Amyloidosis: Uncommon cause of dysphonia

Abstract

Objectives: Case report of 3 cases of laryngeal amyloidosis Methods: Three cases of localized amyloidosis without systemic disease were identified at Centro Univerisitario de Otorrinolaringologia y Cirugia de Cabeza y Cuello at the Univerisity Hospital in Monterrey Mexico. In each patient the major site of involvement was glottic with small focus in the false vocal folds. Medical workup including full blood count, CSR, urea, electrolytes, ureanalysis, liver function test, chest x-ray, were performed. Physical examination ruled out systemic disease. Congo red staining confirmed the diagnosis in all surgical specimens. Results: Localized laryngeal amyloidosis was identified in 3 patients (2 males and 1 female) with ages ranging from 33 to 67 years. The presenting symptoms including hoarsness, throat soreness, voice breaks, and vocal fatigue. The duration of the symptoms before diagnosis varied from 3 to 12 years. Assesstment of the extent of laryngeal spread of disease included CT scan, complete voice analysis, and videolaryngostroboscopy in all patients. Material for biopsy was obtained by direct laryngoscopy, apple-green birefringence was seen with congo red stain establishing the histological diagnosis. The 3 patients underwent phonomicrosurgery for removal of the amyloid implantation using cold knife excision. Conclusion: Laryngeal amyloidosis is a rare disease with an 8 in 1,000,000 presentation rate. It is more common in males with 3:1 prevalence in the fifth decade. Once the diagnosis is confirmed by congo red staining, it is important to rule out systemic amyloid involvement. It is not necessary to do invasive approach on localized disease. Cold knife excision is still a good method to remove the deposition.