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László Rovó - One of the best experts on this subject based on the ideXlab platform.

  • Glottic configuration changes and outcomes of endoscopic arytenoid abduction lateropexy
    European Archives of Oto-Rhino-Laryngology, 2019
    Co-Authors: László Szakács, Balazs Sztano, Vera Matievics, Zsófia Bere, Paul F. Castellanos, László Rovó
    Abstract:

    Introduction Endoscopic arytenoid abduction lateropexy (EAAL) is an effective Glottis enlarging procedure for the treatment of bilateral vocal cord palsy (BVCP). The postoperative glottic configuration changes can be evaluated by modern, high-resolution, 3D image reconstructions. Functional results are described by spirometry as well as objective and subjective phoniatric tests. Methods Unilateral EAAL was performed in ten malignant thyroid gland tumor patients (eight women, two men), who had BVCP after thyroid surgery. Slicer 3D^® software was used for morphometric analysis. Pre- and postoperative peak inspiratory flow (PIF) and standard phoniatric parameters were compared. Results The glottic gap improved significantly (+ 60%). Significant improvement of PIF was found in all cases. Phoniatric tests revealed better quality of voice and patient satisfaction. Their voices changed from a severely impaired to a socially acceptable, almost normal, quality. Conclusion The results support our clinical observations that the ideal position of the lateralization sutures is the one which provides a physiological abduction position of the arytenoid cartilage. Considering these good results, the surgical indications for minimally invasive endoscopic arytenoid lateropexy may be extended.

  • Endoscopic arytenoid abduction lateropexy for the treatment of neonatal bilateral vocal cord paralysis - Long-term results.
    International Journal of Pediatric Otorhinolaryngology, 2019
    Co-Authors: Balazs Sztano, Vera Matievics, Eszter Erdelyi, Ilona Szegesdi, Christopher T. Wootten, Ádám Bach, László Rovó
    Abstract:

    Abstract Objectives Bilateral vocal cord paralysis often causes severe dyspnea requiring an early airway intervention in neonates. Endoscopic arytenoid abduction lateropexy (EAAL) with suture is a quick, reversible, minimally-invasive vocal cord lateralizing technique to enlarge the Glottis. The arytenoid cartilage is directly lateralized to a normal abducted position. It can be performed even in early childhood with the recently-introduced pediatric endoscopic thread guide instrument. The long-term results and the stability of the lateralization were evaluated. Methods Three newborns had inspiratory stridor immediately after birth. Laryngo-tracheoscopy revealed bilateral vocal cord paralysis. Unilateral, left-sided endoscopic arytenoid abduction lateropexy was performed with supraglottic jet ventilation. The follow-up period was >3 years. Results After extubation on the 4–7th postoperative day no dyspnea or swallowing disorder occurred. Laryngo-tracheoscopy, clinical growth charts and voice analysis showed satisfactory functional results. Conclusions The endoscopic arytenoid abduction lateropexy might be a favorable solution for neonatal bilateral vocal cord paralysis. In one step, airway patency can be achieved without irreversible damage to the glottic structures. Normal swallowing function was preserved. The results are durable, and neither medialization nor dyspnea re-appeared during observation.

  • a comparison between transoral Glottis widening techniques for bilateral vocal fold immobility
    Laryngoscope, 2015
    Co-Authors: László Szakács, Balazs Sztano, Vera Matievics, Ádám Bach, Zsófia Bere, Paul F. Castellanos, László Rovó
    Abstract:

