Complaints Of Hoarseness Research Articles

A rare case of extragastrointestinal stromal tumor of vocal cord - case report.

Gastrointestinal stromal tumors (GISTs) are the mesenchymal tumors of the gastrointestinal tract. Extra Gastrointestinal stromal tumors (EGISTs) are rare neoplasms that occur outside the gastrointestinal tract [1]. Miettinen et al. [2] described the first EGIST in 1999. EGIST accounts for 10% of all GISTs [3]. The main distinction between GIST and EGIST is the site of origin of the primary tumor, as GIST occurs throughout the GI tract, from the esophagus to the anus, whereas EGIST is a tumor without any connection with the intestinal wall and are reported in the retroperitoneum, mesentery, and omentum [4]. Hu et al. [5] reported a first case report of EGIST of larynx.We present a second case report of Extra-gastrointestinal stromal tumor of larynx a 47-year-old male reported to ENT Department Command Hospital Central Command Lucknow with complaints of Hoarseness. On examination found to have right vocal cord growth for which he underwent excision of right vocal cord growth. Histopathological examination showed typical of a spindle-cell GIST, showing strong immunoreactivity for CD 117, DOG1, Vimentin and CD 99. 6 months follow up post surgery with no recurrence.

Conservative Management of Early Grade Unilateral Reinke's Edema with Laryngopharyngeal Reflux

Reinke's edema is described as fluid-filled vocal folds in the Reinke's space. Unilateral cases are uncommon and might caused by gastrointestinal reflux. We report a 61-year-old man with complaints of hoarseness since one year ago, which was getting worse for the past two months. Examination of the reflux symptom index (RSI) obtained a score of 23 and reflux finding score (RFS) score of 11. Examination of the flexible fiber laryngoscopy showed that the right vocal fold size was thicker than the contralateral side, greyish in color, soft, and did not bleed easily. The patient was then given conservative therapy with proton pump inhibitors (PPIs), corticosteroids, and mucolytics, accompanied by lifestyle modifications. Clinical improvement was found at four weeks of evaluation. In conclusion, the response to conservative therapy and elimination of risk factors for early-stage Reinke's edema contributes well to disease recovery, particularly those caused by laryngopharyngeal reflux.

Utilization and Findings of Flexible Naso-Pharyngo-Laryngoscopy in Upper Airway Disorders: A Clinic Audit.

Flexible naso-pharyngo-laryngoscopy (NPL) has become an essential clinic tool for evaluating patients with upper airway disorders in otorhinolaryngology. It has been established to be a simple, cost-effective, and minimally invasive technique with good diagnostic yields. This study aimed to audit the procedure of flexible NPL done in our clinic over 2 years and analyse the technique, indications, and findings of the procedure. A retrospective cross-sectional study among all the patients who presented to our ENT clinic in ABUTH Zaria, from July 2021 to June 2023 with upper airway symptoms or neck swelling who had flexible NPL done in the clinic. The records of these patients were reviewed, and information extracted including age, sex, use of anaesthesia, indications and findings of the procedure were entered in SPSS and analysed. Flexible NPL was done in 266 patients aged 4 months to 85 years. Only 3% of the patients required local anaesthesia. The commonest indications were for preoperative evaluation of goitre (26.7%), suspected adenoid hypertrophy (18.4%), complaints of hoarseness (18.8%), and foreign body sensation (12%). The commonest diagnoses made were adenoid hypertrophy (19.9%), laryngeal tumour (5.3%), nasopharyngeal tumour (4.9%), vocal cord palsy (4.9%), rhinitis (4.5%) and pharyngitis (4.1%), laryngitis (3.0%), laryngopharyngeal reflux disease (3.0%) and vocal cord nodule (2.3%). Office flexible NPL was done commonly for preoperative evaluation of goitre, suspected adenoid hypertrophy, hoarseness, and foreign body sensation. The commonest pathologies were adenoid hypertrophy, laryngeal tumour, nasopharyngeal tumour, vocal cord palsy, rhinitis, pharyngitis, and laryngitis.

