Laryngeal Polyps Research Articles

Laser surgery for the laryngeal polyps and nodules: narrative review

Laser surgery for the laryngeal polyps and nodules: narrative review

Neural network architectures in data sequence analysis: diagnosis of Reinke's oedema and Laryngeal polyps

In this review paper, we focus our attention on presenting selected neural network architectures dedicated to the analysis of sequential data, in particular to support the diagnosis of Reinke's oedema and laryngeal polyps. The research discussed here is located in the area of clinical computer decision support systems (CDS) based on the use of artificial recurrent neural networks (RNNs) for speech signal analysis. RNNs are able to predict time series due to their memory and local recurrent connections. In the experimental part, Elman-Jordan artificial neural networks are used, whose characteristics are speed and accuracy in pattern learning allowing real-time decision-making. In the review presented here, one important theme is the use of Bezier curves for preprocessing the speech signal, leading to data reduction and noise elimination. Elman-Jordan networks significantly speed up the learning process and show high classification accuracy in laryngopathy diagnosis.

The Incidence and Treatment of Laryngeal Tumors in Patients Attending Al-Thawra Teaching Hospital, Our Experience

Background: Tumors of the larynx include all masses in the larynx, neoplastic or non-neoplastic. Non-neoplastic are inflammatory, traumatic, or degenerative in origin. Neoplastic tumors are benign or malignant. The symptoms produced by tumors depended on the location and size of tumors. Objective: To evaluate the incidence and methods of treatment of laryngeal tumors. Patients and Methods: Prospective study was carried out from January 2015 to December 2019 at ENT Department, at Al-Thawrah Teaching Hospital Sana'a, Yemen. A total of 130 patients were enrolled in this study,100 males and 30 females. All patients who had laryngeal tumors underwent clinical examination, investigations, and treated according to the type of tumors. Results: A total of 130 patients were enrolled in this study,100 males and 30 females, mean ages were 48.1 years. Neoplasm (62.3%), malignant (96.3%), benign (3.7%), non-neoplastic tumors (37.7%), laryngeal polyps constituted (65.4%) of benign lesions. Hoarseness (100%), difficulty of breathing (34.6%). Left side involved in (61.5%). Advanced malignant (64.1%). Early malignant (30.8%), in situ (5.1%), glottic area (76.9%), supraglottic (14.2%), while transglottic was (10.3%). Modalities of treatment, excision by laryngoscope (35.4%), radiation (32.3%), total laryngectomy (27.7%) speech therapy (3.1%), external approach (1.5%). Conclusion: Malignant tumors were the commonest tumors of the larynx, and Laryngeal polyps were the commonest non-neoplastic tumors in the larynx. Surgical intervention was the main standard method of treatment either neoplastic or non-neoplastic tumors followed by radiation for malignant lesions.

Huge Subglottic Stalked Polyp Treated by Endoscopic Polypectomy Snare at Jalalabad Afghanistan

Polyps are the common benign mucosal lesions of larynx. Usually present as exophytic lesion with thin mucosa. Horsiness is a common symptom and rarely large subglottic polyp causes dyspnea. A patient with horsiness and shortness of breath due to a huge laryngeal polyp around 2cm with thin stalk, linked to thyroid angle below the vocal cords. According the combined decision of Otorhinolaryngologist, Endoscopist and Anesthesiologist, underwent resection of the mass by endoscopic polypectomy snare with electrocautery without any residues and damages. The dyspnea and hoarseness relieved. The histopathological findings confirmed vocal cord benign mass lesion. We consider that careful intubation under the direct vision of bronchoscopy and electrocautery is the safest and useful procedure to secure the upper airway successfully in cases of large subglottic polyp showing dyspnea.

Utility of CK8, CK10, CK13, and CK17 in Differential Diagnostics of Benign Lesions, Laryngeal Dysplasia, and Laryngeal Squamous Cell Carcinoma.

