Laryngeal Lesions Research Articles

Management Challenges And Outcome Of Juvenile Onset Respiratory Papillomatosis In A Tertiary Hospital In North Central Nigeria: A Preliminary Study

Background/Aim: Juvenile Onset Recurrent Respiratory Papillomatosis (JoRRP) is a benign tumour attributed to human papillomavirus infection with a high propensity to recur despite appropriate treatment. It is relatively rare but the commonest benign tumour of the larynx in children. This study is aimed at evaluating its management challenges.
 Materials and methods: This was a retrospective review of patients with JoRRP at Ear, Nose and Throat (ENT) Department, University of Ilorin Teaching Hospital over a 7-year period. The patients' biodata, mode of presentations, surgical care, histopathological findings and management outcome were reviewed.
 Results: A total number of ten patients were diagnosed with JoRRP during the study period. Male to female ratio was 1:1. All the children were delivered per vaginal and sixty percent were first children of their mothers. Hoarseness, breathy voice and worsening difficulty in breathing were the presentation in 7 (70%) of cases, while 3 (30%) presented with only hoarseness and breathy voice. They all presented first to General Practitioners and Paediatricians before ENT Specialist assessment and six (60%) patients presented to ENT department 6 months or more after the onset of symptoms. They all had direct laryngoscopy and excisional biopsy of laryngeal papillomatous lesions. Thirty percent had tracheostomy done. There is a statistical significant relationship between tracheostomy rate and recurrence rate of JoRRP.
 Conclusion: JoRRP is a rare but potentially life-threatening benign tumor of the respiratory tract. Most of our patients presented late and were misdiagnosed at presentation. The key to good management outcome remains early diagnosis, adequate management and regular follow-up.

Peroperační využití potencované kontaktní endoskopie k hodnocení maligního potenciálu slizničních lézí hrtanu, validace ELS klasifikace

Summary Introduction: Enhanced contact endoscopy (ECE) – combination of contact endoscopy and NBI (narrow-band imaging) or IMAGE1 S, is a noninvasive optical technique used for assessment of superfi cial vascular changes of mucosal lesions in high magnifi cation. Aim: The aim of our study was to evaluate the dia gnostic value of ECE in an intraoperative settlement and validation of the ELS classifi cation. Methods: Patients with laryngeal lesions underwent direct laryngoscopy with a structured assessment of the lesion using white light, NBI and ECE. Lesions were classified according to the European Laryngological Society Classifi cation that divides the vascular pattern changes into longitudinal (unsuspicious) and perpendicular (suspicious). Evaluation was correlated with histopathology. Results: 60 patients with 76 lesions were enrolled. Sensitivity, specifi city, positive predictive value (PPV), negative predictive value (NPV) and accuracy for NBI assessment reached 71.4%, 100%, 100%, 53.8% and 78.6%, resp.,  index of 0.556. Sensitivity, specifi city, PPV, NPV and accuracy for ECE reached 86.4%, 89.5%, 95.0%, 73.9% and 87.3%,  index of 0.716. Additional 20% (9/ 45) of the leukoplakias could be assessed with ECE compared to NBI. Conclusions: Our data support the assumption that ECE is a useful tool for pre-histological examination of mucosal lesions, however it cannot fully replace bio psy sampling. ECE shows higher accuracy in detecting malignant lesions compared to NBI and can be especially helpful in the assessment of vocal fold leukoplakia. Key words enhanced contact endoscopy – narrow-band imaging – laryngeal mucosal lesions – squamous cell carcinoma – leukoplakia

