Laryngeal Infection Research Articles

Clinical analysis of biomaterial-silicone keel complex in the vocal folds adhesion treatment

Objective:To retrospectively analyze the clinical effect of biomaterial combined with silicone keel technology in the prevention and treatment of vocal folds adhesion. Methods:The basic data, perioperative conditions and prognosis of 21 cases of vocal folds adhesion treated by biofilm-silicone keel complex were retrospectively analyzed in Huashan Hospital Fudan University. Results:A total of 21 patients were enrolled in this study（19 males（90.5%）, 2 females（9.5%）. Among these patients, 18 cases of early glottic laryngeal carcinoma（T1b）, 1 case of bilateral vocal folds leukoplecta and 2 cases of postoperative vocal folds adhesion. No accidental rupture of the silicone keel occurred during perioperative period, and the silicone keel was removed in 22.4±2.6 days. All patients were reviewed after removing the silicone keel, the overall effective rate was 90.5%（19/21）. Postoperative complications occurred in 5 patients（1 laryngeal infection, 4 granulation tissue hyperplasia）, all of whom were cured after conservative treatment. Conclusion:This study explored the feasibility of biomaterial in the treatment of vocal folds adhesion. The biomaterial-silicone keel complex technology is simple to operate and has effect on the prevention of vocal folds adhesions, which is worth of clinical promotion.

Hyoid epiglottis combined with sternocleidomastoid muscle clavicle flap for repairing laryngeal defect after laryngeal trauma infection: a case report

The initial treatment of open laryngeal trauma must be implemented immediately, with the primary focus on saving lives. However, in the later stages, various factors may cause changes in the structure and function of the larynx, which requires special attention. This article reports on the treatment process of a patient with depression who suffered from laryngeal trauma. Due to the late stage of laryngeal infection causing laryngeal defects, a hyoid epiglottis combined with sternocleidomastoid muscle clavicular flap repair was performed. Additionally, personalized functional exercise was performed, ultimately resulting in recovery.

Chronic Severe Laryngeal Inflammation Caused by Basidiobolomycosis

Basidiobolomycosis is an uncommon fungal infection primarily found in plants. In humans, it typically affects the skin and gastrointestinal tract on manifestation of the infection. A 29-year-old female presented to our clinic with complaints of shortness of breath and voice changes. On examination, she exhibited severe laryngeal edema. She was initially diagnosed with type 3 hereditary angioedema with a normal C1 inhibitor and later as a case of laryngeal sarcoidosis, treatment for both conditions proved ineffective. Ultimately, after further microbiological assessment, she was diagnosed with chronic granulomatous laryngeal fungal infection caused by the Basidiobolus species. Subsequently, she displayed significant improvement with itraconazole treatment. Chronic laryngeal edema can have various underlying causes. This case underscores the importance of considering fungal pathogens, especially rare ones when assessing such conditions. In cases where the diagnosis is uncertain or standard treatments are ineffective, patient reassessment and repeated laryngeal biopsies are essential.

Friend or Foe? Exploring the Role of Cytomegalovirus (HCMV) Infection in Head and Neck Tumors.

Although not regarded as an oncogenic pathogen, the human cytomegalovirus (HCMV) has been associated with a wide array of malignancies. Conversely, a number of studies report on possible anti-tumor properties of the virus, apparently mediated via HCMV-galvanized T-cell tumor killing; these were recently being investigated in clinical trials for the purposes of anti-cancer treatment by means of dendritic cell vaccines and HCMV-specific cytotoxic T cells. In the present study, we have analyzed the relation between a complement of head-and-neck tumors and HCMV infection across 73 countries worldwide using Spearman correlation, univariate and multivariate regression analysis. Intriguingly, HCMV was found to be pro-oncogenic in patients with nasopharyngeal carcinoma; contrarywise, the virus manifested an inverse (i.e., anti-tumor) association with the tumors of the lip/oral region and the salivary glands. Although this putative protective effect was noted initially for thyroid neoplasia and hypopharyngeal tumors as well, after multivariate regression analysis the connection did not hold. There was no association between laryngeal cancer and HCMV infection. It would appear that, depending on the tissue, HCMV may exert both protective and oncogenic effects. The globally observed protective feature of the virus could potentially be utilized in future therapeutic approaches for salivary tumors and neoplasia in the lip/oral region. As correlation does not necessarily imply causation, more in-depth molecular analyses from comprehensive clinical studies are warranted to substantiate our findings.

