Laryngeal Examination Research Articles

A first step towards objective grading of equine laryngeal function

Due to concerns about disagreement between veterinarians when grading resting laryngeal function (LF), a diagnostic decision tree (DDT) has been developed by codifying the Havemeyer grading system and objectively defining certain terms to remove ambiguity. Videoendoscopic examinations of the equine larynx that had previously been assigned a unanimous LF grade by 3 experienced observers were used to develop the DDT and determine the cut-off values.The DDT is a flow chart consisting of a series of dichotomous (yes/no) decisions, to dictate the order of decision making and direct the observer down a pathway towards the most appropriate LF grade. To use the DDT, the observer must know the frame rate of the video and use frame-by-frame video playback when reviewing the videos. The first decision involves determining if full left arytenoid cartilage (LAC) abduction is achieved (≤ grade III.1), or not achieved (> grade III.1). Maintained full LAC abduction (≤ grade II.2) is defined as maintenance of full abduction for ≥ 0.2 seconds. Full LAC abduction that is achieved but not maintained (grade III.1) is defined as maintenance of full abduction for < 0.2 seconds. Arytenoid abductor deficit is categorized into left arytenoid abduction ≥45° from vertical midline (grade III.2) and <45° abduction (grade III.3). The DDT could be used as a first step towards computer assisted laryngeal function grading.

Using Office-Based Zero-Degree Rigid Laryngoscopy to Predict Glottic Exposure in Microlaryngoscopy

OBJECTIVESPoor glottic exposure in microlaryngeal surgery can result in difficult instrumentation or incomplete surgery affecting surgical outcomes. Anticipating poor glottic exposure preoperatively allows surgeons to prepare adequately, ensuring successful surgery. This study aims to determine diagnostic utility of 4mm zero-degree rigid endoscopic laryngeal examination as a tool to predict glottic exposure in microlaryngoscopy. STUDY DESIGNCross-sectional observational study. METHODSThis is a cross-sectional study, conducted from 1st March 2022 to 30th November 2023 at the ENT department of a tertiary care hospital in North India. Total of 35 adult participants who underwent MLS were consecutively enrolled. Participants in whom the lesion was obscuring the anterior commissure and in whom gag reflex prevented complete 0-degree laryngeal examination were excluded from the study. All enrolled participants were evaluated preoperatively with a 4 mm rigid zero-degree laryngoscopic examination and the laryngoscore. The total score on the laryngoscore proforma was calculated and recorded. The visualized glottis on zero-degree laryngoscopy was graded as follows: Grade 1, anterior commissure and the entire glottic plane can be seen; Grade 2, glottis can be seen but not the anterior commissure; Grade 3, only the posterior half of the glottis can be seen; Grade 4, only the arytenoids can be seen. The glottic exposure on microlaryngoscopy was also assessed using the same grading system. Depending on the exposure of the anterior commissure, the cohort was divided into two groups: good laryngeal exposure and difficult laryngeal exposure. Receiver operating characteristic curve analysis was done to evaluate the predictive accuracy of 0-degree laryngoscopy and to compare it with laryngoscore. RESULTSA total of 35 adults participated in the study, of which 28 were men (80%) with median (range) age of 45(24-76) years. The area under the curve for 0-degree laryngoscopy and laryngoscore were 0.97 and 0.83 respectively. Optimal cutoff value (sensitivity, specificity) to identify difficult laryngeal exposure for 0-degree laryngoscopy and laryngoscore were 1.5 (93.3%,100%) and 4.5 (80%,85%) respectively. CONCLUSIONZero-degree laryngoscopy is an excellent predictor of glottic exposure on microlaryngoscopy. Its accuracy surpasses that of the laryngoscore in identifying an ideal candidate for microlaryngoscopy.

