Hoarseness Research Articles

A vocal cord palsy caused by the uterine cancer metastatic tumor in the mediastinum revealed in a patient with a thyroid lesion: a case report and review of the literature

BackgroundThe main cause of vocal cord palsy (VCP) is idiopathic impairment of the recurrent laryngeal nerve (RLN). However, solid tumors along the pathway of the RLN can also impact the nerve’s function. We presented a patient with a thyroid lesion and VCP due to a bulky metastatic mass (uterine cancer) on the aortic arch field in the mediastinum. The report aims to show the significance of comorbid tumors in thyroid pathology and the importance of additional diagnostic methods in avoiding unnecessary surgeries. A patient’s lifetime and the outcome of the disease were also presented.Case presentationA 58-year-old Ukrainian woman with a hoarse voice, intermittent dry cough, and weakness was presented to an endocrine surgeon. Thyroid pathology included signs of hypothyroidism treated with Thyroxine 112.5 µg and a nodule in the left lobe. The lesion is located on the posterior aspect of the lobe, which could probably be a cause of RLN involvement. Fine needle aspiration biopsy (FNAB) was performed twice with Bethesda category 2 result. Fibrolaryngoscopy (FLS) revealed the median position of the left vocal cord. Idiopathic, laryngeal, and thyroid causes of the VCP were excluded. Additionally, the patient displayed her anamnesis of the endometrial clear cell carcinoma following hysterectomy, external beam radiation therapy, and chemotherapy. The mediastinal metastasis was revealed sixteen years later. A chest computed tomography (CT) with intravenous contrast was done. A bulky tumor was found right under the aortic arch. Subsequently, the voice complaints reduced significantly after 4 chemotherapy courses. Cancer progression had led to the appearance of lymph node metastases on the supraclavicular region. Following six months the 60-year-old patient had passed away.ConclusionA history of the disease should always be kept in mind when assessing a patient’s complaints. VCP in case of thyroid pathology and previous secondary malignancy may be caused by metastatic tumor anywhere along the RLN pathway. Such a rare case shows the importance of additional methods of examination which may avoid unnecessary thyroid surgeries.

Do Effects of Voice Rehabilitation in Patients Irradiated for Laryngeal Cancer Remain 5 Years Postradiotherapy?

Laryngeal cancer treated by radiotherapy results in many patients being left with an abnormal voice long-term. This prospective study aims to report efficacy of voice rehabilitation 5years postradiotherapy completion. Seventy-seven patients were randomized into an intervention group (n=37) or a control group (n=40). Voice rehabilitation was administered postradiotherapy. Patients were followed at baseline, 12- and 60-month postradiotherapy with voice recordings assessed using GRBAS protocol (Grade, Roughness, Breathiness, Asthenia, Strain). Patients filled in the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire Head and Neck 35 (EORTC QLQ-HN35) and the Swedish Self-Evaluation of Communication Experiences after Laryngeal Cancer (S-SECEL). There were no statistically significant differences between the intervention and control group in scores reported on EORTC QLQ-HN35, S-SECEL or in perceptual evaluation at study end-point. The intervention group reported an improvement in EORTC QLQ-HN35 Speech between baseline-60months postradiotherapy. No significant changes between 12-60months were observed. The control group demonstrated significant improvement in domains Pain, Senses, Speech, Social eating and Sexuality from baseline-60months postradiotherapy, of which only Speech showed a statistically significant change between 12-60months postradiotherapy (P=0.02). Both groups reported improved S-SECEL scores from baseline-60months, with no significant dynamic between the 12- and 60-month follow-up. Previously observed positive effects of voice rehabilitation on patient communicative skills and perceptual evaluation are no longer noticeable at 5-year post voice therapy completion. Nevertheless, patients receiving voice rehabilitation experience a greater improvement within the first year, which in the control group takes a corresponding 5years.

