Voice Recovery in a Patient with Inhaled Laryngeal Burns

Document Type: Case Report


1 Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea.

2 Department of Humanities, Language and Information, Pusan National University, Pusan, South Korea.


Laryngeal burns cause long-term voice disorders due to mucosal changes of the vocal folds. Inhalation injuries affect voice production and result in changes in the mucosal thickness and voice quality.
Case Report:
A 47-year-old woman was transferred to our department with laryngeal burns sustained during a house fire. On laryngoscopic examination, mucosal waves of both vocal folds were not visualized due to the injury caused by inhalation of high-temperature toxic smoke. Hence, voice analysis, laryngoscopic examinations, and high-speed videoendoscopy (HSV) were performed to evaluate vocal fold vibrations. An absence of mucosal waves and a breathy and strained voice with a severe grade were noted. We report that voice quality was recovered to close to the normal state through multiple treatments such as medication, voice therapy, and counseling.
This paper presents the unique case of a patient with laryngeal burns, in which vibrations of the vocal folds were observed using laryngoscopic examination and HSV. Voice samples before and after treatment were also analyzed. By observing the vibration pattern of the injured vocal fold, it is expected that appropriate diagnosis and treatment planning can be established in clinical practice.


Main Subjects

1. Nottet JB, Duruisseau O, Herve S, Patuano E, Ainaud P, Carsin H, et al. Inhalation burns: apropos of 198 cases. Incidence of laryngotracheal involvement. Ann Otolaryngol Chir Cervicofac. 1997;114:220–5.

2. Hogg G, Goswamy J, Khwaja S, Khwaja N. Laryngeal Trauma Following an Inhalation Injury: A Review and Case Report. J Voice. 2017;31: 388.e27-388.e31.

3. Casper JK, Clark WR, Kelley RT, Colton RH. Laryngeal and phonatory status after burn/inhalation injury: a long-term follow-up study. J Burn Care Res. 2002;23:235–43.

4. Valdez TA, Desai U, Ruhl CM, Nigri PT. Early laryngeal inhalation injury and its correlation with late sequelae. Laryngoscope. 2006;116:283–7.

5. Pfannenstiel TJ, Gal TJ, Hayes DK, Myers KV. Vocal fold immobility following burn intensive care. Otolaryngol Head Neck Surg. 2007;137:

6. Ziegler B, Hirche C, Horter J, Kiefer J, Grutzner PA, Kremer T, et al. In view of standardization Part 2: Management of challenges in the initial treatment of burn patients in Burn Centers in Germany, Austria and Switzerland. Burns. 2017; 43:  318–25.

7. Fang-Gang N, Yang C, Yu-Xuan Q, Yan-Hua R, Wei-Li D, Cheng W, et al. Laryngeal morphologic changes and epidemiology in patients with inhalation injury: a retrospective study. Burns. 2015; 41:1340–6.

8. Park HJ, Cha W, Kim GH, Jeon GR, Lee BJ, Shin BJ, et al. Imaging and Analysis of Human Vocal Fold Vibration Using Two-Dimensional (2D)ScanningVideokymography. J Voice. 2016; 30: 345–53.

9. Švec JG, Schutte HK. Videokymography: High-speed line scanning of vocal fold vibration.                   J Voice. 1996;10:201–5.

10. Kang DH, Wang SG, Park HJ, Lee JC, Jeon GR, Choi IS, et al. Real-time Simultaneous DKG and 2D DKG Using High-speed Digital Camera.      J Voice. 2016;31: 247.e1-247.e7.

11. Shim HJ, Jang HR, Shin HB, Ko DH. Cepstral, Spectral and Time-Based Analysis of Voices of Esophageal Speakers. Folia Phoniatr Logop. 2016; 67: 90–6.

12. Hirano M. Psycho-acoustic evaluation of voice. Clinical examination of voice. 1981:81-4.

13. Nemr K, Simoes-Zenari M, Cordeiro GF, Tsuji D, Ogawa AI, Ubrig MT, et al. GRBAS and Cape-V Scales: High Reliability and Consensus When Applied at Different Times. J Voice. 2012; 26:812. e17-812.e22.

14. Boone DR, McFarlane SC, Von Berg SL, Zraick RI. The voice and voice therapy. 9th Ed: Pearson Higher Ed; 2013; 245-323.

15. Clayton N, Kennedy P, Maitz P. The severe burns patient with tracheostomy: implications for management of dysphagia, dysphonia and laryngotracheal pathology. Burns. 2010;36:850–5.

16. Yeung JK, Leung LT, Papp A. A survey of current practices in the diagnosis of and interventions for inhalational injuries in Canadian burn centres. Can J Plast Surg. 2013;21:221–5.

17. Palmieri TL. Inhalation injury consensus conference: conclusions. J Burn Care Res. 2009; 30: 209–10.