Arytenoid adduction asymmetry among patients with laryngeal disorders

BackgroundArytenoid asymmetry is usually an incidental finding during video-pharyngo-laryngoscopic examinations, and few otolaryngologists have described the clinical implications of this among patient with laryngeal disorders.AimThe aim of the study is to document the prevalence of arytenoid adduction asymmetry in patients who had video-pharyngo-laryngoscopy and determine if there is any possible association between arytenoid adduction asymmetry and hoarseness.MethodsThis is a retrospective descriptive study involving patients who had video-pharyngo-laryngoscopic examinations for various indications. The medical charts and video-pharyngo-laryngoscopic examination findings recorded in the stored database in ENT outpatient departments of two institutions over a 2-year period were retrospectively reviewed for age, sex, occupation, presenting complaint, and indication for video-pharyngo-laryngoscopic findings and diagnosis. Arytenoid adduction asymmetry was defined in relation to the position of the corniculate cartilages, cuneiform cartilages, and aryepiglottic angle. All the variables in the data were analyzed using Statistical Product and Service Solution (SPSS) version 25.ResultsA total of 152 out of 209 patients had complete information needed for the review, 59 were males and 93 females with age range 20–91 years, and mean age was 46 ± 15.5 years. The overall prevalence rate for adduction asymmetry was 44.7%. Arytenoid asymmetry was seen commonest among the 5th and 6th decades of life and highest among the professional voice users (55%), while the male-to-female ratio was 1.6:1.Hoarseness constituted 40.1% of all indications for video-pharyngo-laryngoscopy, with 71% of patients with hoarseness having a primary laryngeal lesion, 26% had laryngopharyngeal reflux, and 3.3% were due to pubertal voice changes. A significant association was found between arytenoid asymmetry of the male gender P-value 0.027 and hoarseness P-value 0.026.ConclusionArytenoid adduction asymmetry is prevalent in the 5th and 6th decades of life, among patients with hoarseness resulting from unilateral primary laryngeal disorders.

Combined PIK3CA and SOX2 Gene Amplification Predicts Laryngeal Cancer Risk beyond Histopathological Grading.

The PIK3CA and SOX2 genes map at 3q26, a chromosomal region frequently amplified in head and neck cancers, which is associated with poor prognosis. This study explores the clinical significance of PIK3CA and SOX2 gene amplification in early tumorigenesis. Gene copy number was analyzed by real-time PCR in 62 laryngeal precancerous lesions and correlated with histopathological grading and laryngeal cancer risk. Amplification of the SOX2 and PIK3CA genes was frequently detected in 19 (31%) and 32 (52%) laryngeal dysplasias, respectively, and co-amplification in 18 (29%) cases. The PIK3CA and SOX2 amplifications were predominant in high-grade dysplasias and significantly associated with laryngeal cancer risk beyond histological criteria. Multivariable Cox analysis further revealed PIK3CA gene amplification as an independent predictor of laryngeal cancer development. Interestingly, combined PIK3CA and SOX2 amplification allowed us to distinguish three cancer risk subgroups, and PIK3CA and SOX2 co-amplification was found the strongest predictor by ROC analysis. Our data demonstrate the clinical relevance of PIK3CA and SOX2 amplification in early laryngeal tumorigenesis. Remarkably, PIK3CA amplification was found to be an independent cancer predictor. Furthermore, combined PIK3CA and SOX2 amplification is emerging as a valuable and easy-to-implement tool for cancer risk assessment in patients with laryngeal precancerous lesions beyond current WHO histological grading.

Narrow band imaging reveals field cancerisation undetected by conventional white light: Optical diagnosis versus histopathology.

To assess whether narrow band imaging (NBI) detects fields of cancerisation around suspicious lesions in the upper aerodigestive tract, which were undetected by white light imaging (WLI). In 96 patients with laryngeal and pharyngeal lesions suspicious for malignancy, 206 biopsies were taken during laryngoscopy: 96 biopsies of suspicious lesions detected by both WLI and NBI (WLI+/NBI+), 60 biopsies adjacent mucosa only suspicious with NBI (WLI-/NBI+), and 46 biopsies of NBI and WLI unsuspicious mucosa (WLI-/NBI-) as negative controls. Optical diagnosis according to the Ni-classification was compared with histopathology. Signs of (pre)malignancy were found in 88% of WLI+/NBI+ biopsies, 32% of WLI-/NBI+ biopsies and 0% in WLI-/NBI- (p < .001). In 58% of the WLI-/NBI+ mucosa any form of dysplasia or carcinoma was detected. The use of additional NBI led to the detection of (pre)malignancy in 32% of the cases, that would have otherwise remained undetected with WLI alone. This highlights the potential of NBI as a valuable adjunct to WLI in the identification of suspicious lesions in the upper aerodigestive tract.

