Laryngeal Complaints Research Articles

Lymphoma recurrence presenting as vocal cord fixation.

Lymphomas of the larynx are a rare finding. Those with lymphoma of the larynx often present with symptoms such as vocal hoarseness, throat pain, dysphagia, and weight loss. This is a case of a 74-year-old man who presents with new onset of hoarseness and dysphagia. He has a previous history of diffuse large B-cell lymphoma (DLBCL) but was thought to be in remission at the time of presentation. On nasolaryngoscopy, there was a large, right sided, sub-mucosal mass with right vocal cord fixation. Physical exam and computed topography of the neck did not identify any adenopathy. Biopsy confirmed the recurrence of DLBCL isolated to the larynx at the time of diagnosis. The patient was treated with chemotherapy and fully recovered his vocal cord motion with resolution of his hoarseness and dysphagia. Physicians should consider lymphoma in patients presenting with laryngeal complaints especially in patients with a history of lymphoma.

Dysphonia and Throat Clearing in Singers During the COVID-19 Pandemic in Brazil

The COVID-19 pandemic in Brazil affected the lives of singers, with negative impacts of the disease on the voice, such as dysphonia and throat clearing. This study aims to evaluate the presence of dysphonia and throat clearing in singers during the COVID-19 pandemic in Brazil. This is a cross-sectional analytical study with a sample of 154 singers from all over Brazil. Data collection was carried out online, by completing the questionnaire created by the researcher using Google Forms. The following were considered the outcome variables: voice impairment and throat clearing. The bivariate analysis was performed to test the relationship between COVID-19 infection and voice impairment, COVID-19 infection and throat clearing, COVID-19 infection and laryngeal complaints (voice impairment and throat clearing). In this study, the mean age of the singers was 35.8 (Standard deviation=±10.2 years) and 59.2% were female. Most of them worked as professional singers (81.1%) and had more than 10 years of professional experience (57.4%), mainly singing pop music (85.4%). A total of 62% reported vocal alterations during the COVID-19 infection and 53% had vocal alterations after the infection, with 44.0% reporting the onset of throat clearing after the infection. There was a significant association between COVID-19 infection and having voice impairment (P=0.03; prevalence ratio - PR: 2.33; CI: 1.04-5.46). An association was observed between the onset of throat clearing and the occurrence of COVID-19 infection (P=0.001; PR: 9.13; CI: 2.47-64.42). The results indicated that there is an association between COVID-19 infection and complaints of dysphonia and throat clearing in Brazilian singers. This study demonstrates the importance of guidance to singers infected with COVID-19 by health voice processionals.

Laryngoscopic findings of age-related vocal fold atrophy are reliable but not specific.

We aimed to evaluate the reliability of laryngoscopic features of vocal fold atrophy as assessed by novice otolaryngology trainees and expert laryngologists. Two expert fellowship-trained laryngologists and three non-expert otolaryngology resident trainees were recruited to view 50 anonymised laryngo-stroboscopic examinations of patients presenting with dysphonia and non-voice, laryngeal complaints. Reviewers were asked to stratify the patient's age, provide an opinion about the presence of age-related vocal fold atrophy and specify which laryngoscopy features were present to make the diagnosis. Tertiary care laryngology practice. Two fellowship-trained laryngologists and three trainee otolaryngologists. Accuracy of age categorisation was determined and Kappa analysis was performed to assess inter-rater agreement. The mean age of patients was 54.9 years old with near equal male to female distribution. The overall accuracy of age category determination by raters was only 30.8%. Kappa analysis demonstrated fair agreement regarding the presence of vocal fold atrophy in non-expert reviewers, and moderate agreement amongst expert reviewers. Features of glottic gap, muscular atrophy of vocal folds and prominent vocal processes were all identified with high agreement (>80.0%). Our study illustrates that while raters can agree on the presence of age-related vocal fold atrophy, the findings may be non-specific and do not necessarily correlate with age.

Long-term upper aerodigestive sequelae as a result of infection with COVID-19.

