• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.17 no.2
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• pp.138-142
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• 2006

Objectives : Vocal cord paralysis(VCP) is a complex disorder which may result from numerous causes. We reviewed and analyzed the trend of clinical characteristics and causes of VCP in Korean patient. Method : A total 197 patients with VCP who visited St.Mary's hospital from March, 2000 to August, 2006 were reviewed retrospectively. They were analyzed according to sex, age, cause of VCP, position of paralyzed vocal fold, treatment methods. Results : The male and female ratio was 1.6 : 1. The unilateral paralyzed vocal fold was fixed at paramedian position in 84% of the cases. The left vocal fold was paralyzed about 2 1/2 times as much as the right vocal fold. Among the causes of VCP 30.9% of the cases were due to postoperative paralysis, and most of those were developed after lung, mediastinal surgery. laryngeal EMG was performed in 47 patients for determines the prognosis and treatment method. In the unilateral VCP, 90 patients were treated with injection laryngoplasty, 21 patients were performed thyroplasty type I. Conclusion : The causes of VCP include various diseases, so, detection of the primary disease is very important, because many fatal diseases are included among the primary diseases, and late detection can cause serious problems. VCP is not only a disease entity in itself, but can be seen as a sign of an underlying disease.

• Tuberculosis and Respiratory Diseases
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• v.41 no.2
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• pp.171-175
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• 1994

Tumor of the trachea are uncommon. Trachea tumor are usually diagnosed late in their natural history, because the tracheal lumen may be extensively involved before symptoms occur, and because symptoms may be confused with those of asthma. Some 19% to 29% of the trachea tumor have laryngeal or lung malignancy. Squamous carcinoma is by far the most frequent among tracheal tumor, although adenocarcinoma and oat cell carcinoma have been described so. Oat cell carcinoma in the trachea are aggressive tumors as they are in the lung and elsewhere. Oat cell carcinoma as well as squamous cell carcinoma are related with tobacco exposure. We presented a case of small cell carcinoma nearly obstructing the trachea and right main bronchus which was partially removed after bronchoscopic ethanol injection, along with a review of the literature.

• Tuberculosis and Respiratory Diseases
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• v.65 no.6
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• pp.532-536
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• 2008

We report on a case of a patient with laryngo-tracheobronchial amyloidosis who complained of cough, sputum, and hoarseness. A chest X-ray showed consolidation in the right middle lobe. A chest CT scan showed diffuse, irregular narrowing of the tracheobronchial tree and atelectasis of the right middle lobe, with calcification of bronchial wall. Bronchoscopic findings were multinodular submucosal thickening of the right vocal cord, and yellowish multinodular submucosal thickening from the lower trachea through both main bronchi, as well as the lingular division of the left upper lobe, the right middle lobe, and the right lower lobe. The right middle lobe bronchus was nearly obstructed. The diagnosis of amyloidosis was made by multiple ronchoscopic biopsies on the right vocal cord and both bronchi. Pathologic findings were characteristic apple-green birefringence under polarized microscopy with Congo-red stain. The patient had no evidence of systemic amyloidosis. The patient is under conservative symptomatic treatment.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.8
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• pp.4847-4851
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• 2013

Objectives: To evaluate accuracy of FDG-PET CT in prediction of persistent disease in head and neck cancer cases and to determine prognostic value of metabolic tumor response. Materials and Methods: Between 2009 and 2011, 46 patients with squamous cell carcinoma of head and neck receiving PET-CT were treated with definitive radiotherapy, with or without chemotherapy. There were 29 nasopharyngeal, 11 hypopharyngeal, 3 oropharyngeal and 3 laryngeal cancer patients, with a median age of 50.5 years (range 16-84), 32 males and 14 females. All patients were evaluated with PET-CT median 3-5 months (2.4-9.4) after completion of radiotherapy. Results: After a median 20 months of follow up, complete metabolic response was observed in 63% of patients. Suspicious residual uptake was present in 10.9% and residual metabolic uptake in 26.0% of patients. The overall sensitivity, specificity, positive predictive value and negative predictive value of FDG-PET-CT for detection of residual disease was 91% and 81%, 64% and 96% respectively. Two year LRC was 95% in complete responders while it was 34% in non-complete responders. Conclusions: FDG PET CT is a valuable tool for assessment of treatment response, especially in patients at high risk of local recurrence, and also as an indicator of prognosis. Definitely more precise criteria are required for assessment of response, there being no clear cut uptake value indicating residual disease. Futhermore, repair processes of normal tissue may consume glucose which appear as increased uptake in control FDG PET CT.

