Benign Laryngeal Lesions Research Articles

Efficacy of KTP Laser-Assisted Marsupialization in the Treatment of Vocal Cysts

ObjectivesVocal cysts, common benign laryngeal lesions, often lead to voice disturbances. Total surgical enucleation presents challenges due to the delicate nature of vocal tissues. Conventional surgery carries risks of recurrence and decreased voice quality due to incomplete removal and potential vocal fold damage. This study investigates the efficacy of Potassium-Titanyl-Phosphate (KTP) laser-assisted marsupialization for the treatment of vocal cysts. Subjects and MethodsWe retrospectively analyzed 78 patients who underwent either conventional surgery or KTP laser-assisted marsupialization to compare the voice outcomes and recurrence rates of the two groups. ResultsKTP laser-assisted group (B) demonstrated significantly higher recurrence rates (18.4%) compared to conventional surgery group (5 %). The mean time to cyst recurrence were 12.4 months in group A and 10.9 months in group B. The degree of postoperative improvement in all voice parameters was not significantly different between the two groups. ConclusionsWhile KTP laser-assisted marsupialization may offer some advantages such as reduced vocal fold damage and ease technique, the higher recurrence rates observed in this study suggest that this technique may not achieve cure rates comparable to conventional surgery. Therefore, careful consideration is necessary when selecting patients for this procedure, and further research is needed to refine the technique and evaluate its long-term efficacy. Level of EvidenceLevel III

Photoangiolytic Lasers for Treatment of Benign Laryngeal Lesions: A Systematic Review and Meta-Analysis.

To compare the efficacy of the 445-nm blue laser to the 585-nm pulsed dye laser (PDL) and 532-nm potassium-titanyl-phosphate (KTP) laser in the treatment of benign laryngeal lesions. Cochrane Library, PubMed, Scopus, and CINAHL. Following PRISMA guidelines, databases were searched from inception through January 29, 2024, for studies reporting the use of photoangiolytic lasers for treatment of benign laryngeal lesions, including the 585-nm PDL, 532-nm KTP laser, and 445-nm blue laser. Outcome measures included lesion resolution (%), mean differences (Δ) in Voice Handicap Index (VHI-10), and summed dysphonia grade, roughness, and breathiness (GRB) scale. A total of 45 studies were included for meta-analysis, consisting of 348 patients treated with PDL, 550 patients with KTP laser, and 338 patients with blue laser. Treatment with blue laser resulted in the greatest lesion resolution (94.0%; 95% confidence interval [CI]: 90.2%-96.7%), followed by KTP laser (90.4%; 95% CI: 84.1%-95.2%), and PDL (86.9%; 95% CI: 62.9%-99.2%). VHI-10 improved significantly in patients following treatment with blue laser (Δ13.3; 95% CI: 10.7-16.0; p < 0.0001), KTP laser (Δ10.3; 95% CI: 7.4-13.3; p < 0.0001), and PDL (Δ7.4; 95% CI: 4.8-10.1; p < 0.0001). GRB improved significantly in patients following treatment with blue laser (Δ4.1; 95% CI: 2.9-5.2; p < 0.0001), KTP laser (Δ3.0; 95% CI: 2.0-4.0; p < 0.0001), and PDL (Δ2.5; 95% CI: 0.8-4.2; p = 0.005). Photoangiolytic lasers are effective in treating benign laryngeal lesions. Blue lasers are promising for laryngeal laser surgery. Laryngoscope, 2024.

Randomized Controlled Trial of Awake Transnasal Laser-Assisted Surgery for Benign Laryngeal Lesions.