Office-Based Blue Laser Therapy vs Thulium Laser Therapy for Reinke’s Edema

ObjectiveTo compare the treatment outcomes of patients with Reinke’s edema (RE) who were treated in-office using the blue laser vs. those treated in-office using the thulium laser. Study design:Retrospective case-control study. MethodsThe medical records and video-recordings of patients who underwent office-based thulium laser therapy for RE between November 2018 and July 2019, and office-based blue laser therapy for RE between November 2023 and March 2024 in a tertiary referral center were reviewed. The primary outcome measures used in this study were the Voice Handicap Index 10 (VHI-10) score and disease regression based on the laryngeal examination performed before and after therapy. ResultsTwenty-two patients were included in this study. They were divided into two subgroups, 12 patients with 22 lesions who underwent office-based thulium therapy and 10 patients with 17 lesions who underwent office-based blue laser therapy. There was no significant difference in the decrease in the mean VHI-10 score following surgery between those treated with the thulium laser vs. those treated with the blue laser (10.5±13.15 vs. 8.2±5.98, p=0.657). Nine out of 22 lesions (40.9%) treated with thulium laser regressed completely compared to 9 out of 17 lesions (52.9%) treated with blue laser. The difference in disease regression between the two subgroups was not statistically significant (p=0.455). ConclusionBlue laser and thulium laser can be used interchangeably in-office for the treatment of RE with no significant difference in patient self-perceived improvement in voice quality and in disease regression. A larger study using objective measures is warranted.

A Prospective Comparative Analysis to Study the Impact on Voice Changes Following Endoscopic Thyroidectomy.

Endoscopic approach has come up as a safe and feasible procedure for thyroidectomy with better cosmetic outcomes. However, concerns over its safety in terms of nerve injury and postoperative voice changes remain. This prospective study evaluated the role of vocal cord function assessment using laryngeal examination and voice analysis in patients who underwent endoscopic hemithyroidectomy either by the trans-oral endoscopic thyroidectomy vestibular approach (TOETVA) or the bilateral axillobreast approach (BABA). Thirty-nine consecutive patients were randomly allocated to either of the 2 groups of endoscopic hemithyroidectomy; 19 in TOETVA and 20 in the BABA groups. Vocal cord function was assessed subjectively using the GRBAS scale and objectively by acoustic analysis of parameters such as jitter, shimmer, mean frequency (F 0 ), noise-to-harmonic ratio (NHR), and maximum phonatory time (MPT) at baseline, postoperative day 10, and 3 months after surgery. There were no significant differences in mean GRBAS scores and values of mean frequency, jitter and shimmer between the 2 groups and on postoperative day 10 and at 3 months compared with baseline. The mean NHR and MPT showed no differences between the 2 procedures. However, there was a significant decrease in their values on day 10 postsurgery, compared with baseline. These values returned to their baseline at 3 months. The other operative parameters were comparable between the 2 groups, except for the shorter mean operative time in the TOETVA group. Perioperative quantitative voice parameters were comparable with no statistically significant difference between the 2 techniques of endoscopic thyroidectomy.

Oxygen concentration titration guided by oxygen reserve index during pediatric laryngeal surgery with high-flow nasal cannula oxygen: a randomized controlled trial.

The objective of this study was to evaluate whether adjusting the oxygen concentration guided by the Oxygen Reserve Index (ORI) during pediatric laryngeal surgery with High Flow Nasal Cannula Oxygen (HFNO) could achieve postoperative PaO2 close to physiological levels while ensuring adequate oxygenation in surgery. Sixty pediatric patients undergoing laryngeal surgery or examination were randomly assigned to two groups. The ORI group received oxygen concentration adjustments every 5min to maintain a target ORI value of 0.21, whereas the control group did not undergo any adjustments. Postoperative PaO2, time weighted average fraction of inspired oxygen (FiO2), and mean Peripheral Oxygen Saturation (SpO2) were compared between groups. Finally, some analyses were conducted to examine the relationship of ORI with PaO2. In general, the postoperative PaO2 was 164.9 ± 48.8mmHg in ORI group and 323.0 ± 87.7mmHg in control group (P < 0.01). The time weighted average FiO2 in the ORI group was 85.9 [81.8-92.7] %. There was no significant difference in mean SpO2 between the two groups (ORI vs. control: 98.4 [97.7-99.2] vs. 98.8 [97.7-99.5]; P = 0.36). According to the analyses, the optimal cut value for ORI was determined to be 0.195 when PaO2 was 150mmHg. In pediatric laryngeal surgery with HFNO, reducing oxygen concentration guided by ORI helped achieve postoperative PaO2 levels closer to physiological norms without compromising intra-operative oxygenation.

