1
|
Malinowski J, Pietruszewska W, Kowalczyk M, Niebudek-Bogusz E. Value of high-speed videoendoscopy as an auxiliary tool in differentiation of benign and malignant unilateral vocal lesions. J Cancer Res Clin Oncol 2024; 150:10. [PMID: 38216796 PMCID: PMC10786956 DOI: 10.1007/s00432-023-05543-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/13/2023] [Indexed: 01/14/2024]
Abstract
PURPOSE The study aimed to assess the relevance of objective vibratory parameters derived from high-speed videolaryngoscopy (HSV) as a supporting tool, to assist clinicians in establishing the initial diagnosis of benign and malignant glottal organic lesions. METHODS The HSV examinations were conducted in 175 subjects: 50 normophonic, 85 subjects with benign vocal fold lesions, and 40 with early glottic cancer; organic lesions were confirmed by histopathologic examination. The parameters, derived from HSV kymography: amplitude, symmetry, and glottal dynamic characteristics, were compared statistically between the groups with the following ROC analysis. RESULTS Among 14 calculated parameters, 10 differed significantly between the groups. Four of them, the average resultant amplitude of the involved vocal fold (AmpInvolvedAvg), average amplitude asymmetry for the whole glottis and its middle third part (AmplAsymAvg; AmplAsymAvg_2/3), and absolute average phase difference (AbsPhaseDiffAvg), showed significant differences between benign and malignant lesions. Amplitude values were decreasing, while asymmetry and phase difference values were increasing with the risk of malignancy. In ROC analysis, the highest AUC was observed for AmpAsymAvg (0.719; p < 0.0001), and next in order was AmpInvolvedAvg (0.70; p = 0.0002). CONCLUSION The golden standard in the diagnosis of organic lesions of glottis remains clinical examination with videolaryngoscopy, confirmed by histopathological examination. Our results showed that measurements of amplitude, asymmetry, and phase of vibrations in malignant vocal fold masses deteriorate significantly in comparison to benign vocal lesions. High-speed videolaryngoscopy could aid their preliminary differentiation noninvasively before histopathological examination; however, further research on larger groups is needed.
Collapse
Affiliation(s)
- Jakub Malinowski
- Department of Otolaryngology, Head and Neck Oncology, Medical University of Lodz, Lodz, Poland.
| | - Wioletta Pietruszewska
- Department of Otolaryngology, Head and Neck Oncology, Medical University of Lodz, Lodz, Poland
| | - Magdalena Kowalczyk
- Department of Otolaryngology, Head and Neck Oncology, Medical University of Lodz, Lodz, Poland
| | - Ewa Niebudek-Bogusz
- Department of Otolaryngology, Head and Neck Oncology, Medical University of Lodz, Lodz, Poland
| |
Collapse
|
2
|
Itamura K, Hsue VB, Barbu AM, Chen MM. Diagnostic Assessment (Imaging) and Staging of Laryngeal Cancer. Otolaryngol Clin North Am 2023; 56:215-231. [PMID: 37030936 DOI: 10.1016/j.otc.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2023]
Abstract
Diagnosis of larynx cancer relies on a detailed history and physical and objective assessment with endoscopy and imaging. Endoscopy is needed to assess for vocal fold function that directly affects staging. Computed tomography and MRI can be used to assess for tumor extent in relation to intra- and extra-laryngeal structures, especially paraglottic and pre-epiglottic space involvement as well as cartilage invasion. Accurate staging is critical for subsequent treatment decision-making regarding larynx preservation.
Collapse
Affiliation(s)
- Kyohei Itamura
- Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, 8635 West Third Street #590W, Los Angeles, CA 90048, USA
| | - Victor B Hsue
- Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, 8635 West Third Street #590W, Los Angeles, CA 90048, USA
| | - Anca M Barbu
- Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, 8635 West Third Street #590W, Los Angeles, CA 90048, USA
| | - Michelle M Chen
- Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, 8635 West Third Street #590W, Los Angeles, CA 90048, USA; Department of Otolaryngology-Head and Neck Surgery, Stanford University, 900 Blake Wilbur Drive Rm W3045, Stanford, CA 94305, USA.
| |
Collapse
|
3
|
Yamauchi A, Imagawa H, Yokonishi H, Sakakibara KI, Tayama N. Multivariate Analysis of Vocal Fold Vibrations in Normal Speakers Using High-Speed Digital Imaging. J Voice 2021; 11:S0892-1997(21)00252-6. [PMID: 34470706 DOI: 10.3390/app11146284] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/30/2021] [Accepted: 08/02/2021] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Little is known about the normal variations in vocal fold vibrations. We conducted a prospective study on normal subjects using high-speed digital imaging (HSDI) to elucidate key parameters regarding age/gender-related normal variations. METHODS Forty-six healthy adult volunteers were divided into young (aged ≤35 years) male, young female, elderly (aged ≥65 years) male, and elderly female subgroups. HSDI data of sustained phonation of /i/ at a comfortable pitch and loudness were obtained, and vibratory parameters were calculated using the visual-perceptual rating, laryngotopography, digital kymography, and glottal area waveform. Multivariate analysis was then performed on these parameters to clarify the subgroup-specific key parameters. RESULTS Four key parameters were identified from a total of 83: one from visual perceptual rating and three from laryngotopography. Subgroup analyses showed that posterior-to-anterior longitudinal phase difference (PD) and high fundamental frequency (F0) were specific to young female participants. A low F0 was specific to young male participants. Large anterior-to-posterior longitudinal PD and its left-right difference were specific to elderly male participants. There were no key parameters for elderly female participants. CONCLUSIONS Methods that can assess F0 and longitudinal PD, such as visual-perceptual rating and laryngotopography, were effective in the evaluation of normal vocal fold vibrations and their variations.
Collapse
Affiliation(s)
- Akihito Yamauchi
- Department of Otolaryngology, The University of Tokyo Hospital, Bunkyo-Ku, Tokyo, Japan.
| | - Hiroshi Imagawa
- Department of Otolaryngology, The University of Tokyo Hospital, Bunkyo-Ku, Tokyo, Japan
| | - Hisayuki Yokonishi
- Department of Otolaryngology, Tokyo Metropolitan Bokutoh Hospital, Sumida-Ku, Tokyo, Japan
| | - Ken-Ichi Sakakibara
- Department of Communication Disorders, Health Sciences University of Hokkaido, Ishikari-Gun, Hokkaido, Japan
| | - Niro Tayama
- Department of Otolaryngology and Tracheo-esophagology, National Center for Global Health and Medicine, Shinjuku-Ku, Tokyo, Japan
| |
Collapse
|
4
|
Heyduck A, Brosch S, Pickhard A, Hoffmann TK, Reiter R. The Efficiency of ( videolaryngo)stroboscopy in Detecting T1a Glottic Carcinoma and Its Preliminary Stages. Ann Otol Rhinol Laryngol 2021; 131:471-477. [PMID: 34148426 DOI: 10.1177/00034894211026732] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The efficiency of laryngovideostroboscopy (LVS) in detecting premalignancies of the vocal fold and early glottic cancer was determined in a prospective monocentric study. In addition, the recovery rate of the mucosal membrane on the vocal fold after surgical intervention was determined by LVS. METHODS We included 159 patients with a leukoplakia of the vocal folds and 50 healthy controls. Clinicopathological data and LVS characteristics (amplitude, mucosal wave, nonvibratory segment, glottic closure, phase symmetry, periodicity) at the lesion site were obtained and compared with the histopathological results. LVS parameters were recorded before cordectomy and in a 12-month follow-up interval. Patients who had prior laryngosurgery, radiotherapy, or laryngeal scarring were excluded. RESULTS Absent or greatly reduced mucosal waves were found in all patients with an invasive carcinoma, in 94% with a severe intraepithelial neoplasia (SIN III), in 38% with a moderate squamous intraepithelial neoplasia (SIN II), in 32% with a mild squamous intraepithelial neoplasia (SIN I), and in 23% with a hyperkeratosis without dysplasia. The sensitivity and specificity of LVS in predicting an invasive carcinoma based on the absence or reduction of mucosal waves was 0.96 and 0.90, respectively. Following surgical intervention, the recovery rate of the mucosal wave and amplitude was 12% in the invasive carcinoma group, 36% in the SIN III group and up to 80% for both these parameters in the SIN I, SIN II, and hyperkeratosis groups. CONCLUSION LVS is a valid tool to identify early glottic carcinoma and its high risk premalignancy carcinoma in situ (CIS). Even when there is no definitive differentiation between SIN I and II, the invasive character of a CIS and an invasive glottic carcinoma can be identified. Especially strobosopic signs of abnormal amplitude and/or mucosal waves, particularly phoniatric halt, are an early indication for a CIS or an invasive carcinoma.
