internal consistency of the VHI-CZ 10 was excellent (Cronbach a = 0.966) and the test-retest reliability was also excellent (ICC = 0.96; P < 0.001). The correlation between the self-assessed severity of the voice disorder and the VHI-CZ 10 score was strong (Spearman‘s ρ = 0.762; P < 0.001). Differences in the VHI-CZ 10 scores between dysphonic and non-dysphonic patients were statistically significant (Mann-Whitney U test; P < 0.001), Correlations between VHI-CZ 30 and VHI-CZ 10 were very strong (total score Spearman‘s ρ = 0.971; subscales 0.915–0.957; P < 0.001). Conclusion: The VHI-CZ 10 is a valid self-assessment tool for dysphonic patients, for measuring their perception of voice disability and vocal behavior.

Effectiveness of voice exercises based on forced glottal attack in treating the unilateral vocal fold paralysis

I. Kuhar                                                                                                                                                                doi: 10.48095/ccorl2025S1_121

Department of ENT and Head and Neck Surgery, KBC Zagreb, Zagreb, Croatia

Introduction: Voice and swallowing disorders caused by unilateral vocal fold paralysis (UVFP)and it’s result of inability to achieve a complete glottal closure can have a major effect on the patients’ quality of life and performance in many everyday activities. Voice quality can range from mild hoarseness and breathiness to total aphonia and significantly reduced length of utterances. Even though surgical treatment has often been used as the primary solution, many recent articles and studies have shown the effectiveness of vocal exercise in improvement of voice quality and dysphagia symptoms. Aims: This study examined the effect of vocal exercises, that are based on forced glottal attack combined with breathing exercises, on voice quality for patients with unilateral vocal fold paralysis. Materials and Methods: Patients who were diagnosed with UVFP were included in voice therapy that started one to 6 months after the first symptoms. Patients were included in voice therapy for four to six months. Ten patients met the criteria of being evaluated at the beginning of the therapy, and then 2 and 6 months after the beginning of the therapy. Objective acoustic voice analysis was measured with Dysphonia severity index using LingWaves program. Results: Voice exercises forcing glottal attack conducted together with breathing exercises had positive effect on instrumental and perceptual voice quality measured with LingWaves program. Maximal phonation time, jitter and shimmer are the variables with the most significant improvement observed. Interindividual variability was high and studies with larger number of participants are needed to confirm or to disprove these results. Conclusions: Voice therapy based on forced glottal attack and breathing exercises showed the efficiency in treating voice disorders in patients with UVFP.

Comparison of voice quality before and after endoscopic vocal cord augmentation using cartilage

S. Klasová, M. Sičák, A. Kumorová                                                                                                               doi: 10.48095/ccorl2025S1_122

Department of ENT and Head and Neck Surgery, Central Military Hospital SNP Ružomberok – Faculty Hospital, Slovakia

Introduction: Endoscopic vocal cord augmentation using cartilage is an effective medialisation technique. Aims: Subjective and objective measurement of voice parameters in patients with glottic insufficiency for various reasons, with varying degrees of dysphonia before endoscopic augmentation of the vocal cord with cartilage, after a month, after a year and several years after surgery. Materials and Methods: From August 2012 to June 2024, 42 patients (15 men and 27 women) in age from 27 to 80 years (mean age 55.3 years) underwent endoscopic augmentation of the vocal cords using cartilage from the auricle. The length of glottic insufficiency before surgery in the patients ranged from 3 to 276 months and the mean length of glottic insufficiency was 40.45 months. Patients were evaluated after a month, a year, and some up to 12 years after surgery. We used auditory voice assessment using a GRBAS scale, we performed a videolaryngostroboscopic and strobokymographic examination, acoustic methods of voice examination – jitter, shimmer and NHR, aerodynamic examinations – examination of maximum phonation time (MPT) and subjective assessment of the voice by the patient based on the voice handicap index (VHI) before and after surgery. Statistical analysis was performed in the program IBM SPSS STATISTICS. Results: We verified statistical significance of differences in monitored parameters with a paired T-test. We found a statistically significant improvement in voice (P less than 0.05) in patients in all observed parameters after one month, after a year and after 12 years. Conclusion: Autologous ear cartilage is safe, effective, body-specific material for vocal cord augmentation, it is not absorbed over time, so it has long-lasting effectiveness.

Myosin light chain kinase 2 and myomesin 2 are related with the stiffness of vocal fold lamina propria in aging rat and human

H.-N. Kwon1, J.-M. Kim1, S.-Ch. Shin1, B.-J. Lee2                                                                                                                                   doi: 10.48095/ccorl2025S1_123

1 Pusan National University Hospital, Busan, Korea

2 Good Gang-An Hospital, Busan, Korea

Introduction: Vocal fold fibroblast plays an important role in the production of extracellular matrix of vocal folds. Myofibroblasts increase in the aging vocal fold lamina propria with an increased alpha-smooth muscle actin (a-SMA). In myofibroblast, various sarcomeric genes are expressed in addition to a-SMA. However, there are no studies of sarcomeric genes with myofibroblast differentiation in the aging vocal fold. Aims: This study aimed to analyze the changes and functions of sarcomeric genes related to myofibroblast differentiation in aging vocal folds through next generation sequencing (NGS) analysis. Materials and Methods: Young (6-month old, 22 rats) and old (22-month old, 22 rats) male Sprague-Dawley rats were used. NGS was performed for the harvested lamina propria of the vocal folds in each group. NGS data were analyzed by the functional annotation using gene ontology and network pathway and network analysis method. After identifying increased sarcomeric gene expression in aging vocal folds, we evaluated their expression in normal human vocal fold lamina propria removed after surgery for various vocal fold lesions. Additionally, we investigated their effects on fibroblast senescence, proliferation ability, myofibroblast differentiation, contraction ability, and stiffness. Results: Among the four sarcomeric genes obtained through network cluster analysis of NGS results, the expression of myosin light chain kinase 2 (Mylk2) and myomesin 2 (Myom2) were significantly increased in lamina propria of old rats compared to young rats. The increases of Mylk2 and Myom2 genes were associated with cellular senescence, but not with proliferative ability of fibroblast. However, the expression of Mylk2 and Myom2 genes increased with myofibroblast differentiation. Inhibition of Mylk2 and Myom2 affects cellular contraction and migration, which leads to reduced stiffness. Conclusion: Our results suggest that Mylk2 and Myom2 are novel biomarkers of the vocal fold myofibroblast and related with the regulation of vocal fold stiffness in aging rat and human.