To compare functional and cost-effectiveness of awake transnasal laser assisted-surgery versus microlaryngeal surgery for benign laryngeal lesions. This was a prospective non-inferiority randomized controlled trial conducted from May 2021 to December 2022 at two tertiary referral hospitals in Hong Kong. Patients were block-randomized to receive either awake transnasal laser-assisted surgery or microlaryngeal surgery, with post-operative follow-up in a multidisciplinary voice clinic for 1-year. Primary outcome was Voice Handicap Index (VHI-30). Secondary outcomes included operation time, complications, length of stay, peri-operative discomfort, recurrence, and medical costs. Sixty-one patients were randomized to either awake transnasal laser-assisted surgery (n = 30) and microlaryngeal surgery (n = 31). Both groups had comparable demographics and laryngeal pathologies. Both groups showed significant improvement of VHI-30 score over time and had comparable post-operative VHI-30. Awake transnasal laser-assisted surgery group had a significantly shorter length of stay (0.5 vs. 1 day) and less throat discomfort (2 vs. 4) compared to microlaryngeal surgery group. Intraoperative complications were more common in microlaryngeal surgery group (14.3% vs. 0%). Otherwise, both groups had similar operative time and recurrence rate. Cost-analysis showed a significantly lower hospital cost for awake transnasal laser-assisted surgery (USD 3090) compared to microlaryngeal surgery group (USD 5120). Awake transnasal laser-assisted surgery was safe, functionally non-inferior, as measured by VHI-30, to microlaryngeal surgery in managing benign laryngeal lesions, while superior to microlaryngeal surgery in peri-operative discomfort and medical costs. 2 Laryngoscope, 134:3732-3740, 2024.

Can Resident Auditory-Perceptual Voice Assessments Predict Medical Urgency of Voice Disorders?

Growing reliance on telemedicine has created new triaging challenges. This study investigated how effectively otolaryngology resident auditory-perceptual voice assessments performed via telemedicine determined the need for urgent in-person clinic visits. Twelve otolaryngology resident physicians (PGY1-PGY5) performed auditory-perceptual assessments on 25 voice samples recorded during initial voice evaluations. Voice samples were balanced in severity and taken in equal numbers from patients with the following diagnoses: benign laryngeal lesions, laryngeal cancer, functional voice disorders, laryngeal edema (associated with LPR), and laryngeal paralysis/paresis. Urgent diagnoses were defined as laryngeal cancer and severe unilateral laryngeal paralysis. For each voice sample, residents were initially blinded to patient medical history. Residents rated severity of voice disorder, predicted patient diagnosis, and determined the urgency of seeing the patient in clinic. Residents then reviewed information from the patient's medical history and again rated urgency of voice disorder. On average, residents identified urgent voice disorders in 56% of cases. After reviewing medical history, this number significantly increased to 77% (P=0.001). Voice severity, smoking history, time since onset, and course of symptoms were considered most influential when determining medical urgency of voice patients. Year in residency program had no effect on rating accuracy. As expected, diagnostic accuracy of auditory-perceptual assessments was low, ranging from 40% for laryngeal paralysis/paresis to 5% for laryngeal edema. Auditory-perceptual voice assessment, combined with medical history, predicted most medically urgent voice disorders. Further work should investigate if task-specific training might improve these results and which medical history items are most critical. Until accuracy of auditory-perceptual assessment of medical urgency is improved, these data underscore the importance of laryngeal examination in identifying medical urgency and etiology of dysphonia.

Identification and analysis of Nonlinear behaviors of vocal fold biomechanics during phonation to assess efficacy of surgery for benign laryngeal Diseases

BackgroundCurrent voice assessments focus on perceptive evaluation and acoustic analysis. The interaction of vocal tract pressure (PVT) and vocal fold (VF) vibrations are important for volume and pitch control. However, there are currently little non-invasive ways to measure PVT. Limited information has been provided by previous human trials, and interactions between PVT and VF vibrations and the potential clinical application remain unclear. Here, we propose a non-invasive method for monitoring the nonlinear characteristics of PVT and VF vibrations, analyze voices from pathological and healthy individuals, and evaluate treatment efficacy. MethodHealthy volunteers and patients with benign laryngeal lesions were recruited for this study. PVT was estimated using an airflow interruption method, VF vibrational frequency was calculated from accelerometer signals, and nonlinear relationships between PVT and VF vibrations were analyzed. Results from healthy volunteers and patients, as well as pre- and post-operation for the patients, were compared. ResultsFor healthy volunteers, nonlinearity was exhibited as an initial increase and then prompt decrease in vibrational frequency at the end of phonation, coinciding with PVT equilibrating with the subglottal pressure upon airflow interruption. For patients, nonlinearity was present throughout the phonation period pre-operatively, but showed a similar trend to healthy volunteers post-operatively. ConclusionThis novel method simultaneously monitors PVT and VF vibration and helps clarify the role of PVT. The results demonstrate differences in nonlinear characteristics between healthy volunteers and patients, and pre-/post-operation in patients. The method may serve as an analysis tool for clinicians to assess pathological phonation and treatment efficacy.