An Unusual Presentation of Squamous Cell Carcinoma in a Never Smoker: A Case Report

Lung Cancer is one of the most common types of cancer found among smokers. However, approximately 10% of lung cancer patients are non-smokers. Non-smokers are frequently seen developing Adenocarcinoma, a type of non-small cell carcinoma with a female predominance. The incidence of Squamous cell carcinoma among non-smokers is very low. Moreover, studies have shown that tetra site metastasis in the case of Squamous cell carcinoma of the lung is almost as rare as 0.6% [1]. The authors report here in this article a case report of a rare and aggressive presentation of Squamous cell carcinoma in a non-smoker. This is a case of a 50-year-old male patient who is a non-smoker, presented with complaints of exertional dyspnoea and cough with expectoration for 3 months which had aggravated since 15 days, associated with hoarseness of voice and diffuse headache since 15 days. There was a history of significant weight loss and loss of appetite for 3 months. CECT thorax revealed a heterogeneously enhancing mass lesion in the anterior segment of the left upper lobe encasing the left pulmonary artery with evidence of liver, adrenal and vertebral metastasis. During the hospital stay, the patient developed complete ptosis of the right eye. MRI brain was done which showed features suggestive of metastasis involving bilateral cerebral and cerebellar hemispheres. USG guided lung biopsy was done and was suggestive of moderately differentiated Squamous cell carcinoma. The patient was planned to be further worked up for IHC markers and PET CT scan to determine the further line of treatment however, unfortunately, the patient succumbed to the disease within 1 week of histopathological diagnosis.

Clinical manifestations of gastro esophageal reflux among patients with chronic laryngitis in Benghazi, 2018

Gastroesophageal reflux disease is a chronic, complex condition that may present with atypical symptoms, including laryngitis. The aim of study to demonstrates the relationship of sings of reflux laryngitis in patients with typical manifestations of Gastroesophageal reflux disease (GERD). The present study included a total of 60 patients suffering chronic laryngitis with a range of age of 23 to 88 years in descriptive study in Benghazi Medical Center in the year 2018. History was collected and indirect laryngoscopy done for cases and data were analyzed using SPSS 23.0. Results The most common symptoms were hoarseness of voice, throat clearing, dysphagia, throat discomfort and globus sensation. No significant association of symptoms with gender of the patients. Most common laryngeal findings were hyperemia, vocal cord changes and posterior commisure hypertrophy. Significant association included only posterior commissure hypertrophy and infra-glottal edema. Conclusions and recommendations, Many didn't seek medical advice and most had no diagnostic procedure. Stronger study designs using proper diagnostic technique and patient education with staff training are recommended.

Management Challenges And Outcome Of Juvenile Onset Respiratory Papillomatosis In A Tertiary Hospital In North Central Nigeria: A Preliminary Study

Background/Aim: Juvenile Onset Recurrent Respiratory Papillomatosis (JoRRP) is a benign tumour attributed to human papillomavirus infection with a high propensity to recur despite appropriate treatment. It is relatively rare but the commonest benign tumour of the larynx in children. This study is aimed at evaluating its management challenges.
 Materials and methods: This was a retrospective review of patients with JoRRP at Ear, Nose and Throat (ENT) Department, University of Ilorin Teaching Hospital over a 7-year period. The patients' biodata, mode of presentations, surgical care, histopathological findings and management outcome were reviewed.
 Results: A total number of ten patients were diagnosed with JoRRP during the study period. Male to female ratio was 1:1. All the children were delivered per vaginal and sixty percent were first children of their mothers. Hoarseness, breathy voice and worsening difficulty in breathing were the presentation in 7 (70%) of cases, while 3 (30%) presented with only hoarseness and breathy voice. They all presented first to General Practitioners and Paediatricians before ENT Specialist assessment and six (60%) patients presented to ENT department 6 months or more after the onset of symptoms. They all had direct laryngoscopy and excisional biopsy of laryngeal papillomatous lesions. Thirty percent had tracheostomy done. There is a statistical significant relationship between tracheostomy rate and recurrence rate of JoRRP.
 Conclusion: JoRRP is a rare but potentially life-threatening benign tumor of the respiratory tract. Most of our patients presented late and were misdiagnosed at presentation. The key to good management outcome remains early diagnosis, adequate management and regular follow-up.