Investigating patient discomfort and tolerance: a comparison of 24-hour multichannel intraluminal impedance pH monitoring with other examinations

H.-J. Lee, Y.-G. Eun                                                                                                                                            doi: 10.48095/ccorl2025S1_124

Otolaryngology – Head and Neck Surgery, Kyung Hee University Medical Center, SEOUL, Korea

Introduction: Laryngopharyngeal reflux (LPR) involves the backflow of stomach contents into the throat, causing irritation. While the 24-hr multichannel intraluminal impedance pH monitoring (24-hr MII) is the diagnostic gold standard, its invasive nature limits use. Aims: To investigate patient pain, discomfort, tolerance and complication during the 24-hr MII compared to other diagnostic methods. Materials and Methods: Prospective study involved patients undergoing 24-hr MII. The control group included patients undergoing ultrasound-guided fine-needle aspiration (FNA) and flexible fiberscope with Müller maneuver. Patient experience was measured using self-reported questionnaires at three points: pre-procedure, immediately after procedure, and post-procedure. Anxiety, pain, discomfort, tolerance and other assessments were assessed using Visual analog scale (VAS) scores. Physicians recorded patient demographics, examination completion, and complications. After treatment, we conducted Decision regret scale survey among patients who underwent 24-hr MII. Results: A total of 170 patients participated: 55 in the 24-hr MII, 50 in the FNA, and 65 in the flexible fiberscope with Müller maneuver. Anxiety levels pre-examination revealed no significant differences between 24-hr MII and other tests. Immediately after and post-examination, there was no significant difference in the degree of pain between 24-hr MII and other tests. However, discomfort and intolerable level were significantly higher VAS score in 24-hr MII compared to the two tests. The proportion of participants unwilling to undergo the examination again was higher for 24-hr MII compared to the other two tests. But patients tended to have a positive perception of the 24-hr MII after treatment. Conclusion: 24-hr MII revealed similar levels of pain compared to FNA and flexible fiberscope with Müller maneuver, but more uncomfortable and less tolerable. Therefore, it is crucial to provide sufficient explanation about the necessity of the examination and obtain patient consent.

The role of voice therapy in voice mutation disorder: six case studies

M. Ligia                                                                                                                                                                doi: 10.48095/ccorl2025S1_125

The Phoniatrics Department, Prof. Dr. D. Hociota Institute of Phonoaudiology and Functional ENT Surgery, Bucharest, Romania

The period of voice mutation during puberty is known, being characterized by acoustic changes and vocal instabilities more pronounced in men than in women. Although voice change occurs at different times and speeds depending on the person, when these vocal instabilities exceed normal limits, concerned individuals realize that they need help and call a specialist. In the present study, 6 male persons 12–24 years old, in different stages of the mutation, are presented. During the evaluation, the following were performed: anamnesis, videolaryngostroboscopic examination (VLS), voice recordings, voice handicap index (VHI), GRBAS scale, pain scale. Each of these patients received emotional support and voice therapy. At the end of the treatment, voice recordings and the GRBAS scale confirmed the visible improvement of voice parameters in all 6 cases. Also, laryngeal discomfort decreased in 4 of the subjects, and VHI decreased considerably in the other two. In conclusion, although the treatment of choice in voice mutation disorder is psychotherapy, the present case studies demonstrate the important role of voice therapy through both its direct approaches and its indirect strategies.

Office based procedures in the larynx – my experience

B. Lorenc                                                                                                                                                             doi: 10.48095/ccorl2025S1_126

Penta Hospitals, Bratislava, Slovakia

Introduction: Office-based procedures in the larynx play a significant role in contemporary laryngology. Methods and Material: In the context of a one-day surgery department, a total of 2,900 surgical procedures were performed between March 2014 and January 2025. Of these, 240 focused on the larynx area, 45 of which were performed under local anaesthesia via a transoral approach. The most prevalent indication was the presence of a polyp on the vocal cords, with less common indications including laryngeal papilloma, granuloma, vocal cord hypotrophy, vocal cord immobility, hyperkeratosis, vascular lesion, and spasmodic dysphonia. The selection of patients was based on various criteria, including irritability (gag reflex), cooperation, mental resilience, time, economic and safety considerations, health condition, and local findings in the larynx. The patients had venous access and a loaded pulse oximeter during the surgery. A combination of lidocaine spray 10% and tetracaine solution 1% was used to numb the pharynx and larynx. The utilisation of optical devices and special instruments for transoral access is also imperative. Results: The study revealed that in all 45 patients, the procedure was performed without complications. The presentation will showcase some interesting cases of patients who have undergone an office-based procedure in the larynx. Conclusion: Office-based procedures are advantageous surgical methods in ENT. However, the utilisation of these methods is contingent upon the availability of appropriate devices and instruments, the expertise of the operating surgeon, effective patient cooperation, the support of an adept operating team, and the identification of suitable cases of laryngeal pathology.

Long-term efficiency of vocal aptitude tests and voice training in student teachers

S. Meuret, M. Fuchs                                                                                                                                          doi: 10.48095/ccorl2025S1_127

Section of Phoniatrics and Audiology, University Clinic Leipzig, Leipzig, Germany

Objective: Teachers are subject to exceptionally high vocal stress throughout their lives and have an increased prevalence of voice disorders. The aim of this study was to evaluate the long-term efficiency of voice training in student teachers during their lifelong career as a teacher. In addition, we investigated the relationship between vocal aptitude tests and teachers‘ vocal health. Methods: In a multicentre case-control study, 202 teachers (median age: 48 years, 165 women, 37 men) were examined. The examination consisted of a standardised anamnesis, analysis of the voice, laryngostroboscopy and audiometry. Subjects were attributed to the case group if at least two of the following criteria were met: pathological videolaryngostroboscopic findings, pathological analysis of the voice, subjective vocal complaints. Results: 65/202 teachers were categorised as cases. Comparing the groups, cases were older (P = 0.001), worked more often in primary schools (P = 0.008) and had more problems with reflux (P = 0.002). 63.8% of the controls had completed a vocal aptitude test before starting their studies, compared to 47.6% of the cases (P = 0.031). A multivariate analysis showed an OR of 1.6 for developing dysphonia if neither voice training nor a vocal aptitude test has taken place during the course of study. Conclusion: Many risk factors associated with dysphonia in teachers are often difficult or impossible to change. Vocal aptitude tests and voice training during the studies represent a primary prevention of occupational dysphonia in the teaching profession.