ObjectivesRespiratory, voice, and swallowing difficulties after severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) may result secondary to upper airway disease from prolonged intubation or mechanisms related to the virus itself. We examined a cohort who presented with new laryngeal complaints following documented SARS‐CoV‐2 infection. We characterized their voice, airway, and/or swallowing symptoms and reviewed the clinical course of their complaints to understand how the natural history of these symptoms relates to COVID‐19 infections.MethodsRetrospective review of patients who presented to our department with upper aerodigestive complaints as sequelae of prior infection with, and management of, SARS‐CoV‐2.ResultsEighty‐one patients met the inclusion criteria. Median age was 54.23 years (±17.36). Most common presenting symptoms were dysphonia (n = 58, 71.6%), dysphagia/odynophagia (n = 16, 19.75%), and sore throat (n = 9, 11.11%). Thirty‐one patients (38.27%) presented after intubation. Mean length of intubation was 16.85 days (range 1–35). Eighteen patients underwent tracheostomy and were decannulated after an average of 70.69 days (range 23–160). Patients with history of intubation were significantly more likely than nonintubated patients to be diagnosed with a granuloma (8 vs. 0, respectively, p < .01). Fifty patients (61.73%) were treated for SARS‐CoV‐2 without requiring intubation and were significantly more likely to be diagnosed with muscle tension dysphonia (19 vs. 1, p < .01) and laryngopharyngeal reflux (18 vs. 1, p < .01).ConclusionIn patients with persistent dyspnea, dysphonia, or dysphagia after recovering from SARS‐CoV‐2, early otolaryngology consultation should be considered. Accurate diagnosis and prompt management of these common underlying etiologies may improve long‐term patient outcomes.Level of evidence4

Inhalative Treatment of Laryngitis Sicca in Patients with Sjögren's Syndrome-A Pilot Study.

Xerostomia and keratoconjunctivitis sicca are the main symptoms of Sjögren’s syndrome. Often patients also suffer from laryngeal complaints, but there is a lack of specific treatment options. The aim of this study was to evaluate the effect of a liposomal inhalation therapy. Patients with Sjögren’s syndrome were included and received a two-month period of liposomal inhalation therapy. The effect was evaluated by standardized questionnaires (patient-reported indices) and measurement of unstimulated whole salivary flow and glandular stiffness. Forty-five patients were included in this study. A comparison of baseline and therapeutic values demonstrated a significant improvement of the EULAR Sjögren’s syndrome patient reported index (ESSPRI) with a baseline of 5.0 ± 2.1 and a therapeutic value of 4.1 ± 2.4 (p = 0.012). This improvement was mainly based on the item on dryness within this score. Overall, the therapy was well tolerated. In conclusion, an inhalative application of liposomes had a beneficial effect on the reported dryness in patients with Sjögren’s syndrome. A first insight into the effect of inhalation therapy on laryngeal symptoms could thus be obtained and at the same time the basis was created on which case calculations can be carried out in the future.

Isolated Laryngeal Tuberculosis: a Diagnostic Dilemma.

Laryngeal tuberculosis is a rare condition, isolated laryngeal tuberculosis without pulmonary manifestations is even more rare. Patients usually presents with voice change, difficulty in swallowing and other constitutional symptoms. The symptoms and findings can look like malignancy in most of the cases. Here, we present a case of primary laryngeal tuberculosis without pulmonary tuberculosis. A 24year old man who presented to us with hoarseness of voice with 1year duration. Laryngoscopic study showed a proliferative growth in the epiglottis, aryepiglottic folds and vocal cords and was diagnosed to have laryngeal tuberculosis on histopathology by the typical appearance of granuloma and caseous necrosis. The patient was started on standard antitubercular therapy and he had an excellent response to the same within 6months. Isolated laryngeal tuberculosis should be suspected in patients with laryngeal complaints with no pulmonary symptoms, especially in a developing country like India where pulmonary tuberculosis is prevalent. Even though isolated laryngeal tuberculosis cases are rare, we should keep in mind the possibility of tuberculosis in the differential diagnosis of laryngeal tumors, as the incidence of tuberculosis is steadily increasing.