The Larynx is Protected from Secondary and Vertical Papillomavirus Infection in Immunocompetent Mice.

Mouse papillomavirus MmuPV1 causes both primary and secondary infections of the larynx in immunocompromised mice. Understanding lateral and vertical transmission of papillomavirus to the larynx would benefit patients with recurrent respiratory papillomatosis (RRP). To test the hypothesis that the larynx is uniquely vulnerable to papillomavirus infection, and to further develop a mouse model of RRP, we assessed whether immunocompetent mice were vulnerable to secondary or vertical laryngeal infection with MmuPV1. Larynges were collected from 405 immunocompetent adult mice that were infected with MmuPV1 in the oropharynx, oral cavity, or anus, and 31 mouse pups born to immunocompetent females infected in the cervicovaginal tract. Larynges were analyzed via polymerase chain reaction (PCR) of lavage fluid or whole tissues for viral DNA, histopathology, and/or in situ hybridization for MmuPV1 transcripts. Despite some positive laryngeal lavage PCR screens, all laryngeal tissue PCR and histopathology results were negative for MmuPV1 DNA, transcripts, and disease. There was no evidence for lateral spread of MmuPV1 to the larynges of immunocompetent mice that were infected in the oral cavity, oropharynx, or anus. Pups born to infected mothers were negative for laryngeal MmuPV1 infection from birth through weaning age. Secondary and vertical laryngeal MmuPV1 infections were not found in immunocompetent mice. Further work is necessary to explore immunologic control of laryngeal papillomavirus infection in a mouse model and to improve preclinical models of RRP. NA Laryngoscope, 134:2322-2330, 2024.

Preclinical Models of Laryngeal Papillomavirus Infection: A Scoping Review.

Laryngeal human papillomavirus (HPV) infection causes recurrent respiratory papillomatosis (RRP) and accounts for up to 25% of laryngeal cancers. Lack of satisfactory preclinical models is one reason that treatments for these diseases are limited. We sought to assess the literature describing preclinical models of laryngeal papillomavirus infection. PubMed, Web of Science, and Scopus were searched from the inception of database through October 2022. Studies searched were screened by two investigators. Eligible studies were peer-reviewed, published in English, presented original data, and described attempted models of laryngeal papillomavirus infection. Data examined included type of papillomavirus, infection model, and results including success rate, disease phenotype, and viral retention. After screening 440 citations and 138 full-text studies, 77 studies published between 1923 and 2022 were included. Models used low-risk HPV or RRP (n = 51 studies), high-risk HPV or laryngeal cancer (n = 16), both low- and high-risk HPV (n = 1), and animal papillomaviruses (n = 9). For RRP, 2D and 3D cell culture models and xenografts retained disease phenotypes and HPV DNA in the short term. Two laryngeal cancer cell lines were consistently HPV-positive in multiple studies. Animal laryngeal infections with animal papillomaviruses resulted in disease and long-term retention of viral DNA. Laryngeal papillomavirus infection models have been researched for 100 years and primarily involve low-risk HPV. Most models lose viral DNA after a short duration. Future work is needed to model persistent and recurrent diseases, consistent with RRP and HPV-positive laryngeal cancer. NA Laryngoscope, 133:3256-3268, 2023.

Nontuberculous Mycobacterial Infection of Larynx and Cervical Trachea.

To present a patient with the first case of NTM (nontuberculous mycobacteria) infection of the larynx extending to cervical trachea, and the first case of subglottic stenosis associated with an NTM infection. Case report and review of the literature. A 68-year-old female with history of prior smoking, gastroesophageal reflux disease, asthma, bronchiectasis, and tracheobronchomalacia presented with a 3-month history of shortness of breath, exertional inspiratory stridor, and hoarseness. Flexible laryngoscopy demonstrated ulceration of medial aspect of right vocal fold and subglottic tissue abnormality with crusting and ulceration extending through the upper trachea. Microdirect laryngoscopy with tissue biopsies and carbon dioxide (CO2) laser ablation of disease completed, and intraoperative culture revealed positive Aspergillus and acid-fast bacilli with Mycobacterium abscessus (type of NTM). Patient began antimicrobial treatment of cefoxitin, imipenem, amikacin, azithromycin, clofazimine, and itraconazole. Fourteen months after initial presentation, patient developed subglottic stenosis with limited extension into the proximal trachea prompting CO2 laser incision, balloon dilation, and steroid injection of the subglottic stenosis. Patient remains disease free without further subglottic stenosis. Laryngeal NTM infections are exceedingly rare. Failure to consider NTM infection in the differential diagnosis when presented with an ulcerative, exophytic mass in patients with increased risk factors (structural lung disease, Pseudomonas colonization, chronic steroid use, prior NTM positivity) may result in insufficient tissue evaluation, delayed diagnosis, and disease progression.