Efficacy Of Vocal Cord Medialization by Injection Thyroplasty Using Liquid Paraffin In Relieving Hoarseness Of Voice In Idiopathic And Traumatic Unilateral Vocal Cord Paralysis

Objective: The objective of the study was to measure the efficacy of injection thyroplasty by liquid paraffin in the medialization of vocal cords in permanent post-traumatic or idiopathic hoarseness. Methodology: A total of 37 patients were enrolled in the study after obtaining approval from the ethical review board. The sample size was calculated using the WHO sample size calculator. All the patients in the study presented with hoarseness of voice due to either traumatic injury, idiopathic aetiology, or post-thyroidectomy. Samples were selected by simple random sampling. It was a Quasi-experimental study. All patients underwent an injection thyroplasty procedure using liquid paraffin to medialize the vocal cords. All the procedures were done under local anaesthesia. The patients were kept in follow-up for 1 year at an interval of 3 months. All the data was entered and analyzed by using SPSS version 24. Paired sample t-test was applied to measure pre-procedure and post-procedure scores. Results: The mean age of the participants was 38 years. Out of 37 patients 23 (62%) patients presented within 6 months of hoarseness of voice. 14 (38%) patients presented after 6 months of hoarseness of voice. 19 out of 23 patients (83%) underwent only a single dose of liquid paraffin via injection thyroplasty to resolve hoarseness of voice. However, out of 14 patients, 7 patients (50%) reportedly had to undergo 2 doses of liquid paraffin via injection thyroplasty. The p-value calculated was <0.005 which was statistically significant. Out of patients presenting after 6 months, 11 patients (79%) underwent transcervical phonation surgery. The p-value calculated was <0.05 which is statistically significant. Conclusion: Our study concludes that liquid paraffin is a safe and cost-effective solution for vocal cord paralysis. Liquid paraffin is not expensive and easily available which can be implied to yield excellent results to improve hoarseness of voice. Patients with late presentation are less likely to get the benefit of this procedure and may have to go for invasive transcervical phonation surgeries. It is recommended that this procedure should be done within 6 months of the development of hoarseness of voice. Keywords: vocal cord palsy, unilateral vocal cord paralysis, laryngeal paralysis, liquid paraffin, injection thyroplasty

Persistent ENT Manifestations in Individuals who Recovered from COVID-19: A Systematic Review.

Introduction Long coronavirus disease (COVID) refers to the persistence of symptoms long after the recovery from the acute phase of the illness, and it is due to the interplay of various inflammatory mechanisms. This has led to emergence of new deficits, including otorhinolaryngological symptoms, in patients wo have recovered from COVID. The plethora of otorhinolaryngological symptoms associated with long COVID are tinnitus, sensorineural hearing loss (SNHL), vertigo, nasal congestion, sinonasal discomfort, hyposmia/anosmia, dysgeusia, sore throat, dry cough, dyspnea, dysphagia, and hoarseness of voice. Objective To evaluate the possible ENT symptoms in patients wo have recovered from COVID and to combine those findings with our experience. Data Synthesis We conducted a search on the PubMed, ENT Cochrane, Web of Science, and Google Scholar databases, and a total of 44 studies were selected for the present review. Conclusion Otorhinolaryngological complications such as tinnitus, SNHL, vertigo, nasal congestion, sinonasal discomfort, hyposmia/anosmia, dysgeusia, sore throat, dry cough, dyspnea, dysphagia, and hoarseness of voice have been widely reported among in long-COVID patients.

