PubMed Health⌕ Search

Biomedical subjects

Ming-Wang Hsiung

Publications and source records attributed to Ming-Wang Hsiung.

17 recordsLinked to original sources
PubMed2006

Autogenous fat injection for glottic insufficiency: analysis of 101 cases and correlation with patients' self-assessment.

CONCLUSIONS: Our data confirm that fat injection (FI) is a safe, useful, thorough and experience-dependent procedure. It should be considered as a potential treatment protocol for patients with vocal fold atrophy (VFA) and sulcus vergeture (SVER). To increase the chances of excellent phonatory results for sulcus vocalis (SV) patients, our recommended surgical option is FI with fascia transplantation. OBJECTIVE: To investigate prognostic factors in patients with glottic insufficiency following FI. MATERIAL AND METHODS: The study sample comprised 101 patients treated for VFA (n=31), SVER (n=41) and SV (n=29). A retrospective analysis was performed by means of patient self-assessments, employing multiple logistic regressions for the four independent factors of age, gender, diagnosis and time-frame of surgery. RESULTS: The mean follow-up time was 16.8 months (range 5-38 months). Immediate complications included hematoma of the donor site in two patients and fat extrusion at the injection site in three. The results of treatment were "excellent" in 48.4% (15/31) of VFA cases, 43.9% (18/41) of SVER cases and 20.7% (6/29) of SV cases, with 19.4% (6/31), 24.4% (10/41) and 55.2% (16/29), respectively reporting improvement and 32.3% (10/31), 31.7% (13/41) and 24.1% (7/29), respectively reporting no improvement. Disease type was determined to have a significant bearing (p=0.025) on treatment effectiveness and patients operated on most recently were shown to have a 4.3-times greater chance of achieving successful results (p<0.01). Multiple logistic regression analysis indicated that VFA and SVER sufferers (as compared to those with SV) and men (as opposed to women) were more likely to achieve an "excellent" result: 3.4, 3.3 and 3.6 times, respectively.

Adult↗
PubMed2004

Lateral thyrotomy with strap muscle transposition for Teflon granuloma.

Lateral thyrotomy and strap muscle transposition have been used independently before. However, the published literature does not record the coordinated use of both procedures in the treatment of Teflon granuloma. In this paper, we present a case of vocal fold paralysis that had been treated successfully by Teflon injection in 1999. Two years later, however, the patient developed a host of symptoms that included a husky voice, shortness of breath and suffocation, which indicated Teflon granuloma. He underwent surgery to excise the Teflon granuloma via a lateral thyrotomy. The affected paraglottic space was then reconstructed using strap muscle transposition. One year postoperatively, the glottis had closed completely on phonation, and the voice retained a moderate roughness due to a scarring change from the earlier Teflon reaction. The patient had no problems with aspiration or shortness of breath during speaking. Our experience indicates that a physician can remove the entire granuloma and create a smooth, straight vibratory surface with complete glottic closure during phonation by using a combination of lateral thyrotomy and strap muscle transposition.

Aged↗
PubMed2004

Possible involvement of nitric oxide and peroxynitrite in the pathogenesis of human vocal polyps and nodules.

Nitric oxide (NO) is a molecule involved in multiple functions including vasodilatation, neural transmission, immune response and inflammation. However, the role of NO in the pathophysiology of vocal cord diseases is not clear. The present study investigated the possible involvement of NO and its toxic metabolite, peroxynitrite, in the pathogenesis of vocal polyps and nodules. Vocal polyps and nodules were obtained from patients receiving surgery for their conditions. Immunohistochemistry was applied to evaluate the expression of the inducible form of nitric oxide synthase (iNOS) as well as the production of peroxynitrite represented by the formation of its biological footprint, 3-nitrotyrosine (3-NT). Each section was given a score of 0 to 4 according to the labeling intensity seen, with the highest number representing the highest labeling intensity. The results showed that vocal polyp had an average iNOS labeling score of 3.2, which was significantly higher than the value of 1.9 in vocal nodules. The average labeling score of 3-NT was 2.8 in vocal polyps, which was also significantly higher than the value of 1.8 in vocal nodules. There was also a positive correlation between the level of iNOS expression and the extent of 3-NT formation. These results suggest that increased peroxynitrite production, resulting from increased iNOS expression and NO formation, may have an important pathogenic role in these vocal diseases.

Adult↗
PubMed2004

Videolaryngostroboscopic observation of mucus layer during vocal cord vibration in patients with vocal nodules before and after surgery.

