Laryngeal Chondritis Research Articles

Auricular and laryngeal chondritis in nursery and finishing pigs.

This work aimed to characterize the clinic-pathological presentation of an outbreak of auricular and laryngeal chondritis in pigs. Visits were made to pig farms, where the clinical history was obtained, and clinical and postmortem examinations were performed. In those farms, 3% to 4% of pigs presented otohematomas, which started in the nursery and extended to the finishing phase. Moreover, some finishing pigs presented with respiratory distress, initially characterized as inspiratory dyspnea, associated by an uncommon respiratory stridor and culminating in death. Grossly, nursery piglets had enlarged ears, and on the cut surface, the cartilage was fragmented and associated with blood clots. In the finishing phase, in addition to auricular lesions, the epiglottis and arytenoid cartilages were thickened and distorted, which partially occluded the lumen. Microscopically, the laryngeal and auricular cartilages were fragmented, displayed a loss of matrix basophilia, and were surrounded by lymphohistiocytic inflammatory infiltrate, with occasional multinucleated giant cells and fibrosis. The lesions exclusively affected elastic cartilages. The disease in finishing pigs led to increased mortality and was a differential diagnosis to respiratory challenges. It was not possible to determine the factor that triggered this condition; however, a nutritional association is suspected. To the authors' knowledge, this is the first report of primary auricular and laryngeal chondritis in pigs.

Magnetic resonance diagnosis of laryngeal chondritis after transoral laser microsurgery for laryngeal cancer.

Laryngeal chondritis (LC) is a rare complication of carbon dioxide transoral laser microsurgery (CO2 TOLMS) for laryngeal tumours and can pose a diagnostic challenge. Its magnetic resonance (MR) features have not been previously described. This study aims to characterise a cohort of patients who developed LC after CO2 TOLMS and describe its clinical and MR findings. Clinical records and MR images of all patients presenting with LC after CO2 TOLMS between 2008 and 2022 were reviewed. Seven patients were analysed. Timing of LC diagnosis ranged from 1 to 8 months after CO2 TOLMS. Four patients were symptomatic. Abnormal endoscopic findings included suspected tumour recurrence in 4 patients. MR documented focal or extensive signal changes involving the thyroid lamina and para-laryngeal space with T2 hyperintensity, T1 hypointensity and intense contrast enhancement (n = 7), and minimally reduced mean apparent diffusion coefficient (ADC) values (1.0-1.5 x 10-3 mm2/s) (n = 6). A favourable clinical outcome was achieved in all patients. LC after CO2 TOLMS has a distinctive MR pattern. When tumour recurrence cannot be confidently excluded based on imaging, antibiotic therapy, close clinical and radiological follow-up and/or biopsy are recommended.

Flock health survey of Irish Texel society breeders and larynx examination in Texel sheep

BackgroundLaryngeal chondritis is a disease of undetermined aetiology, characterised by oedema, ulceration, abscessation and necrosis of the laryngeal mucosa and cartilage. The initial aim of the study was to document flock health issues identified by Irish pedigree Texel breeders using a questionnaire survey. Additionally, given the reports of breed predisposition for laryngeal chondritis in Texels, a further aim was to identify if laryngeal problems were perceived as an issue. Work was then conducted to identify if pre-clinical laryngeal mucosal pathology was identifiable in Texel sheep showing no overt clinical signs of respiratory disease and if associations existed between laryngeal measurements and laryngeal pathology.Thirty one larynges were collected from a Texel flock that previously had laryngeal chondritis diagnosed in fallen stock. Gross visual inspection was performed to identify and grade (0–5) laryngeal pathology. A series of measurements were then performed on larynges that had been formalin fixed. Associations between independent variables (larynx measurements) and the dependent variable (laryngeal pathology score) were examined.ResultsRespiratory disease was the most frequently identified health issue. Farmer-diagnosed ‘throat problems’ were reported by over 80% of respondents.Laryngeal pathology was noted in Texels showing no overt clinical signs of respiratory disease. Associations between laryngeal measurements and laryngeal pathology were identified relating to the angle between the cranial point of the cricoid cartilage and the vocal process of the arytenoid cartilage.ConclusionsMild laryngeal pathology was noted in animals with no overt clinical signs of respiratory disease. Future research should examine whether significant associations between laryngeal measurements and laryngeal pathology identified in the current study can be measured ante mortem, and whether such ante mortem measurements will allow early identification of sheep at risk of developing laryngeal chondritis.

