M1 Surgical Medialization with Silastic Implant for Unilateral Vocal Fold Immobility; 35 Years Experience Objective: Chart review of 483 patients with unilateral vocal fold immobility, comparing short and long term voice results for medialization vs combined medialization and reinnervation, managed by the author over a 35 year period. Methods/design: Videostroboscopic evaluations were reviewed regarding preinterventional status and voice outcomes after surgery by speech and language pathologists. Results: Medialization with Silastic implant N= 351 Paralysis/Paresis = 217 Cricoarytenoid Joint Immobility = 124 Voice “normal” = 190 Voice “much better” = 144 Voice improved, but not satisfactory = 17 Combined reinnervation and Medialization with silastic implant N=132 Paralysis/Paresis = 128 Voice “normal” = 116 Voice “much better” = 14 Conclusions: Vocal fold paralysis/immobility can be managed by adjustment of the cartilage skeleton, repositioning of the vocal fold(s) and/or reinnervation. Combined medialization and reinnervation has been effective in achieving better long term voice results in unilateral paralysis. Harvey M. Tucker, M.D., F.A.C.S., Professor of Otolaryngology/Head & Neck Surgery, Case Western Reserve University School of Medicine at MetroHealth Medical Center M2 Development of Patient Oriented Voice Disorder Management System Objective: Established the voice disorder management system is an evidence based, patient centered to improve care for individuals with voice disorder and provide support for their caregivers. The system is that productive, patient-centered interactions between informed patients and knowledgeable teams across the care continuum can lead to optimal outcomes and patient self-management support. Methods: A novel computer based on Browser/Server mode is adopted in the system. It adopts Java Server Pages (JSP) technique and Tomcat of the runtime environments, SQL Server 2000 as backstage supporter's database .With the friendly mutual interfaces, it has applied to patient with help of the physicians in the out-patient. The data which we want includes basic information, previous history, symptoms and signs and inspection. The data will be organized into some questions in the web page. Then the choice of the questions will be saved into the database by the JDBC (Short for Java Database Connectivity) Results: The patient orient voice management adopt of effective web application platforms and appropriate project management methodologies. The system is self-management support protocols, and delivery system to manage the individual needs of patients. The management system includes patient and clinician education, explicit evidence-based care plans, expert care availability, patient self-care, counseling, comprehensive patient tracking, calendaring features and monitoring of outcomes. Conclusions: Patient oriented voice disorder management is implemented by the following multidisciplinary team members. Voice disorder management improves patient adherence to treatments and disease control compared with usual care and relies on patient education and reminders, and clinician education and feedback. Thus, the team offers services tailored to patients’ needs and preferences rather than attempting to provide a specific treatment to all subjects regardless of their preferences or needs. Jialin Liu, M.D., Director, Department of Medical Informatics, West China Hospital/West China Medical School, Sichuan University Dinghou Wen, M.S., Professor, Department of Otolaryngology, West China Hospital, Sichuan University Rui Zhang, Ph.D., Department of Medical Informatics, West China Hospital/West China Medical School, Sichuan University M3 Current Status of Intracordal Injection of Basic Fibroblast Growth Factor for Vocal Fold Scar and Atrophy Introduction: Basic fibroblast growth factor (bFGF) has a regenerative effect of dermis and epidermis with a strong angiogenetic effects. Basic FGF has also proved to increase production of hyaluronic acid from the vocal fold fibroblasts, which is suitable for regeneration of the vocal fold in case of vocal fold scar and atrophy. The present retrospective study reports the current status of bFGF injection therapy for the vocal fold. Materials and Methods: Forty cases with vocal fold atrophy (24 cases) or scar (16 cases) have been treated with transcordal injection of bFGF. Injection was basically repeated 4 times with interval of 1 week between each injection. Follow up periods were 3-72 months (mean 15 months) in atrophy cases and 3-48 months (mean 14.8 months) in scar cases. Maximum phonatory time, voice handicap index (VHI)-10, and GRBAS scale were evaluated. Results: MPT, VHI-10 and GRBAS were significantly improved in both atrophy and scar cases. The degree of