Postintubation Phonatory Insufficiency: A Challenging Diagnosis

Ramos, Phoebe Helena; Lagos, Antonia; Napolitano, Carla; Badia, Priscila

doi:10.1016/j.jvoice.2020.07.011

Cited by 5 publications

(14 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…3 As such, PGI is believed to be underdiagnosed. 1,2 Clinicians should therefore be primed to inspect the posterior commissure in patients presenting with persistent vocal limitation and a history of prolonged intubation.…”

Section: Discussionmentioning

confidence: 99%

“…Voice therapy and reconditioning may be appropriate for some patients. 2 In others, sufficient closure of the defect will be required to address the air leak during phonation. While injection augmentation laryngoplasty has been well established for various glottic pathologies, its use in treatment of PGI offers disappointing results.…”

Section: Discussionmentioning

confidence: 99%

“…Because the arytenoids can obscure the posterior glottis during in office laryngoscopy, diagnosis may be elusive and the treatment is often challenging. 2 The tight adherence of the mucosa on the arytenoid often precludes injection augmentation. In addition, laryngeal framework surgery often fails to correct the posterior glottic defect.…”

Section: Introductionmentioning

confidence: 99%

“…Clinically, patients with PGI present with a breathy voice, decreased maximum phonation time, and psychosocial stressors related to vocal handicap. Because the arytenoids can obscure the posterior glottis during in office laryngoscopy, diagnosis may be elusive and the treatment is often challenging 2 . The tight adherence of the mucosa on the arytenoid often precludes injection augmentation.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, laryngeal framework surgery often fails to correct the posterior glottic defect. Other described surgeries include autologous mucosal grafts, large aryepiglottic fold rotational flaps, or posterior cricoid reduction laryngoplasty 2 . However, these approaches may diminish airway caliber and may require intubation or tracheostomy during the recovery period.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Endoscopic Posterior Rotation Flap for Posterior Glottic Insufficiency

et al. 2022

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Endoscopic Posterior Rotation Flap for Posterior Glottic Insufficiency

et al. 2022

View full text Add to dashboard Cite

Scoping Review of Surgical Rehabilitation of Post Intubation Phonatory Insufficiency

Ferraro,

Blunck,

Benninger

et al. 2023

The Laryngoscope

View full text Add to dashboard Cite

ObjectivesPost intubation phonatory insufficiency (PIPI) or posterior glottic diastasis describes posterior glottic insufficiency (PGI) caused by prolonged intubation causing medial arytenoid ulceration, mucosal scarring, and incomplete cricoarytenoid joint adduction. The purpose of this review is to showcase diagnostic findings, surgical rehabilitation, and gaps in our treatment algorithm of PIPI.Data SourcesEmbase, PubMed, Scopus, Web of Science.Review MethodsTwo independent reviewers completed a systematic search of the literature studying PIPI. Reported intubation history, laryngeal defect, clinical symptoms, surgical intervention, and outcomes were gathered from included studies.ResultsNine studies met our inclusion criteria for full review, (45 patients) all of which were case reports/series. All patients had posterior glottic defects, most commonly loss of medial arytenoid tissue, causing varying degrees of PGI. Eleven patients had vocal fold (VF) immobility or hypomobility. Treatment interventions were observation (1), speech therapy (2), VF or posterior glottic injection augmentation (15), medialization laryngoplasty (4), arytenoid repositioning (6), endoscopic (19) or open (3) posterior cricoid reduction, local mucosal rotation flap (11), or free mucosal graft (2) to fill the glottic defect. Observation, voice therapy, and augmentation or type 1 laryngoplasty failed to improve symptoms. Other surgical techniques improved symptoms with varying outcomes.ConclusionPIPI is a difficult injury to diagnosis and treat. Conservative measures and augmentation/laryngoplasty often fail to fix the PGI. Our review supports symptom improvement with reconstruction of the posterior glottic defect with cricoid reduction or mucosal grafts. Future investigation is needed to better define the diagnosis and successful treatment algorithm. Laryngoscope, 2023

show abstract

Endoscopic Mucosal Rotational Flap for Posterior Glottic Insufficiency: A Case Report

Pagel,

Jonas,

Daniero

et al. 2024

The Laryngoscope

View full text Add to dashboard Cite

The report describes the novel use of an endoscopic CO2 LASER assisted posterior glottic rotation flap in a professional voice user with non‐intubation related posterior glottic insufficiency. The 78‐year‐old patient presented with progressive dysphonia and dyspnea with speaking with stroboscopy findings of posterior glottic insufficiency.After several empiric voice treatments without improvement, the described surgery was performed to correct posterior glottic insufficiency. After surgery, VHI‐10 improved from 25 to 9, overall CAPE‐V from 69 to 6.5. The patient resumed public speaking and lecturing with maintained improvement in vocal quality and function at last follow‐up six months postoperatively. Laryngoscope, 2024

show abstract

Postintubation Phonatory Insufficiency: A Challenging Diagnosis

Cited by 5 publications

References 14 publications

Endoscopic Posterior Rotation Flap for Posterior Glottic Insufficiency

Endoscopic Posterior Rotation Flap for Posterior Glottic Insufficiency

Scoping Review of Surgical Rehabilitation of Post Intubation Phonatory Insufficiency

Endoscopic Mucosal Rotational Flap for Posterior Glottic Insufficiency: A Case Report

Contact Info

Product

Resources

About