Indirect Laryngoscopy Research Articles

Endoscopic diagnosis of laryngeal precancerous lesions and early laryngeal cancer

ISince laryngeal cancer currently occupies a leading position in frequency of occurrence among all tumors of the upper respiratory tract of modern humans, the importance of its detection at an early stage of development cannot be overestimated. Existing diagnostic methods using rigid endoscopes, including direct and indirect laryngoscopy, have significant limitations in a number of patients. The use of modern video endoscopic technology allows diagnosing precancerous lesions and laryngeal cancer at an early stage of the tumor process, which significantly expands the possibilities of minimally invasive organ-preserving treatment.

Evaluating the Impact of Direct, Direct Video, and Indirect Video Laryngoscopy Training on the Proficiency of Medical Students in Performing Direct Laryngoscopy: A High-Fidelity Manikin-Based Assessment.

Endotracheal intubation (ETI), a potentially lifesaving intervention employed frequently in the emergent setting, is a manual skill that improves with repetitive practice and high-quality feedback. Classically, ETI centered around Direct Laryngoscopy (DL); however, with the advent and recent availability of Indirect Video Laryngoscopy (IVL) and Direct Video Laryngoscopy (DVL), studies have demonstrated varying results on the benefit of Video Laryngoscopy (VL) in training. We hypothesize that a training program centered on DVL, allowing students to visualize the anatomy and simultaneously receive instructor feedback via a real-time video feed, will practically improve student performance in DL. Our study of first-year medical students from the Edward Via College of Osteopathic Medicine (n = 21) randomized participants to one of three cohorts: DL, IVL, and DVL in a manikin-based simulation laboratory evaluated on successful intubation, time to successful intubation, dental injury, Numeric Rating Scale (NRS) to assess the trainee's perception of their performance and confidence level of performing intubation in a real-life scenario. Our results did not demonstrate a statistically significant difference between the three training modalities based on the outcomes assessed. Although IVL and DVL cohorts achieved 100% success following training, compared to 71% in the DL cohort, the results were not statistically significant. This is potentially due to our limited sample size, as our sample did not meet the calculated 162 participants for 80% power. These findings suggest that a larger sample size may be required to determine if there is a significant difference in outcomes for these training modalities.

Incidence and risk factors for recurrent laryngeal nerve injury after thyroid surgery

ObjectivesInjury to the recurrent laryngeal nerve (RLNI) is a known possible morbidity after thyroid surgery. The clinical presentation varied in severity, from changes in voice quality and swallowing in unilateral cases to airway compromise in bilateral cases. In minor cases, vocal fold paralysis (VFP) may occur unnoticed. Although many intraoperative measures have been implemented to minimize nerve injury, the risk remains, either transient or permanent. This study evaluated the incidence and potential risk factors of recurrent laryngeal nerve injury after thyroidectomy.MethodsRetrospective data analysis was conducted on 1368 patients who underwent thyroidectomy at the National Guard Hospital, King Abdul-Aziz Medical City, Jeddah, Saudi Arabia, between January 2008 and December 2021. Evaluations were conducted on the pathological features, surgical procedure type, and state of the recurrent laryngeal nerve during surgery as contributing to recurrent laryngeal nerve injury. All patients underwent preoperative and postoperative indirect laryngoscopy examinations with or without videostroboscopy. Physiological testing of the RLN using neurostimulation and laryngeal palpation (NSLP) or intraoperative neuromonitoring (IONM) was performed in all cases. VFP was considered present when vocal fold mobility was absent or significantly reduced.ResultsA total of 1368 patients (2177 nerves at risk) who underwent thyroidectomy and fulfilled the inclusive criteria (809 bilateral, 559 unilateral) were evaluated. A total of 62% of patients were more than 45 years old, and the mean age was 48.36 ± 13.03 with a male-to-female ratio of 1:3.6. Eight-hundred one (58.6%) patients underwent total or subtotal thyroidectomies (1602 nerves at risk). Two-hundred seventy-six patients underwent hemithyroidectomy (276 nerves at risk), and 291 patients underwent completion or redo surgeries (299 nerves at risk). Of these 1368 patients, post-surgery laryngoscopy showed reduced or absent vocal fold mobility in 47 (3.4%) patients. Forty-three out of 47 patients had unilateral vocal fold paralysis, and 4 had bilateral VFP. When we analyzed the three risk factors statistically significant for postoperative RLN palsy, age (OR, 1.01; 95% CI, 0.98–1.05; p = 0.365) became non-significant. The other risk factors (extent of surgery and histopathological diagnosis) remained statistically significant (p = 0.004 and 0.031). After adjustment, the extent of surgery, including total thyroidectomy and revision surgery, was strongly associated with a higher risk of odds of postoperative RLN palsy. Physiological RLN stimulation was performed in all cases with NSLP or INOM, and no significant association was observed in the incidence of VFP (p = 0.365). In most cases, symptoms were spontaneously resolved with recovery of vocal fold movement within a few months.ConclusionIn this study, 3.4% of the recurrent laryngeal nerve showed postoperative dysfunction either transient or permanent VFP. Intraoperative identification of the nerve remains the gold standard of care during thyroidectomy. Neuromonitoring aids in detecting the nerve, particularly in severe cases, but does not reduce the nerve injury compared to NSLP.

