Gregory Robert Dion

Objectives: Accurate evaluation of glottic anatomy in adults with dysphonia can be challenging when videostroboscopy is limited by altered anatomy, supraglottic hyperfunction, or posterior glottic pathology. We sought to evaluate the clinical utility of Dynamic Voice Computed Tomography ( DVCT ) in complex adult voice patients with prior laryngeal framework surgery or suspected posterior glottic insufficiency ( PGI ). Methods: Retrospective cohort study of 15 adult patients undergoing DVCT for evaluation of dysphonia at a tertiary laryngology practice between February 2025 and February 2026. Demographics, prior surgical history, standardized voice measures, videostroboscopy findings. Results: Fifteen adults underwent DVCT (mean age 62.8 years; 40% female). Ten had prior thyroplasty, and five had known or suspected PGI . All had abnormal acoustic and perceptual voice measures out of proportion to stroboscopy appearance. DVCT imaging findings and clinical management were analyzed. DVCT provided additional clinically relevant anatomic information beyond videostroboscopy in all patients. Imaging most commonly identified posterior glottic insufficiency, vertical height mismatch, implant malposition, or arytenoid malposition not fully appreciated on stroboscopy. CT findings influenced surgical decision‐making in the majority of patients, confirming candidacy in 47%, altering planned procedures in 33%, and avoiding surgery in 13%. Conclusions: DVCT is a useful tool in the evaluation of dysphonic adults with prior laryngeal framework surgery or PGI , providing complementary characterization of glottic anatomy that informs surgical decision making. Level of Evidence: 4.

Objectives: Extracellular matrix (ECM)‐based scaffolds and gels demonstrate promise for vocal fold scar treatment; however, these injectables necessitate invasive procedures and repeated dosing. Multiple injections to the folds can damage the tissue, leading to fibrotic outcomes. We hypothesize that a nebulized vocal fold lamina propria ECM (VFLP‐ECM) formulation can provide an effective regenerative treatment for upper airway delivery in a novel delivery approach. Methods: A porcine‐derived, nebulized formulation of VFLP‐ECM was synthesized for targeted VF delivery. Bilateral vocal fold injuries were induced in Sprague Dawley rats using micro forceps. Forty‐eight hours postinjury, animals were assigned to a (1) injury alone/control group or a nebulized treatment group receiving (2) phosphate buffer saline (PBS), (3) collagen type I (COLI), or (4) extracellular matrix (VFLP‐ECM), with six animals in each group. Larynges were harvested 14 days postinjury and histologically analyzed using Hematoxylin and Eosin and Masson's trichrome staining. Results: Histological analysis demonstrated reduced collagen deposition and lower myofibroblast density in the VFLP‐ECM treated group compared to PBS and injury alone controls. Additionally, treated tissues exhibited increased lamina propria thickness and improved extracellular matrix organization, indicative of regenerative rather than fibrotic remodeling. Conclusion: Nebulized delivery of VFLP‐ECM improved VF tissue characteristics. This study suggests a potential application for nebulized decellularized ECM in supporting vocal fold tissue regeneration during the acute phase of wound healing, with long‐term effects warranting further investigation. Level of Evidence: NA.

