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Authors' Reports
Md Noorain Alam
describes for SIIC the most significant aspects of his articledescribe para SIIC los aspectos relevantes de su artículo
Voice therapy in perosns with arytenoid dislocation due to tracheal intubation.
Voice therapy in cases with arytenoid dislocation
Efficacy of voice therapy in patient with arytenoid dislocation as a complication of tracheal intubation.
The article was published by
El artículo fue publicado por
Indian Journal of Otology
Volume / Volumen: 21
Number / Número: 1
First and last pages / Páginas inicial-final: 33-36
Year / Año: 2015
Month / Mes: 1
This journal, which is covered by SIIC Data Bases,
is part of the bibliographic collections of the Biblioteca Biomédica (BB) SIIC.
Esta revista, clasificada por SIIC Data Bases,
integra el acervo bibliográfico de la Biblioteca Biomédica (BB) SIIC.
Volume / Volumen: 21
Number / Número: 1
First and last pages / Páginas inicial-final: 33-36
Year / Año: 2015
Month / Mes: 1
This journal, which is covered by SIIC Data Bases,
is part of the bibliographic collections of the Biblioteca Biomédica (BB) SIIC.
Esta revista, clasificada por SIIC Data Bases,
integra el acervo bibliográfico de la Biblioteca Biomédica (BB) SIIC.
Principal institution where the research took place
Institución principal de la investigación
C U SHAH MEDICAL COLLEGE & HOSPITAL, SURENDRANAGAR, GUJARAT, India
Research description / Descripción de la investigación
Bibliographic references
Referencias bibliográficas
1. Kambic V, Radsel Z. Intubation lesions of the larynx. Br J Anaesth 50:587-90, 1978.
2. Rethi A. An operation for cicatricial stenosis of the larynx. J Otolaryngol 104:267-70, 1978.
3. Mencke T, Echternach M, Kleinschmidt S, Lux P, Barth V, Plinkert PK, et al. Laryngeal morbidity and quality of tracheal intubation: A randomized controlled trial. Anesthesiology 98:1049-56, 2003.
4. Talmi YP, Wolf M, Bar-Ziv J, Nusem-Horowitz S, Kronenberg J.Postintubation arytenoid subluxation. Ann Otol Rhinol Laryngol 105:384-90, 1996.
5. Sataloff RT, Bough Jr D, Spiegel JR. Arytenoid dislocation: Diagnosis and Treatment. Laryngoscope 104:1353-61, 1994.
6. Hirano M. Clinical examination of the voice. New York: Springer-Verlag; pp. 81-84, 1981.
7. Jacobson BH, Johnson A, Grywalski C, Silbergleit A, Jacobson G, Benninger MS, et al. The Voice Handicap Index (VHI): Developmentand validation. Am J Speech Lang Pathol 6:66-9, 1997.
8. Frink EJ, Pattison BD. Posterior arytenoid dislocation followinguneventful endotracheal intubation and anesthesia. Anesthesiology 70:358-60, 1989.
Institución principal de la investigación
C U SHAH MEDICAL COLLEGE & HOSPITAL, SURENDRANAGAR, GUJARAT, India
Research description / Descripción de la investigación
Chandigarh, India
(especial para SIIC)
Introduction
Arytenoid cartilage dislocation is a relatively less reported (about 0.1%)1 event which is an infrequent cause of vocal fold mobility. Primary cause of arytenoid cartilage dislocation within larynx is tracheal intubation followed by external laryngeal trauma. Tracheal intubation is performed in critically injured, ill or anesthetized patient, which involves placement of flexible plastic tube into trachea to maintain airway or to serve as a conduit for drug administration.
Arytenoid dislocation may cause painful swallowing2 accompanied with voice symptoms like decreased volume and breathiness. In 14%-50% of patients who receive general anesthesia hoarseness after tracheal intubation has been reported.3 Phonosurgical treatment involves endoscopic reduction to align the height of the vocal processes. Another option is vocal cord medialization procedures in case of late arytenoid subluxation.4 Early diagnosis of arytenoid dislocation is important as delay may lead to ankylosis of cricoarytenoid joint with permanent impairment of voice quality and possibly compromised airway protection.5 There is a lack of literature on incidence of arytenoid dislocation.