Behavioral Management of Laryngeal Complaints Caused by Vagal Nerve Stimulation for Medically Refractory Epilepsy

This study investigated behavioral management of dysphonia and laryngeal dyspnea secondary to use of vagal nerve stimulation (VNS) in an individual with medically refractory epilepsy. Retrospective chart review. Medical records from a single patient were reviewed. The patient received treatment with the speech-language pathologist (SLP) and laryngologist to observe patterns of laryngeal hyperfunction using biofeedback, and treatment with the SLP to learn to perform rescue breathing techniques, relaxation techniques, and awareness of muscle tension to aid the control of symptoms during activation. Data collected included neurology and laryngology notes. Neurology notes were used to track VNS settings, tolerance, and incidence of seizures. Laryngology notes included documentation of diagnosis, treatment, and measures of patient perception of severity (ie, Voice Handicap Index, Dyspnea Index, Cough Severity Index). Prior to treatment, the patient was unable to receive benefits from VNS due to severe laryngeal adverse effects, such that the device remained off for eight months postimplantation. Following treatment, the patient effectively managed laryngeal side effects and was able to tolerate increases in VNS output current, signal frequency, and duration. Voice therapy was effective in managing changes in vocal fold mobility and laryngeal tension. As the number of individuals receiving VNS for epilepsy and inflammatory conditions increases, the SLP and laryngologist may play a key role in interdisciplinary management of laryngeal side effects secondary to vagal nerve stimulation.

Laryngeal complaints and videolaryngoscopic laryngeal alterations in rheumatoid arthritis patients and its association with disease activity and duration

Background: Rheumatoid arthritis (RA) is an autoimmune systemic disease with a wide clinical presentation. The laryngeal manifestations are often masked by the articular disability often experienced in the early and late stages of the disease. Objective: Association between different laryngeal complaints and videolaryngoscopic laryngeal alterations in patients with RA, and disease activity and duration. Patients and methods: A retrospective study was conducted on 79 patients with RA. All subjects were recruited from the out-patient clinic of physical medicine, rehabilitation, and rheumatology in Al-Menoufia University Hospitals during the period from March 2015 to March 2017. All patients were subjected to both phoniatric and rheumatological assessment. Results: Patients with phonasthenic symptoms and globus pharynges had significantly (p=0.01, 0.008 respectively) higher disease duration than patients without. No significant association found between rheumatoid arthritis duration and different videolaryngoscopic laryngeal alterations, patient’s self-assessment of the impact of laryngeal complaints on their lives, and auditory perceptual assessment (APA) of patient’s voice characters. As regards rheumatoid disease's activity no significant correlation has been established (p&gt;0.05) with different laryngeal complaints except for patients in remission who had higher prevalence of intermittent dysphonia than patients with low activities. Rheumatoid disease's activity had no significant association with different laryngeal findings except those with moderate activity; they had significantly higher prevalence of vocal folds nodules than patients with high activity and patients in remission. Conclusion: A significant association between the disease's duration and presence of laryngeal complaints, dysphonia, and its persistence has been established. Also, patients with phonasthenic symptoms and globus pharynges had significantly higher disease duration than patients without. Rheumatoid diseases activity had significant association with different laryngeal complaints in patients with remission that had higher prevalence of intermittent dysphonia than patients with low activities. No significant association between the disease activity and different laryngeal findings that has been found except for patients with DAS-28&gt;3.2, they had significantly higher prevalence of rheumatoid nodules.

