Cricoarytenoid arthritis in Sjögren’s syndrome

Rare Diseases of Larynx, Trachea and Thyroid

This review article covers data on rare diseases of the larynx, the trachea and the thyroid. In particular, congenital malformations, rare manifestations of inflammatory laryngeal disorders, benign and malignant epithelial as well as non-epithelial tumors, laryngeal and tracheal manifestations of general diseases and, finally, thyroid disorders are discussed. The individual chapters contain an overview of the data situation in the literature, the clinical appearance of each disorder, important key points for diagnosis and therapy and a statement on the prognosis of the disease. Finally, the authors indicate on study registers and self-help groups.

Cricoarytenoid joint arthritis: a possible complication of dermatomyositis

Cricoarytenoid joint arthritis is most frequently reported in Rheumatoid Arthritis and in other systemic diseases such as Sjogren's syndrome, Systemic Lupus Erythematosus, Ankylosing Arthritis, Juvenile Chronic Arthritis, and autoimmune hepatitis but it has not been reported in dermatomyositis. In this paper, we report the case of a 43 years-old woman treated for dermatomyositis who presented with hoarseness and severe odynophagia. The laryngoscopy revealed the presence of an extensive white swelling of the left cricoarytenoid joint with reduced mobility of the left vocal cord, consistent with left cricoarytenoid joint arthritis, which has not previously been described in dermatomyositis to our knowledge. Treatment with high doses of prednisone produced a complete resolution of the laryngeal symptoms.

Laryngeal Involvement in Connective Tissue Disorders. Is it Important for Patient Management?

Connective tissue disorders (CTDs) involve multiple organ systems and may have a significant impact on the overall health and quality of life of the affected individuals. The present paper aims to review the current knowledge on the laryngeal manifestations of CDTs, and describe the available diagnostic and treatment options. Systematic literature review in Medline and other database sources. Information from related books was also included. Prospective controlled, double-blind prospective, prospective, and transversal cohort studies, case series, case reports, systematic reviews, and consensus papers. Laryngeal involvement mostly occurs in rheumatoid arthritis (13-75% of patients). It is not uncommon in active and progressive clinical course, though can also occur in silent or inactive CDTs. The crico-arytenoid joint is the most commonly affected site. Common symptoms include throat pain, dyphonia and hoarseness. Careful clinical assessment of the larynx by flexible naso-endoscopy, video-stroboscopy, or direct laryngoscopy, and appropriate imaging are required for pertinent patient management. Stridor is a sign of a life-threatening condition, and may require prompt surgical intervention. However, mild symptomatology may mislead clinicians, and the related diagnosis may be significantly delayed. The current evidence as identified in the present study suggest that laryngeal manifestations of CDTs are often underdiagnosed, due to a range of non- specific symptoms. A multidisciplinary team approach with ENT input is necessary to improve the overall patient management.

Asymmetric mineralization of the arytenoid cartilages in patients without laryngeal cancer

BACKGROUND AND PURPOSE

Sclerosis of the arytenoid cartilage may be seen as an incidental finding in patients who do not have laryngeal cancer but may also be an early sign of neoplastic infiltration. Our purpose was to determine the frequency of asymmetric mineralization, in particular sclerosis, of the arytenoid cartilages on CT scans in adults who have no history of laryngeal cancer.

MATERIALS AND METHODS

Cervical CT scans of 972 consecutive patients seen in our emergency department were retrospectively evaluated. Three hundred twenty-two patients were excluded who were younger than 18 years of age or whose arytenoids could not be reliably seen due to artifacts. Six hundred fifty patients (424 men, 226 women) were assessed, and their arytenoid cartilages were graded as nonmineralized, calcified, sclerotic, or ossified on each side separately. The mean age of patients was 44.3 ± 17.8 years (range, 18-97 years).

RESULTS

The frequencies of asymmetric arytenoid cartilage sclerosis, calcification, and ossification were 4.9% (32/650), 4.4% (29/650), and 3.4% (23/650), respectively, with an overall asymmetric mineralization frequency of 12.9% (84/650). Asymmetric sclerosis was more common in women (16/226, 7.1%) than in men (16/424, 3.8%), but the difference was just at statistical significance (P = .05). The rate of unilateral arytenoid sclerosis was 4.6% in all subjects, 6.6% in women, and 3.5% in men. Unilateral sclerosis is much more frequently associated with the left arytenoid than the right.

CONCLUSIONS

Asymmetric mineralization of the arytenoid cartilages was seen in 12.9% of our study population. This should be taken into account when evaluating CT scans of patients with laryngeal cancer for arytenoid cartilage invasion to avoid false-positive reads.

Hoarseness Due to Bamboo Nodes in Patients with Autoimmune Diseases: A Review of Literature

SUMMARY

This is a retrospective report on clinical features, laryngoscopic examinations, and follow-up markers of laryngeal manifestation described as bamboo nodes in three female patients with transverse cystic lesions of the vocal folds, treated with logopedic therapy. This study examines logopedic and phoniatric aspects in patients with submucosal "bamboo joint-like nodes" of both vocal folds, and reveals an improvement of different voice quality features after conservative traditional voice therapy. There still exists no standard treatment regimen in patients with rheumatoid disease of the larynx; a lack of consensus is most evident in the role of voice therapy. We would like to emphasize the favorable impact of logopedic therapy in benign laryngeal disorders with underlying autoimmune diseases.