Electronic Laryngoscope Research Articles

Pediatric laryngeal clefts: an experience in the diagnosis and management of 13 cases

Objective: To investigate the diagnosis and management of laryngeal cleft. Method: The clinical data of 13 cases of laryngeal cleft treated between 2007 and 2015 was analyzed retrospectively. Results: The children with laryngeal cleft were classified according to the classification of Benjamin-Inglis, as type Ⅰ(11 cases), typeⅡ(1 case) and type Ⅲ(1 case). All patients were confirmed by microlaryngobronchoscopy under general anaesthetic. Eleven typeⅠ and 1 type Ⅱ clefts were managed conservatively, with which all type Ⅰ patients were successfully managed, while the type Ⅱ patient was resolved by surgical endoscopy. The type Ⅲ patient was treated by open repair but the results was poor. Conclusions: Patients who suffered with choking on feeding or recurrent aspiration pneumonia, especially coexisted with other congenital malformation, needed detailed evaluation for laryngeal cleft, although which was a rare congenital abnormality. Electronic laryngoscope could be the first step to screen the cleft, while microlaryngobronchoscopy is the gold standard for diagnosis of laryngeal cleft. The majority of children with lower type clefts can be managed conservatively. Surgical endoscopy has high success rate when strictly following the indication. Type Ⅲ and Ⅳ clefts have high mortality for usually combining with severe complications and abnormalities.

Expression and significance of pepsin in lingual tonsil hypertrophy

Objective: To discuss the relationship between lingual tonsil hypertrophy and laryngopharyngeal reflux. Methods: Ninety-two patients who received throat surgery in Nanfang Hospital between October 2015 and October 2016 were enrolled. Twenty-six healthy volunteers were recruited as normal controls. All participants were assessed with the reflux finding score(RFS) and the size of lingual tonsils were evaluated using a clinical grading system proposed by Friedman under electronic laryngoscope. The score of reflux symptom index(RSI), personal history and medical history were gathered. Biopsy specimens of lingual tonsils were taken from all participants for the immunohistochemical stain of pepsin.SPSS 19.0 software was used for statistical analysis. Results: There were 46.2% (12/26) pepsin-positive and 53.8% (14/26) pepsin-negative volunteers in normal controls. There were 87.0% (80/92) pepsin-positive and 13.0% (12/92) pepsin-negative patients in study group. The severity of lingual tonsil hypertrophy and expression intensity of pepsin in patients were significantly higher in volunteers (Z=-3.636, Z=-5.273, P<0.01). The severity of lingual tonsil hypertrophy was positively associated with the pepsin level in patients (r=0.556, P<0.01). The patients with pepsin-positive expression showed significant correlation between lingual tonsil hypertrophy and the positive rate of RSI and RFS (r=0.258, r=0.225, P<0.05). Analysis of correlated factors indicated that lingual tonsil hypertrophy was associated with smoking (χ(2)=8.502, P<0.05). Conclusions: The expression of pepsin can be detected in lingual tonsil tissues. The lingual tonsil hypertrophy is closely related to laryngopharyngeal reflux.

The adhesion separation operation with CO₂ laser combined withtriamcinolone acetonide vocal cord submucosal injection for the treatment to vocal cord adhesion

Objective:To investigate the effect of adhesion separation operation with CO₂ laser via prop-up laryngoscope combine with triamcinolone acetonide submucosal injection via electrolaryngoscope to vocal cords adhesion.Method:Sixteen cases of vocal cord adhesion patients(2 cases of children,14 cases of adult) were enrolled in the study. Fourteen patients had the history of surgery(Reinke edema,vocal polyp,pediatric laryngeal papilloma,laryngeal cancer),2 cases were diagnosed as laryngeal tuberculosis. Adhesion separation operation and triamcinolone acetonide submucosal injection(once a week,three weeks) were conducted. All patients were examined with electronic laryngoscope every month for six monthes.Result:Fourteen patients had good triangle shape of glottis vocalis and good sound voice. One cases of laryngeal cancer and 1 cases of laryngeal tuberculosis patients still had adhesion in the anterior commissure of the vocal cords,but with the improvement in breathing and pronunciation.Conclusion:Adhesion separation operation with CO₂ laser via prop-up laryngoscope combine with triamcinolone acetonide submucosal injection via electrolaryngoscope were effective for treatment to vocal cord adhesion,whichimprove the patient's breathing and voice with little trauma and few complications.

