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Purpose: Vocal fold epithelium is composed of layers of individual epithelial cells joined by junctional complexes constituting a unique interface with the external environment. This barrier provides structural stability to the vocal folds and protects underlying connective tissue from injury while being nearly continuously exposed to potentially hazardous insults, including environmental or systemic-based irritants such as pollutants and reflux, surgical procedures, and vibratory trauma. Small disruptions in the epithelial barrier may have a large impact on susceptibility to injury and overall vocal health. The purpose of this article is to provide a broad-based review of current knowledge of the vocal fold epithelial barrier. Method: A comprehensive review of the literature was conducted. Details of the structure of the vocal fold epithelial barrier are presented and evaluated in the context of function in injury and pathology. The importance of the epithelial-associated vocal fold mucus barrier is also introduced. Results/Conclusions: Information presented in this review is valuable for clinicians and researchers as it highlights the importance of this understudied portion of the vocal folds to overall vocal health and disease. Prevention and treatment of injury to the epithelial barrier is a significant area awaiting further investigation.

Clinical diagnosis of voice pathologies is performed by analyzing audio, color, shape, and vibration patterns of the laryngeal recordings which are taken with medical imaging devices such as video-laryngostroboscope, direct laryngoscopy, and high-speed videoendoscopes. This paper examines state-of-the-art methods and reveals open issues and problems of computing solutions for analysis and identification of laryngeal disorders. We propose a categorical representation of the most significant applications published so far in terms of their scopes, used methodologies, and achieved results. Laryngeal image/video analysis is discussed in four main categories: segmentation of vocal folds, classification of vocal fold disorders, vocal fold vibration analysis, and vocal fold image stitching. By this study, we reveal new opportunities and potentials of vision-based computerized solutions for evaluation, early diagnosis, and prevention of laryngeal disorders.

Unilateral vocal fold paralysis (UVFP) is a condition characterized by impaired vocal fold mobility, typically diagnosed using laryngeal videoendoscopy. While deep learning (DL) models using static images have been explored for UVFP detection, they often lack the ability to assess vocal fold dynamics. We developed an auto-diagnostic DL system for UVFP using both image-based and video-based models. Using laryngeal videoendoscopic data from 500 participants, the model was trained and validated on 2639 video clips. The image-based DL model achieved over 98% accuracy for UVFP detection, but demonstrated limited performance in predicting laterality and paralysis type. In contrast, the video-based model achieved comparable accuracy (about 99%) in detecting UVFP, and substantially higher accuracy in predicting laterality and paralysis type, outperforming the image-based model in overall diagnostic utility. These results demonstrate the advantages of incorporating temporal motion cues in video-based analysis and support the use of DL for comprehensive, multi-task assessment of UVFP. This automated approach demonstrates high diagnostic performance and may serve as a complementary tool to assist clinicians in the assessment of UVFP, particularly in enhancing workflow efficiency and supporting multi-dimensional interpretation of laryngeal motion.

Background Differentiation of fibroblasts into myofibroblasts is necessary for wound healing, but excessive myofibroblast presence and persistence can result in scarring. Treatment for scarring is limited largely due to a lack of comprehensive understanding of how fibroblasts and myofibroblasts differ at the transcript level. The purpose of this study was to characterize transcriptional profiles of injured fibroblasts relative to normal fibroblasts, utilizing fibroblasts from the vocal fold as a model. Results Utilizing bulk RNA sequencing technology, we identified differentially expressed genes between four cell lines of normal fibroblasts (cVFF), one line of scarred fibroblasts (sVFF), and four lines of fibroblasts treated with transforming growth factor-beta 1 (TGF-β1), representing an induced-scar phenotype (tVFF). Principal component analysis revealed clustering of normal fibroblasts separate from the clustering of fibroblasts treated with TGF-β1; scarred fibroblasts were more similar to normal fibroblasts than fibroblasts treated with TGF-β1. Enrichment analyses revealed pathways related to cell signaling, receptor-ligand activity, and regulation of cell functions in scarred fibroblasts, pathways related to cell adhesion in normal fibroblasts, and pathways related to ECM binding in fibroblasts treated with TGF-β1. Although transcriptomic profiles between scarred fibroblasts and fibroblasts treated with TGF-β1 were relatively dissimilar, the most highly co-expressed genes were enriched in pathways related to actin cytoskeleton binding, which supports the use of fibroblasts treated with TGF-β1 to represent a scarred cell phenotype. Conclusions Transcriptomics of normal fibroblasts differ from myofibroblasts, including from those retrieved from scar and those treated with TGF-β1. Despite large differences in transcriptomics between tVFF and sVFF, tVFF serve as a useful in vitro model of myofibroblasts and highlight key similarities to myofibroblasts extracted from scar pathology, as well as expected differences related to normal fibroblasts from healthy vocal folds.