Objective: Innovative therapies are needed to improve the treatment of laryngotracheal stenosis. This study investigated the local tissue response of a novel injectable drug delivery platform in a leporine tracheal model. Methods: Dye‐loaded polymer (empty) implants were delivered into the pretracheal tissue of three New Zealand White rabbits using an 18‐gauge needle and custom applicator to simulate peritracheal delivery adjacent to tracheal stenosis. Three additional rabbits underwent tracheal injury via electrocauterization to serve as comparative injury controls, and three additional rabbits were included as no‐implant, no‐injury tracheal controls. Animals underwent laryngoscopy and bronchoscopy on Days 0 and 14 to evaluate the primary outcome of local airway safety after implant placement. Secondary outcomes included ultrasound implant localization, indentation mapping of tracheal wall structural stiffness, and histological assessment. Results: Implant‐treated tracheas ( n = 3) maintained lumen patency and organized tissue architecture without visible stenosis or microscopic inflammation, whereas injured tracheas ( n = 3) demonstrated luminal distortion and disorganized early remodeling. Implant location was confirmed by ultrasound. Indentation mapping showed lower mean anterior and posterior tracheal wall stiffness in implant‐treated specimens (5.28 and 4.47 mN/mm, respectively) compared with injured specimens (37.38 and 11.20 mN/mm, respectively). Posterior mucosal thickness was also lower in implant‐treated tracheas than injured tracheas (31.02 vs. 56.07 μm). Overall, the implants did not appreciably alter the native tracheal structure. Conclusion: This novel injectable platform was well tolerated in the pretracheal space and preserved native tracheal structure, supporting future studies of therapeutic‐loaded implants for stenosis mitigation and treatment. Level of Evidence: NA.

This study investigates vocal fold vibration by characterizing glottal geometry and aerodynamic properties at different coronal planes along the posterior to anterior axis in excised canine larynges. Multi-plane, phase locked two-dimensional (2D) particle image velocimetry was used to reconstruct the medial glottal wall geometry and intraglottal flow fields across equidistant coronal planes during phonation. The results reveal significant spatial variation in glottal shape and flow dynamics, with larger glottal openings and divergence angles observed in the mid-coronal and anterior planes compared to the posterior plane. Flow separation vortices (FSV) consistently formed along the medial glottal wall during the closing phase but varied in size and location depending on coronal position. In the mid-coronal and anterior regions, FSV formed closer to the inferior edge and produced stronger flow entrainment, higher circulation, and greater negative gauge pressures, leading to more pronounced flow skewing during closure. In contrast, FSV in the posterior region formed near the superior aspect, exhibited weaker entrainment and circulation, and resulted in less pronounced glottal skewing. These findings highlight fluid structure interactions within the glottis and underscore the importance of considering the posterior to anterior variations to improve our understanding of voice production mechanisms.

Vocal fold scarring poses a significant challenge. It is characterized by prolonged and often irreversible impairment of vocal function due to loss of pliability and disruption of the lamina propria's native extracellular matrix (ECM). Current treatments remain largely palliative, aiming to improve glottic closure rather than restore normal tissue biomechanics. As research deepens into the wound healing pathways and fibrotic mechanisms underlying scar formation, injectable therapies are emerging as approaches to modulate healing and restore vibratory function. This review outlines the pathophysiology of vocal fold scarring and evaluates emerging injectable strategies designed to restore tissue architecture and function. These include biomaterial-based implants, antifibrotic and pro-regenerative biologics, stem cell therapies, and advanced drug delivery systems. The translational challenges include anatomical constraints, delivery precision, animal models, immune compatibility, degradation kinetics, and the lack of standardized outcome measures. The review highlights the ongoing research on injections of implants for vocal fold scarring that support biomechanical properties and modulate local tissue repair. However, further advanced and long-term studies, including clinical trials, are needed to fully elucidate their safety, efficacy, and toxicity profiles. In addition, their scalability and reproducibility within pharmaceutical manufacturing must be rigorously validated to support clinical translation.