Laryngeal chondritis in two Dorper sheep

Laryngeal chondritis is an acute obstructive upper respiratory condition characterised by severe dyspnoea and laryngeal stridor, considered an uncommon disease in sheep. In this study, we describe detailed clinical evolution,...

Laryngeal chondritis as a differential for upper airway diseases in German sheep

BackgroundOvine laryngeal chondritis is a rare entity of sheep in the USA, Great Britain, New Zealand and Iceland, but has not been reported in Germany so far. Here, two German cases are reported.Case presentationTwo rams showed severe and progressive signs of dyspnea. Endoscopically, a severe bilateral swelling of the larynx was identified in both rams. Due to poor prognosis and progression of clinical signs one ram was euthanized, while the other ram died overnight. In both cases, a necrosuppurative laryngitis and chondritis of arytenoid cartilages was found at necropsy. Fusobacterium necrophorum and Streptococcus ovis were isolated from the laryngeal lesion in one animal.ConclusionsThis is the first report of ovine laryngeal chondritis in continental Europe. This entity should be considered a differential diagnosis for upper airway disease in sheep.

Scar contracture prevention with local steroid injections in transoral videolaryngoscopic surgery

ObjectiveThe aim of this study was to evaluate the efficacy and safety of local steroid injections to prevent scar contracture after transoral videolaryngoscopic surgery (TOVS) in hypopharyngeal cancer patients. MethodsPatients were enrolled in this study if they had received a local steroid injection during TOVS and had attended an outpatient clinic after at least three months. All patients were being treated for hypopharyngeal cancer and received a single session of triamcinolone acetonide, injected using a 21-gage needle. Retrospective chart reviews were performed, and the degree of scar contracture, pharyngeal stenosis, vocal fold movements, and adverse events were evaluated. Scar contracture was assessed using a scoring system, which compared the endoscopic findings of treatment and matched pair control groups. ResultsA total of 20 patients received local steroid injections during TOVS and were enrolled in the treatment. Scar contracture was seen in 14 patients (70%); however, the degree of scar contracture was significantly decreased when compared to control cases. Vocal fold immobility was observed in five patients, but no pharyngeal stenosis was noted. Adverse effects, such as postoperative laryngeal chondritis or cervical spondylitis, were seen in three patients who had previously been treated with resection to the muscularis propria or definitive irradiation. ConclusionLocal steroid injection during TOVS significantly reduced the degree of postoperative scar contracture. However, caution should be used when treating with local steroid injection during TOVS, as this may complicate wound healing in patients who have already received treatment.

Relapsing polychondritis - analysis of symptoms and criteria.

ObjectivesRelapsing polychondritis (RP) is a rare disease characterised by recurrent inflammation of the cartilaginous structures and proteoglycan-rich organs. The aim of this case series study is to share the 10-year clinical experience of our department in diagnosing RP patients in the context of data from available published studies.Material and methodsA retrospective case analysis of 10 patients with symptoms of RP, hospitalised at the Department of Rheumatology and Internal Diseases of Wrocław University Hospital between January 2008 and December 2018.ResultsNine out of 10 patients fulfilled at least one of the three sets of the diagnostic criteria. The mean age (±standard deviation) at diagnosis was 54.4 ±13.3 years and ranged from 32 to 73 years. The symptoms suggestive of the RP diagnosis were mainly inflammation of the pinna (in 80% of patients) and laryngeal stenosis (in 20% of patients). The mean age at which initial symptoms were observed was 52.3 ±12.0 years and ranged from 31 to 69 years. Auricular chondritis was the first manifestation of the disease in 40% of cases (two women and two men) laryngeal chondritis in 20%, nasal chondritis in 10%, and bronchial stenosis in 10%. Other initial symptoms were polyarthritis, which was present in 10% of cases (male) and general symptoms observed in 10%.ConclusionsA thorough analysis of the entire medical history with specific questions about the occurrence of the manifestations of the disease in the past leads to the diagnosis of RP. The RP also should be considered in differential diagnosis of respiratory track narrowings. It is very useful to apply the three sets of criteria simultaneously in the diagnostic process.

