Search Results (29)

Background/Objectives: Video laryngoscopy is one of the primary methods used by otolaryngologists for detecting and classifying laryngeal lesions. However, the diagnostic process of these images largely relies on clinicians’ visual inspection, which can lead to overlooked small structural changes, delayed diagnosis, and interpretation errors. Methods: AI-based approaches are becoming increasingly critical for accelerating early-stage diagnosis and improving reliability. This study proposes a hybrid Convolutional Neural Network (CNN) architecture that eliminates repetitive and clinically insignificant frames from videos, utilizing only meaningful key frames. Video data from healthy individuals, patients with vocal fold nodules, and those with vocal fold polyps were summarized using three different threshold values with the Structural Similarity Index Measure (SSIM). Results: The resulting key frames were then classified using a hybrid CNN. Experimental findings demonstrate that selecting an appropriate threshold can significantly reduce the model’s memory usage and processing load while maintaining accuracy. In particular, a threshold value of 0.90 provided richer information content thanks to the selection of a wider variety of frames, resulting in the highest success rate. Fine-tuning the last 20 layers of the MobileNetV2 and Xception backbones, combined with the fusion of extracted features, yielded an overall classification accuracy of 98%. Conclusions: The proposed approach provides a mechanism that eliminates unnecessary data and prioritizes only critical information in video-based diagnostic processes, thus helping physicians accelerate diagnostic decisions and reduce memory requirements. Full article

Background: miRNA profiling across different stages of laryngeal carcinogenesis explores dysregulated molecules relevant to engaged gene pathways and identifies markers for differential diagnosis and prognosis in early mucosal lesions of the larynx. Methods: Tissue samples were prospectively collected from 28 patients with hypertrophic vocal fold lesions: no dysplasia (ND), low-grade dysplasia (LGD), high-grade dysplasia (HGD), and invasive cancer (IC), as well as from 3 patients with vocal fold polyps. miRNA profiling of the samples was performed using microfluidic cards—TaqMan^® Human MicroRNA Array A. A comparative analysis of ΔCt (dCt) miRNA expression levels was conducted between groups. Results: hsa-miR-216a-5p and hsa-miR-488-3p were selectively expressed in control tissues, while hsa-miR-105-5p and hsa-miR-516a-5p were exclusively detected in HGD and IC samples. Significant differences in miRNA expression were identified across 4, 16, 17, and 38 miRNA types between control and ND, LGD, HGD, and IC groups, respectively. hsa-miR-185-5p and hsa-miR-21-5p showed significantly altered expression between ND and LGD, HGD, and IC (p = 0.026, 0.001, 0.002; and p = 0.021, 0.002, 0.001, respectively). Twenty-five miRNAs were differentially expressed between LGD and both HGD and IC, while eleven miRNAs distinguished HGD from IC. Notably, hsa-miR-503-5p expression decreased progressively with increasing histological severity. Conclusions: Distinct miRNA expression profiles are associated with progressive stages of laryngeal mucosal lesions. Specific miRNAs may serve as valuable biomarkers for early detection, risk stratification, and prognosis in vocal fold carcinogenesis. Full article

Background: Immunological and rheological properties are important factors of the surfactant protein (SP) family, whose impact on tumorigenesis is not yet known, although some SPs have been identified as tumor marker candidates for various malignancies. This study describes the detection of the two surfactant family proteins SP-G and PLUNC in healthy glottis, the presence of SP-G in glottic cancer, and the in vitro tissue regeneration potential of SP-G and PLUNC on epithelial cells. Methods: The expression and distribution of SP-G and PLUNC were investigated immunohistochemically in squamous cell carcinomas of the vocal folds. The expression of both proteins was analyzed by Western blot in micro-dissected healthy vocal fold mucosa from body donors. The hypopharyngeal squamous carcinoma cell line (FaDu) was used as an in vitro model for wound healing experiments with Electric cell–substrate impedance sensing (ECIS). Results: The results show the presence of SP-G and PLUNC in epithelial cells of the healthy vocal folds and the submucosal glands of the vestibular folds. SP-G was detected in squamous cell carcinomas of the vocal folds. SP-G and PLUNC show accelerated wound healing of FaDu cells in vitro. Conclusions: SP-G and PLUNC were first detected in the vocal fold of the human larynx. SP-G shows a distinct presence in glottic carcinoma, whose relevance needs to be determined in future studies. SP-G and PLUNC exhibit a positive influence on the repair mechanisms of epithelial lesions of the glottis. The data presented form the basis for follow-up studies focusing on the impact of SP-G in glottic cancer development and the potentially meaningful clinical effect of SP-G and PLUNC on tissue repair of the human vocal fold. Full article