Managing a difficult airway due to supraglottic masses: successful videolaryngoscopic intubation after induction of general anesthesia.

While awake, flexible bronchoscopic intubation has long been considered the gold standard for managing anticipated difficult airways, the videolaryngoscope has emerged as a viable alternative. In addition, the decision to perform awake intubation or to proceed with airway management after induction of general anesthesia should be grounded in a comprehensive assessment of risks and benefits. A 41-year old female patient was scheduled for excision of bilateral, mobile, and pedunculated masses on both aryepiglottic folds, which covered almost the entire upper part of the glottis. We conducted a comprehensive evaluation of the patient's signs and symptoms, which included neither stridor nor dyspnea in any position, along with the otolaryngologist's opinion and the findings from the laryngeal fiberscopic examination. Given the potential challenges and risks associated with awake flexible bronchoscopic intubation for this patient, we decided to proceed with gentle tracheal intubation using a videolaryngoscope under general anesthesia. In case of failed mask ventilation and tracheal intubation, we had preplanned strategies, including awakening the patient or performing an emergent tracheostomy, along with preparations to support these strategies. Ensuring that mask ventilation was maintained with ease, the patient was sequentially administered intravenous propofol, remifentanil, and rocuronium. Under sufficient depth of anesthesia, intubation using a videolaryngoscope was successfully performed without any complications. Videolaryngoscopic intubation after induction of general anesthesia can be a feasible alternative for managing difficult airways in patients with supraglottic masses. This approachshould be based on a comprehensive preoperative evaluation, adequate preparation, and preplanned strategies to address potential challenges, such as inadequate oxygenation and unsuccessful tracheal intubation.

Persistent Shortness of Breath in Post-COVID-19 Patients: Inducible Laryngeal Obstruction Can Be a Cause

BackgroundInducible laryngeal obstruction (ILO) is the adduction of the true vocal folds during inspiration or, less frequently, expiration. Its etiology is unknown. PurposeThis study aimed to identify ILO as a possible cause of shortness of breath (SOB) in post-COVID-19 patients. MethodsA retrospective study was conducted on 59 post-COVID-19 adults complaining of shortness of breath. We collected the cases' clinical and chest imaging data, including demographic data, pulmonary function test, CT chest, and laryngeal endoscopic examination. A visual score was used to assign the severity of the glottic obstruction. The grades of this score ranged from 0 (complete patency) to 3 (almost complete closure). ResultsILO was detected in 8 out of 59 cases (13.5%). Two cases out of 8 had glottic closure grade 1, while 5 cases had glottic closure grade 2, and one had glottic closure grade 3. There was a positive correlation between ILO grades (the severity of glottic closure) and pulmonary function test (PFT) results (the degree of upper airway restriction). Pulmonary function tests in ILO have a specific pattern. It was typical for the expiratory loop to be normal and the inspiratory loop to be flattened. ConclusionILO is a possible cause of SOB in post-COVID-19 adult cases. It should be considered during evaluation and management.

The sensitivity of laryngeal findings in predicting high-grade dysplasia in patients with vocal fold leukoplakia undergoing office-based biopsies: A retrospective analysis of 100 cases.

To investigate the sensitivity of laryngeal findings in predicting high-grade dysplasia/carcinoma in situ (CIS) and squamous cell carcinoma (SCC) in patients with vocal fold leukoplakia. A retrospective review of the medical records and video recordings of the laryngeal examination of patients with vocal fold leukoplakia who underwent un-sedated office-based laryngeal biopsy in a tertiary referral center between January 2022 and August 2023 was conducted. Laryngeal findings included the size, surface, projection, and edges of the lesion. Vocal fold leukoplakia was classified according to the WHO as benign, low-grade dysplasia, high-grade dysplasia/CIS, and squamous cell carcinoma. Seventy patients with 100 vocal fold leukoplakia were included. Size was found to have the highest sensitivity with an AUC of 0.730 (95% CI [0.618-0.842], p = 0.002) followed by surface and projection with AUCs of 0.672 (95% CI [0.548-0.795], p = 0.019) and 0.675 (95% CI [0.546-0.804], p = 0.017), respectively. Furthermore, the odds of diagnosing high-risk lesions (high-grade dysplasia/CIS and SCC) were the greatest when the lesion was large and rough (OR = 10.28; 95% CI [3.08-34.36]). The morphological features of vocal fold leukoplakia may assist the physician in predicting the risk of malignancy. Large and rough lesions were more likely to harbor high-grade dysplasia/CIS and SCC compared to small and smooth lesions.