Laryngeal assessment of patients with rheumatoid arthritis using laryngeal photodocumentation

Objective The aim was to assess the prevalence of dysphonia and laryngeal changes upon videolaryngoscopic examination of patients with rheumatoid arthritis (RA). Background RA effects on larynx vary from mild asymptomatic effect to life-threatening conditions. Many authors have emphasized the need of studies in different communities on its effect. In Egypt, the knowledge regarding its manifestations on the larynx, as well as its laryngeal alterations, is limited. Patients and methods A total of 79 patients diagnosed as having RA in Menoufia University Hospitals from March 2015 to March 2017 were assessed by taking history and asking about different laryngeal complaints followed by telescopic videolaryngeal examination. Results The estimated prevalence of laryngeal complaints in patients with RA was 57%. The most frequent complaints were globus pharyngeus in 53.2% of patients followed by phonasthenic symptoms in 32.9% of the patients. Dysphonia prevalence was 25.3%. Regarding videolaryngoscopic findings, the prevalence of changes was present in 86.15% of the patients. Most common finding has been posterior laryngitis, which was found in 78.5% of patients, followed by glottic gap in 34.2% and vocal folds rheumatoid nodules in 26.6% of them. Conclusion Laryngeal complaints and videolaryngoscopic morphological findings are prevalent among patients with RA, with a prevalence rate of 57 and 86.15%, respectively. The most frequent complaints were globus pharyngeus in 53.2% of patients followed by phonasthenic symptoms in 32.9% of the patients. Most common videolaryngoscopic findings have been posterior laryngitis, which was found in 78.5% of our patients, followed by glottic gaps in 34.2%.

A study of relationship between reflux symptom index and reflux finding score in patients with laryngopharyngeal reflux

Background: Diagnosis of laryngopharyngeal reflux (LPR) is considered as a challenge by otorhinolaryngologists. Reflux symptom index (RSI) and reflux finding score (RFS) are two diagnostic tools which yield in the diagnosis of LPR. The aim of the study was to establish an association between RSI and RFS in patients with LPR. Materials and Methods: A cross-sectional analytical study was conducted on 30 patients who were enrolled. RSI score and RFS were obtained as per pro forma. RSI score ≥13 and RFS ≥7 were indicated to be positive for LPR. Results: Of the 30 patients enrolled, males and females were 16 and 14, respectively. Mean RSI score was 23.83 (standard deviation [SD] = 9.07) and mean RFS was 16.07 (SD = 7.31) were obtained. The most common presenting symptom was lump in the throat (80%) and the sign was hyperemia/erythema (83.33%). A strong correlation of 0.86 (P = 0.01) was established between RSI and RFS. Conclusion: LPR plays a key role in patients with laryngeal complaints. RSI and RFS can be implemented easily in the diagnosis of LPR.

Allergic laryngitis: unraveling the myths

This article provides a thorough review of the literature highlighting the articles that have advanced our knowledge about the sensitivity of the larynx to allergens in the air or ones consumed. This area of inquiry requires continued interest and investigation. As the field of clinical laryngology changes, and more information is discovered about the possible causal association between allergy and vocal pathologies, practicing otolaryngologists, allergists, and other medical professionals may discover more comprehensive methods to evaluate and treat their allergic patients, particularly those who present with complaints of dysphonia, dysphagia, laryngopharyngeal reflux (LPR), and/or dyspnea. There continues to be epidemiological studies designed to describe the relationship of allergy to vocal symptoms and signs. Both population and smaller studies have recently attempted to link these two conditions. Unfortunately, the patient with chronic laryngeal complaints is often tagged by default with the diagnosis of LPR and treated with proton pump inhibitors, which are not always beneficial. The endoscopic assessment may not be as reliable to make the diagnosis of LPR as the examination is subjective and the inter-rater reliability is low. It has been demonstrated by direct laryngeal provocation studies that sticky-viscous endo-laryngeal mucous is the only reliable finding consistently associated with allergy potential allergic tissue reactivity. The interrelationship of allergic sensitivity and chronic laryngitis in certain individuals is becoming clearer because our knowledge of inquiry has increased and the available routine technology to diagnose these conditions has remarkably improved. Notwithstanding these advancements, much more research is needed on this subject to reduce the frequency of mis-diagnoses and mis-management of allergic patients.

Laryngopharyngeal Reflux: Is It the Real Culprit in Patients with Laryngeal Complaints?