Case report: An unusual case of 'black' larynx.

Ulcerative necrotic supraglottitis is a rare entity of laryngeal infection leading rapidly in laryngeal necrosis, systematic complications and potentially fatal outcomes. We present a case of a 50-year-old gentleman with ulcerative necrotising supraglottitis and no co-morbidities who presented in Ear Nose and Throat Service in the Accident and Emergency department due to dysphagia and weakness. He was treated with an emergency tracheostomy with neck exploration and washout and received appropriate supporting antibiotic regime. He improved and was eventually decannulated, able to breathe phonate and swallow appropriately. After a thorough review of the literature regarding necrotising infections of the laryngeal cavity, only 7 cases have been reported, all in immunocompromised patients with severe complications. Our case report is the first ulcerative necrotic supraglottitis in a healthy individual who was treated early and aggressively with impressive results.

Fungal and Bacterial Co-infection of Supraglottis in an Immunocompetent Patient Secondary to Herbal Medicine

Fungal infections are among the major infections among immunocompromised patients. They are becoming more common with the widespread use of antibiotics, steroid therapy, and the increasing number of immunocompromised patients. However, the incidence of laryngeal fungal and bacterial co-infection has rarely been reported. As same as laryngeal fungal infection, it mimics other types of laryngeal disease such as gastroesophageal reflux disease, granulomatous disease, and malignant lesions. There is a high likelihood of misdiagnosis, leading to delayed treatment and morbidity from fungal and bacterial co-infection of the larynx. A high index of suspicion is required to make the diagnosis and one should look for evidence of immunosuppression and predisposing factors to local mucosal barrier impairment. However, herbal medicine is a rare cause. We present a case of fungal and bacterial co-infection of supraglottis in an immunocompetent patient secondary to herbal medicine.

Expanded Basal Compartment and Disrupted Barrier in Vocal Fold Epithelium Infected with Mouse Papillomavirus MmuPV1.

Laryngeal infection with low-risk human papillomaviruses can cause recurrent respiratory papillomatosis (RRP), a disease with severe effects on vocal fold epithelium resulting in impaired voice function and communication. RRP research has been stymied by limited preclinical models. We recently reported a murine model of laryngeal MmuPV1 infection and disease in immunodeficient mice. In the current study, we compare quantitative and qualitative measures of epithelial proliferation, apoptosis, differentiation, and barrier between mice with MmuPV1-induced disease of the larynx and surrounding tissues and equal numbers of uninfected controls. Findings supported our hypothesis that laryngeal MmuPV1 infection recapitulates many features of RRP. Like RRP, MmuPV1 increased proliferation in infected vocal fold epithelium, expanded the basal compartment of cells, decreased differentiated cells, and altered cell–cell junctions and basement membrane. Effects of MmuPV1 on apoptosis were equivocal, as with RRP. Barrier markers resembled human neoplastic disease in severe MmuPV1-induced disease. We conclude that MmuPV1 infection of the mouse larynx provides a useful, if imperfect, preclinical model for RRP that will facilitate further study and treatment development for this intractable and devastating disease.