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.

Use of a rigid curved laryngoscope for observation and debridement of degenerated cricoid cartilage in nasogastric tube syndrome: A case report.

Nasogastric tube syndrome (NGTS) is a complication of NGT placement that can cause sore throat, bilateral vocal cord paralysis, and airway constriction. Although rare, this condition should be known by all physicians because it is sometimes fatal. We report a case of NGTS that was successfully diagnosed and debrided with a rigid curved laryngoscope. A 79-year-old man was referred to our department for evaluation of persistent pharyngeal pain and dysphagia after thoracic aortic aneurysm surgery. He had restricted bilateral vocal fold abduction, and the NGT had been placed for nearly 120 days. After induction of general anesthesia, the patient underwent laryngeal examination using a rigid curved laryngoscope, which revealed ossified cricoid cartilage in the postcricoid area, leading to confirmation of NGTS. The NGT was removed, and the protruding bony lesion was debrided. Subsequently, the patient underwent gastrostomy to improve his nutritional status. One month later, the postcricoid lesion improved, and the patient was able to tolerate an oral diet. The pathophysiology of NGTS is thought to involve ulceration of the postcricoid mucosa and injury of the posterior cricoarytenoid muscle by contact with the NGT. Although the treatment has not been established, early removal of the NGT is important. In the present case, the rigid curved laryngoscope was useful for resection of the bony lesion, which contributed to early epithelialization and symptom improvement.

OTORHINOLARYNGOLOGICAL FINDINGS INRHEUMATOID ARTHRITIS (RA) PATIENTS

Rheumatoid arthritis is a persistent inflammatory illness that impairs joint function by destroying cartilage and causing synovitis. It is a debilitating illness that affects every joint in the body. Additionally, it manifests extra-articularly, impacting the auditory system as well as ENT manifestation. Regarding Laryngeal Symptoms, dysphonia or changes in voice quality can be caused by autoimmune illnesses in general and RA in particular. These changes can be caused by either functional or anatomical l modifications.Material and Method: 60 adults with rheumatoid arthritis classified into two groups the 1st group have disease duration less than or equal to 5 years and the 2nd group is more than 5 years. Disease activity was assessed using DAS 28 (Disease activity score). The entire patient underwent otoscopic examination of ears &amp; Laryngeal examination as well asfull audiological evaluation including pure tone and speech audiometry and immetencemetryin the form of tympanometry and acoustic reflexes to assess middle function. Results: A total of 60 patients, 40 patients with a disease duration of less than or equal to five years (1st group). The 2nd group had disease duration of more than five years they were 20 patients. In RA patients the disease activity score was done using DAS-28 CRP, the first group with mean 5.3±1.3, the second group had a mean 5.9± 1.4. As for the Otorhinolaryngological findings we found that otalgia &amp;myringo sclerosis and rhinogrnic findings there are no significant difference between the two groups. As regard laryngeal findings there are no significant difference between the two groups as regard edema, GERD and laryngeal swellings. Hearing loss was present in 16 (40%) patients in the first group and 17(85%) patients in the second group with highly significant difference between the two groups,there was direct correlation between disease duration °ree of hearing loss. Conclusion: our research revealed that the duration of RA had little bearing on laryngeal findings. On the other hand, the length of the illness had an effect on rhinogenic findings. Additionally, duration of RA and hearing test showed a direct association.

Office Rigid Laryngoscopy as a Predictor for Glottic Exposure in Microlaryngoscopy.

