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Wei H, Wang W, Bai Q, Li Z. Primary Vocal Cord Aspergillosis Can Involve the Trachea and Bronchus in Previously Healthy Patients: A Case Report. Ear Nose Throat J 2024:1455613241249097. [PMID: 38676418 DOI: 10.1177/01455613241249097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
Primary vocal cord aspergillosis is extremely rare in immunocompetent individuals, in whom lesions are mainly confined to the larynx, with the possibility of tracheal and bronchial infection largely ignored. In this article, we present a case of primary vocal cord aspergillosis involving the trachea and bronchus in a previously healthy 55-year-old woman. Our case highlights that vocal cord aspergillosis can involve the trachea and bronchus and that laryngoscopy alone may be insufficient to secure a comprehensive diagnosis in healthy patients presenting with hoarseness, pharyngalgia, and normal chest radiography. Furthermore, influenza B virus infection may be a risk factor for this rare disease.
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Affiliation(s)
- Huasheng Wei
- Department of Respiratory and Critical Care Medicine, Dazhou Central Hospital, Dazhou, China
| | - Weilin Wang
- Department of Respiratory and Critical Care Medicine, Dazhou Central Hospital, Dazhou, China
| | - Qinwen Bai
- Department of Respiratory and Critical Care Medicine, Dazhou Central Hospital, Dazhou, China
| | - Zhihui Li
- Department of Respiratory and Critical Care Medicine, Dazhou Central Hospital, Dazhou, China
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Gautam M, Yadav SK, Agarwal P, Sharma D. Low cost smart phone based laryngoscopy for the assessment of vocal cords in patients undergoing thyroid surgery: A pilot study. Trop Doct 2024:494755241246823. [PMID: 38654398 DOI: 10.1177/00494755241246823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Can a smart phone application be reliably used for laryngoscopy? This thesis was tested for peri-operative evaluation of vocal cords in patients undergoing thyroid and parathyroid surgery.
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Affiliation(s)
- Maithily Gautam
- Junior Resident, Department of Surgery, NSCB Medical College, Jabalpur, MP, India
| | - Sanjay Kumar Yadav
- Assistant Professor, Department of Surgery, NSCB Medical College, Jabalpur, MP, India
| | - Pawan Agarwal
- Professor, Department of Surgery, NSCB Medical College, Jabalpur, (MP) India
| | - Dhananjaya Sharma
- Professor and Head, Department of Surgery, NSCB Medical College, Jabalpur, MP, India
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Arshad AM, Sulaiman T, Benghashir HM, Aldubai HN, Hussein MS. Tuberculosis imitating malignancy: Unusual presentation as a metastatic tumor - A case report. Qatar Med J 2024; 2024:5. [PMID: 38686372 PMCID: PMC11056642 DOI: 10.5339/qmj.2024.qitc.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 02/02/2024] [Indexed: 05/02/2024] Open
Affiliation(s)
| | - Theeb Sulaiman
- Pulmonology Department, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Mousa Shaher Hussein
- Pulmonology Department, Hamad Medical Corporation, Doha, Qatar
- Department of Clinical Medicine, Qatar University, Doha, Qatar
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Chornenkyy Y, Than J, Ghadersohi S, Melin-Aldana H, Chou P. Laryngeal Ganglioneuromatosis in a Child With Multiple Endocrine Neoplasia Type 2B (MEN2B): Case Report and Review of Literature. Cureus 2024; 16:e55406. [PMID: 38562350 PMCID: PMC10984640 DOI: 10.7759/cureus.55406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2024] [Indexed: 04/04/2024] Open
Abstract
Multiple Endocrine Neoplasia type 2B (MEN2B) is an autosomal dominant cancer syndrome caused by a mutation in rearranged during transfection (RET) proto-oncogene and includes medullary thyroid carcinoma, pheochromocytoma, gastrointestinal neuromas, and mucosal ganglioneuromas. Medullary thyroid carcinoma is the major cause of mortality in MEN2B syndrome. Medullary thyroid carcinoma can often appear during the first years of life. While mucosal neuromas in MEN2B are common, laryngeal neuromas are extremely rare. We present a third case of a pediatric patient with a laryngeal neuroma localized to the left true vocal cord and conduct a literature review of vocal cord neuromas in MEN2B patients.
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Affiliation(s)
- Yevgen Chornenkyy
- Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Joseph Than
- Internal Medicine, NYC Health and Hospitals/South Brooklyn Health, Brooklyn, USA
| | - Saied Ghadersohi
- Pediatric Otolaryngology - Head & Neck Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, USA
- Otolaryngology - Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Hector Melin-Aldana
- Pathology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, USA
| | - Pauline Chou
- Pathology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, USA
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Ni XG, Zhu JQ, Tie CW, Wang ML, Zhang W, Wang GQ. Laryngoscopy-based scoring system for the diagnosis of vocal fold leukoplakia. J Laryngol Otol 2024; 138:331-337. [PMID: 37994484 DOI: 10.1017/s0022215123000683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
OBJECTIVE To propose a scoring system based on laryngoscopic characteristics for the differential diagnosis of benign and malignant vocal fold leukoplakia. METHODS Laryngoscopic images from 200 vocal fold leukoplakia cases were retrospectively analysed. The laryngoscopic signs of benign and malignant vocal fold leukoplakia were compared, and statistically significant features were assigned and accumulated to establish the leukoplakia finding score. RESULTS A total of five indicators associated with malignant vocal fold leukoplakia were included to construct the leukoplakia finding score, with a possible range of 0-10 points. A score of 6 points or more was indicative of a diagnosis of malignant vocal fold leukoplakia. The sensitivity, specificity and accuracy values of the leukoplakia finding score were 93.8 per cent, 83.6 per cent and 86.0 per cent, respectively. The consistency in the leukoplakia finding score obtained by different laryngologists was strong (kappa = 0.809). CONCLUSION This scoring system based on laryngoscopic characteristics has high diagnostic value for distinguishing benign and malignant vocal fold leukoplakia.
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Affiliation(s)
- Xiao-Guang Ni
- Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ji-Qing Zhu
- Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Cheng-Wei Tie
- Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mei-Ling Wang
- Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Wei Zhang
- Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Gui-Qi Wang
- Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Feng Y, Du Y, Li M, Jia G, Gong L, Li L. Low-grade malignant myofibroblastic sarcoma of the larynx: a case report. J Int Med Res 2023; 51:3000605231193929. [PMID: 37684014 PMCID: PMC10492498 DOI: 10.1177/03000605231193929] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/24/2023] [Indexed: 09/10/2023] Open
Abstract
Low-grade myofibroblastic sarcoma (LGMS) is a rare malignant mesenchymal tumor derived from myofibroblasts. It is commonly identified in the head and neck, and particularly in the oral cavity, but rarely in the larynx. In this case report, we describe a patient who presented with hoarseness and underwent electronic fiber laryngoscopy, which revealed a neoplasm on the surface of his left vocal cord. The vocal cord tumor was resected under general anesthesia, and a malignant LGMS was diagnosed on postoperative pathologic examination. The results of immunohistochemical staining of the sections for vimentin (diffuse +), actin (partial +), and desmin (-) were consistent with this diagnosis. The patient recovered well after the surgery, and there was no recurrence of the neoplasm.
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Affiliation(s)
- Yu Feng
- Department of Otorhinolaryngology Head and Neck Surgery, Liaocheng People’s Hospital, Liaocheng, China
- Shandong First Medical University (Shandong Academy of Medical Sciences), Jinan, China
| | - Yongya Du
- Department of Otorhinolaryngology Head and Neck Surgery, Liaocheng People’s Hospital, Liaocheng, China
- Department of Otorhinolaryngology Head and Neck Surgery, Liaocheng Dongchangfu People′s Hospital, Liaocheng, China
- Shandong First Medical University (Shandong Academy of Medical Sciences), Taian, China
| | - Maocai Li
- Department of Otorhinolaryngology Head and Neck Surgery, Liaocheng People’s Hospital, Liaocheng, China
| | - Guotao Jia
- Department of Otorhinolaryngology Head and Neck Surgery, Liaocheng People’s Hospital, Liaocheng, China
| | - Lili Gong
- Department of Otorhinolaryngology Head and Neck Surgery, Liaocheng People’s Hospital, Liaocheng, China
| | - Lianqing Li
- Department of Otorhinolaryngology Head and Neck Surgery, Liaocheng People’s Hospital, Liaocheng, China
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Hamilton NJI, Saccente-Kennedy B, Ambler G. The use of basic fibroblast growth factor to improve vocal function: A systematic review and meta-analysis. Clin Otolaryngol 2023; 48:725-733. [PMID: 37246756 DOI: 10.1111/coa.14073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 03/29/2023] [Accepted: 05/01/2023] [Indexed: 05/30/2023]
Abstract
OBJECTIVES This systematic review and meta-analysis examines if intralaryngeal injection of basic fibroblast growth factor 2 (FGF2) can improve voice outcomes in those with vocal disability. DESIGN A Systematic review of original human studies reporting voice outcomes following intra-laryngeal injection of basic fibroblast growth factor 2 in those with vocal dysfunction. Databases searched were Medline (1946-July 2022), Embase (1947-July 2022), Cochrane database and Google Scholar. SETTING Secondary or tertiary care centres that undertook the management of voice pathology Hospital. PARTICIPANTS Inclusion criteria were original human studies reporting voice outcome measurements following intralaryngeal injection of FGF2 to treat vocal fold atrophy, vocal fold scarring, vocal fold sulcus or vocal fold palsy. Articles not written in English, studies that did not include human subjects and studies where voice outcome measures were not recorded before and after FGF2 injection were excluded from the review. MAIN OUTCOME MEASURES The primary outcome measure was maximum phonation time. Secondary outcome measures included acoustic analysis, glottic closure, mucosal wave formation, voice handicap index and GRBAS scale. RESULTS Fourteen articles were included out of a search of 1023 and one article was included from scanning reference lists. All studies had a single arm design without control groups. Conditions treated were vocal fold atrophy (n = 186), vocal cord paralysis (n = 74), vocal fold fibrosis (n = 74) and vocal fold sulcus (n = 56). A meta-analysis of six articles reporting on the use of FGF2 in patients with vocal fold atrophy showed a significant increase of mean maximum phonation time of 5.2 s (95% CI: 3.4-7.0) at 3-6 months following injection. A significant improvement in maximum phonation time, voice handicap index and glottic closure was found following injection in most studies assessed. No major adverse events were reported following injection. CONCLUSIONS To date, intralaryngeal injection of basic FGF2 appears to be safe and it may be able to improve voice outcomes in those with vocal dysfunction, especially vocal fold atrophy. Randomised controlled trials are needed to further evaluate efficacy and support the wider use of this therapy.