Use of Indocyanine green (ICG) angiography to minimize anastomotic leak in the neck after esophagectomy

Introduction: Anastomotic leak after esophagectomy for cancer of mid and lower esophagus and gastroesophageal junction (GEJ) still remains a major challenge. Poor perfusion of the gastric conduit remains the main factor for leak. Intra-operative assessment of the gastric conduit with indocyanine green (ICG) angiography helps to select a properly perfused site for anastomosis, thus minimizing the leak. Methods: Patients undergoing surgery for cancer of esophagus and GEJ either through open or minimally approach were taken up for this study. Stomach was used for reconstruction and anastomosis was made in neck. A 0.1ml of test dose of ICG was given intra-dermally to look for any reaction. After that a dose of 5-10 milligrams was injected intravenously. Perfusion was assessed with infrared light using laparoscopic telescope. The timing of perfusion of the conduit was recorded. Well perfused segment was used for gastroesophageal anastomosis. Different parameters including leak were compared with non-ICG group. Results: We studied 474 patients. Among these patients 67 were in ICG group and 407 were in non-ICG group. Mean age, mean weight loss and co-morbidities were similar in both groups. 72% of patients in ICG group and 50% of patient in non-ICG groups had multimodality treatment. 67% of patients in ICG group and 46% of patients in non-ICG group underwent minimally invasive surgery (p<0.001). Post-operative complications like pneumonia, recurrent laryngeal nerve palsy and surgical site infection were similar in both groups. Post-operative mortality was seen in 1.5% and 3.7% in ICG group and non-ICG group respectively (p=0.4). Overall leak in ICG group was 9% and 16.5% in non-ICG group (p=0.06). In ICG group with the perfusion time of more than 60 seconds, the leak rate was only 3.5% in comparison to 16.5% in non ICG group (p=0.009). Conclusion: ICG angiography provides an objective assessment about the perfusion of gastric conduit during the time of anastomosis. Anastomosis at area of gastric conduit with perfusion time less than 60 seconds, minimizes leak rate in neck.

Hoarseness in a nigerian tertiary health facility: Prevalence, aetiology and predisposing factors.

To determine the prevalence, aetiology and predisposing factors in patients presenting with hoarseness to Usmanu Danfodiyo University Teaching Hospital, Sokoto. The study was a prospective, hospital-based study involving patients with hoarseness ≥7 years. Demographic characteristics and information on voice abuse, smoking, alcohol ingestion and gastroesophageal reflux disease (GERD) were taken. Participants had laryngeal endoscopy using a flexible nasopharyngolaryngoscopy to determine the cause of hoarseness. A prevalence of 2.97% was obtained in the study, and the age range of participants was 7 to 78 years, with a male:female ratio of 1.3:1. The most common cause of hoarseness was laryngeal inflammation 38 (40.0%), followed by benign neoplasm 24 (25.3%) , malignancy 20 (21.1%) and trauma 10 (10.5%). Voice abuse, GERD and smoking were significant predisposing factors for benign neoplasm (χ2 = 8.73; P = 0.0031), inflammation (χ2 = 19.79; P < 0.0001) and malignancy of the larynx (χ2 = 10.66; P = 0.0011), respectively. The study showed that acute and chronic laryngeal infection and neoplasms (benign and malignant) of the larynx were the most common causes of hoarseness. Voice abuse, smoking and GERD were the commonest predisposing factors.

Atypical presentation of an uncommon pathogen

Establishing a definitive diagnosis of Nocardia infection can be challenging due to its rarity, its diverse clinical presentation and the limitations in cultivating this microorganism. Only two cases of laryngeal nocardiosis have previously been reported, both in immunocompromised patients. We describe the case of a 67-year-old seemingly immunocompetent wildlife photographer, with an extensive travel history to Asia and Central America, who presented with an 8 month history of hoarse voice and odynophagia. An initial CT had revealed the presence of a laryngeal “mass” suggestive of malignancy, but several biopsies showed granulomatous inflammation. These were not sent for microbiological investigation. Empirical high dose steroids -started due to concerns of airway compromise- did not significantly improve his symptoms. Further laryngeal biopsies led to the isolation of a fungal mold (Chaetomium spp) of uncertain relevance. Voriconazole was initiated but not tolerated. A repeat biopsy was arranged: Fungal cultures were negative, however histological examination revealed branching gram positive bacteria. Nocardia spp was isolated on mycobacterial culture media and confirmed by PCR. Speciation was inconclusive. Co-trimoxazole was continued for 6 months with good clinical and radiological response. Treatment was discontinued at the patient's request, but within two months he relapsed with worsening dysphagia and odynophagia accompanied by weight loss. He was found to have developed a further post-cricoid collection with associated necrosis. Co-trimoxazole was restarted for 12 months followed by life-long secondary prophylaxis. He remains well with no further recrudescence. This case illustrates the many challenges in the diagnosis and treatment of nocardiosis. Abstract without diagnosis Establishing a definitive diagnosis of infection with this microorganism can be challenging due to its rarity, its diverse clinical presentation and the limitations in cultivating it. Only two cases of laryngeal infection have previously been reported, both in immunocompromised patients. We describe the case of a 67-year-old seemingly immunocompetent wildlife photographer, with an extensive travel history to Asia and Central America, who presented with an 8 month history of hoarse voice and odynophagia. An initial CT had revealed the presence of a laryngeal “mass” suggestive of malignancy, but several biopsies showed granulomatous inflammation. These were not sent for microbiological investigation. Empirical high dose steroids -started due to concerns of airway compromise- did not significantly improve his symptoms. Further laryngeal biopsies led to the isolation of a fungal mold (Chaetomium spp) of uncertain relevance. Voriconazole was initiated but not tolerated. A repeat biopsy was arranged: Fungal cultures were negative, however histological examination revealed a pathogen through Gram stain. This microorganism was further isolated on mycobacterial culture media and confirmed by PCR. Speciation was inconclusive. Tailored treatment was continued for 6 months with good clinical and radiological response. Treatment was discontinued at the patient's request, but within two months he relapsed with worsening dysphagia and odynophagia accompanied by weight loss. He was found to have developed a further post-cricoid collection with associated necrosis. Once he completed 12 months of treatment, life-long secondary prophylaxis ensued. He remains well with no further recrudescence.