There are no reliable immunohistochemical markers for diagnosing laryngeal squamous cell carcinoma (SCC) or diagnosing and grading laryngeal dysplasia. We aimed to evaluate the diagnostic utility of CK8, CK10, CK13, and CK17 in benign laryngeal lesions, laryngeal dysplasia, and laryngeal SCC. This retrospective study included 151 patients diagnosed with laryngeal papilloma, laryngeal polyps, laryngeal dysplasia, and laryngeal SCC who underwent surgical treatment between 2010 and 2020. Immunohistochemistry (IHC) was carried out using specific monoclonal antibodies against CK8, CK10, CK13, and CK17. Two experienced pathologists performed semi-quantitative scoring of IHC positivity. The diagnostic significance of the markers was analyzed. CK13 showed a sensitivity of 100% and a specificity of 82.5% for distinguishing between laryngeal SCC and laryngeal dysplasia and benign lesions. CK17 showed a sensitivity of 78.3% and specificity of 57.1% for the detection of laryngeal SCC vs. laryngeal dysplasia. CK10 showed a sensitivity of 80.0% for discriminating between low-grade and high-grade dysplasia, and a specificity of 61.1%. Loss of CK13 expression is a reliable diagnostic tool for diagnosing laryngeal lesions with malignant potential and determining resection lines. In lesions with diminished CK13 expression, CK17 could be used as an auxiliary immunohistochemical marker in diagnosing laryngeal SCC. In CK13-negative and CK17-positive lesions, CK10 positivity could be used to determine low-grade dysplasia. CK8 is not a useful IHC marker in differentiating between benign laryngeal lesions, laryngeal dysplasia, and laryngeal SCC.

Frequency and Clinical Presentations of Laryngeal Polyps

Background: Since the Laryngeal polyp counts as one of the most prevalent laryngeal disorders which could burden the individual and society and lack of evidence with regard to its risk factors especially in Iran present study was carried out to determine Frequency and clinical presentations of laryngeal polyps. Methods: In this cross-sectional analytic study, 150 patients diagnosed with laryngeal polyps who sought care at Emam Reza hospital of Tabriz from 1390 to 1396 were included. Collected data consisted of Age, Gender, Occupation, Living area, chief complaint, History of other diseases, history of vocal abuse, history of polyp in first degree relatives and habit history of patients. Results: Majority of participants (84.7%) were male. Thirty percent of Laryngeal polyp were in fifth decade of life. Only 30 percent of individuals declared a history of vocal abuse at some point. Hoarseness was the main complaint and one-third of patients mentioned a history of GERD. One -third of them consumed cigarettes. Conclusion: Male Gender could increase the risk of developing laryngeal polyp. Age of 40-60 years and living in an urban setting could as well considered as a risk factor.

Detection of human papillomavirus (HPV) DNA in benign laryngeal lesions and role of cigarette smoking as an inducing factor.

The association of human papillomavirus (HPV) in laryngeal malignancies is largely known. This study evaluated the association between HPV and benign laryngeal lesions and also the role of smoking and alcohol consumption in increasing the prevalence of HPV in such benign lesions. Seventy-eight specimens of benign laryngeal lesions including 26 polyps, 26 dysplasia, and 26 other lesions such as nodules and cysts were enrolled in this study. Polymerase chain reaction (PCR) technique was used to detect HPV DNA in the tissues. The role of smoking and alcohol consumption in the prevalence of HPV was also evaluated through appropriate statistical tests. This study showed that the prevalence of HPV in benign laryngeal lesions was not statistically significant. The Cohen's effect size for comparing polyps vs. other lesions was nearly 0.7, indicating that HPV prevalence in laryngeal polyps may be clinically meaningful. Another finding in our study is the role of smoking in increasing the HPV prevalence in laryngeal polyps (P = 0.034). In benign laryngeal polyps, HPV prevalence may be clinically important. Smoking acts as a co-factor to induce HPV infection in laryngeal polyps in our study.

Nuclear EGFR Expression Is Associated With Poor Survival in Laryngeal Carcinoma.

