Laryngeal Findings Research Articles

Outcomes of acid suppressive therapy in patients with posterior laryngitis

Objective: To evaluate the results of acid suppressive therapy (AST) in posterior laryngitis (PL) patients with and without documented pharyngeal acid reflux (PAR). Methods: The charts of all patients with PL who received AST and who had undergone pharyngeal pH monitoring were reviewed. Results of AST in patients with PL with and without documented PAR were evaluated by laryngeal examination, symptom scores, and self-reported overall benefit. Results: Thirty-nine patients with PL had received AST and undergone pharyngeal pH monitoring. Follow-up ranged from 2 to 27 months. Laryngeal findings were improved in patients with and without PAR. Pretreatment total symptom scores were significantly greater than that of posttreatment in patients with and without documented PAR. Overall benefit from AST was reported by the majority of PL patients with and without documented PAR. Conclusion: These findings support the use of AST to reduce or eliminate signs and symptoms in PL regardless of documentation of PAR. (Otolaryngol Head Neck Surg 2001;124:16-22.)

Effect of Aggressive Therapy on Laryngeal Symptoms and Voice Characteristics in Patients with Gastroesophageal Reflux

Gastroesophageal reflux (GER) is associated with a variety of laryngopharyngeal signs and symptoms. Injury of the laryngopharynx as a result of GER can be refractory to conventional antireflux therapy. This prospective study was undertaken to evaluate the prevalence of laryngopharyngeal signs and symptoms in patients with documented GER and to assess the response to a high-dose combination antireflux therapy consisting of cisapride and pantoprazole. Twenty-two patients with symptoms of GER were enrolled. After baseline evaluation using a history questionnaire for symptoms, laryngeal endoscopy and vocal acoustic analysis, patients were started on treatment consisting of pantoprazole 40 mg b.d. and cisapride 20 mg twice daily. Repeat history and otolaryngologic evaluation was performed at 4 weeks. Laryngopharyngeal symptoms were frequent in most patients, with throat clearing and globus being the most prevalent symptoms followed by vocal fatigue and excess mucus production. Almost 90% of the patients had abnormal endoscopic laryngeal findings but the acoustic parameters did not show any abnormal results except for mild elevation in the shimmer. After treatment, all symptoms and endoscopic abnormalities improved significantly except for intermittent dysphonia and laryngeal mucosal redness. Acoustic abnormalities did not change significantly following therapy. Laryngeal symptoms and voice abnormalities are highly prevalent in patients with GER. Combination antireflux therapy with a proton pump inhibitor and a prokinetic agent results in rapid symptomatic and endoscopic response in the majority of patients.

Voice characteristics, effects of voice therapy, and long-term follow-up of contact granuloma patients

This study evaluates the laryngoscopic findings and voice characteristics of male contact granuloma patients before and after voice therapy and at a follow-up about 9 years later. Pre- and posttherapy recordings as well as follow-up recordings were made for 19 granuloma patients. Pretherapy revealed the most salient perceptual voice characteristics were low pitch, monotony, and a high degree of vocal fry and hyperfunction. Interjudge reliability for these traits was high. Immediately following therapy the healed patients (n = 10) had a decrease in hyperfunction, vocal fry, and monotony, while the unhealed patients (n = 9) had an increase in hyperfunction and vocal fry decreased only marginally. Monotony decreased significantly in this group. As regards the acoustic analyses, no significant differences were found in mean fundamental frequency (F0) or perturbation. At the follow-up assessment 4 patients had granuloma while 15 had normal laryngeal status. Perceptually their voice characteristics resembled those pretherapy independently of the laryngeal findings. The results suggest that reduced hyperfunction and decreased vocal fry may create better circumstances for the healing process at the posterior glottis.

Laryngeal histologic findings in infants with palatal defects with or without craniofacial malformations.

