[Chronic laryngitis and carcinoma (author's transl)]

The role of oral formulation of hyaluronic acid and chondroitin sulphate for the treatment of the patients with laryngopharyngeal reflux

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Reflux Esophagitis as a Possible Risk Factor in the Development of Pharyngolaryngeal Squamous Cell Carcinoma

Aims and background

To determine the role of reflux esophagitis in the development of pharyngolaryngeal squamous cell carcinoma in non-smoking and non-drinking patients.

Methods

The study population consisted of 92 consecutive non-smoking and non-drinking patients with histologically confirmed squamous cell carcinoma of the pharynx and the larynx. As a control, a group of 125 lifetime non-smoking and non-drinking cancer-free subjects was selected.

Results

Patients with pharyngolaryngeal cancer had a higher prevalence of reflux esophagitis than the control subjects (P <0.0001).

Conclusions

Our results confirm that reflux esophagitis in itself is associated with an increased risk of upper aerodigestive tract cancer.

Gastro-pharyngeal reflux and total laryngectomy. Increasing knowledge about its management

PURPOSE

Investigate the incidence, the degree and the effect of gastro-pharyngeal reflux (GPR) in laryngectomised patients.

MATERIALS AND METHODS

Behavioral and 24-hour pH- and impedance-monitoring data were prospectively analyzed for 25 laryngectomised patients with no previous history of GER in outpateints' setting. Reflux detected was characterized as either acid, weakly acidic or nonacid. Proximal reflux was found at 15cm above the LES.

RESULTS

40% of patients presented a pathological number of reflux episodes in the upright position (p<0.0001); 9 of them presented a pathologic bolus exposure time. Bolus exposure at the proximal sphincter was one fourth-fold lower than 5cm above the LES (p=0.3593). There was a prevalence of acid reflux at both sphincters (p<0.0001); liquid reflux was prevalent at the LES (p=0.003) and mixed reflux at the UES (p=0.0001). Median REs was higher than time acid exposure (p=0.0013).

CONCLUSIONS

Pre- and post-surgical reflux investigation could identify preexisting reflux severity and screen potential high-risk cancer patients for postoperative complications. This might allow the early onset of acid suppressive therapy in presence of pathologic findings in high-complication risk cancer patients.

Duodenal Contents Reflux-Induced Laryngitis in Rats: Possible Mechanism of Enhancement of the Causative Factors in Laryngeal Carcinogenesis

Objectives:

The main factors considered responsible for the onset of laryngeal cancer are tobacco smoking and alcohol abuse. Recently, gastroesophageal reflux has also been implicated as a causative factor in several laryngeal disorders, including laryngeal cancer. However, the significance of gastroesophageal reflux in laryngeal cancer is controversial.

Methods:

We investigated the histologic features of the esophagus and larynx in a rat model of reflux of the duodenal contents. Cell proliferation was also evaluated in laryngeal samples by detection of Ki67 antigen.

Results:

In this reflux model, laryngitis with infiltration of inflammatory cells and proliferation of small mucous glands was evident from 10 weeks after operation, and basal cell hyperplasia around the epiglottis and hyperplastic changes in the larynx were detected at 30 weeks. No dysplastic or malignant lesions were detected in the laryngeal samples within the duration of the experiment, in spite of detection of malignancy in 31.3% of lesions in esophageal samples at 30 weeks. The Ki67 index at each week was significantly higher than that of the control animals.

Conclusions:

Previous studies have shown smoking and alcohol abuse to have refluxogenic effects. Reflux of duodenal contents causes laryngitis. Reflux does not appear to be an independent risk factor for laryngeal carcinogenesis, but it may enhance the acknowledged etiologic risk factors, namely, smoking and alcohol abuse, by promoting cell proliferation.

Pepsin promotes proliferation of laryngeal and pharyngeal epithelial cells

OBJECTIVE/HYPOTHESIS

Laryngopharyngeal reflux (LPR) is thought to be a significant risk factor for laryngeal squamous cell carcinoma (SCC), but causality has never been proven. It is accepted that chronic reflux into the esophagus can induce metaplastic changes in esophageal mucosa with subsequent increased risk of esophageal adenocarcinoma, but no similar associations have been established for LPR and laryngopharyngeal SCC. The objective of this study was to test the hypothesis that reflux of pepsin into the laryngopharynx can promote carcinogenesis.