Collapse
Affiliation(s)
- Adrienne Heyduck
- Section of Phoniatrics and Pedaudiology, Department of Otolaryngology, Head and Neck Surgery, University of Ulm, Ulm, Germany
| | - Sibylle Brosch
- Section of Phoniatrics and Pedaudiology, Department of Otolaryngology, Head and Neck Surgery, University of Ulm, Ulm, Germany
| | - Anja Pickhard
- Department of Otolaryngology, Head and Neck Surgery, Technical University, Munich, Germany
| | - Thomas K Hoffmann
- Department of Otolaryngology, Head and Neck Surgery, University of Ulm, Ulm, Germany
| | - Rudolf Reiter
- Section of Phoniatrics and Pedaudiology, Department of Otolaryngology, Head and Neck Surgery, University of Ulm, Ulm, Germany
| |
Collapse
|
5
|
Laryngeal Mid-Cord Erythroleukoplakias: How to Modulate the Transoral CO 2 Laser Excisional Biopsy. Cancers (Basel) 2020; 12:cancers12082165. [PMID: 32759787 PMCID: PMC7464010 DOI: 10.3390/cancers12082165] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 12/17/2022] Open
Abstract
Background: The endoscopic appearance of glottic erythroleukoplakias is non-predictive of their histopathology, potentially ranging from keratosis to invasive squamous cell carcinoma (SCC). The aim of this study was to assess a comprehensive workup for the one-step diagnosis and treatment of mid-cord erythroleukoplakias, using CO2 laser excisional biopsy. Methods: We evaluated 147 untreated patients affected by 155 mid-cord erythroleukoplakias submitted to excisional biopsy by subepithelial (Type I) or subligamental cordectomy (Type II), across two academic institutions. Patients were evaluated by preoperative videolaryngostroboscopy, pre- and intraoperative videoendoscopy with biologic endoscopy (narrow band imaging, NBI, or the Storz professional image enhancement system, SPIES), either with or without intraoperative saline infusion into the Reinke’s space. Adequacy of treatment was the primary outcome. Results: The histopathologic diagnosis was keratosis in 26 (17%) cases, squamous intraepithelial neoplasia (SIN1-2) in 47 (30%), carcinoma in situ in 21 (14%), and SCC in 61 (39%) patients. The adequacy of treatment across the entire cohort was 89%. The intraoperative saline infusion procedure, facing not clearly suspicious lesions, raised the adequacy of treatment from 60% to 90% (p = 0.006). Conclusions: Excisional biopsy by Type I–II cordectomies, after a comprehensive diagnostic workup, should be accepted as an adequate and cost-effective treatment of unilateral mid-cord glottic erythroleukoplakias.
Collapse
|
6
|
Umeno H, Hyodo M, Haji T, Hara H, Imaizumi M, Ishige M, Kumada M, Makiyama K, Nishizawa N, Saito K, Shiromoto O, Suehiro A, Takahashi G, Tateya I, Tsunoda K, Shiotani A, Omori K. A summary of the Clinical Practice Guideline for the Diagnosis and Management of Voice Disorders, 2018 in Japan. Auris Nasus Larynx 2020; 47:7-17. [DOI: 10.1016/j.anl.2019.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/29/2019] [Accepted: 09/06/2019] [Indexed: 12/01/2022]
|
7
|
Mehlum CS, Kjaergaard T, Grøntved ÅM, Lyhne NM, Jørkov APS, Homøe P, Tvedskov JF, Bork KH, Möller S, Jørgensen G, Philipsen BB, Godballe C. Value of pre- and intraoperative diagnostic methods in suspected glottic neoplasia. Eur Arch Otorhinolaryngol 2019; 277:207-215. [PMID: 31654182 DOI: 10.1007/s00405-019-05698-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 10/12/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the individual and combined ability of videostroboscopy (VS), high-speed digital imaging (HSDI), enhanced endoscopy (EE) and saline infusion (SI) to predict neoplasia, defined as glottic precursor lesion (GPL) or T1a glottic cancer, in patients suspected for glottic neoplasia. METHODS A nationwide prospective cohort study of patients treated by cordectomy for suspected GPL or T1a glottic cancer from August 1st 2016 to October 31st 2018 was conducted in the five Danish University Departments of Head and Neck surgery. Sensitivity, specificity, negative and positive predictive values, and area under Receiver Operating Curves (AUC-ROC) were calculated with 95% confidence intervals with respect to the histological diagnosis. Logistic regression with an imputation model for missing data was applied. RESULTS 261 patients aged 34-91 years participated; 79 (30.3%) with non-neoplasia (i.e., inflammation, papilloma, hyperkeratosis) and 182 (69.7%) neoplasia, hereof 95 (36.4%) with GPL and 87 (33.3%) with T1a glottic cancer. Data from 188 VS, 60 HSDI, 100 preoperative EE, 209 intraoperative EE, and 234 SI were analyzed. In the complete case analysis the AUC-ROC of each diagnostic test was low, but increased when the tests were combined and especially if the combination included EE. However, multinomial logistic regression with imputation showed significant association (p < 0.05) only between age, male gender, and perpendicular vasculature in intraoperative EE, and the endpoint neoplasia. CONCLUSIONS Intraoperative EE was the most accurate diagnostic method in detecting neoplasia. The prediction ability of methods applied preoperatively was more limited, but improved when test modalities were combined.
Collapse
Affiliation(s)
- Camilla Slot Mehlum
- Department of ORL Head and Neck Surgery and Audiology, Odense University Hospital, J. B. Winsløwsvej 4, 5000, Odense, Denmark.
| | - Thomas Kjaergaard
- Department of Otorhinolaryngology-Head and Neck Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark
| | - Ågot Møller Grøntved
- Department of ORL Head and Neck Surgery and Audiology, Odense University Hospital, J. B. Winsløwsvej 4, 5000, Odense, Denmark
| | - Nina Munk Lyhne
- Department of Head and Neck Surgery, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| | | | - Preben Homøe
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Lykkebækvej 1, 4600, Køge, Denmark
| | - Jesper Filtenborg Tvedskov
- Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Rigshospitalet, University Hospital of Copenhagen and University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Kristian Hveysel Bork
- Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Rigshospitalet, University Hospital of Copenhagen and University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Sören Möller
- OPEN-Open Patient Data Explorative Network and Department of Clinical Research, Odense University Hospital and University of Southern Denmark, J. B. Winsløwsvej 9, 5000, Odense, Denmark
| | - Gita Jørgensen
- Department of ORL Head and Neck Surgery and Audiology, Odense University Hospital, J. B. Winsløwsvej 4, 5000, Odense, Denmark
| | - Bahareh Bakhshaie Philipsen
- Department of ORL Head and Neck Surgery and Audiology, Odense University Hospital, J. B. Winsløwsvej 4, 5000, Odense, Denmark
| | - Christian Godballe
- Department of ORL Head and Neck Surgery and Audiology, Odense University Hospital, J. B. Winsløwsvej 4, 5000, Odense, Denmark
| |
Collapse
|
8
|
Ali SA, Smith JD, Hogikyan ND. The White Lesion, Hyperkeratosis, and Dysplasia. Otolaryngol Clin North Am 2019; 52:703-712. [PMID: 31078307 DOI: 10.1016/j.otc.2019.03.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Laryngeal mucosal precursor lesions represent a challenging clinical entity. Updated classification systems allow for grade-based categorization. Multiple management options exist, with treatment decisions made jointly by physician and patient and focused on both appropriate lesion treatment and preservation of laryngeal structure and function. Traditional methods include cold steel and CO2 laser excision, with newer modalities using angiolytic lasers for lesion ablation. Both operating room-based and office-based treatment options exist, and there are advantages and disadvantages to each approach. Research is ongoing to advance the understanding of lesion biology, and to optimize prevention and treatment.
Collapse
Affiliation(s)
- S Ahmed Ali
- Department of Otolaryngology - Head & Neck Surgery, Michigan Medicine, 1904 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5312, USA
| | - Joshua D Smith
- Department of Otolaryngology - Head & Neck Surgery, Michigan Medicine, 1904 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5312, USA
| | - Norman D Hogikyan
- Department of Otolaryngology - Head & Neck Surgery, Michigan Medicine, 1904 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5312, USA.
| |
Collapse
|
9
|
Strieth S, Ernst BP, Both I, Hirth D, Pfisterer LN, Künzel J, Eder K. Randomized controlled single-blinded clinical trial of functional voice outcome after vascular targeting KTP laser microsurgery of early laryngeal cancer. Head Neck 2019; 41:899-907. [PMID: 30702173 PMCID: PMC6972647 DOI: 10.1002/hed.25474] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 04/14/2018] [Accepted: 07/24/2018] [Indexed: 11/30/2022] Open
Abstract
Background Local control rate (LCR) of early glottic cancer is high after radiation therapy or transoral laser microsurgery (TLM). The aim of this study was to investigate functional voice outcome after TLM using a microvessel‐ablative potassium‐titanyl‐phosphate (KTP) laser in comparison with a gold standard cutting CO2 laser. Methods The primary end point of this prospective, randomized, single‐blinded, clinical phase II study with control group was voice outcome during a follow‐up of 6 months assayed by Voice Handicap Index (VHI‐30)‐questionnaires in patients with unilateral high‐grade dysplasia, carcinoma in situ or early glottic cancer undergoing TLM‐KTP (n = 8) or TLM‐CO2 (n = 12). The secondary end point was LCR. Results Starting from the 9‐week‐follow‐up visit, TLM‐KTP yielded significantly reduced VHI scores compared to TLM‐CO2. No relapse occurred after TLM‐KTP in contrast to one recurrence after TLM‐CO2 within 6 months. Conclusion Multicenter phase II or III studies on voice outcome or local control rate after TLM‐KTP in early glottic cancer are warranted enrolling larger patient cohorts.
