Laryngeal Function Research Articles

Tissue-Engineered Implant for Hemilaryngectomy Reconstruction with Recurrent Laryngeal Nerve Injury.

Laryngeal cancer resections often require excision of portions of the larynx along with sacrifice of the ipsilateral recurrent laryngeal nerve (RLN). In such cases, there are no reconstructive options that reliably restore laryngeal function, rendering patients with severe functional impairment. To address this unmet clinical need, we extend our evaluation of a 3-implant mucosal, muscle, cartilage reconstruction approach aimed at promoting functional laryngeal restoration in a porcine hemilaryngectomy model with ipsilateral RLN transection. Six Yucatan mini-pigs underwent full-thickness hemilaryngectomies with RLN transection followed by transmural reconstruction using fabricated collagen polymeric mucosal, muscle, and cartilage replacements. To determine the effect of adding therapeutic cell populations, subsets of animals received collagen muscle implants containing motor-endplate-expressing muscle progenitor cells (MEEs) and/or collagen cartilage implants containing adipose stem cell (ASC)-derived chondrocyte-like cells. Acoustic vocalization and laryngeal electromyography (L-EMG) provided functional assessments and histopathological analysis with immunostaining was used to characterize the tissue response. Five of six animals survived the 4-week postoperative period with weight gain, airway maintenance, and audible phonation. No tracheostomy or feeding tube was required. Gross and histological assessments of all animals revealed implant integration and regenerative remodeling of airway mucosa epithelium, muscle, and cartilage in the absence of a material-mediated foreign body reaction or biodegradation. Early voice and L-EMG data were suggestive of positive functional outcomes. Laryngeal reconstruction with collagen polymeric mucosa, muscle, and cartilage replacements may provide effective restoration of function after hemilaryngectomy with RLN transection. Future preclinical studies should focus on long-term functional outcomes. NA Laryngoscope, 134:4604-4613, 2024.

Effects of Voice Therapy on Maximum Phonation Time and S:Z Ratio in Patients With Primary Muscle Tension Dysphonia

ObjectiveThis study aimed to evaluate the influence of voice therapy on maximum phonation time (MPT) and S:Z ratio in patients diagnosed with primary muscle tension dysphonia (pMTD). The goal was to investigate whether pMTD is associated with reduced S:Z ratio and prolonged MPT. Study DesignProspective cohort study. MethodsA comparative analysis was conducted on a cohort of patients diagnosed with pMTD. Prevoice and postvoice therapy assessments of MPT and S:Z ratio were performed. Data from these measurements were analyzed to determine the impact of voice therapy on the studied parameters. A paired t test was used to evaluate MPT and S:Z ratio pretherapy and post therapy. ResultsFifty-two patients met the inclusion criteria for the study, having completed a laryngology evaluation with diagnosis of pMTD and agreeing to voice therapy between July 22, 2021, and April 4, 2023. Sixteen of these patients completed a full course of voice therapy. The Voice Handicap Index-10 (VHI-10), MPT, and S:Z ratio were measured during initial evaluation as part of a complete laryngeal function study. A statistically significant reduction in VHI-10 scores was observed, with values decreasing from 17.81 (±2.81) pretherapy to 8.81 (±1.8) post therapy (P < 0.001). However, no significant differences were detected in MPT or the S:Z ratio following the intervention. ConclusionsThere is a lack of correlation between subjective evaluations of voice (VHI-10) and objective assessments (MPT and S:Z ratio), indicating that these objective parameters may not accurately reflect changes in voice quality following therapy in the pMTD population. Lay SummaryMPT and S:Z ratio do not appear to be uniformly impacted in patients with pMTD. Moreover, these measures do not consistently improve following voice therapy for pMTD.

Evaluation of laryngeal function using a novel AI model to test new antidotes for fentanyl-induced laryngospasm

Evaluation of laryngeal function using a novel AI model to test new antidotes for fentanyl-induced laryngospasm

Long-Term Laryngeal Function and Quality of Life Following Treatment of Early Glottic Cancer: A Meta-Analysis.

