False Vocal Cord Research Articles

M018 MULTIPLE INTUBATIONS FOR "ANAPHYLAXIS": ANOTHER PRESENTATION FOR INDUCIBLE LARYNGEAL OBSTRUCTION

Inducible laryngeal obstruction (ILO) refers to a transient narrowing of the larynx due to paradoxical adduction of the vocal folds, false vocal cords or supraglottic tissue leading to periodic laryngeal obstruction. ILO is associated with exercise, reflux, inhaled irritants, and stress. Common symptoms include subjective throat tightness, choking sensation, cough and occasionally stridor or dysphonia. Recurrent intubations for a history of repeated anaphylactic events should trigger a thorough evaluation for ILO, especially in patients who present with atypical histories.

EP24 Arthritis mutilans coexisting with three separate granulomatous diseases

Case report - IntroductionGranulomatous disorders are diverse in their aetiologies and presentations. We present an unusual case of severe psoriatic arthritis patient who subsequently developed multiple granulomatous diseases over time, granulomatous interstitial nephritis, granulomatous sarcoidosis with hilar lymphadenopathy and localised laryngeal granulomatous inflammation secondary to lambda type amyloidosis.Case report - Case description52-year-old gentleman with arthritis mutilans secondary to severe poorly controlled psoriatic arthritis was followed up in Rheumatology clinic. Earlier therapy with leflunomide and methotrexate provided inadequate control. Golimumab, despite giving a good response, was stopped in 2013 after 5 months of treatment due to acute kidney injury. Renal biopsy revealed granulomatous interstitial nephritis, thought to be Golimumab-induced based on the timing of usage and reversibility with discontinuation. He was then trialled on Ustekinumab and Secukinumab in 2016 and 2017 respectively with variable response.He also had a few-years history of voice change (high pitched) and sore throat which he attributed to recurrent colds. He denied dysphagia or breathlessness, and he did not have stridor. He has never smoked and only drank alcohol occasionally. ENT team noted white deposits on erythematous and thickened false vocal cords and posterior glottis with a thin web on microlaryngoscopy, which histologically proved to show granulomatous inflammation, potentially consisting of amyloid, although congo red stain was negative. On further investigation, including SAP scan, he was diagnosed with localised lambda type amyloid. Increasing throat pain and worsening dysphonia prompted change of management from conservative to a surgery at a specialist centre and an input from speech and language therapy team.During this time, consideration for Etanercept for his joint and skin disease was put on hold, pending further management of laryngeal amyloidosis. Furthermore, he presented to hospital with breathlessness in 2019, where his chest X-ray showed bulky right hilum and a follow-up CT chest revealed calcified right hilar and mediastinal lymphadenopathy, ground glass opacification and consolidation. Histology from hilar node was suggestive of sarcoidosis, with stain negative for amyloid.He underwent removal of false vocal cords for his symptomatic laryngeal amyloidosis. He continues to be followed up at the local Rheumatology, Dermatology and ENT team.Case report - DiscussionGranulomatous diseases have vast aetiologies, including infectious, immunological, neoplastic, and chemical-induced processes. The age at which they affect patients and tissue they involve also vary hugely. This is the first reported case of three seemingly unrelated granulomatous diseases occurring in a single patient with severe refractory psoriatic arthritis. Retrospective reassessment of the histology samples supported that these are three separate pathologies. It is very unusual for one patient to acquire multiple separate granulomatous diseases, which was why the diagnostic process of this patient was challenging. In this case, managing the original underlying psoriatic arthritis was particularly difficult due to interruptions of treatment for adverse drug effects and investigations and treatment of subsequent granulomatous diseases. The case also raises questions about possible currently unknown association between the pathologies.Case report - Key learning pointsKey points are the uniqueness of this case and that it highlighted the possibility of currently under-reported association between these three granulomatous conditions. As ever, a multidisciplinary approach to managing such a complex patient is important for the provision of good care.

Rare Case of False Vocal fold (ventricular band) Ductal Cyst.