Collapse
Affiliation(s)
- Sebastian Strieth
- Department of Otorhinolaryngology—Section of Head and Neck SurgeryGoethe‐University Medical CenterFrankfurt/MainGermany
| | - Benjamin P. Ernst
- Department of Otorhinolaryngology—Section of Head and Neck SurgeryGoethe‐University Medical CenterFrankfurt/MainGermany
| | - Ina Both
- Department of Otorhinolaryngology—Section of Head and Neck SurgeryGoethe‐University Medical CenterFrankfurt/MainGermany
| | - Daniel Hirth
- Department of Otorhinolaryngology—Section of PhoniatricsGoethe‐University Medical CenterFrankfurt/MainGermany
| | - Lara N. Pfisterer
- Department of Otorhinolaryngology—Section of PhoniatricsGoethe‐University Medical CenterFrankfurt/MainGermany
| | - Julian Künzel
- Department of Otorhinolaryngology—Head and Neck SurgeryJohannes Gutenberg‐University Medical CenterMainzGermany
| | - Katharina Eder
- Department of Otorhinolaryngology—Section of PhoniatricsLudwig‐Maximilians‐University Medical CenterMunichGermany
| |
Collapse
|
10
|
Abstract
PURPOSE OF REVIEW The purpose of this article is to provide an update on English-language literature evaluating the current understanding of incidence, management, and prevention of vocal fold leukoplakia focusing on premalignancy. RECENT FINDINGS Recent studies have continued to try to elucidate factors influencing recurrence and progression of dysplastic disease, though results vary. Although advanced diagnostic techniques have attempted to predict disease behavior, tissue diagnosis continues to be essential. Studies reinforce the necessity of removal of disease as the primary treatment, whereas use of photoangiolytic lasers via the ablative technique has increased, as has transition of some patients into the office-based settings for treatment. Although genetic and molecular testing may hold promise for predictive purposes, further study is necessary, and chemotherapy for recalcitrant disease continues to be an area of study with few case studies being reported. SUMMARY Management of vocal fold leukoplakia continues to progress in terms of identification and treatment. Although many work to advance our knowledge in the field and push treatment strategies toward newer avenues, pathologic diagnosis, eradiation of disease on the basis of experience and skill, and close surveillance continue to be paramount.
Collapse
|
11
|
Rzepakowska A, Sielska-Badurek E, Cruz R, Sobol M, Osuch-Wójcikiewicz E, Niemczyk K. Narrow band imaging versus laryngovideostroboscopy in precancerous and malignant vocal fold lesions. Head Neck 2018; 40:927-936. [PMID: 29322573 DOI: 10.1002/hed.25047] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 06/19/2017] [Accepted: 11/07/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND This is a comparative analysis of the diagnostic accuracy of narrow band imaging (NBI) and laryngovideostroboscopy (LVS) in the assessment of premalignant and malignant vocal fold lesions. METHODS A prospective analysis was performed on 105 consecutive patients with vocal fold lesions. The NBI and LVS were obtained before the microsurgery. RESULTS The NBI and LVS showed no significant differences in identifying premalignant and malignant pathologies. However, in analysis restricted to identification of only malignant lesions, the specificity (88.9% vs 20.6%), accuracy (90.5% vs 51.4%), and positive predictive value (PPV; 84.8% vs 45.1%) were significantly higher for NBI (P value < .001; .015; and .045, respectively). A comparison of LVS scored results relative to each NBI type revealed statistically significant differences (P < .001). A moderate positive correlation between NBI and LVS was demonstrated (P = .54). CONCLUSION The NBI and LVS are useful, complementary tools in evaluating early potential vocal fold malignancies. The NBI was superior to LVS on several statistical analyses.
Collapse
Affiliation(s)
- Anna Rzepakowska
- Otolaryngology Department, Warsaw Medical University, Warsaw, Poland
| | | | - Raul Cruz
- Otolaryngology Department, Kaiser Permanente Medical Center, Oakland, California
| | - Maria Sobol
- Biophysics and Human Physiology Department, Warsaw Medical University, Warsaw, Poland
| | | | | |
Collapse
|
12
|
Son HJ, Lee YS, Ku JY, Roh JL, Choi SH, Nam SY, Kim SY. Radiological tumor thickness as a risk factor for local recurrence in early glottic cancer treated with laser cordectomy. Eur Arch Otorhinolaryngol 2017; 275:153-160. [DOI: 10.1007/s00405-017-4793-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 10/25/2017] [Indexed: 10/18/2022]
|
13
|
Ahn SH, Hong HJ, Kwon SY, Kwon KH, Roh JL, Ryu J, Park JH, Baek SK, Lee GH, Lee SY, Lee JC, Chung MK, Joo YH, Ji YB, Hah JH, Kwon M, Park YM, Song CM, Shin SC, Ryu CH, Lee DY, Lee YC, Chang JW, Jeong HM, Cho JK, Cha W, Chun BJ, Choi IJ, Choi HG, Lee KD. Guidelines for the Surgical Management of Laryngeal Cancer: Korean Society of Thyroid-Head and Neck Surgery. Clin Exp Otorhinolaryngol 2017; 10:1-43. [PMID: 28043099 PMCID: PMC5327593 DOI: 10.21053/ceo.2016.01389] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 10/24/2016] [Indexed: 01/08/2023] Open
Abstract
Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to develop clinical practice guidelines for the surgical treatment of laryngeal cancer. This Task Force conducted a systematic search of the EMBASE, MEDLINE, Cochrane Library, and KoreaMed databases to identify relevant articles, using search terms selected according to the key questions. Evidence-based recommendations were then created on the basis of these articles. An external expert review and Delphi questionnaire were applied to reach consensus regarding the recommendations. The resulting guidelines focus on the surgical treatment of laryngeal cancer with the assumption that surgery is the selected treatment modality after a multidisciplinary discussion in any context. These guidelines do not, therefore, address non-surgical treatment such as radiation therapy or chemotherapy. The committee developed 62 evidence-based recommendations in 32 categories intended to assist clinicians during management of patients with laryngeal cancer and patients with laryngeal cancer, and counselors and health policy-makers.