To review the literature concerning long-term functional outcomes and quality of life (QoL) in patients undergoing transoral laser microsurgery (TLM) versus radiotherapy (RT) for early glottic cancer. A systematic search was conducted across PubMed, Scopus, and Cochrane Library from inception until April 2024. Articles considered were primary studies directly comparing the 2 treatment modalities in a population of T1 and T2 glottic cancer. Interest outcomes were patient report outcome measures (PROMs) of vocal function and QoL, clinician-reported measures, and acoustic analyses parameters. There was no significant difference between TLM and RT in grade, roughness, breathiness, asthenia, strain (relative risk, 1.11; 95% confidence interval [CI], 0.60-2.07; I2 = 90.96; P < .001), Voice Handicap Inventory-30 scores (standardized mean difference [SME] 0.51; 95% CI, -0.04-1.07; I2 = 89.72; P < .001), or fundamental frequency (SME 0.56; 95% CI, -0.14-1.25; I2 = 91.12; P < .001). The TLM group had significantly better performance with regards to jitter (SME 0.54; 95% CI, 0.08-1.00; I2 = 79.42; P < .001) and shimmer (SME 0.53; 95% CI, 0.11-0.95; I2 = 74.94; P < .001). The risk of bias was assessed to be serious. The findings suggest comparable long-term PROMs between TLM and RT in the treatment of early glottic carcinoma, with TLM showing better acoustic analysis outcomes. However, the available evidence remains scarce, of high heterogeneity, and at risk of bias. A direct comparison between TLM and RT through large randomized controlled trials is needed to provide more substantial evidence to determine the optimum treatment.

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 ≥ 0.2seconds. Full LAC abduction that is achieved but not maintained (grade III.1) is defined as maintenance of full abduction for < 0.2seconds. 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.

The key problems of diagnosis and treatment of vocal cord paralysis

Vocal cord paralysis is a common condition that significantly impairs laryngeal function and can even be life-threatening. Over nearly a century, researchers have conducted extensive animal and clinical studies to achieve accurate diagnosis and restore laryngeal function, making significant progress. Approaches have evolved from mechanically narrowing the glottis to restore phonation, to enlarging the glottis to relieve breathing difficulties, and ultimately to the development of surgical techniques aimed at restoring vocal cord mobility, significantly advancing the field. The publication of expert consensus guidelines on the diagnosis and treatment of vocal cord paralysis has standardized the principles and technical standards for managing this condition. However, a vast amount of related knowledge-including the disease's pathogenesis, diagnostic criteria, surgical principles, and techniques-still requires broader dissemination and further refinement. Advancing this knowledge will guide clinical practice and further enhance the diagnosis and treatment of this condition in China.

Glottic widening procedures (GWPs) to avoid tracheostomy in infants’ bilateral vocal cord paralysis: A systematic review and meta-analysis

ObjectiveThis systematic review and meta-analysis evaluated the efficacy of various glottic widening procedures (GWPs) in avoiding tracheostomy in infants with bilateral vocal cord paralysis (BVCP). MethodsA systematic literature search was conducted in PubMed, Scopus, Web of Science, and Cochrane Library from inception to July 2023, without any timeframe limitations. Studies reporting GWPs (Endoscopic anterior-posterior cricoid split, Botox injection, suture lateralization, and other procedures including laser posterior cordotomy/arytenoidectomy) in infants with BVCP were included. Meta-analysis was performed to assess tracheostomy avoidance and secondary outcomes including voice, swallowing, and resolution of airway symptoms. ResultsThirteen studies with 100 patients were included. The mean age was 51.6 days. The etiology of BVCP was idiopathic (83 %), neurologic (10 %), and acquired (7 %). The GWP interventions were successful in 88 % of patients, with only 12 % requiring tracheostomy after surgery. The pooled proportion for avoiding tracheostomy was 0.88 (95 % CI 0.82–0.94) across interventions, with no significant differences between techniques. Among patients who avoided tracheostomy, 64 % had normal voice, 86 % tolerated oral feeding, 77 % had airway symptom resolution, and 70 % had recovery of vocal cord mobility. ConclusionGWPs prevent a majority of infants with BVCP from undergoing tracheostomy, without permanent alterations to laryngeal function. All interventions were comparable in efficacy. Further research with larger sample sizes is warranted.