Voice outcome and quality of life after early glottic carcinoma

A. E. Milea, C. Sarafoleanu                                                                                                                              doi: 10.48095/ccorl2025S1_128

ENT and Head and Neck Clinical Department, “Sfanta Maria” Clinical Hospital, Bucharest, Bucharest, Romania

Introduction: Many patients with early glottic cancer, after treatment remain with voice impairment that perturb their daily life activities. Aim: The aim of this report was to evaluate the importance of voice therapy in patients with early glottic carcinoma after the surgical treatment. Materials and Methods: A prospective study included 15 patients with early glottic carcinoma treated by transoral cordectomy. The patients started voice therapy in one month after the surgical treatment. Initially and after completing the therapy the impact on quality of life was evaluated through EORTC Head and Neck Questionnaire (EORTC H&N 35) and the voice outcome through Voice handicap index score videolaryngostroboscopy, laryngeal fibroscopy and auditory perceptual voice quality analysis through GRBAS rating scale. Patients underwent vocal function exercises, resonant voice therapy and semi occluded vocal tract exercises in different combinations. Results: Statistical analysis showed voice improvement after voice therapy, subjectively on VHI score, clinically on videolaryngostroboscopy or laryngeal fibroscopy, GRBAS rating scale and also the quality of life improved on EORTC H&N 35 score. Patients who performed vocal function exercises, resonant voice therapy and semi occluded vocal tract exercises had a better voice outcome in comparison with those who performed vocal function exercises and resonant voice therapy. Conclusions: Voice therapy is effective in patients with voice impairments after early glottic carcinoma’s treatment. It was noticed an improvement in voice and also in the quality of life.

Mapping the intralaryngeal course of recurrent laryngeal nerve – a case series

A. Mohan1, R. R2, J. R. Menon3                                                                                                                                                                                 doi: 10.48095/ccorl2025S1_129

1 ENT, Dr. Somervell Memorial CSI Medical College, Thiruvananthapuram, India

2 Anatomy, Government Medical College, Alleppey, India

3 Dr. Jayakumar‘s Institute of Laryngology, Thiruvananthapuram, India

Introduction: Neurolaryngology is a fast-developing field with a lot of new surgical procedures, which require a detailed knowledge of intralaryngeal anatomy of the laryngeal nerves. Aims: The aim of this study was to find out the intra laryngeal course and branching pattern of recurrent laryngeal nerve. Materials and Methods: The study was conducted in 15 cadaver specimens obtained from the Department of Anatomy in a Government Medical College in India. The intra laryngeal course of 30 recurrent laryngeal nerves was dissected out bilaterally and the branching pattern was noted. Results: In the 30 hemi larynx specimens dissected, the recurrent laryngeal nerve entered the larynx posterior to the cricothyroid joint. In 28 specimens (93.3%), the main trunk of recurrent laryngeal nerve had an intralaryngeal division whereas in two specimens (6.7%) there was an extralaryngeal division. In 24 specimens, 2 branches from the recurrent laryngeal nerve were found to be innervating the PCA (80%). In the rest 6 specimens, single branch pattern was found (20%). In 2 specimens, the posterior cricoarytenoid was found to have innervation from the superior laryngeal nerve. The interarytenoid was found to get innervations from the internal branch of superior laryngeal nerve in 27 specimens studied (90%). The branch to thyroarytenoid was the most sturdy and consistent of all the branches of the recurrent laryngeal nerve. Galen’s anastomosis was found in 13.3% of specimens. Conclusion: In our study, the entry point of recurrent laryngeal nerve was highly constant. Intralaryngeal division of recurrent laryngeal nerve was found to be more common than extra laryngeal division. Multiple pedicle innervation to posterior cricoarytenoid was more common. In 2 specimens, the posterior cricoarytenoid was found to have innervation from the internal laryngeal nerve. We found that in 90% of specimens, internal laryngeal nerve gave branches to interarytenoid.

Laryngeal findings in patients undergoing experimental vagal nerve stimulation for heart failure: a case series

L. Murgašová1, Z. Urbániová1, A. Krivosheev2, D. Heřman2, M. Chovanec1                                                            doi: 10.48095/ccorl2025S1_130

1 Department of Otorhinolaryngology, Charles University, 3rd Faculty of Medicine and University Hospital Královské Vinohrady, Prague, Czech Republic

2 Department of Cardiology, Charles University, 3rd Faculty of Medicine and University Hospital Královské Vinohrady, Prague, Czech Republic

Introduction: Vagal nerve stimulation (VNS) represents modality with broad applications across various medical disciplines. Initially developed for the treatment of refractory epilepsy, VNS is now utilized for managing depression, and other neuropsychiatric disorders. Its applications have been extended to cardiovascular diseases, including refractory heart failure. Despite its growing application, the impact of VNS on laryngeal function and voice production remains underexplored. Aim: To present unique laryngeal findings and explore the potential implications of VNS in a case series of three patients with experimental VNS for heart failure. Materials and Methods: Three male patients aged 73 to 86 years with advanced heart failure were enrolled in case study investigating the effects of VNS on larynx. These patients underwent right sided VNS implantation between 2020 and 2022 at the Dept. of Cardiology, University Hospital Královské Vinohrady. During the follow-up period, all participants underwent complex examination at the Dept. of Otorhinolaryngology, University Hospital Královské Vinohrady, Prague. Detailed videolaryngoscopic, acoustic and functional voice assessments to further characterize and quantify the observed vocal changes were performed. Results: Two of three patients reported varying degree of dysphonia. A laryngeal finding, characterized by a clicking motion in the posterior part of the larynx, predominantly originating from the left posterior region, was identified. This phenomenon was observed to occur periodically, lasting 10–15 seconds approximately every minute, irrespective of the phonatory or respiratory state. The findings suggest a potential link between the altered neuromuscular coordination of the larynx and vagal modulation induced by VNS. Conclusion: These results provide valuable insights into the complex interaction between VNS and laryngeal innervation. Further investigation is warranted to elucidate the clinical significance and potential implications for optimizing VNS therapies in both cardiac and non-cardiac conditions.