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Affiliation(s)
- Nick J I Hamilton
- UCL Division of Surgery and Interventional Sciences, Head & Neck Academic Centre, University College London, London, UK
- Department of Laryngology, Royal National Ear Nose & Throat Hospital, University College London Hospitals NHS Trust, London, UK
| | - Brian Saccente-Kennedy
- Department of Laryngology, Royal National Ear Nose & Throat Hospital, University College London Hospitals NHS Trust, London, UK
| | - Gareth Ambler
- UCL Department of Statistical Science, University College London, London, UK
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8
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Woo JH, Oh JH, Lim BW, Kim DY. Treatment Results of Vocal Process Granuloma: Intubation versus Contact Granuloma. Int Arch Otorhinolaryngol 2023; 27:e191-e196. [PMID: 37125377 PMCID: PMC10147457 DOI: 10.1055/s-0043-1768205] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 01/07/2021] [Indexed: 05/02/2023] Open
Abstract
Introduction Contact granulomas (CGs) and intubation granulomas (IGs) are known to have different clinical manifestations despite having the same pathological features. Objective The purpose of the present study was to analyze the treatment results for CG and IG and to obtain clinical information. Methods We retrospectively reviewed the medical records of patients diagnosed with vocal process granuloma (VPG) between January 2015 and December 2018. The patient's age, sex, medical history, lesion size, lesion type, reflux finding score (RFS), response to treatment, duration of treatment, and follow-up period were compared. Results Eighteen patients with CG and 14 patients with IG were included in the study. The IG group had more female patients ( p = 0.0009), showed better response to proton pump inhibitor (PPI) and steroid inhalation (SI) ( p = 0.036), and had a shorter treatment period ( p = 0.0029) than the CG group. Five patients who received botulinum toxin injections in their vocal cords had complete remission. Conclusion Compared with CG, IG was more responsive to treatment with PPI and SI and required a shorter duration of treatment.
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Affiliation(s)
- Joo Hyun Woo
- Department of Otorhinolaryngology-Head and Neck Surgery, Gachon University College of Medicine, Gil Medical Center, Seongnam, South Korea
- Address for correspondence Joo Hyun Woo, MD, PhD Department of Otorhinolaryngology-Head and Neck Surgery, Gachon University, Gil Medical Center, ENT officeNamdong-daero 774 beon-gil 21, Namdong-gu, Incheon 21565South Korea
| | - Jae Hwan Oh
- Department of Otorhinolaryngology-Head and Neck Surgery, Gachon University College of Medicine, Gil Medical Center, Seongnam, South Korea
| | - Byung Woo Lim
- Department of Otorhinolaryngology-Head and Neck Surgery, Gachon University College of Medicine, Gil Medical Center, Seongnam, South Korea
| | - Dong Young Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Gachon University College of Medicine, Gil Medical Center, Seongnam, South Korea
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Borrelli M, Nasrollahi T, Raskin J, Khan S, Alexander RE. Laryngotracheal Recurrent Papillomatosis: A Case Study and Survey of Surgical and Systemic Management. Ear Nose Throat J 2022; 101:47S-51S. [PMID: 36173000 DOI: 10.1177/01455613221128714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This case report presents a 72-year-old man with longstanding recurrent respiratory papillomatosis (RRP). He has undergone multiple procedures for the condition, including an apparent urgent surgical airway followed by tracheoplasty repair. Modern management of complicated RRP should include both local debulking and systemic approaches. Systemic bevacizumab (Avastin) has shown some initial success as an effective treatment option, in addition to other medications such as pembrolizumab. Other future care strategies may include an HPV vaccination and other adjuvants; vaccination has been reported to have the possibility of drastically reducing the incidence of RRP.
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Affiliation(s)
- Michela Borrelli
- 22494Cedars Sinai Sinus Center of Excellence, Los Angeles, CA, USA.,Cedars-Sinai Division of Otolaryngology, Los Angeles, CA, USA
| | - Tasha Nasrollahi
- 22494Cedars Sinai Sinus Center of Excellence, Los Angeles, CA, USA.,Cedars-Sinai Division of Otolaryngology, Los Angeles, CA, USA.,California Northstate University College of Medicine, Elk Grove, CA, USA
| | - Jonathan Raskin
- 22494Cedars Sinai Sinus Center of Excellence, Los Angeles, CA, USA.,Cedars-Sinai Division of Otolaryngology, Los Angeles, CA, USA.,6918Oakland University William Beaumont School of Medicine, Detroit, MI, USA
| | - Sana Khan
- 43986American University of Antigua College of Medicine, Osbourn, AN, USA
| | - Ronda E Alexander
- 22494Cedars Sinai Sinus Center of Excellence, Los Angeles, CA, USA.,2013Montefiore Medical Center, Bronx, NY, USA
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10
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Steehler AJ, Rothman R, Sadhar B, Saran M, Lipman SP, Lipman RI. Tapia's Syndrome After Cardiac Surgery: A Case Report and Review of Literature. Ear Nose Throat J 2022:1455613221113807. [PMID: 35829719 DOI: 10.1177/01455613221113807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Tapia's syndrome is considered a neuropraxic injury of the recurrent laryngeal nerve and hypoglossal nerve which commonly presents after postoperative general anesthesia as hoarseness and dysphagia. Clinicians should consider this diagnosis in those presenting with symptoms of cranial nerve X and cranial nerve XII injury in the post-extubation setting for prompt diagnosis and management. Here, we report a rare case of Tapia's syndrome following cardiac surgery which was then treated with carboxymethylcellulose gel implant injection.
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Affiliation(s)
- Andrew J Steehler
- Department of Otolaryngology Head and Neck Surgery, University of Pittsburgh Medical Center Hamot, Erie, PA, USA
| | - Ryan Rothman
- Medicine Institute, Allegheny Health Network, Pittsburgh, PA, USA
| | | | - Manick Saran
- Department of Otolaryngology Head and Neck Surgery, University of Pittsburgh Medical Center Hamot, Erie, PA, USA
| | - Sidney P Lipman
- Department of Otolaryngology Head and Neck Surgery, University of Pittsburgh Medical Center Hamot, Erie, PA, USA
| | - Ruthann I Lipman
- Department of Otolaryngology Head and Neck Surgery, University of Pittsburgh Medical Center Hamot, Erie, PA, USA
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Gadalla AAEH, Othman KM, Hamela MAA, El Bohy AEMM. Value of laryngeal ultrasound in comparison with flexible laryngoscope in diagnosis of various laryngeal masses: a cross-sectional study. Egypt J Radiol Nucl Med 2022; 53:223. [PMCID: PMC9574845 DOI: 10.1186/s43055-022-00904-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background The term "vocal cord mass" refers to any abnormal growth of the vocal cords. This may include nodules, cysts, polyps, or cancers. Hoarseness of voice is considered the most common symptom of laryngeal lesions. Ultrasound imaging has evolved into a valuable and effective technique for evaluating the head and neck region, including the larynx's structure. Our aim is to evaluate laryngeal ultrasound as an alternative technique to the flexible laryngoscope in the diagnosis and assessment of various laryngeal masses.
Results The study included 30 males (57.7%) and 22 females (42.3%) who presented with hoarseness of voice. All patients had laryngeal ultrasonography, which was followed by flexible laryngoscopy. The most commonly affected cord was the left vocal cord (42.3%), followed by the right vocal cord (32.7%), and finally both of them (25%). The sensitivity of laryngeal ultrasonography was 88.5% compared to the gold standard flexible laryngoscopy (p value 0.031). Conclusions The laryngeal ultrasonography is a highly successful technique in the diagnosis and assessment of various laryngeal masses and could be complementary to flexible laryngoscopy in many cases, especially when laryngoscopy is contraindicated, with relatively high sensitivity in the detection of laryngeal masses.
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Affiliation(s)
| | - Khaled Mohamed Othman
- grid.7776.10000 0004 0639 9286Faculty of Medicine, Radiology Department, Cairo University, Cairo, Egypt
| | - Mo’men Ali Ameen Hamela
- grid.7776.10000 0004 0639 9286Faculty of Medicine, Department of Otorhinolaryngology, Cairo University, Cairo, Egypt
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Shan Q, Huang W, Wang Z, Xue Q, Shi Z, Zhou J, Wu Z, Ding X, Mao A, Shang M, Wang Z. Preliminary Experience With a Novel Metallic Segmented Transcordal Stent Modified With Three-Dimensional Printing for Inoperable Malignant Laryngotracheal Stenosis. Front Oncol 2021; 11:619781. [PMID: 34381701 PMCID: PMC8350761 DOI: 10.3389/fonc.2021.619781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 07/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background This study aims to assess the feasibility of a novel metallic segmented transcordal stent modified with three-dimensional (3D) printing for treating inoperable malignant laryngotracheal stenosis and the tolerability of the stent. Methods This was a retrospective study. The stents were individually customized with the aid of 3D printing model based on the anatomic features of each patient’s airway. The stent was composed of two separate segments that corresponded to the larynx and the upper trachea. The stents were barrel-shaped at the proximal end to prevent migration. The proximal end of the stent was located slightly above the vocal cord. The technical and clinical success of stenting procedure, patient tolerability, and stent-related complications of patients were evaluated. Results Ten patients with dyspnea caused by malignant laryngotracheal stenosis underwent implantation of such stents. Technical and clinical success of the stenting procedure were achieved in all patients. For all patients, basic communication in life could be maintained by speaking softly. During follow-up, one patient showed intolerance to the stent, and the stent was retrieved 2 weeks after stenting. Stent migration was found in one patient, and the position of the stent was readjusted. Granulation tissue proliferation was found in two patients and was treated with cryotherapy by bronchoscopy. There were no deaths associated with stenting. Conclusions The individually customized metallic segmented transcordal stent is feasible and tolerable for patients with inoperable malignant laryngotracheal stenosis. The implantation of this stent may serve as a novel alternative treatment for patients who are not suitable for surgery or tracheotomy.