Concurrent Challenges: Multiple Myeloma and Cardiac Amyloidosis

We report a case of 56-year-old male with known case of Hypertension and Hypothyroidism presented with complaints of generalised weakness and weight loss since 8 months (approx. 40kg), tightening in and around the mouth and hoarseness of voice with dysphagia since 6 months, swelling in feet since 3 months, cough and constipation on and off since one month. The laboratory results indicated that the serum calcium (S.Ca2+) level was 14.1 mg/dl and the ionized calcium (Ca2+) level was 1.62 mmol/l. Immunoglobulins were low {IgA- 17 mg/dl (50-410 mg/dl), IgG- 386 mg/dl (650-1500 mg/dl), IgM- 20 mg/dl (60-280 mg/dl); Immunofixation electrophoresis (IFE) revealed positive result for lambda free light chain (Figure 1) and further quantitative value lambda free light chain was high (Lambda free - 2054.89 mg/l). Whole Body FDG PET Scan revealed non-FDG avid lytic lesions at multiple bone sites. In view of suspicion of Multiple Myeloma, bone marrow aspiration and trephine biopsy were done which confirmed the diagnosis of Multiple Myeloma. ECG showed low voltage QRS complexes and 2D echo revealed- Global LVEF 55-60%, Dilated LA, concentric LVH with altered myocardial echotexture, no RWMA, Grade II diastolic dysfunction present (raised LVEDP), RVSP-39mmhg (moderate PAH), findings S/O- cardiac amyloid; which was later confirmed with Cardiac MRI. Abdominal fat pad biopsy revealed area of necrosis but negative for congo red stain (amyloidosis). The patient underwent VCD (bortezomib; cyclophosphamide; dexamethasone) chemotherapy with Daratumumab. By the time of publication, the patient had received autologous stem cell transplantation and after 10 courses of VCD with Daratumumab, repeat bone marrow aspiration and histo-biopsy revealed complete remission of myeloma. The uncommon Multiple Myeloma complication in this clinical case was associated with restricted cardiomyopathy as a result of secondary cardiac amyloidosis. This is true for both Multiple Myeloma and cardiac amyloidosis. When one of these diagnoses is initially established, more investigation should be done to rule out the other illness, keeping in mind the necessity of meeting standard diagnostic criteria and the challenge of conducting an effective diagnostic workup in occasionally complex clinical situations.

Presentation and Management of Thyroid Hydatid Cyst: A Comprehensive Systematic Review of the Literature

Introduction Hydatid cysts of the thyroid gland, though rare, pose a diagnostic and therapeutic challenge. This systematic review summarizes current knowledge on the presentation, diagnosis, and management. Methods A systematic review of the published studies of thyroid hydatid cysts was conducted. The included studies of thyroid hydatid cysts had the following properties: 1) The thyroid infection was confirmed by diagnostic modalities, surgical findings, or histopathology. 2) The case presentation was provided in the study. 3) The cyst(s) were originally located or adhered to the thyroid and did not rupture into it from the other adjacent structures or organs. Results Overall, 39 studies were compatible with the inclusion criteria. Turkey had the highest case occurrence (36%). Female predominance (59%) and a mean age of 38.33 years were observed. Mass (79.5%) was the most common symptom, followed by hoarseness of voice (4%). Serology (18.75% positive) and ultrasound (77.5%) were primarily used for diagnosis. Surgery was the mainstay of treatment (96%), with total thyroidectomy (32.6%) and left hemithyroidectomy (16%) being the most common approaches. No recurrence was reported in the follow-up period (0%). Conclusion This review highlights the rarity, clinical presentation, diagnosis, and successful surgical management of thyroid hydatid cysts. Further research is needed to optimize diagnostic methods and explore alternative treatment options.

Retrospective Analysis of the Efficacy and Safety of Ultrasound-Guided Radiofrequency Ablation in the Treatment of Papillary Thyroid Microcarcinoma: A Follow-Up Study of Continuous Postoperative Surveillance and Large-Sample Data.