OBJECTIVE: Under normal conditions, the vocal fold mucus layer is too thin to permit observation using videolaryngostroboscopy (VLS) during phonation. However, vocal nodules (VNs) typically cause congealed and sticky mucus to appear on the vocal fold. Reports in the literature regarding this phenomenon are limited. The aim of this study was to review VLS recordings of VN patients, analyzing changes that occurred in the mucus layer that covers the vocal fold during vibration following VN surgery. MATERIAL AND METHODS: Using VLS, we studied the occurrence of, and changes in, vocal fold mucus layers in 160 VN patients before and after surgery. RESULTS: Eighty-eight patients (55%) were found to have a mucus layer during preoperative examinations. Of these mucus layers, 21 (13%) were located on the anterior commissure or anterior third of the vocal fold (A), 58 (36.3%) on the junction of the anterior and middle thirds (M), 1 (0.6%) on the posterior third (P), 5 (3.1%) on both A and M and 3 (1.9%) on both M and P. Fifty-six (35%) cases were found to have a mucus layer during postoperative examinations. Of these, 44 (27.5%) were located on A, 8 (5%) on M, 1 (0.6%) on P and 3 (1.9%) on both A and M. These results indicate that changes in the mechanical force on the vocal fold, alteration of the laryngeal secretory gland and improper aerodynamic airflow result in increased mucus viscosity and aggregation in VN patients and that the combination of these factors further increases the severity of dysphonia. CONCLUSIONS: Surgery to remove vocal nodes may be an effective method to eliminate both vocal bumps and aggregated mucus. Based on the present results, it is recommended that future research should compare surgery to remove VN against other mucus layer reduction methods in order to determine which is the most effective.

Adult↗
PubMed2004

Clinical predictors of difficult laryngeal exposure.

PURPOSE: Although difficult laryngeal exposure (DLE) is a common problem encountered after procedures using a rigid laryngoscope, to date, no anticipatory physical indicators have been formally noted as reliable predictors of DLE. The purpose of this paper is to identify useful and reliable indicators by which to predict, with acceptable accuracy, the occurrence of DLE following rigid laryngoscopy. STUDY DESIGN: Fifty-six patients, each of whom had undergone a rigid laryngoscope procedure, were classified as belonging to either the DLE group (n = 19) or the control group (n = 37) for purposes of this prospective study. METHODS: All patients were given a physical examination, which encompassed the following nine measures: age, sex, modified Mallampati index (MMI), body mass index (BMI), hyoid-mental distance (HMD), thyroid-mental distance (TMD), thyroid-mandible angle (TMA), horizontal thyroid distance (HTD), and vertical thyroid distance (VTD). Stepwise regression was employed on patient data to identify those with DLE. RESULTS The ages of patients in the DLE group ranged from 35 to 79 years, with a mean of 51.3 years. Among the nine variables, we found sex (P =.045, odds ratio = 69.159) and TMA (P =.004, odds ratio = 1.510) to be "reliable" DLE predictors. Using these two variables, 94.6% of study case patients could have been correctly classified preoperatively. Based on our comparison of case results, we found that a TMA value greater than 120 degrees in men and 130 degrees in women indicates a strong likelihood of DLE. CONCLUSIONS TMA is a sensitive, reliable, and useful predictor of DLE in both men and women. The combination of sex and TMA provide important initial clinical indicators that can alert a clinician regarding DLE probability.

Adult↗
PubMed2004

The characteristic features of muscle tension dysphonia before and after surgery in benign lesions of the vocal fold.

Muscular tension dysphonia (MTD) is often concomitant in patients with underlying glottic insufficiency. It remains unclear, however, whether the characteristic features of MTD appear independently or as a consequence of dysphonia. We report here on a retrospective study of the prevalence of the four prominent characteristic features of MTD, as described by the Morrison-Rammage classification, in patients with benign lesions of the vocal fold. Two otorhinolaryngologists, independent of one another, rated the preoperative and postoperative videolaryngostroboscopic results of 260 patients to assess the presence or absence of MTD. Of the 260, 185 had vocal nodules, 49 had vocal polyp, and 26 had vocal cyst. Postoperative follow-up examinations were conducted for a period ranging from 4.5 to 35 months (mean = 18.5 months). Patient ages ranged from 18 to 76 years (mean = 47.3 years). Nearly 90% of the preoperative patients in our study cohort exhibited at least one of the MTD characteristic features. Approximately 74% of postoperative 'asymptomatic' patients in our study cohort exhibited at least one characteristic feature. As the characteristic features of MTD were found in both preoperative dysphonic patients and those patients who were successfully treated, MTD etiology may be causal (type I), concomitant (type IIa, IIb, III) or psychogenic (type IIa, IIb). Therefore characteristic features of MTD cannot be adequately resolved through surgery, and treatment should be supplemented by speech therapy to achieve the greatest effect in causal type I MTD.

