Lipostructure is a valuable technique for voice rehabilitation in glottic incompetence.

Laryngeal hemiplegia (LH) is the most common disorder of laryngeal motility. It is deemed not to cause obstruction of the upper airway; in fact, the main symptoms are dysphonia and breathiness, and respiratory impairment is not commonly reported. The aim of this study was to objectively assess upper airway patency in 41 patients affected by LH (mean age, 54.4 +/- 15.2 years; 27 female) and 30 controls (mean age, 50.0 +/- 16.1 years; 19 female) by means of flow-volume loop spirometry and body plethysmography to measure specific airway resistance (sRaw) at increasing respiratory frequencies. The causes of LH were cervical surgery (28), tumor infiltration (5), and unexplained (8). None of the patients or controls was affected by lower airway disease. Spirometry showed that the patients had inspiratory flows (PIF, FIF50) significantly lower than those of the controls (p < .0001), whereas the expiratory flows (FEV1, FEF50) were normal, with the exception of peak expiratory flow (PEF), which was reduced, especially in female patients. The mean FEF50/FIF50 ratio (about unity in the normal subjects) was >1, as is typical of variable extrathoracic obstruction. Plethysmography showed that the values of sRaw of the LH group were not statistically different from those of the controls at 30 +/- 5 breaths per minute, but they progressively and significantly increased at 60 +/- 5 (p < .01) and 90 +/- 5 breaths per minute (p < .002), whereas no significant sRaw change was observed in the controls. These results show that LH causes obstruction of the upper airway that can be assessed and quantified by means of spirometry and body plethysmography. A dynamic narrowing due to inspiratory medialization of the paralytic vocal fold and flow turbulence during hyperventilation seem to be the causes of patency impairment. The flow-volume loop is an excellent, inexpensive, and easily available means of functionally evaluating upper airway obstruction, but some patients have difficulty in performing an inspiratory test that requires maximal effort, and the flow reduction during forced ventilation may be partially due to the effort dependency of the tests themselves. Plethysmographic assessment of airway resistance may be a valid alternative or complement, as it reveals an increase in sRaw at increasing respiratory frequencies.

Objectives: Paradoxical vocal fold motion (PVFM) is a condition that exhibits inappropriate adduction of the vocal cords during inspiration, with females comprising the majority of the patients. As awareness has increased, more patients are being referred for evaluation. No study to date has reported additional laryngeal pathologies found concurrent to PVFM.Methods: A retrospective chart review of patients referred for evaluation of "paradoxical vocal fold motion" between July 2002 and December 2002 was performed. Questionnaires were completed by the patients at the time of the office visit. Data collected from the medical record included age, sex, duration of symptoms prior to evaluation, asthma, gastroesophageal reflux symptoms, and laryngoscopic findings. Exercise stress testing was performed when suitable. The diagnosis of PVFM was made based on history and laryngoscopy.Results: 32 patients were identified. There was a 29:3 (90.6%) female predominance. Mean age of presentation was at 28 years (12-67 years). The median time from the onset of respiratory symptoms to diagnosis was 4.5 years (range, 0.5 to 30 years). 17/32 (53%) had asthma. 12/32 had laryngeal findings suggestive of GERD. 4/32 (12%) had laryngoscopic findings of chronic laryngitis. 10/32 (31%) had additional findings including laryngomalacia, vocal fold motion impairment, sulcus vocalis, nodules, subglottic stenosis, and Reinke's edema.Conclusions: PVFM is still under-recognized, as demonstrated by a median duration of symptoms prior to diagnosis of 4.5 years. Additional laryngeal pathologies may be seen in 1/3 of patients. As in previously published studies, there was a female predominance and relative prevalence of asthma.