The work was supported by research projects of Charles University: GA UK No. 260623, and COOPERATIO 43 SURG.

Partial deafness dysphonia in adults – is it gender related?

K. Myszel1,2                                                                                                                                                                                                                                      doi: 10.48095/ccorl2025S1_131

1 Audiology and Phoniatrics, Institute of Physiology and Pathology of Hearing, Warsaw, Poland

2 Center of Hearing and Speech, Kajetany, Poland

The purpose of the study was to assess whether changes in acoustic structure of voice in partial deafness (PD) patients present gender differences. The study group included 30 adults, 15 females and 15 males with post lingual partial deafness. Control group was composed of 20 normal hearing women and 20 normal hearing men. The study showed, that PD patients present voice dysfunctions described by the presence of abnormalities in acoustic voice parameters, compared to control groups. Of all 15 MDVP parameters measured in females, 12 parameters presented changes of statistical importance: F0, Jita, PPQ, sPPQ, vF0, ShdB, Shim%, APQ, sAPQ, vAm, NHR and VTI. Remaining 3 parameters, namely SPI, DUV and NUV, were also changed vs control group, however statistical importance was not achieved. Compared to control group only F0 and SPI were decreased, all other parameters presented increases in PD females. In males 14 parameters presented changes of statistical importance: Jita, PPQ, sPPQ, vF0, ShdB, Shim%, APQ, sAPQ, vAm, NHR, VTI, SPI, DUV and NUV. The only parameter change which did not achieve statistical importance was F0. Compared to control group all parameters were increased in PD males. Directions of changes in acoustic voice parameters were mostly the same in females and males, showing increases which achieve statistical importance in most of the parameters; differences were noted only referring to fundamental frequency F0 and soft phonation index (decrease in females vs increase in males). However, SPI change in PD females did not achieve statistical importance. The study showed that in PD females and males, majority of acoustic parameters (13 of 17) present increases compared to control groups. Voice abnormalities in PD females and males appeared to show a great degree of similarity in terms of the values range and direction of changes.

Bilateral vocal cord polyp

Z. Naghıyev                                                                                                                                                        doi: 10.48095/ccorl2025S1_132

Otorhinolaryngology Department, Ministry of Defense of Azerbaijan, Main Military Hospital, Baku, Azerbaijan

The vocal polyps are unilateral pediculated mass originated from mucosa of true vocal cord. In this study, we have reported the bilateral vocal cord polyps. Voice Handicap Index-10 (VHI-10) and acoustic voice analyses were performed in 24 years of age a male patient with bilateral vocal cord polyps operated with endolaryngeal microsurgery with endoscopic approach and the results were compared. It has been demonstrated that the physiology of the larynx can be protected with a successful surgical excision and the phonatuary functions of the vocal cords can be returned to normal. Additional post-operative voice therapy improved patients’ quality of voice.

Primary ciliary dyskinesia and its ENT manifestations

M. Neupauer, I. Goljerová, Z. Ďuríňová                                                                                                      doi: 10.48095/ccorl2025S1_133 Department of Pediatric Otorinolaryngology MF and NICHD, National Institute of Children’s Diseases, Bratislava, Slovakia

To evaluate the clinical condition of patients diagnosed with primary ciliary dyskinesia (PCD) from an otorhinolaryngological perspective, assess the occurrence of symptoms in the upper respiratory tract, and review previous care, including surgical interventions. Methods: A retrospective analysis was conducted on medical records of patients diagnosed with PCD at the Children‘s Faculty Hospital in Bratislava from 2007 to July 2016. Clinical symptoms, ENT examination findings, and diagnostic approaches were evaluated. Additionally, the quality of life of patients was assessed using the SF-36 questionnaire. Results: Most patients presented with chronic rhinitis, sinusitis, and recurrent otitis media. Chronic respiratory symptoms persisted despite treatment, emphasizing the need for specialized diagnostic centers. Situs inversus, a common finding in primary ciliary dyskinesia, was observed in 6 patients within the cohort. SF-36 outcomes indicated reduced quality of life, significantly impacted by persistent ENT-related complications. Conclusion: Early diagnosis and tailored management of PCD are crucial to improving patient outcomes. This study highlights the vital role of otorhinolaryngologists in early detection and comprehensive care of PCD patients. Improved diagnostic protocols and multidisciplinary approaches are recommended.

Voice rehabilitation after thyroidectomy: clinical approaches and outcomes

G. Nukusbekova                                                                                                                                                doi: 10.48095/ccorl2025S1_134

Department of ENT, Kazakhstan-Russia Medical University, Almaty, Kazakhstan

Thyroidectomy, performed for both malignant and benign thyroid conditions, often presents a significant postoperative challenge in preserving voice function due to the proximity of the thyroid gland to key structures like the larynx and recurrent laryngeal nerves. Aims: To propose a comprehensive approach aimed at optimizing voice recovery, addressing psychosocial aspects of voice changes, and improving patients‘ quality of life. Materials and Methods: This article discusses a multifaceted approach to voice rehabilitation following thyroidectomy, based on clinical experience in phoniatrics. From January 2024 to January 2025, 38 patients with vocal cord paresis following thyroidectomy were examined. Diagnostic evaluation of patients before and after treatment was performed using videolaryngostroboscopy and voice recordings. Results: 21 patients underwent conservative treatment: physiotherapy using amplipulse, pharmacological therapy, inhalations with medications and voice therapy for 7–10 days. 15 patients experienced restoration of voice function after the treatment course. Six patients with improved voice function were advised to continue voice therapy for up to 1 month. After one month, voice function was fully restored. In 17 patients, injection laryngoplasty was performed 2–4-times within a year. Patients in follow-up reported improvement in voice function. Key rehabilitation strategies, including both conservative and active voice therapy techniques, tailored to the individual needs of the patient, are presented. Special attention is given to the role of physiotherapy and voice therapy, the importance of early intervention, and the use of nerve stimulation with amplipulse and specialized voice exercises. The use of medical interventions, such as pharmacological treatments and, when necessary, injection laryngoplasty, is also discussed. Conclusions: An early, individualized approach to voice rehabilitation allows for faster recovery of voice function, improves patients‘ quality of life, and facilitates the rapid restoration of professional working capacity.