Laryngeal cysts are benign laryngeal lesions of which incidence rate is just about 5%. These cysts have various initial presentations depending on the sites of origin. False vocal folds (ventricular band) rarely gets involved: only 5% of total benign laryngeal cysts cases. They are classified into several types based on the sites of origin and the underlying pathophysiology. Ductal cysts of false vocal fold (ventricular band) are very rare. Common symptoms are dysphagia, dysphonia, dyspnea and foreign body sensation. We discussed an elderly patient who presented with just dysphonia and final diagnosis is ductal cyst arising from false vocal cord (ventricular band). He recovered fully after endoscopic microlaryngeal resection and no recurrence was seen after 1 year. The patient was a chronic smoker but no absolute causal relationship and risk factors associated with this pathology were identified. The investigations, features and outcome of the cyst are further elaborated. Several treatment modalities were reported in literature but no superiority comparison were made.

Head and neck injuries after a bomb explosion: Diagnostic findings and treatment approaches.

To identify the types and severity of head, face and neck (HFN) injuries, which occurred as a result of a bomb explosion and reached serious life-threatening levels, using radiological imaging methods, and to discuss the options of treatment at the time of presentation. Of the 16 patients brought to the emergency department, 14 with HFN injuries were included in the study. Computed tomography (CT) and radiography scans were performed at the time of presentation in all patients, except for one. The injuries were divided into three groups according to their localization as head, face, and neck. A subgaleal hematoma was seen in 10 of 11 (78.5%) patients with head injuries. Eight (57.1%) of nine patients with facial injury had fractures and/or ocular injury in the orbital wall, and seven (50%) patients had maxillofacial bone fractures. Among ocular trauma cases, open-globe injuries were detected in three patients (21.4%), closed-globe in two (14.2%), and both types in three (21.4%). Of the five (35.7%) patients with secondary blast injuries in the neck, three (21.4%) had laryngeal trauma (Zone 2) due to shrapnel, localized in the false vocal cord, epiglottis, and thyrohyoid membrane, respectively. Emergency surgery was performed on a patient with a specific laryngeal injury. We consider that in patients presenting to the emergency department with blast HFN injuries, after providing airway patency and hemodynamic stability, CT and CT angiography should be performed because these modalities guide the treatment accurately and promptly.

Unusual Sites for Extracranial Head-Neck Schwannomas.

Schwannomas are a frequent cause of swellings in the head and neck region. Due to the abundance of peripheral, cranial and autonomic nerves in this region, schwannomas can present in variety of locations, posing a diagnostic and therapeutic challenge to the surgeon. Unusual sites in head and neck region can have varied presentation depending on the site of origin. We identified unusual extracranial locations of head and neck schwannomas, their presenting features and surgical management. Retrospective review of cases of extracranial head and neck schwannomas operated in the Department of Otolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, New Delhi, a tertiary referral centre between July 2015 and June 2019. A total of 42 cases of extracranial head and neck schwannomas were operated. Among them, 9 cases were found to arise from uncommon sites, such as parotid gland (n = 1), infratemporal fossa (n = 2), external auditory canal (n = 1), subglottis (n = 1), false vocal cord (n = 1), frontal recess (n = 1), maxillary sinus (n = 1) and retromolar trigone (n = 1). All patients underwent excision via relevant approaches. Nerve of origin was identified in 4/9 cases. One case had postoperative neurological deficit. No recurrences were noted in mean follow-up of 19months. Schwannomas ought to be considered as a differential diagnosis for swellings/ mass in any part of head and neck region. Comprehensive evaluation with appropriate imaging and histology should be done in all cases. Preoperative counselling and consent regarding neurological deficit pertaining to possible nerve of origin is required in each case.

Laryngeal Oncocytic Cyst: An Uncommon Incident

Oncocytic cysts of the larynx are benign and rare lesions constituting a pathologically distinct sub-group of cysts. In this report, we present a case with dyspnea with two large masses on false vocal cord identified by video laryngoscopy. Fiberoptic nasotracheal intubation revealed oncocytic laryngeal cysts.