Discrimination of vocal folds lesions by multiclass classification using autofluorescence spectroscopy: An ex vivo study.

Autofluorescence spectroscopy is effective for noninvasive detection but underutilized in tissue with various pathology analyses. This study evaluates whether AFS can be used to discriminate between different types of laryngeal lesions in view of assisting in vocal fold surgery and preoperative investigations. A total of 1308 spectra were recorded from 29 vocal fold samples obtained from 23 patients. Multiclass analysis was performed on the spectral data, categorizing lesions into normal, benign, dysplastic, or carcinoma. Through an appropriate selection of spectral components and a cascading classification approach based on artificial neural networks, a classification rate of 97% was achieved for each lesion class, compared to 52% using autofluorescence intensity. The ex vivo study demonstrates the effectiveness of AFS combined with multivariate analysis for accurate classification of vocal fold lesions. Comprehensive analysis of spectral data significantly improves classification accuracy, such as distinguishing malignant from precancerous or benign lesions.

Validation of Ni\'s Grading and European Laryngological Society Grading for Laryngeal Lesions: A Prospective Cross-sectional Study

Validation of Ni\'s Grading and European Laryngological Society Grading for Laryngeal Lesions: A Prospective Cross-sectional Study

The Application of I-Scan Imaging for Evaluating Benign Vocal Lesions

Current standard methods for evaluating benign vocal lesions, including white light laryngoscopy and video laryngostroboscopy, may struggle to identify smaller lesions. While histopathological results obtained from laryngeal microsurgery provide definitive results, their invasiveness can lead to scarring and impaired phonological outcomes. Intralesional steroid injection has recently gained acceptance, but it lacks pathological diagnostic capabilities. Therefore, there is a growing need for a simple examination that can enhance the diagnosis of benign vocal lesions. NBI, from Olympus Corporation, has shown promising outcomes in detecting and characterizing laryngeal lesions. The i-scan technology by PENTAX, while providing the ability to improve visual clarity during endoscopic procedures, has been addressed less in this field. Our study aims to further investigate the application of i-scan imaging in benign vocal lesions, enrolling patients diagnosed with vocal cysts, polyps, and nodules. We conducted i-scan imaging prior to office-based intralesional steroid injection, assessing the possibility of its providing additional diagnostic information for benign vocal lesions without additional burden.

Clinical significance of type IV vascularization of laryngeal lesions according to the Ni classification

BackgroundScattered, small, dot-like intraepithelial papillary capillary loops (IPCLs) represent type IV epithelial vascularization according to “Ni classification” and are considered to be nonmalignant. According to the European Laryngological Society classification, these loops are malignant vascular changes. This contradiction has high clinical importance; therefore, clarification of the clinical significance of type IV vascularization according to the Ni classification is needed.MethodsThe study was performed between June 2015 and December 2022. All recruited patients (n = 434) were symptomatic, with macroscopic laryngeal lesions (n = 674). Patients were investigated using the enhanced endoscopic methods of narrow band imaging (NBI) and the Storz Professional Image Enhancement System (IMAGE1 S). The microvascular patterns in the lesions were categorized according to Ni classification from 2011 and all lesions were examined histologically.ResultsA total of 674 lesions (434 patients) were investigated using flexible NBI endoscopy and IMAGE1 S endoscopy. Type IV vascularization was recognized in 293/674 (43.5%) lesions. Among these 293 lesions, 178 (60.7%) were benign (chronic laryngitis, hyperplasia, hyperkeratosis, polyps, cysts, granulomas, Reinkeho oedema and recurrent respiratory papillomatosis); 9 (3.1%) were squamous cell carcinoma; 61 (20.8%) were mildly dysplastic, 29 (9.9%) were moderately dysplastic, 14 (4.8%) were severe dysplastic and 2 (0.7%) were carcinoma in situ. The ability to recognize histologically benign lesions in group of nonmalignant vascular pattern according to Ni (vascularization type I-IV) and distinguish them from precancers and malignancies was with accuracy 75.5%, sensitivity 54.4%, specificity 94.4%, positive predictive value 89.6% and negative predictive value 69.9%.ConclusionLaryngeal lesions with type IV vascularization as defined by Ni present various histological findings, including precancerous and malignant lesions. Patients with type IV vascularization must be followed carefully and, in case of progression mucosal lesion microlaryngoscopy and excision are indicated.

