False Vocal Cord Research Articles

上気道アミロイドーシス症例

Localized amyloidosis of the airway is a rare condition. The present study describes a case of amyloidosis of the false vocal cord and nasopharynx.A 74-year-old male was referred to our outpatient clinic for the purpose of further examination of a mass in the larynx. On examination, the left false vocal cord was found to be swollen and an irregular bulging of the back of the soft palate was also observed.Histological examination revealed massive deposits of homogenous, eosinophilic hyaline-like substance in the sub-epithelial connective tissue.Under general anesthesia through the tracheotomy opening, laryngofissure was performed on April 2, 1981. After splitting of the thyroid cartilage in the midline, the inner aspect of the larynx was exposed. The lesion occupied the left false vocal cord area but the surface was not ulcerative. The tumorous lesion was removed as much as possible along with the overlying mucosa.The resected raw surface was covered by suturing the remaining mucosa.Further histological examination showed that the hyaline-like substance was Congored positive and metachromatic. Congo-red stain with polarization was also positive.No other part of the body including the rectal mucosa showed signs of amyloid deposits.

こう頭アミロイドーシスの１症例

A case of amyloidosis of the larynx is reported. The patient was a 39-year-old woman who complained of hoarseness of approximately 8 months' duration. Indirect laryngoscopy showed a yellow-red tumorous swelling in the bilateral false vocal cords, with normal mobility. Results of physical and laboratory examinations were all normal. Biopsy of the lesion revealed amyloidosis. Final diagnosis was made of solitary amyloidosis of the larynx. Laryngeal amyloid mass was entirely removed through the thyrotomy. A polarized microscopic examination showed that eosinophilic materials observed in H.E. stain were yellow-green positive in Congored stain, indicating that these materials were amyloid in nature. Amyloid fibrils in (4-10) nm width were observed in the lesion by electron microscopy. The patient remains asymptomatic for approximately four years after operation.

Zur Definition, H�ufigkeit und Relevanz plattenepithelialer Dysplasien im Larynx. Histologische Untersuchungen

The histological analysis of the more than 3,000 neoplasias of the larynx sent in to us for examination over the last 20 years, revealed approximately 10% benign and 40% malignant tumours. The remaining 50% covers tumourlike lesions and includes the dysplasias which, at approximately 20%, account for almost one-fifth of all the neoplasias of the larynx. Differential diagnostically, the dysplasias must be distinguished from carcinoma in situ, in which the disturbance in differentiation involves the entire thickness of the multi-layered squamous epithelium, there is a complete loss of stratification, and in which the epithelia reveal numerous nuclear atypias and mitoses. Dysplasias and carcinoma in situ are found not only in the mucosa, but also in the exophytically growing papillomas. A common feature is the fact that, under the light microscope, the basal membrane appears intact. The localization of the dysplasias is quite obviously oriented to the natural occurrence of the squamous epithelium. Some 80% are localized in the glottis, the remaining 20% being almost exclusively found in the region of the false vocal cords. Here, carcinoma in situ and circumscribed invasive carcinoma occur with about equal frequency. Thus, squamous cell dysplasias in the larynx represent the pre-cancerous conditions in this region.

Laryngeal Edema Associated With Sickle β-Thalassemia Disease

SICKLE β-thalassemia, a hemoglobinopathy closely related to sickle cell disease, demonstrates vaso-occlusive phenomena similar to homozygous sickle cell anemia. We describe a patient who experienced severe laryngeal edema secondary to sludging of sickled RBCs (drepanocytes) in the capillaries and lymphatic channels in the laryngeal microvasculature. To our knowledge, this finding has not been previously reported in the literature. <h3>Report of a Case</h3> A 29-year-old man with known sickle β-thalassemia disease came to the emergency room with acute dyspnea on June 26, 1980, and was admitted to the hospital. Indirect laryngoscopy showed marked edema of the left arytenoid mucosa and false vocal cord. The true vocal cord was obscured by a ventricular band. The glottic opening was diminished on deep inspiration. The right side of the larynx, however, appeared normal. A regimen of 100 mg of hydrocortisone every six hours produced some abatement of the patient's symptoms. Two days after admission,

Lymphomatoid Granulomatosis of the Oropharynx

A case of lymphomatoid granulomatosis presenting as midline granuloma has been reported because of the rarity and rapidly fatal course of the disease. The lesion primarily occupied the oropharynx, affecting the posterior pharyngeal wall, uvula, and posterior third of the tongue and extending on to the larynx to invade arytenoid cartilage, true and false vocal cords, and piriform fossa on the right side, with associated intestinal involvement.

