Aims: Anterior cervical osteophytes (ACOs) are a common incidental radiological finding, though unilateral vocal cord palsy (UVCP) as a complication of ACOs is very rare. We conducted a scoping review of the existing literature in order to characterise the demographics, assessment findings, management strategies and follow-up outcomes of ACO-related UVCP. We also report one further case of ACO-related UVCP, a case which represents the first in the literature to utilise preoperative laryngeal electromyography (LEMG) and to describe the concurrent findings of ACOs and laryngopharyngeal reflux. Methodology: The PubMed and Embase electronic databases were searched to identify relevant English-language journal articles published since 2000. Studies reporting on ACOs associated with bilateral vocal cord palsy or with upper airway symptoms in the setting of mobile vocal cords were excluded. Results: Fourteen published cases of ACO-related UVCP were identified in the literature to date, in addition to the case presented herein. Elderly males aged >65 years were the typical demographic affected (12/15 cases). Patients presented predominantly with dysphonia (n=11), with or without upper airway and pharyngeal symptoms. Flexible nasendoscopic findings were reported in all cases; LEMG was used for intraoperative assessment in one previous case, and preoperatively in the current case only. Management involved surgical resection of osteophytes in the majority of cases (n=9). A limited but favourable body of evidence was identified for voice benefit post-osteophytectomy. Conclusion: ACOs should be considered within the differential diagnosis for UVCP. Improvement in voice outcomes is likely following osteophytectomy; preoperative LEMG has potential utility as a diagnostic tool and for prognostication. Further published clinical experience is necessary to better characterise aspects of assessment and management for ACO-related UVCP.

Aims: Vocal fold paralysis (VFP) significantly impacts voice production. Although 40% of unilateral cases (UVFP) may spontaneously recover, 60% lead to permanent disability. Current treatments, such as vocal fold injection or medialization laryngoplasty, may have limitations. Alternatively, neuromuscular electrical stimulation (NMES) shows promise for VFP treatment. This presentation synthesizes key findings from two studies investigating the efficacy of NMES in changing glottal configuration and improving UVFP. Methodology: Study 1 - Changes in laryngeal configuration and voice output in a normalphonic subject were measured using fibreoptic nasolaryngoscopy and high-speed video (HSV), acoustic analysis (fo, formant analysis, Sound Pressure Level (SPL), Cepstral Peak Prominence (CPPs), Relative Fundamental Frequency (RFF) and Low-High Spectral Ratio (LHSR)), and electroglottography (EGG). Data were collected before, during, and after stimulation. Study 2 - Two subjects, with distinct UVFP configurations (median vs paramedian positions), received five consecutive days of 12-minute NMES sessions targeting laryngeal adductor muscles. Data were collected as per Study 1, excluding the HSV. Results: Overall, the results revealed significant improvement in all vocal parameters, mainly for the subject with UVFP in the paramedian position. NMES induced activation of the cricothyroid muscles with no adverse effects. The findings indicated global changes in laryngeal configuration, transitioning from normal to hyperfunctional, characterized by increased RFF, SPL, EGG’s contact quotient, and stiffness. Study 1 showed that laryngeal changes were more pronounced for lower frequencies of NMES and became significant within less than three minutes of application. Conclusions: The results from this study support the efficacy of NMES as a tool for activating intrinsic laryngeal muscles, leading to significant adduction within a few minutes of application. Notably, lower NMES frequencies demonstrated superior muscle activation compared to higher frequencies. These findings support the use of NMES for treating UVFP, particularly in cases located in the paramedian position. Additionally, these findings have also informed a larger GPRWMF-supported project.

Introduction: Angiolytic lasers have provided increasing utility in vocal fold conditions for over 20 years. With evolution of technology, such lasers now include diode and solid state with varying wavelengths of 445nm and 532nm. Both blue light and green light lasers demonstrate effective management options on the vocal folds despite subtle differences. Is one a better choice than the other? Methodology: A retrospective chart review analyzed treatment outcomes of consecutive patients with similar conditions treated by a single surgeon with either the KTP 532nm laser or the 445nm Blue laser. Comparisons were made between the treatments and outcomes for each laser. Results: For 44 patients were identified with half each undergoing blue light or green light-assisted treatment for a range of vocal fold conditions: dysplasia, T1-2 glottic cancer, ectasias and varices, stenosis and papilloma. Similar numbers in each group were used. Operative time, ease of laser use, resolution of disease, number of operations, recurrence rate and patient satisfaction were compared. Treatment outcomes were not statistically different between the laser groups but some subtle differences were noted. The lasers themselves will be compared and contrasted. Conclusion: This study indicates that the newer 445nm blue light laser has similar efficacy for conditions treated previously with 532nm KTP laser. There are theoretical advantages of the blue light laser along with some minor technical advantages for ease of use.

There is no place in the human body that sees the degree of soft-tissue trauma as the true vocal folds. With vocal fold collisions occurring between 100 and 250/second in normal speech some patients, nodules develop. The cornerstone of such patient management is specifically-directed speech therapy. In a subgroup, there is inadequate response and the patient remains unable to meet their vocal demands. Surgery has been the salvage option until intra-lesional steroid injections evolved providing a less-invasive option with minimal recovery time. Methods: Consecutive patients presenting to a single surgeon from 2008 to 2022 with vocal fold nodules were included. All patients had pre-surgery speech therapy, did not subsequently meet their vocal demands and had lesions demonstrated on videostroboscopy. They proceeded to either surgical removal or more recently, intra-lesional steroid injections. Voice handicap index(VHI) and singing voice handicap index(SVHI) were recorded with basic aerodynamic/acoustic measurements. Minimum patient follow-up was one year. Results: 126 patients were included(118 female). Complete date was available on 101 patients with the majority comprising teachers and singers. The VHI was substantially elevated pre-surgery and lowered by both steroid injections or subepithelial resection.(final results pending). Videostroboscopy showed substantial improvement in surface pliability and glottal closure following either intervention with commensurate improvement in voice. Steroid injections resolved symptoms enough to avoid surgical removal in 22 patients. Conclusion: Phonomicrosurgery can benefit patients unable to meet their vocal demands despite speech therapy and with persisting vocal fold nodules. A newer approach however, of simple intra-lesional steroid injections provides a necessary less-invasive option. It can avoid formal surgery in some, restoring vocal fold pliability and glottal closure with minimal downtime and suitable long-term outcomes.