Collapse
Affiliation(s)
- Korean Society of Thyroid-Head and Neck Surgery Guideline Task Force
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Catholic Kwandong University College of Medicine, Incheon, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, University of Ulsan College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Chosun University College of Medicine, Gwangju, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Daejin Medical Center, Bundang Jesaeng Hospital, Seongnam, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Kyung Hee University School of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Wonkwang University School of Medicine, Iksan, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Inje University College of Medicine, Busan, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Seonam University College of Medicine, Goyang, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Kosin University College of Medicine, Busan, Korea
| | - Soon-Hyun Ahn
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Jun Hong
- Department of Otorhinolaryngology Head and Neck Surgery, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Soon Young Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Kee Hwan Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Jong-Lyel Roh
- Department of Otorhinolaryngology Head and Neck Surgery, University of Ulsan College of Medicine, Seoul, Korea
| | - Junsun Ryu
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
| | - Jun Hee Park
- Department of Otorhinolaryngology Head and Neck Surgery, Chosun University College of Medicine, Gwangju, Korea
| | - Seung-Kuk Baek
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Guk Haeng Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Sei Young Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jin Choon Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Man Ki Chung
- Department of Otorhinolaryngology Head and Neck Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Hoon Joo
- Department of Otorhinolaryngology Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong Bae Ji
- Department of Otorhinolaryngology Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Jeong Hun Hah
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Minsu Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Young Min Park
- Department of Otorhinolaryngology Head and Neck Surgery, Daejin Medical Center, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Chang Myeon Song
- Department of Otorhinolaryngology Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Sung-Chan Shin
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Chang Hwan Ryu
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
| | - Doh Young Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Young Chan Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jae Won Chang
- Department of Otorhinolaryngology Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Ha Min Jeong
- Department of Otorhinolaryngology Head and Neck Surgery, Wonkwang University School of Medicine, Iksan, Korea
| | - Jae-Keun Cho
- Department of Otorhinolaryngology Head and Neck Surgery, Inje University College of Medicine, Busan, Korea
| | - Wonjae Cha
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Byung Joon Chun
- Department of Otorhinolaryngology Head and Neck Surgery, Seonam University College of Medicine, Goyang, Korea
| | - Ik Joon Choi
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Hyo Geun Choi
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Kang Dae Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Kosin University College of Medicine, Busan, Korea
| |
Collapse
|
14
|
Zeitels SM, Akst LM, Bums JA, Hillman RE, Broadhurst MS, Anderson RR. Pulsed Angiolytic Laser Treatment of Ectasias and Varices in Singers. Ann Otol Rhinol Laryngol 2016; 115:571-80. [PMID: 16944655 DOI: 10.1177/000348940611500802] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: Varices and ectasias in singers are typically the result of phonotraumatic shearing stresses and/or collision forces on the microcirculation within the superficial lamina propria. These lesions can be debilitating in performing vocalists because of the effect of recurrent hemorrhage and/or as a contributing factor to the morbidity of other mass lesions such as polyps, nodules, and cysts. Phonomicrosurgical treatment of performers is understandably approached with great trepidation, as the vocal liability of surgically disturbing the superficial lamina propria and epithelium must be balanced with the inherent detrimental vocal effect(s) of the lesion(s). Pulsed angiolytic lasers that emit radiation at high absorbance peaks of oxyhemoglobin were examined to determine whether they were an efficacious treatment approach for ectasias and varices based on these lasers' mechanisms of action and prior experience in phonomicrosurgery. Methods: A prospective trial was done in 39 patients (40 procedures in 54 vocal folds) without complication to evaluate the effectiveness of a 585-nm pulsed dye laser (PDL; 25 cases) and a 532-nm pulsed KTP laser (15 cases) in a noncontact mode to treat 65 varices and 43 ectasias. Twenty-nine of 39 patients had varices and ectasias associated with other phonotraumatic mass lesions that required resection. Results: All patients have resumed full vocal activities, and no patient has had a subsequent hemorrhage or vocal deterioration. Conclusions: Both the 585-nm PDL and the 532-nm pulsed KTP laser were found to be efficacious and relatively safe treatment modalities for vascular abnormalities of the vocal folds in singers. Noncontact selective photoangiolysis of the aberrant vessels prevented future bleeding without substantial photothermal trauma to the overlying epithelium and surrounding delicate superficial lamina propria, thereby allowing for optimal postoperative mucosal pliability and glottal sound production. However, the pulsed KTP laser was substantially easier to use because of its enhanced hemostasis due to its longer pulse width. Vessel wall rupture was commonplace during use of the 585-nm PDL, but rarely occurred during photoangiolysis with the 532-nm pulsed KTP laser.
Collapse
Affiliation(s)
- Steven M Zeitels
- Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | | | | | | | | |
Collapse
|
15
|
Zeitels SM, Franco RA, Dailey SH, Burns JA, Hillman RE, Anderson RR. Office-Based Treatment of Glottal Dysplasia and Papillomatosis with the 585-NM Pulsed Dye Laser and Local Anesthesia. Ann Otol Rhinol Laryngol 2016; 113:265-76. [PMID: 15112968 DOI: 10.1177/000348940411300403] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Treatment of glottal papillomatosis and dysplasia was mirror-guided and performed in surgeons' offices in the 19th century. It migrated to the operating room in the 20th century to accommodate direct laryngoscopic surgery, which required assistants to administer anesthesia and procedural support. Presently, the primary treatment goals, which are disease regression and voice restoration or maintenance, are tempered by the morbidity of general anesthesia and potential treatment-induced vocal deterioration. In fact, general anesthesia has been appropriately considered to be an acceptable source of morbidity for the promise of a precise procedure, which usually ensures airway safety and an optimal vocal outcome. However, patients with recurrent glottal papillomatosis and keratosis with dysplasia are typically monitored with various degrees of watchful waiting until there is a subjective judgment (on the part of the patient and surgeon) that the disease is more of a liability than is the procedure to treat it. Innovations in the 585-nm pulsed dye laser delivery system have allowed for its use in the clinic with local anesthesia through the working channel of a flexible fiberoptic laryngoscope. A prospective assessment was done on 51 patients in 82 cases of recurrent glottal papillomatosis (30) and dysplasia (52). All individuals had previously undergone microlaryngoscopic management with histopathologic evaluation. Five procedures could not be completed because of impaired exposure (2) or discomfort (3). Of those patients who could be treated, there was at least a 50% disease involution in 68 of 77 cases (88%) and 25% to 50% disease regression in the remaining 9 (12%). Patient self-assessment of the voice revealed that 34 of 77 were improved, 39 were unchanged, 4 were slightly worse, and none were substantially worse. These data confirm that diseased mucosa can be normalized without resection or substantial loss of vocal function. The putative mechanisms, which vary according to the fluence (energy) delivered by the laser, are photoangiolysis of sublesional microcirculation, denaturing of epithelial basement membrane linking proteins, and cellular destruction. Furthermore, this relatively safe, effective technique allowed for treatment of many patients (in a clinic setting) in whom classic surgery-related morbidity would have often delayed intervention.
Collapse
Affiliation(s)
- Steven M Zeitels
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | | | |
Collapse
|
16
|
Peretti G, Piazza C, Mensi MC, Magnoni L, Bolzoni A. Endoscopic Treatment of cT2 Glottic Carcinoma: Prognostic Impact of Different pT Subcategories. Ann Otol Rhinol Laryngol 2016; 114:579-86. [PMID: 16190089 DOI: 10.1177/000348940511400801] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: The cT2 glottic squamous cell carcinomas are a heterogeneous group of lesions in terms of superficial and deep extension. As a consequence, they differ greatly in treatment indications and prognosis. The aim of the present study was to divide cT2 glottic tumors into subcategories according to radiologic and postoperative histopathologic information, in order to identify risk factors connected with determinate survival, local-regional control, and laryngeal preservation rates. Methods: We retrospectively analyzed 55 cT2 glottic lesions treated at a single institution by carbon dioxide laser with at least 2 years of follow-up. Clinical, radiologic, surgical, and histopathologic data were reviewed, and the tumors were accordingly divided into 5 subcategories: I, or pT2 with lateral supraglottic extension (19 patients); II, or pT2 with lateral subglottic extension (6 patients); III, or pT2 with supracommissural and/or subcommissural extension (10 patients); IV, or pT2 with deep vocal muscle infiltration (14 patients); and V, or pT3, for superior and/or inferior paraglottic space invasion lateral to the thyroarytenoid muscle not detected before operation by computed tomographic scan (6 patients). Results: The disease-free survival, ultimate local control with laser alone, and laryngeal preservation rates were compared for each subcategory. Statistically significant differences were found only for the pT3 subgroup (2-year rates of 16.7%, 16.7%, and 16.7% for pT3 versus 5-year rates of 80.5%, 84.7%, and 93.3% for the entire pT2 group). Conclusions: Endoscopic treatment of cT2 glottic tumors can be considered effective when the pT2 stage has been confirmed. In cT2/pT3 patients, after the first endoscopic resection that allows the correct pT staging, additional treatment should always be considered.
Collapse
Affiliation(s)
- Giorgio Peretti
- Department of Otolaryngology, University of Brescia, Spedali Civili, Brescia, Italy
| | | | | | | | | |
Collapse
|
17
|
van Balkum M, Buijs B, Donselaar EJ, Erkelens DCA, Goulin Lippi Fernandes E, Wegner I, Grolman W, Janssen LM. Systematic review of the diagnostic value of laryngeal stroboscopy in excluding early glottic carcinoma. Clin Otolaryngol 2016; 42:123-130. [PMID: 27177444 DOI: 10.1111/coa.12678] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Laryngeal stroboscopy is an important diagnostic tool in the work-up of patients with phoniatric complaints. The aim of this article was to evaluate the diagnostic value of laryngeal stroboscopy in excluding glottic carcinoma in patients with suspected glottic carcinoma. DATA SOURCES PubMed, Embase and the Cochrane Library. REVIEW METHODS A systematic literature search was performed in PubMed, Embase and the Cochrane Library. Studies reporting original study data were included. Studies were selected based on predefined inclusion and exclusion criteria and were consequently systematically assessed for their relevance and risk of bias. Studies with low relevance, high risk of bias or both were excluded from analysis. The prevalences, sensitivities, specificities and post-test probabilities of laryngeal stroboscopy for detecting glottic carcinoma were extracted or calculated with data supplied in the articles. RESULTS Seven studies, with high relevance and moderate risk of bias, were selected for data extraction. The baseline risk of glottic carcinoma was 25-49% in the included studies. Sensitivity ranged between 80% and 100% and specificity between 25% and 100%. Post-test probabilities of malignancy in case of an abnormal stroboscopy ranged between 35% and 100%. Post-test probabilities of malignancy in case of a normal stroboscopy ranged between 0% and 29%. CONCLUSION A normal laryngeal stroboscopic result predicts the absence of invasive carcinoma. Laryngeal stroboscopy can therefore be suggested as a useful supplemental examination in the standard diagnostic work-up for all patients with suspected glottic carcinoma.