Validation of the Filipino Voice Handicap Index-10 (FVHI-10)

Rationale/Objective: The Voice Handicap Index (VHI) is a self-assessment tool that evaluates the patient’s reaction and perception to a vocal disorder. This study aimed to establish, validate and assess the reliability of the Filipino translation of the Voice Handicap Index 10 (FVHI-10). Methods: The VHI-10 was translated and adapted to the Filipino language and culture with the help of the Sentro ng Wikang Filipino- University of the Philippines Manila. A self-assessment of voice quality and FVHI-10 were performed by the patients and their GRBAS scale scoring was rated by a speech language pathologist. The Spearman’s correlation between the FVHI-10 and the self-assessment and GRBAS scale scores was obtained to test for validity. To evaluate the reliability of the FVHI-10, testing through determining internal consistency was conducted through the use of Chronbach α coefficient, inter-item correlation, item-total correlation and Cronbach α coefficient if tool item was deleted. Results: Fifty-five individuals participated in the study (29 males, 26 females, age range: 30-55 years) with the diagnosis of voice disorder based on complaints of hoarseness or dysphonia and laryngoscopic f indings. Convergent validity was confirmed with moderate to strong correlation between the FVHI-10 and self-assessment (r=-.893, p<.05) and GRBAS scale scores (r=.427, p<.05). Reliability as measured through internal consistency was confirmed (Cronbach α=.874) (average ρ<.5) (corrected item-total correlation>0.3) (average inter item correlation=.15-.85). Conclusion: The FVHI-10 was determined to be a valid and reliable instrument that can be utilized in the assessment of Filipino patients with voice disorders. Key words: Dysphonia, voice disorder, reliability, validity, voice handicap index-10, quality of life, Philippines

A Case of Laryngeal Amyloidosis with Dyspnea Triggered by Infection

Laryngeal amyloidosis is a relatively rare disease, and usually carries a good prognosis. However, if a patient with laryngeal amyloidosis develops inflammation of the larynx, airway narrowing and dyspnea may occur. In this article, we report the case of a patient with laryngeal amyloidosis who had a long clinical course and required two tracheostomies and microlaryngeal surgeries.The patient was a woman in her 30s at the time of her initial visit, who visited our hospital with the complaint of hoarseness. Laryngoscopy revealed a yellow lesion around the vocal cords. A tracheostomy and microlaryngeal surgery were performed for biopsy and reduction of the lesion. Histopathological examination of the resected lesion revealed the diagnosis of laryngeal amyloidosis, and after closure of the tracheotomy, the patient was followed up as an outpatient. Nineteen years later, the patient visited our hospital again with the chief complaint of dyspnea, and was hospitalized. She was diagnosed as having airway narrowing caused by recurrent laryngeal amyloidosis and laryngeal edema, and treated with antimicrobial agents. The laryngeal inflammation and edema subsided, however, the dyspnea due to airway narrowing caused by laryngeal amyloidosis failed to improve, so that a second tracheostomy and microlaryngeal surgery were performed.Although laryngeal amyloidosis is said to carry a good prognosis, dyspnea caused by edema of the larynx and recurrence of amyloidosis could be fatal, as in this case. Unlike in the case of other types of localized amyloidosis, otolaryngologists/head and neck surgeons should be aware that early amyloidosis reduction surgery under local anesthesia or microlaryngeal surgery is important for patients presenting with even mild clinical symptoms, such as hoarseness, to prevent the risk of development of airway obstruction due to infection.

A Rare Case: Laryngeal Sarcomatoid Carcinoma

Background: Spindle cell carcinoma (sarcomatoid carcinoma) is a rare carcinoma that accounts for 2-3% of all laryngeal malignancies. Here, we present a case with laryngeal tumor diagnosed as Spindle cell carcinoma. Case Presentation: Fifty-nine-year-old male patient was admitted to our clinic with the complaint of hoarseness and shortness of breath that has been increasing for 10 months. Indirect laryngoscopy performed on the patient, and a polypoid lesion was detected in the anterior of the left vocal cord. The patient was admitted to our clinic for direct laryngoscopy and the lesion was completely excised from the base. The case was diagnosed as “sarcomatoid carcinoma in histopathological examination. Conclusion: Sarcomatoid carcinoma is usually diagnosed and treated at an early stage. So, it has a good prognosis. However, it has a poor prognosis in the advanced stage.