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Affiliation(s)
- Qungang Shan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Huang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ziyin Wang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qingsheng Xue
- Department of Anesthesiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhihong Shi
- Department of Otolaryngology & Head and Neck Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianping Zhou
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhiyuan Wu
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoyi Ding
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Aiwu Mao
- Department of Interventional Radiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mingyi Shang
- Department of Interventional Radiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhongmin Wang
- Department of Radiology, RuiJin Hospital/Lu Wan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Aygun N, Kostek M, Isgor A, Uludag M. Anatomical, Functional, and Dynamic Evidences Obtained by Intraoperative Neuromonitoring Improving the Standards of Thyroidectomy. Sisli Etfal Hastan Tip Bul 2021; 55:146-55. [PMID: 34349588 DOI: 10.14744/SEMB.2021.45548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/07/2021] [Indexed: 12/19/2022]
Abstract
The use of intraoperative neuromonitoring (IONM) is getting more common in thyroidectomy. The data obtained by the usage of IONM regarding the laryngeal nerves’ anatomy and function have provided important contributions for improving the standards of the thyroidectomy. These evidences obtained through IONM increase the rate of detection and visual identification of recurrent laryngeal nerve (RLN) as well as the detection rate of extralaryngeal branches which are the most common anatomic variations of RLN. IONM helps early identification and preservation of the non-recurrent laryngeal nerve. Crucial knowledge has been acquired regarding the complex innervation pattern of the larynx. Extralaryngeal branches of the RLN may contribute to the motor innervation of the cricothyroid muscle (CTM). Anterior branch of the extralaryngeal branching RLN has always motor function and gives motor branches both to the abductor and adductor muscles. In addition, up to 18% of posterior branches may have adductor and/or abductor motor fibers. In 70–80% of cases, external branch of superior laryngeal nerve (EBSLN) provides motor innervation to the anterior 1/3 of the thyroarytenoid muscle which is the main adductor of the vocal cord through the human communicating nerve. Furthermore, approximately 1/3 of the cases, EBSLN may contribute to the innervation of posterior cricoarytenoid muscle which is the main abductor of ipsilateral vocal cord. RLN and/or EBSLN together with pharyngeal plexus usually contribute to the motor innervation of cricopharyngeal muscle that is the main component of upper esophageal sphincter. Traction trauma is the most common reason of RLN injuries and constitutes of 67–93% of cases. More than 50% of EBSLN injuries are caused by nerve transection. A specific point of injury on RLN can be detected in Type 1 (segmental) injury, however, Type 2 (global) injury is the loss of signal (LOS) throughout ipsilateral vagus-RLN axis and there is no electrophysiologically detectable point of injury. Vocal cord paralysis (VCP) develops in 70–80% of cases when LOS persists or incomplete recovery of signal occurs after waiting for 20 min. In case of complete recovery of signal, VCP is not expected. VCP is temporary in patients with incomplete recovery of signal and permanent VCP is not anticipated. Visual changes may be seen in only 15% of RLN injuries, on the other hand, IONM detects 100% of RLN injuries. IONM can prevent bilateral VCP. Continuous IONM (C-IONM) is a method in which functional integrity of vagus-RLN axis is evaluated in real time and C-IONM is superior to intermittent IONM (I-IONM). During upper pole dissection, IONM makes significant contributions to the visual and functional identification of EBSLN. Routine use of IONM may minimalize the risk of nerve injury. Reduction of amplitude more than 50% on CTM is related with poor voice outcome.
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Kim Y, Oh J, Choi SH, Jung A, Lee JG, Lee YS, Kim JK. A Portable Smartphone-Based Laryngoscope System for High-Speed Vocal Cord Imaging of Patients With Throat Disorders: Instrument Validation Study. JMIR Mhealth Uhealth 2021; 9:e25816. [PMID: 34142978 PMCID: PMC8277344 DOI: 10.2196/25816] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/17/2021] [Accepted: 05/13/2021] [Indexed: 11/13/2022] Open
Abstract
Background Currently, high-speed digital imaging (HSDI), especially endoscopic HSDI, is routinely used for the diagnosis of vocal cord disorders. However, endoscopic HSDI devices are usually large and costly, which limits access to patients in underdeveloped countries and in regions with inadequate medical infrastructure. Modern smartphones have sufficient functionality to process the complex calculations that are required for processing high-resolution images and videos with a high frame rate. Recently, several attempts have been made to integrate medical endoscopes with smartphones to make them more accessible to people in underdeveloped countries. Objective This study aims to develop a smartphone adaptor for endoscopes, which enables smartphone-based vocal cord imaging, to demonstrate the feasibility of performing high-speed vocal cord imaging via the high-speed imaging functions of a high-performance smartphone camera, and to determine the acceptability of the smartphone-based high-speed vocal cord imaging system for clinical applications in developing countries. Methods A customized smartphone adaptor optical relay was designed for clinical endoscopy using selective laser melting–based 3D printing. A standard laryngoscope was attached to the smartphone adaptor to acquire high-speed vocal cord endoscopic images. Only existing basic functions of the smartphone camera were used for HSDI of the vocal cords. Extracted still frames were observed for qualitative glottal volume and shape. For image processing, segmented glottal and vocal cord areas were calculated from whole HSDI frames to characterize the amplitude of the vibrations on each side of the glottis, including the frequency, edge length, glottal areas, base cord, and lateral phase differences over the acquisition time. The device was incorporated into a preclinical videokymography diagnosis routine to compare functionality. Results Smartphone-based HSDI with the smartphone-endoscope adaptor could achieve 940 frames per second and a resolution of 1280 by 720 frames, which corresponds to the detection of 3 to 8 frames per vocal cycle at double the spatial resolution of existing devices. The device was used to image the vocal cords of 4 volunteers: 1 healthy individual and 3 patients with vocal cord paralysis, chronic laryngitis, or vocal cord polyps. The resultant image stacks were sufficient for most diagnostic purposes. The cost of the device including the smartphone was lower than that of existing HSDI devices. The image processing and analytics demonstrated the successful calculation of relevant diagnostic variables from the acquired images. Patients with vocal pathologies were easily differentiable in the quantitative data. Conclusions A smartphone-based HSDI endoscope system can function as a point-of-care clinical diagnostic device. The resulting analysis is of higher quality than that accessible by videostroboscopy and promises comparable quality and greater accessibility than HSDI. In particular, this system is suitable for use as an accessible diagnostic tool in underdeveloped areas with inadequate medical service infrastructure.
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Affiliation(s)
- Youngkyu Kim
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea.,Department of Convergence Medicine, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Jeongmin Oh
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea
| | - Seung-Ho Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, Seoul, Republic of Korea
| | - Ahra Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea
| | - June-Goo Lee
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea.,Department of Convergence Medicine, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Yoon Se Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, Seoul, Republic of Korea
| | - Jun Ki Kim
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea.,Department of Convergence Medicine, College of Medicine, University of Ulsan, Seoul, Republic of Korea
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15
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Dong Z, Zhang C, Zhao Q, Huangfu H, Xue X, Wen S, Wu Y, Gao W, Wang B. Alterations of bacterial communities of vocal cord mucous membrane increases the risk for glottic laryngeal squamous cell carcinoma. J Cancer 2021; 12:4049-4063. [PMID: 34093809 PMCID: PMC8176248 DOI: 10.7150/jca.54221] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 04/21/2021] [Indexed: 01/02/2023] Open
Abstract
Bacteria are among the important factors that play a role in the balance of human health, and their relationship with some tumors has been well established. However, the association between bacteria colonizing the vocal cords and glottic laryngeal squamous cell carcinoma (GLSCC) remains unclear. Here, we investigated whether bacterial communities of the vocal cord mucous membrane play a role in the development of GLSCC. We collected tumor tissue and normal adjacent tissue (NAT) samples from 19 GLSCC patients, and the bacterial communities were compared with control samples (control) from 21 vocal cord polyps using 16S rRNA high-throughput pyrosequencing. We detected 41 phyla, 93 classes, 188 orders, 373 families, and 829 genera in the vocal cord mucous membrane. A comparison of the bacterial communities in the NAT samples showed higher α‐diversity than in the tumor samples. In the tumor samples, seven groups of bacteria, i.e., the phylum Fusobacteria, the class Fusobacteriia, the order Fusobacteriales, the family Fusobacteriaceae, and the genera Fusobacterium, Alloprevotella, and Prevotella, were significantly enriched, as revealed by linear discriminant analysis coupled with effect size measurements (LEfSe). However, bacteria from the phylum Firmicutes were most significantly enriched in the vocal cord polyp tissues. These findings suggest alterations in the bacterial community structure of the vocal cord mucous membrane of GLSCC patients and that seven groups of bacteria are related to GLSCC, indicating that imbalances in bacterial communities increase the risk for the development of GLSCC.
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Affiliation(s)
- Zhen Dong
- Shanxi Key Laboratory of Otorhinolaryngology Head and Neck Cancer, First Hospital of Shanxi Medical University, Taiyuan 030001, China.,Department of Otolaryngology Head & Neck Surgery, First Hospital of Shanxi Medical University, Taiyuan 030001, China.,Shanxi Province Clinical Medical Research Center for Precision Medicine of Head and Neck Cancer, First Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Chunming Zhang
- Shanxi Key Laboratory of Otorhinolaryngology Head and Neck Cancer, First Hospital of Shanxi Medical University, Taiyuan 030001, China.,Department of Otolaryngology Head & Neck Surgery, First Hospital of Shanxi Medical University, Taiyuan 030001, China.,Shanxi Province Clinical Medical Research Center for Precision Medicine of Head and Neck Cancer, First Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Qinli Zhao
- Department of Otolaryngology Head & Neck Surgery, First Hospital of Shanxi Medical University, Taiyuan 030001, China.,Shanxi Province Clinical Medical Research Center for Precision Medicine of Head and Neck Cancer, First Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Hui Huangfu
- Department of Otolaryngology Head & Neck Surgery, First Hospital of Shanxi Medical University, Taiyuan 030001, China.,Shanxi Province Clinical Medical Research Center for Precision Medicine of Head and Neck Cancer, First Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Xuting Xue
- Shanxi Key Laboratory of Otorhinolaryngology Head and Neck Cancer, First Hospital of Shanxi Medical University, Taiyuan 030001, China.,Shanxi Province Clinical Medical Research Center for Precision Medicine of Head and Neck Cancer, First Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Shuxin Wen
- Department of Otolaryngology Head & Neck Surgery, Shanxi Bethune Hospital, Taiyuan 030032, China.,Shanxi Province Clinical Medical Research Center for Precision Medicine of Head and Neck Cancer, First Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Yongyan Wu
- Shanxi Key Laboratory of Otorhinolaryngology Head and Neck Cancer, First Hospital of Shanxi Medical University, Taiyuan 030001, China.,Shanxi Province Clinical Medical Research Center for Precision Medicine of Head and Neck Cancer, First Hospital of Shanxi Medical University, Taiyuan 030001, China.,Key Laboratory of Cellular Physiology, Ministry of Education, Shanxi Medical University, Taiyuan, 030001, China.,Department of Biochemistry & Molecular Biology, Shanxi Medical University, Taiyuan 030001, China
| | - Wei Gao
- Shanxi Key Laboratory of Otorhinolaryngology Head and Neck Cancer, First Hospital of Shanxi Medical University, Taiyuan 030001, China.,Shanxi Province Clinical Medical Research Center for Precision Medicine of Head and Neck Cancer, First Hospital of Shanxi Medical University, Taiyuan 030001, China.,Key Laboratory of Cellular Physiology, Ministry of Education, Shanxi Medical University, Taiyuan, 030001, China.,Department of Cell biology and Genetics, Basic Medical School, Shanxi Medical University, Taiyuan 030001, China
| | - Binquan Wang
- Shanxi Key Laboratory of Otorhinolaryngology Head and Neck Cancer, First Hospital of Shanxi Medical University, Taiyuan 030001, China.,Department of Otolaryngology Head & Neck Surgery, First Hospital of Shanxi Medical University, Taiyuan 030001, China.,Shanxi Province Clinical Medical Research Center for Precision Medicine of Head and Neck Cancer, First Hospital of Shanxi Medical University, Taiyuan 030001, China
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16
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Bryk P, Głuszek S. Does neuromonitoring affect voice quality in patients subjected to a complete thyroidectomy ? Otolaryngol Pol 2021; 75:16-23. [PMID: 34552022 DOI: 10.5604/01.3001.0014.8779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Voice dysfunction is the most common complication of thyroid surgery. The use of intraoperative neuromonitoring (IONM) is to protect the recurrent laryngeal nerves, the damage of which causes voice dysfunction. The aim of the study was to evaluate voice quality in patients who underwent complete thyroidectomy operated on with the application of IONM as well as a group of patients operated on with only macroscopic nerve visualization. In the analysis, clinical voice assessment was performed with particular focus on voice efficiency using the Voice Handicap Index (VHI), Vocal Tract Discomfort (VTD) and GRBAS scale. The study group consisted of 205 patients operated on with IONM. The control group consisted of 162 patients subjected to surgery only with macroscopic visualization of recurrent laryngeal nerves, without IONM. During the follow-up period from 2 to 10 years after surgery, checkups were performed. Each patient who came for a checkup was subjected to perceptual voice evaluation with the use of the GRBAS scale, indirect laryngoscopy procedure and voice selfevaluation with two questionnaires (VHI and VTD). The frequency of vocal fold palsy did not differ significantly statistically in the study group and the control group. Both in the study group and in the control group, patients with vocal fold paralysis had statistically significantly higher results in the VHI and VTD questionnaires as well as in the GRBAS study. Patients with recurrent laryngeal nerve injury show significant differences in the scope of voice handicap, both in the voice quality assessment with the use of the GRBAS scale, and self-evaluation questionnaires: VHI and VTD. All voice disorders evaluated with self-assessment are medium voice disability.