The objective of this study was to determine whether specimens from infants with palatal defects (PDs) with or without craniofacial malformations (CFMs) exhibit aberrant laryngeal histologic findings compared with specimens from normal infants. Ten laryngeal specimens from infants with PDs with or without CFMs were histologically compared with 7 laryngeal specimens defined as normal from the same collection. Both groups were similar in terms of demographics and airway manipulation. All infants were prelingual. Comparisons were made at 3 levels: supraglottic, glottic, and subglottic. Histologically, no significant differences in primary laryngeal structures were found between the PD with or without CFM group and the group defined as normal. Acquired and intubation-type injuries, such as inflammation, ulceration, capillary congestion, and scar tissue, were more prevalent and severe in the study group. The primary laryngeal histologic findings of specimens from individuals with PDs with or without CFMs do not differ substantially from those from normal individuals; however, individuals with PDs do appear to be somewhat more susceptible to intubation injury and other acquired laryngeal injury. Meticulous airway management is essential.

Anterior submucous laryngeal cleft

Upper airway obstruction in the newborn is frequently due to congenital laryngeal anomalies. One of these, the posterior laryngeal cleft, is often associated with subglottic stenosis and respiratory difficulty. This discussion of the anterior laryngeal cleft reports findings in an infant who required intubation immediately after birth and survived only 3 days. The anterior cricoid cleft was associated with severe congenital anomalies including congenital tracheal stenosis.

歯性感染症から喉頭蓋前隙に膿ようを形成した１例

The preepiglottic space is located in front of the epiglottis. It is an extremely narrow space surrounded by the hyoid bone, periosteum and ligament. We encountered a rare case of phlegmon of the oral floor that spread posteroinferiorly along the geniohyoid muscle, forming an abscess in the preepiglottic space.A 51-year-old man presented to our clinic with remarkable swelling and pain in the oral floor and submandibular region. He was admitted, treated by incision to promote pus discharge, and given antibiotics. There after, the main symptoms improved rapidly. However, he complained of swallowing pain and dyspnea. Computed tomography revealed an abscess in the posterior region of the hyoid bone. The region is the preepiglottic space, often invaded by laryngeal cancer. The patient was successfully treated because of an accurate diagnosis, and re-incision was done to promote pus discharge from preepiglottic space. When inflammation spreads into the preepiglottic space, clinical findings are often sparse because this region is surrounded by the hyoid bone. Computed tomographic and laryngeal fiberscopic findings are useful in diagnosis.

Incidence of abnormal laryngeal findings in asymptomatic singing students

Objective: Abnormalities in the mucosal lining of the vocal folds may interfere with the normal vibratory patterns and result in vocal limitations, especially for singers whose demands are great. A prospective, longitudinal study was undertaken to investigate the incidence of laryngeal abnormalities in asymptomatic singing students. Methods: Sixty-five singing students at the school of music underwent videostroboscopic evaluation and completed a comprehensive questionnaire. Videos were rated by 3 experienced clinicians, and interrater reliability was calculated. Results were correlated with demographic factors, background medical history, and singing history. Results: Five students (8.3%) exhibited early signs of benign vocal fold lesions (2 with nodules and 3 with cysts). A high incidence of posterior erythema (n = 44; 73.4%), suggesting possible reflux, was found. Conclusions: A surprisingly high number of otherwise asymptomatic singing students demonstrated abnormal laryngeal findings. Their relationship with vocal performance will be addressed as well as implications for preventative measures. (Otolaryngol Head Neck Surg 1999;121:69-77.)