Collapse
Affiliation(s)
- M van Balkum
- Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - B Buijs
- Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - E J Donselaar
- Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - D C A Erkelens
- Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - E Goulin Lippi Fernandes
- Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - I Wegner
- Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.,Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - W Grolman
- Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.,Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - L M Janssen
- Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| |
Collapse
|
18
|
Mehlum CS, Rosenberg T, Groentved AM, Dyrvig AK, Godballe C. Can videostroboscopy predict early glottic cancer? A systematic review and meta-analysis. Laryngoscope 2015; 126:2079-84. [DOI: 10.1002/lary.25745] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/14/2015] [Accepted: 09/24/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Camilla S. Mehlum
- Department of Otorhinolaryngology-Head and Neck Surgery; Odense University Hospital; Odense Denmark
| | - Tine Rosenberg
- Department of Otorhinolaryngology-Head and Neck Surgery; Odense University Hospital; Odense Denmark
| | - Aagot M. Groentved
- Department of Otorhinolaryngology-Head and Neck Surgery; Odense University Hospital; Odense Denmark
| | - Anne-Kirstine Dyrvig
- Centre for Innovative Medical Technology; Odense University Hospital; Odense Denmark
| | - Christian Godballe
- Department of Otorhinolaryngology-Head and Neck Surgery; Odense University Hospital; Odense Denmark
| |
Collapse
|
19
|
Tibbetts KM, Tan M. Role of Advanced Laryngeal Imaging in Glottic Cancer. Otolaryngol Clin North Am 2015; 48:565-84. [DOI: 10.1016/j.otc.2015.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
|
20
|
Whited CW, Dailey SH. Evaluation of the Dysphonic Patient (in: Function Preservation in Laryngeal Cancer). Otolaryngol Clin North Am 2015; 48:547-64. [PMID: 26096136 DOI: 10.1016/j.otc.2015.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The evaluation of the dysphonic patient begins with a complete understanding of the laryngeal anatomy and physiology of voice production. A thorough history must be taken regarding the dysphonia qualities, alarming symptoms, and confounding factors. The complete head and neck examination culminates in a detailed visualization of the vocal folds using image-capturing laryngoscopy as well as stroboscopy or high-speed digital imaging to fully evaluate the viscoelastic properties of the vocal fold cover-body structure and function. Finally, the evaluation leads to the biopsy of any concerning lesions either under magnification in the operating room or topical anesthesia in the office.
Collapse
Affiliation(s)
- Chad W Whited
- Otolaryngology-Head & Neck Surgery, University of Wisconsin at Madison, 600 Highland Avenue, BX7375 Clinical Science Cntr-H4, Madison, WI 53792-3284, USA
| | - Seth H Dailey
- Section of Laryngology and Voice Surgery, Otolaryngology-Head & Neck Surgery, University of Wisconsin at Madison, 600 Highland Avenue, BX7375 Clinical Science Cntr-H4, Madison, WI 53792-3284, USA.
| |
Collapse
|
21
|
Quantification of Vocal Fold Vibration in Various Laryngeal Disorders Using High-Speed Digital Imaging. J Voice 2015; 30:205-14. [PMID: 26003886 DOI: 10.1016/j.jvoice.2015.04.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 04/28/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To quantify vibratory characteristics of various laryngeal disorders seen by high-speed digital imaging (HSDI). METHODS HSDI was performed on 78 patients with various laryngeal disorders (20 with polyp, 16 with carcinoma, 13 with leukoplakia, 6 with vocal fold nodule, and 33 with others) and 29 vocally healthy subjects. Obtained data were quantitatively evaluated by frame-by-frame analysis, laryngotopography, digital kymography, and glottal area waveform. RESULTS Overall, patients with laryngeal pathologies showed greater asymmetry in amplitude, mucosal wave and phase, smaller mucosal wave, and poorer glottal closure than vocally healthy subjects. Furthermore, disease-specific vibratory disturbances that generally agreed with the findings in the literature were quantified: comparing polyp with nodule, differences were noted in longitudinal phase difference, amplitude, and mucosal wave. In comparison with leukoplakia and cancer, nonvibrating area was more frequently noted in cancer. CONCLUSIONS The HSDI analysis of various voice disorders using multiple methods can help phonosurgeons to properly diagnose various laryngeal pathologies and to estimate the degree of their vocal disturbances.
Collapse
|
22
|
Misono S, Marmor S, Yueh B, Virnig BA. T1 glottic carcinoma: do comorbidities, facility characteristics, and sociodemographics explain survival differences across treatment? Otolaryngol Head Neck Surg 2015; 152:856-62. [PMID: 25715348 PMCID: PMC5560894 DOI: 10.1177/0194599815572112] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 01/20/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Recent large-scale studies have observed differences in survival following treatment for early laryngeal carcinoma depending on treatment type but were not able to take sociodemographic, comorbidity, and facility data into account. The objective of this study was to determine whether survival differences across treatment types persist when these factors are included in the analysis. STUDY DESIGN Retrospective cohort analysis. SETTING Linked Surveillance, Epidemiology, and End Results (SEER)-Medicare data files. SUBJECTS AND METHODS Medicare beneficiaries who were identified through the SEER registries (1991-2009) as having T1 glottic squamous cell carcinoma (scca) and a known treatment type were included. RESULTS A total of 2338 patients with incident T1 glottic scca were identified. Most were white and male. Treatment type was radiation only in 47%, local surgery and radiation in 39%, and local surgery only in 14%. Black race and increased comorbidities were associated with worse survival. When sociodemographics, comorbidities, and facility characteristics were taken into account, survival differences were observed across treatment types, with those receiving local surgery demonstrating better overall and cancer-specific survival. CONCLUSION These results suggest that following treatment of T1 glottic scca, there may be survival differences across treatment types beyond those explained by sociodemographic, comorbidity, and facility characteristics.
Collapse
Affiliation(s)
- Stephanie Misono
- Department of Otolaryngology/Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Schelomo Marmor
- Department of Otolaryngology/Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Bevan Yueh
- Department of Otolaryngology/Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Beth A Virnig
- Division of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| |
Collapse
|
23
|
El-Demerdash A, Fawaz SA, Sabri SM, Sweed A, Rabie H. Sensitivity and specificity of stroboscopy in preoperative differentiation of dysplasia from early invasive glottic carcinoma. Eur Arch Otorhinolaryngol 2015; 272:1189-93. [DOI: 10.1007/s00405-015-3530-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 01/25/2015] [Indexed: 11/30/2022]
|
24
|
Unger J, Lohscheller J, Reiter M, Eder K, Betz CS, Schuster M. A Noninvasive Procedure for Early-Stage Discrimination of Malignant and Precancerous Vocal Fold Lesions Based on Laryngeal Dynamics Analysis. Cancer Res 2014; 75:31-9. [DOI: 10.1158/0008-5472.can-14-1458] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
25
|
von Stülpnagel B, Hagen R, Olzowy B, Witt G, Pau HW, Just T. Comparative Study between the Surgeon's Intraoperative Evaluation and Histopathology for Diagnosis of Laryngeal Lesions. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2014; 2014:635251. [PMID: 27419206 PMCID: PMC4897163 DOI: 10.1155/2014/635251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 06/18/2014] [Indexed: 11/17/2022]
Abstract
Objective. To compare the surgeon's evaluation and histopathology for diagnosis of laryngeal lesions. Material. A clinical survey was distributed to laryngeal surgeons, ENT clinicians, and students in 2013 at the Department of Otorhinolaryngology in Rostock. Participants were asked to anonymously identify laryngeal pathologies and to assess the severity of the lesion starting from hyperplasia and inflammation over moderate dysplasia to early laryngeal cancer. Images of similar clinical laryngeal lesions were demonstrated in a multiple-choice modus to assess the surgeon's intraoperative evaluation. The questionnaires were digitally processed and evaluated. The results were correlated with histopathology and compared between experienced laryngeal surgeons, clinicians inexperienced in laryngeal surgery, and medical students from the Medical Faculty of the University of Rostock. Results. Sensitivity and specificity varied among the various groups, being highest in experienced laryngeal surgeons. In this group, sensitivity, specificity, positive and negative predictive value, and accuracy were 85%, 56%, 44%, 90%, and 65%, respectively. In 4% and 31%, laryngeal disease was underdiagnosed and overdiagnosed, respectively. In this group, Kappa statistics resulted in Kappa 0.32 (P < 0.001). Conclusion. This clinical survey clearly demonstrates that conformity between histopathology and evaluation of the laryngeal lesion depends on the surgeon's experience.