Results of the study of conservative treatment of laryngeal manifestations of laryngopharyngeal reflux

Gastroesophageal reflux disease (GERD) is a disease of the gastrointestinal tract caused by the discharge of stomach contents into the esophagus. In GERD, both esophageal and extraesophageal manifestations are widespread, but, unfortunately, the latter are less well known. About one third of GERD patients have extraesophageal symptoms, which can occur even in the absence of the usual esophageal symptoms of GERD, which makes diagnosis difficult. The most common of these is laryngitis. In addition to reflux laryngitis, laryngopharyngeal reflux (LFR) can cause the development of contact granulomas, laryngeal stenosis, functional dysphonia, vocal fold nodules, Reinecke's edema, and laryngeal neoplasms. These symptoms disappear after taking antireflux therapy, but there is still no consensus on its duration.Aim. To evaluate the results of treatment of laryngeal manifestations of LFR with omeprasole 20 mg 30 minutes before meals in the morning.Methods. The study involved 531 patients with complaints of hoarseness, of which women 337 - 63.5%, men 194 - 36.5%. We prescribed omeprasole 20 mg 30 minutes before meals in the morning for 6 weeks. Patients were questioned using the Reflux Symptom Index (RSI) questionnaire and indirect laryngoscopy with an assessment of laryngeal changes according to the Reflux Signs Scale (RSS).Results. There was a statistically significant decrease in hoarseness 1 week after treatment, which continues to decrease 6 weeks after the initiation of treatment when evaluating the data on the RSI questionnaire. There was no statistically significant difference in the laryngoscopic picture before the start of treatment and after 1 week of treatment according to RSS; a statistically significant decrease in the quantitative assessment of RSS was revealed 6 weeks after the initiation of treatment.Conclusions. Omeprasole at a dose of 20 mg in 30 minutes reduces the symptoms of LFR already after 1 week, the decrease in the severity of symptoms continues by 6 weeks of its use. Improvement of the laryngoscopic picture with the appointment of omeprazole 20 mg 30 minutes before meals occurs by the 6th week of its use. A positive correlation was found between the severity of LFR symptoms, including hoarseness, and the severity of changes in the laryngoscopic picture.

A rare case of a solitary laryngeal xanthoma and its clinical implications in a developing country like India

<p class="abstract">We present a rare case of a solitary laryngeal xanthoma in a 42 year old male, with complaints of hoarseness and change in voice since1 year. Direct laryngoscopic examination revealed a smooth textured polyp like mass arising from anterior 1/3rd of left vocal cord. No other similar lesions were noted anywhere else on his body. Microlaryngeal excision of mass was done and sent for histopathological examination, which showed fragments of stratified squamous epithelium with sub-epithelium displaying sheets of foamy cells. Immunohistochemistry was positive for CD68 and a diagnosis of solitary laryngeal xanthoma was arrived at. Follow up of the patient showed no recurrence but investigations revealed dyslipidemia, which was newly detected. Hence a diagnosis of a solitary laryngeal xanthoma, even without any other lesions, warrants a thorough investigative workup, including lipid profile, even in patients who are not known cases of dyslipidemia. This becomes especially important in a country like India, where a large number of cases of dyslipidemia go undetected; leading to atherosclerosis and even cardiac events in the future.</p>

Case report of a patient with recurrence after endoscopic submucosal dissection for superficial esophageal cancer, diagnosed with mediastinal lymph node endoscopic ultrasound-fine needle aspiration based on the symptom of hoarseness

The patient was an 81-year-old man who presented with a complaint of hoarseness. When he was 80 years old, he had developed superficial esophageal cancer and had undergone endoscopic submucosal dissection (ESD) at our hospital. Two months after the ESD, he developed hoarseness. Computed tomography (CT) scan showed no abnormal findings at that time;therefore, he was diagnosed with idiopathic vocal cord paralysis, and followed up with symptom treatment in the Gastroenterology and Otolaryngology Departments. Ten months after the ESD, a CT scan revealed mediastinal lymph node swelling. He was admitted to our hospital for histopathological examination of the lymph node using endoscopic ultrasound-fine needle aspiration (EUS-FNA). The histopathological examination revealed squamous cell carcinoma of the lymph node, similar to the primary esophageal tumor. This result suggests that laryngeal nerve paralysis involving hoarseness is caused by lymph node metastasis of superficial esophageal cancer. We report that histopathological examination with EUS-FNA helps in determining the cause of hoarseness that develops after ESD.