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Affiliation(s)
- Piotr Bryk
- Teaching Department of General, Oncological Surgery and Endocrinology of the Provincial Polyclinical Hospital in Kielce, Poland
| | - Stanislaw Głuszek
- Teaching Department of General, Oncological Surgery and Endocrinology of the Provincial Polyclinical Hospital in Kielce, Poland
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17
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Talmor G, Nguyen B, Geller MT, Hsu J, Kaye R, Caloway C. Vocal Fold Motion Impairment Following Chemotherapy Administration: Case Reports and Review of the Literature. Ann Otol Rhinol Laryngol 2021; 130:405-415. [PMID: 33501843 DOI: 10.1177/0003489421990149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Chemotherapy-induced vocal fold motion impairment (CIVFMI) is a rare complication of cancer therapy with potential for airway compromise. The objective of this review is to present 2 new cases of CIVFMI to add to the literature as well as characterize the demographics, symptoms, exam findings, airway complication rates and prognosis of CIVFMI. METHODS A search of Pubmed/MEDLINE (1970 to May 1, 2020), Embase (1970 to May 1, 2020), and Cochrane Library using medical study heading (MeSH) terms related to chemotherapy (drug therapy, chemotherapy, vincristine, vinblastine, paclitaxel) and vocal cord motion impairment (vocal cord, cords, vocal folds, immobility, hypomobility) was performed. Exploratory pooling of data without formal meta-analysis was performed. RESULTS A preliminary search yielded 148 abstracts, review articles and studies. A total of 23 studies met inclusion criteria. There were 35 total cases presented in the literature, with a mean age of 29.5 (0.4-78). The most common cancer diagnosis was acute lymphoblastic leukemia (n = 15, 42.9%), and the most common agent was vincristine (n = 30, 85.7%). Dysphagia, bilateral CIVFMI, and vocal fold immobility rather than hypomobility were more common in pediatric patients. There were 8 cases of surgical airway intervention, including tracheostomy and posterior cordotomy. The duration of symptoms was 7 to 420 days, and spontaneous resolution was reported in 32 cases. CONCLUSIONS CIVFMI has potential for airway complications requiring surgical intervention. Spontaneous resolution after cessation of the offending agent is the most likely outcome. Bilateral CIVFMI, dysphagia and vocal fold immobility are more common in the pediatric population.
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Affiliation(s)
- Guy Talmor
- Department of Otolaryngology-Head and Neck Surgery, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Brandon Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Melin Tan Geller
- Department of Otolaryngology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jeffrey Hsu
- Northwest Permanente Physicians and Surgeons, Clackamas, OR, USA
| | - Rachel Kaye
- Department of Otolaryngology-Head and Neck Surgery, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Christen Caloway
- Department of Otolaryngology-Head and Neck Surgery, Rutgers-New Jersey Medical School, Newark, NJ, USA
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18
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Baldelli L, Provini F, Cortelli P. Fatal Familial Insomnia: A Rare Disease with Unique Clinico-Neurophysiological Features. Mov Disord Clin Pract 2021; 8:162-163. [PMID: 33426175 DOI: 10.1002/mdc3.13116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/04/2020] [Indexed: 11/08/2022] Open
Affiliation(s)
- Luca Baldelli
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM) University of Bologna Bologna Italy
| | - Federica Provini
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM) University of Bologna Bologna Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna Bologna Italy
| | - Pietro Cortelli
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM) University of Bologna Bologna Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna Bologna Italy
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19
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Menon A, Emam D, Al-Mannai O, Shallik N, Al-Khafaji M. Channeled fiberoptic for vocal cord polyp excision under spontaneous respiration using intravenous anesthesia and hi-flow nasal oxygen (STRIVE-Hi) technique: A case report and review of the literature. Qatar Med J 2020; 2020:27. [PMID: 33282711 PMCID: PMC7684548 DOI: 10.5339/qmj.2020.27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 04/05/2020] [Indexed: 11/21/2022] Open
Abstract
Microlaryngoscopy for benign vocal cord lesion excision is a procedure with good outcomes and relatively few complications that is performed worldwide. The anterior one-third of the vocal cords is a relatively common site to find benign polyps, and the excision of cases with adequate laryngeal exposure is relatively easy. However, they can sometimes present a challenge when laryngeal exposure is suboptimal, which leads to trouble in accessing the site. The factors that can lead to difficulties in laryngeal exposure are numerous, such as restricted mouth opening, limited neck extension, large tongue size, and others. The preoperative prediction of difficult laryngeal exposure (DLE) can be obtained by different scoring and grading systems. We have used the Laryngoscore in this case. However, management options for such cases remain limited. Here, we present a case that was managed using channeled cup forceps under fiberoptic endoscopy with the STRIVE-Hi technique used to administer anesthesia.
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Affiliation(s)
- Abhishek Menon
- Department of Otolaryngology, Hamad Medical Corporation, Doha, Qatar
| | - Dina Emam
- Department of Otolaryngology, Hamad Medical Corporation, Doha, Qatar
| | - Olfa Al-Mannai
- Department of Otolaryngology, Hamad Medical Corporation, Doha, Qatar
| | - Nabil Shallik
- Department of Anaesthesiology, Hamad Medical Corporation, Doha, Qatar
| | - Muayad Al-Khafaji
- Department of Otolaryngology, Hamad Medical Corporation, Doha, Qatar
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20
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Zeng C, Lin Q. Ectopic Thyroid Tissue on the Vocal Cord: A Case Report. Laryngoscope 2020; 131:E1391-E1392. [PMID: 32985681 DOI: 10.1002/lary.29063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/25/2020] [Accepted: 08/09/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Chaojun Zeng
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Hospital of Putian City, Putian, China
| | - Qin Lin
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Hospital of Putian City, Putian, China
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21
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Ban MJ, Lee SC, Park JH, Park KN, Kim HK, Lee SW. Regenerative efficacy of fibroblast growth factor for the treatment of aged vocal fold: From animal model to clinical application. Clin Otolaryngol 2020; 46:131-137. [PMID: 32558170 DOI: 10.1111/coa.13597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 02/03/2020] [Accepted: 06/04/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVES We assessed fibroblast growth factor (FGF) regenerative efficacy in an aged vocal fold rat model and confirmed it in a prospective clinical trial. DESIGN, SETTING, AND PARTICIPANTS For animal experiments, 48 Sprague-Dawley rats were divided into two groups: 24 six-month-olds (young group) and 24 twenty-four-month-olds (old group). FGF was injected once a week thrice into the left vocal fold of the old group, dividing them into two sub-groups (injected [left] and uninjected [right]). Additionally, we conducted a prospective clinical trial for 38 patients with aged atrophic vocal fold. MAIN OUTCOME MEASURES A month post-injection, excised larynx from the three groups was subjected to comparative histopathological (ratio of relative lamina propria to total vocal fold) and mRNA expression analysis (of procollagen I, hyaluronic acid synthase (HAS)-2 and matrix metalloproteinase (MMP)-2) by real-time PCR. We performed perceptual, stroboscopic, acoustic aerodynamic test and Voice Handicap Index survey prior to and 1, 6 and 12 months after FGF injection. RESULTS In rats, the relative lamina propria ratio increased after FGF injection. Procollagen I mRNA level decreased, whereas that of HAS-2 and MMP-2 increased significantly in the injected compared to the uninjected old group. Enrolled patients showed improved subjective and objective voice parameters after FGF injection, and these were maintained for a year. Potential side effects were not observed. CONCLUSIONS Animal experiments and prospective clinical trial suggest that FGF injection to vocal fold can significantly improve voice quality until one year, without complications, and is effective for aged atrophic vocal fold treatment.