Collapse
Affiliation(s)
- Benjamin von Stülpnagel
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Rostock, Doberaner Straße 137-139, 18057 Rostock, Germany
| | - Robert Hagen
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Rostock, Doberaner Straße 137-139, 18057 Rostock, Germany
| | - Bernhard Olzowy
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Rostock, Doberaner Straße 137-139, 18057 Rostock, Germany
| | - Gabriele Witt
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Rostock, Doberaner Straße 137-139, 18057 Rostock, Germany
| | - Hans Wilhelm Pau
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Rostock, Doberaner Straße 137-139, 18057 Rostock, Germany
| | - Tino Just
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Rostock, Doberaner Straße 137-139, 18057 Rostock, Germany
| |
Collapse
|
26
|
Oncologic Efficacy of Angiolytic KTP Laser Treatment of Early Glottic Cancer. Ann Otol Rhinol Laryngol 2014; 123:840-6. [DOI: 10.1177/0003489414538936] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Angiolytic laser removal of early glottic cancer with ultra-narrow margins was reported in a pilot study 5 years ago as an innovative surgical treatment strategy to better preserve vocal function. Subsequently, in a cohort of > 90 patients, enhanced voice outcomes were achieved and there was diminished need for post-treatment phonosurgical reconstruction. However, the initial pilot study examining oncologic efficacy had a limited number of patients and most did not have 3-year follow-up. Consequently, further analysis of the oncologic efficacy is valuable. Method: Retrospective review. Results: One hundred seventeen patients (T1a-71, T1b-11, T2a-10, T2b-25) underwent potassium-titanyl-phosphate (KTP) laser treatment of early glottic cancer with a minimum 3-year follow-up (average = 53 months). The “b” designation delineated bilateral disease. Disease control for T1 and T2 lesions was 96% (79/82) and 80% (28/35), respectively. All 10 recurrences were treated with radiotherapy. Fifty percent (5/10) were controlled with radiotherapy, and the other 5 died of disease. Larynx preservation and survival were achieved in 99% (81/82) with T1 disease and 89% (31/35) with T2 disease. Conclusion: This investigation provides further evidence that angiolytic KTP laser removal of early glottic cancer with ultra-narrow margins is an effective oncologic treatment strategy. Radiotherapy was preserved for future use in more than 90% of patients. Since a majority of patients are referred by an otolaryngologist to undergo treatment of early glottic cancer with radiotherapy, this investigation provides compelling information to reappraise this paradigm.
Collapse
|
27
|
Stroboscopy in Detection of Laryngeal Dysplasia Effectiveness and Limitations. J Voice 2014; 28:262.e13-262.e21. [DOI: 10.1016/j.jvoice.2013.07.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Accepted: 07/16/2013] [Indexed: 11/21/2022]
|
28
|
Luers JC, Sircar K, Drebber U, Beutner D. The impact of laryngeal dysplasia on the development of laryngeal squamous cell carcinoma. Eur Arch Otorhinolaryngol 2013; 271:539-45. [DOI: 10.1007/s00405-013-2670-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Accepted: 08/17/2013] [Indexed: 10/26/2022]
|
29
|
Friedman AD, Hillman RE, Landau-Zemer T, Burns JA, Zeitels SM. Voice outcomes for photoangiolytic KTP laser treatment of early glottic cancer. Ann Otol Rhinol Laryngol 2013; 122:151-8. [PMID: 23577566 DOI: 10.1177/000348941312200302] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Surgery and radiotherapy routinely provide high cure rates in treating early glottic cancer. Therefore, key metrics for success are optimal voice outcome and preservation of future cancer treatment options. Remarkably, there is a paucity of pretreatment versus posttreatment voice outcome data. Angiolytic KTP (potassium titanyl phosphate) laser treatment of early glottic cancer with ultranarrow margins was initiated to better preserve vocal function. Given that effective oncological results have been achieved, it was hypothesized that this approach would also result in improved posttreatment measures of vocal function that more closely approximate historical norms than pretreatment values. METHODS Pretreatment and posttreatment voice outcome data were obtained for 92 patients (64 with T1 cancer and 28 with T2 cancer) who underwent 532-nm KTP laser treatment of early glottic cancer in a study design in which each patient essentially served as his or her own control. The evaluations included objective measures (acoustic and aerodynamic) and patients' self-assessments of vocal function (Voice-Related Quality of Life; V-RQOL). A series of mixed analyses of variance were conducted for all vocal function measures, with tumor stage and depth of invasion as the between-subjects variables and time (presurgery versus postsurgery) as the within-subject variable. RESULTS There were statistically significant (p < or = 0.05) postoperative improvements for acoustic (perturbation and noise-to-harmonics ratio) and aerodynamic (subglottic pressure and vocal efficiency) measures of vocal function, as well as for V-RQOL assessment. CONCLUSIONS Comprehensive pretreatment and posttreatment voice measures in a large patient cohort demonstrated that the KTP laser significantly improved postoperative vocal function in patients with early glottic cancer. Furthermore, radiotherapy was preserved as an oncological treatment option.
Collapse
Affiliation(s)
- Aaron D Friedman
- Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | | | | | | |
Collapse
|
30
|
Uloza V, Vegienė A, Pribuišienė R, Šaferis V. Quantitative Evaluation of Video Laryngostroboscopy: Reliability of the Basic Parameters. J Voice 2013; 27:361-8. [DOI: 10.1016/j.jvoice.2012.12.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Accepted: 12/17/2012] [Indexed: 10/27/2022]
|
31
|
Arens C. Transoral treatment strategies for head and neck tumors. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2012; 11:Doc05. [PMID: 23320057 PMCID: PMC3544208 DOI: 10.3205/cto000087] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The introduction of transoral endoscopic surgery has initiated a fundamental change in the treatment of head and neck cancer. The endoscopic approach minimizes the intraoperative trauma. Due to the lower burden for the patient and the savings potential these methods have gained wide acceptance. These transoral accesses routes allow experienced surgeons to reduce the morbidity of surgical resection with no deterioration of oncologic results. This suggests a further extension of the indication spectrum and a high growth potential for these techniques and equipment in the coming years. For selected patients with selected tumors the minimally invasive transoral surgery offers improved oncological and functional results. In the present paper, different surgical access routes are presented and their indications discussed.
Collapse
Affiliation(s)
- Christoph Arens
- Clinic for Ear, Nose and Throat Medicine, University Hospital Magdeburg, Germany
| |
Collapse
|
32
|
Elidan G, Elidan J. Vocal Folds Analysis Using Global Energy Tracking. J Voice 2012; 26:760-8. [DOI: 10.1016/j.jvoice.2011.07.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Accepted: 07/18/2011] [Indexed: 10/14/2022]
|
33
|
Krausert CR, Ying D, Choi SH, Hoffman MR, Jiang JJ. Effect of vocal fold injury location on vibratory parameters in excised canine larynges. Otolaryngol Head Neck Surg 2012; 148:89-95. [PMID: 23070053 DOI: 10.1177/0194599812464336] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the effect of vocal fold injury location on vibratory amplitude and lateral phase difference. STUDY DESIGN Repeated measures with each excised canine larynx serving as own control. SETTING Basic science study conducted in university laboratory. METHODS Vocal fold vibration of excised canine larynges was recorded with a high-speed camera before and after inducing vocal fold injury at 1 of 5 locations: anterior, middle, posterior, medial, or superior. Medial and superior injuries were created within the middle third of the vocal fold. Five larynges were used for each of the 5 injury locations. Kymography was performed at the midpoint of the vocal folds for each video. Pre- and postinjury vibratory amplitude and lateral phase difference were compared for each location. RESULTS The anterior and medial injuries produced consistent decreases in vibratory amplitude. Middle and posterior injuries might slightly decrease amplitude. Superior injuries seemed to have no effect on amplitude. Anterior and medial injuries induced phase asymmetry between the right and left vocal folds. Middle injuries appeared to affect phase difference slightly, whereas posterior and superior injuries had no effect. CONCLUSION Injury to the anterior or medial portions of the vocal fold may be most likely to cause abnormal vocal fold vibration. Using caution in these locations during phonosurgery may favor superior postoperative vocal outcomes.
Collapse
Affiliation(s)
- Christopher R Krausert
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53706, USA
| | | | | | | | | |
Collapse
|
34
|
Manfredi C, Bocchi L, Cantarella G, Peretti G. Videokymographic image processing: Objective parameters and user-friendly interface. Biomed Signal Process Control 2012. [DOI: 10.1016/j.bspc.2011.02.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
35
|
Evaluation of voice and quality of life after transoral endoscopic laser resection of early glottic carcinoma. The Journal of Laryngology & Otology 2011; 125:706-13. [PMID: 21481298 DOI: 10.1017/s002221511100065x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study aimed to evaluate voice and quality of life after transoral laser resection of early glottic carcinoma. METHODS We studied 19 patients undergoing transoral laser resection of tumour stage (T) one or T2 glottic carcinoma. Laryngeal function was evaluated by video-stroboscopy, vocal function by the Voice Symptom Scale, the grade-roughness-breathiness-asthenia-strain scale and objective phoniatric assessment, and quality of life by the University of Washington Quality of Life questionnaire. RESULTS Patients' glottic carcinoma tumour-node-metastasis (TNM) staging was T1 N0 M0 in 14 patients and T2 N0 M0 in five. Overall voice grade, roughness and breathiness were mild to moderate in 84 per cent; asthenia and voice strain were more uniformly distributed, with 15 per cent of patients having normal voice quality. Eight patients developed a glottic web post-operatively; anterior commissure web was significantly associated with worse voice grade (p = 0.05). Seven patients (47 per cent) had a 'mucosal wave' on the operated vocal fold; this was significantly associated with less strain on phonation (p = 0.05). Voice Symptom Scale score was low overall (15 patients (78.9 per cent) scored less than 30). The fundamental frequency and frequency irregularity were normal in nine patients (47.3 per cent); the closed quotient was normal in six (31.5 per cent). The averaged quality of life score was ≥ 90 in 14 patients (73.7 per cent); 18 (94.7 per cent) felt their health-related quality of life was either the same or better post-operatively; and overall quality of life was positive in all. CONCLUSION Transoral laser resection of T1 and T2 glottic carcinoma enables adequate tumour tissue excision with preservation of acceptable vocal function. Most patients' post-operative quality of life is very good. Anterior commissure web formation is associated with poorer vocal function.