Medidas espectrais e cepstrais em mulheres com disfonia comportamental

ABSTRACT Purpose To investigate whether there are differences in cepstral and spectral acoustic measures between women with behavioral dysphonia with and without laryngeal lesions and verify whether there is a correlation between such measures and the auditory-perceptual evaluation of voice quality. Methods The sample comprised 78 women with behavioral dysphonia without laryngeal lesions (BDWOL) and 68 with behavioral dysphonia with laryngeal lesions (vocal nodules) (BDWL). Cepstral peak prominence (CPP), cepstral peak prominence-smoothed (CPPS), spectral decrease, and H1-H2 (difference between the amplitude of the first and second harmonics) were extracted. They were submitted to the auditory-perceptual evaluation (APE) of the grade of hoarseness (GH), roughness (RO), breathiness (BR), and strain (ST). Results BDWL women had higher H1-H2 values and lower CPP and CPPS values than BDWOL women. More deviant voices had lower CPP and CPPS values. Breathy voices had lower CPP and CPPS values and higher H1-H2 values than rough ones. There was a weak negative correlation between CPP and RO, a moderate negative correlation with GH, and a strong negative correlation with BR. CPPS had a moderate negative correlation with GH, RO, and BR. H1-H2 had a weak positive correlation with BR. There was a weak positive correlation between spectral decrease and ST. Conclusion H1-H2, CPP, and CPPS were different between BDWOL and BDWL women. Furthermore, cepstral and spectral measures were correlated with the different APE parameters.

Can Resident Auditory-Perceptual Voice Assessments Predict Medical Urgency of Voice Disorders?

Growing reliance on telemedicine has created new triaging challenges. This study investigated how effectively otolaryngology resident auditory-perceptual voice assessments performed via telemedicine determined the need for urgent in-person clinic visits. Twelve otolaryngology resident physicians (PGY1-PGY5) performed auditory-perceptual assessments on 25 voice samples recorded during initial voice evaluations. Voice samples were balanced in severity and taken in equal numbers from patients with the following diagnoses: benign laryngeal lesions, laryngeal cancer, functional voice disorders, laryngeal edema (associated with LPR), and laryngeal paralysis/paresis. Urgent diagnoses were defined as laryngeal cancer and severe unilateral laryngeal paralysis. For each voice sample, residents were initially blinded to patient medical history. Residents rated severity of voice disorder, predicted patient diagnosis, and determined the urgency of seeing the patient in clinic. Residents then reviewed information from the patient's medical history and again rated urgency of voice disorder. On average, residents identified urgent voice disorders in 56% of cases. After reviewing medical history, this number significantly increased to 77% (P=0.001). Voice severity, smoking history, time since onset, and course of symptoms were considered most influential when determining medical urgency of voice patients. Year in residency program had no effect on rating accuracy. As expected, diagnostic accuracy of auditory-perceptual assessments was low, ranging from 40% for laryngeal paralysis/paresis to 5% for laryngeal edema. Auditory-perceptual voice assessment, combined with medical history, predicted most medically urgent voice disorders. Further work should investigate if task-specific training might improve these results and which medical history items are most critical. Until accuracy of auditory-perceptual assessment of medical urgency is improved, these data underscore the importance of laryngeal examination in identifying medical urgency and etiology of dysphonia.