Benign Lesions of Larynx and Its Micro-Laryngeal Surgery - A Clinical Evaluation

BACKGROUND&#x0D; The larynx is a unique organ in the spectrum of functions it performs. Its role in normal respiration, maintenance and protection of the airway. Simple laryngeal lesions are not uncommon. The great majority of the cordal benign lesions are non-neoplastic, usually in a ratio of about 6:1. They are the product of some form of irritation and do not have the histological characteristics of true neoplasms. Therapy is directed at restoring as much normal function of the larynx as possible. Microlaryngeal surgery and postoperative voice rest offer a cost-effective, useful and safe approach to the management of benign laryngeal lesions.&#x0D; Objectives&#x0D; The study was undertaken to identify the common types of benign lesions of the larynx and the age, sex distribution, symptomatology, sites of involvement and histopathology of the lesions following micro-laryngeal surgery. Microlaryngeal surgery and postoperative voice rest offer a cost-effective, useful and safe approach to the management of benign laryngeal lesions.&#x0D; METHODS&#x0D; A prospective study was conducted from February 2017 to September 2019 at NRM ENT Hospital, Raichur, Karnataka and a secondary referral hospital. 30 patients with benign laryngeal lesions were included based on the patient’s clinical symptoms and findings on indirect laryngoscopy in the age group of 13–65 years. All non-operative cases and malignant cases were excluded. Routine preoperative surgical work-up and therapeutic micro-larnygoscopic procedures were employed.&#x0D; RESULTS&#x0D; A male preponderance with a male-to-female ratio of 1.3:1 was observed. The majority of the patients were in the age group of 31–40 years. Non-neoplastic lesions are much more common than neoplastic lesions. Vocal nodules, polyps, and angiofibromas with the same pathogenesis were common lesions. Abuse of voice, exposure to a known agent, and trauma were causative factors. Most of the lesions are solitary and unilateral, arising from the vocal cord. The right side is the common side, and sessile lesions are more numerous than pedunculated. Only 10% of cases are true neoplastic; vocal polyps, nodules, and angiofibromas with the same pathophysiology account for 70% of cases.&#x0D; CONCLUSIONS&#x0D; Benign lesions of the larynx are common in males, but in this series, amusingly, housewives are at the top of the list. Voice abuse, exposure to a known agent and trauma are the etiological factors. A common symptom is hoarseness of voice. On the basis of this study, it has been emphasized that the removal of the tumor should be flushed from the surface of the vocal cords to aviod any injury to the epithelium, which can be done either under microscopic or endoscopic view.

Indirect laryngeal surgery of vocal fold polyps: a dying or evolving art?

Vocal fold polyps (VFPs) are the most common benign laryngeal lesions that require surgery and are routinely managed by microlaryngoscopy (MLS) under general anaesthesia. Prior to introduction of MLS, VFPs were removed using indirect laryngoscopic surgery (ILS) in local anaesthesia, a procedure that required substantial surgical skill to operate with an unmagnified mirror view of the larynx. With the adoption of wireless endoscopy equipment and personal computers, we tried to simplify this technique so that it can be easily performed in the office. This study aimed to assess the effectiveness of ILS by comparing voice outcomes with MLS. ILS and MLS were performed in six patients each. Treatment outcomes were measured using a voice self-assessment and objective acoustic analysis. The total cost of both procedures was calculated. Both techniques allowed successful removal of VFPs in all patients, without significant intergroup differences in voice outcomes. The cost of ILS was significantly lower. Despite the pilot nature of the study and the small sample size, our data indicate the potential value of this technique which, considering its simplicity and economic value could be used as an alternative to MLS in carefully selected patients.

"Pre and Post Treatment Comparison of S/Z Ratio in Benign Laryngeal Lesions".