STUDY DESIGN

Translational research study.

METHODS

Normal human laryngeal primary epithelial cell cultures and hypopharyngeal FaDu SCC cells were exposed to human pepsin and analyzed by Human Cancer PathwayFinder and miRNA Superarrays, flow cytometry, and Western blot to determine the effect of pepsin on carcinogenesis. Laryngeal biopsy specimens taken from cancer patients and normal control subjects were analyzed for the presence of pepsin by Western blot.

RESULTS

Microarray analysis demonstrated that pepsin significantly altered the expression of 27 genes implicated in carcinogenesis and also affected the expression of 22 microRNAs known to be altered in human head and neck cancers. Pepsin increased proliferation in both FaDu SCC cells and cultured normal laryngeal epithelial primary cells by increasing S phase distribution on flow cytometry analysis in a time- and dose-dependent manner. Furthermore, pepsin was detected in 60% (3/5) human laryngeal cancer biopsies, absent in all (0/5) normal control specimens.

CONCLUSIONS

These data support a role for refluxed pepsin in the promotion of epithelial proliferation and carcinogenesis of the larynx and pharynx.

Increased risk of laryngeal and pharyngeal cancer after gastrectomy for ulcer disease in a population-based cohort study

Background:

Gastrectomy has been indicated as a risk factor for laryngeal cancer, and possibly also for pharyngeal cancer, but few studies are available. The postulated mechanism is increased bile reflux following gastrectomy.

Methods:

This was a population-based cohort study of patients who underwent gastrectomy for peptic ulcer disease between 1964 and 2008 in Sweden. Follow-up data for cancer was obtained from the Swedish Cancer Register. Relative risk was calculated as standardised incidence ratios (SIRs) with 95% confidence intervals (CIs).

Results:

The gastrectomy cohort comprises 19 767 patients, contributing 348 231 person-years at risk. The observed number of patients with laryngeal (n=56) and pharyngeal cancer (n=28) was two-fold higher than the expected (SIR: 2.0, 95% CI: 1.5–2.6 and SIR: 2.4, 95% CI: 1.6–3.5, respectively). After exclusion of 5536 cohort members with tobacco- or alcohol-related disease, the point SIRs remained increased (SIR: 1.6, 95% CI: 1.1–2.2 and SIR: 1.7, 95% CI: 0.9–2.8, respectively). The SIRs of laryngeal and pharyngeal cancer increased with time after gastrectomy (P for trend <0.0001), and were particularly increased ⩾30 years after gastrectomy (SIR: 4.8, 95% CI: 2.1–9.5 and SIR: 10.2, 95% CI: 3.7–22.3, respectively).

Conclusion:

Gastrectomy for peptic ulcer disease might entail a long-term increased risk of laryngeal and pharyngeal cancer.

Is there any association between esophagogastric endoscopic findings and laryngeal cancer?

PURPOSE

The aim of the study was to survey the association between prevalence of acid-related inflammation in the upper digestive tract and laryngeal cancer.

MATERIALS AND METHODS

A case-control study was done in an otolaryngology ward at an academic university. Totally, 65 patients with laryngeal cancer and 65 cancer-free matched controls underwent esophagogastroduodenoscopy, and endoscopic findings were collected.

RESULTS

In the case group, positive endoscopic findings were significantly higher than the control group (87.7% vs 58.5%; P < .001). Laryngeal cancer patients had erosive esophagitis, and gastritis ± other findings more than the control group (48 vs 29 cases) and the difference was statistically significant.

CONCLUSION

The difference between endoscopic findings in cases and controls was statistically significant. Severe inflammation and erosion existed in patients with laryngeal cancer that could be due to increased acid secretion. Our study supported the hypothesis that gastric acid and pepsin play a role in laryngeal cancer.

The role of laryngopharyngeal reflux as a risk factor in laryngeal cancer: a preliminary report

Objectives

To evaluate the significance of laryngopharyngeal reflux (LPR) as a risk factor in laryngeal cancer.