A Modified Epiglottis-Tongue Root Flap for Postoperative Laryngeal Stenosis in a Cancer Patient with a History of Radiotherapy

Introduction: Cricohyoidoepiglottopexy (CHEP) has emerged as a promising surgical technique for treating laryngeal stenosis, offering a low rate of restenosis and a high rate of successful decannulation. However, postoperative radiation therapy can complicate open surgery for some patients due to radiation-induced cellular and tissue damage. This damage can make adequate exposure or mobilization of the larynx challenging. Case Summary: A 71-year-old male, who had undergone a partial laryngectomy 3 years prior, developed laryngeal stenosis and difficulty plugging after 35 rounds of radiotherapy. Initially, CHEP was planned, but intraoperatively, it was found that traditional CHEP would result in excessive anastomotic tension. To prevent complications, we designed an epiglottis-tongue root flap for laryngeal function reconstruction. The patient experienced no restenosis and was successfully extubated. Discussion: By separating the preepiglottal space and mobilizing the base of the tongue to construct the epiglottis-tongue root flap, modified CHEP can achieve laryngeal function reconstruction in patients postradiotherapy. It is essential to conduct a comprehensive evaluation of the patient’s overall condition, degree of stenosis, tongue-to-tongue root status, and cervical tissue adhesion before surgery.

Beyond complete remission: A comparative analysis of long-term laryngeal function in patients with hypopharyngeal and laryngeal cancer following radiotherapy and concurrent chemoradiation.

This study evaluates functional larynx preservation in patients with hypopharyngeal cancer (HPC) and laryngeal cancer (LC) who achieved complete remission following radiotherapy (RT) or concurrent chemoradiation (CCRT). HPC and LC patients treated with RT/CCRT from 1999 to 2017 were retrospectively analyzed. Severe late dysphagia and tracheostomy cases were assessed to determine laryngeal function. Long-term preservation rate of functional larynx and associated factors were evaluated. Of 152 patients (55 HPC, 97 LC), nine developed severe dysphagia, occurring on average 58.2 months post-treatment. HPC and cervical node metastasis significantly increased the risk of laryngeal function impairment (p < 0.001 and p = 0.014, respectively), presenting a continued decline in functional larynx preservation rate beyond 10 years. Patients with HPC and cervical node metastasis demonstrate an increased risk for long-term laryngeal function impairment despite successful oncologic outcomes. This risk extends beyond 10 years, underscoring the need for prolonged monitoring and comprehensive support.

Outcome of Patients with Early Glottic Laryngeal Carcinoma Treated with Radical Radiotherapy

Introduction: Glottic cancer is the most common laryngeal cancer and it has the most favorable prognosis, mainly if diagnosed early. Ideally, early glottic cancer (T1–T2 N0) should be managed with a single modality either microsurgery or definitive Radiotherapy. The local control rate with definitive radiotherapy is approximately 83–95% for T1 and 70–80% for T2 lesions. This study intends to find out the treatment outcome in early glottic cancer treated with radical radiation treatment from 1st January 2014 to 31st December 2019 at our center. Methods: This was a retrospective analysis of medical records and radiation charts of all patients of early stage glottis cancer who underwent radiation treatment from 1st January 2014 to 31st December 2019 at our centre. The statistical analysis was done using SPSS version 20.0.Continuous variables such as age was summarized in terms of either mean ± Standard Deviation or median (inter quartile range) depending on the statistical distribution of data. Categorical variables were e pressed in terms of frequency and percentage. Survival analysis was done using Kaplan Meier curves. Results: A total of 91 patients underwent radical radiation for early glottic carcinoma at our centre. The median age was 63 years (42-85 years). Out of them 94% were males and 6% were females. 78% of patients had stage 1 disease and 22% had stage 11 disease. 52% of patients had co morbidities and 48% did not have any comorbidity All cases had Squamous cell carcinoma histology. 59% of patients had anterior commissure involvement. 12 out of 91 (13%) patients developed local recurrence on follow up. The five year disease free survival was 84.3%. The five year overall survival was 87.7%. There was a statistically significant difference in survival between stage I and stage II. Conclusion: For T1–T2 glottic carcinomas, definitive RT can provide a good term local control and survival with the preservation of the normal structure and function of larynx.