咽喉頭異常感とＧＥＲＤ Ｐｒｏｔｏｎ Ｐｕｍｐ Ｉｎｈｉｂｉｔｏｒを用いた臨床成績

Compared to the situation in western countries, reflux esophagitis is relatively rare in Japan. With the recent trend towards aging and the increasingly Westernized diet in this country, the incidence of this disease is now on the rise. Researchers have long highlighted anassociation between refluxes ophagitis and vocal cord nodules, nonspecific inflammatory granulation and other conditions of the larynx. In the West, reflux esophagitis is regarded as important from the viewpoint of managing dysphonia.In the present communication, we report the results of an investigation into the etiological factors associated with reflux esophagitis. Endoscopic examination of the esophagus was performed in order to detect the presence of lesions in esophageal mucosa of 49 patients. These patients had laryngeal or hypopharyngeal redness, swelling or drug-resistant reflux esophagitis, and were selected, from patients with paresthesias of the pharynx and larynx who attended 7 institutions between June 1995 and February 1997. Proton pump inhibitors were administered to these patients, and thier therapeutic efficacy investigated by comparing the subjective symptoms, laryngeal or hypopharyngeal findings, and endoscopic findings. The assessment of the severity of the endoscopic findings was performed using the Los Angeles classification with the addition of Grade-O, in which no mucosal breaks were observed; thus the classification had 5 grades: G-O, G-A, G-B, G-C, and G-D.Prior to the treatment, 33 patients were evaluated by endoscopy as G-O, 10 as G-A, 2 as G-B, 4 as G-C, and 0 as G-D. Furthermore, a high incidence of reflux esophagitis was observed 32.7% (16/49). The improvement in subjective symptoms after 8 weeks of treatment with lansoprazole was 75.5% (37/49). On endoscopy, there was no deterioration of the symptoms observed in the G-O patients. In contrast, the degree of improvement in the 16 patients assessed as G-A and above was 75% (12/16). Based on these findings, we conclude that reflux esophagitis frequently shows a strong association with paresthesias of the pharynx and larynx, and that treatment with lansoprazole is effective for this condition.

‘Hidden’ laryngeal injuries in homicidal strangulation: how to detect and interpret these findings

These studies were designed to demonstrate that the usual method of laryngeal dissection carries a significant risk of overlooking important laryngeal injuries. Formalin-fixed hyoid-larynx complexes were prepared in a prospective forensic study involving 191 cases of homicidal strangulation, 1984 to 1997. The basic steps of the applied method included: complete resection of the thyroid cartilage, a horizontal incision through the cricoid cartilage before opening the larynx dorsally, inspection of the laryngeal joints, and incisions of the laryngeal muscles. Using this procedure allowed us to detect the following injuries, which otherwise would have been destroyed or overlooked: (a) 17 incomplete fractures restricted to the dorsal surfaces of the thyroid laminae and 10 incomplete or non-dislocated fractures of the cricoid cartilage. In 7 cases, such a hidden fracture was the only laryngeal injury resulting from neck compression. (b) Extensive laryngeal muscle hemorrhages, especially of the vocal folds, were found in almost half of all cases, more rarely in strangulation by ligature and more frequently in manual strangulation. Gross hemorrhages were the decisive local laryngeal finding in 19 cases. (c) Laryngeal joint injuries (bleedings) were found in 18% to 52% of the different strangulation types. (d) Hemorrhages of the laryngeal mucosa were common findings that occur in about 60% of all cases; only in rare cases do such bleedings have a special diagnostic value. The quantity and significance of findings obtainable from complete preparation clearly document Camps's demand made in 1976 to dispense with the usual laryngeal dissection technique (dorsal scissor incision through the cricoid cartilage), at least in (questionable) strangulation cases.

“Hidden” Laryngeal Injuries in Homicidal Strangulation: How to Detect and Interpret These Findings