Methods

We performed a case-control study with 29 consecutive laryngeal cancer patients who had undergone 24-hour ambulatory double pH monitoring from 2003 to 2006. The control group included 300 patients who had undergone 24-hour ambulatory double pH monitoring due to LPR-related symptoms. We analyzed the prevalence of LPR and numerous parameters from the 24-hour ambulatory double pH monitoring in the laryngeal cancer patient and control groups. Pathologic LPR is defined when more than three episodes of LPR occur in 24 hours.

Results

The prevalence of pathologic LPR was significantly higher in the laryngeal cancer group than the control group (P=0.049). The reflux number of the upper probe was significantly higher in the laryngeal cancer group (P<0.001). However the effects of pathologic LPR on laryngeal cancer risk were diluted after adjusting for smoking and alcohol consumption in the multivariable logistic regression.

Conclusion

The pathologic LPR might be a possible risk factor in the development of laryngeal cancer. A further study should be necessary to verify the exact role of LPR in laryngeal cancer.

Analysis of Pepsin in Tracheoesophageal Puncture Sites

Objectives:

Tracheoesophageal puncture (TEP) and prosthesis insertion is a well-established method of voice rehabilitation after laryngectomy. Maintenance of the prosthesis and tract can be challenging, and reflux to the TEP site has been proposed as a cause. The sites of TEP were evaluated for the presence of pepsin in tissue biopsy specimens and tract secretions to explore this association.

Methods:

Patients with TEP were interviewed for a history of symptoms related to reflux, medication use history, TEP voice quality, and incidence of TEP complications. Tissue biopsy specimens and tract secretions were obtained from TEP sites and analyzed for the presence of pepsin via sodium dodecyl sulfate–polyacrylamide gel electrophoresis Western blot analysis.

Results:

Twelve of 17 patients (47%) had some history of preoperative or postoperative symptoms of gastroesophageal reflux disease or laryngopharyngeal reflux. Pepsin was present within the TEP site in a total of 10 of 17 patients (58%; 7 of 17 tissue biopsy specimens and 6 of 7 secretion samples). There were no statistically significant associations between the presence of pepsin and sex, reflux history, use of acid suppressive medicine, or time since laryngectomy.

Conclusions:

Reflux with subsequent pepsin deposition into the TEP tract occurs in a majority of laryngectomy patients. Further studies on the effect of reflux on the health and function of the TEP tract are warranted.

[Bright white vocal folds and capillary ectasias. Late sequelae after radiotherapy]

We report on visible laryngeal changes after radiotherapy. In this study, three women and two men aged 50-64 years were involved. In three cases, the primary tumor was a carcinoma of the thyroid gland and in one case a carcinoma of the esophagus. Due to dysplasia of the vocal folds, one patient underwent primary radiotherapy. Endoscopy was performed 4 to 22 years after radiotherapy. The larynx was examined by video-laryngoscopy and stroboscopy. We found a characteristic pattern of the vocal folds in all patients: bright white vocal fold surface, ectasia of capillaries and increased angiogenesis. We only found this pattern in patients after radiotherapy. In our opinion, these findings are late sequelae of radiotherapy. The picture of laryngitis due to radiotherapy can be distinguished from chronic laryngitis of other etiology using these criteria.

Is laryngopharyngeal reflux an important risk factor in the development of laryngeal carcinoma?

Laryngopharyngeal reflux (LPR) as a causative irritating factor in the development of laryngeal carcinoma has been suggested. However, the association between LPR and laryngeal carcinoma remains unclear. The aim of this study was to compare the prevalence and severity of reflux between patients with laryngeal carcinoma and clinical LPR. The intention was to find out if a correlation exists between the laryngeal findings and the level of acid reflux. The study population consisted of 29 patients with laryngeal cancer (group I), 33 LPR patients with normal laryngeal findings (group II) and 70 LPR patients with related laryngeal pathology (group III). The results of 24-h, double-channel ambulatory esophageal pH monitoring were analyzed comparing the three groups. The occurrence and severity of abnormal acid reflux at the upper and lower esophageal segments were evaluated. The incidence of LPR or gastroesophageal reflux (GER) did not vary in any of the three groups (LPR was present in 62, 42 and 56% of the patients, while GER was present in 45, 24 and 37% of the patients, respectively). Patients with LPR or GER from the three groups did not differ significantly in terms of the number of acid reflux episodes and percentage of times when the pH was <4. Our data do not support the hypothesis that LPR can be an independent risk factor in the development of larynx cancers. However, the data also do not thoroughly exclude the possibility. The reason why LPR leads to variable pathologies in the larynx may be uncovered by studies probing the differences between patients via detailed examinations of the local anti-reflux barriers such as epithelial morphology and functions.