improvement in each parameter shows no significant difference between atrophy and scar cases. When success is determined by the improvement of VHI-10 more than 5 (Gartner-Schmidt J, 2010), the success rate for atrophy and scar cases were 89% and 73%, respectively. Mild to severe hyperemia was observed in 10 of 24 cases in atrophy, and in 11 of 16 cases in scar. All of them were resolved within a few months. Recurrence of atrophy or scar occurred in 3 of 24 cases and 2 of 16 cases, respectively (12%). Recurrence occurs at 12-36 months in atrophy cases, and at 36-48 months in scar cases. Conclusion: Intracordal bFGF injection was effective for both atrophy and scar cases, and no significant difference was observed in the degree of improvement between both groups. However success rate seemed to be higher in the atrophy cases. Recurrence occurs in 12% with no difference between both pathologies. More effective delivery system is now under research. Shigeru Hirano, M.D., Ph.D., Associate Professor, Department of Otolaryngology, Kyoto University Yo Kishimoto, M.D., Ph.D. Nao Hiwatashi, M.D. Mami Kaneko, M.S., SLP M4 Inter-Rater Reliability in Analysis of Laryngoscopic Features for Unilateral Vocal Fold Paresis Objective The diagnosis of paresis in patients with vocal fold motion impairment remains a challenge. In particular, laryngoscopy examination may result in significant disagreement in diagnosis among providers. We hypothesize that systematically evaluating for a standard set of clinical parameters will increase the diagnosis concordance among providers. Methods Two laryngologists (rater 1) and two trainees (rater 2) rated laryngoscopic findings in 19 patients suspected of paresis. The diagnosis was confirmed with laryngeal EMG. A standard set of 27 ratings was used for each examination that included movement, laryngeal configuration and stroboscopy signs. A Kappa co-efficient was calculated for agreement in laryngoscopy findings and effectiveness in predicting the laterality of paresis. Results A substantial agreement (kappa coefficient >0.61) existed between the raters for vocal fold length, vocal fold thickness, bowing, and reduction in movement. A moderate agreement (kappa coefficient > 0.41) existed between raters for pyriform opening and reduced kinesis. The senior author was accurately able to diagnose the side of paresis in 89.5% of cases for a kappa coefficient of 0.78, while the trainees correctly predicted the side of paresis in 63.1% for a kappa coefficient of 0.35. The raters agreed on the diagnosis in 73.7% of cases for a kappa coefficient of 0.50. Conclusions Using a standard set of laryngoscopic findings improved the provider’s ability to identify the laterality of vocal fold paresis and increased inter-rater reliability compared to other series. Arjun Parasher, M.D., Resident, Department of Otolaryngology, Icahn School of Medicine at Mount Sinai Tova F. Isseroff, M.D., Fellow, Department of Otolaryngology, Icahn School of Medicine at Mount Sinai Amanda Richards, MBBS, FRACS, Department of Otolaryngology, Icahn School of Medicine at Mount Sinai Mark Sivak, M.D., Assistant Professor, Department of Neurology, Icahn School of Medicine at Mount Sinai Peak Woo, M.D., Clinical Professor, Department of Otolaryngology, Icahn School of Medicine at Mount Sinai M5 The Ventriloquist: A Double Voice or a Double Language? A voice from elsewhere, the ventriloquist: is the magician of the voice Ventriloquist: a strange word indeed! In Greek, he’s called egastrimitos: from gaster, stomach and mythos, speech - the spoken voice of the stomach. Yet who has ever seen stomach articulate words… His set lips give the illusion of a voice coming from elsewhere. to manipulate vowels and consonants, cheating is often necessary The formation of vowels and consonants depends on the shape of the buccopharyngeal and respiratory tract. This contortionist of the larynx owes his talent to his fast neurological control over this zone, and to his lung capacity. The ventriloquist can’t form all the vowels and consonants the same way, so how can he cheat? Whereas Christian, the ventriloquist, smacks his lips together to voice consonants, Freddy, his puppet, can’t benefit from this gesture. The most problematic consonants are p, b, f and m. These professionals find c, d, g, k, n, q, s, and x relatively straightforward, whereas articulating r, t, v, and z is a little trickier. A genuine language evolves for the puppet: barrier becomes varrier. Formidable becomes hormidable. Your brain immediately corrects the fraudulent letter. When Freddy sings ‘The singer from Mexico’, he pronounces it -Nexico, but the auditory illusion is perfect, you hear ‘Mexico’. The ventriloquist learns what amounts to a second language. His reflex, when the puppet