Objective: Intralesional steroid injections for vocal fold (VF) scarring are rapidly cleared, limiting their effectiveness. This study evaluates the efficacy of a light‐activatable dexamethasone implant compared to a single steroid injection for VF scar healing. Methods: Ten rabbits underwent endoscopic VF injury and were treated with either a dexamethasone injection or a light‐activatable implant; injured‐only and no‐injury VFs served as controls. On days 0 and 21, VF implants were irradiated with a near‐infrared pulsed laser for 1 min. Larynges were harvested after 42 days. High‐speed video (> 10 kHz) of excised larynges captured VF vibrations for kymographic analysis. Normal force, structural stiffness, and displacement were measured. Data were analyzed with appropriate statistical tests. Results: Compared to injury‐only VFs, implant‐treated VFs demonstrated significantly reduced normal force and stiffness (5.28 ± 0.77 mN vs. 2.34 ± 0.66 mN, p < 0.0001; 17.74 ± 2.45 mN/mm vs. 6.80 ± 1.32 mN/mm, p < 0.0001), and increased displacement at 1.96 mN (0.14 ± 0.02 mm vs. 0.29 ± 0.05 mm, p < 0.0001) along the injury zone. Implant‐treated VFs exhibited larger amplitude ratios and improved tissue architecture than untreated scars. No differences in quantitative measures were observed between implant‐treated and injection‐treated groups. Conclusion: A light‐activatable dexamethasone implant improved VF biomechanics, vibratory behavior, and histological outcomes in a rabbit injury model comparable to a single steroid injection. This novel approach shows promise for delivering controlled, repeatable therapy to VF scars.

Objective: Patients with cricopharyngeus muscle dysfunction (CPMD) with and without diverticula (e.g., Zenker Diverticulum) often struggle with dysphagia for years prior to diagnosis or intervention. Surgical treatment is successful; yet, there is limited long‐term data on dysphagia outcomes after surgery. Methods: Individuals prospectively enrolled in the Prospective Outcomes of Cricopharyngeal Hypertonicity (POuCH) collaborative with and without diverticula who underwent surgery from November 2014 to August 2024 and had at least 12 months of follow‐up were included. Eating Assessment Tool 10 (EAT10) was used to characterize patient‐reported outcomes. Descriptive statistics were performed using means, frequencies, and spaghetti plots. Results: Of 164 patients initially identified, 2 withdrew and 2 were excluded for incomplete data; 160 were included. 31% were women, with a mean (SD) age of 70.1 (11.5). Endoscopic surgery (113, 71%) was more common than open technique (47, 29%). 19.4% of patients had undergone previous surgery. Postoperatively, patients were found to have improved EAT‐10 scores, with smaller changes recorded after 36 months. Median change in EAT‐10 compared to preoperative score was −12 points [IQR: −18, −5] at 12 months. 39 (24%) patients were followed for > 24 months (median change −11 [IQR: −14, −7]); 26 (16%) > 36 months (−9.5 [−17, −5]), and 12 (7.5%) > 48 months (−4 [IQR: −18, 4]). Six patients died during the study period. Conclusion: Improved dysphagia after surgery appears stable with minimal change over time. Most patients (96.3%) survive at least 1 year. Surgical intervention for patients with CPMD with or without diverticula is an effective and reliable treatment option. Level of Evidence: 4.

Objectives: Preclinical models are necessary to study the pathophysiology of laryngotracheal diseases and novel treatments. Currently, there is no consensus on species, injury mechanics, and study duration This review provides a contemporary overview of the studies of vocal fold and laryngotracheal injuries in preclinical models.Methods: A search was performed in PubMed and Web of Science involving various animal models undergoing vocal fold, trachea, and laryngotracheal injury and/or wound healing studies from 2013 to 2023. Articles were independently screened and selected by four reviewers.Results: Of 1279 filtered studies, 197 studies were identified and categorized by species, study duration, and mechanism of injury (MOI): vocal fold stripping, intubation, lasers, microtools, scraping, and other MOIs. Within each MOI, studies were grouped by animal model, with subsections discussing tissue target, research aim, analysis method, and study duration. Leporine and rat models were the most employed animal models for both vocal fold wound healing and laryngotracheal models. Leporine studies had the broadest diversity in MOIs, with lasers, microtools, scraping, and other methods used. Comparatively, rat studies primarily utilized vocal fold stripping as a MOI, perhaps second to anatomic limitations. Larger species, specifically porcine models, were most prevalent in intubation injury studies. Ferret, mouse, and ovine models were less utilized. Study duration varied from 1 day to 3 months in vocal fold injury models and 30 min to 12 months in laryngotracheal injuries.Conclusion: This review provides a foundational framework to collate and interpret available data on preclinical vocal fold and laryngotracheal injury models to guide future study design.Level of Evidence: Five scoping review/NA.