The aim of present study was to find out the efficacy of voice therapy as independent management option in patient with arytenoid dislocation as a complication of tracheal intubation.
Case study
A 37 year old male patient underwent laprotomy (intestine surgery) at CU Shah Medical College and Hospital. Tracheal intubation was administered and post surgery the patient developed breathy and soft voice. He was referred to ENT department for the complaint of change in voice. Direct laryngoscopy revealed both vocal cords bowing with subclinical subluxation. The patient was then referred to Speech Language Therapy department for voice therapy.
Voice evaluation
Voice evaluation involved perceptual, acoustical and psychosocial impact assessment. Perceptual assessment was carried out using GRBAS scale (grade, roughness, breathiness, asthenia, and strain).6 Each parameter was rated on a four point scale ranging from 0 (normal), 1 (slight), 2 (moderate), and 3 (extreme).
Acoustic assessment was done using Praat software. Objective measurement of Pitch range, jitter, shimmer and harmonic to noise ratio (HNR) was carried out using this software.
The psychosocial impact of the change in voice was carried out using Voice Handicap Index (VHI),7 which is 30 items, five point scale (0-4). The impact of the voice disorder may be classified as mild, moderate or severe based on overall score. Voice therapy
Voice therapy schedule involved following techniques: 1. Vocal hygine 2. Laryngeal manipulation exercise - Larynx of the patient was manipulated using the index finger and thumb of the clinician and patient was given practice to speak when the larynx was positioned so that it allowed optimal phonation 3. Abdominal breathing exercise - The patient was asked to take abdomen out ward during inhalation and inward during exhalation.
4. Head positioning - Head of the patient was adjusted at different position while the patient was phonating/a/ sound and was asked to speak with head positioned which allowed best phonation.
5. Pushing and Pulling exercise - The patient was asked to push/pull a large object, e.g. a table while phonating/a/sound 6. Hard glottal exercise - The patient was asked to produce vowels and words in a sudden plosive manner 7. Increasing loudness exercise - The patient was asked to count 1-5 while increasing the loudness at each number so that number 1 is softest and number 5 is spoken with the loudest voice.
Voice therapy schedule consisted of two sessions per week and total duration was 2 months. At the end of therapy, perceptual, acoustical and psychosocial impact assessment was readministeredusing GRBAS scale, Praat software and VHI respectively. Pre and post voice therapy measurements were compared to find out the effect of voice therapy.
Results
Following are the findings comparison of pre and of post voice therapy measurements.
Under perceptual analysis (GRBAS scale) pre voice therapy evaluation measurement was G2R2B3A2S3, which was abnormal while post voice therapy measurement was G0R0B0A0S0 i.e. voice was perceptually normal. Acoustical analysis (Praat software) showed improvement in most of the parametersin post voice therapy measurements. Pitch range increased from 13 Hz to 65.94 Hz. All Jitter values decreased like jitter local decreased from 5.87% to 2.41%. All shimmer values also decreased like shimmer local (dB) decreased from 20.88 dB to 15.89 dB.Harmonic to Noise Ratio value increased from mean HNR 1.62 dB to 5.96 dB.Under psychosocial impact analysis VHI measurements showed improvement in each of three domains i.e. functional (17.15 to 3.94), physical (22.7 to 19.9) and emotional component (19.9 to 5.99). Thus post voice therapy there was improvement in most of components of perceptual, acoustic and psychosocial domains of voice.
Discussion
Principal theories which have been proposed to explain the mechanism of arytenoid dislocation as a rest of tracheal intubation include incomplete neuromuscular blockage, motor reactions during endotracheal intubation, or direct trauma to the cricoarytenoid joints leading to joint cavity hemorrhage or serosynovitis.
In the literature, a case has been reported as a complication of the uneventful and apparently straightforward endotracheal intubation and anesthesia.9 In our patient, the cause ofarytenoid dislocation was unclear, as the intubation was not traumatic. Results from the present study suggest that voice therapy helps.
Conclusion
Voice therapy may be used as an adjunct to phonosurgery or independently as an effective intervention to reduce breathiness and hoarseness in patients with arytrenoid dislocation which also in turn improves overall quality of life.