Heterogeneous Bovine Acellular Dermal Matrix for Mucosal Repair in Reconstructive Surgery for Laryngeal and Hypopharyngeal Carcinoma

Background: We performed this study to explore the clinical effects of a heterogeneous bovine acellular dermal matrix (ADM) used for repairing mucosal defects in reconstructive surgery following resection for laryngeal and hypopharyngeal carcinoma. Patients and Methods: A summary analysis was carried out on the surgical data of 93 patients who underwent reconstructive surgery using a heterogeneous bovine ADM following resection of laryngeal and hypopharyngeal carcinoma. The patients underwent an electronic laryngoscope review. Results: After 3-6 months, the repaired mucosa had replaced the mucosal defects in 88 patients who had undergone stage I reconstruction, recovering local function. Due to infection, 3 patients had a laryngeal fistula and 2 patients had a pharyngeal fistula; the fistula incidence rate was 5.4%. 86 patients underwent successful tracheal extubation (extubation rate, 92.5%). The duration from tracheotomy to extubation was 8-31 days; the average duration was 10.4 days. Conclusion: The heterogeneous bovine ADM is a new, safe, and effective material for reconstructive surgery. In patients with large mucosal defects, it avoids the trauma caused by flap repair.

Clinical analysis, prevention and treatment strategies of 19 cases with suspected arytenoid subluxation

Objective To improve the diagnostic consciousness, prevention and treatment of suspected arytenoid subluxation(AS) during perioperative period.Methods A contemporary review of 19 patients'medical records,making an analysis about the clinical symptoms and signs of suspected AS during perioperative period,finding out the possible associated risk factors and putting forward some prevention and treatment strategies.Results Among the 19 suspected AS patients,male was 63.1％ and female was 36.9％.The initial symptom of 19 patients is hoarseness or sore throat at 1st or 2nd day after general anesthesia.They all were diagnosed as suspected AS by otolaryngology physicians or electronic laryngoscope.Of 19 patients,6 underwent the manipulation of the restoration of normal movement of arytenoids and vocal fold,2 of them were corrected by twice.The symptom of hoarseness was alleviated after surgery in 4 patients (66.7％),but not in 2 cases (33.3％).The rest 13 patients were asked to do more voice practice,without any special treatment.Conclusions Medical history and electronic laryngoscope are helpful to early diagnose the suspected AS,but laryngeal electromyography is needed for final diagnosis.The key points for treatment of AS are early detection and early diagnosis.The preferred treatment is arytenoids joint restoration.Steroid hormones and indomethacin have an important supporting role in the treatment. Key words: Arytenoid subluxation; Tracheal intubation; Nasogastric tube intubation; Restoration

Effect of psychological intervention on patients with electronic laryngoscope

Objective To explore the effect of psychological intervention on patients with electronic laryngoscope.Methods 100 patients with electronic laryngoscope in our department from August 2013 to January 2014 were randomly divided into experimental group and control group,50 cases in each group.Control group received routine examination with health education,experimental group received psychological intervention on the basis of control group.Compared the effect of two groups.Result The one time inserting lens successful rate of experimental group was significantly higher that of control group (98％ vs.60％),with shorter inspection time and less discomfort.Conclusion Psychological intervention can reduce patients' psychological burden,improve the success rate of inspection,worthy of promotion. Key words: Psychological intervention; Electronic laryngoscope; Patients' compliance

Observation the clinical curative effect of children's laryngopharyngeal reflux and sleep apnea hypopnea syndrome