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Affiliation(s)
- Myung Jin Ban
- Department of Otorhinolaryngology - Head and Neck Surgery, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Seung Chul Lee
- Department of Otorhinolaryngology - Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jae Hong Park
- Department of Otorhinolaryngology - Head and Neck Surgery, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Ki Nam Park
- Department of Otorhinolaryngology - Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Hee Kyung Kim
- Department of Pathology, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Seung Won Lee
- Department of Otorhinolaryngology - Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon, Korea
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Abstract
OBJECTIVE Anastomosing hemangioma (AH) is a novel tumor of vascular origin. Though well-documented in the kidney and retroperitoneum, only a single case has been documented in the head and neck, and AH in larynx has not been described. METHODS A 37-year-old male presented with difficulty in breathing, and hoarseness. Imaging revealed a lesion involving left paraglottic and cricothyroid spaces with destruction of cricoid cartilage, suggestive of a malignant cartilageneous neoplasm. Multiple biopsies were non-diagnostic. RESULTS Intraoperative frozen section during transcervical resection showed a vascular tumor devoid of nuclear atypia. Histopathological examination revealed a vasoformative tumor comprised of anastomosing capillary-sized vessels lined by flat and hobnail endothelial cells, consistent with AH. The patient was disease-free at 12 months. CONCLUSION AH are rare neoplasms that may mimic a malignancy on imaging, especially in sites where they have not been documented. Due to their vascular nature, biopsies are often non-diagnostic, making preoperative diagnosis difficult. Frozen section may assist in decision-making on the extent of resection required.
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Affiliation(s)
- Rimlee Dutta
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Aanchal Kakkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Pirabu Sakthivel
- Department of Otorhinolaryngology and Head Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Kumar
- Department of Otorhinolaryngology and Head Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
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Nassimizadeh A, El-Shummar S, Emery K, Costello D. Vocal fold medialization-A 5-year series of single surgeon consecutive medialization with review of literature. J Eval Clin Pract 2020; 26:281-289. [PMID: 31168894 DOI: 10.1111/jep.13169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/15/2019] [Accepted: 04/18/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION ENT UK released guidelines in 2010 detailing the requisite structure for the creation of a laryngeal intervention clinic. The senior author's practice is the only one regionally that offers this service, and our objective was to review this to determine whether vocal cord medialization injections were showing an improvement in quality of voice for patients. MATERIALS AND METHODS Patients were reviewed in a specialist voice clinic prior to being offered vocal cord injection under local anaesthetic in a separate dedicated weekly clinic. They would be assessed by the senior author and a dedicated voice specialist speech and language therapist (SALT). This would include a preinjection grade, roughness, breathiness, asthenia, and strain (GRBAS), Voice Handicap Index (VHI)-10, and the measuring of maximum phonation time (MPT) with the aid of Opera Vox Apple iPad application. RESULTS Data were available for 186 injections, on patients with a median age of 66 years (interquartile range [IQR]: 51-75), of whom 61% were male. VHI-10 score improved significantly, from a mean of 26.7 to 12.5 (P < .001). A significant improvement in MPT was also observed, from a median of 3.0 to 6.3 (N = 66, P < .001). Improvements in all components of the GRBAS score were also observed (all P < .001), with between 43% and 88% of cases reporting reductions after the procedure. Patients receiving a repeat procedure saw a significantly smaller improvement in VHI-10 than those where it was the primary treatment (mean reduction: 9.8 vs 15.5, P = .018). Analysis of MPT found a significant correlation between the quantity of injection material used and the degree of improvement observed (rho = 0.355, P = .004). CONCLUSION Vocal Cord local anaesthetic medialization injection is a swift, safe, and effective short-term method of improving dysphonia.
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Affiliation(s)
- Abdul Nassimizadeh
- Department of Otolaryngology, University Hospital Birmingham, Birmingham, UK
| | - Suliman El-Shummar
- Department of Otolaryngology, University Hospital Birmingham, Birmingham, UK
| | - Katrina Emery
- Department of Otolaryngology, University Hospital Birmingham, Birmingham, UK
| | - Declan Costello
- Department of Otolaryngology, University Hospital Birmingham, Birmingham, UK
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Alicura Tokgöz S, Saka C, Akın İ, Köybaşıoğlu F, Kılıçaslan S, Çalışkan M, Beşaltı Ö, Çadallı Tatar E. Effects of phenytoin injection on vocal cord healing after mechanical trauma: An experimental study. Turk J Med Sci 2019; 49:1577-1581. [PMID: 31652040 PMCID: PMC7018381 DOI: 10.3906/sag-1903-63] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 07/17/2019] [Indexed: 11/24/2022] Open
Abstract
Background/aim Phenytoin is an anticonvulsant drug which causes fibroblast proliferation, collagen synthesis, and an increase in epidermal growth factor. Therefore, the aim of the present study is to evaluate the effect of phenytoin injection on the wound healing process in rats with vocal cord injury by histopathological methods. Materials and methods The vocal cords of 10 albino Wistar rats were damaged bilaterally; the left vocal cord was kept as the control group. Phenytoin was injected in the right vocal cord. Ten rats were sacrificed. The thickness of the lamina propria and density of the fibroblast and collagen were evaluated histopathologically. Results Thickness of the lamina propria was 18.0 ± 7.1 µm in the control group, 65.5 ± 10.7 µm in the phenytoin group. The density of fibroblast and collagen were statistically lower in the control group compared the phenytoin group (P < 0.05). Conclusion Phenytoin injection in rats after vocal cord injury significantly increased the thickness of the lamina propria and density of fibroblast and regular and mature collagen in the lamina propria. The findings in our study provide a feasible scientific view for adding phenytoin treatment to vocal cord surgeries in otolaryngology practice, but further studies are needed in order to evaluate the use of phenytoin in preventing the formation of scar tissue and possible effects on vocal cord vibration in humans after vocal cord injury.
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Affiliation(s)
- Sibel Alicura Tokgöz
- Department of Otorhinolaryngology, University of Health Sciences Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Cem Saka
- Department of Otorhinolaryngology, University of Health Sciences Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - İstemihan Akın
- Department of Otorhinolaryngology, University of Health Sciences Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Fulya Köybaşıoğlu
- Department of Pathology, Faculty of Medicine, Yüksek İhtisas University, Ankara, Turkey
| | - Saffet Kılıçaslan
- Department of Otorhinolaryngology, Düzce Atatürk State Hospital, Düzce, Turkey
| | - Murat Çalışkan
- Department of Surgery, Faculty of Veterinary Medicine, Ankara University, Ankara, Turkey
| | - Ömer Beşaltı
- Department of Surgery, Faculty of Veterinary Medicine, Ankara University, Ankara, Turkey
| | - Emel Çadallı Tatar
- Department of Otorhinolaryngology, University of Health Sciences Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
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Best SR, Esquivel D, Mellinger-Pilgrim R, Roden RBS, Pitman MJ. Infectivity of murine papillomavirus in the surgical byproducts of treated tail warts. Laryngoscope 2019; 130:712-717. [PMID: 31041820 DOI: 10.1002/lary.28026] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 04/05/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Human papillomavirus (HPV) is a highly stable DNA virus that causes disease in human organ systems, including the larynx and oropharynx. The treatment of HPV-associated diseases with scalpels, lasers, and other surgical instruments has the potential to release infectious particles, placing healthcare workers at risk. The objectives of this study were to create a reproducible in vivo animal model of papillomavirus infectivity and to compare the infectivity of byproducts of surgically treated mouse papillomavirus (MmuPV1) warts. STUDY DESIGN Animal study. METHODS Nude laboratory mice (Mus musculus) with established MmuPV1 tail warts were treated with scalpel excision, potassium titanyl phosphate (KTP) laser ablation, and coblator treatment. Uninfected nude mice were challenged with surgical byproducts, including ablated and heated tissue, and surgical smoke products. The incidence and time course of the appearance of warts was recorded. RESULTS There was rapid transmission of virus in mice challenged with scalpel-treated warts, with 50% penetrance of infection at day 13 and 100% at day 32. For KTP-treated warts, there was the slower development of infection (50% by day 35) but 100% penetrance by day 52. Coblator-treated tissue reached 50% penetrance at day 59 and a maximum of 73% penetrance. Smoke plume captured during treatment with the KTP laser and coblator was highly infectious, as was the material captured in a laser filter. CONCLUSIONS MmuPV1 remains infectious in all modes of surgically treated tissue, and the smoke plume is capable of transmitting infection. Healthcare workers should use appropriate precautions to lower their risk of infection when treating papillomavirus-associated diseases. LEVEL OF EVIDENCE NA Laryngoscope, 130:712-717, 2020.
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Affiliation(s)
- Simon R Best
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Daniel Esquivel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | | | - Richard B S Roden
- Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Michael J Pitman
- Department of Otolaryngology-Head and Neck Surgery, The Voice and Swallowing Institute, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York, U.S.A
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Lechien JR, Saussez S, Nacci A, Barillari MR, Rodriguez A, Le Bon SD, Crevier-Buchman L, Harmegnies B, Finck C, Akst LM. Association between laryngopharyngeal reflux and benign vocal folds lesions: A systematic review. Laryngoscope 2019; 129:E329-E341. [PMID: 30892725 DOI: 10.1002/lary.27932] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/14/2019] [Accepted: 02/25/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To investigate the role of laryngopharyngeal reflux (LPR) in the development of benign lesions of the vocal folds (BLVF). METHODS PubMed, Cochrane Library, and Scopus were searched by three independent investigators for articles published between January 1990 and November 2018 providing substantial information about the role of LPR in the development of nodules, polyps, cysts, Reinke's edema, and sulcus vocalis. Inclusion, exclusion, diagnostic criteria and clinical outcome evaluation of included studies were analyzed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. RESULTS Of the 155 relevant publications, 42 studies were included. Thirty-five were clinical studies and seven were experimental research studying the impact of reflux on vocal fold tissue. Only seven clinical studies utilized objective LPR diagnoses (pH monitoring), suggesting an association between LPR and the development of nodules, polyps, and Reinke's edema. These studies were characterized by a substantial heterogeneity due to discrepancies in inclusion/exclusion criteria, diagnostic methods, and clinical outcome evaluation. The few basic science studies on this topic support that LPR creates an environment that may predispose to BLVF through changes in defense mechanisms of the vocal folds, cell-to-cell dehiscence, inflammatory reaction of the vocal folds, and reaction to phonotrauma. CONCLUSIONS Caustic mucosal injury from LPR could cause increased susceptibility of the vocal fold mucosa to injury and subsequent formation of nodules, polyps, or Reinke's edema. However, the heterogeneity and the low number of high-quality studies limit the ability to draw definitive conclusions. Future clinical and experimental studies are needed to better identify the role of reflux in development of BLVF. Laryngoscope, 129:E329-E341, 2019.