Extraesophageal reflux and upper aerodigestive tract diseases

Reflux disease can cause multiple disorders not only of the esophagus but also of the upper aerodigestive tract. In the last decade, an association between reflux disease and multiple head and neck diseases was described, including those of the larynx and pharynx as well as those of the nose, the sinuses and the middle ear. The present article summarizes these different diseases and possible pathomechanisms are explained. In particular, there is a need to differentiate between the classical gastroesophageal reflux disease (GERD) and the extraesophageal manifestation of the reflux disease, called extraesophageal reflux (EER). Both diseases are characterized by different symptoms and can cause different disorders. To differentiate between GERD and EER, double-probe pH monitoring is mandatory. At last, some aspects of reflux therapy are explained.

No Association between Gastroesophageal Reflux and Cancers of the Larynx and Pharynx

PURPOSE

To examine the proposed relation between gastroesophageal reflux disease and cancers of the larynx and pharynx.

EXPERIMENTAL DESIGN

A cohort of 66,965 patients with discharge diagnoses of heartburn, hiatal hernia, or esophagitis was identified in the Swedish Inpatient Register. We observed a total of 376,622 person-years in the cohort. Identification of laryngeal and pharyngeal cancers was achieved through the Swedish Cancer Register. Standardized incidence ratios, the ratio of the observed to the expected number of cancers, derived from the general Swedish population and adjusted for sex, age, and calendar year, was used to estimate the relative risk.

RESULTS

During follow-up, 30 cases of laryngeal and 31 cases of pharyngeal cancer were detected in the cohort. Slightly increased risks of laryngeal [relative risk, 1.6; 95% confidence interval (CI), 1.1-2.2] and pharyngeal carcinomas (relative risk, 1.9; 95% CI, 1.3-2.8) were observed in the total reflux cohort. After stratification to exclude cohort members with a diagnosis of alcoholism, no significant increase in the risk of laryngeal (relative risk, 1.3; 95% CI, 0.8-2.0) or pharyngeal carcinomas (relative risk, 1.0; 95% CI, 0.5-1.6) was found compared with the general population. Furthermore, there were no dose-response patterns of the risk for laryngeal and pharyngeal cancers with years of cohort follow-up, indicators of reflux severity, or specificity of reflux diagnosis.

CONCLUSION

This study provides no evidence in support of the proposed association between gastroesophageal reflux disease and cancers of the larynx or pharynx.

Effects of gastroesophageal reflux disease in laryngeal carcinoma

Gastroesophageal reflux disease is associated with various otolaryngological disorders. The aim of this retrospective study was to determine the role of gastroesophageal reflux disease in the development of laryngeal squamous cell carcinoma (SCC) in non-smoking and non-drinking patients. The study population consisted of 36 consecutive non-smoking and non-drinking patients with histologically confirmed SCC of the larynx. As a control, a group of 125 lifetime non-smoking and non-drinking cancer-free subjects were selected. Patients with laryngeal cancer had a higher prevalence of gastroesophageal reflux disease than the control subjects (P < 0.0001). Our results confirm the fact that gastroesophageal reflux disease in itself is associated with an increased risk of laryngeal cancer.

Association of laryngeal cancer with previous gastric resection

OBJECTIVE

To investigate the association between gastric surgery and cancer of the larynx.

SUMMARY BACKGROUND DATA

Biliary reflux is frequent after gastric surgery and may reach the proximal segment of the esophagus and the larynx. It is possible that duodenal content (consisting in bile acids, trypsin), together with pepsin and acid residues when gastric resection is partial, may cause harmful action on the multistratified epithelium of the larynx.