Carcinoma glottis with parotid metastasis

Introduction: Glottic carcinomas represent approximately one third of the laryngeal cancers. True glottis includes both true vocal cords including anterior and posterior commissures. True vocal cord are as such devoid of lymphatics, so the chances of lymph node metastasis as such is very low. The chances of distant metastasis is also very rare. Herein we report a case of glottic cancer metastasising to parotid gland. Case report: A sixty eight year old male non smoker reported to our department with complaint of change of voice since three months. On computed tomography scan of head and neck, soft tissue thickness of about seven millimeter was seen over right true and false vocal cord and 2.3 * 1.9 cm lesion was seen involving the left lobe of the parotid gland. MRI of neck and paranasal sinuses was performed immediately following tomography which showed 2.6*1.9*3.1 cm lesion was seen involving deep lobe of left parotid gland which appeared isointense on T1w, hyperintense on T2w, not suppressed on STIR. There was no any evidence of capsular breach. Seven millimeter thickness was seen over right true and false vocal cord. These findings were further confirmed by direct laryngoscopic examination which showed mucosal irregularity over right true and false vocal cord with normal mobility of both vocal cords and punch biopsy was taken from it which came out to be well differentiated squamous cell carcinoma. Ultrasonography guided biopsy was taken from the deep lobe of the left parotid gland which came out to be metastatic squamous cell carcinoma. Patient was offered curative radiotherapy to a dose of 55 Gy in 20 fractions and the parotid lesion was addressed by parotidectomy, which showed no evidence of malignancy which might be considered to be an abscopal effect. Conclusion: The involvement of the parotid gland in case of glottic cancer is a very rare occurrence.

Vocal fold schwannoma in a 13-year-old girl

Laryngeal neurogenic tumors are extremely rare clinical entity. It is a benign and slowly growing neoplasm. Schwannoma of the larynx often arises from the aryepiglottic fold and false vocal cord. Schwannoma of the larynx particularly at the true vocal fold is extremely uncommon. Laryngeal schwannoma typically presents with hoarseness of voice and globus sensation. If the tumor is increases to bigger size, it may lead to dyspnea and stridor. It has an excellent prognosis with low potential for malignant transformation. It should be considered as a differential diagnosis of sublingual pathologies such as salivary gland lesions such as vocal fold polyp. Surgical excision of the tumor is the primary treatment of choice in case of lingual schwannoma. The endoscopic transoral route is considered as the most commonly used approach for vocal fold schwannoma. We report a case of vocal fold schwannoma in a 13-year-old girl which was excised endoscopically.

Larynx-preserving reconstruction after extended base of the tongue resection

As the base of the tongue (BOT) plays essential roles in speech and swallowing, surgical resection of BOT cancer is typically avoided. Moreover, standard reconstructive procedures for larynx-preserving BOT defects have not yet been established. We performed immediate flap reconstruction after wide resection of BOT cancer with laryngeal preservation. Herein, the functional and oncological results of our strategy were analysed. We retrospectively evaluated patients who underwent extended BOT resection (including the oral tongue, upper/lateral oropharyngeal wall, epiglottis and false vocal cord) with laryngeal preservation between April 2006 and April 2016. We classified defects involving the oral tongue or upper/lateral oropharyngeal wall as the lateral extension type and those involving the epiglottis or false vocal cord as the laryngeal extension type. Lateral extension-type defects were closed primarily and filled with a deepithelialised skin or muscle flap. Laryngeal extension-type defects were reconstructed using a bulky skin flap plus hyo-thyroid-pexy to create a neo-epiglottis. Postoperative functional and oncologic outcomes were assessed. We enrolled 18 patients with extended BOT defects. Of them, 11 had a history of irradiation. The tracheal cannula was removed in all cases, although laryngeal extension defects were associated with a longer duration to removal. All patients achieved complete oral intake and retained intelligible speech, with preservation of laryngeal function. There was no local recurrence, and the 5-year overall survival was 88.9%. Following wide BOT resection, reconstruction with laryngeal preservation is feasible even in cases involving irradiated tumours with laryngeal extension.