Application of folded flap in laryngeal and hypopharyngeal function reconstructions after surgery of piriform sinus cancer

Objective: To investigate the use of folded flap for repair of laryngeal and hypopharyngeal defect and the clinical efficacies of laryngeal and hypopharyngeal function reconstructions after surgery of piriform sinus cancer. Methods: A retrospective analysis was performed for 10 cases of piriform sinus cancer that were treated in the Second Norman Bethune Hospital of Jilin University from January 2020 to April 2023 and all patients were males, aged 42-68 years. The first choice of treatment for all patients was surgery. After function neck dissection and tracheotomy, partial laryngectomy and hypopharyngectomy were carried out. The folded island flaps were prepared and used for the repairs of laryngeal and hypopharyngeal defects and the reconstructions laryngeal and hypopharyngeal functions. The patients were followed up. Results: The laryngeal and pharyngeal cavities were reconstructed well in 10 patients, and all the flaps survived, with no case of pharyngeal fistula. All patients were able to eat normally through the mouth at 2 weeks after surgery without obvious choking, and 4 patients completed the swallowing function evaluation without aspiration or only a small amount of aspiration. All the 10 patients underwent postoperative radiotherapy. The postoperative follow-up time was 5.4-41.4 months, and there was no case with tumor recurrence or death. Laryngoscopy showed that 8 patients had a spacious new laryngeal orifice, which met the conditions for extubation, of whom 7 patients had their tracheal tubes removed and 1 patient was still under observation, and that 2 patients had a slightly narrowed new laryngeal orifice due to a thick skin flap, with further follow-up observation. All patients retained their phonatory functions after surgery. Conclusion: Folded island flap can be used for the function reconstructions of the larynx and hypopharynx after surgery of pyriform sinus cancer.

Is precision medicine the solution to improve organ preservation in laryngeal/hypopharyngeal cancer? A position paper by the Preserve Research Group.

In locally advanced (LA) laryngeal/hypopharyngeal squamous cell carcinoma (LHSCC), larynx preservation (LP) strategies aim at the cure of the disease while preserving a functional larynx, thus avoiding total laryngectomy and the associated impact on the quality of life. In the last decades, apart from transoral and open-neck organ preservation approaches, several non-surgical regimens have been investigated: radiotherapy alone, alternate, concurrent or sequential chemoradiation, and bioradiotherapy. Despite major progress, the identification of reliable and effective predictors for treatment response remains a clinical challenge. This review examines the current state of LP in LA-LHSCC and the need for predictive factors, highlighting the importance of the PRESERVE trial in addressing this gap. The PRESERVE trial represents a pivotal initiative aimed at finding the optimal therapy for laryngeal preservation specific to each patient through a retrospective analysis of data from previous LP trials and prospectively validating findings. The goal of the PRESERVE trial is to develop a comprehensive predictive classifier that integrates clinical, molecular, and multi-omics data, thereby enhancing the precision and efficacy of patient selection for LP protocols.

The use of thyroid flap for preserving laryngeal function in laryngeal cancer.

