Otolaryngologic Clinics of North America

Advancements in Clinical Laryngology As with many medical specialties, Otolaryngology has been moving toward subspecialization. Through the hard work of interested innovators in both general otolaryngology and head and neck surgical specialties, Laryngology has developed into a highly specialized and scientific field. The last decade has seen a steep rise in specialists getting trained in voice health. Clinical and bench research on subjects of vocal tract physiology, voice production and pathology, and techniques for addressing these problems is being published in high-level journals.

Transgender Voice and Communication Voice is a complex marker for gender and pivotal to the gender reassignment process. The goal of the transgender patient is to achieve a voice and communication style that is congruent with their gender identity. Voice and speech therapy are fundamental for successful transition. Phonosurgery, to adjust pitch, can be an important adjunct to relieve the patient from active pitch elevation of voice to free them to focus on the other adjustments needed and learned through behavioral training with speech and voice therapy. The authors review current management options for transgender patients with difficulties in voice and communication style.

Reinke's Edema Reinke's edema (RE) is the polypoid degeneration of one or both vocal folds within Reinke's space. The viscoelastic properties of the mucosal folds are characteristically altered by the expansion of the subepithelial space. Most frequently, patients present with dysphonia, with women being more affected than men. The primary risk factor is tobacco use. Voice overuse and laryngopharyngeal reflux are also considered to be contributory. Although RE shares the same primary risk factor as malignancy, the risk of malignancy is low, and dysplasia is found only in 0% to 3% of cases. Treatment is focused on decrease of risk factors, such as implementation of smoking cessation, voice therapy, and reflux control. Surgical techniques aim to decrease redundant polypoid mucosa in order to improve voice and restore the glottic airway. Recurrence of RE is high.

Identification and Management of Chronic Laryngitis Chronic laryngitis is an inflammatory process of at least 3 weeks duration and affects phonation, breathing, and swallowing. This article describes the infectious, inflammatory, and autoimmune causes of chronic laryngitis. Symptoms of chronic laryngitis are nonspecific and may range from mild to airway compromise requiring emergent tracheostomy.

Hoarseness Guidelines Redux The Hoarseness Guideline Update provides an evidence-based approach to a patient who presents to the clinic with hoarseness. The guidelines cover management decisions in acute and chronic dysphonia for patients of all ages before and after laryngeal examination. The present review discusses the process used to develop these guidelines, including limitations of the process and each key action statement.

The Art of Caring for the Professional Singer Training in care of the voice for the general otolaryngologist has improved with the presence of more fellowship-trained laryngologists within academic training programs. However, preparation for caring for the professional singer goes beyond the basic understanding of voice evaluation, laryngeal imaging, and microlaryngeal surgery. The otolaryngologist must have a deeper understanding of the demands, vocabulary, psyche, and economics of the professional singer to provide optimal care. The ramification of recommendations made or procedures undertaken by the otolaryngologist can have serious consequences in a singer's career. This article introduces the otolaryngologist to the specifics of caring for professional singers.

Voice Therapy as Primary Treatment of Vocal Fold Pathology Voice therapy may offer a valuable and viable option for the treatment of vocal fold pathology. This article provides an overview of the history of voice therapy within the context of treatment of laryngeal disorders, types of voice therapy, efficacy and outcome data to support the use of voice therapy, and clinical considerations and caveats.

Sulcus Vocalis Sulcus vocalis, defined as a type of groove along the free edge of the vocal fold, disrupts the normal, pliable vocal fold cover, causing alterations in the intrinsic mucosal wave. The primary symptom is breathy, effortful dysphonia. Diagnosis may be challenging, and this classically has led to difficulties with identification and management. Treatment options, although often promising, have been notoriously unreliable. Current understanding, considerations for management, and future treatment options are explored.

Reflux and the Voice Dysphonia is often blamed on laryngopharyngeal reflux (LPR) in the face of a normal flexible laryngoscopic examination. LPR remains primarily (and unfortunately) a diagnosis of exclusion rather than inclusion in the face of vague throat complaints and laryngeal signs attributed to reflux. LPR remains misdiagnosed and overdiagnosed as the cause of many identical, vague throat symptoms and laryngeal complaints. Despite LPR being commonly implicated as the cause of a myriad of nonspecific pharyngeal symptoms, LPR as a physiologic process is common. Whether or not it is a contributor to a patient's symptoms, especially dysphonia, is the focus of this article.

Diagnosis and Treatment of Benign Pediatric Lesions Dysphonia is common in pediatrics and affects individuals from infancy through their teenage years. Pediatric dysphonia has a variable impact on children, ranging from no impact to a severe social barrier. Although most etiologies are benign, potentially life-threatening causes must be ruled out by direct examination of the larynx. The most common benign lesions of the larynx in pediatrics are vocal nodules, vocal fold polyps, cysts, granulomas, ectasias, sulcus vocalis, and vascular lesions, including hemangioma and postcricoid cushion. Treatment of benign vocal lesions should be tailored to the individual patient and the perceived impact.

Alexandros Sfakianakis
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alsfakia@gmail.com