History Of Dysphonia Research Articles

Voice Handicap Evaluation of Patients with Pathologic Sulcus Vocalis

The purpose of this study was to characterize the psychosocial impact of dysphonia on patients with pathologic sulcus vocalis by use of the Voice Handicap Index (VHI). The VHI was administered to 15 patients (11 women and 4 men) with pathologic sulcus vocalis. The VHI subscale and total scores were compared with previously published data from individuals with no history of dysphonia and from patients with vocal fold scar. Additional comparisons were performed for patients with unilateral sulcus versus bilateral sulci, type II sulcus versus type III sulcus, and sulcus with concomitant vocal fold scar versus sulcus without concomitant scar. The VHI scores for patients with pathologic sulcus vocalis were significantly greater than those for individuals with no history of dysphonia and for patients with vocal fold scar. In addition, significantly greater VHI scores were observed for patients with sulcus vocalis with concomitant scar versus those with sulcus alone. These data suggest that pathologic sulcus vocalis can be a severely handicapping condition, particularly in the presence of concomitant scar.

Clinical manifestations of primary malignant mucosa: Associated lymphoma of the larynx

Objectives: Primary mucosa-associated lymphoma of the larynx is a very rare condition. The purpose of this presentation is to describe the clinical manifestations of this condition. We report 2 different clinical presentations of this case. Methods: Patient 1 was a 56-year-old patient presented with history of dysphagia and dysphonia. Laryngoscopy revealed an ulcerating mass in the left false cord and an ipsilateral vocal cord palsy. Histology revealed florid lymphocytic infiltration with scattered blasts. Immunohistochemistry was CD3+, CD20+, IgM+, and CD5-ve. Treatment with combination chemotherapy was instituted and the patient is alive and disease-free after 24 months. Patient 2 was a 64-year-old man with history of dysphonia. Laryngoscopy showed a submucosal spherical mass in the right false cord. Biopsy confirmed MALT lymphoma with the same immunohistochemistry. Treatment with chemotherapy was instituted and he is alive and well after 12 months. Results: We challenge the previously held view that MALT lymphomas of the larynx always have the same clinical presentation. The histological diagnosis of the condition consistent and is dependent on immunohistochemistry with positivity of the following markers: CD3, CD20, and IgM. The clinical picture can be varied and follow that of any malignancy in the larynx. Conclusion: Surgery only has a role in the diagnosis of this lympho-proliferative disease. Treatment should be directed to a multidisciplinary lymphoma team. The rarity of this tumor probably is due to the lack of recognition.

Patient reported benefit of the efficacy of speech therapy in dysphonia

Background/aim: To date there has been no major randomized comparison of speech therapy with the untreated natural history of dysphonia. This study aimed to perform a prospective, controlled assessment of the efficacy of speech therapy in a heterogeneous group of patients with dysphonia. Method: Of 661 consecutive patients with dysphonia, presenting to one ORL clinic over 2 years, 204 were deemed likely to benefit from speech therapy; the 51 men and 153 women were aged 17–87 years. Baseline investigations: laryngoscopy, demographic, social, psychological, voice data. Patients were randomized to speech therapy (100 patients) or no treatment (104 patients). Following a period of 6 weeks therapy or observation, psychological, medical and voice assessments were made by researchers blind to treatment group. To date, the two groups have been compared on patient’s subjective rating of change in voice. Results: Seventy-four patients in the treatment group (74%) and 71 patients in the control group (69%) continued in the study for the 6-week follow-up assessment. Patients in the treatment group were significantly more likely to report improvement in their voices after the 6 week period (Z = 4.46, P < 0.0000). The results are shown in Table 1. Conclusions: Initial findings suggest that the majority of this heterogeneous group of patients with dysphonia find speech therapy more beneficial than a period of observation. Analysis of our objective psychological, medical and voice data is underway to establish whether this patient-reported benefit reflects objective improvement in voice quality, psychological status and quality of life.

Acute suppurative thyroiditis and aggressive malignant thyroid tumors: differences in clinical presentation.

Aggressive malignant thyroid tumors (AMTT) may mimic the clinical symptoms and signs of acute suppurative thyroiditis (AST) in the early course of the disease process. Our objective was to analyze the clinical features of these two conditions, to assess the best way of early diagnosis, and to propose proper treatment. We retrospectively reviewed and analyzed the clinical features of 30 patients, who had similar clinical pictures of AST and were managed at Chang Gung Memorial Medical Center in Linkou, Taiwan, during the period from 1983 to 1996. These patients were consequently diagnosed as either AST or AMTT. The data were analyzed by the Mann-Whitney U, chi-square and Fisher's exact tests. Among the 30 patients, 25 patients (Male/Female (M/F) ratio = 9/16) were diagnosed as having AST and 5 (M/F ratio = 1/4) as AMTT. After statistical analysis we concluded that the presence of the following factors, namely, older age at diagnosis (P = 0.0155), history of dysphonia (P = 0.0325), right thyroid lobe involvement (P = 0.0151), large size of lesions (P = 0.0013), presence of anemia (P = 0.0075), and sterile pus cultures from thyroid aspirates (P = 0.0013) were cause to suspect a malignancy if the condition did not improve after antibiotics. Delay in diagnosis and management of AMTT may result in a poor prognosis (P = 0.0082). Due to the high mortality rate of AMTT, we should closely observe the patients with poor prognostic variables of acute thyroiditis. Earlier detection and aggressive surgical intervention for AMTT might improve the outcome.

RESIDENT'S PAGE: PATHOLOGY

<h3>Pathologic Quiz Case 1</h3> Venkataramanan Srinivasan, DLO, FRCS; David S. Nicholas, MRCPath; Poole, England A 60-year-oldwhite man presented with a history of throat pain brought on by swallowing. The pain, which was centered in the left hyoid region, had started insidiously a few months earlier. He had no history of dysphonia, dysphagia, difficulty with breathing, or earache. He had stopped smoking 20 years earlier. Microlaryngoscopy with the patient under general anesthesia revealed a 1×1-cm smooth mass in the left arytenoid region. The rest of the larynx and pharynx was normal, and there were no palpable lymph nodes in the neck. The mass was excised for histopathologic examination. The patient became asymptomatic after the surgical procedure. The histologic features are shown in<b>Figure 1</b>and<b>Figure 2</b>. An immunohistochemical stain for S100 protein is shown in<b>Figure 3</b>. What is your diagnosis? <h3>Pathologic Quiz Case 2</h3> Wesley Heartfield, MS;