To retrospectively evaluate the efficacy and safety of ultrasound-guided radiofrequency ablation (RFA) in the treatment of papillary thyroid microcarcinoma (PTMC) through a follow-up study of continuous postoperative surveillance and large-sample data. The efficacy of ultrasound-guided RFA was evaluated by measuring the tumor volume reduction rate (VRR), tumor disappearance rate, and disease progression in 358 patients with low-risk unifocal PTMC who underwent ultrasound-guided RFA at Hangzhou Weja Hospital, while the safety was evaluated by measuring their complications. The VRR was -745.69 ± 1012.69 (%), -150.35 ± 395.5 (%), 46.47 ± 138.74 (%), 92.95 ± 27.88 (%), 97.78 ± 10.99 (%), and 99.27 ± 3.82 (%), respectively, at 1, 3, 6, 12, 18, and 24 months after RFA. The corresponding tumor disappearance rate was 1.68%, 9.78%, 43.85%, 82.68%, 92.59%, and 95.63%, respectively. No local recurrence, new tumors, lymph node metastasis, distant metastasis, and deaths caused by recurrent/metastatic PTMC were found at the last follow-up. Except for 3 cases (0.84%) with thickening or hoarseness of voice and 3 cases (0.84%) with coughing during drinking water, no other complications were found. Ultrasound-guided RFA has good efficacy and safety for the treatment of low-risk unifocal PTMC and can be promoted for use in patients who meet the required indications.

“Abhi Toh Main Jawan Hoon” (For I am forever young): Reflections on the agentic cinematic presence of Zohra Sehgal in British Indian films

ABSTRACT Representations of older women in film and media have reiterated the negative stereotypes of age-induced incapacitation and loss of voice and agency. However, actor Zohra Sehgal, hailed as the “grand old lady of Bollywood”, re-engages with the normative construct of the passive/submissive screen characterization of an older female. Sehgal’s remarkable performances in The Jewel in the Crown (1984), Bhaji on the Beach (1993), and Bend It Like Beckham (2002) highlight the silenced realities of older women within the diasporic space in terms of desire, autonomy, and choice. In British cinema, where the subjectivities of South Asian older individuals (particularly women) were seldom acknowledged, Sehgal’s on-screen presence challenged and overturned marginalization based on age and ethnicity. Through the paradigm of active/successful ageing, this article argues that the politics of gendered representation and ageing have been recontextualized in British Indian diasporic films to reflect on a positive embodiment of Indian older women.

Hyperkinetic Dysarthria voice abnormalities: a neural network solution for text translation

Hyperkinetic Dysarthria voice abnormalities: a neural network solution for text translation

Biography of Muscle Tension Dysphonia: A Scoping Review

Background: Muscle Tension Dysphonia is a relatively new clinical entity that, despite being one of the most frequent causes of functional dysphonia, is little-known by many otorhinolaryngologists. Objective: The objective of the current work is to describe the evolution of Muscle Tension Dysphonia—the concepts and the ways it has been diagnosed and treated—from its first descriptions to our current knowledge. Design: A scoping review was conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. A search of three bibliographic databases was performed to identify original articles on Muscle Tension Dysphonia. Study selection and characterization was conducted by three independent reviewers and was further reviewed by a fourth individual. In case of relocating any of the studies, it was performed by agreement of two reviewers. We excluded articles not written in English or Spanish, letters to the editor, review articles, studies of the pediatric population, articles related to dysphagia, and other publications that were not relevant. Results: The search identified 1144 articles published from 1983 to December 2022. A total of 581 studies were repeated and another 462 were excluded because they were not written in English or Spanish, were not original articles, or were not relevant to the objective of the study. Finally, 101 articles were included in the review. The articles included in the review were divided into three groups considering the objective and conclusions of each study: 21 articles were classified as “Etiology and Physiopathology”, 29 articles as “Diagnosis”, and 51 articles were included in the “Treatment” group. Conclusions: The concept of Muscle Tension Dysphonia has been developed during the last forty years. For its diagnosis, endoscopic visualization of the larynx is crucial, but must be combined with the patient’s clinical history and other methods can also be useful. This entity should be addressed in a multidisciplinary approach, with the active participation of speech therapists. Most therapeutic options include voice education, vocal hygiene, and rehabilitation of the voice.