Good glottic exposure is a prerequisite for a good microlaryngeal surgery. Often this is difficult to predict preoperatively. This study aims to evaluate the utility of office-based rigid laryngoscopy (70°) as a screening tool to predict laryngeal exposure during micro laryngoscopy. Sixty-nine patients underwent office-based rigid laryngeal examination followed by micro laryngoscopic surgery for benign vocal cord lesions. Office-based laryngoscopy was classified as grade 1 when the entire glottis with anterior commissure (AC) was visualized without undue traction of tongue; grade 2 when AC was visualized only during phonation and with some traction of tongue and grade 3 when there is an inability to visualise the glottis adequately despite moderate traction of tongue and the examination was completed using a flexible scope. These were correlated with laryngeal exposure during micro laryngoscopy. 42 patients were categorized as grade 1 out of which 39 (93%) had a favourable laryngeal exposure (class 1) while only 3 (7%) had a partially favourable exposure (class 2). 18 patients were categorized as grade 2 out of which 12(66%) had a favourable exposure (class 1) as against 6 (33%) who had a partially favourable exposure (class 2). Nine of our patients were categorized as grade 3 out of which all 9 (100%) had an unfavourable exposure (class 3) requiring angled tele laryngoscopy to complete the surgery. A strong correlation between office-based laryngoscopic grading and exposure during operative laryngoscopy was obtained statistically (Cramer's V test, V = 0.746). Office examination with a 70° telescope is a good predictor of glottic exposure during micro laryngoscopy. We believe that the ease of performing a micro laryngoscopy in the operating room is directly proportional to the ease of doing laryngoscopy in the office.

Pediatric Unilateral Vocal Fold Paralysis

Purpose: The aim of this case study was to provide a review of a pediatric patient diagnosed with unilateral vocal fold paralysis. Method: The case history, voice samples, laryngeal examinations, and diagnostic probes were reviewed in a 10-year-old girl with the chief complaint of persistent dysphonia, characterized by use of both a breathy and a typical voice. Perceptual ratings were completed using both Consensus Auditory-Perceptual Evaluation of Voice and Grade, Roughness, Breathiness, Asthenia, and Strain scales. Cepstral peak prominence was determined and compared for the same file segment using both Praat and Analysis of Dysphonia in Speech and Voice analysis programs. Treatment probes during the initial preoperative visit are described. Results: The patient was able to compensate for short phonation tasks, but longer conversations were judged to have increased dysphonia and increased vocal fatigue. Because noted compensation was unable to be stabilized or sustained, both a reinnervation of the ansa cervicalis to the recurrent laryngeal nerve and voice therapy techniques were recommended as part of the multidisciplinary team plan. Conclusion: Pediatric patients with unilateral vocal fold paralysis may present with complex phonatory behaviors. This case study paired with supplemental acoustic and videostroboscopy files provides an opportunity to practice both an auditory-perceptual and acoustic assessment and to rate a laryngeal examination. Supplemental Material: https://doi.org/10.23641/asha.24163926

Outcome following elective unilateral arytenoid lateralization performed in an outpatient manner is comparable to hospitalization for dogs with laryngeal paralysis.

To compare outcomes and short-term complications of dogs with laryngeal paralysis treated with unilateral arytenoid lateralization performed on an outpatient versus inpatient basis. 44 client-owned dogs. Medical records were retrospectively reviewed to identify dogs that underwent unilateral arytenoid lateralization for the treatment of laryngeal paralysis between 2018 and 2022. Signalment, surgical technique, anesthesia time, comorbidities, laryngeal examination, concurrent procedures, use of prokinetics and sedatives, episodes of vomiting, episodes of regurgitation, duration of hospitalization, postoperative complications, anxiety scores, and pain scores were recorded. Variables were compared between dogs and grouped by outpatient or inpatient management. The overall complication rate was 22.7% (10/44), with 35% (7/20) being in the inpatient group and 12.5% (3/24) being in the outpatient group. The overall mortality rate was 6.8% (3/44). The overall morbidity for hospitalized patients versus those undergoing and outpatient procedure was 5% (1/20) and 4.2% (1/24), respectively. There was no significant difference between overall rate of complications and mortality rates between the inpatient and outpatient groups. Results suggested that outpatient management of dogs with laryngeal paralysis treated with elective unilateral arytenoid lateralization is an appropriate method of postoperative management with no difference in complication or mortality rates. Further prospective studies with standardized surgical, sedative, and antiemetic protocols are warranted to evaluate more definitely.