ABSTRACT Aim The aim of this study is to evaluate the role of laryngopharyngeal reflux (LPR) in patients with laryngeal complaints and study the correlation between reflux symptom index (RSI) and reflux finding score (RFS). Materials and methods This is a study of 104 patients, who presented in the ear, nose, and throat outpatient department at the Civil Hospital, Ahmedabad, India, from April 2015 to April 2016, with complaints like change of voice, chronic cough, foreign body sensation, throat clearing, difficulty swallowing, and regurgitation. All the patients were examined with 90° endoscope by a single examiner, and an RSI ≥13 was considered as indicative of reflux. Observation and discussion The mean age of the 104 patients was 47.2 years. The male-female ratio was 1:1.8. The RSI ranged from 5 to 44, with a mean of 22.99 and standard deviation (SD) of 7.43. The RFS ranged from 4 to 22, with a mean of 11.04 and SD of 3.07. Both the parameters showed high correlation (correlation coefficient 0.98). Conclusion The LPR plays an important contributory role in patients with laryngeal complaints. The RFS and RSI can be used as routine parameters in establishing the diagnosis of reflux. How to cite this article Shah RV, Vishwakarma R. Laryngopharyngeal Reflux: Is It the Real Culprit in Patients with Laryngeal Complaints? Int J Phonosurg Laryngol 2017; 7(1):6-9.

Laryngopharyngeal reflux: an overview on the disease and diagnostic approach

Background Laryngopharyngeal reflux (LPR) can be defined as chronic symptoms or laryngeal mucosal damage caused by the abnormal reflux of gastric contents into the upper airway. LPR plays an important role in up to 50% of laryngeal complaints that present in the otolaryngeal clinic, and the symptomatology of LPR has more different presentation. LPR is suspected in the presence of symptoms of hoarseness, dysphagia, cough, globus, excessive mucus, throat pain, throat clearing, and laryngospasm. Diagnosis of LPR is confirmed using the following: reflux symptom index (RSI), laryngoscopic examination [reflux finding score (RFS)], and esophagogastroduodenoscopy. Patients and methods A cross-sectional study was conducted on 60 patients with typical gastroesophageal reflux disease (GERD) symptoms and laryngeal complaints; these studied patients were recruited from patients who attended the outpatient clinic of Tropical Medicine and Gastroenterology, and Phoniatric Unit, Assiut University Hospital. The symptom questionnaire and the classification proposed by Belafsky and his colleagues (RSI) are used and upper endoscopy is performed for the diagnosis of GERD patients. Nasofibrolaryngoscopy for all these patients was performed to compare the results (RFS). Psychiatric assessment was performed by a psychiatric specialist using symptoms checklist revised 90. Patients with a score more than 60 will be re-evaluated using the following questionnaires: Hamilton checklist of symptoms of depressive illness and Hamilton rating scale for anxiety. Results All studied patients showed positive RSI (100%) and diagnostic endoscopy showed GERD in 58 (96.7%) patients, and 32 (53.3%) of them were found to have a positive finding in laryngoscopy; the findings were as follows: vascular congestion and vocal cord hyperemia in 32 (100%) patients, vocal cord edema in 26 (81%), phonatory gap in 13 (40%), subglottic edema in 12 (37%), vocal cord swelling in 10 (31.25%), and contact granuloma in eight (25%). A positive significant correlation was detected between phonasthenia symptoms, mostly lump sensation, hoarseness, throat clearing, and dry mouth (symptoms), and laryngeal finding (RFS), except for difficulty in swallowing saliva. There is a strong association between psychological symptoms and the presence of LPR; the most commonly detected manifestation was anxiety, and there was a positive significant correlation with anxiety and a negative significant correlation between depression and reflux symptoms. Conclusion RSI and RFS could be useful for the diagnosis and evaluation of LPR in patients with GERD complaining of laryngeal symptoms. Psychological intervention can improve the general well-being and quality of life of patients with gastrointestinal symptoms.