METHODS

A retrospective case-control study on subjects admitted between January 1987 and May 2002 in the same hospital in Rome was carried out. The study included 828 consecutive patients with laryngeal cancer (cases) and 825 controls with acute myocardial infarction. Controls were randomly sampled out of a total of 10,000 and matched with cases for age, sex, and year of admission. Logistic regression models were used to assess the role of gastric resection in determining laryngeal cancer risk while controlling for potential confounding factors.

RESULTS

Previous gastrectomy was reported by 8.1% of cases and 1.8% of the controls (P < 0.0001). A 4-fold association emerged between gastric surgery and laryngeal cancer risk (adjusted OR = 4.3, 95% CI: 2.4-7.9). The risk appeared strongly increased 20 years after surgery (OR = 14.8, 95% CI: 3.4-64.6). Heavy alcohol drinking (OR = 2.5, 95% CI: 1.8-3.5), smoking (OR = 4.7, 95% CI: 3.3-6.7), and blue-collar occupation (OR = 4.6, 95% CI: 3.2-6.7) were all independently associated with the risk of laryngeal cancer.

CONCLUSIONS

Previous gastric surgery is associated with an increased risk of laryngeal cancer. A periodic laryngeal examination should be considered in long-term follow-up of patients with gastric resection.

The role of acid and alkaline reflux in laryngeal squamous cell carcinoma

HYPOTHESIS

At present, main factors considered responsible for the onset of squamous cell carcinoma are tobacco smoking, alcohol abuse, and exposure to viral and toxic agents. In last years, great interest has been focused on gastroesophageal reflux as independent carcinogenic factor and co-carcinogen in association with smoking and alcohol assumption.

STUDY DESIGN

Initially, the aim of this study was to objectively evaluate the presence of distal and proximal esophageal reflux with multielectrode pH measurement in patients with cancer of the larynx and/or hypopharynx (group A). However, in the course of the study, pharyngolaryngeal cancer was also observed in 4 patients with achlorhydria; therefore, the hypothesis that alkaline reflux might be involved in the onset of laryngeal cancer was tested (group B).

METHODS

Twenty-one consecutive patients with laryngeal or hypopharyngolaryngeal squamous cell carcinoma (group A) entered the study. Twenty-one patients without laryngo-pharyngeal diseases were used as control subjects. A validated questionnaire of the clinical history was completed by all patients who underwent 24-hour pH monitoring. Group B included 40 consecutive gastrectomized patients (28 males and 12 females) in whom biliary or alkaline reflux was directly consequent to Billroth I or Billroth II operation. The control group was composed of 40 non-gastrectomized dyspeptic patients. The clinical history was controlled and obtained; EDGS and ENT examination with videolaryngoscopy was performed in all patients.

RESULTS

In group A, pH measurement showed pathological reflux in 80.9% (17 of 21) of patients with no typical symptoms in 63.7% of them. The difference was significant with respect to the control group. In group B, 6 of 40 (15%) had preneoplastic lesions or a history of laryngeal tumor. The difference was significant with respect to the control group. A total of 7.5% of group B patients had previously undergone CO2 laser cordectomy for laryngeal squamous cell carcinoma and 7.5% had leukoplakia. We found a significantly higher incidence (<.05) of neoplastic and preneoplastic disease of the larynx in patients undergoing Billroth II and total gastrectomy than in those undergoing Billroth I and Roux-en-Y resection. We also found a significant increase (<.01) in ENT lesions in the group of patients who had undergone gastrectomy more than 20 years previously.

CONCLUSIONS

In agreement with literature reports, results obtained in group A confirmed that gastroesophageal reflux is often present in patients with neoplastic lesions of the pharynx and larynx. Furthermore, gastric resection is indicated for the first time as an additional risk factor or cofactor of precancerosis and squamous cell carcinoma of the pharynx or larynx. Further studies are necessary to establish the cause and effect relationship between biliary reflux and pharyngo-laryngeal tumors.

Prevalence of reflux in 113 consecutive patients with laryngeal and voice disorders

OBJECTIVES

The goal was to estimate the prevalence of laryngopharyngeal reflux (LPR) in patients with laryngeal and voice disorders.