• Phonetics and Speech Sciences
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• v.4 no.1
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• pp.125-131
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• 2012

The patients with incomplete glottic closure have an important feature decreasing the maximum phonation time (MPT) because airflow rate or air leakage is greater than people without voice disorders. Also they can appear a problem in the intensity regulation. This study analyzed MPT difference based on the comfortable intensity and louder intensity and the correlation between MPT and respiration volume of unilateral vocal fold palsy (UVFP) and sulcus vocalis (SV) group. The twenty with UVFP, the 21 with SV, the 21 normal subjects measured MPT in /a/ vowel prolongation task with comfortable intensity and louder intensity and compared analysis by measuring FVC, $FEV_1$, $FEV_1/FVC$ to analyze the correlation between MPT and respiration volume. First, a comparison of MPT according to the intensity between groups is that MPT of the normal group was statistically significant long compared to the patient group in comfortable intensity, but MPT between groups was not statistically significant difference in the louder intensity. Second, an analysis of the correlation between MPT and respiration volume is that this was statistically significant correlation between MPT in comfortable intensity and MPT in louder intensity. But this did not show statistically significant correlation between intensity and respiration volume. This study can be supported the preceding study results deduced that shorting MPT of the patient group compared to the normal group was originated in the problem of laryngeal valving mechanism at the level of vocal folds rather than a problem of respiratory function. Also at the phonation by varying the intensity, the result can deduce that in the case of patient group, the length of MPT had been improved by increasing the glottal closure ratio in the louder intensity. These results can support the theoretical basis that should be applied to the clinicians by varying the intensity at the voice evaluation and voice therapy for the patients with the glottis incompetence.

• Journal of Chest Surgery
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• v.25 no.12
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• pp.1508-1515
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• 1992

Between 1975 and 1992, forty five patients with trachea stenosis received tracheoplasty for relief of obstruction. The causes of airway problem are brain contusion[19 cases, 40%], cerebrovascular disease[3 cases, 7%], drug intoxication[8 cases, 18%], psychotic problem[2 cases, 4%], trachea tumor[3 cases, 7%], adult respiratory distress syndrome[9 cases, 20%] and direct trauma[1 case, 2%]. Direct causes of trachea stenosis were complications of tracheostomy[36 cases, 80%], complications of nasotracheal intubation[5 cases, 11%], tumor[3 cases, 6%] and trauma[1 case, 2%]. Thirty one patients underwent the sleeve resection and end-to-end anastomosis. Five patients performed a wedge resection and end-to-end anastomosis. Forteen patients received the Montgomery T-tube for relief of airway obstruction. Four patients have done simple excision of granulation tissue. Two, subglottic stenosis patients were received Rethi procedure[anterior division of cricoid cartilage, wedge partial resection of lower thyroid cartilage and Montgomery T-tube molding] and the other subglottic stenosis patient underwent permanent trachea fenestration. Including cervical flexion in all patients postoperatively, additional surgical techniques for obtain tension-free anastomosis were hyoid bone release technique in two cases, and hilar mobilization, division of inferior pulmonary ligament and mobilization of pulmonary vessel at the pericardium were performed in one case. Cervical approach was used in 39 cases, cervicomediastinal in 12 cases and transthoracic in one case. Complications of tracheoplasty were formation of granulation tissue at the anastomosis site[3 cases], restenosis[9 cases], trachea-innominate artery fistula[2 cases], wound infection[2 cases], separation of anastomosis[2 cases], air leakage[3 cases], injury to a recurrent laryngeal nerve[temporary 8 cases, permanent 2 cases] and hypoxemia[1 case]. Surgical mortality for resection with primary reconstruction was 6.7%, with one death due to postoperative respiratory failure and two deaths due to tracheo-innominate artery fistula.