The membrane EGFR (mEGFR) protein overexpression in the head and neck squamous cell carcinoma (SCC) is considered to cause increased EGFR activity which adds to tumorigenicity and therapy resistance. The mEGFR upon stimulation can translocate to the nucleus nuclear EGFR (nEGFR) where it has been associated with poor prognosis and worse survival in many cancers. The relevance of differentially located EGFR proteins in laryngeal lesions has not been studied enough and remains unclear. Aim of our study was to examine nEGFR and mEGFR protein expression as well as EGFR gene status and cell cycle proliferation markers in the laryngeal polyps, dysplasia, and SCC using immunohistochemistry and in situ hybridization. There was significantly higher frequency of strong nEGFR between SCC, dysplasia, and polyps (P<0.0001), and strong mEGFR in the SCC and laryngeal dysplasia comparing to polyps (P<0.0001). Gene amplification was confirmed only in relatively small number of SCC but not in non-neoplastic lesions. In dysplasia the statistically significant positive correlations between nEGFR, and Ki-67 (P=0.029), p53 (P=0.001), and cyclin D1 (P=0.031) were found. nEGFR and mEGFR expression showed statistically significant inverse correlation in the SCC (P=0.004) as well as nEGFR and cyclin D1 (P=0.032). Univariate statistical analysis showed statistically significant correlation between strong nEGFR protein expression and worse overall survival in laryngeal SCC, alone or in coexpression with strong cyclin D1 and high Ki-67 (P=0.025, P=0.046, P=0.043, respectively). Our data show that nEGFR cellular localization might influence biology of the laryngeal carcinogenesis and is indicator of poor survival.

Study the Role of Human Papilloma Virus and Laryngopharyngeal Reflux in Adult Vocal Fold Polyps

There are a few potential reasons for vocal overlap polyps in grown-ups. The mechanical harm is the fundamental driver for polyp arrangement. Laryngopharyngeal reflux and human papilloma infection are conceivable co-factors. The point of this examination was to discover the related parts of laryngopharyngeal reflux and human papilloma infection in the advancement of grown-up vocal crease polyps. This cross-sectional observational investigation included 50 grown-up patients gave vocal crease polyps. Patients were preoperatively evaluated for the presence of laryngopharyngeal reflux utilizing the approved nine-thing reflux indication file and eight-thing reflux discovering score. All patients were exposed to extraction of the laryngeal polyp by microlaryngoscopic medical procedure. The extracted tests were sent for human papilloma infection (HPV) identification by PCR. Laryngopharyngeal reflux (LPR) was introduced in 34 patients (68%). Reflux side effect list went from 6 to 25 (mean 13.06 ± 4.95). Reflux discovering score went from 3 to 18 (mean 10.08 ± 4.32). Seventeen patients (34%) had positive HPV-6. Fifteen patients had positive HPV-6 out of 34 patients determined to have LPR (44.11%), contrasted with just two patients had positive HPV-6 among 16 patients without LPR (12.5%) (P = 0.027). There were critical relations between presence of HPV-6 and both reflux side effect record and reflux discovering score; both were essentially higher among patients with positive HPV-6 (P = 0.028) and (P < 0.001) individually. Both laryngopharyngeal reflux and human papilloma infection assume significant related functions in the improvement of vocal

Laryngeal polyp associated with reflux disease: a\xa0case report

BackgroundAmong the most common benign laryngeal lesions are vocal nodules and polyps. Their etiology is related to vocal abuse. Gastroesophageal reflux disease is a common condition presenting with a broad spectrum of symptoms, among which are extraesophageal manifestations such as laryngeal polyps.Case presentationA 24-year-old Middle Eastern woman presented to the author’s institution with dysphonia and dyspepsia. She underwent endoscopy and was diagnosed with severe reflux disease. In addition, laryngoscopy revealed a polyp at the left vocal cord, and the patient underwent polypectomy. Histopathological examination revealed a laryngeal polyp of telangiectatic type characterized by hyperplastic epithelial covering with reactive atypia, prominent superficial acanthosis with neutrophils, and prominent chronic inflammation and thrombosed vessels in the stroma.ConclusionThis report focuses on the pathological findings associated with a laryngeal polyp in a young patient diagnosed with severe reflux disease. Acknowledging such characteristic changes in a laryngeal polyp could aid in the diagnosis of gastroesophageal reflux disease.

Laryngeal cytology: A cytological, histological, P16 and human papillomavirus study.