Determinants of speech intelligibility in laryngectomized patients with voice prostheses

F. Mattioli1, S. Donvito1, M. Pellegrino2                                                                                                                                                           doi: 10.48095/ccorl2025S1_135

1 Department of Otolaryngology Head and Neck Surgery, University Hospital of Modena and Reggio Emilia, Modena, Italy

2 Department of Otolaryngology Head and Neck Surgery – Audiology Program, University Hospital of Modena and Reggio Emilia, Modena, Italy

Total laryngectomy with voice prosthesis remains the standard of care for advanced laryngeal cancers, yet postoperative voice outcomes vary significantly. This study aims to comprehensively evaluate speech intelligibility – defined as the clarity of the patient’s voice as perceived by listeners – and to identify clinical and demographic determinants that may predict superior outcomes. Patients undergoing laryngectomy with voice prosthesis at our center were prospectively enrolled. Although data from additional centers may be incorporated in the final analysis, the current study focuses on our institutional cohort. Postoperative assessments included validated questionnaires addressing both quality of life and voice-specific parameters. Recordings were conducted in a standardized clinical setting using a cardioid microphone placed at a fixed distance. Patients were instructed to articulate phonetically balanced words and phrases in Italian, which were later evaluated by a panel comprising both experts and non-experts to assess intelligibility subjectively. Objective voice analysis was performed on recordings of a sustained vowel (/a/) and two Italian CAPE-V validated sentences. These samples were processed using VoxPlot software to quantify acoustic parameters such as shimmer, jitter, and signal-to-noise ratio (SNR). Additionally, a clinician-administered questionnaire provided further insight into various dimensions of voice quality. Our investigation seeks to correlate subjective intelligibility scores with objective acoustic metrics and to determine the influence of factors such as lesion site, lesion type, and patient age on voice outcomes. Preliminary analyses suggest meaningful associations that could guide tailored rehabilitative strategies. Ultimately, the integration of subjective and objective measures in this study is expected to enhance our understanding of postoperative voice rehabilitation and to inform best practices in patient management.

Neuroendocrine tumor of the larynx: a case report

L. Peterková, P. Lukeš, M. Bonaventurová                                                                                                 doi: 10.48095/ccorl2025S1_136 Department of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of Medicine, Charles University, and Motol University Hospital, Prague, Czech Republic

Introduction: Neuroendocrine tumors (NETs) of the larynx are rare, accounting for less than 1% of laryngeal malignancies. These tumors can vary in differentiation, from well-differentiated, low-grade neoplasms to aggressive carcinomas. Diagnosis is challenging, as initial symptoms often mimic benign conditions. Early recognition is essential due to the distinct management and prognosis compared to other laryngeal pathologies. Case Presentation: A 54-year-old female presented to the otorhinolaryngology department with a three-month history of a sensation of pressure in the throat, without pain or other symptoms. Laryngoscopy revealed a lesion on the right aryepiglottic fold, with vascular changes in narrow-band imaging (NBI) resembling inflammatory alterations. The patient was scheduled for microlaryngoscopy. Initial findings suggested a benign cyst, but histopathological examination unexpectedly identified a moderately differentiated neuroendocrine tumor (NET). A reoperation with margin extension was subsequently performed. Staging investigations excluded regional or distant metastases, and postoperative recovery was uneventful. Conclusion: This case highlights the importance of considering neuroendocrine tumors in the differential diagnosis of laryngeal lesions, even when the initial presentation resembles benign conditions. Early histopathological assessment is crucial for accurate diagnosis and appropriate management. Enhanced awareness among otorhinolaryngologists can expedite diagnosis and improve patient outcomes.

Case report: myoneurectomy in a patient with adductor spasmodic dysphonia

K. Plačková, M. Zábrodský, P. Kalitová, E. Košlabová, J. Plzák                                                             doi: 10.48095/ccorl2025S1_137 Department of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of Medicine, Charles University, and Motol University Hospital, Prague, Czech Republic

Background: A patient was referred to our clinic by a phoniatrician after experiencing two years of dysphonia, characterized by a strangled and breathy voice. Initial treatments included relaxation techniques and proton pump inhibitors for chronic laryngitis, attributed to smoking and gastroesophageal reflux disease. Occupational exposure to solvents may have further exacerbated the condition. The dysphonia was classified as adductor spasmodic dysphonia (ASD). Methods: Following consultation, the patient received botulinum toxin injections into the bilateral thyroarytenoid muscles. The treatment was administered three times over intervals of 8 and 10 months. Despite of the initial improvement in phonation and voice quality, the patient began experiencing dyspnea on exertion and globus sensation six months after the final injection. Consequently, transoral laser myoneurectomy of the bilateral thyroarytenoid muscles was performed. Results: Following the procedure, the patient experienced significant improvement in voice quality and reported high satisfaction with the outcomes. Conclusion: Botulinum toxin injections are effective in managing adductor spasmodic dysphonia, although their effects are temporary, typically lasting only a few months. Transoral laser myoneurectomy, offers a viable long-term solution, providing sustained improvement in vocal function.

