Background: Recurrent laryngeal nerve (RLN) injury is a major concern in thyroid surgery as the effects can vary from hoarseness of voice to life-threatening complications like stridor. Hence, identification and preservation of the nerve is of utmost importance. The landmarks for identification are tracheoesophageal groove, inferior thyroid artery (ITA), ligament of berry, and tubercle of Zuckerkandl. The ITA is noted to be a constant landmark in identifying the RLN. The main aim of the study is to identify the relationship of the ITA with the RLN during thyroid surgery. Materials and methods: A total of 91 patients who underwent total thyroidectomy, completion, and hemithyroidectomy from January 2018 to December 2018 were included in the study. The position of the RLN with respect to the ITA was noted being as superficial, deep, or between the branches. Results: Among a total of 150 RLNs, 140 (93.3%) were identified and 10 were not identified. In 125 (89%) dissections, the ITA was superficial to the RLN and in 15 dissections it was noted to be deep to the RLN. Conclusion: Even though the RLN can be identified by various landmarks, the relationship with the ITA is consistent. However, as the nerve may be either superficial or deep to the ITA, knowledge of anatomy and variations of the RLN is necessary to ensure its preservation. Clinical significance: The knowledge of relationship of the RLN with the ITA helps in identification and preservation of nerve, thus avoiding injury to the nerve and consequent complications.

Introduction: Teachers are occupational voice users reporting vocal fatigue as a frequent vocal discomfort. The vocal fatigue index (VFI) tool is a self-administered questionnaire proposed to measure individuals who have vocal fatigue. While research on another patient-administered questionnaire - the voice handicap index-10 (VHI-10), is extensive, experimental works in understanding the correlation between voice handicap and vocal fatigue are unknown. Aims and objectives: This study was undertaken to document vocal fatigue and voice handicap in primary school teachers and also understand the nature of correlation between VFI and VHI-10. Materials and methods: This study is a cross-sectional survey with convenience-type sampling. A total of 110 healthy females within the age of 22–50 years participated. Nonteachers (group I) and teachers (group II) rated the VFI and VHI-10 questionnaire as per its standard guidelines and the data was subjected to descriptive and inferential statistics. Results: Results of the study revealed group I to have lower VHI-10 scores compared to group II. However, in the VFI questionnaire, group II scores were higher than group I. Independent t test revealed a statistically significant difference only for VFI at p < 0.05. Karl Pearson's correlation test indicated a strong positive relationship between VHI-10 and VFI. Conclusion: From the present study, it can be concluded that vocal fatigue is observable in primary school teachers compared to nonteachers. An increase in VFI scores predicts teachers who are at high-risk of developing voice handicap.

Aging causes changes in the speech mechanism that varies from individual to individual. Acoustic cues of aging are regarded as the product of the physiology of the system. The frequency and amplitude perturbations are commonly seen amongst aged voice. It is necessary to discern changes precipitated by normal aging from those that are secondary to the pathological aging process. The aim of the study was to profile the perturbation (frequency and amplitude) norms in aged. Materials and methods: A total of n = 162 participants, in the age range of 60–70 years, were enrolled. The acoustic analysis was done using the Multidimensional Voice Profile (MDVP) software. Results: The mean values obtained for most of the acoustic measures were observed to be higher with increase in age. Some of the acoustic measures significantly varied across the age groups and the genders. Conclusion: This normative data will aid in differentially diagnosing the variations in normal aging from those secondary to the pathological aging process.

Singer's vocal apparatus is comprised of her entire body and mind and is easily influenced by hormonal variations. The hormonal changes may have adverse effects on a singer's vocal performance. There is very little understanding about the aerodynamic measures among singers especially during the different phases of menstrual cycle in Indian population. Aims and objectives: To study the effect of menstrual cycle on aerodynamic measures among singers and nonsingers. The objectives of the study were to profile aerodynamic measures in singers and nonsingers, to compare the aerodynamic measures between the singers and nonsingers, and to study the effect of menstrual phase on aerodynamic measures between singers and nonsingers. Materials and methods: The participants in group I comprised of 30 nonsingers in the age range of 18–25 years. Group II comprised of 15 trained singers (received training formally more than 3 years), and group III had 15 untrained singers in the age range of 18–25 years. The forced vital capacity (FVC), forced expiratory volume in first second (FEVl), and peak expiratory airflow (PEF) were recorded. Descriptive statistics and repeated measure of ANOVA were done to study the effect of menstrual cycle on aerodynamic measures among singers and nonsingers using SPSS 16.0. Results: In the present study, the overall mean scores obtained for all the aerodynamic measures were reduced during menstrual phase as compared to the aerodynamic measures obtained during the follicular phase among both singers and nonsingers.