Objectives: This study evaluates the potential of high-speed videoendoscopy (HSV) in differentiating between benign and malignant glottic lesions, offering a non-invasive diagnostic tool for clinicians. Moreover, a new parameter derived from high-speed videoendoscopy (HSV) had been proposed and implemented in the analysis for an objective assessment of the vocal fold stiffness. Methods: High-speed videoendoscopy (HSV) was conducted on 102 participants, including 21 normophonic individuals, 39 patients with benign vocal fold lesions, and 42 with glottic cancer. Laryngotopographic parameter describing the stiffness of vocal fold (SAI) and kymographic parameters describing amplitude, symmetry, and glottal dynamics were quantified. Statistical differences between groups were assessed using receiver operating characteristic (ROC) analysis and lesion classification was performed using a machine learning model. Results: Univariate receiver operating characteristic (ROC) analysis revealed that SAI (AUC = 0.91, 95% CI: 0.839–0.962) and weighted amplitude asymmetry (AUC = 0.92, 95% CI: 0.85–0.974) were highly effective in distinguishing between normophonic and organic lesions (p < 0.01). Further multivariate analysis using machine learning models demonstrated improved accuracy, with the SVM classifier achieving an AUC of 0.93 for detecting organic lesions and 0.83 for distinguishing benign from malignant lesions. Conclusions: The study demonstrates the potential value of parameter describing the pliability of infiltrated vocal fold (SAI) as a non-invasive tool to support histopathological evaluation in laryngeal lesions, with machine learning models enhancing diagnostic performance. Full article

Advancements in dynamic laryngeal imaging, particularly high-speed videoendoscopy (HSV), have addressed several limitations of laryngovideostroboscopy (LVS). This study aimed to compare the success rates of LVS and HSV in generating recordings suitable for objective functional assessment of vocal fold movements. Methods: This study included 200 patients with voice disorders (123 with benign glottal lesions, 56 with malignant lesions, and 21 with functional voice disorders) and 47 normophonic individuals. All participants underwent LVS followed by HSV. Kymographic analysis was performed to evaluate phonatory parameters, including amplitude, symmetry, and glottal dynamics. The success of both methods in generating analyzable kymograms was assessed, and statistical comparisons were made using the chi-square test (significance level set at p < 0.05). Results: The failure rate for LVS was significantly higher (43.32%) compared to HSV. HSV successfully generated kymograms in 68.22% of cases where LVS failed. The primary factors contributing to LVS failure included synchronization issues, inadequate recording brightness, unstable phonation, and hidden glottal opening. Failure rates related to structural obstacles were similar between the two methods. HSV demonstrated superior kymogram feasibility across all subgroups, with the highest success observed in cases of organic glottal pathologies (30.73%). A significant advantage of HSV was observed for both benign and malignant glottal lesions, especially in cases of asynchronous vocal fold oscillations. Conclusions. By overcoming the inherent limitations of LVS, HSV provides a more reliable and objective assessment of phonatory function. Its ability to generate suitable kymograms with greater precision makes HSV a valuable tool for routine clinical diagnostics, enabling the accurate identification of subtle laryngeal pathologies and enhancing diagnostic accuracy. Full article

Background: This study aimed to investigate the relationships between kymographic parameters derived from high-speed videoendoscopy (HSV) and simultaneously recorded acoustic signals. The research provides insights into the vibratory dynamics of various glottal pathologies, assessed across different glottal widths, and their mutual relations with audio data. Methods: The study included 192 participants categorized as normophonic or having functional or organic lesions (benign, premalignant, and malignant). Parameters describing vocal fold oscillations were calculated using HSV kymography for three glottal widths, along with corresponding acoustic data. Initially, linear correlations between these parameters were assessed. Next, the consistency in cycle detection and its influence on the correlation levels were evaluated. Results: The fundamental frequency (F0) and mean Jitter (Jita) showed the highest correlations between the HSV- and audio-determined parameters (F0: 0.97, Jita: 0.40–0.70), with even stronger correlations when the number of detected cycles was consistent (F0: 0.99, Jita: 0.68–0.98). The correlations for other parameters ranged from low to moderate, with no significant differences observed between the diagnostic subgroups (functional changes and benign and malignant glottal lesions). However, in the premalignant lesions group, high correlations (0.77–0.9) were observed between the HSV and audio parameters, but only for measures describing period perturbations. Beyond F0 and mean Jitter, consistency in cycle detection did not significantly affect correlation levels. Conclusions: The simultaneous audio signal proved useful in verifying the accuracy of HSV quantification measures, particularly for F0, which showed strong agreement between the methods. Discrepancies in other parameters and low correlations between HSV-derived kymography and audio data may suggest the influence of the throat, mouth, and nose resonators, which are added to the glottal signal. While the kymographic analysis based on HSV provides detailed descriptions of vocal fold oscillations, it does not fully capture the three-dimensional structure and complex functionality of the vocal folds. Full article