Laryngeal Manifestations of Neurofibromatosis.

To describe the range of findings in patients with neurofibromatosis (NF) presenting to a laryngology clinic and to analyze the etiologic factors of vocal fold dysfunction in this cohort. Case series with chart review. Tertiary laryngology practice. All cases of NF presenting to an academic laryngology practice were retrospectively reviewed (August 2005 to May 2014), with a total of 34 cases. Demographic data, symptoms, and endoscopic examination findings were reviewed. Etiologic factors of laryngeal complaints were analyzed with reference to NF-associated pathologies and surgical history. Thirty-four patients with NF-1 or NF-2 were evaluated, and 28 of these patients (6 NF-1 and 22 NF-2) had laryngeal pathology. The most common presenting symptoms were vocal weakness (n = 21), dysphagia (n = 5), and globus (n = 4). Three patients had NF-related vocal fold masses on examination, including 2 neurofibromas and 1 schwannoma. Unilateral vocal cord paralysis was seen in 17 patients; bilateral paralysis was observed in 5 patients. Of patients with unilateral or bilateral paralysis, 20 had intracranial masses (vestibular schwannoma, meningioma, or skull base tumors), and 16 had previously undergone surgery for these lesions. Of the patients with NF-associated intracranial tumors, 87.0% presented with vocal cord paralysis, whereas only 40.0% of those without intracranial masses had paralysis (P = .0560). Seven patients underwent medialization procedures. Neurofibromatosis patients may present to laryngology clinic with primary laryngeal tumors or, more commonly, unilateral or bilateral paralysis. Otolaryngologists should be keenly aware of vocal fold paralysis caused by the NF-associated tumors, with particular attention to bilateral paralysis in NF-2.

Laryngopharyngeal reflux disease in a series of Sri Lankan patients

Laryngopharyngeal reflux disease (LPR) occurs due to reflux of gastric contents into the larynx, pharynx and upper aerodigestivetractas a result of upper oesophageal sphincter dysfunction. Other aliases commonly used are extraesophageal reflux, reflux laryngitis or posterior laryngitis. LPR contributes up to 50% of laryngeal complaints hence; it is commonly encountered in clinical practice. LPR is present in 4-10% of those with gastro oesophageal reflux disease (GORD) while, about 20-70% with LPR has symptoms of GORD. However, there is paucity of data regarding LPR, its characteristics and associations in a Sri Lankan population. Therefore, this study aimed to describe the demographic characteristics, presenting symptoms, dietary patterns and associations and laryngoscopic findings in the study population. It also explores the relationship between the reflux symptoms index (RSI) and the reflux findings score (RFS) and the effect of treatment on the above parameters. Ceylon Journal of Otolaryngology Vol.4(1) 2015 pp.9-12

Lower Oropharyngeal Acid Exposure and Higher Psychological Distress Exists Amongst Subjects With Laryngeal Symptoms and Response to PPI Therapy