Direct Visualization of Laryngeal Mucociliary Clearance in Adults.

Mucociliary clearance is a protective mechanism of the respiratory tract that facilitates the removal of foreign particles and microorganisms. There is a paucity of data on the mucociliary clearance in the adult larynx. Our study aims to visualize and describe the mucociliary clearance of the adult larynx in healthy subjects. Subjects were identified from a volunteer database. Exclusion criteria included laryngeal disease, previous laryngeal surgery, recent upper respiratory infection, and current smoking. A high-definition videolaryngoscope was used to visualize the larynx. The larynx was topicalised with local anesthetic. Methylene blue was placed on both false vocal cords and at the petiole of the epiglottis. Dye clearance was recorded and analyzed. In total, 10 participants participated, 7 men and 3 women, with a mean age of 42 ± 15.7 years (range: 25-71). The average reflux symptom index score was 1.4. Clearance of the dye from the false vocal cords followed a uniform lateral flow, up onto the aryepiglottic folds. The dye from the petiole had minimal vertical movement. Swallowing cleared dye from the aryepiglottic folds. The average time for dye clearance to the aryepiglottic fold was 2.21 ± 1.14 minutes. This is the first study visualizing the mucociliary clearance of the larynx. Ciliary directionality was consistent in the participants studied, with dye moving superolateral from the false cords to the aryepiglottic fold. Swallowing was an effective mechanism for clearance from the endolarynx, when the dye had reached the aryepiglottic fold. Future research can study potential alterations in laryngeal mucociliary clearance in chronic disease states.

Clinical Characteristics and Management of Saccular Cysts: A Single Institute Experience

Objectives A saccular cyst is defined as a dilated saccule of the larynx, filled with mucus, and is located between the false vocal cords and the thyroid cartilage. Although this uncommon laryngeal condition is benign in nature, it could lead to dyspnea, stridor, and airway obstruction, depending on its size and location. Furthermore, some saccular cysts have been associated with laryngeal carcinoma. This study aimed to characterize this rather uncommon laryngeal condition to aid in determining the proper management of this pathology.Methods Medical records were retrospectively reviewed of all patients with saccular cysts diagnosed and treated between 2006 and 2017 at a tertiary otolaryngologic care center.Results Seven patients with saccular cysts were identified (male:female=2:5; mean age, 34.1 years); two were pediatric patients. Surgical intervention was performed in all patients by laryngo-microsurgery using CO2 laser. There was no recurrence after the initial surgical treatment.Conclusion Saccular cysts can be managed endoscopically using CO2 laser, without requiring an external approach. Therefore, an endoscopic approach should be actively considered for an optimal treatment outcome.

Evaluating the Effect of Endoscopic Sinus Surgery on Laryngeal Mucosa Stroboscopic Features.

The major presenting symptom of nasal polyps is nasal obstruction. The role of nasal obstruction in the genesis of laryngeal disorders is still unknown. The aim of this study was to evaluate laryngeal videostroboscopic changes after functional endoscopic sinus surgery (FESS) in patients with nasal polyposis. A longitudinal study was carried out from March 2012 to June 2013. Thirty patients with bilateral nasal polyposis who did not respond to maximum medical treatment and were candidates for FESS were recruited. Laryngeal videostroboscopy was performed before and 3 months after FESS. Glottic gap, true vocal cord (TVC) borders and pliability, false vocal cord (FVC) movement, laryngeal erythema and mucosal edema were documented. Laryngeal erythema and TVC edema were significantly decreased after FESS. Laryngeal erythema was documented in 18 patients after a 3-month follow-up. Four patients (13.3%) showed mild-to-moderate TVC edema and 26 patients (86.7%) had normal TVC mucosa. The results of this study show that FESS has a significant impact on laryngeal videostroboscopic features including laryngeal erythema and TVC edema.