Introduction
Arytenoid cartilage dislocation is a relatively less reported (about 0.1%)1 event which is an infrequent cause of vocal fold mobility. Primary cause of arytenoid cartilage dislocation within larynx is tracheal intubation followed by external laryngeal trauma. Tracheal intubation is performed in critically injured, ill or anesthetized patient, which involves placement of flexible plastic tube into trachea to maintain airway or to serve as a conduit for drug administration.
Arytenoid dislocation may cause painful swallowing2 accompanied with voice symptoms like decreased volume and breathiness. In 14%-50% of patients who receive general anesthesia hoarseness after tracheal intubation has been reported.3 Phonosurgical treatment involves endoscopic reduction to align the height of the vocal processes. Another option is vocal cord medialization procedures in case of late arytenoid subluxation.4 Early diagnosis of arytenoid dislocation is important as delay may lead to ankylosis of cricoarytenoid joint with permanent impairment of voice quality and possibly compromised airway protection.5 There is a lack of literature on incidence of arytenoid dislocation.
The aim of present study was to find out the efficacy of voice therapy as independent management option in patient with arytenoid dislocation as a complication of tracheal intubation.
Case study
A 37 year old male patient underwent laprotomy (intestine surgery) at CU Shah Medical College and Hospital. Tracheal intubation was administered and post surgery the patient developed breathy and soft voice. He was referred to ENT department for the complaint of change in voice. Direct laryngoscopy revealed both vocal cords bowing with subclinical subluxation. The patient was then referred to Speech Language Therapy department for voice therapy.
Voice evaluation
Voice evaluation involved perceptual, acoustical and psychosocial impact assessment. Perceptual assessment was carried out using GRBAS scale (grade, roughness, breathiness, asthenia, and strain).6 Each parameter was rated on a four point scale ranging from 0 (normal), 1 (slight), 2 (moderate), and 3 (extreme).
Acoustic assessment was done using Praat software. Objective measurement of Pitch range, jitter, shimmer and harmonic to noise ratio (HNR) was carried out using this software.
The psychosocial impact of the change in voice was carried out using Voice Handicap Index (VHI),7 which is 30 items, five point scale (0-4). The impact of the voice disorder may be classified as mild, moderate or severe based on overall score. Voice therapy
Voice therapy schedule involved following techniques: 1. Vocal hygine 2. Laryngeal manipulation exercise - Larynx of the patient was manipulated using the index finger and thumb of the clinician and patient was given practice to speak when the larynx was positioned so that it allowed optimal phonation 3. Abdominal breathing exercise - The patient was asked to take abdomen out ward during inhalation and inward during exhalation.
4. Head positioning - Head of the patient was adjusted at different position while the patient was phonating/a/ sound and was asked to speak with head positioned which allowed best phonation.
5. Pushing and Pulling exercise - The patient was asked to push/pull a large object, e.g. a table while phonating/a/sound 6. Hard glottal exercise - The patient was asked to produce vowels and words in a sudden plosive manner 7. Increasing loudness exercise - The patient was asked to count 1-5 while increasing the loudness at each number so that number 1 is softest and number 5 is spoken with the loudest voice.
Voice therapy schedule consisted of two sessions per week and total duration was 2 months. At the end of therapy, perceptual, acoustical and psychosocial impact assessment was readministeredusing GRBAS scale, Praat software and VHI respectively. Pre and post voice therapy measurements were compared to find out the effect of voice therapy.
Results
Following are the findings comparison of pre and of post voice therapy measurements.
Under perceptual analysis (GRBAS scale) pre voice therapy evaluation measurement was G2R2B3A2S3, which was abnormal while post voice therapy measurement was G0R0B0A0S0 i.e. voice was perceptually normal. Acoustical analysis (Praat software) showed improvement in most of the parametersin post voice therapy measurements. Pitch range increased from 13 Hz to 65.94 Hz. All Jitter values decreased like jitter local decreased from 5.87% to 2.41%. All shimmer values also decreased like shimmer local (dB) decreased from 20.88 dB to 15.89 dB.Harmonic to Noise Ratio value increased from mean HNR 1.62 dB to 5.96 dB.Under psychosocial impact analysis VHI measurements showed improvement in each of three domains i.e. functional (17.15 to 3.94), physical (22.7 to 19.9) and emotional component (19.9 to 5.99). Thus post voice therapy there was improvement in most of components of perceptual, acoustic and psychosocial domains of voice.