Invasive diagnostic methods, such as punch biopsies, have a potential to produce undesirable side effects in the larynx, such as scarring and vocal dysfunction. This study is an attempt to assess the diagnostic potential of cytology to efficiently diagnose premalignant and malignant laryngeal lesions, while sparing patients the risk of complications of punch biopsies. Laryngeal smears, using endocervical-type brushes, and punch biopsies were procured from each patient. Smears were prepared and the brush was cut and put in Surepath preservative solution for cytological analysis and human papillomavirus (HPV) DNA testing. A Real-TM Quant kit that detects 14 HPV types was used for genotyping. Immunohistochemical staining for p16 was performed on cytological and histological specimens. Cytological diagnosis was correct in 84.6%, 100% and 100% of cases with a histological diagnosis of squamous cell carcinomas, high-grade squamous intraepithelial lesions and benign lesions, respectively. However, cytological interpretation was correct only in 25% of low-grade squamous intraepithelial lesions. HPV DNA test was positive in only one case, which was a laryngeal polyp. Testing for p16 was negative in all the cytological and histological material. Laryngeal cytology is a useful diagnostic tool in establishing the diagnosis of high-grade squamous epithelial cell abnormalities. Recognition of low-grade lesions, however, is challenging. HPV genotyping and p16 staining do not seem to be helpful ancillary techniques in cytological material procured from the larynx.

Prenatal diagnosis and misdiagnosis of fetus unilateral pulmonary agenesis by ultrasonography

Objective To study the expression of nuclear factor-kappaB (NF-κB) and the counts of lymph vessels in laryngeal squarnous cell carcinoma and polyps of vocal cord tissues, and explore their clinicopathologic significance and correlation in the course of laryngeal carcinoma. Methods SP immuno-histochemical method was used to detect the expression of NF-κB and the counts of lymph vessels on the routinely paraffln-embedded sections of the specimens from 50 cases laryngeal squamous cell carcinoma and 10 cases of polyps of vocal cord tissues. Results The positive rate of NF-κB and the counts of lymph ves-sels in laryngeal carcinoma[60. 0% ,( 13.3±3.4)/HP]were significantly higher ( P <0. 05 and P <0. 01respectively) than those in polyps of vocal cord tissues[10.0 % ,(6. 1±3. 8)/HP]. The positive rate of NF-κB and the counts of lymph vessels in well differentiated adenocarcinoma and cases without metastasis were significantly lower( P < 0. 05, P <0. 01 ), compared with poor-differentiated adenoearcinoma and ca-ses with metastasis. The counts of lymph vessels in the NF-κB positive cases were significantly higher than thoseinNF-κBnegativecases[(14.9±4.1)/HPvs (9.8±3.1)/ HP, P <0.01] . Conclusions The expression of NF-κB and the counts of lymph vessels might be important markers to be used to monitor the progression, biological behaviors, metastatic status and prognosis of laryngeal carcinoma. NF-κB might pro-mote lympoangiogenesis in laryngeal squnmous cell carcinoma tissues. Key words: Laryngeal neoplasms/ME/PA; Carcinoma, squamous cell/ME; NF-kappa B/ME; Lymphangiogenesis

The Effectiveness of Hyaluronic Acid in The Recovery of The Voice After Phonosurgery

Objective: The purpose of this study was to compare the effectiveness of hyaluronic acid aerosol in the post-operative treatment of phonosurgical patients with standard therapy. Patients and methods: authors examined two groups of patients undergoing surgery for laryngeal polyps. Group 1 patients received post-operative treatment with aerosol flunisolide and group 2 patients received post-operative treatment with aerosol hyaluronic acid. The results of the treatments were evaluated according to Italian Society of Logopedics and Phoniatrics (SIFEL) protocol. Results: There was a more rapid functional recovery of vocal parameters in patients treated with hyaluronic acid, who obtained good recovery of vocal parameters within 10 days. Conclusion: The study demonstrates the effectiveness of post-operative aerosol hyaluronic acid for recovery of the voice after surgery for laryngeal polyps. Subsequent studies in other diseases are required to validate the post-operative use of hyaluronic acid in laryngeal surgery.

Head and Neck Myxoma Presenting as Isolated Laryngeal Polyp

Myxoma is a benign tumour with a propensity for local infiltration and recurrence. Laryngeal myxoma presents as a submucosal polyp. Being an uncommon tumour and mimicking vocal cord polyp, only anecdotal evidence is available in the literature. The literature was reviewed from 1986 onwards using the keywords “myxoma” and “larynx.” The databases used were PubMed, Google Scholar, Scopus, and Web of Science. Along with this, we also report our case of vocal fold myxoma. We found a total of 19 studies reporting laryngeal myxoma. Laryngeal myxoma typically affects males in the 6th decade with a history of smoking. Unlike myxomas originating outside the larynx, recurrence is not widely described, and microlaryngeal surgery will usually suffice. Laryngeal myxomas should definitely be kept in the list of differential diagnosis when dealing with a benign-looking vocal fold lesion.