• Proceedings of the KSLP Conference
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• 2003.11a
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• pp.182-182
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• 2003

Objectives : The methods to treat glottic incompetence include thyroplasty type I, arytenoid abduction, and intracordal injection using various materials. The intracordal injection is easy and simple and does not require skin incision. In general, the grafted cartilage shows a high survival rate, a low absorption rate and small voluminous change. The authors performed injection of minced autologous auricular cartilage and fat using a Bruning injector in unilateral vocal cord palsy We evaluate the effect and safety of autologous auricular cartilage intracordal injection. Study Design : Retrospective study. Methods : Auricular cartilage was obtained by incising tragus vertically and it was minced with a scalpel and #15 blade. About 2g of abdominal fat was obtained by small periumbrical incision and cut into small pieces. The minced cartilage was put into a 1$m\ell$ injector and then the injector was filled with fat. The operation was conducted under laryngeal microscope. Minced cartilage was injected into the vocalis muscle at the junction of the middle and posterior third of the vocal fold. In three cases, we performed autologous cartilage intracordal injection. Results : We observed no postoperative complications, such as dyspnea, granulation, inflammation, in any of the cases. The voice was improved compared with the voice prior to operation in all cases. Conclusion : Although the cases are still limited and the observation period is short, we suggest that the autologous cartilage using the auricular cartilage is the ideal and new effective augmentative material in vocal cord palsy.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.22 no.2
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• pp.133-136
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• 2011

Background and Objectives : Previous jet ventilation is not becoming more common because of high price, making loud noise, and causing a movement of the vocal cords due to the jet stream. So we designed a new type of manually controlled jet ventilation using previous laryngoscope and introduced it's clinical application. Materials and Method : A prospective study involved 20 patients all having undergone surgical intervention under new type of manually controlled jet ventilation from June 2009 to January 2011. The prospective study was to assess the vital sign and operative and postoperative complications. Results : The Manually Controlled Jet Ventilation were performed in 20 patients. 50% of the patients have Post-located laryngeal lesion, 20% with tracheal stenosis, 20% with glottic cancer biopsy and laser cordectomy, 10% with postglottic stenosis. Conclusion : Manually Controlled Jet Ventilation (Manujet) can be used for airway surgery.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.28 no.2
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• pp.112-117
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• 2017

Background and Objectives : The purpose of this study was to classify patients with unilateral vocal fold paralysis according to their fixed location and to analysis the effects of two treatment methods by early voice therapy and injection laryngoplasty. Materials and Methods : Twenty patients who were classified as full abduction and slight abduction according to the position of paralysis were treated injection laryngoplasy, and 23 patients were treated by voice therapy. Twenty patients were treated injection laryngoplasy and 23 patients were treated voice therapy. Results were evaluated by acoustic analysis, electroglottography, cepstrum analysis before and after therapy. The voice therapy was conducted by improving the larynx movement and glottal contact, whilst removing hypertension of the supraglottic and use the breathing. Results : Significant improvement was found in the acoustic parameter, cepstrum parameter, and EGG before and after treatment in both groups. There was no significant difference between the two groups when compared before and after treatment to compare the effects of injection laryngoplasty and voice therapy. Conclusion : The initial treatments for unilateral vocal cord paralysis are injection laryngoplasty and voice therapy. however, there is no precise standard about which method should be applied first. Therefore, in this study, we tried to classify patients according to their paralysis position and then apply two methods. The results of this study suggest that voice therapy and Injection laryngoplasty at the initial stage is a very useful method to improve voice quality of vocal fold paralysis and improve laryngeal function.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.28 no.2
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• pp.96-99
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• 2017

Background and Objectives : The management of Reinke's edema includes usually medical treatment and voice therapy. Laryngomicrosurgery (LMS) is also necessary, especially to improve airway obstruction. However, voice outcome after LMS has not been determined well. The aim of this study was to evaluate effectiveness of LMS for Reinke's edema and analyze the voice outcomes after LMS. Materials and Methods : Twenty-five patients with Reinke's edema who underwent LMS from September 2007 to December 2016 were enrolled in this study. We analyzed reflux finding score (RFS), reflux symptom index (RSI), and acoustic parameters before and after surgery. Results : Male was 15 (60%) and female was 10 (40%), and mean age was 49.6 years. Preoperative mean value of RFS decreased significantly up to 3 months after LMS ($18.3{\pm}2.2$ and $10.0{\pm}2.2$ at preoperative and 3 months postoperatively, respectively). The mean value of Jitter decreased significantly before and after surgery ($2.71{\pm}2.81%$ and $1.06{\pm}1.21%$ before and after LMS, p=0.041). The mean value of Shimmer also decreased significantly before and after surgery ($7.97{\pm}3.63%$ and $4.83{\pm}1.85%$, respectively, p=0.006). Conclusion : LMS is effective in the treatment of Reinke's edema. It results in favorable acoustic outcomes and laryngoscopic findings in properly selected patients.