Botulinum toxin has several important properties that make it an ideal chemical denervator. These include its high degree of specificity for the neuromuscular junction, its ability to induce temporary and reversible denervation, and its limited degree of side effects and complications. Botulinum toxin is being used safely in a wide variety of clinical settings by many different specialists. In otolaryngologic practice, it is being administered for the treatment of at least a dozen conditions, including various dysphonias, dystonias, and spasms as well as torticollis, facial nerve paralysis, and hyperkinetic facial lines. Studies have shown that botulinum toxin injections have a high rate of success in temporarily relieving symptoms.

Botulinum Toxins↗

PubMed2000

Vocal fold granuloma: the "ball-valve" phenomenon.

Explore the source record for details and available documents.

Acute Disease↗

PubMed1999

Laryngeal sarcoidosis presenting as an isolated submucosal vocal fold mass.

Sarcoidosis can affect the larynx as a manifestation of systemic disease or as isolated laryngeal involvement. Classically, laryngeal involvement affects the supraglottis, and less commonly the subglottis, and true vocal fold involvement is rare. The clinical course is often highlighted by frequent exacerbations and remissions that, when associated with vague complaints and constitutional symptoms, are probably the greatest contributor to delayed presentation and diagnosis. We describe an unusual case of sarcoidosis that presented after a long and protracted clinical course as an isolated submucosal vocal fold mass requiring deep biopsy for diagnosis. A review of the literature with emphasis on diagnosis, appropriate airway management, and treatment is presented.

Chronic Disease↗

PubMed1999

Phonomicrosurgical resection of glottal papillomatosis.

Controlled debulking has been the surgical approach to treat laryngeal papillomatosis for over a century despite dramatic improvements in surgical technology. It is commonplace to leave disease in the glottis at the end of the procedure (eg, in the anterior commissure) because of complications associated with attempted complete removal. This study examined the recurrence patterns of adult glottal papillomatosis after phonomicrosurgical microflap resection. Between 1990 and 1995, 22 patients underwent phonomicrosurgical resection of glottal papillomatosis. Six patients had not undergone previous microlaryngeal surgery and 16 patients had had prior procedures. All patients underwent resection of all visible papillomatosis, and this frequently required staged resections. The subepithelial infusion technique was used to facilitate the resection in most cases. No patient who underwent resection for primary disease had a recurrence. Ten of 16 (62%) patients who presented with recurrent disease did not have a recurrence after microflap resection. Follow up on all patients was at least 2 years. This preliminary report suggests that recently developed phonomicrosurgical microflap resection techniques can eradicate adult glottal papillomatosis in some cases, and that resection of papillomatosis appears to be preferable to conventional debulking and/or ablation techniques.

Adult↗

PubMed1999

Vocal tremor reduction with deep brain stimulation.

We present a case illustration of the significant effect that deep brain stimulation (DBS) of the thalamus can have on vocal tremor. A 72-year-old female with a history of essential tremor was noted preoperatively to have a moderate vocal tremor (3 on a scale of 1-5). Following bilateral DBS of the thalamus, the vocal tremor rating improved to 1. Acoustic analysis demonstrated her vocal tremor to be affecting the amplitude of her voice at 5.58 Hz preoperatively, at 1. 93 Hz postoperatively with both leads on and at 1.54 Hz with only the left lead on. A videotaped endoscopic view of the patient's vocal cords (presented at the 1999 ASSFN meeting) clearly illustrated the dramatic changes apparent in the vocal tremor when the stimulators were turned on and off.

Aged↗

PubMed1999

Ectasias and varices of the vocal fold: clearing the striking zone.

Vascular malformations such as ectasias and varices (Es and Vs) are frequently encountered in patients who present with recurrent vocal fold hemorrhage and/or other traumatic vocal fold lesions. This study examined Es and Vs with regard to their anatomic presentation, phonomicrosurgical management, and treatment outcome. Forty-two patients (39 of them singers) were treated for a total of 87 Es and Vs: 67 of 87 (77%) were on the superior surface of the vocal fold and 20 of 87 (23%) were on the medial surface of the vocal fold. Eighty-three percent were located in the middle musculomembranous region (the striking zone), where the greatest aerodynamically induced shearing stresses occur during phonation. Treatment was performed with carbon dioxide laser cauterization (13 patients), or a new technique utilizing cold instrument excision by means of epithelial cordotomies (23 patients), while a combined approach was employed in 6 patients. Comparisons of preoperative and postoperative stroboscopy revealed improvement or no significant change in all patients in whom the cold instrument technique was used, and increased epithelial stiffness was noted in 4 of 19 patients in whom the carbon dioxide laser was used. Clearing the striking zone appears to have halted further hemorrhages by removing the the fragile Es and Vs from this injury-prone region of the vocal fold. Interpretations of stroboscopic examinations were directed at providing new insights into the biomechanical forces of vocal fold vibration that probably contribute to the genesis of Es and Vs in the vocal folds.

Adolescent↗

PubMed1999

Education in laryngology: rising to old challenges.

Education in laryngology has been a subject of interest at least since Louis Elsberg's address to the first meeting of the American Laryngological Association in 1879. Remarkable scientific, technological, and clinical advances during the 1980s and 1990s have elevated the standard of laryngological care. It is essential for training programs to promulgate these important advances through well-planned, comprehensive curricula. Such training should also foster an appreciation for the kinds of creative thought, interdisciplinary collaboration, and imaginative clinical practice that have been responsible for many of the recent dramatic advances in the field of laryngology.

Education, Medical↗

PubMed1999