Benign laryngeal lesions like vocal nodules, vocal polyp, vocal fold cysts are mostly found in patients complaining of change in voice. S/Z ratio has become the most frequently used clinical tool to assess phonatory mechanics. This study shows the pre-treatment and post-treatment comparison of S/Z ratios in patients with benign laryngeal lesions. To evaluate the outcome of microlaryngeal surgery in patients with benign laryngeal lesions using S/Z ratio as an outcome parameter. During this study, 65 patients with complaints of change in voice, with clinical evidence of benign laryngeal lesions underwent microlaryngeal surgery. Improvement in symptoms were measured preoperatively and postoperatively using S/Z ratio. This ratio was calculated by asking the patient to to maximally sustain 'S' and 'Z', repeated thrice. S/Z ratio was calculated by dividing the maximum duration for which /S/ was sustained by the maximum duration for which /Z/ was sustained. A ratio of more than 1.4 suggested a vocal cord disorder. There was statistically significant difference observed in S/Z ratio values, from pre-treatment to 6months post-treatment, with P value 0.001. Pre and post treatment assessment of patients with benign vocal fold lesions showed significant improvement in S/Z ratio postoperatively. It is the simplest and a reliable objective method of voice assessment and can also be used in assessing the outcome of the treatment.

The Safety and Efficacy of the 445-nm Blue Laser for Operative Management of Benign Nonvascular Laryngeal Lesions

Adult voice center patients who underwent surgical intervention for vocal fold (VF) mass, VF scar, laryngeal stenosis, laryngeal web, or Reinke's edema were included in this retrospective study. Outcomes were compared to those achieved when traditional treatment modalities were used, including cold steel, CO2 laser, potassium-titanyl-phosphate (KTP) laser, and coblator. Strobovideolaryngoscopy footage was evaluated using a previously described model at four time points: postoperative visit #1: 1-14 days, postoperative visit #2: 30-60 days, postoperative visit #3: 61-365 days, postoperative visit #4: >365 days. Eighty cases using the blue laser and 153 controls (n=78 cold steel, n=51 KTP laser, n=22 CO2 laser, n=2 coblator) were included in this study. Procedures performed using blue laser included VF mass excision (n=45), VF scar reduction (n=16), laryngeal stenosis resection/repair (n=25), laryngeal web excision (n=7), and reduction of Reinke's edema (n=1). On postoperative strobovideolaryngoscopy examination, the surgical objective score did not differ significantly between the blue laser cohort and all controls at any postoperative visit. VF edema did not differ significantly between the blue laser cohort and all controls at any postoperative visit. VF hemorrhage scores were significantly lower in the blue laser cohort compared to all controls at the first postoperative visit, but hemorrhage had resolved almost entirely by the second postoperative visit in all groups. Postoperative VF stiffness was worse in the blue laser group at the third postoperative visit compared to controls, but both groups had improved to similar levels by the fourth postoperative visit. The rate of lesion recurrence (24.29% versus 17.19%) did not differ significantly between the blue laser cohort and controls on multivariate analysis (Odds ratio [OR]=1.081 [0.461-2.536]). The complication rate (12.50% versus 10.46%) did not differ significantly between the blue laser cohort and all controls on multivariate analysis (OR=0.992 [0.375-2.624]). The blue laser was associated with a lower rate of revision surgery (30.00% versus 34.64%) on multivariate analysis (OR=0.380 [0.168-0.859]). The 445-nm blue laser is safe and effective for the management of benign laryngeal lesions. It has efficacy and safety similar to those of traditional treatment modalities (including cold steel, CO2 laser, and KTP laser). Use of the blue laser may lead to lower rates of early postoperative hemorrhage and revision surgery. No adverse effects attributed directly to the use of the blue laser were observed in this study. Further research is encouraged to confirm or refute these findings.

Management of Idiopathic Vocal Process Granuloma: A Survey of Academic Laryngologists.