Airway obstruction due to a laryngeal polyp following insertion of a laryngeal mask airway

BackgroundLaryngeal mask airway (LMA) insertion contributes to airway protection in patients with a laryngeal tumor around the glottis. There has been no report of LMA insertion itself exacerbating airway obstruction in such patients.Case presentationA 62-year-old male underwent elective surgical resection of a large laryngeal polyp. The polyp was attached to the right vocal fold and synchronously swung inward into the trachea and outward to the larynx with inspiration and expiration, respectively. Although manual positive pressure ventilation was easily achieved without any airway obstruction after anesthetic induction, the airway was completely obstructed by the polyp lodged between the vocal cords immediately after LMA insertion. Soon after removal of the LMA, patency of the airway was dramatically improved.ConclusionOur experience indicates that we should pay attention to airway obstruction due to lodging of the polyp between the vocal cords after LMA insertion in patients with a laryngeal polyp.

Therapeutic approach of laryngeal polyps

Laryngeal polyps are the most frequent benign tumors of the vocal folds. The most characteristic clinical sign is dominated by the sudden onset of dysphonia which becomes permanent in time. Vocal abuse is incriminated in literature as the predominant etiological factor. Often, the vocal fold polyp is unilateral, situated in the membranous part of the vocal fold, and can reach an ample size, leading to consecutive glottis obstruction. The authors present the main therapeutic approach applied on a patient admitted in the clinic with this benign pathology. The therapeutic management consisted in complete tumor resection using endoscopic “cold steel” techniques combined with laser CO2, followed by postoperative speech therapy.

A Large Vocal Fold Polyp Causing Dyspnea

Laryngeal polyps are common, but some hospitals have reported that a giant vocal fold polyp could cause dyspnea. We encountered a giant vocal fold polyp with dyspnea. Under general anesthesia, laryngomicrosurgery successfully improved the symptoms of the dyspnea. In this case, stenosis of the posterior glottis (considered to be the respiratory glottis) due to a giant vocal fold polyp was thought to be the cause of the preoperative dyspnea.

Laryngeal actinomycosis with dysplasia in a young male with a recurrent laryngeal polyp.

Laryngeal actinomycosis with dysplasia in a young male with a recurrent laryngeal polyp.

Giant laryngeal polyp: an unusual indication of tracheostomy.

Benign laryngeal lesions, especially laryngeal polyps are very common and they usually only cause hoarseness andrarely develop into dyspnea.This condition is generally attributed to smoking. Cardiorespiratory failure and sudden death due tolarge laryngeal polypwas reported in the literature. The preferred treatment of large polyps is surgical excision using suspension microlaryngoscopy. We present a case of a 60-year-old man presented to the emergency with stridor and severe dyspnea. He had a 4-month history of a neglected inspiratory dyspnea and dysphonia. Fiberoptic laryngoscopy revealed a large laryngeal mass causing airway obstruction. Administration of oxygen, inhalation and intravenous administrationof corticosteroid did not relieved hissymptoms. As intubation was judged impossible, an emergency tracheostomy was performed to salvage the patient. After tracheostomy, the dyspnea ceased. Computed tomography scan showed a homogeneous regular formation of 2.5×1.5 cm obstructing the glottis and the subglottislumen. Direct laryngoscopy under general anesthesia identified a valve-like large polyp attached to the anterior wall of the subglottic region. The polyp wastotally excised with no complication. Decannulation was carried out on the second postoperative day. The masswas histologically diagnosed as normal vocal cord polyp.

False Cord Retractor: An important Tool in diagnosing Posterior Laryngeal Cleft

ABSTRACT When the tracheoesophageal septum fails to develop or fuse, a laryngeal cleft is formed. It may or may not be associated with a tracheoesophageal fistula. Diagnosing a laryngeal cleft is not straightforward as was found to be in this case. Here, the cleft was masquerading as a laryngeal polyp, which resulted in misdiagnoses and delay in the management. A false cord retractor was of significant help in diagnosing the cleft. We recommend the use of this instrument during evaluation of laryngobronchoscopy in all patients suspected to have a laryngeal cleft. How to cite this article Bradoo R, Dave VJ, Joshi A, Shah K. False Cord Retractor: An important Tool in diagnosing Posterior Laryngeal Cleft. Int J Phonosurg Laryngol 2017;7(1):20-22.