Evaluating of Supraglottic Subunits in Swallowing Function in Supraglottic Cancer Patients Pre- and Post-Transoral Laser Microsurgery.

This study aims to assess the impact of supraglottic cancer on swallowing functionality and its anatomical correlations before and after laser surgery. The study seeks to determine the extent of score changes post-surgery, pinpoint the most influential anatomical component in swallowing, predict post-surgery outcomes, and ascertain the effect on patients' quality of life. Patients with supraglottic cancer and dysphagia were identified through stroboscopy and indirect laryngoscopy. Exclusion criteria encompassed a history of prior radiotherapy, chemotherapy, or distant metastases. Demographic data, tumor stage, comorbidities, risk factors, and treatment details were documented. Swallowing evaluation employed the translated EAT10 self-assessment questionnaire, administered before and after transoral laser microsurgery (TLM) at baseline and 6 months later. Additional treatments, rehabilitation duration, NG tube use, and post-surgery complications were recorded. At the six-month follow-up, 9 patients had EAT-10 scores ≥ 3, while 7 patients scored < 3. Five patients underwent post-TLM additional therapies, and 9 patients had neck dissections. Involved subunits were epiglottis (11 patients), arytenoid (5 patients), FVC (13 patients), and TVC (3 patients). Seven patients received dysphagia treatment. Analysis revealed significant associations between follow-up EAT-10 scores and dysphagia treatment (p = 0.04), smoking (p = 0.02), and FVC involvement (p = 0.02). Our study on supraglottic cancer treatment with transoral laser microsurgery (TLM) revealed variable EAT-10 scores after a six-month follow-up. Adjunctive therapies and neck dissections were administered to some patients. Significant associations were found between follow-up scores, dysphagia treatment, smoking history, and FVC involvement, highlighting the complex interplay between interventions and patient factors. Further research is needed for optimization.

Role of multidetector computed tomography in assessment of laryngeal cancer: experiences from 31 cases

Aims. To compare the efficacy of computed tomography from endoscopic examination in diagnosing and staging laryngeal carcinoma. Methods. From February 2019 to July 2020, we conducted a retrospective study on patients with laryngeal carcinoma. After receiving a clinical diagnosis of laryngeal masses, patients underwent indirect laryngoscopy evaluation before being referred for computed tomography (CT) scans. A postimaging biopsy was undertaken via direct laryngoscopy. Imaging features of the tumor, such as size, level of invasion, and tumor staging, were analyzed. Results. The mean age was 61±11, with 90% of male patients. The risk of laryngeal cancer for those patients who were active smokers (93.5%) and alcohol consumers (67.7%). The most common symptom was hoarseness (93.5%). In CT image, more than half of the cancers were carcinoma of the glottis (29%) and two regions, supraglottis and glottis (22.6%), while the less common cancers were the subglottic (3.2%) and all three regions (9.7%) carcinoma, especially true vocal cord (67.7%) is the most common site starting carcinoma. The percentage of tumor spreading to paraglottic space and pre-epiglottic space was 50% and 30.6%, respectively. The most common stage of laryngeal cancer in CT was the T3 stage (35.5%). Compared to laryngoscopy, there is a weak agreement (Kappa=0.518) in staging in laryngeal cancer in CT. Conclusion. MDCT is better in staging of laryngeal cancer in the T3 and T4 stages as compared to laryngoscopy.