Prolapse of the laryngeal ventricle.

Many varied lesions may protrude into the laryngeal lumen from between the true and false vocal cords. These protrusions can be precisely diagnosed only by biopsy. Prolapse of the laryngeal ventricle is one of these lesions; it is a distinct clinicopathologic entity, a primary lesion unrelated to other laryngeal or systemic disease. Eversion of the ventricle (or saccule) is a similar protrusion that is secondary to pulsion or traction by an associated laryngeal lesion. Other lesions that may produce similar clinical findings and gross appearance include benign tumors, cysts, and, rarely, squamous cell carcinoma. Biopsy is therefore mandatory to plan rational treatment. A review of 26 patients who had been diagnosed as having prolapse resulted in the reclassification of 20 cases of prolapse and six cases of eversion. Prolapse is possibly unrelated etiologically to cough, or chronic laryngeal or respiratory tract infection. The histopathologic data suggest further that prolapse is a result of fatty infiltration, edema, and inflammation of the periventricular tissue above the ventricle, which cause the tissue to enlarge and protrude into the laryngeal lumen from between the true and false vocal cords.

Laryngocele and saccular cysts.

The symptoms, endoscopic findings, treatment and results of 46 patients with laryngoceles and saccular cysts are presented. Thirty-four were adults; 12 were infants and children under three years of age. Twenty-two adults had anterior saccular cysts, nine had lateral saccular cysts; three had laryngoceles. Ten infants and children had saccular cysts; two had laryngoceles. A laryngocele is an abnormal dilatation of the saccule which communicates with the lumen of the larynx, fills with air but on occasion may be temporarily distended with mucus; laryngoceles may be congenital or acquired. A saccular cyst is a mucus-filled dilatation of the saccule which does not communicate with the laryngeal lumen; saccular cysts are classified as lateral or anterior. Laryngoceles and saccular cysts represent abnormalities of the laryngeal saccule; a developmental spectrum exists among the normal saccule, large saccule, laryngocele and saccular cyst. The treatment of saccular cysts in infants and children is primarily repeated aspiration. In adults, symptomatic laryngoceles and large lateral saccular cysts are treated by an external approach; endoscopic aspiration and unroofing of small lateral saccular cysts is sometimes adequate and is attempted first. Anterior saccular cysts are treated by endoscopic excision biopsy. Carcinoma of the larynx may be found in association with a laryngocele or saccular cyst and must be diligently searched for by biopsies in the region of the saccular orifice. A smooth mass involving the area of the false vocal cord and aryepiglottic fold cannot be assumed to be a lateral saccular cyst; biopsies of the ventricle and saccule and deep incisional biopsies of the mass are indicated to rule out a carcinoma originating in the ventricle or saccule.

Laryngogram in Patients with the So-called Foreign Body Sensation in the Pharyngolarynx