Identification and analysis of Nonlinear behaviors of vocal fold biomechanics during phonation to assess efficacy of surgery for benign laryngeal Diseases

BackgroundCurrent voice assessments focus on perceptive evaluation and acoustic analysis. The interaction of vocal tract pressure (PVT) and vocal fold (VF) vibrations are important for volume and pitch control. However, there are currently little non-invasive ways to measure PVT. Limited information has been provided by previous human trials, and interactions between PVT and VF vibrations and the potential clinical application remain unclear. Here, we propose a non-invasive method for monitoring the nonlinear characteristics of PVT and VF vibrations, analyze voices from pathological and healthy individuals, and evaluate treatment efficacy. MethodHealthy volunteers and patients with benign laryngeal lesions were recruited for this study. PVT was estimated using an airflow interruption method, VF vibrational frequency was calculated from accelerometer signals, and nonlinear relationships between PVT and VF vibrations were analyzed. Results from healthy volunteers and patients, as well as pre- and post-operation for the patients, were compared. ResultsFor healthy volunteers, nonlinearity was exhibited as an initial increase and then prompt decrease in vibrational frequency at the end of phonation, coinciding with PVT equilibrating with the subglottal pressure upon airflow interruption. For patients, nonlinearity was present throughout the phonation period pre-operatively, but showed a similar trend to healthy volunteers post-operatively. ConclusionThis novel method simultaneously monitors PVT and VF vibration and helps clarify the role of PVT. The results demonstrate differences in nonlinear characteristics between healthy volunteers and patients, and pre-/post-operation in patients. The method may serve as an analysis tool for clinicians to assess pathological phonation and treatment efficacy.

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

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

Chronic Infectious Laryngitis: The Role of Empirical Therapy and Biopsy: A Report of 5 Cases

Chronic infectious laryngitis is a clinical mimic of laryngeal carcinoma which can be due to bacterial or fungal aetiology. Both conditions present with non-specific symptoms with leucoplakia on examination. The role of biopsy of laryngeal lesions in the absence of risk factors of laryngeal carcinoma is debatable as it responds to antifungal therapy. This study aimed to review the predisposing factors and role of biopsy in chronic infectious laryngitis. A retrospective review of all cases of chronic infectious laryngitis presented to our centre between 2018 and 2021 were conducted. Clinical features, risk factors, antifungal therapy and its response were reviewed. All cases of chronic infectious laryngitis avoided the need of biopsy while had successful empirical antifungal therapy except for one refractory case. Biopsy of the refractory case was negative for malignancy and the culture-proven Staphylococcus aureus laryngitis was successfully treated with antibiotics. Empirical antifungal therapy in cases of chronic infectious fungal laryngitis with close serial follow-up had good outcome. Biopsy should be reserved for refractory cases to exclude malignancy and guide further antimicrobial therapy.

Indirect laryngeal surgery of vocal fold polyps: a dying or evolving art?

Vocal fold polyps (VFPs) are the most common benign laryngeal lesions that require surgery and are routinely managed by microlaryngoscopy (MLS) under general anaesthesia. Prior to introduction of MLS, VFPs were removed using indirect laryngoscopic surgery (ILS) in local anaesthesia, a procedure that required substantial surgical skill to operate with an unmagnified mirror view of the larynx. With the adoption of wireless endoscopy equipment and personal computers, we tried to simplify this technique so that it can be easily performed in the office. This study aimed to assess the effectiveness of ILS by comparing voice outcomes with MLS. ILS and MLS were performed in six patients each. Treatment outcomes were measured using a voice self-assessment and objective acoustic analysis. The total cost of both procedures was calculated. Both techniques allowed successful removal of VFPs in all patients, without significant intergroup differences in voice outcomes. The cost of ILS was significantly lower. Despite the pilot nature of the study and the small sample size, our data indicate the potential value of this technique which, considering its simplicity and economic value could be used as an alternative to MLS in carefully selected patients.