    Objective Comparison of different endoscopic Glottis-widening procedures designed for bilateral vocal cord immobility (BVCI) is a challenge. This is because a statistically efficient analysis and comparable clinical series is hard to obtain considering the variable aspects of the results and the evaluation methods. This study of a large number of cadaver larynges provides comparable, objective data for the evaluation of the possible postoperative breathing and voicing function. Study Design A morphometric study was performed on 50 male and 50 female larynges to compare the different suture lateralization and resection procedures. Methods The postoperative characteristic of glottic configuration was evaluated following vocal cord laterofixation, endolaryngeal arytenoid abduction lateropexy (EAAL), Schobel's external lateralization procedure (SELP), transverse cordotomy (TC), and medial and total arytenoidectomies (AE). The glottic area and the parameters determining the phoniatric outcomes were assessed by a digital image analyzer program. Results Improvement of glottic area was observed after all procedures, but arytenoid abduction procedures were significantly the most effective. However, the smallest vocal cord angles were found in TC and AE; the injury of the voicing structures results in a deterioration of vocal mechanics and can be reasonably assumed to negatively influence the voice. Endolaryngeal arytenoid abduction lateropexy and SELP may provide the best phonation closure when residual adduction regeneration can occur. Conclusion This study demonstrates the complexity of the correct surgical decision making in BVCI. Procedures that utilize physiological abduction of the arytenoid cartilage seem to be more advantageous, especially if recovery of adductor function occurs. Level of Evidence N/A. Laryngoscope, 125:2522–2529, 2015

Daniel Rodenstein - One of the best experts on this subject based on the ideXlab platform.

  • nasal two level positive pressure ventilation in normal subjects effects of the Glottis and ventilation
    American Journal of Respiratory and Critical Care Medicine, 1996
    Co-Authors: Veronica F Parreira, Genevieve Aubert, Myriam Dury, Pierre Delguste, Daniel Rodenstein
    Abstract:

    The purpose of this study was to examine the behavior of the Glottis during intermittent positive-pressure ventilation (nIPPV) using a two-level positive-pressure ventilator and to compare the glottic adaptation to this ventilatory mode with the one observed using volumetric ventilators, recently reported by us. Six healthy subjects were studied during both wakefulness and sleep. Their Glottis was continuously monitored through a fiberoptic bronchoscope. We measured breath by breath the widest inspiratory angle formed by the vocal cords at the anterior commissure, the corresponding tidal volume, and other indices. We used the controlled ventilatory mode. The expiratory pressure was kept at 4 cm H2O, and the inspiratory pressure was increased by steps from 10 to 15 to 20 cm H2O. Increases in inspiratory pressure did not always lead to increases in effective ventilation reaching the lungs. This was due to a significant narrowing of the Glottis by adduction of the vocal cords in all subjects. Periodic breathing with or without apneas were common during wakefulness, but especially during sleep, representing 10.5 +/- 11% (SD) of total sleep time. We conclude that effective ventilation during nIPPV using a two-level positive-pressure ventilator in the controlled mode is less predictable and less stable than during nIPPV using volumetric ventilators.

  • effects of nasal positive pressure hyperventilation on the Glottis in normal sleeping subjects
    Journal of Applied Physiology, 1995
    Co-Authors: V Jounieaux, Genevieve Aubert, Myriam Dury, Pierre Delguste, Daniel Rodenstein
    Abstract:

    We have recently observed obstructive apneas during nasal intermittent positive-pressure ventilation (nIPPV) and suggested that they were due to hypocapnia-induced glottic closure. To confirm this hypothesis, we studied seven healthy subjects and submitted them to nIPPV while their Glottis was continuously monitored through a fiber-optic bronchoscope. During wakefulness, we measured breath by breath the widest inspiratory angle formed by the vocal cords at the anterior commissure along with several other indexes. Mechanical ventilation was progressively increased up to 30 l/min. In the absence of diaphragmatic activity, increases in delivered minute ventilation resulted in progressive narrowing of the vocal cords, with an increase in inspiratory resistance and a progressive reduction in the percentage of the delivered tidal volume effectively reaching the lungs. Adding CO2 to the inspired gas led to partial widening of the Glottis in two of three subjects. Moreover, activation of the diaphragmatic muscle was always associated with a significant inspiratory abduction of the vocal cords. Sporadically, complete adduction of the vocal cords was directly responsible for obstructive laryngeal apneas and cyclic changes in the glottic aperture resulted in waxing and waning of tidal volume. We conclude that in awake humans passive ventilation with nIPPV results in vocal cord adduction that depends partly on hypocapnia, but our results suggest that other factors may also influence glottic width.

Prasanta Kumar Ghosh - One of the best experts on this subject based on the ideXlab platform.