For the purpose of clarifying the etiological factors of the so-called foreign body sensation of the pharyngolarynx, the author investigated the degree of hypertrophy of the lingual tonsil and the mobility of the pharyngolaryngeal region by means of laryngograms.Forty-two patients suffering from the so-called foreign body sensation of the throat were examined in this study. Twenty nomal subjects were also examined as a control. The results obtained were as follows.1. As compared to the control group, hypertrophy of the lingual tonsil was more frequently found in the cases suffering from the so-called foreign body sensation. Severe hypertrophy was found in 14 cases (33%); moderate hypertrophy was found in 11 cases(26%), and slight hypertrophy was found in 17 cases (41%). In the control group, 5 cases (25%) and 15 cases (75%) showed moderate and slight hypertrophy, respectively, while no cases showed severe hypertrophy.2. The more the lingual tonsil was hypertrophic, the more often it kept touching the epiglottis.3. An apparent abnormality in the mobility of the pharyngolarynx was frequently found in the cases suffering from the so-called foreign body sensation in the throat. The abnormality in mobility was found in the recessus pyriformis, in the true and false vocal cords and in the epiglottis vallecula. For each degree of hypertrophy of the lingual tonsil, the abnormality was found in 33 cases (79%), 32 cases (76%) and 19 cases (45%), respectively. In the control group, it was found in 4 cases (20%), 1 case (5%), and 3 cases (15%), respectively.4. No significant relationship was found between the degree of the hypertrophy of the lingual tonsil and the incidence of abnormal mobility in the pharyngolaryngeal region.

Surgical Treatment For Not-Decannulated Patients

Glottic enlargement is necessary as operative treratment for the glottic stenosis of notdecannulated cases which developed as a sequela fo tracheostomy. Depending on the causative disease, the difficulty is variable and the surgical procedure also should be varied.1) Cleanliness and anti-inflammatory treatment around the tracheostomy-wound was made operative treatment unnecessary in not-decannulated cases of infants after tracheostomy.2) Glottic stenosis due to neuro-muscular paresis can be successfully treated by former methods (Kelly, Woodman, etc.).3) In the cases of glottic stenosis due to scar of radiation or inflammation, glottis must be enlarged by laryngofissure, that means resection of unilateral vocal cord, false vocal cord and arytenoid cartilage. Glottic reconstruction has been better done in these cases.4) Operative methods for glottic stenosis due to laryngeal trauma are often difficult, something extraordinary in cases, in comparison with other cases.5) We have an impression that a little larger glottic enlargement is advisable since the glottis frequently tends to constrict in the postoperative course.

Histologic changes in the larynx in relation to smoking habits.

Histologic changes in the larynx were microscopically studied in 942 men who died and came to autopsy at the Veterans Administration Hospital, East Orange, N. J., between 1964-1967. Atypical changes in cells in the epithelium of the larynx were most often observed in the true vocal cord and, to a lesser degree, in the false vocal cord and the area of the larynx above the vocal cord. The least changes were observed in the area below the vocal cord. The histologic changes (including cells with atypical nuclei, carcinoma in situ, and early invasive carcinoma) were highly related to smoking habits. They were much higher in cigarette smokers than in men who never smoked; they increased in proportion to the number of cigarettes smoked per day before death and were seen to a greater degree in cigarette smokers than in cigar and pipe smokers. Ex-cigarette smokers had fewer such changes than men who continued to smoke cigarettes up to the time of death. Cells with disintegrating nuclei were found mainly in ex-cigarette smokers.

A fatality from juvenile laryngeal papillomatosis.

THE DIFFICULTIES encountered in the management of laryngeal papillomatosis have been known for many years. One case of sudden death three months following a tracheostomy for laryngeal papillomata is presented to emphasize the unrecognized clinical manifestations of this tumor. This is the 11th case of juvenile papillomata encountered in 23 years at Milwaukee Children's Hospital and the first death from this disease. Report of a Case History .—A 7-month-old baby boy was first seen for hoarseness and dyspnea while crying. Direct laryngoscopy showed a single papilloma of the left true vocal cord. The papilloma was excised, and pathological diagnosis was benign squamous cell papilloma of the larynx. At age 16 months the patient was admitted for intermittent hoarseness of three months' duration. Direct laryngoscopy showed wart-like papillomas on both true and false vocal cords. The lesions were again removed and the same pathological condition was found. At 19 months of