Preserving laryngeal function after partial laryngectomy for laryngeal cancer is an important consideration. Therefore, we examined the use of thyroid flaps for this purpose. We analyzed 21 patients who underwent thyroid flap reconstruction after partial laryngectomy for laryngeal cancer in the Department of Otorhinolaryngology Head and Neck Surgery, the Second Xiangya Hospital of Central South University from January 2010 to January 2020. All patients were male and aged 51-64 years. Seventeen patients underwent modified tracheocricohyoidoepiglottopexy, and the remaining four patients underwent modified cricohyoidopexy. The thyroid flap was pedicled from the superior thyroid blood vessels. In the modified tracheocricohyoidoepiglottopexy, the flap was turned to cover the area between the tracheal ring and epiglottis to reconstruct the anterior wall of the cricoid cartilage, whereas in the modified cricohyoidopexy, it was turned over between the cricoid cartilage and tongue root to reduce anastomotic tension. A total of seven patients underwent radiotherapy and chemotherapy after surgery. Thyroid flap reconstruction was successfully performed in all patients. The postoperative hospitalization time was 9-21 days, the postoperative nasal feeding time was 18-47 days, and the tracheotomy tube was removed 30-160 days after surgery. No laryngeal stenosis, flap necrosis, bleeding complication, or dysfunction of the thyroid and parathyroid glands was observed after surgery. Two patients experienced wound infections about 1 week after discharge and were admitted again for antibiotic treatment. After dressing and compressing the neck wound, the patients were discharged. Three patients experienced local tumor recurrence after surgery, two of whom did not receive radiotherapy and chemotherapy after modified tracheocricohyoidoepiglottopexy. No patients had distant metastasis after surgery. Thyroid flaps have significant application value in the reconstruction of the laryngeal cavity after partial laryngectomy for laryngeal cancer. It has high safety and feasibility, convenient surgical procedure, and satisfactory postoperative outcomes.

Rare Space Occupying Benign Lesions of the Larynx: Management.

Benign tumors of larynx are broadly classified as epithelial and non-epithelial. The management option depends on the tumor characteristics such as size, location and the extent of the tumor. The treatment opted should be able to remove the tumor in toto without compromising the laryngeal function. The current study is to discuss the various treatment options for benign tumors of larynx. The current study is a cross-section observational study which includes 6 cases of benign tumors of the larynx, that were diagnosed and treated at a tertiary care centre. Among the 6 cases, 4 case were treated with an open external approach whereas 2 cases were treated endoscopically. Benign laryngeal tumors with limited intraluminal lesion can be approached by an endoscopic approach whereas large tumors predominantly extra mucosal and has extra laryngeal extension are best treated with open approach without damaging the laryngeal mucosa.

Efficacy of PD-1 inhibitors combined with nab-paclitaxel and cisplatin in the neoadjuvant treatment of locally advanced hypopharyngeal squamous cell carcinoma

Objective: To assess the efficacy of neoadjuvant treatment with PD-1 (programmed cell death protein 1) inhibitors combined with paclitaxel (albumin-conjugated) and cisplatin (TP regimen) for locally advanced hypopharyngeal squamous cell carcinoma and laryngeal organ function preservation. Methods: Data of 53 patients, including 51 males and 2 females, aged 38-70 years old, who were diagnosed with locally advanced hypopharyngeal squamous carcinoma confirmed by histology and enhanced CT at the Cancer Prevention and Control Center of Sun Yat-sen University during the initial treatment from January 1, 2019 to January 15, 2023, were retrospectively analyzed. All patients received neoadjuvant therapy with PD-1 inhibitors combined with albumin-bound paclitaxel (260 mg/m2) and cisplatin (60 mg/m2) for 3 to 4 cycles. The main outcome measures were larynx dysfunction-free survival (LDFS), overall survival (OS), and progression-free survival (PFS). Survival curves were plotted using the Kaplan-Meier method, and Cox multifactorial analysis was further performed if Cox univariate analysis was statistically significant. Results: The overall efficiency was 90.6% (48/53). The 1-year and 2-year LDFS rates were 83.8% (95%CI: 74.0% to 94.8%) and 50.3% (95%CI: 22.1% to 91.6%), the 1-year and 2-year OS rates were 95.2% (95%CI: 88.9% to 100.0%) and 58.2% (95%CI: 25.6% to 81.8%), and the 1-year and 2-year PFS rates were 83.9% (95%CI: 74.2% to 94.9%) and 53.5% (95%CI: 32.1% to 89.1%). Adverse events associated with the neoadjuvant therapy were mainly myelosuppression (45.3%), gastrointestinal reactions (37.7%) and hypothyroidism (20.8%). Conclusion: The neoadjuvant treatment of locally advanced hypopharyngeal squamous cell carcinoma using PD-1 inhibitors combined with paclitaxel and cisplatin can provide with a higher survival rate with a improved laryngeal organ function preservation rate.

The Global Experience of Laryngeal Transplantation: Series of Eleven Patients in Three Continents.