"Pre and Post Treatment Comparison of S/Z Ratio in Benign Laryngeal Lesions".

Benign laryngeal lesions like vocal nodules, vocal polyp, vocal fold cysts are mostly found in patients complaining of change in voice. S/Z ratio has become the most frequently used clinical tool to assess phonatory mechanics. This study shows the pre-treatment and post-treatment comparison of S/Z ratios in patients with benign laryngeal lesions. To evaluate the outcome of microlaryngeal surgery in patients with benign laryngeal lesions using S/Z ratio as an outcome parameter. During this study, 65 patients with complaints of change in voice, with clinical evidence of benign laryngeal lesions underwent microlaryngeal surgery. Improvement in symptoms were measured preoperatively and postoperatively using S/Z ratio. This ratio was calculated by asking the patient to to maximally sustain 'S' and 'Z', repeated thrice. S/Z ratio was calculated by dividing the maximum duration for which /S/ was sustained by the maximum duration for which /Z/ was sustained. A ratio of more than 1.4 suggested a vocal cord disorder. There was statistically significant difference observed in S/Z ratio values, from pre-treatment to 6months post-treatment, with P value 0.001. Pre and post treatment assessment of patients with benign vocal fold lesions showed significant improvement in S/Z ratio postoperatively. It is the simplest and a reliable objective method of voice assessment and can also be used in assessing the outcome of the treatment.

The influence of clinical experience on reliable evaluation of pharyngeal and laryngeal lesions: comparison of high-definition laryngoscopy using narrow band imaging with fibre-optic laryngoscopy.

Fibre-optic laryngoscopy is still widely used in daily clinical practice; however, high-definition laryngoscopy using narrow band imaging could be more reliable in characterising pharyngeal and laryngeal lesions. Endoscopic videos were assessed in a tertiary referral hospital by 12 observers with different levels of clinical experience. Thirty pairs of high-definition laryngoscopy with narrow band imaging and fibre-optic laryngoscopy videos were judged twice, with an interval of two to four weeks, in a random order. Inter- and intra-observer reliability, sensitivity and specificity were calculated in terms of detecting a malignant lesion and a specific histological entity, for beginners, trained observers and experts. Using high-definition laryngoscopy with narrow band imaging, inter-observer reliability for detecting malignant lesions increased from moderate to substantial in trained observers and experts (high-definition laryngoscopy with narrow band imaging κ = 0.66 and κ = 0.77 vs fibre-optic laryngoscopy κ = 0.51 and κ = 0.56, for trained observers and experts respectively) and sensitivity increased by 16 per cent. Inter-observer reliability increased with the level of clinical experience, especially when using high-definition laryngoscopy with narrow band imaging.

Contact Endoscopy – Narrow Band Imaging (CE-NBI) data set for laryngeal lesion assessment

The endoscopic examination of subepithelial vascular patterns within the vocal fold is crucial for clinicians seeking to distinguish between benign lesions and laryngeal cancer. Among innovative techniques, Contact Endoscopy combined with Narrow Band Imaging (CE-NBI) offers real-time visualization of these vascular structures. Despite the advent of CE-NBI, concerns have arisen regarding the subjective interpretation of its images. As a result, several computer-based solutions have been developed to address this issue. This study introduces the CE-NBI data set, the first publicly accessible data set that features enhanced and magnified visualizations of subepithelial blood vessels within the vocal fold. This data set encompasses 11144 images from 210 adult patients with pathological vocal fold conditions, where CE-NBI images are annotated using three distinct label categories. The data set has proven invaluable for numerous clinical assessments geared toward diagnosing laryngeal cancer using Optical Biopsy. Furthermore, given its versatility for various image analysis tasks, we have devised and implemented diverse image classification scenarios using Machine Learning (ML) approaches to address critical clinical challenges in assessing laryngeal lesions.