Living Foreign Body in the Larynx: A Rare Case Report

Foreign body aspiration (FBA) is a common incidence in young children. While living FB like maggots have been reported very frequently, Leeches are rarely reported as FBA at any age. In this case we report a 55-year-old female from rural area presented with hoarseness, dyspnoea and cough since one month, upon Indirect laryngoscopy a blackish aneurysmal like FB in the larynx was seen. A neck computed tomography (CT) demonstrated a polypoidal soft tissue like shadow with changing positions in subsequent axial cuts. Finally, direct laryngoscopy was performed under local anaesthesia in operation theatre and a 9 cm leech was found in the larynx overlying sub glottis and glottis area which was removed immediately with the Luc’s forceps. Keywords: Living foreign body, Larynx, Foreign body aspiration.

Lingual Thyroid: Concerns for the Anaesthesiologist

Abstract The lingual thyroid gland is rare, and it occurs due to failure of the thyroid gland to descend to its normal cervical location during embryogenesis. It can be associated with an increase in levels of thyroid-stimulating hormone. Lingual thyroid can be challenging to the anaesthesiologist as it poses difficulties while securing the airway. The lingual thyroid gland may present with dysphagia, dysphonia, upper airway obstruction or haemorrhage. Oropharyngeal mass can cause difficult intubation and failure to ventilate. Preoperative airway evaluation and indirect laryngoscopy will indicate the need for fibreoptic bronchoscopy-guided intubation. We report the case of a 50-year-old female with a lingual thyroid gland for breast surgery under general anaesthesia.

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.

PECULIARITIES OF THE COURSE AND TREATMENT OF ACUTE INFECTIOUS RHINOSINUSITIS IN VOICE-SPEAKING PROFESSIONALS

Numerous scientific studies are dedicated to the study of the morphological structure of the vocal cords and the diagnostic criteria of their lesions. The purpose of the work: the study of changes in the quality of the voice and the condition of the vocal cords in persons of voice-speaking professions who were treated for acute viral or bacterial rhinosinusitis and continued to work (had vocal strain) during the illness.Research material and methods. The examination data of 24 patients (16 women and 8 men) of voice-speaking professions who were treated for acute viral or bacterial rhinosinusitis and continued to work (had voice strain) during the illness were analyzed. For each patient, a phoniatric patient study card was filled out, in which passport data was noted, including profession, patient complaints, data on life history, disease history and objective examination of ENT organs: pharyngoscopy, rhinoscopy, otoscopy, indirect laryngoscopy, which was performed with the help of 700 or 900 rigid endoscope. Research results. The analysis of the examination data of 24 patients (16 women and 8 men) of voice professionals who were treated for acute viral or bacterial rhinosinusitis and continued to work (had vocal strain) during the illness showed that during the control examination of the data of the patients for 7-10 days since the beginning of treatment, indirect laryngoscopy and stroboscopy revealed: hemorrhage in one fold - 3 cases, prenodular thickening of the edges of the vocal folds - 8 cases. The mobility of the folds was preserved in all patients, but during phonation, a gap formed between the folds in 19 patients, which was accompanied by hypertonus of the vestibular folds in 3 cases. During stroboscopy of this group of patients, vocal fold asynchrony was detected in 21 cases. The PMF was shortened in 21 patients and was 12 + 1.3 s (norm – 16s), and in men – 16 + 1.5 s (norm – 21s). Conclusions. In the treatment of patients of voice-speaking professions with acute viral or bacterial rhinosinusitis, changes in the vocal folds are observed, with possible hypertonus.

Comparative Evaluation of Linscope and King Vision Video Laryngoscopes in Tracheal Intubation: A Randomized Controlled Trial.