Vocal process granulomas (VPGs) are benign laryngeal lesions that may manifest as ulcerated regions of the vocal fold or nodular polypoid lesions. Gold standard treatments for idiopathic VPG are yet to be established at this time. This study evaluated clinical decision-making and outcomes in the treatment of VPG patients based on experiences of academic laryngologists across the United States. A 21-question survey was developed to evaluate each respondent's specific VPG patient population, clinical decision-making in treating VPG, and corresponding treatment outcomes. The survey was distributed to 168 laryngologists at academic institutions across the United States. Data were analyzed through the Qualtrics platform. A total of 106 responses were analyzed, with a completion rate of 63.1%. Etiology of VPG was most commonly attributed to phonotrauma (96.2%) and reflux (71.8%). Primary first-line treatment was most commonly antireflux medications (92%). Other common first line treatments included voice therapy (58.8%) and inhaled steroids (42.5%). With these treatments, the majority of laryngologists report that recurrence is uncommon (68.4%). Dysphonia was cited as the most frequent long-term sequelae at 27.8%. VPG treatment strategies continue to be controversial across the United States with many treatments described in the literature with variable application in the practice of academic laryngologists today. Based on survey results, antireflux medications and voice therapy may be the most widely used and most effective treatment options. Establishment of gold standard therapy for VPG as well as further research into recurrent or persistent VPG despite antireflux and voice therapy should be explored. 5 Laryngoscope, 134:795-802, 2024.

Office-Based Treatment of Vocal Fold Polyps and Reinke's Edema: A Rational Comparison With Suspension Laryngoscopy.

Benign laryngeal lesions have traditionally been treated through suspension laryngoscopy under general anesthesia (GA). Recently, the development of operative videoendoscopes coupled with photoangiolytic lasers has allowed clinicians to treat these conditions in the outpatient clinic. We report our experience in the office-based (OB) setting for the treatment of patients affected by vocal fold polyps (VFPs) and Reinke's edema (RE), comparing it to patients treated under GA. A retrospective analysis was conducted on patients affected by VFP or RE. A 445 nm diode blue laser was used through the operative channel of a flexible video-endoscope for OB procedures, while GA surgeries were carried out with cold steel instrumentation. The Voice Handicap Index-10 (VHI-10) represented the primary outcome. Endoscopic outcomes, duration, and morbidity of the procedures were investigated as secondary outcomes. A total of 153 patients were retrospectively enrolled. 52 were treated in an OB setting, while 91 underwent GA. Regarding patients with RE, both the OB and GA cohorts showed a significant improvement in VHI-10 (from 12.7 to 2.6 and 19.5 to 5.1, respectively; p < 0.001), as did those with VFPs (from 11.8 to 2.3 and 15.9 to 2.9 respectively; p < 0.001). No differences were found when comparing VHI-10 in the OB and GA cohorts. The mean procedural time of OB treatment (4.9 min) was significantly shorter than GA (37.1 min). No adverse events were reported. Our data demonstrate the efficacy and safety of the OB setting. For selected patients, OB treatments offer comparable vocal outcomes, favorable morbidity, and reduced operation times, making them an appealing alternative to the traditional approach. 3 Laryngoscope, 133:2665-2672, 2023.

Flexible Endoscopic Surgery for Benign Nonepithelial Lesions of the Larynx.

The traditional approach for the management of benign laryngeal lesions is transoral microsurgery. In cases of anatomic particularities, such as insufficient cervical extension, short mandible, temporomandibular joint ankylosis etc., and contraindications for general anesthesia, transoral microsurgery is not possible. In such cases transnasal flexible endoscopic surgery under local anesthesia can be a relevant alternative. The purpose of the study was to assess the possibilities of flexible endoscopic management of benign nonepithelial lesions of the larynx. Flexible endoscopic surgical interventions were performed on 315 patients with different benign nonepithelial lesions of the larynx. The larynx pathology was represented by following lesions: myxoid polyp, polypoid degeneration of vocal folds, fibrous polyp, angiofibrous polyp, angiomatous polyp, nonspecific granuloma, cyst, lipoma, neurofibroma and amyloidosis. In 97,8% of the cases interventions were performed under local anesthesia with spontaneous respiration. In 88,6% of the cases interventions were performed as outpatient procedures. In all the cases the expected result was obtained - complete ablation of the visible lesion. In 7 cases repeated interventions were performed for recurrent lesions. Flexible endoscopic surgery is an efficient method for the treatment of benign nonepithelial lesions of the larynx, that offers a relevant therapeutic alternative, especially for the patients who have contraindications for general anesthesia or transoral microsurgery. The advantages of the method, worthy of mentionning, are positive economic effect and time economy, the intervention being possible in an outpatient setting for the majority of patients. The online version contains supplementary material available at 10.1007/s12070-022-03444-z.