Aims and objectives: To determine the effect of early physiotherapy in endotracheal intubation-induced temporomandibular joint dysfunction (TMD) and to compare the effect of early physiotherapy interventions and conventional treatment (CT) in TMD in endotracheal extubated patients. Meterials and methods: An experimental study was carried out in 40 endotracheal extubated (ETE) subjects diagnosed with TMD. The subjects were randomly allocated to group I as an experimental group receiving early physiotherapy and group II as a conventional group receiving routine treatment for 14 days. The outcome measures were used the American Academy of Orofacial Pain (AAOP) Questionnaire, visual Analog scale (VAS), physical assessment tool, range of motion (ROM) of TMJ, tenderness over orofacial muscles. Results: The results obtained show that both the groups showed significant improvement in the outcome variables and therefore aids with early correction of dysfunction. Within group analysis showed statistically more significant improvement in all outcome measures for group I. VAS (p < 0.0001), ROM for all four motions (p < 0.0001), auscultation test = 95% improvement, provocation test = 95% improvement, tenderness = 95%. However only, AAOP questionnaire was not significant for group II (p value > 0.001). Conclusion: We found that those early physiotherapy interventions showed significant improvement in the outcome variables concluding that it improves TMJ mobility and reduces pain. It can be further concluded that conventional treatment can be more efficacious if combined with early physiotherapy interventions.

Background: Preservation of voice is an important concern for patients undergoing thyroidectomy. The objective of our study was early identification of the voice-related problems in postthyroidectomy patients and starting voice therapy as early as possible, in order to prevent faulty voice production techniques in them. Materials and methods: One hundred and eighteen patients who underwent thyroidectomy in our study period were included for study. Voice evaluation was done preoperatively and postoperatively with videolaryngoscopy (VLS), maximum phonation duration (MPD), and fundamental frequency of voice (Fo). Voice therapy was initiated in patients who had voice disorders. Results: Thirty-three patients in early postoperative period had voice disorders. Among these 33 patients, four patients had recurrent laryngeal nerve (RLN) paresis, 22 patients had external branch of superior laryngeal nerve (EBSLN) paresis, and 7 patients had normal vocal fold mobility. Four patients had voice changes in the late postoperative period. Voice rehabilitation therapy was started in these 33 patients. All the patients recovered well with voice therapy and without surgical intervention. Conclusion: Early identification of voice disorders and initiation of voice rehabilitation therapy will considerably reduce the voice morbidity in thyroidectomy patients.

Laryngeal foreign bodies are less common than bronchial foreign bodies. They pose a challenge sometimes because of subdued symptoms and therefore resulting in late diagnosis. Removal of such foreign bodies is challenging especially in infants, and one needs to be prepared for all sorts of variations on the OT table. We present an interesting case where an 8-month-old infant presented with a toe ring inside her larynx, which was peculiarly causing symptoms of both respiratory obstruction and pooling of saliva. The top flat part of the toe ring was seen to be covering the posterior half of the glottis and its ring was stuck inside the cricopharynx. This was a case of a single foreign body obstructing both the tracts at the same time. It was removed carefully with direct laryngoscopy and the patient recovered uneventfully after the procedure.

The common tracheobronchial foreign bodies in adults are food items such as peanuts. Aspirated medical devices are rarely seen. If a tracheobronchial foreign body is not diagnosed and removed early, severe complications such as pneumonia and atelectasis can result. We are presenting a 50-year-male patient with accidental aspiration of fractured metallic tracheostomy tube in the left main bronchus. Patient was otherwise asymptomatic. The foreign body was removed under general anesthesia using a zero degree endoscope and bronchoscopic forceps. Postoperative period was uneventful, and the patient was discharged the next day with oral medications. This case has been described here as lifesaving device presented as life-threatening emergency and to highlight the importance of tracheostomy tube care.