Bacterial laryngotracheobronchitis as one cause of airway obstruction in older children

Laryngitis, tracheitis and bronchitis is a common, usually self-limiting viral infection. Bacterial laryngitis, tracheitis and bronchitis is caused by secondary bacterial infection of a viral laryngeal infection leading to a mucopurulent exudate that can cause acute upper airway obstruction and eventually lead to a life-threatening condition. Bacterial tracheitis should be considered in the differential diagnosis of any child with acute upper airway obstruction. This diagnosis should also be considered in any child with viral croup that does not respond to conventional treatment. The correct way to definitively diagnose bacterial tracheitis is by direct visualisation of the trachea by bronchoscopy, but this may not be necessary in all cases. Management includes close observation and monitoring, early initiation of broad-spectrum antibiotics, pain management, and clearing the airways of lingering secretions. The decision to secure an airway by intubation or tracheotomy should be made on an individual basis depending on the severity of symptoms and the patient’s condition. If diagnosed early and treated properly, complete recovery can be expected. We present two patients diagnosed with laryngotracheobronchitis, in whom a correct diagnosis allowed successful recovery.

One hundred and one consecutive transoral endoscopic parathyroidectomies via the vestibular approach for PHPTH: a worldwide multi-institutional experience.

The transoral vestibular approach for thyroid and parathyroid surgery is being adopted rapidly world-wide. Currently there is a paucity of information on this approach for primary hyperparathyroidism (PHPTH). If this approach is safe and efficacious it would provide patients a completely scarless option for parathyroidectomy. To determine whether parathyroidectomy via the transoral vestibular approach can be successfully done in a safe and efficient manner. Consecutive case series of 101 transoral parathyroidectomies performed over a two-year period. Multi-institutional, academic, high-volume transoral thyroidectomy centers from the USA, Israel, and Thailand. A consecutive series of adult patients with a biochemical diagnosis of classic PHPTH and who met criteria for parathyroidectomy based on established international consensus for surgery for PHPTH. All patients also had well-localized single adenomas on at least two preoperative imaging studies. Transoral endoscopic parathyroidectomy vestibular approach. Surgical success rate defined by immediate intra or post-operative return to normal PTH values. Surgical complications including recurrent laryngeal nerve injury, permanent hypoparathyroidism, and infection. Of the 101 consecutive transoral parathyroidectomy patients 84% were female with an average age of 54.23 ± 11.0years and an average BMI of 27.35 ± 6.19. Ninety-nine out of the 101 patients had immediate return to normal PTH after resection for a surgical success rate of 98%. There were no permanent recurrent laryngeal nerve injuries, one temporary nerve palsy, and no permanent hypoparathyroidism. The median operative time dropped from 130.5min (IQR 86) to 66.5min (IQR 56) between the first- and second-half of cases. Transoral endoscopic parathyroidectomy via the vestibular approach is a scarless method of removing parathyroids that is clinically feasible, safe, and efficacious and is a reasonable option for focused minimally invasive parathyroidectomy that can be offered to select patients with PHPTH.