Background: Dysphonia, a common symptom after thyroid surgery, is most often caused by damage to the recurrent laryngeal nerve. Laryngeal electromyography (LEMG) is used as a qualitative diagnostic tool to distinguish neurological etiology from other causes of dysphonia. The purpose of this study is to establish the value of LEMG as a predictor factor in the recovery of unilateral recurrent paralysis post-thyroidectomy. Methods: This study included 11 patients with unilateral vocal fold palsy (UVFP) evidenced on the videostrobolaryngoscopy (VSL) after thyroidectomy. Electrical activity of thyroarytenoid (TA) muscles of the patients included in the study was recorded through LEMG and the prognosis of the lesions was classified as excellent, fair, or poor based on the presence of spontaneous activity and motor unit recruitment. Results: LEMG at the first clinic visit showed an excellent prognosis in three of the cases, a fair prognosis in three of the cases, and five of them indicated a poor prognosis. At 6 months after the first LEMG, patients with a poor prognosis were unchanged and showed no LEMG improvement. Those with an excellent prognosis showed an increased recruitment response, and LEMG was normal. In one patient with a fair prognosis and minimal spontaneous activity, LEMG recruitment decreased during reevaluation. The other two fair-prognosis patients had a normal LEMG. Conclusions: A correlation was found between LEMG findings and functional recovery of the vocal cords, demonstrating that the presence of spontaneous activity represents a negative prognostic factor. However, due to limited patient cohorts, the sensitivity of the LEMG as a prognostic tool in the functional recovery of the larynx is not yet established and requires further research. Full article

(1) Background: Assessing phonatory disorders due to laryngeal biomechanical alterations requires aerodynamic analysis, assessing subglottic pressure, transglottic flow, and laryngeal resistance. This study explores whether the acoustic parameter, the relative fundamental frequency (RFF), can be studied using the current acoustic analysis protocol at the University of Navarra’s voice laboratory and its association with pathologies linked to laryngeal biomechanical alterations. (2) Methods: A retrospective cohort study included patients diagnosed with muscular tension dysphonia, organic lesions of the vocal fold, and vocal fold paralysis (VFP) at the Clínica Universidad de Navarra from 2019 to 2021. Each patient underwent endoscopic laryngeal exploration, followed by acoustic study, RFF calculation, and an aerodynamic study. Additionally, a control group was recruited. (3) Results: 79 patients and 22 controls were studied. Two-way ANOVA showed significant effects for groups and cycles in offset and onset cycles. Statistically significant differences were observed in cycle 1 onset among all groups and in cycles 1 and 2 between the control group and non-healthy groups. (4) Conclusions: RFF is a valuable indicator of phonatory biomechanics, distinguishing healthy and pathological voices and different disorders. RFF in onset cycles offers a cost-effective, accurate method for assessing biomechanical disorders without complex aerodynamic analyses. This study describes RFF values in VFP for the first time, revealing differences regardless of aerodynamic patterns. Full article

(1) Background: Vocal fold nodules are bilateral lesions that can have an important negative impact on a person’s job performance, social interaction, and quality of life. This study aims to analyze multidimensional voice evaluation outcomes in a group of patients with bilateral vocal fold nodules who underwent voice therapy. (2) Methods: A retrospective analysis was performed in 42 patients on the following voice evaluations, before and after voice therapy: visual-perceptual (video-laryngostroboscopic evaluation), auditory-perceptual voice analysis based on the GRBAS scale, and aerodynamic voice analysis. Data were collected from January 2001 to December 2019. Data analyses were performed with non-parametric tests (Wilcoxon test) using α = 0.05. (3) Results: The patient average age was 33.6.1 ± 10 years (range 19–60), and 95.2% were female. Voice therapy was delivered by an experienced speech-language pathologist once a week, with an average of 9.8 ± 3 appointments (range 8–17). Vocal fold lesions disappeared in 40.4% of the patients after voice therapy, especially in participants receiving early voice therapy (p = 0.035). When comparing pre- and post-therapy audio-perceptual results, all parameters were improved with statistical significance (p < 0.05) except for the asthenic voice scale. Aerodynamic parameters were all improved but without statistical significance (p > 0.05); (4) Conclusions: Early timing to initiate voice therapy after the onset of symptoms or diagnosis seems to be an important factor for the success of voice therapy (absence of vocal fold nodules). Full article