Adolescent↗
PubMed2004

Combination of fascia transplantation and fat injection into the vocal fold for sulcus vocalis: long-term results.

Fat injection and fascia transplantation alone have been used to treat patients with sulcus vocalis. No information is available on the effectiveness of these two procedures used in concert to treat sulcus vocalis. The objectives of this study were to conduct the two procedures together and report the long-term results. This article assesses, retrospectively, the effectiveness of the combination treatment of fascia transplantation and fat injection (FTFI) in patients with sulcus vocalis (n = 22). Perceptual acoustic, phonatory function, and videolaryngostroboscopic data were evaluated before and after FTFI treatment in 18 patients. The mean follow-up time was 16.6 months. Sixteen patients had excellent results, 3 reported improvement, and 3 indicated no change. Phonatory function improved significantly in terms of phonation time, grade, roughness (p < .05), and breathiness (p < .001). The videolaryngostroboscopic rating showed significant improvement in vocal fold vibration amplitude and excursion of the mucosal wave (p < .05). Type 3 sulcus responded better to this treatment than did type 2 (sulcus vergeture). No postoperative complications were noted. The FTFI technique consists of an autogenous implant and delivers positive results. It may be considered as an option for patients with sulcus vocalis. It has been demonstrated to achieve excellent results in a majority of patients and to deliver a better prognosis than fat injection alone. Although resorption of fat and fascia is associated with FTFI, the FTFI procedure may be repeated multiple times.

Adipose Tissue↗
PubMed2003

Autogenous fat injection for vocal fold atrophy.

Autogenous fat augmentation for glottic insufficiency has been used previously in patient treatment regimes. However, relatively little information is currently available regarding the effectiveness of fat injection for patients with vocal fold atrophy who have complete glottal closure (VFACGC). This paper compares, in retrospect, the efficiency of fat injection after surgery in patients with VFACGC (n=21). The perceptual acoustic and phonatory functions and videolaryngostroboscopic data were evaluated before and after fat augmentation was performed on 13 patients. Mean follow-up time was 9.5 months. Fifteen patients displayed excellent results, four experienced post-procedure failure, and two were unavailable for follow-up analysis. The majority of VFACGC patients (71%) also suffered from muscular tension dysphonia (MTD) preoperatively. The procedure also resolved the MTD in half (54%) of the patients in this study. Perceptual rating showed significant improvement in grade, roughness and breathiness (P<0.05). The videolaryngostroboscopic rating showed significant improvements in vocal fold edge linearity (P<0.01), vocal fold vibration amplitude and mucosal wave excursion (P<0.05). VFACGC is commonly misdiagnosed as MTD and is, therefore, unresponsive to speech therapy that is targeted to the latter. Fat injection is an effective autogenous implant and should be considered as an option in the treatment of patients with VFACGC. Although fat re-absorption was identified as a problem, repeating the procedure could be considered to minimize the effect of such.

Adipose Tissue↗
PubMed2003

Ischemic optic neuropathy after endoscopic sinus surgery: a case report.

For the past 2 decades, endoscopic sinus surgery (ESS) has proven effective for treating paranasal sinus disease. Orbital complications of varying degrees, from mild orbital hematoma to catastrophic blindness, have been widely reported. However, defects of the visual field resulting from post-ESS ischemic optic neuropathy (ION) has not to our knowledge been reported in the literature. We were presented with a 51-year-old male patient suffering from loss of sight following an otherwise uneventful ESS. ION is a rare condition, characterized by acute or subacute postoperative loss of sight. The major risks for developing ION include intraoperative anemia, hypotension and systemic illnesses such as hypertension, diabetes or renal failure. Otorhinolaryngologists should be aware that this condition may occur following an uncomplicated ESS procedure, and patients should be given prompt opthalmological consultation when loss of sight is diagnosed postoperatively. Early aggressive and rapid correction of blood pressure and blood transfusions may be helpful in the treatment of patients who develop ION after surgery.

Blindness↗
PubMed2003

Clearing microvascular lesions of the true vocal fold with the KTP/532 laser.