Anatomy and Pathology of the Texel Sheep Larynx.

Laryngeal chondritis, or “Texel throat”, is a disease affecting the upper respiratory tract of sheep with breeds like the Texel appearing to be predisposed. Previous work suggests the conformation of these breeds of sheep may be predisposing these animals to laryngeal disease. This study evaluated the anatomy of the Texel sheep larynx and describes incidental pathology. Forty-three larynges from rams of the Texel and Bluefaced Leicester breeds of sheep were measured and photographed. A larynx from each breed was submitted for computed tomography (CT) and magnetic resonance imaging (MRI). Measurements, photography, CT, and MRI demonstrated a difference in the anatomy of the larynx between breeds and a higher proportion of Texel sheep had laryngeal lesions. This study supports the hypothesis that the anatomy of the Texel sheep could be pre-disposing the breed to laryngeal chondritis.

Laryngeal Chondritis in Sheep in Iceland

Laryngeal chondritis is a chronic disease in sheep with low morbidity, high mortality and unresolved pathogenesis. The disease has been recognized recently in Iceland and affects both ewes and rams. Animals of different ages are affected, but lambs and yearlings predominate. The disease is seen in housed animals and most cases occur during the late winter months. We report the gross and microscopical findings in 45 cases of laryngeal chondritis in Icelandic sheep.

Laryngeal chondritis induced by C3–4 osteophyte following supracricoid laryngectomy with cricohyoidoepiglottopexy: report of two cases

We have performed supracricoid laryngectomy with cricohyoidoepiglottopexy or with cricohyoidopexy for tumour (T) stage T2 and T3 laryngeal cancer cases and some T4 cases. We report the clinical symptoms and management, using this technique to avoid complications. Among patients undergoing the procedure, two cases manifested laryngeal chondritis following laryngectomy with cricohyoidoepiglottopexy. This complication was caused by C3-4 cervical osteophytes physically contacting the cricoid cartilage. Laryngeal microlaryngoscopy was performed, which revealed white, necrotic tissue in the posterior wall of the pharynx and persistent oedema of the neoglottis. When encountering a patient with an excessive osteophyte formation at the level of C3-4, one needs to take extra precautions when undertaking laryngectomy with cricohyoidoepiglottopexy or with cricohyoidopexy.

Positron emission tomography/computed tomography as a method for detection and monitoring of laryngeal chondritis

Infections of the laryngeal cartilages occur clinically as local pain, dysphonia, dysphagia or dyspnoea and may lead to destruction of the laryngeal skeleton. We present positron emission tomography/computed tomography (PET-CT) as a new method for detection and monitoring of laryngotracheal chondritis. We prospectively analyzed all patients undergoing PET-CT examination, of whom we were clinically suspicious of laryngeal cartilage chondritis. When a chondritis had been confirmed by PET, therapy was started, and the course of inflammation was monitored. Three patients were selected, where application of PET is demonstrated. We analyzed nine patients, five of them suffering from a present or past cancerous disease of the neck region. Four patients suffered from symptoms that occurred after percutaneous tracheotomy and long-term intubation. Chondritis of the laryngeal skeleton or upper parts of the trachea was diagnosed in seven of nine subjects by using PET-scan. PET-CT provides a reliable tool in diagnosis of laryngeal cartilage chondritis. Furthermore, it is an excellent tool in monitoring objectively presence and grade of an infection. This may play a decisive role in tracheal surgery or to estimate success of conservative therapy.