Occupational HPV exposure and protective vaccination: insights from a scoping review

J. Prasad1, T. Chen2, C. Robotti2, Y. Karagama3, N. van der Poel4, S. Hey2                                                                 doi: 10.48095/ccorl2025S1_138

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

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

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

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

Introduction: Managing HPV-related lesions can pose the occupational risk of human papillomavirus exposure, with various surgical specialties increasingly advocating for protective HPV vaccination among clinical staff. With the high prevalence of recurrent respiratory papillomatosis requiring regular ablative surgery and the growing adoption of in-office laser treatments, laryngologists are particularly at risk. Aims: To assess current perspectives on occupational HPV exposure risks and the potential protective role of vaccination for laryngeal surgeons. Materials and Methods: A systematic search of the literature on occupational HPV exposure and vaccination attitudes was conducted. English-language, human studies of all research formats discussing occupational exposure to HPV or healthcare professionals’ outlook on vaccination were included. Data on demographics, concern levels on HPV exposure, and attitudes towards vaccination were analyzed. Concern levels were defined by degree of concern on a four-point scale with the following categories: “N/A”, “significant concern”, “moderate concern”, “unconcerned”. Outlook on vaccination was defined on a four-point scale with the following categories: “N/A”, “advocates for vaccination”, “considers vaccination”, and “vaccination unnecessary”. Results: Of 50 articles included, 47 (94%) acknowledged occupational HPV exposure risks, with 22 (44%) expressing significant concern and 15 (30%) reporting moderate concern. 14 articles (28%) recommended protective vaccination for the operators, 12 (24%) advocated for it, and 4 (8%) considered it. Only 1 (2%) deemed vaccination unnecessary. Laryngology-specific concerns were only reported in 5 articles (10%), whereas the majority were from specialties such as gynaecology (20%), dermatology (18%) and general surgery (8%). Articles emerged predominantly from the USA (40%) and the UK (20%). Conclusion: HPV exposure is widely recognized as an occupational risk across surgical specialties, including Laryngology, particularly with the management of RRP. Nearly one-third of articles advocate vaccination for operators. Further research is critical to quantify risks and assess the protective role of vaccination.

The use of rhythmic electrical stimulation in the treatment of movement disorders of the vocal folds

T. Shydlovska, T. Volkova                                                                                                                                doi: 10.48095/ccorl2025S1_139

Voice and Hearing Department, State Institution “O. S. Kolomiychenko Institute of Otolaryngology of National Academy of Medical Sciences of Ukraine”, Kyiv, Ukraine

Introduction: Voice disorders often stem from dysfunctions in the movement of the vocal folds, which can result from various causes, including impaired coordination of their activity. One promising treatment method for these disorders is electrical stimulation of the laryngeal muscles. Aims: Improvement of the treatment of movement disorders of the vocal folds with the use of rhythmic electrical stimulation. Materials and Methods: The treatment was carried out on 23 patients with movement disorders of the vocal folds due to various etiologies, including post-surgical changes following thyroid gland operations, traumatic injuries to the laryngeal nerve, and infections. The treatment regimen included voice therapy, medications, and rhythmic electrical stimulation sessions. Laryngostroboscopy (using Storz equipment), acoustic voice analysis (using Praat and Lar programs), and electroencephalography were conducted as part of the diagnostic and monitoring processes. Results: All patients with movement disorders of the vocal folds received drug therapy, which was taking into account to the condition of the larynx and the bioelectric activity of the brain. Medications included stimulants, nootropics, and sedatives. Voice exercises were prescribed on an individual basis. Electrical stimulation was performed using a special device with individually selected intensity and stimulus frequency, based on the results of acoustic voice analysis. During stimulation, functional loads on the vocal folds were used, which were selected individually taking into account both the necessary physiological load and the emotional perception of the material by the patient. Following comprehensive treatment, all patients demonstrated improved coordination and motor activity of the vocal folds, as well as enhanced voice quality. Conclusion: The use of rhythmic electrical stimulation, with individually selected stimulus parameters based on acoustic voice analysis, combined with medication and voice therapy, significantly improves the effectiveness of treatment for movement disorders of the vocal folds of various origins.

Successful surgical treatment of advanced juvenile-onset recurrent respiratory papillomatosis using optical image enhancement – a case report

K. Smatanová1, M. Kovács1, A. Burián2                                                                                                                                                             doi: 10.48095/ccorl2025S1_140

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

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

Introduction: Therapy of juvenile-onset recurrent respiratory papillomatosis is challenging. Despite vaccination, surgical intervention still plays an important role. Therefore, refinement in surgical technique and intraoperative visualization is inevitable. Aims: To present the successful surgical therapy of a 2-year-old pediatric patient with advanced laryngeal, pharyngeal, esophageal papillomatosis utilizing intraoperative optical image enhancement beside CO₂ laser vaporisation. Materials and Methods: The 2-year-old girl was incidentally noted with mesopharyngeal papilloma and associating hoarseness suggesting laryngeal papillomatosis. Due to COVID-19 pandemia and lack of compliance of the child’s guardian, the scheduled endolaryngeal procedure shifted in time. Six months later the child was presented with aphonia and mild inspiratory stridor urging surgical solution. Therefore, endolaryngeal intervention was performed under totally intravenous anesthesia. During the procedure, precise evaluation of the extension of papillomatosis was carried out with rigid endoscopy completed with optical image enhancement. It was followed by meticulous CO₂ vaporisation of the lesions located to the larynx, hypopharynx and upper segment of the esophagus. The procedure was continuously controlled by image enhancement endoscopy. One year following the first surgery, a repeated intervention was necessary due to recurrence resulting in dysphonia. Between the procedures, the child was given nine component vaccination scheme against human papilloma virus. Results: The initially detected advanced respiratory, pharyngeal, esophageal papillomatosis remarkably regressed due to the two endolaryngeal procedures and adjuvant vaccination. Conclusion: Rigid endoscopy with optical image enhancement can be a valuable additional tool for intraoperative evaluation of papillomatosis affecting the upper aerodigestive system. Application of this imaging technique facilitates more comprehensive CO₂ laser vaporisation. Along with adjuvant vaccination, it may contribute to more efficient therapy of advanced respiratory papillomatosis.