Introduction: Predicting therapeutic response in patients with laryngopharyngeal reflux (LPR) symptoms is challenging. Consequently, patients with suspected LPR often receive empiric proton-pump inhibitor (PPI) therapy and up to 50% may not respond. The Restech Dx-pH probe is a transnasal catheter that measures oropharyngeal pH. We hypothesized that higher oropharyngeal acid burden is associated with a greater PPI response. The aims of this study were to (1) correlate oropharyngeal pH probe parameters with PPI response and (2) evaluate if alternative clinical surrogates predict PPI response. Methods: This was a physician blinded prospective cohort study conducted at a tertiary care teaching institution between 1/2013 and 10/2014. Adult subjects with laryngeal symptoms >1 month and a Reflux Symptom Index score (RSI) ≥13 off PPI therapy 2 weeks prior to study were recruited from an otolaryngology clinic. Laryngoscopy and oropharyngeal pH assessment with the Restech Dx-pH system were first performed, followed by an 8 to 12 week trial of omeprazole 40 mg once daily. Prior to, and following PPI therapy, subjects completed various symptom questionnaires [Table 1]. PPI response was defined as > mean delta RSI (difference between pre- and post-PPI therapy RSI).Table 1: Clinical variables by PPI Responder & Non-responder groupsResults: Of 34 subjects, 15 (44%) had a PPI response. Percent time of oropharyngeal pH below 5.0 did not correlate with change in RSI (Spearman's rho -0.07, P=0.7); similar trends were seen for pH < 4.0, 5.5 & 6.0. Low acid exposure ( < 1%) was significantly associated with PPI response when compared to high acid exposure (≥1%) [Figure 2]. PPI responders had higher psychological distress scores prior to treatment and a significantly greater reduction in post-treatment Brief Symptom Index, Negative Affect, and Heartburn Vigilance Scale scores. Baseline and delta GerdQ scores were significantly higher in the PPI responder group.Figure 2Conclusion: Contrary to our hypothesis, low oropharyngeal acid burden was associated with PPI symptom response, suggesting a non-acid mechanism of laryngeal symptoms in this group. PPI responders had higher psychological distress, indicating an association between cognitive affective symptoms and laryngeal complaints and supporting the placebo effect of PPI therapy. The etiology of laryngeal symptoms is undoubtedly complex, and the role of oropharyngeal pH testing to predict PPI response remains unclear.Figure 1

Dysphonia associated with the use of inhaled corticosteroids.

This article discusses the relationship between inhaled corticosteroids and dysphonia, with discussion of the therapeutic use of inhaled steroids in laryngeal disease and a review of negative laryngeal effects of this class of medication in patients with reactive airway disease. Although prescribed for their anti-inflammatory effects (predominantly for pulmonary disease and less often for laryngeal conditions), corticosteroid inhalers can cause laryngeal inflammation. This may relate to chemical irritation from the inhaler itself as well as fungal inflammation related to opportunistic candidiasis that may accompany inhaler use. Patients who suffer from dysphonia because of inhaler use may improve if switched to another inhaler. Studies suggest that ciclesonide metered-dose inhaler may have less oropharyngeal deposition and therefore be associated with reduced oropharyngeal candidiasis and dysphonia compared with other inhaled corticosteroids. Corticosteroid inhalers are a common cause of dysphonia and their use should be investigated in any patient with laryngeal complaints.

Association of cagA Positive Helicobacter pylori Infection and Laryngeal Squamous Cell Carcinoma: A PCR Approach.

Helicobacter pylori is a gram-negative bacillus causing benign and malignant gastric diseases such as gastroesophageal reflux (GER). In larynx, H. pylori causes chronic inflammation and mucosal destruction that may lead to malignant changes. Although, H. pylori poses several virulence factors, cagA is probably the main factor in this regard. To evaluate the role of cagA gene in laryngeal squamous cell carcinoma (LSCC), a case-control study was conducted on patients with laryngeal complaints during 2010-2012. Seventy-two patients with LSCC (case group) and 72 patients without malignancy (control group) were included in the study. The H. pylori and cagA factor were assessed in laryngeal specimen of patients with PCR technique. 33% of patients in case group (24 patients) and 45.8% (33 patients) of control group were positive for H. pylori. CagA gene was present in 13.8% (10 patients) of case group specimens and 31.9% (23 patients) of control group. This difference was statistically significant with Mantel-Haenszel statistical test analyses. The results showed that patients with LSCC have significantly lower incidence of laryngeal H. pylori infection and cagA virulence factor than those without LSCC. Findings from this study support the protective effect of H. pylori infection against laryngeal cancer.