These studies were designed to demonstrate that the usual method of laryngeal dissection carries a significant risk of overlooking important laryngeal injuries. Formalin-fixed hyoid-larynx complexes were prepared in a prospective forensic study involving 191 cases of homicidal strangulation, 1984 to 1997. The basic steps of the applied method included: complete resection of the thyroid cartilage, a horizontal incision through the cricoid cartilage before opening the larynx dorsally, inspection of the laryngeal joints, and incisions of the laryngeal muscles. Using this procedure allowed us to detect the following injuries, which otherwise would have been destroyed or overlooked: (a) 17 incomplete fractures restricted to the dorsal surfaces of the thyroid laminae and 10 incomplete or non-dislocated fractures of the cricoid cartilage. In 7 cases, such a "hidden" fracture was the only laryngeal injury resulting from neck compression. (b) Extensive laryngeal muscle hemorrhages, especially of the vocal folds, were found in almost half of all cases, more rarely in strangulation by ligature and more frequently in manual strangulation. Gross hemorrhages were the decisive local laryngeal finding in 19 cases. (c) Laryngeal joint injuries (bleedings) were found in 18% to 52% of the different strangulation types. (d) Hemorrhages of the laryngeal mucosa were common findings that occur in about 60% of all cases; only in rare cases do such bleedings have a special diagnostic value. The quantity and significance of findings obtainable from complete preparation clearly document Camps's demand made in 1976 to dispense with the usual laryngeal dissection technique (dorsal scissor incision through the cricoid cartilage), at least in (questionable) strangulation cases.

Type I posterior laryngeal clefts.

Posterior laryngeal clefts (PLCs) are described in the literature as rare laryngeal abnormalities. The authors believe type I clefts are much more common than previously reported. In two busy pediatric tertiary care centers, such clefts are the second most common congenital laryngeal finding at rigid endoscopy, second only to laryngomalacia. PLCs frequently present with symptomatology that can be attributed to other common disease processes and are often undiagnosed unless the surgeon maintains a high index of suspicion and specifically examines the posterior glottis by palpation during microlaryngoscopy. This report presents a series of 41 patients with type I PLCs, reviews their subtle and often confusing presenting signs and symptoms, and describes a simple yet reliable method of diagnosis.

Incidence of abnormal laryngeal findings in singing students

Incidence of abnormal laryngeal findings in singing students

36: Incidence of Abnormal Laryngeal Findings in Singing Students

36: Incidence of Abnormal Laryngeal Findings in Singing Students

下咽頭喉頭所見と胃食道逆流症の関連について

下咽頭喉頭所見と胃食道逆流症の関連について

Association of Esophageal Reflux and Globus Symptom: Comparison of Laryngoscopy and 24‐Hour pH Manometry

Thirty-one patients with globus sensation were examined by dual probe pH manometry and videolaryngoscopy to investigate the role of gastroesophageal reflux disease in association with globus. Abnormal laryngeal findings, which included grossly abnormal and subtle changes, were seen in 17 patients. These findings included pharyngeal erythema (12 patients), interarytenoid pachydermia (11), laryngeal edema (11), arytenoid erythema (9), and thick mucus (3). Twenty-one of the 31 pH probe studies showed gastroesophageal reflux disease (14 grossly abnormal, 6 borderline abnormal) with Johnson and DeMeester composite scores for the distal probe. There was no correlation between the upright and supine position, nor was there correlation between positive laryngeal findings and a positive pH probe study. We conclude that globus sensation is often a nonspecific symptom of laryngopharyngeal irritation in which gastroesophageal reflux disease plays a significant role. Combining careful laryngoscopic examination with pH probe studies can help to differentiate between patients with organic pathology caused by gastroesophageal reflux disease and patients with other nonspecific laryngopharyngeal disorders.

Association of esophageal reflux and globus symptom: Comparison of laryngoscopy and 24-hour pH manometry

Thirty-one patients with globus sensation were examined by dual probe pH manometry and videolaryngoscopy to investigate the role of gastroesophageal reflux disease in association with globus. Abnormal laryngeal findings, which included grossly abnormal and subtle changes, were seen in 17 patients. These findings included pharyngeal erythema (12 patients), interarytenoid pachydermia (11), laryngeal edema (11), arytenoid erythema (9), and thick mucus (3). Twenty-one of the 31 pH probe studies showed gastroesophageal reflux disease (14 grossly abnormal, 6 borderline abnormal) with Johnson and DeMeester composite scores for the distal probe. There was no correlation between the upright and supine position, nor was there correlation between positive laryngeal findings and a positive pH probe study. We conclude that globus sensation is often a nonspecific symptom of laryngopharyngeal irritation in which gastroesophageal reflux disease plays a significant role. Combining careful laryngoscopic examination with pH probe studies can help to differentiate between patients with organic pathology caused by gastroesophageal reflux disease and patients with other nonspecific laryngopharyngeal disorders. (Otolaryngol Head Neck Surg 1996;115:502-7.)