The loss of laryngeal function affects breathing, swallowing, and voice, thus severely compromises quality of life. Laryngeal transplantation has long been suggested as a solution for selected highly affected patients with complete laryngeal function loss. To obtain insights regarding the advantages, weaknesses, and limitations of this procedure and facilitate future advances, we collected uniform data from all known laryngeal transplants reported internationally. A case series. Patients were enrolled retrospectively by each institutional hospital or clinic. Eleven patients with complete loss of laryngeal function undergoing total laryngeal transplantation between 1998 and 2018 were recruited. After a minimum of 24 months follow-up, three patients had died (27%), and there were two graft explants in survivors, one total and one partial, due to chronic rejection. In the remaining cases, voice was functional in 62.5% and 50% achieved decannulation. Swallowing was initially restricted, but only one patient was gastrostomy-dependent by 6 months and all had normal or near-normal swallowing by the end of year two after transplantation. Median follow-up was 73 months. Functional (voice, swallowing, airway) recovery peaked between 12 and 24 months. Laryngeal transplantation is a complex procedure with significant morbidity. Significant improvements in quality of life are possible for highly selected individuals with end-stage laryngeal disorders, including laryngeal neoplasia, but further technical and pharmacological developments are required if the technique is to be more widely applicable. An international registry should be created to provide better quality pooled data for analysis of outcomes of any future laryngeal transplants. 4 Laryngoscope, 134:4313-4320, 2024.

Linear Measurement of Females' Vocal Fold Across Different Ages

Abstract Background One of the most complex oragns of the human body is the larynx so Understanding its morphology is an important step toward understanding the detailed laryngeal anatomy, and physiology. Different studies have described the linear measurements of the larynx in different measuring methods. but no studies have been structured to describe vocal fold length in vivo in females at different stages of their lives.The vocal instrument is comprised of the vibratory body, the respiratory power source and the oropharyngeal resonating chambers. Voice is characterized by its intensity, frequency, and harmonics. The harmonics are hormonally dependent. Aim of the Work The aim of this study is to screen the membranous vocal fold length in different ages throughout females’ life and if it is affected by hormonal changes in their lives or not. Study Design a comparative cross-sectional study. Patients and Methods This comparative cross-sectional study was carried out on 120 Egyptian Arabic speaking apparently healthy females at the outpatient clinic of the Units of Phoniatrics, ENT Department of both Ain Shams University Hospitals and Zagazig University Hospitals. Results It was obvious that female’s larynx is affected by age and sex hormones that is reflected on the laryngeal structure and function. Although the results showed non significant relation between the length of the membranous part to aging this may be due to small sample size that could not reflect that difference. Conclusion The vocal imprint is characteristic to each individual. It reveals personality and translates emotions. The voice evolves with age. It bears both the scars of life, as well as its joys and pleasures. Nevertheless, the human voice remains intangible and a fertile field for future research in the cycle of life.

Utility of bioselection with neoadjuvant chemotherapy for organ preservation in patients with T4 laryngeal cancer

BackgroundNeoadjuvant chemotherapy for induction selection of definitive treatment (IS) protocols have shown excellent outcomes for organ preservation and survival in patients with T3 laryngeal squamous cell carcinoma (LSCC). We seek to evaluate survival and organ preservation outcomes in T4 LSCC patients treated with IS protocols. MethodsRetrospective cohort of advanced T3 and T4 LSCC patients who underwent IS protocols based upon potential for preserving a functional larynx. Patients received one neoadjuvant cycle of platinum-based chemotherapy with either 5-fluorouracil or docetaxel or with two cycles of platinum-based chemotherapy with docetaxel and a Bcl-2 inhibitor. Patients who achieved ≥ 50 % response as determined by radiographic review and/or endoscopic evaluation received definitive chemoradiation. Patients who had < 50 % response after IS underwent total laryngectomy (TL) followed by post-operative radiation +/- chemotherapy. ResultsAmongst T4 patients, 114 met inclusion criteria including 89 who underwent IS protocols and 25 who received an upfront TL. In total, 76.0 % of T3 patients and 71.9 % of T4 patients responded to IS and underwent definitive chemoradiation. There was no significant difference in hazard of death between T4 IS and T4 TL patients (HR: 0.9, p = 0.86). Among responders, there was no significant difference in 5-year laryngectomy-free survival (T3 – 59.6 %, T4 44.3 %, p = 0.15) or laryngeal preservation by T stage (T3 – 72.8 %, T4 – 73.0 %, p = 0.84). ConclusionsSelect T4 patients may benefit from organ preservation using IS protocols with similar response rates to patients with T3 tumors, without compromising survival when compared to upfront TL.