Discussion
Principal theories which have been proposed to explain the mechanism of arytenoid dislocation as a rest of tracheal intubation include incomplete neuromuscular blockage, motor reactions during endotracheal intubation, or direct trauma to the cricoarytenoid joints leading to joint cavity hemorrhage or serosynovitis.
In the literature, a case has been reported as a complication of the uneventful and apparently straightforward endotracheal intubation and anesthesia.9 In our patient, the cause ofarytenoid dislocation was unclear, as the intubation was not traumatic. Results from the present study suggest that voice therapy helps.
Conclusion
Voice therapy may be used as an adjunct to phonosurgery or independently as an effective intervention to reduce breathiness and hoarseness in patients with arytrenoid dislocation which also in turn improves overall quality of life.
Bibliographic references
Referencias bibliográficas
1. Kambic V, Radsel Z. Intubation lesions of the larynx. Br J Anaesth 50:587-90, 1978.
2. Rethi A. An operation for cicatricial stenosis of the larynx. J Otolaryngol 104:267-70, 1978.
3. Mencke T, Echternach M, Kleinschmidt S, Lux P, Barth V, Plinkert PK, et al. Laryngeal morbidity and quality of tracheal intubation: A randomized controlled trial. Anesthesiology 98:1049-56, 2003.
4. Talmi YP, Wolf M, Bar-Ziv J, Nusem-Horowitz S, Kronenberg J.Postintubation arytenoid subluxation. Ann Otol Rhinol Laryngol 105:384-90, 1996.
5. Sataloff RT, Bough Jr D, Spiegel JR. Arytenoid dislocation: Diagnosis and Treatment. Laryngoscope 104:1353-61, 1994.
6. Hirano M. Clinical examination of the voice. New York: Springer-Verlag; pp. 81-84, 1981.
7. Jacobson BH, Johnson A, Grywalski C, Silbergleit A, Jacobson G, Benninger MS, et al. The Voice Handicap Index (VHI): Developmentand validation. Am J Speech Lang Pathol 6:66-9, 1997.
8. Frink EJ, Pattison BD. Posterior arytenoid dislocation followinguneventful endotracheal intubation and anesthesia. Anesthesiology 70:358-60, 1989.
SIIC System of Assisted Editing (SSEA)
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The article is strictly related to the following sections of siicsalud
El artículo se relaciona estrictamente con las siguientes secciones de siicsalud
Information about the full text
Acerca del trabajo completo
Voice therapy in cases with arytenoid dislocation
Author / Autor
Md Noorain Alam1, Deepanshu Gurnani2, Vikas Sinha3, Nehal Patel4, Sachin Jindal5, Pawan Sharma6
6 Dr., M. P. Shah Government Medical College, Jamnagar
Access to the original source
Indian Journal of Otology
Article URL: / URL del artículo:
http://www.indianjotol.org/
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www.siicsalud.com/main/distriprinrel.php
/ Sistema SIIC de Edición Asistida (SSEA)
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The author's report was accepted on La crónica del autor fue aprobada el 2021, March 9 |
Published in siicsalud Publicado en siicsalud 2021, June 7 |
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The article is strictly related to the following sections of siicsalud
El artículo se relaciona estrictamente con las siguientes secciones de siicsalud
 Health Care Management / Administración Hospitalaria |
Otorrhinolaryngology / Otorrinolaringología |
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and secondarily related to the following sections y secundariamente con las siguientes secciones
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Information about the full text
Acerca del trabajo completo
Voice therapy in cases with arytenoid dislocation
Author / Autor
Md Noorain Alam1, Deepanshu Gurnani2, Vikas Sinha3, Nehal Patel4, Sachin Jindal5, Pawan Sharma6
6 Dr., M. P. Shah Government Medical College, Jamnagar
Access to the original source
Indian Journal of Otology
Article URL: / URL del artículo:
http://www.indianjotol.org/
siic DB: / siic DB:
www.siicsalud.com/main/distriprinrel.php
ua40317