Seeing Voices: A Dynamic, Interprofessional Approach to Teaching Performing Arts and Speech-Language Pathology Students About Vocal Anatomy and Physiology

Seeing Voices was an interprofessional, technology-enabled, large-scale, teaching and learning event developed to address the need to improve voice students' knowledge of laryngeal anatomy and physiology toward understanding and maintaining vocal health. Seeing Voices trialed a novel interprofessional educational approach, collected both quantitative and qualitative data about student experiences of laryngostroboscopic examination, and built a databank of laryngeal recordings for future student learning. Seeing Voices involved two 3-hour seminars in a large, university lecture space, run by an interprofessional team (speech-language pathologists, vocal coach, Ear Nose and Throat consultant) with quality equipment projecting laryngeal images to large screens with expert commentary in real time. Participants were 18 students who volunteered for laryngeal examination (9 per seminar) and student attendees (n=175) from performing arts courses (classical singing, contemporary, jazz, musical theater, acting) and a speech-language pathology course. A quantitative evaluation of knowledge gained was undertaken using a Qualtrics survey. Results from pre (n=175; performing arts=120; speech-language pathology (SLP)=55) and postevent (n=99; performing arts=56; SLP=43) questionnaires were received from the students who attended. Interviews were collected from 15 of the 18 student volunteers about their experiences of nasendoscopic evaluation and data were analyzed using qualitative description and qualitative content analysis. Quantitative results demonstrated a strong trend toward increased knowledge following attendance at the event across year cohorts for both student groups. Qualitative interviews highlighted the value in seeing multiple examples of normal laryngeal functioning across different vocal techniques in real time. For those undertaking nasendoscopic examination, simultaneously seeing and feeling laryngeal maneuvers used in training appeared to promote understanding of their own vocal mechanism and the purpose of different vocal techniques. Seeing Voices offers a novel way to improve interprofessional collaboration, and engagement with, and understanding of, laryngeal anatomy and vocal health by students in performing arts and speech-language pathology courses.

A Clinico- Etiological Evaluation of Vocal Cord Paralysis

Introduction: This is a case study of 61 cases admitted in our hospital to study the various etiologies of vocal cord immobility (including both paralysis and paresis of vocal cord) and to study the incidence of vocal cord immobility.Vocal cord paralysis is a common symptom of the disease which can be originated from laryngeal nerve paralysis following laryngeal carcinoma, oesophageal carcinoma, bronchogenic cancers, thyroid neoplasms, surgical procedures in neck and thorax, post anaesthesia complication,or neurologic diseases. Materials and methods: The present study includes all the cases having vocal cord paralysis presenting in out-patient department of Otorhinolaryngology, examination of larynx externally,by indirect laryngoscopy and direct laryngoscopy was done.All the routine and systemic examination were done. Results: In our study, left vocal cord was the most commonly involved and was observed in 40(65.5%) patients, with neoplasm being the most common cause in 19(31.1%) patients. Right vocal cord involvement was found in 20(32.8%) patients, with neoplasm being the most common cause in 13 (21.3%) patients. The ratio of left side and right side involvement of vocal cord was 2:1 in our study. The longer course of the Left Recurrent Laryngeal Nerve might account for the difference. Conclusion: In our study the etiology which was found to be more common was neoplasms then that of idiopathic causes. The reason behind this could be advanced investigation procedures which allows us to do a thorough work upon any case, but even after that we have found some of Idiopathic causes as well.

Renal Cell Carcinoma Metastasizing to the Cricoid Cartilage Presenting With Subglottic Stenosis: A Case Report and Literature Review.

A 72-year-old Japanese man with a 4-month history of hoarseness and 1-week history of difficulty breathing was admitted to our department. He underwent right total nephrectomy for primary clear cell-type renal cell carcinoma (RCC) 6 years ago and left partial nephrectomy for the metastasis 4 years ago. Flexible laryngeal fiberscope examination revealed bilateral subglottic stenosis without obvious mucosal lesions. Enhanced computerized tomography (CT) scan of the neck revealed that the cricoid cartilage had become bilaterally expansive and tumorous lesion exhibiting enhancement. We performed tracheostomy on the appointed day and biopsied the tumor in the cricoid cartilage via the skin incision. Results of histologic and immunohistologic examinations for AE1/AE3, CD10, and vimentin positivity were consistent with clear cell-type RCC. Chest and abdomen CT scans revealed a few tiny metastases in the upper lobe of the left lung but no recurrence in the abdomen. At 2 weeks from the day of tracheostomy, total laryngectomy was performed. Postoperatively, the patient was treated transorally with axitinib (10 mg/day) and as of 12 months he remains alive with unchanging lung metastasis. Next-generation sequencing of targeted regions using a surgical specimen from the tumor revealed a frameshift mutation in the von Hippel-Lindau gene (p.T124Hfs*35) and a missense mutation in the TP53 gene (p.H193R).