Histological evaluation of the equine larynx after unilateral laser‐assisted ventriculocordectomy

Trans-endoscopic laser surgery, such as unilateral laser-assisted ventriculocordectomy (LVC), has gained popularity in the treatment of RLN because a laryngotomy incision or general anaesthesia are not required. However, removal of the vocal fold and ventricle takes considerable laser energy and could cause collateral tissue damage, including injury to the adjacent laryngeal cartilages. To document the histological effects of laser surgery on laryngeal tissues in horses that have undergone LVC for the treatment of laryngeal hemiplegia (LH). Six horses were used: 4 with experimentally induced LH that had subsequently undergone LVC 6 months prior to euthanasia; and, 2 horses were used as controls. One of the control horses with naturally occurring LH was used to study the effect of neuropathy alone, whereas the other was subjected to euthanasia immediately following LVC to evaluate the acute effect of laser surgery. Using a band saw, each larynx was sectioned transversely at 5 mm intervals and evaluated histologically. Acutely, LVC caused thermal damage to adjacent soft tissues but did not affect the histology of the laryngeal cartilages. Six months after LVC, laryngeal cartilages were histologically normal and there was squamous metaplasia of the repaired laryngeal mucosa, resulting in restitution of the mucosal integrity. Using a diode laser in contact fashion at 20 W, LVC can be used to remove the laryngeal vocal fold and ventricle without causing laryngeal cartilage damage. Laryngeal chondritis is an unlikely consequence of LVC.

Perichondrial flap to prevent chondritis and cartilage necrosis in salvage vertical partial laryngectomy for recurrent glottic carcinoma after irradiation: A new procedure

ConclusionWe conclude that our new closure method using the posterior- and inferior-based perichondrial flap may diminish the chance of development of chondritis in salvage vertical partial laryngectomized patients with recurrent glottic cancer.ObjectivePost-radiation laryngeal chondritis with resultant cartilage necrosis is one of the most dreaded complications of radiotherapy treatment of glottic carcinoma. In the case of salvage vertical partial laryngectomy, the risk of its development may be increased. We introduce a new posterior- and inferior-based perichondrial flap procedure to prevent postoperative chondritis after salvage vertical partial laryngectomy.Material and methodsThe perichondrium is incised along the midline and upper border of the thyroid cartilage, but not along the inferior border, unlike the conventional method. Then, the posterior- and inferior-based perichondrial flap, along with the cricothyroid muscle fascia, is elevated from the midline. For closure of the pharyngeal lumen, the outer perichondrium of the lesion side is sutured to the inner perichondrium of the contralateral side to protect the larynx from pharyngeal secretion. The utility of this procedure is reviewed retrospectively in 10 patients with locally persistent or recurrent squamous cell carcinoma of the vocal cord after failed laryngeal radiation therapy between 1994 and 2001.ResultsNone of our patients developed chondritis postoperatively. The interval between the operation and removal of the tracheostomy tube ranged from 8 to 23 days (mean 12 days). Patients were able to swallow without aspiration within 7–22 days of the operation (mean 10 days). Discharge from hospital was possible after a mean recovery period of 11 postoperative days.

Toxic cure: Hyperfractionated radiotherapy with concurrent cisplatin and fluorouracil for Stage III and IVA head-and-neck cancer in the community

PurposeTo evaluate efficacy and toxicity of the Duke University chemoirradiation regimen for locally advanced head-and-neck cancer in a regional community cancer center. Methods and materialsBetween June 1998 and June 2002, 50 patients with Stage III or IVA squamous cell carcinoma of the head and neck were treated definitively with concurrent combined modality therapy (CMT). Patients received accelerated, hyperfractionated radiotherapy (AFRT), 1.2–1.25 Gy b.i.d., to a median prescribed dose of 70 Gy. Chemotherapy consisted of cisplatin 12 mg and fluorouracil 600 mg/m2 daily for 5 consecutive days during Weeks 1 and 6, followed by two cycles after AFRT. Patients with N2-N3 neck disease (n = 21; 42%) were considered for neck dissection depending on their response to AFRT and chemotherapy. Twenty-nine patients with Stage III and IVA disease treated between 1991 and 1997 with definitive RT alone served as historical controls. ResultsForty-nine patients (98%) in the CMT group completed the prescribed AFRT and 38 (76%) completed four cycles of chemotherapy. Three of 8 patients who underwent neck dissection had a pathologically complete response. The median follow-up for all patients was 23 months. The actuarial progression-free survival rate at 2 years was 75% for the CMT group vs. 40% (p <0.01) for the RT group. The overall survival rate was 80% and 43% (p <0.01), respectively, for the CMT and RT groups. Acute Radiation Therapy Oncology Group Grade 3 toxicities for the CMT group were mucosal (n = 50; 100%), skin (n = 9; 18%), and hematologic (n = 3; 6%). Late Grade 3-4 toxicities consisted of pharyngeal stricture (n = 7; 14%), laryngeal chondritis (n = 3; 6%), osteoradionecrosis (n = 2; 4%), and peripheral neuropathy (n = 1; 2%). ConclusionThis aggressive regimen of AFRT with concurrent cisplatin and fluorouracil with or without neck dissection is feasible in the community setting for patients with Stage III and IVA head-and-neck cancer. Early results indicated excellent survival, albeit with universal acute mucosal, and considerable, although acceptable, late toxicity.