To observe the clinical curative effect of anti-reflux treatment for obstructive sleep apnea hypopnea syndrome (OSAHS) in children. Twenty children with sleep-disordered breathing were included in this study. There were 15 males and 5 females, aged 3-9 years old, median 6 years old. The electronic laryngoscope, polysomnography (PSG) monitoring, Reflux symptom index (RSI) questionnaire and Reflux finding score (RFS) were used to establish the initial diagnosis of OSAHS with LPRD, preclude adenoid hypertrophy and tonsil hypertrophy and nasal disorders. Oral Domperidone and Omeprazole were given for treatment. For children under 3-year-old, the dosage of Domperidone was 0.6 ml.kg⁻¹.day⁻¹.For children over 3-year-old, Domperidone combined with Omeprazole were given with the dosage of 0.3 mg.kg⁻¹.day⁻¹. After 4 weeks of treatment, 19 patients symptoms of OSAHS include disturbed sleep, dyspnoea and apneic attack improved. After 8 weeks of treatment, 20 cases with OSAHS symptoms improved than before treatment. Under the electronic laryngoscope, the decrease in pharyngeal lymphoid follicles, the epiglottis, aryepiglottic fold and scoop intergenic region erythema shallow, edema lessened. After treatment of 4 weeks and 8 weeks, there was statistically significant (P < 0.05). Before and after treatment, the difference of RFS was statistically significant (P < 0.05); PSG monitoring proved significant effect in 3 cases (15.0%), effective in 11 cases (55.0%) and 6 cases were ineffective (30.0%). Twenty patients with obstructive apnea index change was not obvious (P > 0.05), apnea hypopnea index and lowest artery oxygen saturation better, differences were statistically significant (Z of 2.819 and 2.733 respectively, P < 0.05). The treatment of LPRD can improve the symptoms of OSAHS, these two diseases may coexist in mutual relations.

Production of Personalized Thyroid Cartilage Scaffold and Histological Analysis

To meet the bone defect on the personalized needs of implantation, this study presents the manufacture of personalized thyroid cartilage hydroxyapatite (HA) scaffold by the rapid prototyping(RP) technique combined with CT image reconstruction and employs the foaming of suspensions prior to the in situ polymerization of organic monomers contained in the compositions. The organic additives are eliminated at temperatures above 300°C, and sintering is carried out for consolidation of the ceramic matrix. Spherical interconnected cells with sizes ranging from 100μm to 250μm characterize the porous structure, depending on the specimen density. The biological properties of porous personalized scaffolds loaded with bone morphogenetic protein 2 (rhBMP-2) were evaluated, by which a simulated surgical method of thyroid cartilage defects in rabbits and repairing with artificial scaffolds, and compared with rhBMP-2 loaded dense personalized or porous non-personalized scaffolds. The results of the histological analysis and the electronic laryngoscope inspection of airway indicate that rhBMP-2/HA/ porous personalized scaffolds is a promising composite having osteogenic efficient enough for repairing thyroid cartilage defects.