Introduction: Laser surgery of the larynx is currently the standard of clinical practice in a multitude of procedures. Lasers with photoangiolytic properties have a wide application in endolaryngeal lesions. One of their most prominent features is the ability to coagulate blood vessels, reducing unwanted tissue damage. Our objective is to expose the uses of the blue laser (445 nm) in the larynx. Material and methods: A retrospective study was carried out including 47 patients treated with blue photoangiolytic laser from October 2021 to January 2023 at a university hospital. Demographic data, type of lesion presented, date of intervention and scope of the procedure, as well as the parameters of the laser used, were recorded. The number of sessions received per patient, the result and complications were also collected. Results: A total of 47 patients with laryngeal lesions were treated, including vascular angiomas, laryngeal sulcus vocali, vocal cord polyps, Reinke’s edemas, laryngeal papillomatoses, subglottic stenosis, laryngeal synechiae, subglottic granulomas, glottic scars, vocal fold leukoplakias, laryngeal dysplasias and tracheostomal granulomas. The mean age was 52.5 years, and 64.3% of the patients were women. The range of power used in the resective surgeries was 2–10 Watts with a 20-millisecond window. The average number of sessions received was 2.1 (range 1–4). A satisfactory situation was obtained in 45 of the 47 patients treated (95.75%), and an evident decrease in lesions was seen in the remaining two. There was no evidence of any complications directly derived from the use of the blue laser. Twenty-seven cases (54%) were treated exclusively in-office. Conclusions: The blue laser is safe and effective in the treatment of a wide range of laryngeal pathologies. Its advantages include its portability, its photoangiolytic qualities as well as its ability to vaporize tissue in contact mode, which can treat subepithelial vessels or resect lesions. Full article

The aim of the study was to utilize a quantitative assessment of the vibratory characteristics of vocal folds in diagnosing benign and malignant lesions of the glottis using high-speed videolaryngoscopy (HSV). Methods: Case-control study including 100 patients with unilateral vocal fold lesions in comparison to 38 normophonic subjects. Quantitative assessment with the determination of vocal fold oscillation parameters was performed based on HSV kymography. Machine-learning predictive models were developed and validated. Results: All calculated parameters differed significantly between healthy subjects and patients with organic lesions. The first predictive model distinguishing any organic lesion patients from healthy subjects reached an area under the curve (AUC) equal to 0.983 and presented with 89.3% accuracy, 97.0% sensitivity, and 71.4% specificity on the testing set. The second model identifying malignancy among organic lesions reached an AUC equal to 0.85 and presented with 80.6% accuracy, 100% sensitivity, and 71.1% specificity on the training set. Important predictive factors for the models were frequency perturbation measures. Conclusions: The standard protocol for distinguishing between benign and malignant lesions continues to be clinical evaluation by an experienced ENT specialist and confirmed by histopathological examination. Our findings did suggest that advanced machine learning models, which consider the complex interactions present in HSV data, could potentially indicate a heightened risk of malignancy. Therefore, this technology could prove pivotal in aiding in early cancer detection, thereby emphasizing the need for further investigation and validation. Full article

Background: Sulcus vocalis (SV) is a longitudinal groove in the free edge of the true vocal cord. It may impair phonation with incomplete glottic closure, phonasthenia and hoarseness. This study aims to detect a correlation between benign vocal cord lesions and the incidence of the SV. Methods: A retrospective study was carried out on patients who underwent transoral surgery due to benign vocal fold lesions and were selected according to strict criteria. Patients were divided into a group with sulcus vocalis (Group wSV) and a group without sulcus vocalis (Group w/oSV). The possible correlations between variables were assessed by the Pearson chi-square test (p < 0.05). Results: The study included 232 vocal cord lesions in 229 patients: 62.88% were females whose mean age was 46.61 ± 14.04. The most frequent diseases were polyps (37.94%), nodules (18.53%) and Reinke’s edema (21.12%). Statistically significant relationships were found between age and SV (p-value 0.0005) and between mild dysplasia and SV (p-value 0.03). Conclusions: This study did not detect a cause–effect relationship between SV and benign vocal fold lesions. SV within vocal fold lesions is more common in younger patients, suggesting a congenital nature of SV. In conclusion, in the case of a benign vocal fold lesion, a possible SV should be considered and researched to provide the patient the best healthcare. Full article