Introduction Indirect laryngoscopy has become a widely accepted method for learning the techniques of airway management. The incorporation of small, less expensive, and yet more reliable video cameras in laryngoscopes has given the process of laryngoscopy and intubation a big leap. The King Visionvideo laryngoscope (Medline Industries, USA) has demonstrated promise in several settings while the Linscope video laryngoscope(Centrum, Turkey) is a newly launched device and no literature is available to the best of our knowledge. Therefore, we aimed to compare the performance of the Linscope video laryngoscope (VL) and King Vision video laryngoscope. Method This is a randomized controlled trial study. Seventy patients, after approval from the institute's ethical clearance, were divided into two groups. In Group A, patients were intubated with Linscope VL and in Group B patients were intubated with King Vision VL as per the protocol. The primary outcome measure was the duration of tracheal intubation. Secondary outcomes were measured by the number of attempts, ease of intubation, and glottic view. Results Both Linscope VL and King Vision VL groups were comparable in terms of mean intubation time (20.34 s vs. 19.45 s). The endotracheal intubation with both devices was 100% successful at the first attempt. Both the devices provided a percentage of glottic opening (POGO) score of > 70% and a clear vision of the glottis. The POGO score obtained with King Vision VL was 83.57 ± 11.41% and with Linscope VL was 87.85 ± 10.31%. POGO score was greater with Linscope VL compared to King Vision VL, but the difference was not statistically significant (p-value>0.05). Conclusion King Vision demonstrated shorter intubation time and fewer optimization maneuvers. Both devices achieved a 100% success rate on the first attempt. While both devices are viable first-line options, King Vision's well-established efficacy in the literature suggests its preference over Linscope till extensive evidence is available in the future.

Role of flexible fiberoptic nasopharyngolaryngoscopy and indirect laryngoscopy in the diagnosis of laryngopharyngeal pathologies

Background: Visualization of the larynx and pharynx is essential to diagnose and treat pathologies, and to prognosticate. This can be done by using indirect laryngoscopy, rigid and flexible endoscopy, and direct laryngoscopy. The main purpose of the article was to assess the profile of laryngopharyngeal pathologies diagnosed by flexible fiberoptic nasopharyngolaryngoscopy and indirect laryngoscopy in patients with laryngopharyngeal symptoms and to estimate the level of agreement between flexible fiberoptic nasopharyngolaryngoscopy and indirect laryngoscopy for selected laryngopharyngeal conditions like vocal nodule, vocal cord polyp, Reinke’s edema, hypopharyngeal growth, vocal cord palsy, vocal cord growth. An Independent t-test and chi-square test were used to analyze the results. Statistical package for the social sciences (SPSS) version 20 was used for statistical analysis. Methods: In this descriptive cross-sectional study, 101 patients with laryngopharyngeal symptoms were subjected to both indirect laryngoscopy and flexible fiberoptic nasopharyngolaryngoscopy. The structures visualized, pathologies detected, time taken and discomfort levels were statistically analyzed. Results: In our study, we found that laryngopharyngeal symptoms were more common among the 61 to 70 years age group. The majority of them were males. The majority of them were retired employees. The most common presenting complaint was difficulty in swallowing, followed by globus sensation and voice change. All structures were visualized by flexible fiberoptic nasopharyngolaryngoscopy. Whereas, in indirect laryngoscopy, some structures were visualized and some were not. Pyriform fossa apex and post-cricoid region were not visualized for all patients with indirect laryngoscopy. Laryngopharyngeal reflux was the most common pathology detected. There is no significant difference between IDL and FOL in site, subsite, and clinical appearance of the pathology detected. There is a significant difference between IDL and FOL in time taken (FOL has a higher mean) and discomfort levels (IDL has a higher mean). Conclusions: Though indirect laryngoscopy is cost-effective in terms of investment, the time taken for the procedure is also less, flexible fiberoptic laryngoscopy is considered superior because it can visualize all structures and can detect pathologies early in their stage so that the patient gets treatment early which can alter the prognosis.

Unusual foreign bodies in upper aero digestive tract – Our experience at tertiary care centre

Foreign bodies ingestion is especially common in the pediatric age group, whereas in adults occur accidently or among those with psychiatric disorders, mental retardation, prisoners and alcoholics, Preexisting GI tract abnormalities, such as previous surgery, strictures, or functional abnormalities, increases the risk of a swallowed foreign body becoming lodged at the site of the abnormality.This retrospective study was conducted in 32 patients with upper aero digestive tract unusual foreign bodies presenting to our department on emergency basis in a duration of one year. This Study was conducted in ENT department tertiary care Centre in duration of 2021-2022, 32 patients presented with unusual FB in upper aero digestive tract were treated in our department on an emergency basis. There were 14 male (43.75%) and 18 female (56.25%) ranging in age from 2 to 62 years. The main symptoms patients complained were difficulty in swallowing and pain. Detailed history with examination of nasal cavity, oral cavity and pharynx by indirect laryngoscopy and finally X-ray or CT scan were the diagnostic tools as required. The location of the FB was in the esophagus, Pyriform sinus, hypopharynx in decreasing order.The treatment consisted of rigid endoscopy and foreign body removal under general anesthesia or sedation. No major complications occurred in procedure except one in with iatrogenic esophageal perforation that was managed conservatively. Endoscopy is a reliable method in the treatment of upper aero digestive tract foreign body (FB) impaction.