Clinical efficacy of enhanced contact endoscopy in detection of malignant and premalignant laryngeal lesions

A. Švejdová1,2, J. Šatanková1,2, L. Zeinerová1, M. Homoláč1,2, J. Krtičková1,2, J. Laco2,3, V. Chrobok1,2               doi: 10.48095/ccorl2025S1_141

1 Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Hradec Králové, Hradec Králové, Czech Republic

2 Charles University, Faculty of Medicine in Hradec Králové, Czech Republic

3 The Fingerland Department of Pathology, University Hospital Hradec Králové, Czech Republic

Introduction: Enhanced contact endoscopy (ECE) is a non-invasive technique used for assessment of superficial vascular changes of mucosal lesions in high magnification. Aims: The aim of our study was to evaluate the clinical efficacy of ECE in an intraoperative settlement. Methods: Structured assessment of laryngeal mucosal lesions using enhanced endoscopy (NBI and ECE) was performed in a prospective clinical trial. Lesions were classified according to the European Laryngological Society Classification into non-suspicious and suspicious. Evaluations of endoscopic methods (NBI and ECE) were correlated with histopathology, histopathology being the gold standard. Sensitivity, specificity, accuracy, positive predictive value, negative predictive value, AUC, diagnostic odds ratio, Kappa, incremental yield and Youden’s index for NBI and ECE were calculated. Results: A total of 110 patients with 136 lesions were enrolled, 50 benign non-neoplastic lesions, 8 squamous cell papillomas, 45 dysplasias, 33 squamous cell invasive cancers. Compared to NBI, ECE demonstrated higher sensitivity (91.0 vs. 83.1%) and accuracy (90.4 vs. 86.8%). NBI achieved higher specificity (91.8 vs. 89.7%). PPV and NPV for ECE were 92.2 and 88.1%, whereas for NBI 93.1 and 80.4%. ECE showed greater overall diagnostic performance, with a diagnostic odds ratio (DOR) of 88.3 vs 55.2 and Kappa index of 0.805 vs 0.736. Conclusions: ECE enhances diagnostic sensitivity and accuracy and represents a valuable addition to laryngeal cancer diagnostics.

The effectiveness of voice therapy in female with mutational falsetto: a case report

L. Tien, S.-L. Chang                                                                                                                                           doi: 10.48095/ccorl2025S1_142

ENT Department, Chi Mei Medical Center, Tainan City, Taiwan

Introduction: During adolescence, natural growth changes in the larynx lead to a shift in voice pitch – about one octave lower in males and about 2 to 3 semitones lower in females. This process is called mutational change. When the voice fails to transition from the higher pitch of pre-puberty to the lower pitch of adulthood, it is termed mutational falsetto. This article shares the speech therapist provided a 35-year-old female mutational falsetto with a complete voice therapy intervention and the changes in the patient‘s voice after the treatment. Aims: This study explores the effectiveness of voice therapy in female with mutational falsetto. Although typically noticed in men, it is often overlooked in women. Patients may experience throat discomfort, hoarseness and altered pitch, tight throat when speaking, difficulty speaking for long periods of time, difficulty in social interaction, and require voice therapy. Materials and Methods: The subject is a 35-year-old female who experienced voice discomfort for a year. Clinical evaluation, including physiological and functional voice assessments, identified mutational falsetto. The primary intervention used was voice therapy. Results: The first therapy session successfully elicited a normal low pitch. Two weeks later, after a second session, the patient could maintain a normal pitch most of the time, though some pitch instability remained. After two months, follow-up showed the patient could consistently use an appropriate pitch in daily life. Conclusion: In the female case in this article, she used an inappropriate high pitch, no one thought it was wrong, but it caused voice problems and was in need of voice therapy. After treatment and follow-up, she was able to speak with an appropriate pitch, and the discomfort in his throat was improved. The voice therapy was very successful.

Improving the method of surgical voice rehabilitation of patients after laryngectomy

I. Tsymbaliuk                                                                                                                                                      doi: 10.48095/ccorl2025S1_143

State institution “O. S. Kolomiychenko Institute of Otolaryngology of National Academy of Medical Sciences of Ukraine”, Kyiv, Ukraine

Introduction: Laryngectomy for laryngeal cancer leads to profound disability of the patient – complete loss of voice. An effective method of voice rehabilitation after laryngectomy is surgical – as tracheoesophageal shunt (TES) and tracheopharyngeal shunt (TPS). Aims: Improving the method of surgical rehabilitation by the method of tracheoesophageal shunt with prosthetics (TESBP) in patients after laryngectomy. Materials and Methods: Surgical rehabilitation by the TESBP method was performed on 74 patients with cancer of the larynx and laryngeal part of the pharynx, who underwent laryngectomy. Results: The developed method of forming a stable tracheostomy allows not to use a tracheostomy tube from the first day of the postoperative period, forming a stable tracheostomy of the correct shape and reducing the likelihood of complications. The method of TESHP has been improved by changing the design. The proposed instrument is a tube, the front end of which is cut at an angle according to the type of the Bruninx bronchoesophagoscope, the tube is curved at different radii. Due to the diameter, it is possible to pass the tube in a narrowed pharynx, reducing its trauma; the bend of the tube is more physiological, partially repeating the course of the pharynx, which reduces the need for significant extension of the head, the pressure of the tube on the incisors and soft tissues; the front end of the tube protrudes and is easily palpated through the wall of the esophagus and trachea. Conclusion: The proposed method of forming a tracheostomy makes it possible to form a stable stoma of the correct shape in patients after laryngectomy, which is a favorable basis for further vocal and respiratory rehabilitation. The improved method of TESHP by changing the design of the esophageal tube ensures minimal tissue trauma, reduces the time of surgical intervention, and expands the possibilities of patient rehabilitation.

Laser surgery versus radiotherapy in early glottic carcinoma

B. Uhliarová, Ľ. Roháč, M. Lásková, T. Pniak                                                                                              doi: 10.48095/ccorl2025S1_144 ENT, FD Roosevelt Faculty Hospital, Banská Bystrica, Slovakia

Objective: A therapeutic decision in the treatment of early glottic carcinoma with radiotherapy (RT) or transoral (TOS) surgery is still an open issue. Subjects and Methods: The study was conducted on a series of 120 cases of early glottic carcinoma (T1, T2) treated with transoral microscopic laser surgery or RT. The oncologic results and voice quality were evaluated. Results: A total of 36 patients received RT and 94 patients were treated by laser cordectomy (30 vs. 70%; P = 0.01). No difference in local control or disease-free interval was found. There was statistical significance favoring patients treated with TOS when it comes larynx preservation, mostly in T2 glottic tumours. Self-assessment of voice quality showed no statistically significant differences. Patients treated with RT had longer maximum phonation time. Conclusions: Transoral laser surgery in early glottic cancer is oncologically safe procedure that has similar oncological results with RT, with lower risk of total laryngectomy.