Objective: This systematic review aims to determine whether the use of vapor electronic cigarettes causes organic dysphonia in adults.Materials and methods: The review follows the guidelines of the PRISMA statement and identifies databases such as PubMed, EBSCO, ScienceDirect, SpringerLink, and Scopus for document searches in order to address the research question.Results: The document search, conducted through identification, selection, elimination, and in-clusion phases, yielded 33 articles to address the research question. The review established that vapor electronic cigarettes have immeasurable detrimental effects on the voice at both structural and functional levels. The anatomical structures of the vocal apparatus are affected, leading to al-terations in voice functionality. These alterations are evident in changes to voice qualities such as timbre, tone, intensity, rhythm, and prosody. Additionally, the use of vapor electronic cigarettes triggers various symptoms, including pain, irritation, and inflammation.Conclusions: Both short-term and long-term use of electronic cigarettes significantly negatively affects the vocal health of young and older adults. This review emphasizes the detrimental influen-ce of vapor electronic cigarettes on voice-related aspects, including dysphonia and vocal fold dys-function.

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.

Objectives Augmentation laryngoplasty represents a therapeutic choice for patients who suffer from glottic insufficiency of different etiologies. There have been multiple injectables that have been proven effective. The present study examines the short‐term effects of vocal fold augmentation on phonation, swallowing, and breathing in individuals with glottic insufficiency. In addition, a decision plan is also proposed. Methods Data from medical records and operative notes were used to conduct a retrospective cohort study on patients with glottic insufficiency who underwent vocal fold augmentation from 2016 to 2023. Hyaluronic acid, calcium hydroxyapatite, and polydimethylsiloxane were the injectable materials that were used. An analysis was conducted on phonation, breathing, swallowing, and laryngoscopy findings both before and after vocal folds' augmentation. Results Seventy‐nine patients were included, which represents 97 injections. The median (IQR) preoperative Voice Handicap Index‐10 (VHI‐10) score improved from 21 (15–28) to 16 (9–25) postoperatively (p < 0.001). The GRBAS scale also significantly decreased (p < 0.001). The median (IQR) preoperative Dyspnea Index score improved from 6 (0–17) to 2 (0–10) postoperatively (p < 0.05). Laryngoscopic findings showed significant improvement in the bulk of the vocal folds. There was no significant change in swallowing. Conclusions In case of dysphonia secondary to glottic insufficiency, augmentation laryngoplasty using various injectable materials has proven to be an effective option across a range of different etiologies, as it results in significant improvements in voice quality. The choice of the injectable material depends upon the severity and the etiology of glottic insufficiency. Key points When deciding on the best injection material for augmentation laryngoplasty, the patient's age, overall health, and the cause and severity of their glottic insufficiency must be considered. Percutaneous vocal fold augmentation under local anesthesia shows better voice quality results compared to vocal fold augmentation under general anesthesia through suspension laryngoscopy.