A rare case of isoniazid mono-resistant tuberculosis presenting as cardiac tamponade along with an anterior mediastinal mass in a 15-year-old immunocompetent patient.

A 15-year-old boy presented with a sudden onset of breathlessness for 7 days, gradual loss of weight of 17.6 lbs over the last month and progressive hoarseness of voice for 7 months. The contrast-enhanced computed tomography (CECT) scan revealed a heterogeneously enhancing lesion in the anterior mediastinum with multiple discrete lymph nodes in the cervical and mediastinal locations. The GeneXpert MTB/RIF assay performed on the CT-guided biopsy of the mass was negative, but the culture for Mycobacterium tuberculosis was positive at 7 weeks of incubation. There was a suboptimal radiological response after 6 months of treatment. First-line drug susceptibility testing (DST) performed by line probe assay (LPA) on the positive culture detected high-level resistance to isoniazid. The treatment was modified as per DST results to which the patient responded well.

Clinical characteristics of 4,520 paediatric patients infected with the SARS-CoV-2 omicron variant, in Xi'an, China.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has broad tissue tropism and high transmission, which are likely to perpetuate the pandemic. The study aim to analyze the clinicopathogenic characteristics in paediatric patients. In this single-centre study, we retrospectively included all confirmed cases infected by SARS-CoV-2 infection at Xi'an Children's Hospital, China, from 1 December to 31 December 2022. The demographic, clinical, laboratory, and radiological features of the patients were analysed. A total of 4,520 paediatric patients with SARS-CoV-2 omicron variant infections were included. Of these, 3,861 (85.36%) were outpatients, 659 (14.64%) were hospitalised patients, and nine patients (0.20%) died. Of the nine patients who died, five were diagnosed with acute necrotising encephalopathy (ANE). The most common symptoms were fever in 4,275 (94.59%) patients, cough in 1,320 (29.20%) patients, convulsions in 610 (13.50%) patients, vomiting in 410 (9.07%) patients, runny nose/coryza in 277 (6.13%) patients, hoarseness of voice in 273 (6.04%) patients. A blood cell analysis showed a slight elevation of monocytes (mean: 11.14 ± 0.07%). The main diagnoses for both outpatients and inpatients were respiratory infection with multisystem manifestations. A high incidence of convulsions is a typical characteristic of children infected with SARS-CoV-2. Five of the nine COVID-19 fatalities were associated with ANE. This indicates that nervous system damage in children with SARS-CoV-2 infection is more significant.

Frequency of Complications Related to Prone Position During General Anesthesia

Background: The prone position is widely used in spine and spinal cord surgeries and in reconstructive back surgery. If the patients are not placed in this position correctly and safely, or if they are not carefully displaced from a supine to a prone position, they may suffer many irreversible injuries This study aimed to determine the incidence of prone position complications during general anesthesia and surgery and related factors in the operating rooms of Mazandaran University of Medical Sciences hospitals in Iran. Methods: A total of 121 patients who were subjected to surgery in a prone position were examined in terms of complications related to this position. The variables of this study were age, gender, weight, type and duration of surgery, co-morbidity, patient’s body mass index (BMI), eye injury, airway swelling, runny nose, patient’s state of consciousness, neck stiffness, and lower jaw movement restriction. The other variables included skin bruising, redness and burning of the skin, presence of pain, sore throat and cough, hoarse voice, nausea, damage to the ear, peripheral nerves, and genital tract of men, which were recorded in the data collection sheet after obtaining information. The data were analyzed by SPSS 22 software. Results: Overall, 62% of patients were women, and the average age of patients was 45.23 years. In addition, 19.4% of patients had a BMI>30. Lumbar fusion surgery was the most common surgery in the prone position (43.8%). Surgery time had a direct and significant relationship with the prevalence of complications in patients (P=0.00). The most frequent post-surgical complication in the prone position was throat problems (hoarseness, sore throat, throat swelling, and cough) with 71 patients (58.7%), followed by eye complications in the prone position with 67 patients (55.4%). Conclusion: The prone position is one of the most sensitive body positions for brain, spine, and kidney surgeries. The results of this study also showed a high prevalence of immediate complications after surgery, most of which were on the head and face of patients. Considering the sensitivity of this area and its care, taking preventive measures by the anesthesia team can guarantee the patient’s health.