Heterotopic Salivary Gland Tissue in the Larynx

Heterotopic Salivary Gland Tissue (HSGT) of the larynx is an extremely rare pathology, with only 8 cases reported in English literature. We are reporting 2 cases of HSGT in the larynx which we encountered in our practice. The first one is a unique presentation of a 45 year old female with HSGT in bilateral false vocal cords. While the second case is 50-year-old male patient with HSGT in the left false vocal cord and subglottic region. With these 2 cases, we would be discussing about the clinical presentation of this rare anomaly and add to the literature.

Hoarseness as a presentation of mycosis fungoides infiltrating the larynx

Laryngeal involvement is a rare manifestation of mycosis fungoides (MF), with only nine reported cases of cutaneous T cell lymphoma with laryngeal or vocal cord involvement. Herein, we report the...

Investigation of the Effects of Speech Signal Length on Vocal Disorder Sorting Done Via Dynamic Pattern Modeling

Development of a noninvasive method for separating different vocal fold diseases is an important issue concerning vocal analysis. Due to the time variations along a pathologic vocal signal, application of dynamic pattern modeling tools is expected to help in the detection of defects that occur in the speech production mechanism. In the present study, the hidden Markov model, which is a state space model, is employed to sort some of the vocal diseases. Moreover, this research mainly investigates the effects of the processed vocal signal lengths on the mentioned sorting task. To this end, the signal lengths of 1, 3, and 5 seconds of different disorders are used. The experimental results show that some pathologic conditions in vocal folds such as cyst, false vocal cord, and mass are more evident in continued voice production, and the recognition accuracies gained via dynamic modeling of pathologic voice signals with more lengths are considerably improved.

Clinicopathologic Findings and Treatment Outcome of Laryngectomized Patients with Laryngeal Cancer and Hypopharyngeal Cancer: An Experience in Thailand

Objective:To evaluate the clinicopathologic findings and treatment outcome in laryngectomized patients with laryngeal cancer and hypopharyngeal cancer.Materials and Methods:The authors retrospectively reviewed the medical records of 212 patients who had been newly diagnosed and treated with laryngectomy between January 2000 and December 2010. The age, gender, clinical manifestations, associated predisposing condition, tumor WHO grade, AJCC tumor stage, maximum tumor size, anatomical involvement, type of surgery, postoperative sequelae, treatment and therapeutic outcome were analyzed.Results:The present study included laryngeal cancer (n = 155) and hypopharyngeal cancer (n = 57). The patients’ age ranged from 38 to 84 years, with the mean age of 62.08±9.67 years. The common clinical presentations were hoarseness (73.6%), cervical lymphadenopathy (35.8%), sorethroat (22.2%), and odynophagia (14.6%). The laryngeal cancer commonly involves true vocal cord (86.5%), anterior commissure (65.8%), false vocal cord (56.8%), laryngeal ventricle (53.5%), subglottis (47.1%), and paraglotic space (35.5%), respectively. Fifty-three percent of cases had stage IV cancer. The most common postoperative surgical sequela was hypothyroidism (77.8%). The overall 5-year survivals for laryngeal cancer and hypopharyngeal cancer were 55% and 9%, respectively. The 5-year survival for node-negative cases was 61.8% versus 17% for node-positive cases (p< 0.001). AJCC stage of laryngeal cancer and hypopharyngeal cancer was a significant predictor of 5-year survival (p< 0.001 and p = 0.004, respectively).Conclusions:The advanced AJCC stage, advanced T stage, advanced N stage, extracapsular tumor spread, and tumor invasion of false vocal cord, epiglottis, preepiglottic space, paraglottic space, thyroid cartilage, cricothyroid membrane were found to significantly augment the decrease of 5-year survival in laryngeal cancer. Only advanced AJCC stage was significantly associated with 5-year survival rate in hypopharyngeal cancer.

Localized Laryngeal Amyloidosis

ABSTRACT Amyloidosis in head and neck is rare but a benign disease. Among the sites in head and neck, larynx is the most commonly involved. A 40-year-old female had presented with hoarseness of voice and dyspnea with a mass in false vocal cord, which was biopsied and diagnosed as amyloidosis. After excluding systemic diseases, final diagnosis of localized laryngeal amyloidosis was given. How to cite this article Baruah R, Khaund G, Kalita A. Localized Laryngeal Amyloidosis. Int J Phonosurg Laryngol 2016;6(1):32-34.