Primary laryngeal histoplasmosis: a case report

BackgroundHistoplasmosis is a fungal infection that commonly occurs in the lungs or in disseminated form. Primary laryngeal histoplasmosis is a very rare condition that can mimic laryngeal carcinoma or laryngeal tuberculosis. The purpose of this case report is to highlight the rare occurrence of primary laryngeal histoplasmosis with no involvement of other organs, especially the lungs, the diagnosis dilemma, and the antifungal protocol for this case.Case presentationWe report a case of a 47-year-old male, who is a pigeon breeder, presented with chronic hoarseness. There were no signs of pulmonary or systemic involvement. Biopsy from laryngeal mucosa was confirmed as histoplasmosis, and he was started on intravenous (IV) amphotericin B for 2 weeks and oral itraconazole for 2 months.ConclusionPrimary laryngeal histoplasmosis is considered a very rare occurrence. The laryngeal lesion may mimic conditions such as laryngeal carcinoma and laryngeal tuberculosis. Histopathology examination remains the gold standard, and antifungal treatment is the choice of therapy.

The Safety and Efficacy of the 445-nm Blue Laser for Operative Management of Benign Nonvascular Laryngeal Lesions

Adult voice center patients who underwent surgical intervention for vocal fold (VF) mass, VF scar, laryngeal stenosis, laryngeal web, or Reinke's edema were included in this retrospective study. Outcomes were compared to those achieved when traditional treatment modalities were used, including cold steel, CO2 laser, potassium-titanyl-phosphate (KTP) laser, and coblator. Strobovideolaryngoscopy footage was evaluated using a previously described model at four time points: postoperative visit #1: 1-14 days, postoperative visit #2: 30-60 days, postoperative visit #3: 61-365 days, postoperative visit #4: >365 days. Eighty cases using the blue laser and 153 controls (n=78 cold steel, n=51 KTP laser, n=22 CO2 laser, n=2 coblator) were included in this study. Procedures performed using blue laser included VF mass excision (n=45), VF scar reduction (n=16), laryngeal stenosis resection/repair (n=25), laryngeal web excision (n=7), and reduction of Reinke's edema (n=1). On postoperative strobovideolaryngoscopy examination, the surgical objective score did not differ significantly between the blue laser cohort and all controls at any postoperative visit. VF edema did not differ significantly between the blue laser cohort and all controls at any postoperative visit. VF hemorrhage scores were significantly lower in the blue laser cohort compared to all controls at the first postoperative visit, but hemorrhage had resolved almost entirely by the second postoperative visit in all groups. Postoperative VF stiffness was worse in the blue laser group at the third postoperative visit compared to controls, but both groups had improved to similar levels by the fourth postoperative visit. The rate of lesion recurrence (24.29% versus 17.19%) did not differ significantly between the blue laser cohort and controls on multivariate analysis (Odds ratio [OR]=1.081 [0.461-2.536]). The complication rate (12.50% versus 10.46%) did not differ significantly between the blue laser cohort and all controls on multivariate analysis (OR=0.992 [0.375-2.624]). The blue laser was associated with a lower rate of revision surgery (30.00% versus 34.64%) on multivariate analysis (OR=0.380 [0.168-0.859]). The 445-nm blue laser is safe and effective for the management of benign laryngeal lesions. It has efficacy and safety similar to those of traditional treatment modalities (including cold steel, CO2 laser, and KTP laser). Use of the blue laser may lead to lower rates of early postoperative hemorrhage and revision surgery. No adverse effects attributed directly to the use of the blue laser were observed in this study. Further research is encouraged to confirm or refute these findings.