Endotrakeal Entübasyon ve Laringeal Maske Çeşitlerinin Ses Kalitesi Üzerine Etkileri

Amaç: Endotrakeal entübasyon (ETE) ve laringeal maske airway'ler (LMA) postoperatif dönemde değişik oranlarda laringeal semptomlara ve sesin akustik özelliklerinde değişikliklere neden olmaktadırlar. Bu çalışmada; ETE, klasik LMA, proseal LMA ve I gel LMA'nın laringeal semptomlar ve sesin akustik analizindeki parametrelere etkilerini karşılaştırmayı amaçladık. Gereç ve Yöntemler: Çalışmaya, ses oluşumunu etkilemeyen alt batın ve ekstremite cerrahisi uygulanan 80 hasta dahil edildi. Preoperatif hemen, postoperatif 2. saat ve postoperatif 24. saat içerisinde ses kısıklığı, globus faringeus (boğazda yabancı cisim hissi), boğaz temizliği yapma hissi, boğaz ağrısı, ses kaybı, seste kabalaşma ve seste çatallaşmanın sorgulandığı klinik anket formu dolduruldu, ve sesten izole odada akustik analiz yapıldı. Akustik analizde bazal frekans, jitter (her bir periyottaki temel frekans varyasyonları), shimmer (her bir periyottaki temel amplitüd varyasyonları), harmonik/gürültü oranı ve normalleştirilmiş gürültü enerjisi parametreleri karşılaştırıldı. Bulgular: Grup ETE'de ses kısıklığında preoperatif ve postoperatif 2. saat arasında diğer gruplara göre anlamlı düzeyde artış gözlemlendi (p=0,005). Boğaz temizliği yapma hissinde istatistiksel anlamlılık bulundu. T2 ve T24 zaman periyotlarında gruplar ses kısıklığı bakımından karşılaştırıldığında, istatistiksel olarak anlamlı artış saptanmadı (sırasıyla p=0,179, p=1,000) Klasik LMA grubunda boğaz temizliği yapma hissinde istatistiksel anlamlı artış bulundu. Bu klinik değerlendirmeler postoperatif erken dönemde mevcut olup, 24. saatte normal değerlerine geriledi. Akustik analizde sadece proseal LMA grubunda postoperatif 2. saatte jitter ölçümünde anlamlı fark bulundu. Diğer akustik ölçüm parametrelerinde anlamlı farklılık bulunmadı. Sonuç: Endorakeal entübasyon ve klasik LMA kullanımının postoperatif erken dönemde ses fonksiyonları üzerine etkisi olabileceği, yeni geliştirilen, özellikle hava ile şişirilmeyen jel yapılı LMA'ların laringeal yakınmalara ve ses fonksiyonlarına minimal etkili olabileceği sonucuna varıldı.

Ultrasonography diagnostic validity in structural and functional laryngeal disorders

Objectives The aim of the study was to assess the role of ultrasound in detecting and characterizing laryngeal anatomy with a special focus on vocal cords and study of some laryngeal disorders and their possible ultrasonographic appearance. Background Laryngeal examination with rigid endoscopy has the advantages of producing large, bright images. Unfortunately, patients with a sensitive gag reflex, patients with limited jaw or neck mobility, or those with stridor may not tolerate laryngeal endoscopic examination. It is also difficult in most infants and children. Thus, high-resolution (frequency) laryngeal ultrasonography may provide an alternative diagnostic tool. Patients and methods The study group included 50 patients who had complaints related to the larynx such as hoarseness of voice, chronic cough, chocking attacks, stridor, or neck swelling. These patients were referred from the ENT outpatient clinic. Results In the present study, of the 50 patients with laryngeal complaints, 10 patients (20%) were normal, 10 (20%) had vocal fold palsy, 10 (20%) had laryngeal tumor, four (8%) had vocal fold ulcer, four (8%) had vocal fold nodules, three (6%) had vocal fold polyp, three (6%) had vocal fold cyst, two (10%) had vocal fold dysfunction, two (10%) had interarytenoid edema, and two (10%) had laryngocele. Conclusion High-resolution laryngeal ultrasound can be used for assessment of vocal fold lesions, tumors, and mobility. Because of its real-time ability and noninvasive nature, ultrasonography is considered an effective diagnostic tool for the proper assessment of the vocal fold mobility rather than other diagnostic modalities, but is less effective in vocal cord ulcers and small lesions because of a limitation of the air-mucosa interface