Some Observations of Laryngeal Phenomena Derived from High-Speed Motion Pictures

The activity of the larynx was photographed by a Fastax high-speed camera during the production of short, normal vowels; short, breathy vowels: tense and lax glottal stops; and the VCV utterance /ɛhɛ/. During the breathy vowel the arytenoids are separated. A triangular aperture is thus formed at the posterior portion of the glottis in contrast to the complete closure typical of normal vowels. The glottal stop is produced by the contraction of the sides and anterior of the larynx at and below the level of the false vocal cords. During the closure of the tense glottal stop some vocal cord motion was observed. The rate of closure and relaxation for the tense and lax glottal stops appears to be approximately constant. The pattern of laryngeal activity for both vowels of the utterance /ɛhɛ/ differed from that typical of normal short vowels insofar as vocal cord motion started before closure of the arytenoids, giving a breathy effect.

Fluoroscopic and spot-film examination of the larynx.

While body-section radiography (1, 2, 4, 6, 9), positive-contrast technics 8, 11), and cineradiography (1) provide excellent visualization of the laryngeal apparatus, these procedures require special equipment and preparation and are often complicated and time-consuming. In many cases a preliminary screening examination with fluoroscopic spot-filming will eliminate the need for a more extensive study. Although inspection of the larynx is recommended as part of a complete duoroscopic examination of the chest in standard radiological texts and treatises on the subject (5, 10, 12), scant attention has been paid to the advantages of spot-film recording of the appearance of the larynx, particularly in the postero-anterior projection (3, 7, 13), as an aid in diagnosis. The size, shape, and spatial arrangement of the valleculae, epiglottis, laryngeal vestibule, pyriform recesses, true and false vocal cords, and laryngeal ventricles can usually be determined with accuracy on spot-films of the larynx, and the movements of the true cords and shape of the subglottic space can be visualized in considerable detail (Figs. 1, 2, 3, 4, and 8). Vocal cord paralysis can be diagnosed with ease (Figs. 5 and 6), and encroachment of tumors upon the air-filled laryngeal passages can be defined with little difficulty (Fig. 7). Technic The examination is ordinarily carried out with the patient erect and facing the examiner. The chin is elevated to uncover the laryngeal structures, and fluoroscopy is performed. The patient is instructed to phonate on command and to sustain phonation for several seconds. This preliminary rehearsal prior to actual filming adds to the ease of performance and quality of the examination. When the examiner is satisfied that the patient understands and is able to do what is expected of him, four exposures are made on two 8 × 10-inch films, with conventional spot-filming apparatus: posteroanterior exposures during quiet respiration and while phonating a high-pitched “E,” and lateral exposures under the same circumstances; 80 to 90 kvp and about 15 mas are usually adequate technical factors. Phototimed spot filming often adds to the quality of the films. Advantages The examination may be performed in a few minutes without discomfort to the patient and without the need for preparation. It has the advantage of providing views of the larynx in two projections and two states of physiologic activity on only two films. It permits the examiner to form an opinion about laryngeal mobility at the time of fluoroscopy, and it allows him to control respiration and phonation completely during filming. While fluoroscopic spot-films of the larynx are often inferior to other more elaborate examinations in respect to minor morphologic detail of the false cords, vestibule, and pyriform recesses, they usually afford excellent visualization of the true cords and subglottic space.

Hoarseness due to phonation by the false vocal cords: dysphonia plicae ventricularis.

In the differential diagnosis of hoarseness, most physicians consider such disorders as tumor, infection, or altered innervation of the larynx. While these are important causes of hoarseness, another disorder resulting in this symptom is overlooked frequently. This disorder, dysphonia plicae ventricularis (DPV) is one in which hoarseness is the result of phonation with the false vocal cords (ventricular bands). The purpose of this paper is to call attention to the clinical features, diagnosis, and therapy of this common, benign condition. Report of Cases Case 1.— A 75-year-old woman entered the Salt Lake County General Hospital on Jan. 10, 1955, complaining of an intermittent cough of 3 weeks' duration. Persistent hoarseness also had been present for one week. She denied hemoptysis, chest or throat pain, fever, voice strain, smoking, or previous hoarseness. On physical examination the only pertinent findings were severe hoarseness and a brassy cough. Thickened false vocal cords were

Surgical rehabilitation of voice following laryngofissure.