Ultrasound-guided Stellate Ganglion Block for Upper Extremity Phantom Limb Pain - A Case Series

Abstract Background: Stellate ganglion block (SGB) is effectively utilized in various sympathetically mediated pain conditions of head and neck, upper limb such as complex regional pain syndrome, postherpetic neuralgias, but there has been a paucity of evidence of SGB for the management of phantom limb pain (PLP). Methods: Ten upper extremity PLP patients underwent ultrasound-guided SGB block. Under real-time needle tip visualization and after ensuring negative aspiration, 5 mL of 1% lignocaine and 4 mg of dexamethasone were injected. Postprocedure pain score (numerical rating scale [NRS]) and patient satisfaction score (Likert scale) were noted, and patients were followed-up for the next 60 days. Results: The baseline NRS score (Mean [standard deviation]) of 7.8 (0.748) showed significant reduction (P < 0.001) to 2.8 (0.748) at immediate postinjection, to 2.6 (0.663) at day 7, at day 30 (2.9 [0.7]), and at day 60 (30.775). Most of the patients (80%–90%) were somewhat to very much satisfied with the treatment response (score 4–5 on Likert scale) at all the follow-up intervals. Only mild and transient adverse events were demonstrated in two patients who developed hoarseness of voice. Conclusion: Ultrasound-guided SGB effectively reduces pain and improves patient satisfaction in postamputee patients who developed PLP, over 2 months of the follow-up period. Further prospective randomized controlled trials over a larger duration with more sample size are needed to provide more concrete evidence.

Repairing partial suprahyoid epiglottis-preserved circumferential defect in near total laryngectomy with anterior medial thigh flap in advanced laryngeal cancer