Vocal fold leukoplakia (VFL) is a descriptive term for a white plaque in the true vocal folds (TVF). It is estimated at 10.2 cases per 100,000 males and 2.1 per 100,000 females. The most critical aspect of managing a VLF is achieving an accurate pathological diagnosis, since a white plaque in the TVF can have numerous differential diagnoses. Patients with VFL usually complain of hoarseness and vocal strain. The common cause of VFL is premalignant lesions with primary risk factors of tobacco and alcohol consumption. Inflammatory aggressors such as laryngopharyngeal reflux disease are proven to affect directly the incidence of VFL. Infectious agents such as human papilloma virus and Helicobacter pylori may also play a role in the development of VFL. Frequent differential diagnosis includes laryngeal candidiasis, prolonged ulcerative laryngitis, previous head and neck radiotherapy, and, more rarely, lichen planus. The clinical investigation for a VLF includes laryngeal exam through a rigid or a flexible laryngoscope; videochromoendoscopy is a useful tool. Biopsy is mandatory so a pathological diagnosis is made. The most accepted classification for VFL and premalignant lesions is the fifth edition of the World Health Organization, and it uses a two‐tiered system. The treatment for VFL and premalignant lesions can be done by cold knife surgery, KTP laser, or CO2 laser.

Objective To explore factors influencing voice outcome in patients with unilateral vocal fold paresis and paralysis (UVFP). Methods A total of 578 patients diagnosed with UVFP by laryngeal electromyography and follow‐up were included, including 286 males and 292 females, with an average age of (43.18 ± 14.65) years (13–80 years). According to follow‐up analysis, the patients were divided into a vocal improvement group (VIG) and a vocal nonimprovement group (VNG), and the differences in etiology, nerve injury type (recurrent laryngeal nerve [RLN] alone or with superior laryngeal nerve [SLN] injury) and degree (incomplete or complete RLN injury) between the two groups were compared. Results There were 232 patients in the VIG and 346 patients in the VNG. In the VIG, 121 patients (52.16%) had idiopathic vocal fold paresis or paralysis, with a significantly higher proportion than the VNG (41.62%, p = 0.013). Patients with tumor compression, radiotherapy, or congenital factors only presented in the VNG, and there was no significant difference in the proportion of patients with different injury sites between the two groups. There was no significant difference in proportions of RLN injury and RLN+SLN injury between the two groups (p = 0.98). In the VIG, 168 patients (72.41%) had complete RLN injury, which was lower than the VNG (79.77%, p = 0.04). The specific injury types in thyroarytenoid muscles (TA) showed no differences between the two groups. But in posterior cricoarytenoid muscles (PCA) of the VIG, the proportion of decreased recruitment pattern combined with synkinesis was significantly reduced (p < 0.01). Conclusions Idiopathic UVFP has a greater possibility of vocal improvement, while least possibilities were seen in those with tumor compression, radiotherapy, and congenital factors. Complete RLN injury is not conducive to vocal improvement, of which the PCA injury is more evident than TA muscle and PCA synkinesis may be a greater risk factor. Summary Patients with idiopathic UVFP is more likely to get vocal improvement compared to other causes. PCA injury with synkinesis may be a great risk factor for vocal improvement in patients with UVFP.

Ultrafast laser ablation may provide a treatment for vocal fold (VF) scarring. Optical properties of VFs must be known prior to clinical implementation to select appropriate laser surgery conditions. We present scattering lengths of epithelium ℓs  ,  ep, superficial lamina propria ℓs  ,  SLP, and ablation thresholds Fth of human and canine VF tissues. Our experimental approach involves an image-guided, laser-ablation-based method that allows for simultaneous determination of ℓs and Fth in these multilayered tissues. Studying eight canine samples, we found ℓs  ,  ep  =  75.3  ±  5.7  μm, ℓs  ,  SLP  =  26.1  ±  1.2  μm, Fth  ,  ep  =  1.58  ±  0.06  J  /  cm2, and Fth  ,  SLP  =  1.55  ±  0.17  J  /  cm2. Studying five human samples, we found ℓs  ,  ep  =  42.8  ±  3.3  μm and Fth  ,  ep  =  1.66  ±  0.10  J  /  cm2. We studied the effects of cumulative pulse overlap on ablation threshold and found no significant variations beyond 12 overlapping pulses. Interestingly, our studies about the effect of sample storage on the scattering properties of porcine VF show a 60% increase in ℓs  ,  ep for fresh porcine VF when compared to the same sample stored in isotonic solution. These results provide guidelines for clinical implementation by enabling selection of optimal laser surgery parameters for subsurface ablation of VF tissues.