Community Outcomes

Purpose: To evaluate survival and toxicity of the Duke University chemoirradiation regimen for locally advanced head and neck cancer in a regional community cancer center. Methods and Materials: Between June 1998 and April 2001, 34 patients with stage III (n = 17) or IV (n = 17) squamous cell carcinoma of the head and neck were treated with curative intent. Primary tumor sites were: oropharynx (n = 17), larynx (n = 13), oral cavity (n = 2), and hypopharynx (n = 2). Patients received hyperfractionated radiotherapy (HFx RT), 1.2–1.25 Gy twice daily, to a median prescribed dose of 70 Gy. Cisplatin 12 mg and fluorouracil 600 mg per meter square per day were prescribed for five consecutive days during the first and sixth weeks of treatment, followed by two cycles adjuvantly. Patients with initial N2–3 neck disease (n = 14) were considered for selective neck dissection depending upon response to chemoirradiation. Median follow-up was 17 months (range 5.5–34). Results: All patients completed RT as prescribed (range 69.5–77.7 Gy). Twenty-six patients completed the intended 4 cycles of chemotherapy. Four of 7 patients who underwent neck dissection had residual disease in the specimen. Median number of lymph nodes examined was 20 (range 8–35). Actuarial overall survival was 91%. Three patients have failed locally yielding relapse-free survival of 86%. Acute grade 3 toxicity was mucosal (n = 34), skin (n = 5), and hematological (n = 3). Median weight loss during treatment was 7% (range 0–16). Late grade ≥3 toxicity consisted of pharyngeal stricture (n = 5), laryngeal chondritis (n = 3), osteonecrosis (n = 3), peripheral neuropathy (n = 1), and bowel perforation (n = 1). Conclusion: This regimen of HFx RT with concurrent cisplatin and fluorouracil and selective neck dissection is feasible in the community. Early results indicate excellent survival, albeit with universal mucosal and considerable late toxicity.

Association of arytenoid chondritis with equine lymphocyte antigens but no association with laryngeal hemiplegia, umbilical hernias and cryptorchidism.

Associations were sought between ELA A1-A10 and W11 antigens and the presence of laryngeal hemiplegia, arytenoid chondritis, umbilical hernias and cryptorchidism in Thoroughbreds and/or Quarter Horses. No significant associations were detected between laryngeal hemiplegia and any ELA antigen in Thoroughbreds. The association between arytenoid chondritis and A9 was significant with a relative risk (RR) of 15.6 and aetiologic fraction (EF) of 0.80 in Thoroughbreds. There were apparent associations based on RR between A4 and A5 in Quarter Horses with umbilical hernias (RR = 7.5 and 6.1 respectively); however, these were not statistically significant. No significant associations were detected with cryptorchidism in Quarter Horses when the control population included both sexes. When only unaffected males were used as the control group, there was an apparent increase in relative risk with A6 (from RR = 1.7 to 4.3); however this was not statistically significant. Cryptorchidism in Thoroughbreds showed an increased relative risk with A5 regardless of whether the control population included males and females (RR = 4.1) or only males (RR = 4.7) but the increases were not statistically significant.