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Affiliation(s)
- Jerome R Lechien
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium.,Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language Sciences and Technology, University of Mons, Mons, Belgium.,Department of Otorhinolaryngology-Head and Neck Surgery, CHRU de Lille, Université de Lille, Lille, France.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Sven Saussez
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Andrea Nacci
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,ENT Audiology and Phoniatric Unit, University of Pisa, Pisa, Italy
| | - Maria Rosaria Barillari
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, University of Luigi Vanvitelli, Naples, Italy
| | - Alexandra Rodriguez
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Serge D Le Bon
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Lise Crevier-Buchman
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,Department of Otorhinolaryngology-Head and Neck Surgery, Foch Hospital, Paris, France
| | - Bernard Harmegnies
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language Sciences and Technology, University of Mons, Mons, Belgium
| | - Camille Finck
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Liège, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Lee M Akst
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
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Chen X, Zhai W, Yu Z, Geng J, Li M. Determining correct tracheal tube insertion depth by measuring distance between endotracheal tube cuff and vocal cords by ultrasound in Chinese adults: a prospective case-control study. BMJ Open 2018; 8:e023374. [PMID: 30530476 PMCID: PMC6286487 DOI: 10.1136/bmjopen-2018-023374] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Unrecognised malposition of the endotracheal tube can lead to severe complications in patients under general anaesthesia. The purpose of this study was to verify the feasibility of using ultrasound to measure the distance between the upper edge of saline-inflated cuff and the vocal cords. DESIGN Prospective case-control study. SETTING A tertiary hospital in Beijing, China. METHODS In this prospective study, 105 adult patients who required general anaesthesia were enrolled. Prior to induction, ultrasound was used to identify the position of the vocal cords. After intubation, the endotracheal tube (ETT) was fixed at a depth of 23 cm at the upper incisors in men and 21 cm in women. The depth of intubation was verified by video-assisted laryngoscopy. The distance between the upper edge of the saline-inflated cuff and the vocal cords was measured by ultrasound; the ideal distance was considered to be 1.9-4.1 cm. RESULTS Among the 105 cases, two cuffs were too close to the vocal cords and one too far away from the vocal cords. These diagnoses were made by ultrasound and were in agreement with results from direct laryngoscopy. The overall accuracy of ultrasound in identifying malposition of the cuff was 100.0% (95% CI: 96.6% to 100%). The sensitivity, specificity, positive predictive value and negative predictive value of ultrasound were, respectively, 100% (95% CI: 96.5% to 100%), 100% (95% CI: 29.2% to 100%), 100% (95% CI: 96.5% to 100%) and 100% (95% CI: 29.2% to 100%). CONCLUSION Identification of the upper edge of the saline-inflated cuff and the vocal cords by ultrasound to assess the location of the ETT is a reliable method. It can be used to avoid malposition of the ETT cuff and reduce the incidence of vocal cords injury after intubation. TRIAL REGISTRATION NUMBER ChiCTR-DDD-17011048.
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Affiliation(s)
- Xuanling Chen
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
- Department of Anesthesiology, Peking University International Hospital, Beijing, China
| | - Wenwen Zhai
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Zhuoying Yu
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Jiao Geng
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Min Li
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
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Proserpio P, Esposito A, Facchetti D, Tassinari CA, Nobili L. Sleep-Related Rhythmic Sound From the Vocal Cords: A Possible Atypical Form of NREM Parasomnia. J Clin Sleep Med 2018; 14:1621-1624. [PMID: 30176978 DOI: 10.5664/jcsm.7348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 05/17/2018] [Indexed: 11/13/2022]
Abstract
ABSTRACT Sleep-related noises may have different features and etiologies. Here we report an atypical case of an adolescent with episodes of "sleep-related vocalization" occurring every night, especially during the first part of the night. The patient had moderate mental retardation and a dysfunctional dysphonia; she had no recollection of the episodes and complained exclusively of mild excessive daytime sleepiness. A video polysomnography recording documented two typical manifestations during non-rapid eye movement (NREM) sleep, characterized by the persistence of slow waves and without any electroencephalographic or breathing abnormalities. The quantified analysis of the acoustic features while confirming the rhythmic and stable characteristic of the sound suggests the involvement of the vocal fold vibration on its production. We interpreted these episodes as an atypical form of NREM parasomnia. A possible influence of the otolaryngologic abnormality can be hypothesized.
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Affiliation(s)
- Paola Proserpio
- Centre of Sleep Medicine, Department of Neuroscience, Niguarda Hospital, Milan, Italy
| | - Anna Esposito
- Università della Campania "Luigi Vanvitelli", Department of Psychology, Caserta, Italy
| | - Dante Facchetti
- Università della Campania "Luigi Vanvitelli", Department of Psychology, Caserta, Italy
| | | | - Lino Nobili
- Centre of Sleep Medicine, Department of Neuroscience, Niguarda Hospital, Milan, Italy.,IRCCS, Child Neuropsychiatry, G. Gaslini Institute, DINOGMI, University of Genoa, Genoa, Italy
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29
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Erdoğan O, İsmi O, Arpacı RB, Vayısoğlu Y, Özcan C. False-Positive Laryngeal FDG Uptake During PET/CT Imaging: Reinke's Edema. Turk Arch Otorhinolaryngol 2018; 56:114-116. [PMID: 30197811 DOI: 10.5152/tao.2018.3123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 02/13/2018] [Indexed: 11/22/2022] Open
Abstract
Positron emission tomography/computed tomography (PET/CT) is frequently used for diagnosing, staging, and following-up various malignancy types because it provides information on the site and metabolic activity of the tumor. Fluorodeoxyglucose (FDG) uptake by the normal laryngeal tissue is symmetric and low, whereas that under some non-malignant conditions of the larynx, such as vocal cord paralysis and Teflon granuloma, is asymmetrically increased. We reported the first case of histologically proven Reinke's edema causing false-positive laryngeal FDG uptake on PET/CT imaging. A clinician must be aware of these rare benign lesions in the case of increased FDG uptake, and histopathological investigation is mandatory to rule out malignancy for suspicious cases.
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Affiliation(s)
- Osman Erdoğan
- Department of Otorhinolaryngology, Mersin University School of Medicine, Mersin, Turkey
| | - Onur İsmi
- Department of Otorhinolaryngology, Mersin University School of Medicine, Mersin, Turkey
| | | | - Yusuf Vayısoğlu
- Department of Otorhinolaryngology, Mersin University School of Medicine, Mersin, Turkey
| | - Cengiz Özcan
- Department of Otorhinolaryngology, Mersin University School of Medicine, Mersin, Turkey
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30
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Türk B, Akpınar M, Dizdar SK, Kaya KS, Çoktur A, Coşkun BU. Comparison of Postoperative Smoking Cessation Rates of Patients with Benign or Premalignant Vocal Cord Lesions. Sisli Etfal Hastan Tip Bul 2018; 52:114-8. [PMID: 32595383 DOI: 10.14744/SEMB.2017.08760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 11/14/2017] [Indexed: 11/20/2022]
Abstract
Objectives: It has been determined that cigarette is a risk factor for squamous cell carcinomas of the oral cavity, esophagus, and larynx. We aimed to investigate the role of histopathological diagnosis of the lesion in smoker patients with vocal cord lesion on smoking cessation rates and to determine strategies to help them quit smoking. Methods: In this prospective clinical study, we included 182 (112 male, 70 female) smoker patients who underwent direct laryngoscopy and biopsy due to premalignant (dysplasia) or benign (polyp, leukoplasia, nodule) vocal cord lesions between July 2014 and December 2017 at our clinic. Smoking habits (ex-smoker, current smoker) of all smoker patients were questioned at least 6 months postoperatively, and postoperative smoking cessation rates were compared. Results: When the smoking cessation rates of the patients with benign and premalignant vocal cord lesions were evaluated, the smoking cessation rate of the patients with premalignant vocal cord lesions was 3.45 times higher than that of the patients with benign vocal cord lesions (OR, 3.45; 95% CI, 1.76–6.74) (p<0.001). The postoperative application rate of the patients to smoking cessation outpatient clinics was low (6%). Male patients with premalignant lesions were more likely to quit smoking than female patients (p=0.001). Conclusion: Patients with premalignant vocal cord lesions had higher smoking cessation rates. Premalignant vocal cord lesions require clinical follow-up and treatment because of the risk and potential for their transformation into in situ or invasive laryngeal carcinomas.
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Best SR, Ahn J, Langmead S, Dhillon V, Hillel AT, Akst LM, Blakeley JO. Voice and Swallowing Dysfunction in Neurofibromatosis 2. Otolaryngol Head Neck Surg 2017; 158:505-510. [PMID: 29160153 DOI: 10.1177/0194599817741839] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objective Neurofibromatosis 2 (NF2) is a neuro-oncologic condition that presents with bilateral vestibular schwannomas of the cerebellopontine angle (CPA). Voice and swallowing impairment can occur from direct involvement or compression of the vagus nerve or as the result of surgical excision of CPA tumors. The objectives in this study are to (1) assess the prevalence of voice and swallowing impairments and (2) analyze the effects of vagal dysfunction in patients with NF2. Study Design Cross-sectional. Setting Academic tertiary care center. Subjects and Methods Patients at a neurofibromatosis center were mailed Voice Handicap Index and Sydney Swallow Questionnaire surveys. Stroboscopic, voice, and swallowing evaluations were performed for patients who elected to participate in screening exams. Results There were high rates of self-assessed and objective voice and swallowing handicaps in this population. Fourteen of 40 (35%) patients had a self-assessed voice handicap, and 20 of 40 (50%) patients had a self-assessed swallow handicap. Vocal fold motion impairment (VFMI) was observed in 22 of 31 (71%) patients examined, with 27 of 62 (44%) possible vocal cords affected. Velopharyngeal insufficiency (45%) and piriform sinus pooling or residue (39%) were seen in a significant percentage of patients. There was a significant relationship between vocal cord motion impairment and CPA surgical intervention ipsilateral to the impairment ( P = .002). The presence of VFMI was strongly associated with voice ( P = .002) and swallowing ( P = .01) impact on quality of life. Conclusion Speech and swallowing impairments are highly prevalent in patients with NF2, cause significant impact on quality of life, and are most commonly related to surgical interventions in the CPA region.
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Affiliation(s)
- Simon R Best
- 1 Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Julie Ahn
- 1 Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Shannon Langmead
- 2 Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Vaninder Dhillon
- 1 Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Alexander T Hillel
- 1 Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Lee M Akst
- 1 Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jaishri O Blakeley
- 2 Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Nor Hisyam CI, Misron K, Mohamad I. A rare case of a sharp foreign body on the vocal cord. Malays Fam Physician 2017; 12:23-25. [PMID: 29423126 PMCID: PMC5802772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A foreign body (FB) in the upper aerodigestive tract is a common clinical problem that presents as as acute emergency. Sharp FB, such as fish bone or chicken bone, commonly lodges in the tonsil, base of tongue, vallecula or pyriform fossa. Dislodgement of a FB into the laryngopharynx is very rare and specifically onto the vocal cord is extremely uncommon. This case report illustrates a rare case of a sharp FB that was dislodged into the airway and stuck on to the right vocal cord, which was removed under local anaesthesia.