Office-based blue laser therapy for dyspnea in patients with type 3 Reinke's edema.

To investigate the effectiveness of in-office blue laser therapy on dyspnea in patients with type 3 Reinke's edema. The medical records and video-recordings of patients with Reinke's edema type 3 who had undergone office-based blue laser therapy between March 2022 and January 2023 were reviewed. The primary outcome measures assessed before and after surgery were dyspnea severity, risk of obstructive sleep apnea (OSA), and disease regression. The severity of dyspnea was measured using the Dyspnea Severity Index (DSI), the risk of OSA was assessed using the STOP-BANG questionnaire, and disease regression was assessed by reviewing the laryngeal examination before and after surgery. The Voice Handicap Index-10 (VHI-10) was used as a secondary outcome measure. A total of 10 patients were included. The mean age of the study population was 58.9 ± 4.2years. The male-to-female ratio was 2:3. In total, 20 vocal fold lesions were treated among which 18 were reviewed. Eight lesions regressed completely and 10 partially. There was a statistically significant drop in the mean score of DSI after surgery (16.1 ± 10.2 pre-operatively vs 2.3 ± 2.3 post-operatively, p-value < 0.001). The mean STOP-BANG score decreased from 4.8 ± 1.47 to 3.1 ± 1.28 (p-value = 0.001). There was also a significant improvement in VHI-10 score (22.7 ± 7.0 vs 4.4 ± 5.6, p-value < 0.001). Office-based blue laser therapy offers a safe and effective treatment for shortness of breath in patients with type 3 Reinke's edema.

Office-Based Blue Laser Therapy for Vocal Fold Leukoplakia: A Preliminary Report of 12 Cases.

To report the efficacy of office-based blue laser therapy for vocal fold leukoplakia. A retrospective case series. A tertiary care center. A retrospective chart review of patients with vocal fold leukoplakia who underwent office-based blue laser therapy between July 2019 and October 2022 was conducted. The video recordings of their laryngeal examination and their voice evaluation were analyzed before and after surgical intervention. A total of 10 patients, eight with unilateral disease and 2 with bilateral disease, were included in this study. In total, 12 vocal folds with leukoplakia were treated. Nine had a single session and 3 had 2 sessions due to incomplete regression of the lesion after the first laser therapy session. Following treatment, 9 regressed completely (75%) and 3 regressed partially (25%). The mean Voice Handicap Index-10 (VHI-10) score decreased significantly from 15.4 ± 12.9 preoperatively to 3.8 ± 2.86 after surgery (p = .023). There was a statistically significant decrease in the means of grade, roughness, breathiness, asthenia, and strain (p < .05). There was also a statistically significant decrease in the jitter and shimmer percent (p = .008 and p = .048, respectively) and a significant increase in the maximum phonation time from 9.63 ± 3.83to 13.54 ± 5.92 seconds (p = .039). This preliminary study indicates that office-based blue laser therapy is an effective treatment modality for vocal fold leukoplakia.

Surgical management and outcome of a laryngeal myxosarcoma in a dog

AbstractA 9-month-old female spayed French Bulldog presented for respiratory stridor and exercise intolerance. Laryngeal examination showed an abnormally thickened left arytenoid cartilage. Fine needle aspirate of the mass was consistent with a well-differentiated spindle cell proliferation. The mass was marginally excised via a left-sided arytenoid approach and per os. Histopathology confirmed a well-differentiated myxosarcoma. Following surgery, the dog developed severe dyspnea and marked respiratory stridor consistent with airway obstruction secondary to laryngeal edema and inflammation. A permanent tracheostomy was performed. Three months post-operatively the dog was completely recovered, but early tumor regrowth was observed. This is the first report of laryngeal myxosarcoma in a dog. Permanent tracheostomy should be considered early in the surgical management of laryngeal neoplasia when more invasive surgical procedures are not elected to achieve a good outcome.