A Clinical Study of Laryngeal Cysts

ABSTRACT Aim To study cases of cysts of larynx and review the literature regarding precipitating factors and methods of treatment. Materials and methods A retrospective study of eight cases of cysts of larynx in our hospital was carried out from July 2012 to December 2015. In all cases, diagnosis was made by video laryngoscopy and was treated by microlaryngeal surgery under general anesthesia (GA). Results Eight patients with laryngeal cysts were identified, of which five were male and three were female. The mean age was ranging from 40 to 60. On examination, two were diagnosed with cysts from epiglottis, three from aryepiglottic folds, two from false vocal cords, and one from the ventricle. Conclusion As saccular cysts are identified to be associated with neoplastic transformation, it is important to recognize the laryngeal saccular cyst and manage appropriately in its early stages and to differentiate it from other laryngeal cysts. Thorough diagnostic evaluation and surgical intervention necessitates the appropriate management. How to cite this article Kumar Chowdary KVS, Srikanth N, Shaik FB. A Clinical Study of Laryngeal Cysts. Int J Phonosurg Laryngol 2016;6(2):53-56.

Lingual tuberculosis mimicking malignant lesion: A rare manifestation of a common disease

We report a rare case of tuberculosis (TB) of base of the tongue following pulmonary TB. Patient presented to us with chief complaints of sore throat, dysphagia, and hoarseness of voice for 20 days. Examination with 90° telescope revealed ulcerative lesion in the base of the tongue on the left side of size 0.5 cm and another lesion in the left arytenoid and inter arytenoid area extending to the false vocal cord of the left side with undermined edges along with whitish slough at the center of the ulcer. Infection of the oral cavity with Mycobacterium tuberculosis is rare, however, it should be considered among the differential diagnosis of the lesions of the oral cavity. The biopsy is necessary to confirm the diagnosis.

Pulmonary Scintiscan Findings in Sulfur Mustard Injured Patients Suspected for Gastroesophageal Reflux; a Descriptive Cross-Sectional Study

Background:Gastroesophageal reflux disease (GERD) prevalence in patients with sulfur mustard (SM)-induced bronchiolitis obliterans (BO) is higher than exposed cases with mild lung injuries. In this study, we aimed to evaluate the prevalence of microaspirations using nuclear scintiscan among BO patients with SM exposure. Methods: This was a prospective cross-sectional study conducted on patients with SM-induced BO and pulmonary symptom exacerbation referred to the Baqiyatallah Hospital, Tehran, Iran during the year 2009. Following the endoscopy-based diagnosis of GERD by a gastroenterologist, anti-reflux medications were withdrawn for 72 hours and then the patients underwent nuclear scintigraphy scan following 12 hour ingestion of fat containing food as radionuclide dinner. High resolution computed tomography (HRCT), spirometry and bronchoscopy were also performed for all patients. Results: In this study, 39 patients (94.9% men) with mean (± SD) age of 45.1 ± 6.2 years were enrolled. The most common clinical complaints of the patients were thick sputum (97.4%) and dyspepsia (94.7%), followed by chest tightness (89.7%), nocturnal cough (82.1%), and nocturnal dyspnea (66.7%). In HRCT, air-trapping was the most common pulmonary finding (92.1%). In spirometry, mean (±SD) FEV1 and FEV1/FVC were 52.7 ± 22.4% and 70.4 ± 13.9%, respectively. In bronchoscopy, the most common finding was airway remodeling (62.2%), followed by false vocal cord hypertrophy (24.3%). In scintigraphic imaging, only 1 patient had a remarkable finding, in whom, the radionuclide material was seen in the pharynx (proximal GERD), but did not produce marked microaspiration of gastric substances into the airways. Conclusion:Although previous reports demonstrated high prevalence of GERD and microaspiration in patients with SM-induced BO, we did not find remarkable evidence for microaspiration in scintiscan in patients included in this study.