Forestier disease. A clinical case of laryngeal and esophageal compression

The article describes a clinical case of a patient with the first diagnosed Forestier disease — ankylosing diffuse idiopathic skeletal hyperostosis, dysphonia and dysphagia due to laryngeal and esophageal compression. A 79-year-old patient was disturbed by complaints of hoarseness, a sore throat, and a violation of swallowing for four months. Oncology was excluded as a result of the examination. The diagnosis is confirmed by the results of clinical and instrumental examination. A peculiarity of the case is cognitive impairment, which impeded the diagnostic search and influenced the adherence to treatment.

Laryngeal cancer in two non-consanguineous people (spouses): a case report

The objective is to report a rare case of laryngeal cancer in spouses. Case report. A 59-year-old female patient was admitted to the Department of Head and Neck Tumors in December 2019 with complaints of hoarseness. In 1997, she had radiotherapy for T1N0M0 laryngeal cancer. After comprehensive examination, she was diagnosed with recurrent laryngeal cancer. The patient has undergone frontolateral laryngeal resection. A 67-year-old male patient was admitted to the Department of Head and Neck Tumors in November 2019 with T3N0M0 laryngeal cancer (diagnosed 2 months before). He has undergone extended frontolateral laryngeal resection followed by radiotherapy in the postoperative period. Discussion. Both patients had no risk factors, such as occupational hazards or smoking. However, both spouses had close relatives with cancer, what indicates their genetic predisposition to malignant tumors. The female patient was found to have human papilloma virus (HPV) in the tumor cells, whereas her spouse was HPV-negative, although rapid histology showed indirect signs of HPV, which does not exclude the elimination of HPV. Conclusion. In this rare case of laryngeal cancer diagnosed in two non-consanguineous spouses, the disease is likely to be caused by their hereditary predisposition, HPV infection, and the fact that they lived in the same socioeconomic conditions.

Changing Trend in the Etiological Spectrum of Hoarseness of Voice in Rural India: A Prospective Hospital-Based Study.

Hoarseness of voice is one of the common symptoms with which patient presents to an otorhinolaryngologist. Hoarseness is a symptom of diverse etiology. The aim of the study was to study the problem of hoarseness relating to its incidence and to identify the common etiologies and predisposing factors leading to hoarseness of voice. This study comprises of 70 cases of hoarseness presenting to Department of Otorhinolaryngology, VIMS, Ballari, Karnataka from October 2015 to March 2017. After taking a thorough history, a complete otolaryngological examination was carried out and supported by relevant investigations, diagnosis was reached. The incidence of hoarseness of voice was noted to be 0.21% in our study. The majority of patients were in 31-40years and 51-60years of age group, and male to female ratio was 3.7:1, farmers constituted single largest group (34.3%), and most of the patients were from the rural area (82.9%). Smoking was the commonest habit (54.29%) predisposing to hoarseness of voice. Maximum patients presented with hoarseness of duration of 1-3months. Laryngeal malignancy was the commonest aetiology noted in our study (38.6%). A complaint of hoarseness may represent a serious disease and, therefore, should not be ignored, especially if present for more than 2weeks. It needs a complete evaluation to rule out malignancy as a cause.

Rhinoscleroma with laryngotracheal involvement: a case report

<p class="abstract">Rhinoscleroma is a chronic, slowly progressive, granulomatous inflammatory disease of the upper respiratory tract. It is more common in developing countries and rural areas and endemic in Asia, Africa and South and Latin America. We report a case of rhinoscleroma in a young male presented to our Outpatient Department with complaint of hoarseness since one and half years. He had history of dyspnoea on exertion. Patient also had history of bilateral nasal discharge and obstruction. A nasal specimen was taken for histological diagnosis which confirmed rhinoscleroma. Patient was put on medical management and was assessed weekly for improvement by nasal endoscopy and laryngeal examination for one year. A high degree of suspicion is required by clinician to diagnose the disease and prompt treatment should be given to avoid the progression of disease and complications. Patient requires long term follow up for proper management.</p>