INCIDENCE OF HYPOCALCEMIA FOLLOWING NEAR TOTAL THYROIDECTOMY AND TOTAL THYROIDECTOMY

Objective:Our study was conducted at ESIC Medical College and Hospital, Kalaburagi, aimed to evaluate the incidence of hypocalcemia following near-total and total thyroidectomy over a 2-year period from November 2021 to November 2023. Methods: A total of 120 patients above 12 years undergoing thyroidectomy were included. Pre-operative assessments, including clinical history, examination, fine needle aspiration cytology, thyroid function tests, ultrasound neck, and indirect laryngoscopy, were conducted. Blood samples were collected pre-operatively and post-operatively. Hypocalcemia was defined as serum calcium below 8 mg/dL and ionized calcium below 4.4 mg/dL, with transient hypocalcemia lasting less than 6 months and permanent hypocalcemia persisting beyond 6 months. Biochemical and laboratory tests, including thyroid function tests, were performed, and management involved calcium supplementation with or without vitamin D. Results: The study revealed an overall incidence of hypocalcemia at 21.6%, with 7.5% progressing to permanent hypocalcemia. Malignancy was more prevalent in males (60%), while benign disorders were common in females (60% in the age group 20-50 years). Conclusion: Postoperative hypocalcemia, though a frequent complication after near-total and total thyroidectomy, can be mitigated through proper planning, meticulous surgical techniques, and the use of advanced technologies. Regular monitoring and early intervention are imperative for patient well-being, emphasizing the importance of attention to surgical details in minimizing complications.

Silenced by heart – Ortner’s syndrome (cardio-vocal hoarseness) – An unusual manifestation of a distant dreadful disease: A cross-sectional observational study

ABSTRACT Aims and Objectives: This study aims to explore the pathogenesis of hoarseness of voice resulting from cardiovascular disorders that affect the left recurrent laryngeal nerve (LRLN), supported by a review of the existing literature. Materials and Methods: This is a cross-sectional observational study conducted over a 3-year period, spanning from May 2019 to May 2022. The study involved the evaluation of 720 cases of hoarseness of voice through video-laryngoscopy. Within this cohort, we scrutinized eight distinct cases of Ortner’s syndrome, each attributed to various underlying causes. All patients with LRLN paralysis underwent a comprehensive clinical assessment, which encompassed chest X-rays, echocardiography, and chest computed tomography scans. Results: Out of the eight Ortner’s syndrome cases, six were associated with dilated pulmonary arteries, stemming from various etiologies such as rheumatic heart disease, mitral valve prolapse, pulmonary embolism, interstitial lung disease, portopulmonary hypertension, and patent ductus arteriosus. One case presented with pericardial effusion and pulmonary hypertension, while another case featured a dilated aorta secondary to severe aortic regurgitation. Among these cases, three patients underwent valve replacement, one underwent pericardiocentesis, and the remaining cases were managed conservatively. Only one case that underwent mitral valve replacement showed partial improvement in voice, while there was no significant improvement in the other cases. All cases remained under follow-up. Conclusion: Although cardiovascular-related hoarseness is an unusual presentation, it should be kept in mind for all cases of altered voice with underlying cardiac disease. Indirect laryngoscopy should be routinely performed in all cases of cardiac illness having hoarseness of voice.

Comparison of Indirect and Direct Laryngoscopes in Pediatric Patients with a Difficult Airway: A Systematic Review and Meta-Analysis.

This meta-analysis was performed to determine whether an indirect laryngoscope is more advantageous than a direct laryngoscope for tracheal intubation in the setting of a difficult pediatric airway. Data on the intubation failure and intubation time during tracheal intubation were extracted from prospective and retrospective studies identified through a comprehensive literature search. Data from 10 individual articles (11 trials) were combined, and a DerSimonian and Laird random-effects model was used to calculate either the pooled relative risk (RR) or the weighted mean difference (WMD) and the corresponding 95% confidence interval (CI). Meta-analysis of the 10 articles indicated that the intubation failure of tracheal intubation with an indirect laryngoscope was not significantly different from that of a direct laryngoscope in patients with a difficult airway (RR 0.86, 95% CI 0.51-1.46; p = 0.59; Cochrane's Q = 50.5; I2 = 82%). Intubation time with an indirect laryngoscope was also similar to that with a direct laryngoscope (WMD 4.06 s; 95% CI -1.18-9.30; p = 0.13; Cochrane's Q 39.8; I2 = 85%). In conclusion, indirect laryngoscopes had the same intubation failure and intubation time as direct laryngoscopes in pediatric patients with a difficult airway. Currently, the benefits of indirect laryngoscopes have not been observed in the setting of a difficult pediatric airway.