Collapse
|
36
|
Holsinger FC, Nussenbaum B, Nakayama M, Saraiya S, Sewnaik A, Ark N, Ferris RL, Tufano RP, McWhorter AJ. Current concepts and new horizons in conservation laryngeal surgery: An important part of multidisciplinary care. Head Neck 2009; 32:656-65. [DOI: 10.1002/hed.21208] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
37
|
Abstract
OBJECTIVES/HYPOTHESIS High-frequency ultrasound imaging offers the potential for assisting in the diagnosis and treatment of vocal fold pathology if it allows aspects of vocal fold microstructure to be visualized noninvasively. The objective of this study was to assess the ability of high-frequency ultrasound to image vocal fold anatomy and injected biomaterials. STUDY DESIGN The vocal folds of two excised calf larynges were imaged ex vivo and compared with corresponding histological sections. METHODS High-frequency ultrasound imaging was performed under saline submersion using 40 and 50 MHz transducers, and corresponding cryostat cross-sections were stained with H&E, Trichome, and Verhoeff's Van Gieson stains. RESULTS The epithelial surface, lamina propria, and underlying muscle were easily identified with the high-frequency ultrasound as verified with histological sections representing each imaged region. The arytenoid cartilage vocal process can also be clearly distinguished from the surrounding tissue, as can the full extent of injected biomaterials within the superficial lamina propria. Useful ultrasound resolution was obtained to depths of at least 10 mm within the tissue with the 40 MHz transducer. CONCLUSIONS This preliminary study demonstrates the capability of high-frequency ultrasound to image the layered anatomy of the calf vocal fold and to discern materials injected into the superficial lamina propria, indicating that this technology holds a strong potential for use in phonosurgery.
Collapse
|
38
|
Patel R, Dailey S, Bless D. Comparison of High-Speed Digital Imaging with Stroboscopy for Laryngeal Imaging of Glottal Disorders. Ann Otol Rhinol Laryngol 2008; 117:413-24. [DOI: 10.1177/000348940811700603] [Citation(s) in RCA: 141] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: High-speed digital imaging (HSDI), unlike stroboscopy, is a frequency-independent visualization technique that provides detailed biomechanical assessment of vocal physiology due to increased temporal resolution. The purpose of this study was to investigate the clinical value of HSDI compared to that of stroboscopy across 3 disorder groups classified as epithelial, subepithelial, and neurologic disorders. Methods: Judgments of vibratory features of vocal fold edge, glottal closure, phase closure, vertical level, vibratory amplitude, mucosal wave, phase symmetry, tissue pliability, and glottal cycle periodicity from 252 participants were performed by 3 experienced raters. Results: The results revealed that 63% of the data set was noninterpretable for assessment of vibratory function on stroboscopic analysis because of the severity of the voice disorder (100% of participants with severe voice disorders and 64% of participants with moderate voice disorders), whereas HSDI resulted in analysis of 100% of the data. The neuromuscular group (74%) was the most difficult to analyze with stroboscopy, followed by the epithelial (58%) and subepithelial groups (53%), secondary to the severity of hoarseness. Conclusions: Because it is desirable in clinical examination to observe vocal fold vibrations, which cannot be done in cases of severe dysphonia, HSDI may aid in clinical decision-making when patients exhibit values exceeding 0.87% jitter, 4.4% shimmer, and a signal-to-noise ratio of less than 15.4 dB on acoustic analysis. These measures could serve as minimal indications for use of HSDI. The data suggest that HSDI can be viewed as augmentative to stroboscopy, particularly in cases of moderate to severe aperiodicity, in which HSDI may aid clinical decision-making.
Collapse
|
39
|
Shaw HS, Deliyski DD. Mucosal Wave: A Normophonic Study Across Visualization Techniques. J Voice 2008; 22:23-33. [PMID: 17014988 DOI: 10.1016/j.jvoice.2006.08.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2006] [Accepted: 08/08/2006] [Indexed: 11/24/2022]
Abstract
Visualization of vocal fold vibration is essential for accurate diagnoses and optimal treatment of persons with voice disorders. Recently, scientific and anecdotal reports have evidenced an increased amount of variation in the diagnostically relevant features of extent and symmetry of mucosal wave magnitude in normophonic speakers. The objectives of this study were to preliminarily ascertain the variation in mucosal wave magnitude and symmetry for normophonic speakers as assessed via standard and novel techniques, and compare findings across modal and pressed phonations. A correlational design with a multiple baseline across visualization methods approach was used. Mucosal wave presence, magnitude, and symmetry from 52 normophonic speakers were judged via stroboscopy, high-speed videoendoscopy (HSV) playback, mucosal wave playback, and mucosal wave kymography playback. Results demonstrate a prevalence of atypical magnitude and symmetry of mucosal wave during modal and pressed phonations by normophonic persons, differences across techniques, and a relationship between judgments and habitual fundamental frequency. Given the prevalence of mucosal wave magnitude and symmetry variations in the normophonic population, overdiagnosis may be possible without caution. The various visualization techniques provided unique information suggesting that it may be beneficial to use both full view and kymographic visualization techniques in combination. A major restriction of the current commercial HSV systems is the frame rate, typically limited to 2000 frames per second, which appears insufficient for most female habitual phonations.
Collapse
Affiliation(s)
- Heather S Shaw
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, South Carolina 29208, USA.
| | | |
Collapse
|
40
|
Gugatschka M, Kiesler K, Beham A, Rechenmacher J, Friedrich G. Hyperplastic epithelial lesions of the vocal folds: combined use of exfoliative cytology and laryngostroboscopy in differential diagnosis. Eur Arch Otorhinolaryngol 2007; 265:797-801. [DOI: 10.1007/s00405-007-0549-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2007] [Accepted: 11/20/2007] [Indexed: 10/22/2022]
|
41
|
Abstract
Vocal fold masses are often complex in nature and can have a devastating result on the professional voice. These lesions are usually multifactorial with synergistic contributions over time from voice use demands and technique, medical conditions, medications, and the environment. General categories of benign vocal fold masses in professional voice include nodules, polyps, and cysts, but other pathology should be considered, such as reactive lesions, intracordal scarring, feeding varices, and reparative granuloma. A perspective on these issues is essential for proper diagnosis and management. Video procedures for nodule and polyp surgery accompany this content online.
Collapse
Affiliation(s)
- Kenneth W Altman
- Department of Otolaryngology, The Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1189, New York, NY 10029, USA.
| |
Collapse
|
42
|
Dailey SH, Spanou K, Zeitels SM. The Evaluation of Benign Glottic Lesions: Rigid Telescopic Stroboscopy Versus Suspension Microlaryngoscopy. J Voice 2007; 21:112-8. [PMID: 16442777 DOI: 10.1016/j.jvoice.2005.09.006] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2005] [Accepted: 09/06/2005] [Indexed: 11/17/2022]
Abstract
Rigid telescopic strobo-video-laryngoscopy (RTS) is a primary clinical assessment methodology in the office evaluation of benign glottic lesions. However, diagnostic observations can be made only at the time of suspension microlaryngoscopy (SML). The records of 100 consecutive patients undergoing microlaryngoscopy for benign glottic lesions were retrospectively reviewed. Nine of 100 patients were found to have additional glottic lesions during SML. Sixteen additional lesions were noted in these nine patients. Fifteen of 16 lesions were sulci and/or mucosal bridges. Forty-five percent (4/9) of the patients with additional lesions underwent a management change intraoperatively. Three patients underwent additional surgical dissection, and one underwent less dissection than was planned. The discrepancy in diagnosis between rigid telescopic strobo-video-laryngoscopy and suspension microlaryngoscopy highlights certain key points: (1) During office endoscopy, tangential views of the medial surface of the glottis limit the diagnostic sensitivity. (2) Sulci and mucosal bridges are most subject to this limitation. (3) Informed consent should address the potential need for a change in intraoperative management. It is advisable to discuss the possibility for dissection in both vocal folds, even if a unilateral lesion is observed in the office. (4) Microlaryngoscopy is the final diagnostic step in the evaluation of glottic pathology. Meticulous inspection and palpation of the glottis are recommended during SML.