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Affiliation(s)
- C I Nor Hisyam
- (Corresponding author) MD Universiti sains Malaysia Health Campus, 16150 Kota Bharu, Kelantan, Malaysia E-mail:
| | - K Misron
- MD, M.Med ORL-HNS Universiti sains Malaysia, Kelantan, Malaysia
| | - I Mohamad
- MD, M.Med ORL-HNS Universiti sains Malaysia, Kelantan, Malaysia
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Bartlett RS, Guille JT, Chen X, Christensen MB, Wang SF, Thibeault SL. Mesenchymal stromal cell injection promotes vocal fold scar repair without long-term engraftment. Cytotherapy 2017; 18:1284-96. [PMID: 27637759 DOI: 10.1016/j.jcyt.2016.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 07/18/2016] [Accepted: 07/24/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Regenerative medicine holds promise for restoring voice in patients with vocal fold scarring. As experimental treatments approach clinical translation, several considerations remain. Our objective was to evaluate efficacy and biocompatibility of four bone marrow mesenchymal stromal cell (BM-MSC) and tunable hyaluronic acid based hydrogel (HyStem-VF) treatments for vocal fold scar using clinically acceptable materials, a preclinical sample size and a dosing comparison. METHODS Vocal folds of 84 rabbits were injured and injected with four treatment variations (BM-MSC, HyStem-VF, and BM-MSC in HyStem-VF at two concentrations) 6 weeks later. Efficacy was assessed with rheometry, real-time polymerase chain reaction (RT-PCR) and histology at 2, 4 and 10 weeks following treatment. Lung, liver, kidney, spleen and vocal folds were screened for biocompatibility by a pathologist. RESULTS AND DISCUSSION Persistent inflammation was identified in all hydrogel-injected groups. The BM-MSC alone treatment appeared to be the most efficacious and safe, providing an early resolution of viscoelasticity, gene expression consistent with desirable extracellular matrix remodeling (less fibronectin, collagen 1α2, collagen 3, procollagen, transforming growth factor [TGF]β1, alpha smooth muscle actin, interleukin-1β, interleukin-17β and tumor necrosis factor [TNF] than injured controls) and minimal inflammation. Human beta actin expression in BM-MSC-treated vocal folds was minimal after 2 weeks, suggesting that paracrine signaling from the BM-MSCs may have facilitated tissue repair.
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Affiliation(s)
- R S Bartlett
- Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - J T Guille
- Department of ENT and Head and Neck Surgery, University Hospital of Pointe à Pitre, Guadeloupe, French West Indies
| | - X Chen
- Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - M B Christensen
- National Center for Voice and Speech, University of Utah, Salt Lake City, Utah, USA
| | - S F Wang
- Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - S L Thibeault
- Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA.
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Abstract
Rehabilitation of the patients presenting with benign and tumour-like diseases of the larynx (BLT) is currently a serious challenge for modern otorhinolaryngology in view of the high prevalence of this pathology. Dysphonia is a leading clinical symptom of the diseases that considerably deteriorates the quality of life of the patients. Certain benign conditions of the larynx exhibit a tendency toward malignization. The treatment of the patients presenting with benign and tumour-like diseases of the larynx requires a combined approach including the surgical, therapeutic, and phonopedic modalities for the rehabilitation of the vocal function. This article presents a review of the literature on the modern high-energy techniques for the treatment of the patients presenting with benign and tumour-like diseases of the larynx, The advantages and disadvantages of each method are discussed.
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Affiliation(s)
- E B Rakunova
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia, 119991
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Abstract
BACKGROUND Laryngeal ultrasound (LUS) is a new method for vocal cord evaluation in patients with risk of vocal cord palsy (VCP). However, the previously described LUS reportedly had a high failure rate of vocal cord visualization in male patients. A novel gel pad LUS was devised to overcome the limitations of the previous method. METHODS A total of 482 (100 male) consecutive LUS and direct laryngoscopy examinations were performed in thyroidectomy and other neck surgery patients. The conventional LUS and gel pad LUS were used for all patients. Findings were independently cross-validated with direct laryngoscopy. RESULTS The conventional LUS and gel pad LUS methods had a 93.4% and 99.0% visualization rate, respectively, with a sensitivity of 98.0% for both methods, and a specificity of 99.7% and 99.8%, respectively. Among the 482 patients, 51 patients had VCP and 91 patients had diffuse thyroid cartilage calcification interrupting LUS. CONCLUSION The new gel pad LUS method significantly enhances the visualization of vocal cords in patients who have diffuse thyroid cartilage calcification interrupting LUS and, therefore, the overall efficacy of LUS as a perioperative diagnostic tool for VCP.
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Affiliation(s)
- Jung-Woo Woo
- 1 Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, South Korea
- 2 Department of Surgery, Gyeongsang National University Changwon Hospital and Gyeongsang National University School of Medicine , Changwon, Korea
| | - Seo Ki Kim
- 1 Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, South Korea
| | - Inhye Park
- 1 Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, South Korea
| | - Jun Ho Choe
- 1 Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, South Korea
| | - Jung-Han Kim
- 1 Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, South Korea
| | - Jee Soo Kim
- 1 Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, South Korea
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Kim H, Chang JE, Ryu JH, Jung H, Min SW, Lee JM, Hwang JY. Retrospective analysis of vocal cord-to-suprasternal notch distance: Implications for preventing endotracheal tube cuff-induced vocal cord injury. Medicine (Baltimore) 2017; 96:e6155. [PMID: 28207550 PMCID: PMC5319539 DOI: 10.1097/md.0000000000006155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Endotracheal tube (ETT) positioning using the cuff ballottement test, which confirms that the inflated cuff is positioned at the suprasternal notch with squeezing or inflating a pilot balloon, has been reported to be a simple and reliable method of preventing endobronchial intubation. However, in patients with a short vocal cord-to-suprasternal notch, ETT placement using the cuff ballottement test can cause vocal cord injury. In the present study, we assessed the distance from a point 15 mm below the vocal cord to the suprasternal notch (VSD-15), the safe position for ETT cuff placement above the suprasternal notch, and investigated variables for predicting VSD-15.We retrospectively examined neck computed tomography in 427 adult patients and measured VSD-15 and the distance from the thyroid notch to the suprasternal notch (TSD). Patient height, weight, sex, and age were also recorded.In total, 47 patients (11.0%) showed a VSD-15 shorter than 45 mm. VSD-15 significantly correlated with TSD (r = 0.778, P < 0.001) and height (r = 0.312, P < 0.001), and inversely correlated with age (r = -0.321, P < 0.001). In multiple linear regression models, a formula was obtained for VSD-15 (VSD-15 [mm] = -6.220 + 0.744 × TSD [mm] + 0.092 × height [cm] - 0.065 × age [years], R = 0.621).The cuff ballottement test should be used cautiously in patients with a predicted short VSD-15. VSD-15 can be predicted from TSD, height, and age.
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Affiliation(s)
- Hyerim Kim
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Boramae-ro, Dongjak-gu, Seoul
| | - Jee-Eun Chang
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Boramae-ro, Dongjak-gu, Seoul
| | - Jung-Hee Ryu
- Department of Anesthesiology and Pain Medicine, Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seong-nam
| | - Haesun Jung
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
| | - Seong-Won Min
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Boramae-ro, Dongjak-gu, Seoul
| | - Jung-Man Lee
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Boramae-ro, Dongjak-gu, Seoul
| | - Jin-Young Hwang
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Boramae-ro, Dongjak-gu, Seoul
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Popov P, Chapot R, Tanasković S, Vekić B, Sotirovic V, Ilijevski N, Radak D. Vocal Cord Paralysis as the First Sign of Spontaneous Carotid Dissection in a Patient With Extracranial Internal Carotid Artery Aneurysm. Vasc Endovascular Surg 2016; 50:52-6. [PMID: 26912527 DOI: 10.1177/1538574415627698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Spontaneous dissection of supra-aortic arteries is an exceptionally rare cause of vocal cord dysfunction. We are reporting a case of spontaneous carotid dissection and internal carotid artery aneurysm presenting as vocal cord paralysis. CASE REPORT A 44-year-old female was admitted with hoarseness and swallowing disorders. Diagnostic imaging revealed dissection and obliteration of the right internal carotid artery (ICA) 23 mm from the carotid bifurcation. Electromyography revealed unilateral paralysis/paresis of the right vocal cord. Genetic analyses for thrombophilia, methylenetetrahydrofolate reductase, and plasminogen activator inhibitor 1 were found to be at high risk. The patient was discharged after 5 days without any neurological findings, and control angiography revealed complete restitution of the flow in the right ICA one month later. However, a fusiform aneurysm of the distal part of the extracranial right ICA was detected and excluded with endovascular procedure. CONCLUSION Connective tissue systemic disorders and even mild trauma could initiate the dissection process of neck arteries. Precise diagnosis might be difficult even for an experienced neurologist, however, the final outcome is favorable.
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Affiliation(s)
- Petar Popov
- Vascular Surgery Clinic, "Dedinje" Cardiovascular Institute, Belgrade, Serbia School of Medicine, Belgrade University, Belgrade, Serbia
| | - Rene Chapot
- Klinik für Radiologie und Neuroradiologie, Alfried Crupp Krankenhouse Rüttenschield, Essen, Deutchland
| | - Slobodan Tanasković
- Vascular Surgery Clinic, "Dedinje" Cardiovascular Institute, Belgrade, Serbia
| | - Berislav Vekić
- Surgery Department, DrDragiša Mišović, University Medical Center, Baddour Parkway, LB, USA
| | - Vuk Sotirovic
- Vascular Surgery Clinic, "Dedinje" Cardiovascular Institute, Belgrade, Serbia
| | - Nenad Ilijevski
- Vascular Surgery Clinic, "Dedinje" Cardiovascular Institute, Belgrade, Serbia
| | - Djordje Radak
- Vascular Surgery Clinic, "Dedinje" Cardiovascular Institute, Belgrade, Serbia Surgery Department, DrDragiša Mišović, University Medical Center, Baddour Parkway, LB, USA
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Spataro EA, Grindler DJ, Paniello RC. Etiology and Time to Presentation of Unilateral Vocal Fold Paralysis. Otolaryngol Head Neck Surg 2014; 151:286-93. [PMID: 24796331 DOI: 10.1177/0194599814531733] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 03/25/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the etiology, laterality, and time to presentation of unilateral vocal fold paralysis (UVFP) at a tertiary care institution over 10 years. STUDY DESIGN Case series with chart review. SETTING Academic medical center. SUBJECTS AND METHODS All patients seen between 2002 and 2012 by the Department of Otolaryngology at the Washington University School of Medicine (WUSM), with a diagnosis of unilateral vocal fold paralysis, were included. Medical records were reviewed for symptom onset date, presentation date(s), and etiology of UVFP. RESULTS Of the patients, 938 met inclusion criteria and were included. In total, 522 patients (55.6%) had UVFP due to surgery; 158 (16.8%) were associated with thyroid/parathyroid surgery, while 364 (38.8%) were due to nonthyroid surgery. Of the patients, 416 (44.4%) had nonsurgical etiologies, 124 (13.2%) had idiopathic UVFP, and 621 (66.2%) had left-sided UVFP. The diagnosis was more common on the left side in cases of intrathoracic surgeries and malignancies, as expected, but also in idiopathic, carotid endarterectomy, intubation, and skull base tumors. In total, 9.8% of patients presented first to an outside otolaryngologist at a median time of 2.1 months after onset, but these patients presented to WUSM at a median time of 9.5 months. Overall, 70.6% of patients presented to a WUSM otolaryngologist within 3 months of onset. CONCLUSION Iatrogenic injury remains the most common cause of UVFP. Thyroidectomy remains the leading cause of surgery-related UVFP. Patients are typically seen within 3-4 months of onset; however, a significant delay exists for those referred to WUSM.