Unilateral vocal fold paralysis (UVFP) causes glottal incompetence and poor vocal efficiency. The influence of laryngeal neuromuscular control on aerodynamics in UVFP remains unclear. This study investigated the relationship between laryngeal muscle activities using quantitative laryngeal electromyography (LEMG) and aerodynamics in UVFP. This prospective study recruited patients with UVFP, and the diagnosis was confirmed with videolaryngostroboscopy and LEMG. The patient received aerodynamic assessment and LEMG of the thyroarytenoid-lateral cricoarytenoid (TA-LCA) muscle complex and the cricothyroid (CT) muscle. The relationship between quantitative LEMG and aerodynamic parameters was analyzed. A total of 134 UVFP patients without concurrent CT muscle involvement were enrolled. Compared with the normal side, the peak turn frequency of the lesioned side was lower in the TA-LCA (p < 0.001) and CT (p = 0.048) muscles. Stepwise linear regression revealed that the turn ratio of TA-LCA muscles was a robust factor in the decrease in peak expiratory airflow (β = −0.34, p = 0.036), mean airflow during voicing (β = −0.28, p = 0.014), and aerodynamic power (β = −0.42, p = 0.019), and an increase in aerodynamic efficiency (β = 27.91, p = 0.012). In addition, the turn ratio of CT muscles was a potent factor in inducing an increase in aerodynamic resistance (β = 14.93, p = 0.029). UVFP without CT involvement still showed suppression of CT muscles on the lesioned side, suggesting that neurological impairment of the TA-LCA complex could cause asymmetrical compensation of CT muscles, further impeding aerodynamics. The residual function of TA-LCA muscle complexes facilitates less air leakage and power dissipation, enhancing aerodynamic efficiency. On the other hand, the symmetrical compensation of the CT muscles improves aerodynamic resistance. Full article

Unilateral vocal fold polyps can lead to incomplete glottal closure and irregular vocal fold vibration. Depending on polyp size and resulting dysphonia severity, voice therapy or surgery may be recommended. As part of voice therapy, patients may learn how to optimize intrinsic and extrinsic laryngeal muscle use to mitigate benign lesion effects, increase vocal efficiency, and improve voice quality. In this study, we used a low-dimensional mass model with a simulated unilateral vocal fold polyp and varied intra-laryngeal muscle activity to simulate vocal fold vibration across varied conditions. Differing muscle activation has different effects on frequency, periodicity, and intensity. Accordingly, learning how to optimize muscle activity in a unilateral polyp setting may help patients achieve the best possible periodic and most efficiently produced voice in the context of abnormal vocal fold morphology. Full article

The aerodynamic voice assessment of subglottal air pressure can discriminate between speakers with typical voices from patients with voice disorders, with further evidence validating subglottal pressure as a clinical outcome measure. Although estimating subglottal pressure during phonation is an important component of a standard voice assessment, current methods for estimating subglottal pressure rely on non-natural speech tasks in a clinical or laboratory setting. This study reports on the validation of a method for subglottal pressure estimation in individuals with and without voice disorders that can be translated to connected speech to enable the monitoring of vocal function and behavior in real-world settings. During a laboratory calibration session, a participant-specific multiple regression model was derived to estimate subglottal pressure from a neck-surface vibration signal that can be recorded during natural speech production. The model was derived for vocally typical individuals and patients diagnosed with phonotraumatic vocal fold lesions, primary muscle tension dysphonia, and unilateral vocal fold paralysis. Estimates of subglottal pressure using the developed method exhibited significantly lower error than alternative methods in the literature, with average errors ranging from 1.13 to 2.08 cm H₂O for the participant groups. The model was then applied during activities of daily living, thus yielding ambulatory estimates of subglottal pressure for the first time in these populations. Results point to the feasibility and potential of real-time monitoring of subglottal pressure during an individual’s daily life for the prevention, assessment, and treatment of voice disorders. Full article