Objective: To evaluate demographic and videolaryngoscopic features in a large series of juveniles with paradoxical vocal cord dysfunction (PVCD).Design: Case series data from videolaryngoscopic tapes retrospectively evaluated in a masked, controlled fashion, and demographic data collected via retrospective medical chart review.Setting: A tertiary care otolaryngology and speech pathology referral center.Patients: Twenty-two patients with PVCD aged 18 years and younger diagnosed as having PVCD at The Ohio State University Voice Institute, Columbus.Main Outcome Measures: Age, sex, social history, and medical history (demographic); epiglottic position, arytenoid and interarytenoid appearance, phase 0 stability, true vocal cord respiratory motion, degree of anteroposterior (AP) constriction, and false vocal cord adduction (videolaryngoscopic).Results: Of 22 patients, 18 were girls, and 12 had significant social stressors, particularly organized sports. Nineteen patients had posterior laryngeal changes commonly found in gastroesophageal reflux disease. Twelve patients demonstrated abnormal true vocal cord adduction during quiet respiration. Seven patients demonstrated supraglottic anteroposterior constriction and false vocal cord approximation during phonation. Conclusions:Juvenile PVCD is more common in girls and is associated with social stresses. Anatomic laryngeal changes typically associated with gastroesophageal reflux disease are extremely common in these patients. Juveniles with PVCD frequently demonstrate abnormal true vocal cord adduction during quiet respiration. We recommend that initial evaluation of juvenile patients for possible PVCD be conducted via transnasal fiberoptic laryngoscopy while the patient is asymptomatic, and that strong consideration be given to empiric pharmacological treatment of gastroesophageal reflux disease in juveniles diagnosed as having PVCD.

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An acoustical description of speech and voice produced by 10 female tracheoesophageal (TE) speakers is provided. In light of results from earlier descriptions based on male TE speakers, and based on t-test comparisons, the female speakers produced generally more perturbation in fundamental frequency. Potential factors affecting this increase were elapsed time since the laryngectomy and extent of the laryngectomy surgery. The data from this investigation, however, indicate that in oral reading the characteristics of TE speech, including F0, may be highly similar regardless of speaker gender.

identified 108 patients with tracheoesophageal puncture (TEP) for voice restoration. Fifty-one patients received radiation therapy in the management of the disease, 50 did not, and seven were unavailable for follow-up. The records were reviewed and X2 tests applied to identify possible effects of radiation therapy on the achievement of TE speech and on TEP-related complications. Results of a census indicate that, with the exception of radiotherapy, the two groups of patients were highly similar with respect to ultimate achievement of TE speech and to the frequency with which complications occurred, eg, stoma stenosis or leakage via TE fistula. These findings support the incorporation of TEP with the total laryngectomy procedure, even for patients for whom radiation therapy is indicated.

A retrospective census of 106 cases with tracheoesophageal puncture (TEP) compared success and complications in speech restoration between TEP coincidental with or subsequent to laryngectomy. The complications of those patients with primary TEP (68) were largely the effects of cancer and its treatment. When controlling for recurrent disease and patients still in speech therapy, approximately 90% of both groups achieved surgically restored speech. With this parity in TE speech success and occurrences of complications, puncture at the time of the laryngectomy appears to be an effective, expeditious procedure for vocal rehabilitation. HEAD & NECK SURGERY lO:S13O-S134,1988Tracho-esophageal (TE) puncture for voice restoration'22 after total laryngectomy has emerged as a relatively complication-free3 option for the vocal rehabilitation of laryngectomees. While the original procedures described the timing of the puncture as subsequent (secondary) to the laryngectomy, creation of TE fistula at the time of laryngeal amputation (primary puncture) has several advantages over delaying TE puncture:1. The patient is spared additional hospitalization. 2. The process of vocal rehabilitation is initiated immediately and in a manner perceptible to the patient. 3. The three main options for vocal rehabilitation (esophageal and TE speech, and speech with an artificial larynx) are not just potentially available, but are in fact available to the patient and the rehabilitation team.These advantages can be significant in successful patient management, but only if offsetting penalties are not incurred. In 1986, we added our findings4 to an emerging body of data5-8 supporting primary puncture as an effective, efficient approach t o alaryngeal voice rehabilitation. Based on a sample of 36 patients (21 primary and 15 secondary TEPs) we found complications no more common among those with primary TEP than among those with secondary TEP. There was a much higher mortality rate among the patients with primary TEP (5:l