Laryngeal cancer surveillance in heart transplants

Transplantation of human internal organs is accompanied by the risk of the subsequent occurrence of a malignant neoplasm. The increased incidence of malignant neoplasms is due to immunosuppressive therapy, which leads to impaired immune surveillance for malignant neoplasms, as well as increased susceptibility to oncogenic viruses. We have not found a description of the laryngeal cancer development after heart transplantation in the available literature. Here is our observation. Patient P., 66 years old, was admitted to the department of head and neck tumors of the State Clinical Hospital No. 1 on 05/27/19 with complaints of hoarseness. Based on the examination, the diagnosis of laryngeal cancer cT3N0M0M was established. Anamnesis revealed that due to ischemic cardiomyopathy, post-infarction mitral insufficiency, balloon angioplasty and stenting of the right coronary artery on 17.08.11 and 06.11.13, orthotonic heart transplantation was performed. The clinical situation was discussed with mutual participation of oncologists, radiologists, chemotherapists - a combined treatment plan was developed with preoperative radiation therapy of total focal dose (TFD) 44Gy at the first stage, which was carried out with slight positive dynamics, followed by laryngectomy. The uniqueness of this observation lies in the fact that a patient 6 years after heart transplantation was diagnosed with laryngeal cancer, he underwent combined treatment with neoadjuvant radiation therapy, TFD 44 Gy and an operation in the volume of laryngectomy without complications.

Clinico-etiological Profile of Vocal Cord Paralysis

Introduction
 Vocal Cord Paralysis may be of central or peripheral origin based on the underlying pathology. Central Causes contribute about 10% while peripheral causes about 90% and the current study evaluated the clinical profile of vocal cord paralysis.
 Materials and Methods
 A cross-sectional observational study was conducted in the department of ENT for a period of one year. Patients with complaints of hoarseness or aspiration who on laryngoscopy examination with 45° telescope have been diagnosed to have vocal cord paralysis were included for the study. A total of 83 patients were included in our study.
 Results
 Vocal cord palsy was found most commonly after thyroidectomy (20.4%) followed by the idiopathic cause (19.2%). Certain cancers like lung cancer and neck cancers (hypopharyngeal, laryngeal and thyroid) carcinoma had also contributed significantly in the development of vocal cord palsy. Left sided vocal cord palsy (65%) was found to be the commonest side affected followed by bilateral vocal cord palsy.
 Conclusion
 A proper protocol is necessary for identifying the factors responsible for vocal fold paralysis which would help in managing the condition more effectively. Before making a diagnosis as idiopathic vocal cord paralysis, detailed investigations should be carried out to rule out the possibilities of cancer, causing vocal cord paralysis.

Cavernous hemangioma: A rare cause of hoarseness in adult

In contrary to the infantile hemangioma, adult hemangioma differs in terms of its rarity, gender prevalence, location and presenting symptoms. We report a case of a 61-year-old gentleman with right vocal cord cavernous hemangioma who presented to us with the complaint of hoarseness for 6 months duration. Endoscopic laryngeal microsurgery and excision biopsy was performed and the mass was completely excised. Post operatively, the voice improved with no evidence of recurrence.International Journal of Human and Health Sciences Vol. 04 No. 01 January’20 Page : 67-69

A CASE REPORT OF SUCCESSFUL TREATMENT OF STAGE IV ESOPHAGEAL CANCER

Background. Esophageal cancer is among the ten most common cancers and causes-related mortality worldwide. Most patients present with an advanced stage tumor at diagnosis. To treat patients with esophageal cancer, radiation therapy in combination with chemotherapy is usually used. In the clinic of A.F. Tsyb Medical Radiological Scientific Center, patients with advanced esophageal cancer are treated with split-course radiotherapy delivered in two fractions (1–1.5 Gy) with a 4-hour interval. The positive effect is observed significantly earlier than in conventional radiotherapy.Case description. A 50-year-old male patient presented with complaints of hoarseness of voice and difficulty swallowing in February 2015. The patient was diagnosed with stage cТ4N2M1 cervical esophageal cancer (tumor length 3.5 cm) with metastases in cervical lymph nodes and the thyroid and esophageal stenosis (stage IV). Cytological examination revealed keratinizing squamous cell esophageal carcinoma. The tumor was considered inoperable. The patient underwent gastrostomy. Radiation therapy delivered to the tumor and metastases was performed 5 times a week using two lateral fields and one anterior field. The total radiation dose was 60 Gy. A complete response was achieved. Three courses of chemotherapy with carboplatin (AUC 6), paclitaxel (75 mg/m2 ) with a 21-day interval were administered 2 months after radiotherapy. In January 2016, new metastases in the thyroid were detected. Thyroidectomy with microsurgical neurolysis of the laryngeal nerves was performed. The patient is alive 3 years and 7 months after diagnosis.Conclusion. The use of nonconventional fractionated radiotherapy schedules in combination with chemotherapy allows satisfactory treatment outcomes in patients with advanced esophageal cancer to be obtained.