STUDY DESIGN AND SETTING

This was a prospective study of 113 unselected, new patients with laryngeal and voice disorders. Patients completed an extensive medical history form including a reflux symptom profile. A comprehensive otolaryngologic examination was performed with photographic transnasal fiberoptic laryngoscopy. Patients with both symptoms and findings of LPR (78/133, 69%) underwent ambulatory 24-hour double-probe pH monitoring.

RESULTS

Seventy-three percent (57/78) of patients undergoing pH testing had abnormal studies. Thus 50% (57/113) of the entire the study population had pH-documented reflux. Of the diagnostic sub-groups studied, the highest incidence of reflux was found in patients with vocal cord neoplastic lesions (88%) and patients with muscle tension dysphonias (70%). LPR was infrequently found in patients with neuromuscular disorders.

CONCLUSION

LPR occurs in at least 50% of all patients at our center with laryngeal and voice disorders at presentation.

High incidence of laryngopharyngeal reflux in patients with head and neck cancer

OBJECTIVES

Laryngopharyngeal reflux may play a role in the etiology of squamous cell cancer of the head and neck and contribute to complications in head and neck cancer patients after surgery or during radiotherapy.

STUDY DESIGN

Prospective study.

METHODS

To investigate the incidence of laryngopharyngeal and gastroesophageal reflux in patients with head and neck cancer, ambulatory 24-hour double-probe pH monitoring was performed in 24 untreated patients with laryngeal or pharyngeal squamous cell carcinoma. In addition, 10 patients who had been irradiated in the head and neck area were analyzed for reflux to study the effect of radiotherapy on reflux.

RESULTS

Only 4 of the 24 head and neck cancer patients (17%) had neither pathological laryngopharyngeal nor gastroesophageal reflux. Esophageal acid exposure was abnormal in five patients and acid exposure at the level of the upper esophageal sphincter was abnormal in four patients. Eleven patients had pathological reflux in both areas. Irradiated patients did not differ from the untreated patients considering the incidence of pathological laryngopharyngeal or gastroesophageal reflux.

CONCLUSIONS

The data obtained in this study indicate that reflux is a common event in head and neck cancer patients.

The usefulness of screening in the early detection of laryngeal cancer

Opinions are divided about screening for cancer in the early stage and for hyperplastic alterations of the laryngeal mucosa which may lead to cancer. In order to form our own opinion we conducted a laryngological survey of 100 male and 50 female patients aged 30-70, employed in the textile and metallurgical industry, most of whom were smokers. In no case did we detect cancer or any abnormalities that would require immediate additional diagnostic procedures. We are well aware that caution is required in the analysis of data obtained in a sample as small as ours. Nevertheless we were to find even in this small group at risk, at least a few patients with laryngeal mucosa which could progress into cancer, yet we did not detect such changes. For this reason we concluded that screening does not always result in the hoped for outcome. It also requires much time and effort. We even question the justification of yearly examinations of the populations at risk, even though some authors consider this to be feasible. More important than screening is public health education which is primarily the responsibility of general practitioners as well as laryngologists. The population has to be educated and made to understand that surgery or radiation therapy at early stage of cancer is almost totally curable and does not result in any mutilation or invalidity.

The otolaryngologic manifestations of gastroesophageal reflux disease (GERD): a clinical investigation of 225 patients using ambulatory 24-hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury

Occult (silent) gastroesophageal reflux disease (GER, GERD) is believed to be an important etiologic factor in the development of many inflammatory and neoplastic disorders of the upper aerodigestive tract. In order ot test this hypothesis, a human study and an animal study were performed. The human study consisted primarily of applying a new diagnostic technique (double-probe pH monitoring) to a population of otolaryngology patients with GERD to determine the incidence of overt and occult GERD. The animal study consisted of experiments to evaluate the potential damaging effects of intermittent GER on the larynx. Two hundred twenty-five consecutive patients with otolaryngologic disorders having suspected GERD evaluated from 1985 through 1988 are reported. Ambulatory 24-hour intraesophageal pH monitoring was performed in 197; of those, 81% underwent double-probe pH monitoring, with the second pH probe being placed in the hypopharynx at the laryngeal inlet. Seventy percent of the patients also underwent barium esophagography with videofluoroscopy. The patient population was divided into seven diagnostic subgroups: carcinoma of the larynx (n = 31), laryngeal and tracheal stenosis (n = 33), reflux laryngitis (n = 61), globus pharyngeus (n = 27), dysphagia (n = 25), chronic cough (n = 30), and a group with miscellaneous disorders (n = 18). The most common symptoms were hoarseness (71%), cough (51%), globus (47%), and throat clearing (42%). Only 43% of the patients had gastrointestinal symptoms (heartburn or acid regurgitation). Thus, by traditional symptomatology, GER was occult or silent in the majority of the study population. Twenty-eight patients (12%) refused or could not tolerate pH monitoring. Of the patients undergoing diagnostic pH monitoring, 62% had abnormal esophageal pH studies, and 30% demonstrated reflux into the pharynx. The results of diagnostic pH monitoring for each of the subgroups were as follows (percentage with abnormal studies): carcinoma (71%), stenosis (78%), reflux laryngitis (60%), globus (58%), dysphagia (45%), chronic cough (52%), and miscellaneous (13%). The highest yield of abnormal pharyngeal reflux was in the carcinoma group and the stenosis group (58% and 56%, respectively). By comparison, the diagnostic barium esophagogram with videofluoroscopy was frequently negative. The results were as follows: esophagitis (18%), reflux (9%), esophageal dysmotility (12%), and stricture (3%). All of the study patients were treated with antireflux therapy. Follow-up was available on 68% of the patients and the mean follow-up period was 11.6 +/- 12.7 months.(ABSTRACT TRUNCATED AT 400 WORDS)

Malignant tumours in patients with non-invasive squamous cell lesions of the vocal cords

The concept of 'field cancerization' is applicable throughout the upper aerodigestive tract, oesophagus and lung. The material for this study consisted of 232 patients with hyperplasia, keratosis with or without dysplasia, and carcinoma in situ of the vocal cords. The overall risk for these patients with non-invasive squamous cell lesions of the vocal cords to have or to develop an independent, primary malignant tumour was 12.9% (30/232). Carcinomas of the head and neck, lung or oesophagus were diagnosed in 8.2% (19/232) of the patients. Patients with hyperplasia, keratosis, dysplasia and carcinoma in situ of the vocal cords should be carefully followed-up, not only as progression to invasive carcinoma may occur many years after the initial diagnosis, but also as there is a high incidence of independent primary tumours, especially of the multicentric type.

Hyperplasia, keratosis, dysplasia and carcinoma in situ of the vocal cords--a follow-up study

Comparison of reported series of laryngeal lesions is complicated by the inconsistency in the terminology. The classification of these lesions should logically be based on the degrees of dysplasia, as this has a bearing on the prognosis. The material for this study consisted of 193 patients with hyperplasia and/or keratosis, with or without mild dysplasia (Group I), moderate dysplasia (Group II), and severe dysplasia and carcinoma in situ (Group III). They were treated over a 14-year period (1966-1979) at Linköping University Hospital. Of the 98 patients in Group I available for follow-up, 23 had repeat excisions. Moderate dysplasia developed in 3 patients, severe dysplasia in 2, and invasive carcinoma in another 2 within 3 and 3.5 years; they both underwent laryngectomy. Among the 24 patients in Group II available for follow-up, severe dysplasia developed in 3 and invasive carcinoma in 3 up to 13 years after the initial diagnosis, all but one (with severe dysplasia) received a full course of radiotherapy, on one case total laryngectomy was subsequently performed for recurrent carcinoma. Of the 39 patients with severe dysplasia and carcinoma in situ 16 were given primary radiotherapy; 4 of these developed invasive carcinoma; 3 of them underwent total laryngectomy and one partial laryngectomy. Excision or stripping of the vocal cords was the primary treatment in 23 cases; 5 of these developed invasive carcinoma; 2 of them underwent total laryngectomy. Diffuse lesions and well differentiated forms of severe dysplasia caused most problems and had the highest incidence of invasive carcinoma irrespective of the form of treatment. Patients with hyperplasia, keratosis, dysplasia and carcinoma in situ should be carefully followed up, as invasive carcinoma may develop many years after the initial diagnosis.