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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.

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.

Objectives To stratify the severity of cricoarytenoid joint fixation (CAJF) by surgery and understand the role of it played in the bilateral vocal fold immobility (BVFI). The second objective emphasizes on the significance of the preoperative differential diagnosis from neurogenic immobility with medical history and endoscopic findings. Methods A retrospective review was conducted of 74 patients between 2005 and 2022. Careful medical history inquiry, and videolaryngoscopy are conducted to recruit the appropriate surgical candidates. All patients underwent arytenoid remobilization (AR) followed by vocal fold medialization with arytenoid adduction (AA) or lateralization with suture lateralization (SL). The severity of CAJF is graded during the operation or inferred based on the period from operation to recurrence. Result A total of 18 patients, aged between 18 and 76 years, were analyzed. Among them, 14 cases were classified as the adducted type with ventilation problems, with three presenting with dyspnea, and 11 requiring artificial airways. Additionally, four patients presented with the abducted type, characterized by aphonia. Meanwhile, two additional cases were considered for comparison but were not included in this cohort of 18 subjects due to incorrect diagnosis and inappropriate management. Using AR procedure, the AA procedure offered three aphonia subjects a voiced sound without airway impairment and the SL procedure decannulated 100% (11/11) of the artificial airways and improved the airway patency in 100% (3/3) of the non-tracheostomized subjects despite the severity of CAJF. The severity of joint ankylosis was distributed as follows: In the aphonia group, there were three subjects with grade I, one subject with grade II, and 0 subjects with grade III. In the ventilation group, there was one subject with grade I, seven subjects with grade II, and six subjects with grade III. In contrast, the two cases used for comparison experienced recurrent dyspnea and failed decannulation because the AR procedure was not performed. The follow-up period was averaged in 58 and 14 months at least. Conclusion From this experience, it is the accurate preoperative diagnosis instead of the severity of CAJF that determines the successful rate in airway patency and voiced phonation if the AR procedure is utilized. Careful medical history inquiry and videolaryngoscopic examination can correctly differentiate the mechanical from neurogenic origin without the help of EMG. Evidence of level : 4.

Background Physical forces, such as mechanical stress, are essential for tissue homeostasis and influence gene expression of cells. In particular, the fibroblast has demonstrated sensitivity to extracellular matrices with assumed adaptation upon various mechanical loads. The purpose of this study was to compare the vocal fold fibroblast genotype, known for its unique mechanically stressful tissue environment, with cellular counterparts at various other anatomic locales to identify differences in functional gene expression profiles. Results By using RNA-seq technology, we identified differentially expressed gene programs (DEseq2) among seven normal human fibroblast primary cell lines from healthy cadavers, which included: vocal fold, trachea, lung, abdomen, scalp, upper gingiva, and soft palate. Unsupervised gene expression analysis yielded 6216 genes differentially expressed across all anatomic sites. Hierarchical cluster analysis revealed grouping based on anatomic site origin rather than donor, suggesting global fibroblast phenotype heterogeneity. Sex and age-related effects were negligible. Functional enrichment analyses based on separate post-hoc 2-group comparisons revealed several functional themes within the vocal fold fibroblast related to transcription factors for signaling pathways regulating pluripotency of stem cells and extracellular matrix components such as cell signaling, migration, proliferation, and differentiation potential. Conclusions Human fibroblasts display a phenomenon of global topographic differentiation, which is maintained in isolation via in vitro assays. Epigenetic mechanical influences on vocal fold tissue may play a role in uniquely modelling and maintaining the local environmental cellular niche during homeostasis with vocal fold fibroblasts distinctly specialized related to their anatomic positional and developmental origins established during embryogenesis.

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.

Purpose We hypothesized that using a 3D-exoscope (3Dex) in microlaryngoscopic phonosurgery is non-inferior to using a standard operating microscope (OM). To compare the above, we utilized a 3Dex and an OM for microlaryngoscopic vocal fold augmentation with autologous fat in patients with glottic insufficiency and compared the procedure itself and the long-term impact of vocal fold augmentation on subjective and objective voice parameters in both groups. Methods 36 patients with glottic insufficiency received microlaryngoscopic laryngeal augmentation with autologous fat. A 3Dex was utilized in 24 cases for visualization and compared to twelve cases in which an OM was used. Voice parameters were evaluated over a period of twelve months. Results Comparison of operation time and voice parameters between the 3Dex and OM groups did not reveal significant differences. Significant improvement of mean voice quality in all parameters excluding roughness was observed at 3 and 6 months followed then by a slight decrease of voice quality parameters between the 6 and 12 months interval in both groups. Conclusion Our findings indicate no difference concerning operation time and outcome between the use of a 3Dex and an OM in phonosurgery. Our results highlight a significant voice improvement after vocal fold augmentation with autologous fat in glottic insufficiency mediated dysphonia. The smaller viewing system, better ergonomics for the primary surgeon and the assistant and a direct view for the entire surgical team make a 3Dex an interesting alternative for visualization in microlaryngoscopic phonosurgery.