Positive therapy of andrographolide in vocal fold leukoplakia

PurposeVocal fold leukoplakia is a premalignant precursor of squamous cell carcinoma. Although many efforts have been contributed to therapy of this disease, none exhibits a satisfactory result. The aims of this study were to investigate the effectiveness and feasibility of andrographolide therapy in vocal fold leukoplakia and to explore the preliminary mechanism underlying. Materials and MethodsForty-one eligible patients were enrolled in the study. The patients were treated for 10-minute exposures of 5ml (25mg/ml) andrographolide injection aerosols twice a day, and 2weeks was considered as one treatment course. Electronic laryngoscope was used to observe the condition of vocal fold leukoplakia during the treatment. Every patient received one or two treatment courses, and the follow-up was carried out for 12months. Toxic reactions of treatments were evaluated on the basis of the standards of the United States MD Anderson Cancer Center. Moreover, laryngeal carcinoma cell line Hep2 was applied to explore the mechanism of effect of andrographolide. Anti-proliferative effect on Hep2, cell nuclear morphology, express of mitogen-activated protein kinases (MAPK) and pro-apoptotic protein were detected after andrographolide treatment. ResultsWe found that andrographolide exhibited significant curative effects on treatments, which were accompanied by thinning of the lesion of leukoplakia, reduction in the whitish surface area, and return of pink or red epithelium. A complete response up to 85% was observed, and no toxic side effect events occurred during the study. No patient with a complete response had a recurrence in the follow-up. Moreover, cellular experiments in Hep2 indicated that andrographolide activated MAPK pathway and caspase cascade, and finally induced apoptosis in laryngeal carcinoma cell. ConclusionsThe advantages of andrographolide are connected with minimally invasive and localized character of the treatment and no damage of collagenous tissue structures, which are more convenient and less painful for patients. These results suggest that andrographolide treatment is a viable strategy for curing vocal fold leukoplakia.

Etiology of laryngeal stridor in 297 cases of infants

Objective To summarize the cause of laryngeal stridor in infants in order to make accurate diagnosis and treatment of the disease.Methods We reviewed medical records of 297 cases of patients less than 3 year of age with the presenting symptom of stridor who were initially evaluated in the outpatient setting of otorhinolaryngological department from Jan 2005 to Jan 2010.The causes of stridor were clarified by examinations of ultrafine electronic laryngoscope,throat three-dimensional CT,and bronchoscopy in all cases.Patients underwent history-taking,physical examination and flexible laryngoscopy,CT examination or bronchoscopy evaluation in the operating room.Results Of all 297 patients,199 cases ( 67.0％ ) were diagnosed as congenital airway abnomalities for cause of stridor,which included congenital laryngeal abnomalities in 169(84.9％,169/199) and congenital tracheal abnormalities in 30 cases( 15.1％,30/199).Another 98 cases (33.0％,98/297) were diagnosed as acquired disease for cause of stridor.The most congenital laryngeal anomaly was laryngomalacia ( 159,94.1％,159/169 ).The most congenital tracheal abnormalities was tracheomalacia ( 14,46.7％,14/30 ).Sixty-four cases ( 65.3％,64/98 ) were diagnosed as foreign body in airway and 26 cases (26.5％,26/98) were respiratory infection,which were the first and second most common causes of acquired disease for stuidor.Conclusion Congenital airway structural abnormalities as a major cause of infant laryngeal stridor,followed by acquired disorders,including airway foreign body and infection. Key words: Laryngeal stridor; Laryngomalacia; Airway obstruction; Infant

Electronic laryngoscope for transnasal esophageal examination

To evaluate the value of electronic laryngoscope for transnasal esophagoscopy. The electronic laryngoscope was used for transnasal esophagoscopy in 50 patients from June 2009 to June 2011 in our department. There were 32 males and 18 females with their age ranged from 16-88 years (mean 53.8 years). Before esophagoscopy, 1% ephedrine-dicaine mixture was sprayed into the nasal and pharyngeal cavities for topical anesthesia. The esophagoscopy was used for screening examination in the patients with reflux, globus sensation, dysphagia, head and neck cancer, suspected foreign body, and vocal cord paralysis, etc. The transnasal esophagoscopy with electronic laryngoscope was performed successfully in all the patients. Mild nausea and vomiting occurred in 4 patients, but no patient required to stop the examination. Of the 50 patients, 38 patients (76%) had normal findings and 12 patients (24%) had positive findings of the esophagus. Esophageal cancer was diagnosed in one patient, esophageal foreign body in 2 patients, esophageal injury in one patient, candidal esophagitis in 3 patients, esophagitis in 3 patients, and achalasia of the cardia in 2 patients. The electronic laryngoscope for transnasal esophagoscopy is an alternative to conventional esophagoscopy, which is useful for screening the esophagus in the patients with reflux, globus, dysphagia, head and neck cancer, and suspected foreign body, etc.