The voice after laryngofissure may be quite satisfactory; may be hoarse but fairly strong; or rarely may be aphonic, hardly audible. The quality of the voice depends to a great degree on the position of the cicatricial tissue which takes the place of the removed false and true vocal cords. The voice is strong if the normal vocal cord does not have to cross the median line in order to reach the cicatricial cord-like structure. If the newly formed cord is fixed in the paramedian position, the normal vocal cord may well compensate by slightly crossing the midline. Speech therapy may be quite helpful in this group in producing an efficient, slightly hoarse speaking voice. Speech therapy, however, has little or nothing to offer if the cicatricial cord happens to be formed in a position of extreme lateral abduction. The voice is weak and aphonic. There is considerable air waste.

Sphincters of the larynx.

THE PRODUCTION of sound is not the fundamental reason for the existence of the mammalian larynx, for there are mammals with larynges and no voices and, on the other hand, mammals with voices and no larynges. The two do not necessarily go together. Since this is true, what then is the basic purpose of the larynx? The larynx is actually a sphincter—a sphincter which physiologically isolates the respiratory tract below it from that above.* This is its primary purpose. There are, throughout the animal kingdom, no exceptions. The ability of the larynx in man to contribute to the production of sound is nothing more than a fortunate side-effect. There are, however, many types of larynges representing many types of sphincters. The human larynx is a three-tiered sphincter—the first being the true vocal cords; the second, the false vocal cords, and the third, the aryepiglottic sphincter. Some larynges, as described in

The adenolymphomata.

Summary Twelve adenolymphomata are described and also what appears to be the first reported case of this tumour in the false vocal cord. Some theories of origin are discussed and it is stressed that the problem of their genesis belongs to a group of neoplasms. The tumour from the larynx serves to pin point the issue as it tends to focus one's mind in considering the plasticity of tissues. Excision is eminently satisfactory as recurrence is rare and radiotherapy seems to play no part in the treatment.

BOECK'S SARCOID INVOLVING THE FACE AND THE LARYNX

This case of Boeck's sarcoid involving the face and the larynx is being reported because of the unusual distribution of the lesions and particularly because of the laryngeal involvement. Careful review of the Quarterly Cumulative Index Medicus has failed to disclose more than two reports of Boeck's sarcoid of the larynx. Seiferth 1 observed a patient with Boeck's sarcoid of the skin of the face, which occurred together with a fibrous swelling in the region of the epiglottis, partially obstructing the glottis. This patient also had pulmonary involvement. Poe 2 in 1940 and again in 1942 fully described the case of a middle-aged Negro woman with Boeck's sarcoid, who had multiple involvement of the upper respiratory tract. The patient had lesions of the nose, the cheek, the nasal septum, the lips, the hard palate, the soft palate, the uvula, the false vocal cords, the arytenoid cartilages and possibly the epiglottis. The disease

FREQUENCY OF HOARSENESS DUE TO PHONATION WITH THE THYROARYTENOID LIPS: JACKSON'S DYSPHONIA PLICAE VENTRICULARIS

The part played by the supraglottic area, the so-called laryngeal aditus, in voice and phonopathic conditions has long been known to be considerable. This had been pointed out long before the fundamental concepts of vocal function were upset by Cotton, 1 in 1940, when he verified experimentally the postulates of Husson and Tarneaud. 2 In 1902 Scripture 3 suggested that the false vocal cords might well have a definite function. Such a function in the production of voice was defined in 1915 by Muckey. 4 He formulated a law, which has since proved to be true, namely, that correct voice production may be summed up as noninterference with (1) the action of the vocal cords and (2) the opening of the tube that leads out through the pharynx, the buccal cavity and the lips. Muckey went on to say that as a strong fundamental tone is important in the production

Permanent Devocalization of Dogs by Removal of both the True and the False Vocal Cords

In many institutions where it has been necessary to devocalize the laboratory dogs the results have not been satisfactory. In 1932 the writer made a study of the usual devocalizing methods with the...