Huge Subglottic Stalked Polyp Treated by Endoscopic Polypectomy Snare at Jalalabad Afghanistan

Polyps are the common benign mucosal lesions of larynx. Usually present as exophytic lesion with thin mucosa. Horsiness is a common symptom and rarely large subglottic polyp causes dyspnea. A patient with horsiness and shortness of breath due to a huge laryngeal polyp around 2cm with thin stalk, linked to thyroid angle below the vocal cords. According the combined decision of Otorhinolaryngologist, Endoscopist and Anesthesiologist, underwent resection of the mass by endoscopic polypectomy snare with electrocautery without any residues and damages. The dyspnea and hoarseness relieved. The histopathological findings confirmed vocal cord benign mass lesion. We consider that careful intubation under the direct vision of bronchoscopy and electrocautery is the safest and useful procedure to secure the upper airway successfully in cases of large subglottic polyp showing dyspnea.

Utility of CK8, CK10, CK13, and CK17 in Differential Diagnostics of Benign Lesions, Laryngeal Dysplasia, and Laryngeal Squamous Cell Carcinoma.

There are no reliable immunohistochemical markers for diagnosing laryngeal squamous cell carcinoma (SCC) or diagnosing and grading laryngeal dysplasia. We aimed to evaluate the diagnostic utility of CK8, CK10, CK13, and CK17 in benign laryngeal lesions, laryngeal dysplasia, and laryngeal SCC. This retrospective study included 151 patients diagnosed with laryngeal papilloma, laryngeal polyps, laryngeal dysplasia, and laryngeal SCC who underwent surgical treatment between 2010 and 2020. Immunohistochemistry (IHC) was carried out using specific monoclonal antibodies against CK8, CK10, CK13, and CK17. Two experienced pathologists performed semi-quantitative scoring of IHC positivity. The diagnostic significance of the markers was analyzed. CK13 showed a sensitivity of 100% and a specificity of 82.5% for distinguishing between laryngeal SCC and laryngeal dysplasia and benign lesions. CK17 showed a sensitivity of 78.3% and specificity of 57.1% for the detection of laryngeal SCC vs. laryngeal dysplasia. CK10 showed a sensitivity of 80.0% for discriminating between low-grade and high-grade dysplasia, and a specificity of 61.1%. Loss of CK13 expression is a reliable diagnostic tool for diagnosing laryngeal lesions with malignant potential and determining resection lines. In lesions with diminished CK13 expression, CK17 could be used as an auxiliary immunohistochemical marker in diagnosing laryngeal SCC. In CK13-negative and CK17-positive lesions, CK10 positivity could be used to determine low-grade dysplasia. CK8 is not a useful IHC marker in differentiating between benign laryngeal lesions, laryngeal dysplasia, and laryngeal SCC.

Immunohistochemical expression of PDL1 in laryngeal carcinoma in relation to P53 and ki67 proliferative index

Squamous cell carcinoma of larynx is one of the most common malignant neoplasms of the head and neck. Carcinoma of the larynx represents 2.2% of all cancers in men and 0.4% in women, with predilection of old aged men of more than 50 years rather than women. Smoking is the main risk factor. Alcohol, nutritional factors and virus as Human papillomavirus (HPV) play a role in the pathogenesis of laryngeal carcinoma. Programmed death-ligand (PDL1) is the new introduced marker that be considered as treatment target nowadays in addition to its prognostic application. Aims of study: This study was designed to assess the predictive the role of PDL1 in laryngeal squamous cell carcinoma in comparison with other prognostic markers (P53 and Ki-67). Results: The current study revealed that PDL1 expression was reported in about 20 % of laryngeal squamous cell carcinoma and 10% in premalignant, while it was negative in benign laryngeal lesions. Others markers; P53 protein was shown to be positive in around 42.5 percent of laryngeal squamous cell carcinomas, 40 percent of premalignant laryngeal lesions, and about 12 percent of benign laryngeal lesions.

Assessment of Vocal Fold Stiffness by Means of High-Speed Videolaryngoscopy with Laryngotopography in Prediction of Early Glottic Malignancy: Preliminary Report.