Induction chemotherapy followed by transoral laser microsurgery with or without adjuvant therapy for advanced hypopharyngeal cancer patients: A preliminary result.

Hypopharyngeal squamous cell carcinoma (HPSCC) has the poorest prognosis among head and neck cancers. Its treatment may significantly affect breathing, speaking, and swallowing. Induction chemotherapy (ICT) followed by transoral laser microsurgery (TLM) could reduce these adverse effects and achieve good outcomes. This was a retrospective study of 11 patients with advanced HPSCC. All patients underwent ICT and TLM alongside tailor-made adjuvant therapy based on the pathological features. Adjuvant therapy was done in seven of 11 patients (64%). The 3-year disease-free survival and laryngeal preservation rates were 78% and 91%, respectively. At the last follow-up, 10 of 11 patients (91%) had no tracheostomy or feeding tube. ICT followed by TLM is an appropriate treatment for good tumor control in select patients with advanced HPSCC while preserving laryngeal function.

Do tight nosebands have an effect on the upper airways of horses?

The public perception relating to the welfare of horses involved with equestrian sports is associated with training methods used and the presentation of horses at events. In this context, very tight nosebands, which are intended to prevent the horse from opening its mouth, also attract a lot of attention. Various studies have evaluated the impact of tight nosebands on stress parameters, whereas the effect of tight nosebands on upper airway function is unknown. Therefore, the aim of the study was to use overground endoscopy to evaluate changes in pharyngeal and laryngeal function when a tight noseband is fitted. Moreover, the ridden horse pain ethogram (RHpE) was applied to investigate signs of discomfort (Dyson et al., 2018). A randomized, blinded, and prospective study was performed. Sixteen warmblood horses consisting of twelve mares and four geldings with a mean age of 11.63 ± 3.53 years were ridden on 2 consecutive days with either loose or tight nosebands (two fingers or no space between bridge of the nose and noseband, respectively) and inserted endoscope in a random order. Videos were taken in a riding arena during a standardized exercise protocol involving beginner level tasks for 30 min in all gaits. For video analysis, freeze frames were prepared and analyzed at the beginning of the expiration phase. Pharyngeal diameter was measured using the pharynx-epiglottis ratio. Other findings (swallowing, pharyngeal collapse, soft palate movements, and secretion) were also evaluated. Moreover, the RHpE was applied. Descriptive statistics and generalized linear mixed effects models were used. Results with a p-value < 0.05 were considered statistically significant. While the pharynx-epiglottis ratio did not change significantly in horses ridden with loose versus tight nosebands, there was an increase in mean grade and total counts of parameters assessed in the pharyngeal region, for example, grade of secretion (1.5 [±SD 0.89] vs. 3.13 [±SD 0.96]; p = 0.0001), axial deviation of the aryepiglottic folds (0.29 [±SD 0.73] vs. 1.33 [±SD 1.44]; p = 0.01), and pharyngeal collapse (0.69 [±SD 0.87] vs. 1.88 [±SD 1.54]; p = 0.005) in horses ridden with tight nosebands. There was no RHpE score above 8 indicating musculoskeletal pain, but the RHpE scores were significantly higher in horses ridden with tight nosebands (p < 0.001). Video quality was limited when horses showed large amounts of secretion. Another limitation was the small number of horses. Results add to the evidence obtained in other studies that tight nosebands do not only cause adverse reactions based on the RHpE score such as head behind the vertical or intense staring but also contribute to changes in the pharyngeal region, such as increased secretion and collapse of pharyngeal structures. This may provide further support for future decisions regarding regulations on nosebands.