1558 Epiglottic Abscess: A Rare Complication of Adult Epiglottitis

Abstract This report summarises a case of a 23-year-old female who was found to have an epiglottic abscess, an unusual complication of epiglottitis not commonly reported in the literature. Despite the reduced incidence of childhood epiglottitis following widespread Haemophilus Influenzae vaccination, the adult incidence is nonetheless increasing, which would lead to expected higher numbers of resultant complications. Abscess formation should form part of the differential diagnosis when epiglottitis fails to adequately respond to medical management. In these cases, cross-sectional imaging is often required in order to guide surgical management. This involves endoscopic transoral incision and drainage under general anaesthesia, which here brought rapid resolution. Perioperative support of the anaesthetic team is vital: if endotracheal intubation is not possible, a surgical tracheostomy may be required. We reaffirm that endoscopic examination by experienced personnel is appropriate in the initial and ongoing investigation of supraglottic laryngeal infections in order to make a diagnosis and evaluate an airway in stable patients. Such patients must be managed on a ward with airway trained nursing staff and an escalation plan in case of airway compromise. In patients that present in airway obstruction, airway stabilization, with early input from ENT surgeons and anaesthetists, is the priority.

Predictors of Aspiration and Silent Aspiration in Patients With New Tracheostomy.

Purpose Hospitalized, medically complex patients with new tracheostomy are at risk for aspiration. This study reports incidence of aspiration in these patients with new tracheostomy and investigates possible risk factors for aspiration and silent aspiration in this patient population. Method Retrospective review of instrumental swallowing evaluations from hospitalized inpatients with new tracheostomy tubes to determine frequency of aspiration and silent aspiration and patient factors associated with aspiration. Patient variables including sex, age, reason for hospital admission, reason for tracheostomy, duration of intubation, time since tracheostomy placement, and tracheostomy cuff and cap status were examined as possible risk factors for aspiration and silent aspiration. Results Of the 272 patients with new tracheostomies who underwent instrumental swallowing evaluation, 59% aspirated on at least one consistency. Odds of aspiration were twice as high in patients with uncapped tracheostomy compared to closed (i.e., cap or speaking valve in place). Odds of aspiration were 3.4 times greater with patients who underwent tracheostomy for an oropharyngeal etiology (oropharyngeal or laryngeal tumor, surgery, or infection). Of the patients who aspirated, 81% aspirated silently on at least one consistency. Odds of silent aspiration was 4.5 greater with an uncapped tracheostomy. Conclusions Medically complex patients with new tracheostomy are at risk for aspiration and benefit from instrumental swallowing evaluations. Future prospective research is warranted to determine contributing factors responsible for this risk. Lastly, speech pathologists play an important role in the patient's recovery.

A Case of Laryngeal Infection Secondary to Mycobacterium mageritense in an Immunocompetent Patient

Abstract Mycobacterium mageritense is a rare rapidly growing nontuberculous mycobacterium classified as a member of the Mycobacterium fortuitum group. It has been described in the literature in case reports as causing varied types of infections, primarily in patients with an identifiable predisposition such as direct inoculation or immunosuppression. Here we describe the first known case of this bacteria causing a laryngeal infection. The patient in this case did not have any identifiable exposures or immunosuppression leading to the infection.

Complications of Thyroidectomy in Hashimoto Thyroiditis vis-à-vis Benign Goitres

Introduction Surgery for Hashimoto thyroiditis (HT) can be difficult due to dense inflammatory process surrounding the gland and postoperatively patient can develop hypocalcaemia, recurrent laryngeal nerve injury, haematoma and infection. Purpose of this study was to compare the rate of post-operative complications in HT with that in benign goitres. Materials and Methods Data of the patients, who underwent thyroidectomy for benign goitres between January 2013 and December 2017, were reviewed retrospectively. Patients were divided in to two groups. Group A included patients confirmed to have Hashimoto thyroiditis (n=148) and Group B included patients who underwent thyroidectomy for other benign thyroid disorders (n=430). Results A total of 578 patients who underwent thyroidectomy for benign thyroid diseases were included in the present retrospective study. Group A consisted of 148 patients who had HT. Group B consisted of 430 patients who had other benign thyroid diseases. The data was analysed using SPSS 23 and p-value &lt; 0.05 was considered as statistically significant. Patients undergoing thyroidectomy in HT had significantly higher post-operative complication rate (p&lt;0.005). Of the 148 patients with HT, 31.6% (77) had hypocalcaemia while 68.4% (167) with benign goitres had hypocalcaemia. In addition, 51.8% of the patients in the HT group were later diagnosed with malignancy; there were no malignancies present in the group B. Conclusion Though patients with HT suffer higher rate of complications after thyroidectomy when compared to benign goitres, careful pre-operative planning and risk counselling of patients with improved surgical techniques helps to minimize postoperative morbidity.

