Electrophysiological Changes on Laryngeal Motor Neuropathways Cause Voice Disorders for Postradiotherapy Patients with Nasopharyngeal Carcinoma

Cui He; Libing Guo; Mingfen Zheng; Hong Peng; Xuhui Zhang; Changhe Fan; Xiangdong Zhao; Pinggui Gong; Zeyi Deng; Guang Xu; Cuijie Chen

doi:10.1016/j.jvoice.2024.03.037

Electrophysiological Changes on Laryngeal Motor Neuropathways Cause Voice Disorders for Postradiotherapy Patients with Nasopharyngeal Carcinoma

J Voice. 2024 Apr 16:S0892-1997(24)00115-2. doi: 10.1016/j.jvoice.2024.03.037. Online ahead of print.

Authors

Cui He¹, Libing Guo², Mingfen Zheng³, Hong Peng⁴, Xuhui Zhang², Changhe Fan⁵, Xiangdong Zhao³, Pinggui Gong³, Zeyi Deng³, Guang Xu⁶, Cuijie Chen⁵

Affiliations

¹ The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China; Department of Otolaryngology Head and Neck Surgery, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China.
² Department of Oncology, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China.
³ Department of Otolaryngology Head and Neck Surgery, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China.
⁴ Department of Otolaryngology Head and Neck Surgery, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China. Electronic address: doctorpenghong@163.com.
⁵ Department of Psychiatry, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China.
⁶ Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China.

PMID: 38631941
DOI: 10.1016/j.jvoice.2024.03.037

Abstract

Objective: This study explored electrophysiological changes in the laryngeal motor neuropathway and determined whether lesions in the laryngeal motor cortex (LMC) and its descending tract contribute to voice deterioration and peripheral nerve palsy in patients with nasopharyngeal carcinoma (NPC) postradiotherapy (RT).

Study designs: Prospective cohort study.

Methods: Twenty-two patients with NPC at 2 to 4years post-RT (8 female and 14 male), 22 patients with NPC at 8 to 10years post-RT (8 female and 14 male), and 22 healthy individuals (9 female and 13 male) were selected to test their magnetic evoked potentials (MEP), motor nerve conduction, and voice quality using transcranial magnetic stimulation, laryngeal electromyography, and the XION DiVAS acoustic analysis software. Three groups were matched according to approximate age. Multiple comparisons were performed among the three groups.

Results: The voice quality of post-RT patients with NPC deteriorated compared to that of healthy individuals. Bilateral LMC and their corticonuclear tracts to the bilateral ambiguous nuclei of post-RT patients with NPC were impaired according to multigroup comparisons of MEP amplitudes, latencies, and resting motor thresholds. The vagus and recurrent laryngeal nerves (RLN) of post-RT patients with NPC were impaired according to multigroup comparisons of the amplitude and latencies of the compound muscle action potential and latencies of f-waves.

Conclusions: The voice quality of patients with NPC deteriorated after RT. The pathogenesis of post-RT voice deterioration may involve radiation-induced injuries to the vagus, RLN, and bilateral LMC. Furthermore, radiation-induced injuries to the bilateral LMC may contribute to vagus and RLN palsies. These findings support the use of transcranial approaches to treating voice disorders and peripheral nerve palsies in post-RT patients with NPC.

Trial registration: ChiCTR2100054425; Electrophysiological Study of Vocal-Fold Mobility Disorders After Radiotherapy for NPC Patients via Magnetic Evoked Potential and Their Correlation with Voice Quality Assessment; https://www.chictr.org.cn/bin/project/edit?pid=144429.

Keywords: Laryngeal electromyography; Laryngeal motor cortex; Magnetic evoked potential; Nasopharyngeal carcinoma; Radiotherapy; Voice disorder.