Optimizing voice analysis for pathology detection: challenges in data processing

Z. Urbaniová1, Ľ. Verešpejová1, D. Kulkovská1, J. Steinbach2, T. Jirsa2, J. Vrba2, M. Chovanec1      doi: 10.48095/ccorl2025S1_145 1 Department of Otorhinolaryngology, Charles University, 3rd Faculty of Medicine, University Hospital Královské Vinohrady, Prague, Czech Republic

2 University of Chemistry and Technology in Prague, Prague, Czech Republic

Introduction: For over a decade, our team has been engaged in voice analysis, aiming to enhance the accuracy and objectivity of voice disorder assessment. We developed a dedicated software and hardware system to collect and process voice recordings, ensuring precise and controlled data acquisition. These recordings provide a basis for future machine learning applications to improve automated evaluation. This study conducts a statistical analysis of acoustic features in both healthy and pathological voices to identify the most relevant markers for diagnostic purposes. Aims: The primary aim of this study was to evaluate the effectiveness of statistical voice analysis in differentiating pathological voices from healthy ones, with a focus on optimizing acoustic feature extraction for clinical application. Methods: Patients underwent voice analysis alongside a comprehensive laryngological examination. The study included 90 patients divided into two groups: one with no dysphonia and the other with dysphonia of various etiologies. The effects of dysphonia on acoustic parameters, including fundamental frequency, jitter, shimmer, and harmony-to-noise ratio, were analyzed statistically. Results: We initially tested our models using the Saarbrücken voice database, but processed recordings did not achieve the high success rates reported in the literature. Applying the same methodology to our dataset yielded more promising results, aligning with published findings. Our approach demonstrated high accuracy in distinguishing pathological voices, highlighting its clinical potential. Conclusion: Recording patient voices combined with statistical analysis presents a valuable tool for objective voice disorder assessment. We introduce a computationally efficient and clinically applicable voice analysis method with a specialized data processing pipeline. These findings support its potential for routine clinical use. Further refinements in preprocessing and feature extraction are needed to improve diagnostic accuracy.

This work was supported by research projects of Charles University: GA UK No. 260623, and COOPERATIO 43 SURG.

Influence of superior laryngeal nerve palsy on objective voice parameters and on voice handicap index after total thyroidectomy

Z. Veldová, R. Holý, J. Rotnágl, J. Astl                                                                                                         doi: 10.48095/ccorl2025S1_146 Department of Otorhinolaryngology and Maxillofacial Surgery, 3rd Faculty of Medicine, Charles University, Military Faculty Hospital, Prague, Czech Republic

Introduction: Total thyroidectomy (TT) is one of the most common surgical endocrine surgeries. Voice impairment after TT can occur not only in patients with recurrent laryngeal nerve (RLN) transient paralysis, but also in cases of normal vocal cord mobility. One of the causes may be superior laryngeal nerve paresis (SLN). Aim: To compare voice limits using a speech range profile (SRP) in patients before and one month after TT and to investigate the influence of impaired voice quality and prosodic speech factors after TT on the personal life of patients. Materials and methods: A retrospective study, in the period 2020–2024, included 38 patients aged 22–80 years. We compared two groups of patients: group I (N = 24) (without SLN paresis) and group II (N = 38) (with postoperative SLN paresis). Patients underwent video flexible laryngocopy, SRP, and Voice handicap index-30 (VHI-30). Results: In group I, the mean values of Fmax (maximum frequency) and Imax (maximum intensity) decreased in women and VHI-30 increased (P = 0.001). In group II after TT in women, the mean Fo, Fmax and Imax values decreased, and the frequency range of the voice was reduced from 6 to 4 semitones. The dynamic range of the voice was reduced by 3,99 dB in women and 2,1 dB in men. VHI-30 increased (P = 0.001). Conclusion: The study documented a worsening of the mean values of SRP, VHI-30, and voice parameters of patients in group II. Voice disorders also occurred in group I without SLN paresis. Non-paretic causes can also contribute to voice damage after TT. SRP and VHI-30 are suitable tools for comparing voice status in two groups of patients, including those with dysphonia and at the same time mobile vocal cords. SLN paresis can be easily overlooked during a routine laryngoscopic examination.

Analysis of difficulty in exposure during micro laryngoscopy surgery caused by curled epiglottis

N. Zhang, X. Pen, S. Zhang, X. Wei, L. Li, W. Wang, P. Lin, J. Du                                                         doi: 10.48095/ccorl2025S1_147 Department of Otolaryngology Head and Neck Surgery, Tianjin First Central Hospital, China, Tianjin, China

Aims: Difficulty in exposure is a common obstacle to performing microlaryngoscopy surgery, and difficulty in inserting the laryngoscope and exposing the surgical site caused by epiglottic curl is one of the reasons for difficulty in exposure, which is not uncommon during surgery. This study observed the difficulty of exposure caused by curled epiglottis during micro laryngoscopy surgery, and determined the proportion of patients with exposure difficulty caused by curled epiglottis. Materials and Methods: A retrospective analysis was conducted on patients who underwent microlaryngoscopy surgery in the Department of Otolaryngology Head and Neck Surgery at Department of Otolaryngology Head and Neck Surgery, First Central Hospital from October 2024 to January 2025. The proportion of patients with difficulty in exposure due to curled epiglottis was recorded. Results: This study was a single center study that included 412 patients who underwent micro laryngoscopy surgery. The surgical types included micro laryngoscopy for vocal cord polyp resection, vocal cord cyst resection, biopsy, and CO₂ laser surgery. According to statistics, the proportion is 29.33% that patients with difficulty in exposure due to curled epiglottis. There is no significant correlation with the age of the patient. There is no significant difference between genders. It is related to the length of the patient‘s neck, the position of the larynx, and whether the head can smoothly tilt back. Conclusion: Difficulty in exposure caused by curled epiglottis during micro laryngoscopy surgery is a common, with a high proportion. The specific situation still requires multicenter researches.