Clinical Symptoms, Endoscopic and Stroboscopic Imaging in Patients with Laryngeal Fungal Infection in Relation to Fungal Identification Result

This paper aims to describe the similarities and differences in fungal laryngitis’ clinical characteristics, endoscopic, and stroboscopic imaging between patients with positive and non-positive fungal identification results. The study enrolled 48 patients diagnosed with fungal laryngitis by the Endoscopy Department in the National ENT Hospital of Vietnam from August 2019 to March 2020. The study results show that the patients in both groups had dysphonia (100%), with insignificant difference in the severity. However, the patients in the Positive group were more likely to go to hospital right in the first month of the symptom (55%), whereas the patients in the Non-positive group usually waited for more than 3 months (57.1%), (p&lt;0.05). In endoscopic imaging, fungal pseudomembrane could be found mainly on the vocal cords in both groups, with instances spreading to the subglottis (15%) and trachea (5%) in the Positive group (p&lt;0.05). The tissue layer of the patients in the Positive group was mostly inflamed, meanwhile the patients in the Non-positive group were more prone to swelling tissue (67.9%), (p&lt;0.05). In stroboscopic imaging, the difference was minimal. The patients in the Positive group were more likely to lose the mucosal wave formation (60%) than in the Non-positive group (46.4%). There were also insignificant differences in the mucosal wave’s characteristics: asymmetry (50% in the Positive group; 66.7% in Non-positive group), diverse periodicity (50% in the Positive group; 33.3% in the Non-positive group). The paper concludes that there were differences between the two groups of patients and the clinical, endoscopic and stroboscopic findings, fungal identification should be further implemented for definitive diagnosis in patients with fungal laryngitis. &#x0D; Keywords&#x0D; Fungal laryngitis, dysphonia, endoscopic imaging, stroboscopic imaging, fungal identification.&#x0D; References&#x0D; [1] G.D. Brown, D.W. Denning, N.A.R. Gow, and S.M. Levitz, Hidden killers: Human fungal infections. SciTransl Med (4) (2012) 1-6. https://doi.org/10.1126/scitranslmed.3004404 [2] M. Pal, Veterinary and medical mycology. 1st ed. New Delhi: Indian Council of Agricultural Research, 2007.[3] H. Luong, Diagnosis and treatment in patients with fungal laryngitis, Doctoral thesis, Hanoi Medical University, 2004.[4] D. Thai, D. Nguyen, Diagnosis and treatment in fungal laryngitis, Ho Chi Minh Med 15(1) (2011) 222-227.[5] J. Guinea, and M. Torres - Narbona, Pulmonary aspergillosis in patients with chronic obstructive pulmonary disease: incidence, risk factors, and outcome. Clin Microbiol Infect. 16 (7) (2010) 870-877. https://doi.org/10.1111/j.1469-0691.2009.03015.x[6] J.M. Wood, Theodore Anthanasiadis, and Jacqui Allen. 2009. Laryngitis. BMJ (349) (2009) 5827. https://doi.org/10.1136/bmj.g5827.[7] A. Chindamporn, A. Chakrabarti, and R. Li, Survey of laboratory practices for diagnosis of fungal infection in seven Asian countries: An Asia Fungal Working Group (AFWG) initiative, Med Mycol 56 (2018) 416 - 425. https://doi.org/ 10.1093/mmy/myx066 [8] R. Pribuisiene, V. Uloza, and P Kupcinskas, Perceptual and acoustic characteristics of voice changes in reflux laryngitis patients. J Voice 20 (1) (2006) 128 - 136. https://doi.org/10.1016/j.jvoice.2004.12.001.&#x0D; &#x0D; &#x0D;