Upper airway obstruction (partial asphyxia) as the possible cause of exercise-induced pulmonary hemorrhage in the horse: An hypothesis

Summary New evidence confirmed that over 90% of Thoroughbreds have some degree of recurrent laryngeal neuropathy (RLN). This and the recognition that anything less than full extension of the atlanto-occipital joint in a racehorse implied a reduction in patency of the nasopharynx provided the basis of the hypothesis that exercise-induced pulmonary hemorrhage (EIPH) may be caused by an upper airway obstruction and that partial asphyxia could be the primary mechanism. EIPH was associated most frequently with the congenital (hereditary), left-sided, hemiparetic form of RLN. Other obstructive diseases, such as laryngeal chondritis and subepiglottic cysts, may be rare causes. Atlanto-occipital flexion on its own might also cause EIPH but more commonly was thought to be a factor which added to the upper airway obstruction resulting from RLN. Supporting evidence for this hypothesis was derived from retrospective and prospective studies of medical records; from necropsy findings on naturally occurring and experimentally produced cases of EIPH; from surveys on the prevalence of RLN; and from a literature review on asphyxia in man and animals. Clinical evidence which supported the hypothesis indicated that EIPH was a clinical sign of RLN. The epidemiology and prevalence of EIPH and congenital RLN appeared to be the same and both problems had a similar historical antiquity. It was already known that bilateral RLN caused asphyxia and EIPH and it appeared from this study that so also does untilateral RLN also does. Clinical signs of both EIPH and RLN were induced by exercise; both were capable of causing exercise intolerance; both were exacerbated by high ambient temperatures and humidity; both problems were permanent and incurable. EIPH was associated with neither the clinical signs nor the pathology of any other pulmonary disease, but was consistently associated with RLN. For it to be argued that EIPH was predominantly a clinical sign of RLN it was necessary that both problems should belong to the same etiological family. Once again, this condition seemed to be met, as EIPH and RLN both appeared more likely to be hereditary rather than environmental diseases. The pulmonary pathology of EIPH was compatible with asphyxia and similar to asphyxia in man. The bilateral symmetry of pulmonary hemorrhage in EIPH suggested an upper airway location for its causal mechanism. Secondary mechanisms might include such factors as increased upper airway resistance, increased pulmonary negative pressure, pulmonary congestion, hypoxemia, hypercapnia, pulmonary hypertension, increased capillary-alveolar pressure gradient, pulmonary edema, increased capillary permeability and microrupture of alveolar walls. Attempts to disprove the hypothesis failed. A prospective study of 201 Thoroughbreds showing EIPH revealed that all had an upper airway obstruction and 98% had RLN. The authors concluded that the hypothesis appeared to be viable. EIPH would seem to be not only a clinical sign of congenital RLN but possibly the most common sign of this common disease. In relation to RLN, the hypothesis could be restated as follows: o a) A horse with laryngeal paraplegia, a rare form of RLN, may develop pulmonary hemorrhage with minimal exercise. b) A horse with laryngeal hemiplegia, a more common form of RLN, may develop pulmonary hemorrhage with severe exercise. c) A horse with laryngeal hemiparesis, the most common form of RLN, may develop pulmonary hemorrhage with maximal exercise. From this a maxim could be distilled regarding the conditions which may be needed for inducing pulmonary hemorrhage: The greater the airway obstruction, the smaller the exercise stress; the smaller the airway obstruction, the greater the exercise stress. The study drew attention to the importance of including in the routine necropsy protocol an examination of the intrinsic muscles of the larynx. Asphyxia has not in the past been considered as a possible explanation for sudden death in the horse but it became apparent that this represented an omission.

DIPHTHERITIC CRICOID PERICHONDRITIS AND NECROSIS.Read in the Section on Laryngology and Otology, at the Forty-fifth Annual Meeting of the American Medical Association, held at San Francisco, June 5-8, 1894.

The idiopathic inflammation of the laryngeal cartilages is considered a rare affection by the greater part of the authors; who instead affirm that the laryngeal perichondritis and chondritis, as manifestations of certain constitutional illnesses, pocken, typhoid fever, syphilis, lupus, cancer, tuberculosis and mercurial intoxication, are sicknesses which are observed frequently. I think that the idiopathic perichondritis appears many or more times than the symptomatic, and if we do not take notice of it with more attention, it is because it terminates generally by resolution, and passes without being noticed, and we believe it to be an inflammation limited to the mucous membrane, and to the immediately sub mucous tissue, which penetrates into the same cartilage. For which it is called intense inflammation of the arytenoid mucous membrane, that which not only invades the immediately submucous tissue, but that which reaches the crico-arytenoid articulation, beginning in many cases the phlogosis by