Collapse
Affiliation(s)
- Seth H Dailey
- Department of Surgery, University of Wisconsin School of Medicine, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin Hospital and Clinics, Madison, Wisconsin 53792, USA.
| | | | | |
Collapse
|
43
|
Crevier Buchman L, Hans S, Behm E, Tissot V, Laccourreye O, Brasnu D. [How to perform and analyze a stroboscopic examination?]. ANNALES D'OTO-LARYNGOLOGIE ET DE CHIRURGIE CERVICO FACIALE : BULLETIN DE LA SOCIETE D'OTO-LARYNGOLOGIE DES HOPITAUX DE PARIS 2006; 123:203-6. [PMID: 17088709 DOI: 10.1016/s0003-438x(06)76667-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- L Crevier Buchman
- Unité d'exploration voix, parole, déglutition, Service d'Otorhino-laryngologie et de Chirurgie de la face et du cou, hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris
| | | | | | | | | | | |
Collapse
|
44
|
Just T, Stave J, Boltze C, Wree A, Kramp B, Guthoff RF, Pau HW. Laser Scanning Microscopy of the Human Larynx Mucosa: A Preliminary, Ex Vivo Study. Laryngoscope 2006; 116:1136-41. [PMID: 16826048 DOI: 10.1097/01.mlg.0000217529.53079.59] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Laser scanning microscopy (LSM) supplies in vivo information from epithelia up to depths between 0.1 to 0.5 mm. The aim of this ex vivo prospective pilot study was to investigate the potential use of LSM for the diagnosis of laryngeal cancer and its precursors. METHODS Forty-three larynx specimens of 26 patients (age 35-61 years, mean age 51.9+/-9.5 years; 7 women and 19 men) with laryngeal lesions were investigated with LSM. The LSM findings were compared with histopathologic sections. The following criteria were used for characterization of cancerous lesions: enlarged nuclei, enlarged cells with variable shapes, cluster of cells, increased nucleus/cytoplasm ratio, irregular cell architecture, and loss of cellular junctions characterized by lack of visualization of the cell membrane. RESULTS LSM enables the visualization of epithelium up to the basement membrane, Reincke space, the subepithelial vessels, and the fibers of the subepithelial space. In contrast to the squamous epithelium, the respiratory epithelium bears kinocilia. The beat of the cilia and the directed mucous transport can be observed ex vivo. With the use of the presented malignancy criteria, a sensitivity of 72.7% and a specificity of 82.9% for differentiation of dysplasia and benign laryngeal lesions from cancer were reached. CONCLUSIONS LSM in an ex vivo manner supplies microscopic images up to the subepithelial space. LSM could represent a new technology in laryngology to visualize larynx epithelia. In the next step, in vivo LSM will be applied to evaluate laryngeal lesion in vivo.
Collapse
Affiliation(s)
- Tino Just
- Department of Otorhinolaryngology, the Institute for Pathology, University of Rostock, Rostock, Germany.
| | | | | | | | | | | | | |
Collapse
|
45
|
Hans S, de Monès E, Behm E, Laccourreye O, Brasnu D. [How to perform laryngeal nasofibroscopy in adults]. ACTA ACUST UNITED AC 2006; 123:41-5. [PMID: 16609668 DOI: 10.1016/s0003-438x(06)76637-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- S Hans
- Service d'ORL et de chirurgie de la face et du cou, Hôpital Européen G. Pompidou, 20-40 rue Leblanc, 75015 Paris.
| | | | | | | | | |
Collapse
|
46
|
Peretti G, Piazza C, Bolzoni A. Endoscopic treatment for early glottic cancer: indications and oncologic outcome. Otolaryngol Clin North Am 2006; 39:173-89. [PMID: 16469662 DOI: 10.1016/j.otc.2005.10.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Giorgio Peretti
- Department of Otolaryngology, University of Brescia, Piazza Spedali Civili 1, Brescia 25123, Italy.
| | | | | |
Collapse
|
47
|
Gamboa J, Echeverría L, Molina B, Cobeta I. Valoración estroboscópica de laringitis crónicas. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2006; 57:266-9. [PMID: 16872102 DOI: 10.1016/s0001-6519(06)78706-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The laryngostroboscopy allows analysis of the vocal fold vibrations during phonation. Disruption of normal viscoelastic properties of the superficial lamina propria results in aberrant vocal fold vibration and mucosal wave propagation. Therefore, an investigation was performed to relate the stroboscopic results with the anatomopathologic results of chronic laryngitis and glottic cancer. MATERIAL AND METHODS We performed a retrospective study, which included 30 direct laryngoscopies with biopsy of 25 patients and their corresponding laryngostroboscopies. RESULTS 60% of the cases of "absence of mucosal wave" displayed severe dysplasia or carcinoma. 20% of the cases of "limited or present mucosal wave" were carcinoma. CONCLUSIONS The probability of finding severe dysplasia or carcinoma is significantly greater when we find absence of mucosal wave. The presence of mucosal wave does not exclude the possibility of malignant lesion of the vocal fold.
Collapse
Affiliation(s)
- J Gamboa
- Servicio de Otorrinolaringología, Hospital Universitario "Príncipe de Asturias", Alcalá de Henares, Madrid.
| | | | | | | |
Collapse
|
48
|
Sulica L, Behrman A, Roark R. The Inspiratory Maneuver: A Simple Method to Assess the Superficial Lamina Propria During Endoscopy. J Voice 2005; 19:481-4. [PMID: 16102673 DOI: 10.1016/j.jvoice.2004.08.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2004] [Indexed: 11/18/2022]
Abstract
We describe a simple means of assessing the condition of the superficial lamina propria during endoscopy, which we use in our practice as an adjunct to careful stroboscopic examination. An intake of breath against partially adducted vocal folds serves to draw the mucosa inferomedially into the glottis, which reveals areas of diminished mobility, the relationship of mucosal lesions to deeper tissues of the vocal folds, and subtle submucosal lesions. This is possible because of the unique geometry of the glottis that renders the vector forces of airflow different at inspiration and expiration. Because the integrity of the superficial lamina propria is essential to healthy phonation, we have found the inspiratory maneuver useful across a wide variety of mucosal pathologic conditions.
Collapse
Affiliation(s)
- Lucian Sulica
- Department of Otolaryngology, Beth Israel Medical Center, New York, NY 10003, USA.
| | | | | |
Collapse
|
49
|
Matsubara N, Umezaki T, Adachi K, Tomita E, Matsuyama K, Nakagawa T, Nakashima T, Koike K, Kakazu Y, Komune S, Komiyama S. Multidimensional Voice Evaluation in Pretreatment Glottic Carcinoma. Folia Phoniatr Logop 2005; 57:173-80. [PMID: 15915000 DOI: 10.1159/000084137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
It is generally accepted that, in glottic carcinoma, the voice will deteriorate, even in the early stages. This paper reports the degree of hoarseness and multidimensional vocal evaluation of glottic carcinoma patients. Forty-seven male glottic carcinoma patients and a control group of 13 normal subjects were included in this study involving psychoacoustic evaluation by doctors, acoustic analysis, phonogram, maximum phonation time and stroboscopy before treatment. A normal voice or mild hoarseness by psychoacoustic evaluation was found in 35% of cases with T1 and T2 glottic carcinoma. Patients with psychoacoustically inferior vocalization had high scores on acoustic analysis, small phonogram areas, and short maximum phonation time. Stroboscopy revealed attenuation or disappearance of the mucosal wave on the tumor side in all cases, whether the acoustic analysis data were within or beyond the normal limits. We identified two conditions offering superior vocalization in glottic carcinoma patients: (1) the lesion should be unilateral, and (2) the lesion should be flat with no protrusion. We should evaluate patients with glottic carcinoma not only with vocal examination but also using stroboscopy before biopsy.
Collapse
Affiliation(s)
- Naoko Matsubara
- Department of Otorhinolaryngology, Faculty of Medicine, Kyusyu University, Fukuoka, Japan.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Abstract
Laryngeal stroboscopy is arguably the most important clinical tool for the evaluation and treatment of patients with voice disorders. Unfortunately, at present, laryngeal stroboscopy is strictly a clinical tool and has no definitive use in the area of voice research. The limitation with laryngeal stroboscopy is the subjective nature of the interpretation of the video examination. A video stroboscopy research tool was developed using 10 stroboscopic parameters selected from the literature and clinical practice. The stroboscopy research tool was validated with the results of 18 reviewers using the instrument to rate 21 unique "cases" and 6 repeated "cases." The results of this video perceptual analysis study identified which parameters were the most robust and reliable across a wide range of reviewers and validated power analysis curves for future similar research. Furthermore, findings from this study revealed that a greater than 80% intra-rater reliability is the preferred method for the selection of a valid and reliable reviewer. Future research using this instrument will most likely increase the reliability and utility of the instrument with the use of prestudy reviewer training and/or the use of video examples to serve as anchors or external references.
Collapse
Affiliation(s)
- Clark A Rosen
- Department of Otolaryngology, The Eye and Ear Institute, Pittsburgh, Pennsylvania, USA
| |
Collapse
|