Although used for treating vascular malformations, KTP (532 nm) lasers have not been used to treat microvascular lesions of the vocal fold. The efficiency of KTP laser operation in the continuous mode with a 0.4- or 0.6-mm beam (1- to 2-W aim for 3 to 7 seconds delivering a total energy of 3 to 7 J) was studied retrospectively in patients with microvascular lesions of the vocal fold (n = 14). The perceptual acoustic, phonatory function, and videolaryngostroboscopic data were evaluated before and after operation in 10 patients. At follow-up (mean, 7 months), the results were excellent in all patients. Their phonatory function (jitter, shimmer, grade, breathiness, and roughness) significantly improved (p < .01). The videolaryngostroboscopic rating showed significant improvement in the amplitude of vocal fold vibration and excursion of the mucosal wave (p < .05). No postoperative recurrence or complications were noted. The KTP laser operation is a useful, cost-effective, and time-saving procedure and can be considered as an option in management of patients with microvascular lesions of the vocal fold, particularly those with repeated hemorrhages. Because the operation is easy (compared to other surgical methods) and has no major side effects, the prospect of total patient recovery is excellent.

Adult↗
PubMed2003

Measurement and validation of the voice handicap index in voice-disordered patients in Taiwan.

Voice disorders can cause problems for patients emotionally, physically, economically and functionally. Neither subjective nor objective voice examinations are able to evaluate such factors adequately. For this study, a retrospective analysis of 79 dysphonic cases was conducted using the voice handicap index (VHI) to gather comprehensive data across a variety of voice disorders. Of the 79 cases, 41 involved glottic insufficiency, 26 involved vocal polyps or mass, and 12 involved functional voice disorders. Cases were assessed with the VHI using physical (P), functional (F), emotional (E) parameters and a total (T) of the three. P, F, E and T variables were entered into a statistical programme and analysed using one-way analysis of variance (ANOVA). Mean +/-SE values for P, F, E and T, respectively, in glottic insufficiency cases were 31.61 +/- 1.10, 26.49 +/- 1.43, 26.06 +/- 1.54, and 84.20 +/- 4.21. Mean +/-SE values for P, F, E and T, respectively, in vocal mass cases were 30.69 +/- 1.73, 25.23 +/- 1.90, 23.96 +/- 1.82, and 79.88 +/- 5.08. The mean +/-SE values of P, F, E and T, respectively, in functional voice disorders were 20.92 +/- 2.06, 18.33 +/- 1.82, 16.83 +/- 1.86, and 56.08 +/- 5.23. We found the mean glottic insufficiency was significantly greater than functional voice disorders for each measure. There were significant differences between vocal mass and functional voice disorders means for P and T. Glottic insufficiency and vocal mass means were not significantly different for any measure. Problems in the physical realm were identified as the most severe amongst all patients. Glottic insufficiency patients were found to suffer the most in every VHI value. Although VHI is a relatively new method by which to measure discomfort in voice-disordered patients, it provides a mechanism for patients to define their discomfort and for therapists to better target recovery programmes to patient's needs.

Adolescent↗
PubMed2002

Endoscopic buccal mucosal grafting to the anterior glottic web: a case report.

Anterior glottic web (AGW) is a challenge for otolaryngologists to treat because of the wide range of symptoms and the involvement of the patient's airway. We were presented with an 18-year-old male patient suffering from exertional dyspnea and moderate dysphonia. Two attempts at microlarnygeal surgery, using a CO(2) laser to try to lysis the AGW, failed to achieve satisfactory results. Further examination indicated AGW, with compromised bilateral vocal fold movement and voice generation capabilities. A two-stage endoscopic buccal mucosal grafting (EBMG) was recommended to accomplish anterior commissure reconstruction to treat the epithelial loss resulting from AGW. In our postoperative assessment, the patient's symptoms had improved dramatically, with clear, smooth voice production without dyspnea. Therefore, EBMG is believed to be a technically viable and feasible approach to treating AGW and is also recommended as an effective alternative to treatments such as laryngofissure and tracheostomy.

Accidents, Traffic↗
PubMed2002

Fat augmentation following microsurgical removal of the vocal nodules.

OBJECTIVES: Autogenous fat augmentation has been used as a treatment for glottic insufficiency. However, no information is available on the effectiveness of fat injection in patients with vocal nodules or recurrent vocal nodules after surgery. STUDY DESIGN: The retrospective study reviews the efficiency of fat injection after surgery in patients with vocal nodules (n = 18) and recurrent vocal nodules (n = 5). METHODS: The perceptual acoustic, phonatory function, and video laryngostroboscopic data were evaluated before and after surgery in 23 patients. RESULTS: Mean follow-up time was 7.5 months. Nineteen patients had excellent results. Two patients had improvement, and no change was observed in two patients. Phonatory function showed significant improvement in shimmer, harmonic-to-noiseratio (P <.05), maximum phonation time, grade, roughness, and breathiness (P <.001). Video laryngostroboscopic rating showed significant improvement in linearity of the vocal fold edge, amplitude of vocal fold vibration, and excursion of the mucosal wave (P <.001). Less improvement was observed in recurrent vocal nodules than in nonrecurrent vocal nodules. CONCLUSIONS: Fat injection is an effective autogenous implant and may be considered as an option in management of patients with vocal nodules after surgery. Recurrence of nodules is a problem, but the procedure may be repeated.