  • Two step convolutional neural network for automatic Glottis localization and segmentation in stroboscopic videos
    Biomedical Optics Express, 2020
    Co-Authors: Varun Belagali, Achuth Rao M, Pebbili Gopikishore, Rahul Krishnamurthy, Prasanta Kumar Ghosh
    Abstract:

    Precise analysis of the vocal fold vibratory pattern in a stroboscopic video plays a key role in the evaluation of voice disorders. Automatic Glottis segmentation is one of the preliminary steps in such analysis. In this work, it is divided into two subproblems namely, Glottis localization and Glottis segmentation. A two step convolutional neural network (CNN) approach is proposed for the automatic Glottis segmentation. Data augmentation is carried out using two techniques :  1) Blind rotation (WB), 2) Rotation with respect to Glottis orientation (WO). The dataset used in this study contains stroboscopic videos of 18 subjects with Sulcus vocalis, in which the Glottis region is annotated by three speech language pathologists (SLPs). The proposed two step CNN approach achieves an average localization accuracy of 90.08% and a mean dice score of 0.65.

  • automatic Glottis localization and segmentation in stroboscopic videos using deep neural network
    Conference of the International Speech Communication Association, 2018
    Co-Authors: K Rahul, Pebbili Gopikishore, Veeramani Priyadharshini, Prasanta Kumar Ghosh
    Abstract:

    Exact analysis of the glottal vibration patten is vital for assessing voice pathologies. One of the primary steps in this analysis is automatic Glottis segmentation, which, in turn, has two main parts, namely, Glottis localization and the Glottis segmentation. In this paper, we propose a deep neural network (DNN) based automatic Glottis localization and segmentation scheme. We pose the problem as a classification problem where colors of each pixel and its neighborhood is classified as belonging to inside or outside the Glottis region. We further process the classification result to get the biggest cluster, which is declared as the segmented Glottis. The proposed algorithm is evaluated on a dataset comprising of stroboscopic videos from 18 subjects where the Glottis region is marked by the three Speech Language Pathologists (SLPs). On average, the proposed DNN based segmentation scheme achieves a localization performance of 65.33% and segmentation DICE score of 0.74 (absolute), which is better than the baseline scheme by 22.66% and 0.09 respectively. We also find that the DICE score obtained by the DNN based segmentation scheme correlates well with the average DICE score computed between annotation provided by any two SLPs suggesting the robustness of the proposed Glottis segmentation scheme.

  • INTERSPEECH - Automatic Glottis Localization and Segmentation in Stroboscopic Videos Using Deep Neural Network.
    Interspeech 2018, 2018
    Co-Authors: Rahul K, Pebbili Gopikishore, Veeramani Priyadharshini, Prasanta Kumar Ghosh
    Abstract:

    Exact analysis of the glottal vibration patten is vital for assessing voice pathologies. One of the primary steps in this analysis is automatic Glottis segmentation, which, in turn, has two main parts, namely, Glottis localization and the Glottis segmentation. In this paper, we propose a deep neural network (DNN) based automatic Glottis localization and segmentation scheme. We pose the problem as a classification problem where colors of each pixel and its neighborhood is classified as belonging to inside or outside the Glottis region. We further process the classification result to get the biggest cluster, which is declared as the segmented Glottis. The proposed algorithm is evaluated on a dataset comprising of stroboscopic videos from 18 subjects where the Glottis region is marked by the three Speech Language Pathologists (SLPs). On average, the proposed DNN based segmentation scheme achieves a localization performance of 65.33% and segmentation DICE score of 0.74 (absolute), which is better than the baseline scheme by 22.66% and 0.09 respectively. We also find that the DICE score obtained by the DNN based segmentation scheme correlates well with the average DICE score computed between annotation provided by any two SLPs suggesting the robustness of the proposed Glottis segmentation scheme.

Mohammed Mohiuddin - One of the best experts on this subject based on the ideXlab platform.