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Affiliation(s)
- Emily A Spataro
- Department of Otolaryngology-Head and Neck Surgery, Washington, University School of Medicine, St Louis, Missouri, USA
| | - David J Grindler
- Department of Otolaryngology-Head and Neck Surgery, Washington, University School of Medicine, St Louis, Missouri, USA
| | - Randal C Paniello
- Department of Otolaryngology-Head and Neck Surgery, Washington, University School of Medicine, St Louis, Missouri, USA
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Mendelsohn AH, Xuan Y, Zhang Z. Voice outcomes following laser cordectomy for early glottic cancer: a physical model investigation. Laryngoscope 2014; 124:1882-6. [PMID: 24347459 DOI: 10.1002/lary.24563] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 11/15/2013] [Accepted: 12/09/2013] [Indexed: 11/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS The voice effects following laser cordectomy for early glottic cancer are poorly described. We investigated the voice outcomes of subligamentous cordectomy of progressive anterior-posterior extent of excision. STUDY DESIGN Physical phonatory modeling. METHODS The influence of vocal fold surgical defects and corresponding scar was experimentally investigated using a self-oscillating physical model of the vocal folds and compared with the baseline model without defects or scar. RESULTS Results showed that increasing anterior-posterior extent of resection increased phonation threshold pressure and flow rate and reduced excitation of high-order harmonics, resulting in a more breathy and rough voice production. However, it was found that voice production was improved with the placement of scar, which increased both excitation of high-order harmonics and the harmonic-to-noise ratio. CONCLUSIONS Although large anterior-posterior surgical resections resulted in progressive impact on vocal measures, a limited excision of the vocal fold cover surprisingly demonstrated minimal voice changes. Further investigations are required to define the acceptable extent of surgical resection that may result in optimal voice outcomes.
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Affiliation(s)
- Abie H Mendelsohn
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A; Jonsson Comprehensive Cancer Center, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
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Thomassen A, Nielsen AL, Lauridsen JK, Blomberg BA, Hess S, Petersen H, Johansen A, Asmussen JT, Sørensen JR, Johansen J, Godballe C, Høilund-Carlsen PF. FDG-PET/CT can rule out malignancy in patients with vocal cord palsy. Am J Nucl Med Mol Imaging 2014; 4:193-201. [PMID: 24753985 PMCID: PMC3992212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 01/26/2014] [Indexed: 06/03/2023]
Abstract
The aim was to investigate the performance of (18)F-fluorodeoxyglucose PET/CT to rule out malignancy in patients with confirmed vocal cord palsy (VCP). Between January 2011 and June 2013, we retrospectively included consecutive patients referred to PET/CT with paresis or paralysis of one or both vocal cords. PET/CT results were compared to clinical workup and histopathology. The study comprised 65 patients (32 females) with a mean age of 66±12 years (range 37-89). Eleven patients (17%) had antecedent cancer. Twenty-seven (42%) were diagnosed with cancer during follow-up. The palsy was right-sided in 24 patients, left-sided in 37, and bilateral in 4. Median follow-up was 7 months (interquartile range 4-11 months). Patients without cancer were followed for at least three months. PET/CT suggested a malignancy in 35 patients (27 true positives, 8 false positives) and showed none in 30 (30 true negatives, 0 false negatives). Thus, the sensitivity, specificity, positive and negative predictive values, and accuracy were (95% confidence intervals in parenthesis): 100% (88%-100%), 79% (64%-89%), 77% (61%-88%), 100% (89%-100%), and 88% (78%-94%), respectively. Sixteen patients had palliative treatment, while 11 were treated with curative intent, emphasising the severity of VCP and the need for a rapid and accurate diagnostic work-up. In this retrospective survey, biopsy proven malignancy (whether newly diagnosed or relapsed) was the cause of VCP in almost half of patients (42%). PET/CT had a high sensitivity (100%) with a relatively high false positive rate, but was excellent in ruling out malignancy (negative predictive value 100%).
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Affiliation(s)
- Anders Thomassen
- Department of Nuclear Medicine, Odense University HospitalDenmark
| | | | | | | | - Søren Hess
- Department of Nuclear Medicine, Odense University HospitalDenmark
| | - Henrik Petersen
- Department of Nuclear Medicine, Odense University HospitalDenmark
| | - Allan Johansen
- Department of Nuclear Medicine, Odense University HospitalDenmark
| | | | | | | | - Christian Godballe
- Department of ENT Head and Neck Surgery, Odense University HospitalDenmark
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Hoffman HT, Heaford AC, Dailey SH, Bock JM, Van Daele DJ, Ahlrichs-Hanson JS, Quebbemann GJ, Johnson MN, Boltz JE, Tiedt SL. Arytenoid repositioning device. Ann Otol Rhinol Laryngol 2014; 123:195-205. [PMID: 24633946 DOI: 10.1177/0003489414522968] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We report development of a device and technique to manage laryngeal paralysis through minimal-access arytenoid adduction (for unilateral paralysis) and arytenoid abduction (for bilateral paralysis). METHODS A human cadaver study coupled with directed engineering was used to develop instrumentation designed to secure the muscular process of the arytenoid into favorable adducted or abducted positions. Digital video, photography, and 3-dimensional computed tomographic (CT) imaging of cadaveric larynges were done to evaluate the surgical technique. RESULTS Testing of prototypes identified the ideal implant to be a 0.36-mm wire with a distal spring-wound coil placed through a trocar via a small drill hole in the anterior thyroid cartilage. An endoscopic view of transilluminated light through the pyriform sinus mucosa identified the tip location of the trocar adjacent to the muscular process of the arytenoid cartilage. Placement of the device through the trocar permitted rotation to engage the muscular process and/or adjacent soft tissue with the distal coil. Implant fixation to the thyroid cartilage positioned the vocal cord into either adduction or abduction. Three-dimensional CT imaging coupled with review of the video documentation established the feasibility of this technique. CONCLUSIONS We confirm the feasibility of minimal-access arytenoid adduction and abduction through development of a new technique and device.
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Affiliation(s)
- Henry T Hoffman
- The Department of Otolaryngology, University of Iowa, Iowa City, Iowa, USA
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Ritchie A, Youngerman J, Fantasia JE, Kahn LB, Cocker RS. Laryngeal myxoma: a case report and review of the literature. Head Neck Pathol 2013; 8:204-8. [PMID: 23975415 PMCID: PMC4022936 DOI: 10.1007/s12105-013-0485-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 08/13/2013] [Indexed: 02/07/2023]
Abstract
Myxomas are a rare benign neoplasm of uncertain mesenchymal cell origin, typically involving the heart. Laryngeal myxomas are uncommon, and are usually misdiagnosed as laryngeal polyp. To the best of our knowledge, there are only nine reported cases in the English literature. We report a case of a laryngeal myxoma presenting clinically as a left vocal cord polyp in a 77 year old male, and review the literature related to this rare entity.
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Affiliation(s)
- Angela Ritchie
- Division of Oral and Maxillofacial Pathology, Department of Dental Medicine, Hofstra North Shore-LIJ School of Medicine, 270-05 76th Avenue, New Hyde Park, NY 11040 USA
| | - Jay Youngerman
- Department of Otolaryngology, Planview Hospital, 888 Old Country Rd, Plainview, NY 11803 USA
| | - John E. Fantasia
- Division of Oral and Maxillofacial Pathology, Department of Dental Medicine, Hofstra North Shore-LIJ School of Medicine, 270-05 76th Avenue, New Hyde Park, NY 11040 USA
| | - Leonard B. Kahn
- Department of Pathology, Hofstra North Shore-LIJ School of Medicine, 900 Fulton Avenue, Hempstead, NY 11550 USA
| | - Rubina S. Cocker
- Department of Pathology, Hofstra North Shore-LIJ School of Medicine, 900 Fulton Avenue, Hempstead, NY 11550 USA ,6 Ohio Drive Room 25, New Hyde Park, NY 11042 USA
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Abstract
OBJECTIVES We present the second published case of laryngeal involvement in mitochondrial myopathy. METHODS A patient with laryngeal involvement of mitochondrial myopathy is presented, together with a literature review. RESULTS A 41-year-old man presented with progressive breathy dysphonia. His brother had mitochondrial myopathy. Biopsy of the biceps muscle demonstrated cytochrome C oxidase-negative ragged blue fibers confirming mitochondrial myopathy. Videostroboscopy showed marked vocal fold atrophy, but subsequent injection laryngoplasty did not significantly improve the patient's voice, despite improved postoperative glottic closure. CONCLUSIONS Mitochondrial myopathy should be considered in the differential diagnosis of severe early-onset vocal fold atrophy.
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Affiliation(s)
- Elizabeth A Kelly
- Division of Laryngology and Professional Voice, Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Jha PK, Vankalakunti M, Siddini V, Babu K, Ballal SH. Postrenal transplant laryngeal and visceral leishmaniasis - A case report and review of the literature. Indian J Nephrol 2012; 22:301-3. [PMID: 23162277 PMCID: PMC3495355 DOI: 10.4103/0971-4065.101259] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Visceral leishmaniasis (kala-azar) is a disease caused by protozoa of genus Leishmania. It is currently regarded as the second most dreaded parasitic disease, next to malaria. There have been very few case reports of visceral leishmaniasis among the renal transplant recipients. We present a renal allograft recipient with symptoms of fever, sore throat, hoarseness of voice, lymphadenopathy, splenomegaly, and pancytopenia after 7 years post-transplant period. On investigating, he was diagnosed to have extensive visceral leishmaniasis with laryngeal involvement. Despite extensive PubMed literature search, we could not find any case report of postrenal transplant visceral and laryngeal leishmaniasis and to the best of our knowledge this is the first case report of this kind.
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Affiliation(s)
- P K Jha
- Department of Nephrology, Manipal Hospital, Bangalore, India
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