Simple SummaryThe method described in our manuscript can help to objectively assess the vibration of each vocal fold using larygotopographic analysis of high-speed videoendoscopy (HSV) recordings. We have developed image processing and analysis procedures to detect vocal fold regions in HSV films and quantitatively analyze their shape and kinematics. We proposed the term Stiffness Asymmetry Index which can provide valuable information on the texture and kinematic properties of individual vocal fold tissues, which can be important in the diagnosis of early glottis cancer. Our study showed that a low value of SAI indicated large, non-vibrating vocal fold areas, characteristic of infiltrative lesions such as invasive carcinoma. This important clinical information can help to assess the depth of vocal fold invasion before direct histologic examination and discriminate benign from malignant lesions.One of the most important challenges in laryngological practice is the early diagnosis of laryngeal cancer. Detection of non-vibrating areas affected by neoplastic lesions of the vocal folds can be crucial in the recognition of early cancerogenous infiltration. Glottal pathologies associated with abnormal vibration patterns of the vocal folds can be detected and quantified using High-speed Videolaryngoscopy (HSV), also in subjects with severe voice disorders, and analyzed with the aid of computer image processing procedures. We present a method that enables the assessment of vocal fold pathologies with the use of HSV. The calculated laryngotopographic (LTG) maps of the vocal folds based on HSV allowed for a detailed characterization of vibration patterns and abnormalities in different regions of the vocal folds. We verified our methods with HSV recordings from 31 subjects with a normophonic voice and benign and malignant vocal fold lesions. We proposed the novel Stiffness Asymmetry Index (SAI) to differentiate between early glottis cancer (SAI = 0.65 ± 0.18) and benign vocal fold masses (SAI = 0.16 ± 0.13). Our results showed that these glottal pathologies might be noninvasively distinguished prior to histopathological examination. However, this needs to be confirmed by further research on larger groups of benign and malignant laryngeal lesions.

Effects of surgery on the relationship between subglottic pressure and fundamental frequency in vocal fold dynamics in patients with benign laryngeal diseases.

Subglottic pressure (Ps) and fundamental frequency (F0) play important roles in governing vocal fold (VF) dynamics. Theoretical description, model simulation, excised larynx and animal models have been used in previous studies, yet clinically applicable measurements are still lacking. This study aimed to evaluate the effects of surgery for benign laryngeal lesions by investigating the relationship between F0 and Ps. Patients with benign laryngeal lesions who underwent phonosurgery were prospectively recruited. Participants were instructed to sustain voicing the vowel /o/ at three incremental frequencies four semitones apart in the modal register (F01, F02, F03). F0 was estimated by VF vibration on the accelerometer. Ps change was achieved and measured using the airflow interruption method. Thirteen patients with a mean age (SD) of 43.5 (12.4) years were included. The change in F0 per unit change of Ps, which is the slope (Hz/kPa) of the regression line of the frequency-pressure data pairs, decreased as the tension of the VF increased. The slopes significantly increased after the operation for F01 and F02 (36.43 ± 14.68 preoperatively, 53.91 ± 30.71 postoperatively, p = 0.011 and 26.02 ± 10.71; 34.85 ± 17.92, p = 0.046, respectively). In addition, there was a significant decrease in phonation threshold pressure and improvements in the grade, roughness, breathiness, asthenia, strain scale, and the voice handicap inventory-10. The relationship between F0 and Ps may serve as an objective assessment of the outcomes in the treatment of benign laryngeal diseases with clinical relevance.

Expression and clinical significance of FGFR1 and FGFR2 in laryngeal squamous cell carcinoma.