  • prognostic factors for local control and survival in t1 squamous cell carcinoma of the Glottis
    International Journal of Radiation Oncology Biology Physics, 1993
    Co-Authors: Marc S Rudoltz, Alia Benammar, Mohammed Mohiuddin
    Abstract:

    Abstract Purpose: To evaluate the effect of host, tumor, and treatment-related variables on local control and survival in patients with T1N0M0 squamous cell carcinoma of the Glottis. Materials and Methods: Ninety-one patients with TINOMO squamous cell carcinoma of the glottic larynx were analyzed. Median follow-up was 9 years (range 2–25). Patients were treated with daily fractions of 180 cGy to 220 cGy to doses of 5925–7000 cGy (median 6400). The following factors were analyzed: age, sex, histologic grade, disease extent, beam energy, field size, total dose, dose per fraction, and elapsed treatment days. Results: The 5-year actuarial local control was 80%. On univariate analysis, only elapsed treatment days and dose per fraction were significant factors for local control. Local control was 100% if treatment was completed within 42 days, 91% for 43–46 days, 74% for 47–50 days, 65% for 51–54 days, and 50% for 55–66 days ( p = 0.0001). In patients treated at p = 0.006). On multivariate analysis, only elapsed treatment days was a significant factor for local control ( p = 0.0001). The 5-year actuarial survival for the whole group was 92%. Elapsed treatment days was the only variable affecting survival. Survival was 100% if treatment was delivered within 42 days, 96% for 43–46 days, 94% for 47–50 days, 91% for 51–54 days, and 67% for 55–66 days ( p = 0.02). The 5-year actuarial disease-specific survival was 95%, with treatment duration again being the only significant prognostic factor. Disease-specific survival was 97% for treatment completed within 39–54 days versus 80% for 55–66 days ( p = 0.02). Only three (3.3%) patients experienced moderate or severe complications. None of the evaluated parameters impacted significantly on complications. Conclusion: We conclude that elapsed days is the most prognostically significant factor for local control and survival in patients treated with radiotherapy for T1 squamous cell carcinoma of the Glottis. We recommend that these patients be treated with 210 cGy daily fractions to 6300 cGy.

Eun Jung Oh - One of the best experts on this subject based on the ideXlab platform.

  • the usefulness of endotracheal tube twisting in facilitating tube delivery to Glottis opening during glidescope intubation in infants randomized trial
    Scientific Reports, 2020
    Co-Authors: Eun Jung Oh, Young Hee Shin, Eunjin Kwon, Ji Seon Jeong
    Abstract:

    : Despite an excellent view of the Glottis, technical difficulties with endotracheal tube delivery remains in GlideScope intubation. We evaluated whether a spiral-shape twisted tube can facilitate placement of the tracheal tube tip at the center of Glottis opening compared to conventional tube for GlideScope intubation in infants. Eighty-six infants were randomly placed in either the conventional tube group (group C) or the twist tube group (group T). In group T, the shaft of the tube was manually twisted into a loose spiral shape. The primary outcome was the initial center location of the tube tip at the Glottis opening, and the secondary outcome was total tube handling time. The initial center location rate of the tube tip at the Glottis opening was significantly higher in group T than in group C (88% [38/43] vs. 47% [20/43], P < 0.001). In addition, total tube handling time (sec) was significantly shorter in group T than in group C (15.4 ± 4.7 vs. 18.2 ± 5.3, P = 0.012). In this study, the spiral shape twist tube successfully improved the rate of initial center location of the tube tip at Glottis opening and facilitated tube delivery in GlideScope intubation in infants.

  • The usefulness of endotracheal tube twisting in facilitating tube delivery to Glottis opening during GlideScope intubation in infants: randomized trial.
    Scientific Reports, 2020
    Co-Authors: Eun Jung Oh, Young Hee Shin, Eunjin Kwon, Ji Seon Jeong
    Abstract:

    : Despite an excellent view of the Glottis, technical difficulties with endotracheal tube delivery remains in GlideScope intubation. We evaluated whether a spiral-shape twisted tube can facilitate placement of the tracheal tube tip at the center of Glottis opening compared to conventional tube for GlideScope intubation in infants. Eighty-six infants were randomly placed in either the conventional tube group (group C) or the twist tube group (group T). In group T, the shaft of the tube was manually twisted into a loose spiral shape. The primary outcome was the initial center location of the tube tip at the Glottis opening, and the secondary outcome was total tube handling time. The initial center location rate of the tube tip at the Glottis opening was significantly higher in group T than in group C (88% [38/43] vs. 47% [20/43], P