Benign Lesions of Larynx and Its Micro-Laryngeal Surgery - A Clinical Evaluation

BACKGROUND&#x0D; The larynx is a unique organ in the spectrum of functions it performs. Its role in normal respiration, maintenance and protection of the airway. Simple laryngeal lesions are not uncommon. The great majority of the cordal benign lesions are non-neoplastic, usually in a ratio of about 6:1. They are the product of some form of irritation and do not have the histological characteristics of true neoplasms. Therapy is directed at restoring as much normal function of the larynx as possible. Microlaryngeal surgery and postoperative voice rest offer a cost-effective, useful and safe approach to the management of benign laryngeal lesions.&#x0D; Objectives&#x0D; The study was undertaken to identify the common types of benign lesions of the larynx and the age, sex distribution, symptomatology, sites of involvement and histopathology of the lesions following micro-laryngeal surgery. Microlaryngeal surgery and postoperative voice rest offer a cost-effective, useful and safe approach to the management of benign laryngeal lesions.&#x0D; METHODS&#x0D; A prospective study was conducted from February 2017 to September 2019 at NRM ENT Hospital, Raichur, Karnataka and a secondary referral hospital. 30 patients with benign laryngeal lesions were included based on the patient’s clinical symptoms and findings on indirect laryngoscopy in the age group of 13–65 years. All non-operative cases and malignant cases were excluded. Routine preoperative surgical work-up and therapeutic micro-larnygoscopic procedures were employed.&#x0D; RESULTS&#x0D; A male preponderance with a male-to-female ratio of 1.3:1 was observed. The majority of the patients were in the age group of 31–40 years. Non-neoplastic lesions are much more common than neoplastic lesions. Vocal nodules, polyps, and angiofibromas with the same pathogenesis were common lesions. Abuse of voice, exposure to a known agent, and trauma were causative factors. Most of the lesions are solitary and unilateral, arising from the vocal cord. The right side is the common side, and sessile lesions are more numerous than pedunculated. Only 10% of cases are true neoplastic; vocal polyps, nodules, and angiofibromas with the same pathophysiology account for 70% of cases.&#x0D; CONCLUSIONS&#x0D; Benign lesions of the larynx are common in males, but in this series, amusingly, housewives are at the top of the list. Voice abuse, exposure to a known agent and trauma are the etiological factors. A common symptom is hoarseness of voice. On the basis of this study, it has been emphasized that the removal of the tumor should be flushed from the surface of the vocal cords to aviod any injury to the epithelium, which can be done either under microscopic or endoscopic view.

Synchronous presentation of giant anterior neck lipoma and interarytenoid hamartoma

Giant lipomas are benign soft tissue tumor found rarely in the neck and are still rarer in the anterior part of neck. Laryngeal hamartoma (LH) is a very rare lesions and the number of reported cases is limited. Herein, we report a case of 68 years old male with a history of painless, slow growing swelling on anterior neck for past 8 years and also complaints of dyspnoea and stridor for past 6 months. FNAC from anterior neck swelling was suggestive of lipoma. USG and CT findings were suggestive of soft tissue lesions. Indirect and flexible laryngoscopy shows a large pedunculated, globular mass in interarytenoid region. A complete surgical excision of the anterior neck mass and interarytenoid polyp was done. Diagnosis of lipoma and hamartoma was confirmed on histopathology. Patient was followed up for 2 years with no evidence of recurrence.

Indirect laryngoscopy is more effective than direct laryngoscopy when tracheal intubation is performed by novice operators: a systematic review, meta-analysis, and trial sequential analysis.