BackgroundFibroblast growth factor receptor 1 (FGFR1) and fibroblast growth factor receptor 2 (FGFR2) may be of significance in the development of laryngeal squamous cell carcinoma (SCC) tissues. Examination of the expression results of these factors may offer new insights into treatment of the disease, such as genetic and histological targeted target therapy.MethodsWe selected tissue from 30 cases of laryngeal SCC, 23 cases of adjacent normal mucosa, and 26 cases of benign laryngeal mucosal tissues from patients who received surgery at the Otolaryngology Department of the Affiliated Hospital of Chengde Medical College between September 2020 and January 2022. The laryngeal cancers included nine cases of supraglottic, 20 glottic (vocal cord), and one case of subglottic cancer, while all benign laryngeal mucosal lesions were obtained from vocal cord polyps. The expression of FGFR1 and FGFR2 was detected in 30 laryngeal cancers, 23 adjacent normal mucosa, and 26 vocal cord polyps by immunohistochemical technology [immunohistochemistry (IHC)], and the correlation analysis of their expression in laryngeal cancer was performed. P<0.05 was represented statistically significant.ResultsThe expression of FGFR1 and FGFR2 was significantly different in laryngeal SCC and the normal tissue >0.5 cm from the tumor margin (P<0.05), and between laryngeal SCC and vocal polyps (P<0.05). There was no difference in FGFR1 and FGFR2 expression (P>0.05) between normal mucosal margins and vocal cord polyp tissue, and no correlation between FGFR1 and FGFR2 in laryngeal SCC and sex, age, smoking history, alcohol consumption history, tumor diameter, tumor lymph node metastasis, tumor differentiation degree, and Tumor-Node-Metastasis (TNM) stage (P>0.05), A moderate positive correlation between FGFR1 expression and FGFR2 expression in laryngeal SCC was seen (Rs=0.499, P<0.01).ConclusionsFGFR1 and FGFR2 may participate in the occurrence of SCC of the throat: (I) positive FGFR1 and FGFR2 expressions are not associated with gender, age, smoking history, alcohol consumption history, tumor diameter, lymph node metastasis, degree of differentiation, or TNM stage. (II) FGFR2 increases successively with higher FGFR1 expression and with a positive correlation in laryngeal SCC.

Can Vocal Therapy With Transcutaneous Electrical Nerve Stimulation (TENS) Followed by Vocal Exercises Reduce Benign Laryngeal Lesions in Dysphonic Women?: Randomized, Blind Clinical Trial

To investigate the effectiveness of vocal therapy with the use of low-frequency transcutaneous electrical nerve stimulation (TENS) followed by voice exercises on vocal fold lesion size, vocal quality and quality of life in dysphonic women. 27 women with vocal nodules participated, randomized into to: experimental group (EG)-13 women who received vocal therapy with 12 sessions of 20 min of TENS application (pulse:200μs, frequency:10Hz, motor threshold intensity, electrodes positioned in the trapezius muscle [descending fibers and submandibular region, bilaterally]). Each TENS session was followed by 30 min of vocal exercises; and the Control Group (CG)- 14 women who received 12 sessions with 20 min of application of placebo TENS (same conditions EG, but without receiving the stimulus electric), followed by 30 min of vocal exercise. Before, immediately after and one month after vocal therapy, participants underwent vocal recording for acoustic analysis, vocal self-assessment, laryngological examination and answered voice-related quality of life (V-RQOL) protocol. There was reduction in the size of vocal fold lesions only in the EG, immediately after treatment and one month after treatment. Acoustic analysis showed decreases in SPI values immediately after and one month after treatment in both groups. There was improvement in voice self-perception in both groups after treatment and one month after, but no significant difference in V-RQOL values. TENS followed by vocal exercises produced results similar to vocal therapy without TENS regarding voice quality, self-perception and quality of life in voice. However, vocal therapy with low-frequency TENS followed by vocal exercise was effective in reducing vocal fold lesion size in dysphonic women.

Immunohistochemical expression of PDL1 in laryngeal carcinoma in relation to P53 and ki67 proliferative index

Squamous cell carcinoma of larynx is one of the most common malignant neoplasms of the head and neck. Carcinoma of the larynx represents 2.2% of all cancers in men and 0.4% in women, with predilection of old aged men of more than 50 years rather than women. Smoking is the main risk factor. Alcohol, nutritional factors and virus as Human papillomavirus (HPV) play a role in the pathogenesis of laryngeal carcinoma. Programmed death-ligand (PDL1) is the new introduced marker that be considered as treatment target nowadays in addition to its prognostic application. Aims of study: This study was designed to assess the predictive the role of PDL1 in laryngeal squamous cell carcinoma in comparison with other prognostic markers (P53 and Ki-67).Results: The current study revealed that PDL1 expression was reported in about 20 % of laryngeal squamous cell carcinoma and 10% in premalignant, while it was negative in benign laryngeal lesions. Others markers; P53 protein was shown to be positive in around 42.5 percent of laryngeal squamous cell carcinomas, 40 percent of premalignant laryngeal lesions, and about 12 percent of benign laryngeal lesions.