Candidiasis Causing Vocal Fold Leukoplakia: Review of Clinical and Pathological Results of 289 Cases With Vocal Fold Leukoplakia

In laryngology practice, vocal fold leukoplakia is frequently evaluated by suspension laryngoscopy and biopsy examination upon the patient's complaints of hoarseness and dysphonia. The purpose of the present study is to investigate and analyze risk factors, diagnosis, treatment, and follow-up results of cases with Candida leukoplakia. Retrospective case control study. Tertiary medical center. Patients with a diagnosis of vocal fold leukoplakia who underwent direct laryngoscopy and biopsy between 2007 and 2017 and diagnosed as candida or noncandida in their histopathology were assigned into 2 groups. Then they were compared in terms of their demographic characteristics, predisposing factors, diagnosis, treatment, and follow-up results. Of the 289 vocal fold leukoplakia cases, 36 were candida, and 253 were noncandida. The mean age of the patients with Candida leukoplakia was 60.86 years. As for the age groups, the largest group (26.1%) was in the seventh decade (P < .001). The use of inhaled corticosteroids was a significant risk factor (P < .001). For their medical therapy, the patients were administered fluconazole 200 mg per day for 3 weeks, and the treatment yielded successful results in 91.66% of them. In 5 of the patients, candida leukoplakia and superficial epithelial dysplasia were observed, and no malignant transformation was observed during a mean follow-up of 28 ± 13 months. Candidiasis causing vocal fold leukoplakia is rare, and we report the findings of the largest published case series to date. Eliminating predisposing factors and administrating oral fluconazole 200 mg for 3 weeks are sufficient for medical treatment.

Contribution of Ayurveda for the management of Swarabheda: A case study

Background: Voice is a means of communicating verbal messages, which serves as a powerful carrier of personality and emotional, educational, and social status. Dysphonia (impaired voice production) is a very common ailment, affecting nearly one-third of the population at some point in their life. Hoarseness of voice can be correlated to Swarabheda in Ayurveda. The management provided by contemporary medicine for this condition is either conservative or surgical in nature, which is cost worthy. Aims and Objectives: The aim of this study was to assess the efficacy of Ayurvedic management of Swarabheda.Materials and Methods: A 35-year-old woman approached to Ayurvedic hospital with complaints of hoarseness of voice and difficulty and pain while deglutition and talking since 1 year. She was diagnosed with Vataj swarabheda and was treated with Panchakarma treatment including Marsha Nasya with Anutaila and Gandusha along with Shamana Chikitsa. The treatment was continued for consecutive 1 month. Results: Hoarseness of voice was assessed after 15 days with the help of Buffalo III Voice Profile and satisfactory outcome was found especially in the quality and loudness of voice, mental strength, and confidence of patient. Conclusion: The collaborative approach of the aforementioned therapy gives symptomatic relief in Swarabheda.

Glottic cancer in patients without complaints of hoarseness

Background Few studies have investigated the clinical characteristics of patients with glottic cancer without hoarseness. Methods This retrospective clinical study investigated 371 patients with glottic cancer. Results Thirty-two of the 371 patients (8.6%) with glottic cancer first presented to hospitals with complaints other than hoarseness. Although proportions of stage I and T1 disease were significantly higher among patients without hoarseness than among those with hoarseness (p = .0036 and p = .0004, respectively), survival curves showed no significant differences between groups (p = .1334). Conclusion Patients with glottic cancer without complaints of hoarseness were diagnosed at an earlier stage than those with hoarseness. Accumulation of more cases may lead to better survival of patients with glottic cancer without hoarseness compared to those with hoarseness. Checking the larynx of patients without hoarseness or encouraging internists to check the larynx when performing gastroscopic or respiratory examinations may lead to improvement of glottic cancer prognosis. © 2015 Wiley Periodicals, Inc. Head Neck, 2015