INTRODUCTION: The term laryngopharyngeal reflux (LPR) is frequently applied to aerodigestive symptoms despite lack of objective reflux evidence. The aim of this initiative was to develop a modern care paradigm for LPR supported by otolaryngology and gastroenterology disciplines. METHODS: A 28-member international interdisciplinary working group developed practical statements within the following domains: definition/terminology, initial diagnostic evaluation, reflux monitoring, therapeutic trials, behavioral factors and therapy, and risk stratification. Literature reviews guided statement development and were presented at virtual/in-person meetings. Each statement underwent 2 or more rounds of voting per the RAND Appropriateness Method; statements reaching appropriateness with ≥80% agreement are included as recommendations. RESULTS: The term laryngopharyngeal symptoms (LPS) applies to aerodigestive symptoms with potential to be induced by reflux and include cough, voice change, throat clearing, excess throat phlegm, and throat pain. Laryngopharyngeal reflux disease (LPRD) refers to patients with LPS and objective evidence of reflux. Importantly, the presence of LPS does not equate to LPRD. Laryngoscopy has value in assessing for nonreflux laryngopharyngeal processes, but laryngoscopic findings alone cannot diagnose LPRD. LPS patients should be categorized as with or without concurrent esophageal reflux symptoms. While lifestyle modification and empiric trials of acid suppression ± alginates are appropriate when esophageal reflux symptoms coexist, upper endoscopy and ambulatory reflux monitoring are required for LPRD diagnosis when symptoms persist, when LPS is isolated, or when management needs to be escalated to include invasive antireflux management. The two recommended ambulatory reflux monitoring modalities, 24-hour pH-impedance and 96-hour wireless pH monitoring, are not mutually exclusive with distinct roles for the evaluation of LPS. Laryngeal hyperresponsiveness and hypervigilance commonly contribute to both LPS and LPRD presentations and are responsive to laryngeal recalibration therapy and neuromodulators. DISCUSSION: The San Diego Consensus represents the formal modern-day interdisciplinary care paradigm to evaluate and manage LPS and LPRD.

Head and neck cancer encompasses a diverse group of malignant neoplasms originating in regions such as the oral cavity, oropharynx, hypopharynx, larynx, sinonasal cavities, and salivary glands. HNC represents a significant public health challenge, and recent reports indicate an increment in the incidence of HNC in young adults. In 2020, approximately 377,700 new HNC cases and 177,800 HNC-related deaths were reported globally. Major risk factors include tobacco smoking, alcohol consumption, and human papillomavirus (HPV) infections. HNC impacts vital functions such as breathing, swallowing, and speech. Treatments for this type of cancer within this complex anatomy include surgery, radiotherapy, and chemotherapy combinations. Radiotherapy is often an essential component of both curative and palliative HNC treatment, balancing tumor control with the preservation of function and appearance. However, its use can damage adjacent normal tissues, causing acute or chronic toxicity. One complication of HNC irradiation is VF fibrosis, which leads to severe voice impairments, significantly affecting patients’ quality of life. Fibrosis involves excessive and aberrant deposition of extracellular matrix, driven by factors such as TGF-β1 and inflammatory cytokines, which ultimately impair the flexibility and function of VF. Current radiation-induced fibrosis treatments primarily focus on symptom management and include systemic therapies like corticosteroids, anti-inflammatory drugs, and antioxidants. However, these treatments have limited efficacy. Experimental approaches targeting molecular pathways involved in fibrosis are being explored. Given the limitations of these treatments, advancing research is crucial to develop more effective therapeutic strategies that can significantly improve the quality of life for HNC patients, especially those vulnerable to VF fibrosis.