We sought to perform a systematic review and meta-analysis to determine whether indirect laryngoscopy has an advantage over direct laryngoscopy in terms of the tracheal intubation rate, glottic visualization, and intubation time when used by novice operators. We extracted adult prospective randomized trials comparing tracheal intubation with indirect vs direct laryngoscopy in novice operators from electronic databases. We extracted the following data from the identified studies: success rate, glottic visualization, and intubation time. Data from each trial were combined via a random-effects model to calculate the pooled relative risk (RR) or weighted mean difference (WMD) with a 95% confidence interval (CI). We also performed a trial sequential analysis. We included 15 articles (17 trials) comprising 2,290 patients in the systematic review. Compared with the direct laryngoscopy, indirect laryngoscopy improved success rate (RR, 1.15; 95% CI, 1.07 to 1.24; P = 0.0002; I2 = 88%), glottic visualization (RR, 1.76; 95% CI, 1.36 to 2.28; P < 0.001; I2 = 85%), and intubation time (WMD, -9.06sec; 95% CI, -16.4 to -1.76; P = 0.01; I2 = 98%) in tracheal intubation. Trial sequential analysis showed that the total sample size was sufficient to analyze the success rate and intubation time. In this systematic review, we found that the tracheal intubation success rate, glottic visualization, and intubation time were improved when novice operators used indirect laryngoscopy rather than direct laryngoscopy. Trial sequential analysis results indicated that the sample size was sufficient for examining the success rate and intubation time. PROSPERO (CRD42022309045); first registered 4 September 2022.

Modified Laryngeal Forceps for Arytenoid Cartilage Dislocation Caused by Endotracheal Intubation: A Retrospective Case-Control Pilot Study.

Background: Arytenoid cartilage dislocation is considered as a rare laryngeal injury and closed reduction is commonly used as the first choice for the arytenoid dislocation. However, the tools of closed reduction vary, and there is no dedicated tool for closed reduction, and the treatment outcome varies from person to person. This study compared the treatment outcome of the modified laryngeal forceps and traditional laryngeal forceps. Material and Methods: This study conformed to the strengthening the reporting of observational studies in epidemiology guidelines regarding retrospective studies. From May 2021 to February 2023, the records of 28 patients with arytenoid cartilage dislocation caused by endotracheal intubation were reviewed. They were divided into the traditional group (n = 14) and the modified group (n = 14) by gender. Indirect or direct laryngoscopy, video stroboscopy, high-resolution computed tomography, and cricoarytenoid joint 3-dimensional reconstruction were used to evaluate arytenoid position and motion. Clinical characteristics, voice function, procedural skill, and treatment outcome for each case were recorded. Results: Each patient was diagnosed with arytenoid dislocation caused by endotracheal intubation. There was no significant difference in the treatment outcome between the traditional group and the modified group (P > .05). However, the median time interval between closed reduction and the return of normal voice in the traditional group was 31.08 ± 10.56 days, which was significantly longer than the median time of 17.92 ± 3.83 days in the modified group (P < .05). Conclusion: Closed reduction with the modified laryngeal forceps under local anesthesia is an effective and safe procedure. Compared with traditional laryngeal forceps, the modified laryngeal forceps can shorten the treatment duration.

Video laryngoscopy: a double-edged sword

Endotracheal intubation revolutionized anesthesia and allowed prolonged surgical procedures to be performed. It also made positive pressure ventilation possible in patients in respiratory insufficiency and being managed in intensive care units. But successful intubation required the development of laryngoscopes. A variety of blades were developed to be used in different sets of patients. A laryngoscope came to be known as a symbol of the specialty of anesthesiology. But it was not always safe, nor successful, necessitating more sophisticated instruments. Video laryngoscopes were introduced with a sigh of relief for the anesthesiologists in difficult airway cases. Many variations of video laryngoscopes with slight differences have been marketed. But cases of video laryngoscope related injuries have been reported. This paper gives an over-view of the possible mechanism and preventive measures.&#x0D; Abbreviations: DL - Direct laryngoscopy; ETT – Endotracheal intubation; IDL - indirect laryngoscopy; VL - Video laryngoscopy; &#x0D; Key words: Airway management; Instrumentation; Intubation, endotracheal; Laryngoscope; Laryngoscopy&#x0D; Citation: Dhoon TQ, Wilson L, Rajan GRC. Video laryngoscopy: a double-edged sword. Anaesth. pain intensive care 2023;27(3):413−416; DOI: 10.35975/apic.v27i3.2219&#x0D; Received: March 30, 2023; Reviewed: April 11, 2023; Accepted: April 15, 2023