Suction-irrigation attachment for the flexible endoscope without integrated operating channel

Endoscopic inspection of the larynx in patients with long-term intubation or patients pharyngolaryngeal injuries is frequently obscured by blood and other secretions. We developed a simple procedure to improve visibility. A flexible 4-mm endoscope without an operating channel is inserted into an 18-French suction tube through one branch of a Y-shaped connecting tube (Fig.1). Fluid can be aspirated between the endoscope and the surrounding tube. The site can be flushed in a similar manner. In all examined patients (n = 11) we successfully aspirated fluid (blood/saliva/etc.). Our proposed suction and irrigation attachment for flexible 4-mm endoscopes without an operating channel permits reliable aspiration under endoscopic inspection, simplifying endoscopic visualization of laryngeal or pharyngeal findings.

Value of Electromyography in Differential Diagnosis of Laryngeal Joint Injuries after Intubation

Laryngeal joint injury or arytenoid dislocation is not an uncommon complication resulting from intubation trauma, and is best evaluated by laryngeal electromyography (EMG) combined with laryngoscopic examinations. Two cases of cricoarytenoid joint injuries after intubation are reported along with laryngeal EMG findings. Early diagnosis of arytenoid dislocation is important for appropriate surgical management and better prognosis. However, the reported cases, because of delayed referrals, showed prolonged cricoarytenoid joint injuries associated with thyroarytenoid muscle denervation or myopathy, and resultant vocal fold immobility. The results of laryngeal EMG in cricoarytenoid joint injuries can be classified into three different patterns: 1) normal recruitment, 2) myopathy, and 3) denervation or reinnervation of the thyroarytenoid muscles. It is particularly valuable to sample different portions of the thyroarytenoid muscles with EMG in order to evaluate different patterns or pathologic changes of the muscles and nerve paralysis.

Fragmented, Distorted Cricoid Cartilage: An Acquired Abnormality

This paper reports the identification of the fragmented, distorted cricoid cartilage. The laryngeal findings in four patients with this acquired abnormality are presented. The postmortem whole organ serial section of their larynges is described and illustrated with horizontal sections from the Laryngeal Development Laboratory in Chicago. The histopathologic sequence, pathogenesis, and clinical relevance are elucidated.

Laryngeal Electromyography Findings in Idiopathic Congenital Bilateral Vocal Cord Paralysis

Children with idiopathic congenital bilateral vocal cord paralysis (BVCP) were investigated by electromyography (EMG) of the posterior cricoarytenoid and thyroarytenoid muscles to determine whether laryngeal EMG findings had diagnostic or prognostic significance. Four children between 3 weeks and 33 months of age were studied. Three had abductor paralysis and were tracheostomy-dependent, while the fourth had adductor paralysis requiring a feeding gastrostomy. Two of these patients also had other anomalies. Motor unit potentials showing phasic bursts with respiration were found in all four cases, while three children developed a full interference pattern on lightening of the anesthetic. Follow-up for between 37 and 52 months showed no significant clinical improvement in any of the patients. While the diagnosis of idiopathic congenital BVCP can represent a heterogeneous group of conditions, the findings suggest that normal laryngeal EMG findings may be a feature of idiopathic congenital BVCP but do not imply a favorable prognosis for early recovery. They may, however, have implications to explain the likely site of lesion in idiopathic congenital BVCP.