To explore the feasibility to restore pronunciation function by repairing partial suprahyoid epiglottis-preserved circumferential defect in near total laryngectomy with anterior medial thigh flap in advanced laryngeal cancer. A retrospective study of 5 male patients with advanced laryngeal cancer between August 2019 and October 2022, aged 56-73 years, with an average age of 65 years were reviewed. The disease duration ranged from 3 to 24 months, with an average of 8 months. Tumor classification by location: 2 cases of glottic type, 2 cases of supraglottic type, and 1 case of subglottic type; TNM staging: 3 cases of T 4N 0M 0 stage, 1 case of T 4N 1M 0 stage, and 1 case of T 4N 2M 0 stage; American Joint Committee on Cancer (AJCC) staging (2017): stage Ⅳ. Near total laryngectomy with partial suprahyoid epiglottis-preserved and selective bilateral neck dissection were performed before the anterior medial thigh flap was used to repair the circumferential defects. The flap size ranged from 6 cm×5 cm to 8 cm×6 cm. Four patients underwent adjuvant radiotherapy and chemotherapy after operation, while 1 patient did not receive any other adjuvant treatment such as radiochemotherapy. The flaps of all 5 patients survived without obvious neck infection. One patient developed a slight pharyngeal fistula after oral feeding at 1 month after operation, which healed after another week of gastric feeding. Primary healing also achieved in the thigh donor area. One patient had bilateral cervical lymph node metastasis, and 1 patient had lymph node metastasis on one side. The remaining 3 patients had no cervical nodes metastasis on both sides. All 5 patients were followed up 12-36 months, with an average of 27.6 months. Four patients had clear, audible, and hoarse voice while 1 patient (case 3) had pronunciation similar to whispering. Laryngoscopy showed that the reconstructed laryngeal inlet was fissure-shape and the reconstructed laryngo-trachea canal below the laryngeal inlet was gradually enlarged. At 1 month after operation, the gastric tube was withdrawn and the food was taken orally. There was no obvious aspiration pneumonia. The tracheostomy tube could be blocked in 4 patients for from 30 seconds to 3 minutes. Among them, 3 patients were able to make a noticeable pronunciation even when the tube was not blocked, and they were able to engage in barrier-free language communication; the tracheostomy tube could not be blocked in 1 patient who had a pronunciation similar to whispering. Preliminary voice analysis showed that the patients have a relaxed and natural pronunciation, without obvious breath-holding or air-swallowing movement, compared to patients with esophageal pronunciation. Decannulation did not achieved until the last follow-up in all 5 patients. The anterior medial thigh flap can repair circumferential defects after near total laryngectomy in advanced laryngeal cancer patients and achieve satisfactory pronunciation, thus can serve as an effective pronunciation rehabilitation method. The preserved part of epiglottis may play a role to prevent postoperative aspiration.

Impact of Laryngopharyngeal Reflux in Patients with Voice Disorders.

The aim of this study is to evaluate the presence of laryngopharyngeal reflux in patients with voice disorders thereby aiding in the early management and improving the quality of life. Cross Sectional study. This cross sectional study was carried out in a tertiary care hospital, patients with history of voice change for more than 3 weeks were included, and divided into 4 groups depending upon the level of voice use. Patients were asked to fill Koufmann Reflux Symptom Index questionnaire followed by video laryngoscopy and findings were plotted according to Reflux Finding Score. Based on the scoring, impact of LPRD in patient with voice disorders was analysed. Among the 90 study participants, 74 (82.2%) were found to have LPRD. The mean age was 42.76 ± 10.33 years. Majority (43.2%) belong to the age group of 41-50 years, with female predominance (70.3%). Majority (41.9%) of them were level IV voice users. 59.5% were positive Koufman reflex symptom index, 67.6% were positive Reflex finding score. Hoarseness (58.1%) the most common symptom. Laryngopharyngeal reflux disease has to be considered in patients presenting with hoarseness of voice for more than three weeks. Simple and highly reproducible scores like Reflux Symptom Index and Reflux Finding Score proven useful and valuable tools in diagnosing LPRD thereby aiding in early diagnosis and prompt management and improves the patient's quality of life. Level 1.

Lymphoma presenting as a parapharyngeal space tumour

Among all head and neck tumours, approximately 0.5% to 0.8% localize in the parapharyngeal space, with Non-Hodgkin’s lymphomas in this region being exceptionally rare. They are documented in the literature either as isolated cases or in small case series. Here, we present a case involving a middle aged man who exhibited 4 month history of dysphagia and hoarse voice. Upon examination, showed a bulged left side of the soft palate and medialization of the pharyngeal wall. CT and MRI revealed a large lesion in the left parapharyngeal region pushing the pharynx anteromedially. Similar intensity enhancing lesion noted in nasopharynx. A transoral excision of parapharyngeal mass was performed, revealing a large B-cell non-Hodgkin’s lymphoma. Typically, parapharyngeal space tumours are benign, and surgery is the preferred treatment. Patient was transferred to tertiary care oncology hospital for further treatment. This case underscores the rarity but potential presence of extranodal non-Hodgkin’s lymphomas in the head and neck. Recognizing this pathology is crucial due to the different treatment approach it necessitates.