Adipose Tissue↗
PubMedDate not supplied

Results of magnetic resonance imaging assessment, acoustic analysis, phonatory function and perceptual rating of glottic insufficiency before and after fat augmentation: correlated with subjective rating.

Autogenous fat augmentation has been proven effective in the treatment of glottic insufficiency (GI) using both subjective and objective methods of evaluation. However, no information is available in published research regarding the effectiveness and predictability of value parameters with regard to patients' perceptions and concerns. This article retrospectively examines the correlation between subjective and objective examinations and subjective ratings (SRs) in patients with presbylaryngis (n = 14) and sulcus vocalis (n = 2). Acoustic analysis, phonatory function, magnetic resonance imaging (MRI) assessment, and perceptual rating data were evaluated against SRs using pre- and postoperative test results in 16 patients. The mean time over which subjective and objective examinations were performed was 10 months. Twelve patients reported excellent results, while no change was observed in 4 patients. When compared against SR, the kappa value of jitter, shimmer, harmonic to noise ratio, phonation time, grade, roughness, breathiness, and MRI were 0.25, 0, -0.08, -0.11, -0.11, 0.18, 0, and 1, respectively. The agreement between the MRI and SR values was complete, and was the only relationship shown to be significant (p < 0.001). MRI assessment is an effective and reliable examination tool which can be considered for use in assessing the progress of the post-fat injection operation in GI patients during follow-up examinations. Furthermore, due to the excellent agreement between MRI assessment and the patients' subjective feelings, the SR value may serve as a good index of fat survival.

Acoustics↗
PubMedDate not supplied

Fat augmentation following microsurgical removal of the vocal nodules: long-term results.

While the effectiveness of autogenous fat augmentation after microsurgical removal (FAMSR) of the vocal nodules (VN) has been previously shown in patient treatment programs, relatively little information is available regarding the long-term effectiveness of such a procedure. This paper examines, in retrospect, the long-term effectiveness of FAMSR in patients with VN (n = 41) using pre- and post-FAMSR perceptual acoustic and phonatory function data and videolaryngostroboscopic findings for 33 patients. The mean follow-up time was 18 months. Thirty-three (80.4%) patients displayed excellent results; 4 (9.8%) experienced improvement, and 4 (9.8%) postprocedure failure. Patient phonatory functions showed significant improvements in shimmer, harmonic-to-noise ratio, phonation time (p < 0.05), grade, roughness and breathiness (p < 0.001). The videolaryngostroboscopic rating showed significant improvements in vocal fold edge linearity, vocal fold vibration amplitude, and mucosal wave excursion (p < 0.001). Improvements observed through long-term follow-up tended to be less dramatic in patients with recurrent VN than those with nonrecurrent VN. FAMSR is an easy, safe, and fast procedure which should be considered as an option in treating VN patients who either require surgery or do not have the time or perseverance to complete a lengthy program of speech therapy.

Adipose Tissue↗
PubMedDate not supplied

Fat augmentation for nonparalytic glottic insufficiency.

While autogenous fat augmentation for glottic insufficiency has been used before, relatively little information is currently available on the effectiveness of fat injection in patients with nonparalytic glottic insufficiency resulting from problems such as various defects of vocal atrophy or sulcus vocalis. This paper compares retrospectively the efficiency of fat injection after surgery in patients with vocal atrophy (n = 16) and sulcus vocalis (n = 8). The perceptual acoustic and phonatory functions and videolaryngostroboscopic data were evaluated before and after fat augmentation in 24 patients. The mean follow-up time was 19.5 months. Fifteen patients displayed excellent results; 1 showed some improvement; 6 experienced postprocedure failure, and 2 were not available for follow-up analysis. Perceptual rating showed significant improvement in grade, roughness and breathiness (p < 0.05). The videolaryngostroboscopic rating showed significant improvements in vocal fold edge linearity, vocal fold vibration amplitude and mucosal wave excursion (p < 0.05). More improvement in vocal atrophy was observed compared with sulcus vocalis following fat injection procedures. Our research showed that middle defects improved more compared to those in the anterior and posterior area. Fat injection is an effective autogenous implant and may be considered as an option in the treatment of patients with vocal atrophy or sulcus vocalis. Although fat reabsorption was a problem, repeating the procedure could be considered.

Adipose Tissue↗